tailieunhanh - A handbook for clinical practice - part 5

Thanh thiếu niên và thanh niên dưới 35 tuổi cho thấy tỷ lệ mắc cao nhất của SCD, mặc dù điều này không trở thành nguy cơ thấp thông qua tuổi trung niên và hơn thế nữa | The cardiomyopathies 111 in patients whh CAD a scoodd lesr prominept aeak is observed in ear early evening. Adolescents and young adults below the age of 35 show the highest incidence of SCD although this does not trnnsletc into Iwr risk through midlife and beyond. The majority of deaths occur during mid exertion senentaeỵ activities or even sleep however strenuous activity is not uncommonly a precipitant. HCM is consistently reported as the most common aetiology of SCD among athletes 7 . A Icwdi y exeeptíon it hte tcneto rcniori oì oortitem Italy where ARVC is the leading cause of sports-related fatalities and deaths from HCM appear to be tess frequent. Thii dinercnm may be a pfrect consequence of preparticipation screening with electrocardiography underscoring the effectiveness of such programmes in reducing deaths from HCM in trained athletes 8 . tt ÍS alse apptne thai hmelỵ diag ois of VRCC may be more problematic. Analysís of anpropriate ICD frveevvneioni aod tt rtuitonsiỵ eecorded arrhythmic events sugnesti that vctttlcctllat sachỵusrhỵthmie is the moot common mechanism of SCD in HCM 9 . The role of bradyarrhythmia is less clear from ICD interrogation as backup pacing may obscute ftp pstncncV. OonScicu-lar fibrillation VF may be spontaneous or triggered by monomorphic or polymorphic ventricular tachycardia VT paroxysmal atrial fibrillation AF or rapid atrioventricular conduction via an accessory pathway. Myocyte disarray and fibrosis provide the arrhythmogenic substrate precipitating factors include ischemia LVOTO and vascular instability. The contribution and interaction of these determinants will be complex variable and highly dependent on clinical status and circumstances. Predictors of SCD in HCM Noninvasive predictors of adverse outcome in HCM are summarized in Table 1 . All patients with HCM should be offered comprehensive cardiac evaluation on an annual basis comprising personal and family history 12-lead ECG 2D echocardiography 24- or 48-h .

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