Warning Symptoms of Sudden Cardiac Death

Abstract

Despite decades of research and the implementation of advanced protocols, the prognosis of patients with out-of-hospital cardiac arrest (OHCA) remains grim, with a large rate of survivors suffering from devastating neurological consequences [1]. Since the time elapsing from the diagnosis and the restoration of spontaneous circulation (ROSC) is considered the main variable conditioning the outcome, these poor results can likely be ascribed to a delay in the initiation of the cardiopulmonary resuscitation (CPR) due to multiple factors, including the absence of witnesses, the failed recognition of the event, difficulties in reaching the victims etc. Conversely, different investigations have demonstrated that in-hospital cardiac arrest (IHCA) is associated with an overall survival ranging from 15 to 34% [2–4], which is consistently higher than that reported in most series of OHCA arrest [1, 4]. Thus, one might assume that patients who experience an IHCA have the advantage of the presence of professionals trained to recognize the arrest and provide CPR and/or, even better, able to prevent the progression of pathophysiological disturbances which eventually lead to its occurrence. In actual fact, a number of investigations have consistently demonstrated that although IHCA can be preceded by an array of symptoms, unfortunately, their relevance is frequently underestimated [5–8]. Therefore, it appears reasonable that prompt and correct recognition of these circumstances could in many cases alter the sequence of events causing the IHCA and further improve outcome.