Causes of sudden cardiac death, how to prevent it? Sudden cardiac (coronary) death.

In medicine, sudden death from heart failure is regarded as a fatal outcome that occurs naturally. This happens both to people who have had heart disease for a long time, and to people who have never used the services of a cardiologist. A pathology that develops quickly, sometimes even instantly, is called sudden cardiac death.

Often there are no signs of a threat to life, and death occurs within a few minutes. The pathology can progress slowly, starting with pain in the heart area, rapid pulse. The duration of the development period is up to 6 hours.

Cardiac death is distinguished between quick and instantaneous. Lightning option coronary disease heart disease causes death in 80-90% of incidents. Also among the main causes are myocardial infarction, arrhythmia, and heart failure.

Read more about the reasons. Most of them are associated with changes in blood vessels and the heart (arterial spasms, hypertrophy of the heart muscle, atherosclerosis, etc.). Among the common prerequisites are the following:

• ischemia, arrhythmia, tachycardia, impaired blood flow;
• weakening of the myocardium, ventricular failure;
• free fluid in the pericardium;
• signs of heart and vascular diseases;
• heart injuries;
• atherosclerotic changes;
• intoxication;
• congenital defects of valves, coronary arteries;
• obesity, as a result of poor nutrition and metabolic disorders;
  unhealthy lifestyle, bad habits;
• physical overload.

More often, the occurrence of sudden cardiac death is provoked by a combination of several factors simultaneously. The risk of coronary death increases in people who:

• there are congenital cardiovascular diseases, ischemic heart disease, ventricular tachycardia;
• there was earlier case resuscitation after diagnosed cardiac arrest;
• a previous heart attack was diagnosed;
• there are pathologies of the valve apparatus, chronic failure, ischemia;
• facts of loss of consciousness were recorded;
• there is a reduction in blood ejection from the left ventricle by less than 40%;
• A diagnosis of cardiac hypertrophy was made.

Secondary essential conditions for increasing the risk of death are considered: tachycardia, hypertension, myocardial hypertrophy, changes in fat metabolism, diabetes. Bad influence are caused by smoking, weak or excessive physical activity

Signs of heart failure before death

Cardiac arrest is often a complication after cardiac arrest. vascular disease. Because of this, the heart can suddenly stop its activity. After the first signs appear, death can occur within 1.5 hours.

Previous dangerous symptoms:

• shortness of breath (up to 40 movements per minute);
• pressing pain in the heart area;
• the skin becomes gray or bluish and becomes colder;
• convulsions due to hypoxia of brain tissue;
• separation of foam from the oral cavity;
• feeling of fear.

Many people experience symptoms of exacerbation of the disease within 5-15 days. Heart pain, lethargy, shortness of breath, weakness, malaise, arrhythmia. Shortly before death, most people experience fear. You should immediately contact a cardiologist.

Signs during an attack:

• weakness, fainting due to the high rate of ventricular contraction;
• involuntary muscle contraction;
• facial redness;
• pale skin (it becomes cold, bluish or gray);
• inability to determine pulse, heartbeat;
• lack of reflexes of the pupils, which have become wide;
• irregularity, convulsive breathing, sweating;
• loss of consciousness is possible, and after a few minutes breathing cessation.

In case of death, against the background of seemingly good health, symptoms could be present, just not clearly manifested.

Mechanism of disease development

As a result of a study of people who died due to acute heart failure, it was found that most of them had atherosclerotic changes that affected the coronary arteries. As a result, myocardial circulation was disrupted and it was damaged.

Patients experience enlargement of the liver and neck veins, and sometimes pulmonary edema. Coronary circulatory arrest is diagnosed; after half an hour, abnormalities in the myocardial cells are observed. The whole process lasts up to 2 hours. After cardiac activity stops, brain cells experience irreversible changes.

Often cases of sudden cardiac death occur during sleep after breathing has stopped. In a dream, the chances of salvation are practically absent.

Statistics of mortality from heart failure and age characteristics

One in five people will experience this during their lifetime. Instant death occurs in a quarter of victims. The mortality rate from this diagnosis exceeds the mortality rate from myocardial infarction by approximately 10 times. Up to 600 thousand deaths are reported annually due to this reason. According to statistics, after treatment for heart failure, 30% of patients die within a year.

More often coronary death occurs in persons aged 40-70 years with diagnosed vascular and cardiac disorders. Men are susceptible to it more often: at a young age 4 times, in the elderly – 7 times, by the age of 70 – 2 times. A quarter of patients do not reach the age of 60 years. The risk group includes not only elderly people, but also very young people. The cause of sudden cardiac death at a young age may be vascular spasms, myocardial hypertrophy, provoked by the use of narcotic substances, as well as excessive stress and hypothermia.

Diagnostic measures

90% of sudden cardiac death episodes occur outside of hospitals. It’s good if the ambulance arrives quickly and the doctors carry out a quick diagnosis.

