Cardiopatia ischemica
Definizione
L’ 80% delle morti improvvise è causato dalla cardiopatia ischemica, il 10-15% è causato dalle cardiomiopatie, seguono le cause più rare. Prendiamo in esame, pertanto, la principale causa di morte improvvisa: la cardiopatia ischemica.
Circa il 5% dei pazienti che giungono vivi in ospedale con infarto miocardico acuto, avrà un episodio di fibrillazione ventricolare (FV) nelle prime 24 ore successive all’infarto. I pazienti sopravvissuti ad un infarto del miocardio invece hanno un rischio elevato il primo anno successivo all’infarto. In generale, l’occorrenza dell’ episodio di fibrillazione ventricolare non è giustificata né dall’estensione particolarmente importante dell’infarto né dalle condizioni di particolare compromissione della funzione ventricolare sinistra. Quali sono i fattori di rischio di morte improvvisa nel soggetto infartuato ?
1) Il “Paris Prospective Study”, uno studio condotto su oltre 7500 dipendenti pubblici, ha dimostrato che è più probabile che ciò avvenga se i genitori hanno avuto una morte improvvisa cardiaca e in particolare la morte cardiaca improvvisa di uno dei due genitori aumenta il rischio relativo di tale evenienza nel soggetto di circa 2 volte e addirittura di 9 volte se entrambi i genitori sono morti improvvisamente. Ciò fa ipotizzare che esiste una predisposizione, almeno in parte geneticamente trasmessa, ad un’ aumentata instabilità elettrica che possa favorire l’insorgenza di FV in presenza di un appropriato substrato clinico.
2) La riduzione della frazione di eiezione, la presenza di frequenti battiti ectopici ventricolari, un intervallo OT costantemente prolungato ed un episodio di FV nella fase acuta di un infarto a sede anteriore.
3) Preponderanza eccessiva del simpatico sul parasimpatico: variabilità della frequenza cardiaca e la sensibilità barocettiva, che si è rivelata predittiva anche nei soggetti con frazione di eiezione conservata e anche oltre i 65 anni.
Queste sono morti improvvise e non totalmente inattese. In molti soggetti la morte improvvisa rappresenta la prima manifestazione della malattia (per lo più) coronarica e si tratta di morte cardiaca improvvisa totalmente inattesa.
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