Sudden Death in Hospital after Discharge from Coronary Care Unit

Thompson, Peter L.; Sloman, Graeme

doi:10.1136/bmj.4.5780.136

Cited by 45 publications

(7 citation statements)

References 17 publications

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“…Although much attention has been given to the problem of prehospital SCD,'"-' [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] several important areas remain poorly defined. These include: (1) conjectural, and information concerning rhythms which precede those monitored by rescue workers is not available.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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SUMMARYIn order to better understand the problem of prehospital sudden cardiac death (SCD) two groups of individuals were studied. One group was monitored by rescue squads during attempted rescue. These subjects were defibrillated from prehospital ventricular fibrillation (VF) and hospitalized if they survived or autopsied if they could not be resuscitated. The second group were SCDs which were witnessed and described by observers. Detailed past histories of both groups were collected, and either clinical or autopsy diagnoses were obtained.On the day of death or VF, one quarter reported new symptoms (primarily chest pain and dyspnea) preceding collapse by more than 30 minutes, one quarter reported symptoms lasting from 1 to 30 minutes, and one half collapsed instantaneously or within 1 minute of acute symptoms. A history of old myocardial infarction (MI) was present in 41% and of angina pectoris in 54%, and 27% reported new or changing symptoms within four weeks.In defibrillated survivors, "'would-be SCDs,-electrocardiographic (ECG) changes of acute myocardial infarction (AMI) or ischemia were nearly three times more frequent than changes detected histologically in SCDs, and in the former involved predominantly the anterior wall in contrast to the inferior wall in most autopsied deaths. This disparity implicates acute myocardial lesions, particularly of the anterior wall, in the majority of SCDs.Acute coronary lesions were found in 58% of SCDs autopsied. Most of these were ruptured plaquealthough almost one fifth of all autopsied SCDs had thromboses without intimal rupture. Severe chronic multivessel stenosis was present in most subjects, although 15% had only disease of a single vessel and in these, the left anterior descending (LAD) or left main coronary artery were involved in three quarters.The SCD population may be subgrouped into those with recent MI, those with only myocardial ischemia, and those with no detectable myocardial change. When rescuers were able to monitor prehospital SCDs, VF was found in the majority; however, 28% did have other terminal rhythms.

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Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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“…Similarly, we had only one readmission within 2 weeks of discharge and the earliest outpatient death occurred in the 5th week after infarction. It could be argued that a prolonged hospital stay of 6 weeks would sometimes give a chance of resuscitation, but the results of late cardiac arrest are not good (Thompson and Sloman, 1971 Wishnie et al (1971) found in a small group recovering from myocardial infarction that most felt anxious or depressed in the month after discharge, and about 30 per cent of these patients wished to return to hospital in the first week. Few had had advice about physical exercise and most were frustrated by inactivity.…”

Section: Non-fatal Cardiac Complicationsmentioning

confidence: 99%

Section: Early Mobilisation and Dischargementioning

confidence: 99%

Rapid mobilisation after acute myocardial infarction. First step in rehabilitation and secondary prevention.

Thornley¹,

Turner²

1977

Heart

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4Rapid mobilisation after acute myocardial infarction as the first step in a planned programme of rehabilitation and secondary prevention was studied in a group of 142 men under 65 years of age admitted to a coronary care unit.Patients without complications were mobilised after 2 days' bed rest, but the programme was flexible and those with complications were mobilised less rapidly. Fifteen patients died before mobilisation could be started.In 127 who survived long enough to be mobilised, 74 (58%1') spent 2 to 4 days in bed, 42 (33%) 5 to 10 days, and 11 (9%) more than 10 days. The mean period of bed rest was 5-4 days.Rapid mobilisation eliminated the need for physiotherapy and led to early discharge from hospital with more economic use of hospital beds. In 125 patients who were discharged, 99 (7900) had 16 days or less (5 to 16) in hospital. The mean period of hospital stay was 15-5 days.

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“…Primary ventricular fibrillation (PVF) is an acute electrical event in the circumstances of acute myocardial infarction (AMI) which occurs in the absence of cardiogenic shock and which is not a terminal event. It occurs in 7-11% of patients hospitalized for AMI Dhurandhar et al, 1971;Lie et al, 1975); most episodes of PVF occur during the acute phase, but 5% of patients hospitalized for AMI experience PVF after discharge from the Coronary Care Unit (CCU) (Thompson and Sloman, 1971).…”

Section: Introductionmentioning

confidence: 99%

Prediction of in‐hospital ventricular fibrillation from admission data in acute myocardial infarction

Flugelman

Hasin

Tur-Caspa

et al. 1983

Clinical Cardiology

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Summary: We studied retrospectively 26 readily obtainable clinical and electrocardiographic variables in 22 consecutive patients who experienced primary ventricular fibrillation in association with an episode of acute myocardial infarction. Twenty-eight consecutive patients who had an uncomplicated course after acute myocardial infarction served as controls. The clinical profile of the two groups was similar except that patients who had primary ventricular fibrillation smoked more and had a higher peak creatinine phosphokinase level at the time of infarction. The data was evaluated using univariate and stepwise logistic regression analysis. This analysis demonstrated that patients who developed primary ventricular fibrillation had, on admission (I) more evidence of congestive heart failure (Killip classification), (2) a lower diastolic blood pressure, (3) greater STsegment elevation, (4) a longer QT c interval, and (5) 156 model for prediction of the relative risk of primary ventricular fibrillation in a patient with acute myocardial infarction. The ability to identify patients at risk has important therapeutic implications.

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Sudden Death in Hospital after Discharge from Coronary Care Unit

Cited by 45 publications

References 17 publications

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

Rapid mobilisation after acute myocardial infarction. First step in rehabilitation and secondary prevention.

Prediction of in‐hospital ventricular fibrillation from admission data in acute myocardial infarction

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