Emergency doctors note the absence of consciousness, pulse, breathing (or its rare presence), and the absence of pupillary response to light. To continue diagnostic measures needed first resuscitation actions(indirect cardiac massage, artificial lung ventilation, intravenous administration of medications).

After this, an ECG is performed. In case of a cardiogram in the form of a straight line (cardiac arrest), the administration of adrenaline, atropine, and other drugs is recommended. If resuscitation is successful, further laboratory examinations, ECG monitoring, cardiac ultrasound. Based on the results, surgical intervention, implantation of a pacemaker, or conservative treatment medications.

Urgent Care

With symptoms of sudden death from heart failure, doctors have only 3 minutes to help and save the patient. Irreversible changes occurring in brain cells after this time period lead to death. Timely first aid can save lives.

The development of symptoms of heart failure is facilitated by a state of panic and fear. The patient must calm down, relieving emotional stress. Call an ambulance (cardiology team). Sit comfortably, lower your legs down. Take nitroglycerin (2-3 tablets) under the tongue.

Cardiac arrest often occurs in crowded places. Those around you need to urgently call an ambulance. While waiting for her arrival, you need to provide the victim with an influx of fresh air, if necessary, do artificial respiration, perform a heart massage.

Prevention

To reduce mortality, preventive measures are important:

• regular consultations with a cardiologist, preventive procedures and prescriptions (special attention
• patients with hypertension, ischemia, weak left ventricle);
• refusal from provoking bad habits, ensuring proper nutrition;
• norm control blood pressure;
• systematic ECG (pay attention to non-standard indicators);
• prevention of atherosclerosis ( early diagnosis, treatment);
• implantation methods in risk groups.

Sudden cardiac death is a severe pathology that occurs instantly or in a short period of time. The coronary nature of the pathology is confirmed by the absence of injuries and the sudden and rapid cardiac arrest. A quarter of cases of sudden cardiac death are lightning fast, and without the presence of visible precursors.

You may also be interested in:

How to recognize and treat acute failure hearts
Signs of coronary heart disease in men: diagnostic methods

At all times, people have been interested in: why does a person die? In fact, that's enough interest Ask, to answer which we can consider several theories that can shed light on this situation. There are many different opinions on this topic, but in order to understand what death is and why a person is susceptible to it, it is necessary to uncover the mystery of old age. On this moment a large number of scientists are struggling to solve this problem, completely different theories are being put forward, each of which, one way or another, has the right to life. But, unfortunately, none of these theories have been proven at the moment, and this is unlikely to happen in the near future.

Theories related to aging

As for opinions on the question “Why does a person die?”, they are all as diverse as they are similar. What these theories have in common is that natural death always comes with old age. A certain circle of scientists is of the opinion that old age as such begins at the moment of the emergence of life. In other words, as soon as a person is born, the invisible clock begins its reverse stroke, and when the dial goes to zero, the person’s presence in this world will also cease.

There is an opinion that until a person reaches maturity, all processes in the body occur in the active stage, and after this moment they begin to fade away, along with this the number of active cells decreases, which is why the aging process occurs.

As for immunologists and some gerontologists who tried to find an answer to the question “Why does a person die?”, then, from their point of view, with age, autoimmune phenomena intensify in a person against the background of a decrease in the reaction of cells, which, in essence, leads to What the immune system the body begins to “attack” its own cells.

Genetics, naturally, say that the whole problem lies in genes, while doctors argue that human death is inevitable due to body defects that accumulate throughout a person’s life.

Law of nature

Thanks to scientists from the USA who conducted research on this issue, it became known that people die while in the “kingdom of Morpheus”, mainly due to respiratory arrest. This occurs mainly in older people due to the loss of cells that control the breathing process, sending signals to the body to contract the lungs. In principle, such a problem can occur among a lot of people, its name is obstructive apnea, and this problem is the main one. But there cannot be such a cause of death as obstructive apnea. This is due to the fact that the person experiencing oxygen starvation(insufficiency), wakes up. And the cause of death is central sleep apnea. It should be noted that a person may even wake up, but still die due to lack of oxygen, which will result from a stroke or cardiac arrest. But, as mentioned earlier, this disease mainly affects older people. But there are also those who die before reaching old age. Therefore, a very reasonable question arises: why do people die young?

Death of the Young

It's worth starting with what Lately approximately 16 million girls in age category from 15 to 19 years old women become pregnant. At the same time, the risks of infant death are much higher than those of those girls who crossed the 19-year-old barrier. These problems are due to physiological factors, and psychological.

Not the least reason is poor nutrition, and this is due to both obesity and problems associated with anorexia.

Smoking. Drugs. Alcohol

As for bad habits, such as abuse of alcohol, nicotine, and even more so drugs, this problem every year affects younger and younger segments of the population, who not only put their future children at risk, but also themselves.

Still, the most common cause of death among the young population is unintentional injuries. The reason for this can also be alcohol and drugs, not counting youthful maximalism, which cannot be discounted. Therefore, until teenagers reach adulthood, all responsibility for moral and psychological education lies entirely with the parents.

