tailieunhanh - Essential Cardiac Electrophysiology Self Assessment - Part 8

Một người đàn ông 57 tuổi phát triển đau ngực trong khi chơi quần vợt. Năm phút sau đó, ông sụp đổ. Hồi sức tim phổi được cung cấp bởi các đối tác quần vợt của mình cho đến khi một phi hành đoàn xe cứu thương đến 6 phút sau đó. | 8 Sudden Cardiac Death and Risk Stratification Self-Assessment Question 1 A 57-year-old man developed chest pain while playing tennis. Five minutes later he collapsed. Cardiopulmonary resuscitation was provided by his tennis partners until an ambulance crew arrived 6 minutes later. Electrocardiogram showed ventricular fibrillation and external defibrillation restored sinus rhythm. He was admitted to the hospital. The next day coronary angiogram revealed significant 75 stenosis of major epicardial coronary arteries. Left ventriculogram showed ejection fraction of 55 and no regional wall motion abnormalities. Serial electrocardiograms showed transient T-wave inversion. Serum troponin I level peaked at 2. Which of the following is most appropriate at this time A Electrophysiologic study B Implantation of a cardioverter-defibrillator C Coronary artery bypass grafting and implantation of a cardioverterdefibrillator D Coronary artery bypass grafting without implantation of a cardioverterdefibrillator 202 Sudden Cardiac Death and Risk Stratification 203 Sudden cardiac death It is defined as death due to cardiac arrhythmias that occurs within 1 hour of symptoms. In patients presenting with out of hospital cardiac arrest the initial rhythm could be ventricular tachycardia VT ventricular fibrillation VF pulseless activity or asystole depending on the duration from arrest. If the time elapsed is less than 4 minutes 90 of the patients will show VF and 5 will have asystole. As the time interval increases the proportion of asystole as the detected rhythm increases. Post cardiac arrest survival depends on the time elapsed since arrest. The presence of asystole or pulseless cardiac contractions indicates long duration since cardiac arrest and survival of less than 5 . In the presence of acute ischemia or myocardial infarction MI the cause of sudden cardiac death SCD is VF. Less than 30 of these patients with SCD have inducible monomorphic VT. Patients with previous MI abnormal .