<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><FONT class="Apple-style-span" face="Arial">Dr. Leonid Makarov, from Russia asks</FONT><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">- 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? </FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Silvia Priori, from Italy answers</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- In any case of unexplained sudden cardiac death especially at young age an evaluation of family members is reasonable.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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).</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Silvia G Priori</FONT></DIV></BODY></HTML>