How does a person feel at the moment of death?

In fact, the question of a person’s feelings after death has worried all of humanity throughout its existence, but only recently have they begun to say with confidence that all people at the moment of death experience definitely the same feelings. This became known thanks to people who experienced clinical death. Most of them claimed that even lying on the operating table, being immobilized, they continued to hear and sometimes see everything that was happening around them. This is possible due to the fact that the brain is the last thing to die, and this happens mainly due to lack of oxygen. Of course, there are also stories about a tunnel, at the end of which bright light, but there is actually no reliability of this particular information.

Finally

Having delved into the problem and understood it, we can confidently answer the question: why does a person die? Quite often people ask themselves similar questions, but you should not devote your entire life to the problem of death, because it is so short that there is no time to spend it on understanding those problems for which humanity is not yet ready.

Sudden cardiac death is cardiac arrest, an acute hemodynamic syndrome caused by complete cessation of the pumping function of the myocardium, or a condition in which the continued electrical and mechanical activity of the heart does not provide effective circulation.

The prevalence of sudden cardiac death ranges from 0.36 to 1.28 cases per 1000 population per year. About 90% of sudden cardiac deaths occur in out-of-hospital settings.

Our attention should be paid to ensuring that the consequences of a sudden stop of blood circulation have a better prognosis due to the early recognition of this pathology (in a matter of seconds) and the immediate initiation of competent resuscitation measures.

Sudden cardiac death includes only cases characterized by the following symptoms.

1. Death occurred in the presence of witnesses within 1 hour after the appearance of the first threatening symptoms (previously this period was 6 hours).
2. Immediately before death, the patient's condition was assessed as stable and not causing serious concern.
3. Other causes are completely excluded (violent death and death resulting from poisoning, asphyxia, injury or any other accident).

According to ICD-10 there are:

• 146.1 - Sudden cardiac death.
• 144-145 - Sudden cardiac death due to conduction disturbances.
• 121-122 - Sudden cardiac death due to myocardial infarction.
• 146.9 - Cardiac arrest, unspecified.

Some variants of sudden cardiac death caused by different types myocardial pathologies are divided into separate forms:

• sudden cardiac death of a coronary nature - circulatory arrest is caused by exacerbation or acute progression of coronary heart disease;
• sudden cardiac death of an arrhythmic nature - a sudden stop of blood circulation caused by disorders heart rate or conductivity. The onset of such death occurs in a matter of minutes.

The main criterion for diagnosis is death, which occurs within a few minutes in cases where the autopsy did not reveal morphological changes incompatible with life.

ICD-10 code

I46.1 Sudden cardiac death, so described

What causes sudden cardiac death?

By modern ideas, sudden cardiac death is a generalized group concept that unites different shapes heart pathologies.

In 85-90% of cases, sudden cardiac death develops due to coronary heart disease.

The remaining 10-15% of cases of sudden cardiac death are caused by:

• cardiomyopathies (primary and secondary);
• myocarditis;
• malformations of the heart and blood vessels;
• diseases causing myocardial hypertrophy;
• alcoholic heart damage;
• mitral valve prolapse.

Relatively rare causes that provoke a condition such as sudden cardiac death:

• syndromes of ventricular preexcitation and prolonged QT interval;
• arrhythmogenic myocardial dysplasia;
• Brugada syndrome, etc.

Other causes of sudden cardiac death include:

• pulmonary embolism;
• cardiac tamponade;
• idiopathic ventricular fibrillation;
• some other conditions.

Risk factors for sudden cardiac arrest

Myocardial ischemia, electrical instability and left ventricular dysfunction are the main triad of risk for sudden cardiac arrest in patients with coronary heart disease.

Electrical instability of the myocardium is manifested by the development of “threatening arrhythmias”: disturbances of the heart rhythm that immediately precede and transform into ventricular fibrillation and asystole. Long-term electrocardiographic monitoring showed that ventricular fibrillation is most often preceded by paroxysms of ventricular tachycardia with a gradual increase in rhythm, turning into ventricular flutter.

Myocardial ischemia is a significant risk factor for sudden death. The degree of damage is important coronary arteries. About 90% of those who suddenly died had atherosclerotic narrowing of the coronary arteries by more than 50% of the lumen of the vessel. In approximately 50% of patients, sudden cardiac death or myocardial infarction is the first clinical manifestations coronary heart disease.

The highest probability of circulatory arrest is in the first hours acute heart attack myocardium. Almost 50% of all deaths die in the first hour of illness from sudden cardiac death. You should always remember: the less time has passed since the onset of myocardial infarction, the greater the likelihood of developing ventricular fibrillation.

