Sudden cardiac death MUDr Marko Bjeloševič PhD Pediatric Cardiac Center in Bratislava Epidemiology loss of consciousness 25 children at least 1 loss of consciousness before 19 y ID: 1014352
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1. Loss of consciousness/SyncopeSudden cardiac deathMUDr. Marko Bjeloševič, PhD. Pediatric Cardiac Center in Bratislava
2. Epidemiology - loss of consciousness25% children (at least 1 loss of consciousness before 19 y. )1% of all pediatrician visitsgirls>boyspeak: 8-16 years of agemostly benign
3. Loss of consciousnessSyncope (brain hypoperfusion convulsive reaction common)Reflex syncope (98%; benign)VasovagalOrthostaticSituational (urinary…)Cardiac syncope (2%; malignant)Structural heart diseaseArrhythmiaNon-syncope loss of consc.Panic attackTraumaEpilepsyHypoglycemia…
4. Reflex syncope vs. cardiac syncopeOnset (typical)While standing still (church) – vasovagalAfter standing up (in the morning bathroom/near bed) – orthostaticAt the doctors’ (blood taking) - situationalWhile doing sports (running after the ball) – cardiacDiagnostic work-upPatient history – syncope onset, family history (familial sudden death? recurrent syncope?)Physical examination (murmor ?) + blood pressureECGIs the patient at risk of sudden cardiac death ???noyesLifestyle changesCardiologist
5. Sudden cardiac deathOnset: ¼ during exercise; ¾ while restingEpidemiology: <35y. 1:100k; >35y. 10-100:100k in 1 yearEtiology: cardiac>35y. myocardial infarction,...<35y. long QT syndrome (LQTS) 30%, cardiomyopathy 30%,myocarditis 8%, WPW 8%, coronary anomalies 8%, Marfan syndrome with dissecting aneurysm 8%, heart commotionMechanism: ventricular fibrillation -> asystole -> deathAED (automatic external defibrillator) + CPR