LETTER
Is Preventing Sudden Cardiac Death Realistic?
Eduardo A. Sanchez, MD
15 May 1994 | Volume 120 Issue 10 | Pages 891-892
TO THE EDITOR:
The recent overview of sudden cardiac death by Myerburg and colleagues [1] was informative. However, as a general internist, I have difficulty applying this knowledge preventively.
The pathophysiology of sudden cardiac death is multifactorial and complex. To be effective, prevention must be targeted at the general population.
The worst outcome among survivors of a major cardiovascular event is seen in the subgroup with low ejection fractions (<30%). Because the underlying cause in most of these patients is coronary artery disease, does ultrafast computed tomography have a role in identifying coronary calcifications in the screening of these patients?
In view of the unexpected results of the Cardiac Arryhthmia Suppression Trial (CAST) [3], would a different outcome in the treated group have resulted from the use of oral magnesium supplements [4]?
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Author and Article Information
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Lawrence, NY 11559
1. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med. 1993; 119:1187-97.
2. Agatson AS, Janowitz WR. Coronary calcification: detection by ultrafast computed tomography. In: Stanford W, Rumberger JA, eds. Ultrafast Computed Tomography in Cardiac Imaging: Principles and Practice. Mount Kisco, New York: Futura Publishing Co.; 1992:77-95.
3. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989; 331:406-12.
4. Bailie DS, Inoue H, Kaseda S, Ben-David J, Zipes DP. Magnesium suppresses early after depolarizations and ventricular tachyarrhythmias induced in dogs by cesium. Circulation. 1988; 77:1395.
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