[SCD-FORUM] EXPERTS ASK, EXPERTS ANSWER. Dr. Makarov

[SCD Symposium]

Dear dr. Priory, thank you very match for your answer. I am comlectly
agree with your mention. But for practictical realisation of it
approaches and identification of patients with diseases witn high risk
of SCD in young (<45 yo) possiblly important to include family sudden
death in 1-st Class of indication for ECG and Holter monitoring (first
of all for GP physicians). And according to a next mention, guestion -
"Family case of sudden death" is it diagnosis or not for members of
victims family?
Leonid Makarov


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




> ______________________________________________________________________
>
> Dr. Leonid Makarov, from Russia asks
>
> - Is in necessary to perform diagnostic studies in family members  
> of a victim of sudden death by noncoronary origin, if this victim  
> is young (up to 45 years old) and had no background of  
> cardiological disease? If there was such need, what 3 first  
> diagnostic studies should be made? Both in nonspecialized external  
> offices, and in a specialized cardiological high-complexity center?
>
> Dr. Silvia Priori, from Italy answers
>
> - In any case of unexplained sudden cardiac death especially at  
> young age an evaluation of family members is reasonable.
> First important thing in my view is to perform a careful collection  
> of family history with construction of a family tree. Questioning  
> family members for occurrences of sudden death (especially death  
> associated with stress, exercise and emotion or death during  
> sleep); questioning of familial occurrence of for syncope and  
> arrhythmias. Useful to keep in mind that epilepsy is often a  
> diagnosis in pts with repeated syncope and seizure like  
> manifestation: therefore it may be useful to distinguish between  
> typical epilepsy responsive to therapy versus atypical epilepsy non  
> responsive to therapy. The latter may in fact be a misdiagnosis for  
> an arrhythmogenic syndrome).
> In term of investigation of family members first step is an ECG/ 
> holter searching for diagnosis such as Brugada, long QT, and ECG  
> signs of cardiomyopathies. An echo is indicated for identification  
> of right ventricular cardiomyopathy, hypertrophic cardiomyopathy  
> and dilated cardiomyopathy.
> If SCD occurred during physical exercise and/or if any family  
> member experienced syncope during physical activity an exercise  
> stress test may also be performed.
> To summarize: careful collection of family history plus a full non  
> invasive evaluation of close relatives of the SCD victim (brother  
> and sisters and offspring) is the approach used at our clinic for  
> inherited arrhythmogenic diseases. Based on results of the clinical  
> evaluation above the need/value of genetic analysis will be defined.
> Silvia G Priori
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