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Can sudden cardiac death in the young be predicted and prevented? Lessons from autopsy for the emergency physician

White JL, Chang AM, Cesar S, Sarquella-Brugada G

Department of Emergency Medicine; Mayo Clinic College of Medicine, Rochester, Minnesota, USA. Department of Emergency Medicine; Sidney Kimmel Medical College of Thomas Jefferson University and the National Academic Center of Telehealth, Filadelfia, Pensilvania, USA. Departamento de Cardiología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. Departamento de Arritmias Pediátricas, Hospital Sant Joan deDéu, Esplugues de Llobregat, Barcelona, Spain.

Sudden unexpected death in the young, though rare, is devastating for both the family and the community. Although only 1.3 to 8.5 cases of sudden cardiac death (SCD) occur per 100 000 young people, autopsy is often inconclusive. Many causes of SCD are related to autosomal dominant inherited risk, however; therefore, answers are important for survivors. Causes of autopsy-positive SCD in young patients include hypertrophic cardiomyopathy and
arrhythmogenic right ventricular dysplasia. Autopsy-negative SCD has been related to inherited arrhythmogenic causes such as long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, Wolff-Parkinson-White syndrome, and idiopathic ventricular fibrillation. The important question for the emergency physician
is how SCD can be predicted and prevented in the young so that there is no need for an autopsy.

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