Document Detail


Sudden death in hypertrophic and dilated cardiomyopathy.
MedLine Citation:
PMID:  2632825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The long-term prognosis for 314 patients with hypertrophic cardiomyopathy (HCM) and 82 with dilated cardiomyopathy (DCM) was investigated in an attempt to elucidate clinical variables predicting sudden death (SD). In the patients with HCM, 68% of cardiac deaths occurred suddenly and unexpectedly. Variables associated with an increased risk to SD were young age (less than 30 years), reduced fractional shortening (less than 35%) and elevated left ventricular end-diastolic pressure (greater than or equal to 20 mmHg). Eight of the 10 patients who died suddenly during or immediately after strenuous exercise were less than 30 years old, and the collapse tended to be associated with exercise-induced ST-depression. In contrast, SD occurring during mild activities, resting or sleep was mainly observed in those aged 30 years or more. Ventricular tachycardia was observed on electrocardiographic monitoring in 24% of those 30 years or more, while it was rare in those under 30 years (5%). On the other hand, no SD was found in patients with apical hypertrophy nor in those 50 years or more. These observations suggest that HCM patients at a young age, with impaired left ventricular systolic and diastolic function, have an increased risk to SD. Since exercise-induced myocardial ischemia rather than ventricular arrhythmias appears to be the more likely mechanism for SD for those under 30 years old, restriction of strenuous exercise should be strongly advised for these patients. For those aged from 30 to 50 years, ventricular tachycardia should be controlled by antiarrhythmic agents for the prevention of SD. In patients with DCM, 24% of all cardiac deaths were attributed to SD. Although no variables reliably predicted SD, it was of note that only one patient out of 26 with SV1 + RV5 greater than or equal to 35 mm died suddenly. Whereas ventricular arrhythmias are known to be a contributing cause for SD, the prognostic significance of ventricular tachycardia on electrocardiographic monitoring in predicting SD has not yet been established. In addition, antiarrhythmic agents often precipitate hemodynamic deterioration. It therefore appears that use of antiarrhythmic agents is not a therapy of first choice and that primary treatment should be focused upon improvement in ventricular function in order to prevent SD in patients with DCM.
Authors:
Y Koga; M Ogata; K Kihara; K Tsubaki; H Toshima
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Japanese circulation journal     Volume:  53     ISSN:  0047-1828     ISO Abbreviation:  Jpn. Circ. J.     Publication Date:  1989 Dec 
Date Detail:
Created Date:  1990-05-18     Completed Date:  1990-05-18     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7806868     Medline TA:  Jpn Circ J     Country:  JAPAN    
Other Details:
Languages:  eng     Pagination:  1546-56     Citation Subset:  IM    
Affiliation:
Third Department of Medicine, Kurume University School of Medicine, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Blood Pressure
Cardiomyopathy, Dilated / mortality*,  physiopathology
Cardiomyopathy, Hypertrophic / mortality*,  physiopathology
Death, Sudden / epidemiology,  etiology*
Female
Follow-Up Studies
Heart Ventricles / physiopathology
Humans
Male
Middle Aged
Myocardial Contraction
Physical Exertion
Prognosis
Risk Factors
Survival Rate
Tachycardia / mortality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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