Left ventricular dysfunction is one of the most important risk factors for sudden death. Heart failure is a significant arrhythmogenic factor. In this regard, it can be regarded as a significant marker of the risk of sudden arrhythmic death. The most significant reduction in ejection fraction to 40% or less. The likelihood of developing an unfavorable outcome increases in patients with cardiac aneurysm, post-infarction scars and clinical manifestations of heart failure.

Violation autonomic regulation heart with a predominance of sympathetic activity leads to electrical instability of the myocardium and an increased risk of cardiac death. Most significant signs this condition - decreased variability sinus rhythm, increasing the duration and dispersion of the QT interval.

Left ventricular hypertrophy. One of the risk factors for sudden death is severe left ventricular hypertrophy in patients with arterial hypertension and hypertrophic cardiomyopathy.

Restoration of cardiac activity after ventricular fibrillation. To the group high risk the possibility of sudden arrhythmic death (Table 1.1) includes patients resuscitated after ventricular fibrillation.

The main risk factors for arrhythmic death, their manifestations and methods of detection in patients with coronary heart disease

The most prognostically dangerous is fibrillation that occurs outside acute period myocardial infarction. There are conflicting opinions regarding the prognostic significance of ventricular fibrillation that occurs during acute myocardial infarction.

General risk factors

Sudden cardiac death is more often recorded in people aged 45-75 years, and sudden cardiac death occurs 3 times more often in men than in women. But in-hospital mortality during myocardial infarction is higher in women than in men (4.89 versus 2.54%).

Risk factors for sudden death include smoking, arterial hypertension with myocardial hypertrophy, hypercholesterolemia and obesity. Influences and long-term use soft drinking water with insufficient magnesium (predisposes to spasms of the coronary arteries) and selenium (impaired stability occurs cell membranes, mitochondrial membranes, impaired oxidative metabolism and dysfunction of target cells).

Risk factors for sudden coronary death include meteorological and seasonal factors. Research data show that an increase in the incidence of sudden coronary death occurs in the autumn and spring periods, different days weeks, with changes in atmospheric pressure and geomagnetic activity. The combination of several factors leads to a severalfold increase in the risk of sudden death.

Sudden cardiac death in some cases can be provoked by inadequate physical or emotional stress, sexual intercourse, drinking alcohol, generous intake food and cold stimulus.

Genetically determined risk factors

Some risk factors are genetically determined, which is of particular importance both for the patient himself and for his children and close relatives. Long QT syndrome, Brugada syndrome, sudden unexplained death syndrome, arrhythmogenic right ventricular dysplasia, idiopathic ventricular fibrillation, sudden infant death syndrome and others are closely associated with a high risk of sudden death at a young age. pathological conditions.

Recently, great interest has been shown in Brugada syndrome, a disease characterized by the young age of patients, frequent occurrence syncope due to attacks of ventricular tachycardia, sudden death (mainly during sleep) and the absence of signs of organic myocardial damage at autopsy. Brugada syndrome has a specific electrocardiographic pattern:

• right bundle branch block;
• specific ST segment elevation in leads V1-3;
• periodic prolongation of the PR interval;
• attacks of polymorphic ventricular tachycardia during syncope.

A typical electrocardiographic pattern is usually recorded in patients before the development of ventricular fibrillation. When performing an exercise test and a drug test with sympathomimetics (isadrin), the electrocardiographic manifestations described above decrease. During the slow test intravenous administration antiarrhythmic drugs, blocking the sodium current (ajmaline at a dose of 1 mg/kg, procainamide at a dose of 10 mg/kg or flecainide at a dose of 2 mg/kg), the severity of electrocardiographic changes increases. The administration of these drugs in patients with Brugada syndrome can lead to the development of ventricular tachyarrhythmias (up to ventricular fibrillation).

Morphology and pathophysiology of sudden cardiac arrest

Morphological manifestations of sudden cardiac arrest in patients with coronary heart disease:

• stenosing atherosclerosis of the coronary arteries of the heart;
• thrombosis of the coronary arteries;
• cardiac hypertrophy with dilatation of the left ventricular cavity;
• myocardial infarction;
• contracture damage to cardiomyocytes (combination of contracture damage with fragmentation muscle fibers serves as a histological criterion for ventricular fibrillation).

Morphological changes serve as a substrate on the basis of which sudden cardiac death develops. In the majority of patients with coronary heart disease (90-96% of cases) who died suddenly (including patients with asymptomatic course), significant atherosclerotic changes in the coronary arteries (narrowing of the lumen by more than 75%) and multiple lesions of the coronary bed are detected at autopsy ( at least two branches of the coronary arteries).

Atherosclerotic plaques located predominantly in the proximal areas of the coronary arteries are often complicated, with signs of endothelial damage and the formation of wall thrombi or (relatively rarely) completely occluding the lumen of the vessel.

Thrombosis is relatively rare (in 5-24% of cases). It is natural that the longer the period of time from the beginning heart attack until death, the more often blood clots occur.

In 34-82% of the deceased, cardiosclerosis is determined with the most frequent localization scar tissue in the area of ​​localization of the conduction pathways of the heart (posterior septal region).

