SUDDEN CARDIAC DEATH - 1978
SUDDEN CARDIAC DEATH - 1978
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DOI：
10.1161/01.cir.60.7.1593
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发表时间：
1979-01-01
期刊：
影响因子：
37.8
通讯作者：
LOWN, B
中科院分区：
文献类型：
--
作者：
LOWN, B
随着20世纪60年代冠状动脉护理单位的发展，对心源性猝死（SCD）的态度开始改变，因为医生们了解到心脏骤停是可逆的。SCD的问题有两个方面：急性、诱发因素和心肌电不稳定的慢性易感性。要解决这一问题，就需要识别和保护潜在的受害者。室性过早复合体（VPCs）与严重心律失常和早期死亡的发生有关，但仅仅是室性过早复合体的存在并不能区分随后死亡的风险。VPCs应根据频率、持续性、多样性、重复模式和早产程度进行分级。由R-on-T起搏引起的重复性早搏可能表明心室颤动（VF）阈值降低的存在。预防性抗心律失常治疗可能有助于保护从室性心动过速复苏的患者防止复发性心脏骤停。可能影响中枢神经系统交感神经活动的神经药理学因素可以改变心脏易感性，并可能预防VF。狗的研究结果表明，心理压力可以降低心室颤动的心脏阈值。如果心理因素通过增加交感神经张力水平诱发室性心律失常，那么减少神经交感神经活动应能降低SCD的发生率。心源性猝死（SCD）是当代心脏病学面临的主要挑战之一。其严重程度值得关注，每年夺去40多万人的生命，约占所有冠心病死亡人数的60%。猝死的问题从有记载的历史开始就被认识到，但在20世纪60年代之前，SCD很少受到临床和研究界的关注。在某种程度上，这与普遍认为SCD是严重、晚期和不可逆冠状动脉粥样硬化的最终表现有关。由于SCD是出乎意料的，并在医院外击倒了看似健康的受试者，医生认为这是命运的决定，在此之前他或她基本上是无助的。正如科学中经常发生的那样，新的方法不仅带来了新的内容，而且塑造了新的态度。就SCD而言，20世纪60年代迅速发展的冠状动脉护理病房（CCU）刺激了一个新的方向。CCU的经验在很大程度上消除了徒劳的感觉，因为它很快变得明显，心脏骤停是可逆的。从原发性电衰竭中迅速复苏的患者始终能够恢复，并存活了不同的和延长的时间，这取决于他们潜在心脏病的程度。由于心室颤动（VF）在心肌缺血发作的开始时发病率最高，因此可以合理地假设这种相同的机制可以解释院外猝死。CCU显示VF可以逆转，也可以预防。这些发现导致了两种截然不同的策略的发展：1)达到
With the development of coronary care units in the 1960s, attitudes toward sudden cardiac death (SCD) began to change as physicians learned that cardiac arrest was reversible. The problem of SCD has two aspects an acute, precipitating factor and a chronic predisposition to electrical instability ofthe myocardium. Resolution of the problem requires identification and protection of the potential victim. Ven-tricular premature complexes (VPCs) have been related to the development of serious arrhythmias and early death, but the mere presence of VPCs does not discriminate risk of subsequent fatality. VPCs shouldbe graded according to frequency, persistence, multiformity, repetitive pattern and degree of prematurity. Provocation of repetitive extrasystoles by R-on-T pacing may indicate the presence of a reduced threshold for ventricular fibrillation (VF). Prophylactic antiarrhythmic therapy may help protect patients resuscitated from VF against recurrent cardiac arrest. Neuropharmacologic factors perhaps affectingcentral nervous system sympathetic activity can alter cardiac vulnerability and may protect against VF. Findings in dogs indicate that psychologic stress can reduce the cardiac threshold for VF. If psychologic factors predispose to ventricular arrhythmias by increasing the level of sympathetic tone, lessening neural sympathetic activity should reduce the incidence of SCD.SUDDEN CARDIAC DEATH (SCD) is one of the major challenges to contemporary cardiology. Its sheer magnitude demands attention, claiming over 400 thousand lives annually, or about 60% of all coronary heart disease fatalities. The problem of sudden death has been recognized since the beginning of recorded history, yet before the 1960s, SCD received scant attention from clinical and research communities. In part this related to the prevailing perception that SCD was the ultimate expression of severe, far-advanced and irreversible coronary athero-sclerosis. Since the SCD was unexpected and struck down the seemingly healthy subject outside the hospital, the physician deemed it an act of fate before which he or she was largely helpless. As is often true in science, new methodologies not only usher in new content, but also mold new at-titudes. In the case of SCD itwas the burgeoning coronary care units (CCU) of the 1960s that stimulated a new direction. CCU experience largely dispelled the sense of futility, for it became rapidly evident that cardiac arrest was reversible. Patients promptly resuscitated from primary electrical failure consistently recovered and survived for variable and prolonged periods determined by the extent of their underlying heart disease. Because ventricular fibrillation (VF) had its highest incidence at the beginning of a myocardial ischemic episode, it was logical to assume that this same mechanism accounted for out-of-hospital sudden death. The CCU demonstrated that VF can be reversed as well as prevented. These findings have led to the development of two distinct strategies:'1) to reach the