SUDDEN CARDIAC DEATH - MAJOR CHALLENGE CONFRONTING CONTEMPORARY CARDIOLOGY
SUDDEN CARDIAC DEATH - MAJOR CHALLENGE CONFRONTING CONTEMPORARY CARDIOLOGY
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DOI：
10.1016/s0002-9149(79)80021-1
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发表时间：
1979-01-01
影响因子：
2.8
通讯作者：
LOWN, B
中科院分区：
文献类型：
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作者：
LOWN, B
在工业发达国家，心脏性猝死是主要死因。它在有记载的历史的黎明时被认识到，甚至在大约4500年前第六王朝贵族陵墓的埃及浮雕中被描绘出来。心源性猝死使所有年龄的人都受到影响。它既不是圣人也不是罪人，它给人带来了一种不确定和脆弱的感觉。这个问题的严重性值得关注。在美国，心脏性猝死每天夺走大约1200人的生命，或者说大约每分钟有一名受害者。它是20岁至年龄段男性的主要死因，占这一群体死亡人数的32%。将近25%的突然死亡的人没有事先发现的心脏病症状。在退休社区观察到的寡妇过多是因为男性心脏性猝死的发病率增加了三到四倍。老年猝死可能是一种幸事，而不是一种祸害，但它经常会在一个人的壮年时期爆发，中位数只有59岁。医学界已经意识到了这个问题，但基本上忽视了猝死是一个可以解决的问题。这种冷漠并不是缺乏兴趣或关注的结果，而是反映了这样一种信念，即心脏性猝死是冠状动脉粥样硬化的必然结果。由于猝死是不可预测的，并困扰着医院外看似健康的受试者，医生认为这是命运的行为，在此之前，他基本上是无能为力的。冠心病监护病房的出现促使人们重新评估这个复杂的问题。现已清楚，猝死不是晚期冠状动脉粥样硬化的必然结果，而是室颤的结果，因此很容易逆转。7、如果室颤仅仅是严重冠状动脉粥样硬化的后果，一旦逆转，它将立即复发。然而，接受室颤治疗的患者很少有复发的发作，他们通常会恢复并长期存活。9，10室颤是一种电气事故的新概念表明，它的原因不是解剖学的，因此有助于人们对重新定义猝死的基础和开发遏制猝死的方法越来越感兴趣。直到最近，我们无法处理心脏性猝死，并不是因为应用知识的差距，而是知识本身的差距。这次审查的目的是表明我们知道多少，并勾勒出可能取得进一步进展的道路。
In the industrially developed countries, sudden cardiac death is the leading cause of death. It was recognized at the dawn of recorded history and even depicted in Egyptian relief sculpture from the tomb of a noble of the Sixth dynasty approximately 4,500 years ago. Sudden cardiac death has left no age untouched. Sparing neither saint nor sinner, it has burdened man with a sense of uncertainty and fragility. The enormity of this problem demands attention. In the United States, sudden cardiac death claims about 1,200 lives daily, or approximately one victim every minute. It is the leading cause of death among men aged 20 to 64 years, accounting for 32 percent of the fatalities in this group. Nearly 25 percent of persons dying suddenly have had no prior recognized symptoms of heart disease.The excess of widows observed in retirement communities is accounted for by the three- to fourfold greater incidence of sudden cardiac death among men. Sudden death in old age might be a blessing rather than a scourge, but instead it frequently explodes a man's life at its prime, at a median age of only 59 years.The medical profession has sensed the issue but has largely ignored sudden death as a problem amenable to solution. This indifference has not been the result of a lack of interest or concern but a reflection of the belief that sudden cardiac death was the inevitable culmination of coronary atherosclerosis. Because sudden death was unpredictable and afflicted the apparently healthy subject outside the hospital, the physician considered it an act of fate before which he was largely helpless. The advent of the coronary care unit has promoted a reassessment of this complex problem. It has become clear that sudden death is not the inexorable culmination of advanced coronary atherosclerosis but instead is the result of ventricular fibrillation and therefore is readily reversible.7,8If ventricular fibrillation were only the consequence of severe coronary atherosclerosis, once reversed it would promptly recur. However, patients treated for ventricular fibrillation seldom have recurring episodes, and they usually recover and survive for long periods.9,10The new concept that ventricular fibrillation is an electrical accident suggests that its cause is not anatomic and thereby contributes to the growing interest in redefining the basis for sudden death and developing methods for its containment.Until recently our inability to deal with sudden cardiac death has not been due to a gap in the application of knowledge but to a gap in knowledge itself. The purpose of this review is to indicate how much we know and to sketch the path of possible further progress.