Only in 10-15% of patients with coronary heart disease who died suddenly, macroscopic and/or histological features acute myocardial infarction, since the macroscopic formation of such signs requires at least 18-24 hours.

Electron microscopy shows the onset of irreversible changes cellular structures myocardium 20-30 minutes after cessation of coronary blood flow. This process ends 2-3 hours after the onset of the disease, causing irreversible disturbances in myocardial metabolism, its electrical instability and fatal arrhythmias.

Triggering points (trigger factors) are myocardial ischemia, cardiac innervation disorders, myocardial metabolic disorders, etc. Sudden cardiac death occurs as a result of electrical or metabolic disturbances in the myocardium,

As a rule, there are no acute changes in the main branches of the coronary arteries in most cases of sudden death.

Heart rhythm disturbances are most likely caused by the occurrence of relatively small foci of ischemia due to embolization of small vessels or the formation of small blood clots in them.

The onset of sudden cardiac death is most often accompanied by severe regional ischemia, left ventricular dysfunction and other transient pathogenetic conditions (acidosis, hypoxemia, metabolic disorders and etc.).

How does sudden cardiac death develop?

The immediate causes of sudden cardiac death are ventricular fibrillation (85% of all cases), pulseless ventricular tachycardia, pulseless electrical activity of the heart and myocardial asystole.

The triggering mechanism for ventricular fibrillation in sudden coronary death is considered to be the resumption of blood circulation in the ischemic area of ​​the myocardium after a long (at least 30-60 minutes) period of ischemia. This phenomenon is called the phenomenon of reperfusion of ischemic myocardium.

A reliable pattern is that the longer the myocardial ischemia, the more often ventricular fibrillation is recorded.

The arrhythmogenic effect of resumption of blood circulation is caused by leaching from ischemic areas into the general bloodstream biologically active substances(arrhythmogenic substances) leading to electrical instability of the myocardium. These substances are lysophosphoglycerides, free fatty acid, cyclic adenosine monophosphate, catecholamines, free radical lipid peroxide compounds, etc.

Typically, during myocardial infarction, the phenomenon of reperfusion is observed along the periphery in the peri-infarction zone. In sudden coronary death, the reperfusion zone affects larger areas of ischemic myocardium, and not just the border zone of ischemia.

Precursors of sudden cardiac arrest

In approximately 25% of cases, sudden cardiac death occurs instantly and without visible warning signs. In the remaining 75% of cases, a thorough survey of relatives reveals the presence of prodromal symptoms 1-2 weeks before sudden death, indicating an exacerbation of the disease. Most often this is shortness of breath, general weakness, a significant decrease in performance and exercise tolerance, palpitations and interruptions in heart function, increased heart pain or pain syndrome atypical localization, etc. Immediately before the onset of sudden cardiac death, approximately half of the patients experience a painful anginal attack accompanied by fear near death. If sudden cardiac death occurs outside the area of ​​constant observation without witnesses, then it is extremely difficult for the doctor to establish the exact time of circulatory arrest and the duration of clinical death.

How is sudden cardiac death recognized?

Of great importance in identifying persons at risk of sudden cardiac death is a detailed history and clinical examination.

Anamnesis. WITH high degree probability of sudden cardiac death threatens patients with coronary heart disease, especially those who have had a myocardial infarction, who have post-infarction angina or episodes silent ischemia myocardium, clinical signs of left ventricular failure and ventricular arrhythmias.

Instrumental research methods. Holter monitoring and long-term recording of the electrocardiogram allows us to identify threatening arrhythmias, episodes of myocardial ischemia, and assess sinus rhythm variability and QT interval dispersion. Detection of myocardial ischemia, threatening arrhythmias and tolerance to physical activity can be done using stress tests: bicycle ergometry, treadmill testing, etc. Atrial electrical stimulation using esophageal or endocardial electrodes and programmed stimulation of the right ventricle have been successfully used.

Echocardiography allows one to assess the contractile function of the left ventricle, the size of the heart cavities, the severity of left ventricular hypertrophy and identify the presence of zones of myocardial hypokinesis. To identify coronary circulatory disorders, they use radioisotope scintigraphy myocardium and coronary angiography.

Signs of a very high risk of developing ventricular fibrillation:

• a history of episodes of circulatory arrest or syncope (associated with tachyarrhythmias);
• family history of sudden cardiac death;
• decreased left ventricular ejection fraction (less than 30-40%);
• tachycardia at rest;
• low variability of sinus rhythm in persons who have had myocardial infarction;
• late ventricular potentials in persons who have suffered myocardial infarction.

How is sudden cardiac death prevented?

Prevention of sudden cardiac arrest in people of dangerous categories is based on the impact on the main risk factors:

• threatening arrhythmias;
• myocardial ischemia;
• decreased contractility of the left ventricle.

