Sudden death.

The alert physician can identify and probably alter the risk of sudden death for certain patients (see Table 5). It appears preferable to study the patient who has already been identified as having coronary artery disease because of clinical symptoms such as R/O MI, which has been shown to have a high risk for subsequent sudden death. In addition, the physician must be sensitive to the middle-aged man with multiple coronary artery disease risk factors who suddenly decides to have a routine check or develops nonspecific complaints. Once identified, patients can be educated to minimize delay time in seeking medical help with crescendo or prolonged angina. Ambulatory ECG monitoring for detection and characterization of ventricular arrhythmias, and exercise stress testing to detect severe ST depression, can facilitate an estimation of the patient's prognosis. A therapeutic plan, including attack on the patient's coronary artery disease risk factors, patient education, and specific medical or surgical therapies may alter the risk of sudden death. Once an infarction has occurred, rapid transport to a coronary care unit or monitoring facility, and administration of intramuscular lidocaine by medical or paramedical personnel when feasible, appear to lessen out-of-hospital mortality.