Prevention of Sudden Death: Selection of Patients at Risk
Prevention of sudden death requires identification of patients at risk, elucidation of the pathophysiology of the lethal event, and definition of appropriate therapy. As yet, achievement of these three goals is incomplete. Patients generally do not undergo currently available testing procedures (which are at best not totally predictive) until potential risk is heralded by some clinical event. Thus, patients with clinically silent or asymptomatic electrical instability or with coronary artery/ischemic heart disease without angina pectoris may not enter the health care system before an episode of sudden death. Moreover, even if descriptors of risk are noted prospectively, the pathophysiology of sudden lethal events is incompletely understood. The nature and clinical importance of subcellular biochemical abnormalities leading to cardiac electrical instability largely are unknown, and the relationship between chronic, irreversible electrical instability and active ischemia in patients with coronary artery disease remains unclear. Finally, even when risk and likely mechanism of death both are identified in an individual patient, current pharmacological and surgical therapies offer incomplete protection against the lethal event.
KeywordsEjection Fraction Sudden Death Additional Prognostic Information Electrical Instability Stable Ischemic Heart Disease
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