Drug prevention methods

Cordarone is considered the drug of choice for the treatment and prevention of arrhythmias in patients with heart failure of various etiologies. Since there is a number side effects with long-term continuous use of this drug, it is preferable to prescribe it if there are clear indications, in particular, threatening arrhythmias.

Beta blockers

The high preventive effectiveness of these drugs is associated with their antianginal, antiarrhythmic and bradycardic effects. Continuous therapy with beta-blockers is generally accepted for all post-infarction patients who do not have contraindications to these drugs. Preference is given to cardioselective beta-blockers that do not have sympathomimetic activity. The use of beta-blockers can reduce the risk of sudden death not only in patients with coronary heart disease, but also with hypertension.

Calcium antagonists

Prophylactic treatment with the calcium antagonist verapamil in post-infarction patients without signs of heart failure may also help reduce mortality, including sudden arrhythmic death. This is explained by the antianginal, antiarrhythmic and bradycardic effect of the drug, similar to the effect of beta-blockers.

Angiotensin-converting enzyme inhibitors can correct left ventricular dysfunction, which leads to a reduced risk of sudden death.

Surgical methods of treatment

If there are life-threatening arrhythmias that cannot be prevented drug therapy, shown surgical methods treatment (implantation of pacemakers for bradyarrhythmias, defibrillators for tachyarrhythmias and recurrent ventricular fibrillation, intersection or catheter ablation of abnormal conduction pathways for ventricular premature excitation syndromes, destruction or removal of arrhythmogenic foci in the myocardium, stenting and coronary artery bypass surgery with coronary heart disease).

Identify all potential victims of sudden death despite achievements modern medicine, fails. And it is not always possible to prevent circulatory arrest in patients with a known high risk of sudden cardiac arrest. In these cases, the most important method of combating fatal arrhythmias to save the patient’s life is the timely and competent implementation of resuscitation measures when sudden cardiac death has occurred.

Symptoms and course. The following signs are characteristic of sudden cardiac arrest: loss of consciousness, absence of pulse in large arteries (carotid, femoral) and heart sounds, cessation of breathing or sudden appearance of agonal breathing, dilated pupils, change in skin color (gray with a bluish tint). To establish the fact of cardiac arrest, the presence of the first three signs (lack of consciousness, pulse in large arteries, cardiac activity) is sufficient. Time spent searching for pulse major artery, should be minimal. If there is no pulse, then you cannot waste time listening to heart sounds, measuring blood pressure, or taking an electrocardiogram. It must be remembered that in the majority of cases of sudden death, potentially healthy people the average duration of experiencing a complete cessation of blood circulation is within 5 minutes, after which irreversible changes appear in the central nervous system. This time is sharply reduced if circulatory arrest was preceded by any serious illnesses heart, lungs or other organs or systems.

First aid in case of cardiac arrest must be started immediately, even before the ambulance arrives. medical care, since it is important not only to restore the blood circulation and breathing of the sick person, but also to return him to life as a full-fledged person. The patient is given artificial ventilation and indoor massage hearts. He is laid on a hard surface horizontally on his back, his head is thrown back as much as possible, his lower jaw is pushed forward and upward as much as possible. To do this, grab the lower jaw with both hands at its base; teeth lower jaw should be located in front of the teeth upper jaw. For artificial ventilation It is better to use the “mouth to mouth” method, while the nostrils of the sick person should be pinched with the fingers or pressed against the cheek of the person who is reviving. If the patient’s chest expands, it means the inhalation was carried out correctly. The intervals between individual breathing cycles should be 5 seconds (12 cycles in 1 minute). Carrying out indirect massage heart attack is preceded by a strong fist blow to the sternum. The patient is in horizontal position on a hard surface, the hands of the resuscitator are located on the lower third of the sternum, strictly along midline. Place one palm on top of the other and apply pressure to the sternum, do not bend your elbows, apply pressure only to your wrists. Massage tempo - 60 massage movements in a minute. If resuscitation is carried out by one person, then the ratio of ventilation and massage is 2:12; if two people are resuscitating, then this ratio is 1:5, that is, there are 5 compressions for one injection chest. To continue intensive care the patient is hospitalized in the intensive care unit.

Articles from the forum on the topic “ Sudden death»

What is sudden death? Who is a risk factor?

you walk and suddenly bamstststst

Heart attack and stroke are the most common causes of sudden death.

http://ru.wikipedia.org/wiki/Syndrome_external...
Young children are at risk

Yes, this is the origin of death.
Factors:
Male
Age over 50
Relatives who died from the same
Blood lipids are above 7 mmol per liter. any of 5 indicators.
A man's waist circumference is more than 90 cm.
Internationally recognized risk factors for sudden death.

I described the sudden death of an adult male.
In children from birth to eight months, there is a risk of sudden death from respiratory arrest (this means practically healthy children). The reasons for their respiratory arrest are not clear.

No one is a risk factor. That’s why it’s called sudden death syndrome. It’s a very rare and unstudied thing.

sudden death is when it later turns out that a person had a bad heart?

