Sudden Cardiac Death
Sudden cardiac death (SCD) is unexpected cardiopulmonary collapse. SCD can occur as a primary manifestation of ischemic heart disease.
Risk factors mirror the risk factors for coronary artery disease (CAD); cigarette smoking, hyperlipidemia, hypertension, diabetes, obesity, stress, and a positive family history of cardiovascular disease. Men, especially those older than 50 years, and postmenstrual women are susceptible. Additional risk factors include patients who:
- Has known sudden cardiac death survivors.
- Had an acute MI within the past 12 months.
- Have cardiomyopathies that have demonstrated left ventricular ejection fractions <40%,
- Had prolonged QT intervals.
Signs and Symptoms
- A previously normal-appearing adult will suddenly collapse with cardiopulmonary arrest not associated with accidental or traumatic causes.
- There are commonly no prodromal symptoms, although there may be a brief period of anxiousness or chest discomfort.
- Full cardiopulmonary arrest
- No respirations
Acute Care Patient Management
Nursing Diagnosis: Decreased cardiac output related to electrophysiologic instability after resuscitation.
- Patient alert and oriented
- Skin warm and dry
- HR 60 to 100 beats/min
- Absence of lethal dysrhythmias
- BP 90 to 120 mm Hg
- Mean arterial pressure 70 to 105 mm Hg
- Urine output 30 ml/ hr
1. Monitor in the lead appropriate for ischemia or dysrhythmia identification.
2. Analyze ECG rhythm strip at least every 4 hours and note rate, rhythm.
3. Obtain pulse arterial pressures and central venous pressure hourly or more frequently if titrating pharmacologic agents.
4. Monitor arterial oxygen delivery and oxygen consumption as indicators of tissue perfusion.
5. Monitor blood pressure hourly.
6. Monitor hourly urine output to evaluate effects of decreased cardiac output and pharmacologic intervention.
- Review serial 12 lead ECGs and cardiac enzymes to determine whether ischemia, injury, or infarct has occurred.
- Review serial electrolyte levels because disturbance in potassium or magnesium is a risk factor for dysrythmias.
- Review ABGs for hypoxemia and acidosis because these conditions increase the risk for dysrythmias, decreased contractility, and decrease tissue perfusion.
- Provide supplemental oxygen to maintain or improve oxygenation. The patient may be intubated and mechanically ventilated.
- Minimize oxygen demand by maintaining bed rest.
- Be alert for dysrhythmias risk factor for anemia, hypovolemia, hypokalemia, hypomagnesemia and acidosis.
- Because most sudden cardiac death occurances are secondary to a lethal dysrhythmia, 24 hour Holter monitoring and possible electrophysiologic study (EPS) may be done to determine the effectiveness of pharmacologic regimen.