Sudden cardiac death

Sudden cardiac death can occur after exposure to extreme stress and sometimes as a complication of acute neurologic disease. Excessive adrenergic stimulation of the heart is most likely the responsible mechanism for the majority of cases of sudden cardiac death. The neurocardiogenic injury induced by sympathetic overstimulation can affect the myocardium and the electrical conduction system, leading to heart failure and arrhythmias. The characteristic features of stress cardiomyopathy (also known as takotsubo cardiomyopathy or apical ballooning syndrome) can be diagnosed by echocardiography and cardiovascular magnetic resonance imaging. This chapter reviews the history, definition, pathophysiology, triggers, and clinical manifestations of neurocardiogenic injury. It also discusses specific neurologic conditions associated with sudden death: epilepsy (sudden unexplained death in epilepsy, SUDEP) and stroke.