Sometimes a blood clot breaks, and death is also sudden...

Well, not just a bad heart. It's far from the only one.

there are a lot of reasons. and heart, and cerebral hemorrhage, and sleep disturbance

Yes, this often happens: a person does not complain about his health, although he has colitis here and there is pain there, but negligence towards his own health leads to death.

sudden death can also be from diseased blood vessels - stroke (bleeding in the brain) or thromboembolism (a blood clot breaks off and goes to the heart), with diabetes (insulin shock)

Regardless of why a person died, from carbon monoxide poisoning to serious brain disease, it is first important to clearly determine the cause of death. And this is exactly what is difficult. Forensic experts shared information on how they determine whether a death was violent or a suicide, and how they determine in young people.

If you were told that a friend died in a dream, this may mean that the cause of death has not been precisely established, or that loved ones want to keep it a secret. But if the deceased was a young, healthy person, then it is important to find answers to pressing questions.

To those who remain to live in this world and deeply mourn the loss loved one, it is very important to know why a loved one died in order to draw a line. And for family members of the deceased this is especially important information, because awareness of death in a dream can potentially save the lives of his loved ones.

Deceased at home in a dream: actions

“If a loved one dies at home, especially in their sleep, the medical examiner should be notified of the fact afterward unless the death is supported by witness testimony,” says Dr. Candace Schopp, a forensic pathologist and medical examiner in Dallas County. (USA).

“Regardless of whether we accept a case for consideration or not, a lot depends on what medical history“What illness did the patient have and what were the circumstances of his death,” the expert adds.

“The age of the deceased is very important factor in action,” says Schopp. How younger man, the more often an autopsy is performed on the body if it is not known. If the victim is seriously aged (over 50 years old), or has a diagnosis and no signs of violent death, specialists are unlikely to perform an autopsy.

The younger the person, the more often an autopsy is performed.

Suicide version

Death under suspicious circumstances, with suspected suicide, at home, and even in a dream, is a completely different matter. “I will always check the version of suicide if a person died in bed. According to Schopp, the following key points give rise to thoughts of suicide:

• strange objects were found at the scene of the incident;
• there are ambiguities in the medical history;
• the deceased was very young;
• The deceased was in good health.

According to the forensic pathologist, experts also often consider the possibility of an accidental drug overdose. Recently, there has been an increase in the number of people taking prescription medications incorrectly. Among them, opioids (opiates) - narcotic analgesics - were often seen.

Accidents at home

Each year is marked by tragic deaths due to carbon monoxide poisoning, including at home and while sleeping. Dr. Patrick Lantz, professor at the department, talks about this pathological anatomy at Wake Forest University School of Medicine, forensic pathologist and pathologist in North Carolina (USA).

Due to malfunctions of the gas boiler or water heater, carbon monoxide may be released throughout the house. “In this case, people can easily choke on smoke and die,” Lantz says.

Or sometimes the following situation happens: a person has a built-in garage in his house. He started the car to warm it up. And left the garage door closed. “ Carbon monoxide spreads quickly, and is possibly serious,” Lanz is convinced.

Cases are different. Suppose someone gets an electric shock because the wire in an electrical household appliance, such as a hair dryer, is damaged. “The person may have touched the wire in the bathroom. He falls to the floor and falls asleep or falls onto the bed. It’s not always possible to find a person near an electrical appliance,” says the expert.

According to Lantz, if you ever find a deceased person in bed, your actions will depend on the circumstances of the incident: “If the deceased had cancer or chronic cardiovascular disease, the best option will call a therapist to your home.”

In any case, if the death occurred suddenly and unexpectedly, it is important (103) and the police (102). “There are times when a person is alive, but he can barely breathe and he has a pulse that you cannot determine. Therefore, it is important to consult a professional to understand whether the person really died in his sleep,” says Patrick Lanz.

If death occurs suddenly, it is important to call a medical team in Ukraine (103) and the police (102). There are times when a person is alive, but he is barely breathing and he has a pulse that you cannot determine. Therefore, it is important to contact a professional to understand whether a person is alive or not.

Questions of the heart in a dream

Adults who died of natural causes, including at home and in their sleep, and are sent for an autopsy - often people between 20 and 55. Reason for autopsy - unknown reason of death; Plus, they have very few facts and records in the medical record, Schopp says.

According to the expert, the following were often observed in such deceased people:

• slight increase in blood pressure (arterial hypertension);
• diabetes ;
• obesity.

“And in the vast majority of cases, we encounter undiagnosed cardiovascular diseases in our practice,” she adds.

When a person dies suddenly at night or during the day, it is often due to something called cardiac arrhythmia, Schopp admits. In cases of severe cardiac arrhythmia, the propagation of cardiac impulses in the heart may be impaired. Autopsy of the heart may reveal scarring, expert says.

“The patient's heart may be enlarged due to heavy drinking or obesity,” explains the forensic pathologist. In addition, the heart can be abnormally large due to congenital heart diseases.

