Primarna prevencija nagle srčane smrti

master's thesis

• Title (english): Primary prevention of sudden cardiac death
• Author: Toni Ivičić
• Mentor: Davor Puljević (mentor)
• Committee member: Maja Čikeš (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Davor Puljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Posljednjih 20 godina došlo je do pada mortaliteta od kardiovaskularnih bolesti u visokorazvijenim zemljama, kao posljedica implementacije preventivnih mjera za razvoj i progresiju koronarne bolesti i srčanog zatajenja. Približno je svaki četvrti smrtni slučaj izravna posljedica naglog srčanog zastoja, što se definira kao nagla srčana smrt (SCD). U prevenciji i smanjenju incidencije SCD, ključno je učinkovito prepoznavanje osoba pod povećanim rizikom. Primarna prevencija SCD odnosi se na pojedince koji su pod povećanim rizikom za SCD, ali još nisu doživjeli životnougrožavajuću aritmiju ili resuscitirani srčani zastoj. Međutim, još uvijek je izuzetno teško provesti ispravnu stratifikaciju rizika, na što ukazuje podatak da se približno 50% srčanih zastoja događa u bolesnika bez poznate bolesti srca i bez biljega povećanog rizika. Dodatna istraživanja su potrebna kako bi se utvrdilo koji testovi mogu biti korisni u procjeni rizika tih bolesnika, primjerice značaj promjene srčane funkcije, električne nestabilnosti utvrđene EKG-om ili testovima autonomnog živčanog sustava, ili pak sve razvijenijih metoda genotipizacije. Unatoč slaboj osjetljivosti i specifičnosti, jedini pokazatelj koji se dosljedno povezuje s povećanim rizikom za SCD je ejekcijska frakcija lijevog ventrikula (LVEF). Točno prepoznavanje budućih žrtava SCD dodatno dobiva na važnosti uz činjenicu da postoji učinkovita metoda prevencije u vidu defibrilacije putem vanjskog ili ugradbenog defibrilatora. Ugradbeni kardioverter-defibrilatori (ICD) najčešće su korišteni uređaji za elektroterapiju, dok je nosive defibrilatore potrebno dodatno istražiti. Najvažniji aspekt uspješne prevencije SCD je učinkovito liječenje podležećih bolesti i komorbiditeta. Približno 40% smanjenja incidencije SCD, direktna je posljedica redukcije koronarne bolesti srca i drugih srčanih bolesti.

Abstract (english)

In the past 20 years, cardiovascular mortality has decreased in high-income countries, in response to the adoption of preventive measures to reduce the burden of coronary artery disease (CAD) and heart failure (HF). Approximately 1 in every 4 deaths is a direct consequence of suden cardiac arrest (SCA), which is defined as sudden cardiac death (SCD). To prevent SCD and decrease the incidence further, risk stratification is crucial for identifying persons at increased risk. Primary prevention of SCD focuses on individuals who are at risk of SCD but have not yet experienced an aborted cardiac arrest or life-threatening arrhythmias. However, accurate risk stratification remains challenging, because approximately 50% of cardiac arrests occur in individuals without a known heart disease and without detectable markers. Additional research is necessary to determine which further tests are effective in these patients, looking at the significance of alterations in cardiac function, signs of electrical instability identified by electrocardiogram abnormalities or by autonomic tests, and the progressive impact of genetic screening. Despite its insufficient accuracy, the only indicator that has consistently shown an association with increased risk of SCD is left ventricular ejection fraction (LVEF). Correct identification of future SCD victims is especially important as there is an effective treatment, namely defibrillation via an external or internal defibrillator. Implantable cardioverter-defibrillators (ICD) are the most widely used devices, while wearable defibrillators require additional research. The most important aspect of the successful prevention of SCD is effective management of underlying diseases and co-morbidities. Approximately 40% of the observed reduction in SCD is the direct consequence of a reduction of CAD and other cardiac conditions.

• Keywords: nagla srčana smrt; primarna prevencija; stratifikacija rizika; ugradbeni kardioverter-defibrilatori; ventrikularne aritmije
• Keywords (english): sudden cardiac death; primary prevention; risk stratification; implantable cardioverter-defibrillator; ventricular arrhythmias
• Language: croatian
• URN:NBN: urn:nbn:hr:105:371546
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-02 08:38:28