Symptoms Before Sudden Arrhythmic Death Syndrome
Symptoms Before Sudden Arrhythmic Death Syndrome
Symptoms Before SADS. Introduction: No studies in an unselected and nationwide setting have characterized the symptoms and medical history of patients with sudden arrhythmic death syndrome (SADS). The aim of this study was to identify and describe the symptoms and medical history of patients before the presentation of SADS.
Methods and Results: We have previously identified all of the autopsied sudden cardiac deaths (SCD; n = 314) in Danes aged 1–35 years between 2000 and 2006. After comprehensive pathological and toxicological investigation did not reveal a cause of SCD, 136 of the patients were identified as SADS. The National Patient Registry was utilized to obtain information on all in- and outpatient activity in Danish hospitals. All medical records from hospitals and general practitioners, including death certificates and autopsy reports were reviewed. Before death, 48 (35%) SADS patients had cardiac symptoms; among these, 30 (22%) had contacted the healthcare system. Antecedent symptoms (symptoms >24 hours before death) were present in 34 (25%) patients. Prodromal symptoms (symptoms ≤24 hours before death) were present in 23 (17%) patients. Cardiac symptoms included chest pain (n = 16, 12%), dyspnea (n = 18, 13%), palpitations (n = 2, 1%), presyncope/syncope (n = 23, 17%), and aborted SCD (n = 2, 1%). In addition, seizures (n = 25, 18%) were prevalent. In 61 (45%) SADS cases, no previous medical history were recorded.
Conclusion: In this unselected, nationwide study of 136 young SADS patients, 35% had experienced cardiac symptoms before death, most commonly presyncope/syncope, but only one out of five had contacted a healthcare provider with cardiac symptoms.
Autopsies in cases of young sudden unexpected deaths are essential in establishing a cause of death. However, a significant proportion of sudden cardiac deaths (SCD) remain unexplained after autopsy. Sudden arrhythmic death syndrome (SADS) is defined as a SCD that remains unexplained after comprehensive post-mortem evaluation, including histology and toxicology screening. The frequency of these autopsy-negative SADS cases has been variably reported as ranging from 14% to 43% of all SCDs in young persons aged ≤35 years.
Despite extensive research, the prevention of SADS remains challenging. The key to reduce the burden of SADS and prevent further sudden deaths among relatives is to identify the individuals at risk. This, in part, requires an understanding of the symptoms prior to presentation with SADS as well as demographic analyses that may elucidate the underlying cause of death. Premonitory signs and symptoms are often absent in sudden death patients, but symptoms can occur during the days or weeks before SCD. Although symptoms prior to sudden death in SADS patients may have poor predictive values and low sensitivities, it is important to characterize them as they may have value in the overall evaluation of a patient's risk of SADS.
Previous studies have reported symptoms preceding SADS in 4–58% of patients. However, as these studies were based of on selected cases referred to tertiary cardiac centers, they may not be representative for the general population. To date, no studies have systematically and nonselectively investigated the symptoms that SADS patients experience prior to death. Therefore, the aim of this study was to identify and describe the symptoms and medical history preceding SADS presentation in a nationwide cohort of unselected, young SADS patients.
Abstract and Introduction
Abstract
Symptoms Before SADS. Introduction: No studies in an unselected and nationwide setting have characterized the symptoms and medical history of patients with sudden arrhythmic death syndrome (SADS). The aim of this study was to identify and describe the symptoms and medical history of patients before the presentation of SADS.
Methods and Results: We have previously identified all of the autopsied sudden cardiac deaths (SCD; n = 314) in Danes aged 1–35 years between 2000 and 2006. After comprehensive pathological and toxicological investigation did not reveal a cause of SCD, 136 of the patients were identified as SADS. The National Patient Registry was utilized to obtain information on all in- and outpatient activity in Danish hospitals. All medical records from hospitals and general practitioners, including death certificates and autopsy reports were reviewed. Before death, 48 (35%) SADS patients had cardiac symptoms; among these, 30 (22%) had contacted the healthcare system. Antecedent symptoms (symptoms >24 hours before death) were present in 34 (25%) patients. Prodromal symptoms (symptoms ≤24 hours before death) were present in 23 (17%) patients. Cardiac symptoms included chest pain (n = 16, 12%), dyspnea (n = 18, 13%), palpitations (n = 2, 1%), presyncope/syncope (n = 23, 17%), and aborted SCD (n = 2, 1%). In addition, seizures (n = 25, 18%) were prevalent. In 61 (45%) SADS cases, no previous medical history were recorded.
Conclusion: In this unselected, nationwide study of 136 young SADS patients, 35% had experienced cardiac symptoms before death, most commonly presyncope/syncope, but only one out of five had contacted a healthcare provider with cardiac symptoms.
Introduction
Autopsies in cases of young sudden unexpected deaths are essential in establishing a cause of death. However, a significant proportion of sudden cardiac deaths (SCD) remain unexplained after autopsy. Sudden arrhythmic death syndrome (SADS) is defined as a SCD that remains unexplained after comprehensive post-mortem evaluation, including histology and toxicology screening. The frequency of these autopsy-negative SADS cases has been variably reported as ranging from 14% to 43% of all SCDs in young persons aged ≤35 years.
Despite extensive research, the prevention of SADS remains challenging. The key to reduce the burden of SADS and prevent further sudden deaths among relatives is to identify the individuals at risk. This, in part, requires an understanding of the symptoms prior to presentation with SADS as well as demographic analyses that may elucidate the underlying cause of death. Premonitory signs and symptoms are often absent in sudden death patients, but symptoms can occur during the days or weeks before SCD. Although symptoms prior to sudden death in SADS patients may have poor predictive values and low sensitivities, it is important to characterize them as they may have value in the overall evaluation of a patient's risk of SADS.
Previous studies have reported symptoms preceding SADS in 4–58% of patients. However, as these studies were based of on selected cases referred to tertiary cardiac centers, they may not be representative for the general population. To date, no studies have systematically and nonselectively investigated the symptoms that SADS patients experience prior to death. Therefore, the aim of this study was to identify and describe the symptoms and medical history preceding SADS presentation in a nationwide cohort of unselected, young SADS patients.
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