Family illnesses

It is very important to understand the reason for the unexpected death of a loved one, especially if he died before and in his sleep, Lantz says. “Firstly, it helps to correctly explain to the family why the person passed away,” explains the expert. “It is especially important to realize this if the key role is played by hereditary factor in action,” he adds.

Saving a life

Based on the results of the autopsy, experts can advise the loved ones of the deceased, who died at home and in his sleep, to make a diagnosis to identify serious genetic diseases and speed up treatment if the disease is confirmed. Sometimes doctors only observe the disease, and in some situations treatment is prescribed immediately. If doctors diagnose certain types of arrhythmia, then patients are offered to purchase an implantable defibrillator in the heart area.

An implantable cardioverter defibrillator (ICD) is a pacemaker-type device that continuously monitors the heart's rhythm. If the device detects a rhythm disorder that is not too serious, it generates a series of painless electrical impulses to correct the rhythm.

If this does not help or the rhythm disturbance is severe enough, the ICD device generates a small electrical shock called cardioversion. If this does not help or the rhythm disturbance is very severe, the ICD device generates an even stronger electrical shock, called defibrillation.

Prevention and diagnosis of loved ones of the deceased

Diseases of the wall of the aorta, the large, central artery that carries blood from the heart to the body, can lead to rupture of the aorta and sudden death. Aortic aneurysm - common hereditary disease. This is an expansion of the lumen of a blood vessel or heart cavity caused by pathological changes their walls or developmental anomalies.

“Usually family members are asked to do in the event of an aneurysm of the deceased, including in a dream:

• echocardiogram;
• computed tomography;
• magnetic resonance imaging ().

When doctors see that the aorta is beginning to dilate, they suggest using preventive surgery methods,” Lanz reports. “And then sudden death can be prevented,” the doctor clarifies.

Schopp says that when hereditary diseases served possible reason death, then representatives of her institution call relatives. “Sometimes I personally explain everything clearly over the phone,” she says. “In the autopsy report I indicate that this genetic mutation, which is inherited, and I recommend that close family members (especially parents, brothers, sisters, children) go for a consultation with a therapist and get diagnosed,” says the expert.

Mental health issues

When doctors take questions into account, it means that they want to establish whether a person died a natural death or not, especially if this happened at home and in his sleep. “Forensic experts have to do a lot of research on this and talk to the loved ones of the deceased,” says Lantz.

Typically, forensic experts ask similar questions to loved ones of the deceased:

• Maybe the person was there?
• Has he ever taken drugs or serious sedatives?
• Did he sometimes voice his attitude towards suicide attempts and?

If family members answer yes to at least one of these questions, forensic experts decide to perform an autopsy.

“If we receive such information about the characteristics of the deceased, for example: that he was depressed; suicidal tendencies were evident, I think that any expert would say to do an autopsy. The age of the deceased does not play a role in this case. Specialists then want to rule out the possibility of suicide,” he says.

Brain diseases

According to Lanz, brain diseases that can lead to sudden death, including at home and in sleep, are the following:

• extensive stroke;
• extensive hemorrhage due to

What is a cerebral aneurysm? This is a weakening of the wall of one of the blood vessels in the head. Due to the way blood circulates in the head, this “weakness” causes the walls of the vessel to bulge. As with overinflated balloon, such a bulge can lead to rupture, resulting in a cerebral hemorrhage.

According to Lanz, in the case of infections such as meningitis and encephalitis, there may be fatal consequences for the human body. In general, with the development of such serious diseases, obvious symptoms are observed that should be taken into account.

“Epilepsy is known as a disease that causes death in one's sleep,” says Schopp. Perhaps this is due to the fact that the amount of oxygen decreases to the brain, and this provokes epileptic seizure. According to her, usually the patient’s history has already been observed such.

Causes of death in supposedly healthy people

According to Schopp, the incidence of sudden death among apparently healthy people in their beds at home and in their sleep depends on how people understand the word “healthy.” Obesity is a common cause of unexpected death, says forensic pathologist Schopp. “For example, I meet many people in my practice who have serious coronary insufficiency. In addition, I often observe patients at work who have clogged arteries. Such phenomena are “getting younger,” the doctor admits.

The incidence of sudden death among apparently healthy people in their beds depends on how people understand the word “healthy.”

Coronary insufficiency is a concept that means a decrease or complete cessation of coronary blood flow with insufficient supply of oxygen and nutrients to the myocardium.

According to Schopp, sometimes a person, by virtue of his low level income and characteristics of living conditions may not have any entries in the medical book at all for 15 years due to the fact that he could not.

“It’s quite rare for people to die suddenly and unexpectedly in their bed in their sleep,” Lanz is convinced. "Sometimes it happens. In most cases where death comes completely without warning, forensic experts study such incidents very carefully. We would like autopsies to be carried out more often, then we will be able to inform the relatives of the deceased better,” the doctor hopes.