Sudden coronary death: causes, how to avoid. Causes of sudden cardiac death and how to prevent it

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.

For those who remain in this world and are deeply grieving over the loss of a loved one, it is very important to know why the 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 or not, a lot depends on what the patient’s medical history was and what the circumstances of his death were,” the expert adds.

“The age of the deceased is a very important factor in the case,” says Schopp. The younger the person, the more often an autopsy is performed if the body 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 lead 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. IN Lately There has been an increase in the number of people taking prescription drugs 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, a professor in the Department of Pathological Anatomy at Wake Forest University School of Medicine, a forensic expert and pathologist in the state of North Carolina (USA), talks about this.

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 possibly seriously,” Lantz said.

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 Lantz.

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 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 hereditary factor plays a key role in the case,” 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 is often a hereditary disease. This is an expansion of the lumen blood vessel or cardiac cavities, caused by pathological changes in 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 are a possible cause of death, representatives of her institution call loved ones. “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 can 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, due to his low income and living conditions, may not have any entries in his medical record 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.

At all times, people have been interested in: why does a person die? In fact, this is quite an interesting question, to answer which we can consider several theories that can shed light on this situation. There are many on this topic different opinions, 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 that the body’s immune system begins to “attack” its own cells.

Geneticists, 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 the fact that recently, approximately 16 million girls in the age category from 15 to 19 years have 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 death occurs as a result of a fast-flowing latent or clinically pronounced painful condition. As medical practice shows, sudden death in adults often occurs due to acute coronary insufficiency, congenital or acquired cardiac and vascular pathologies. Find out what symptoms may indirectly indicate hidden threat.

What is sudden death

According to international medical recommendations, sudden death is considered to be the death of a person within 6 hours after the appearance of the first symptoms pathological condition. Instant death, or translated into English sudden death, occurs without a known cause. In addition, there are no morphological signs on the basis of which an appropriate diagnosis of the patient’s sudden death can be made at autopsy.

However, during a post-mortem examination of a person, a pathologist, having compared all available data, can make a logical conclusion about the instantaneous or violent death of the person. In most cases, instant death is supported by changes in organs in which continuation of life for the shortest period of time is impossible.

Causes of sudden death

Statistics show that the main cause of most deaths is heart disease: ischemic pathology, the onset of ventricular fibrillation. At the same time, when answering what causes instant death, experts often call chronic illnesses, which last for a long time in hidden form, after which they suddenly worsen and lead to the unexpected death of a person. One of these deadly diseases is cancer.

In most cases, oncology develops asymptomatically and makes itself felt when the patient is often considered hopeless. Thus, malignant liver disease is the main cause of unexpected deaths in China. Another insidious disease that can lead to sudden death is AIDS, which claims millions of lives in Africa every year. In addition, it is worth mentioning separately about Mexico. This is the only country in which cirrhosis of the liver occurs main reason high mortality rate of the population.

In young age

Today, young men and women are exposed to the negative influence of modern lifestyle every day. From TV screens, covers fashion magazines The cult of a slender (often dystrophic) body, accessibility and promiscuity is imposed on young people. Therefore, it is quite understandable that the mortality rate of people just beginning their life journey will increase over time. The main causes of instant death among boys and girls under 25 years of age are considered to be:

• alcohol;
• smoking;
• promiscuity;
• drug addiction;
• poor nutrition;
• psychological sensitivity;
• hereditary diseases;
• severe congenital pathologies.

In a dream

Unexpected death in this condition occurs due to the loss of special cells responsible for the contractility of the lungs. Thus, scientists from the USA were able to prove that people die in their sleep in most cases due to central sleep apnea. In this case, a person may even wake up, but still leave this mortal world due to oxygen starvation caused by a stroke or cardiac arrest. As a rule, elderly people are susceptible to this syndrome. Any specific methods There is no cure for central sleep apnea.

Sudden infant death

This syndrome was first described in the early 60s of the last century, although cases of instant death of infants were recorded earlier, but they were not subjected to such a thorough analysis. Young children have very high adaptive abilities and incredible resistance to a variety of negative factors, therefore, the death of an infant is considered an exceptional situation. However, there are a number of external and internal reasons that can lead to sudden infant death:

• prolongation of the Q-T interval;
• apnea (the phenomenon of periodic breathing);
• deficiency of serotonin receptors;
• overheat.

Risk factors

Due to the fact that the main cardiogenic cause of instant death is ischemic disease, then it is quite logical to assume that the syndromes accompanying this heart pathology can be fully attributed to conditions that can increase the likelihood of sudden death. With all this, it has been scientifically proven that this connection is mediated through the underlying disease. Clinical factors risk for the development of clinical death among patients ischemic syndrome are:

• acute myocardial infarction;
• post-infarction macrofocal sclerosis;
• unstable angina;
• violation heart rate due to ischemic changes (rigid, sinus);
• ventricular asystole;
• myocardial damage;
• episodes of loss of consciousness;
• damage to the coronary (heart) arteries;
• diabetes;
• electrolyte imbalance (eg, hyperkalemia);
• arterial hypertension;
• smoking.

How does sudden death occur?

This syndrome develops in a matter of minutes (less often hours) without any warning in the midst of complete well-being. In most cases, instant death affects young men aged 35 to 43 years. Moreover, often during the pathological examination of the deceased, vascular causes of sudden death are discovered. Thus, studying the increasing cases of instant death, experts came to the conclusion that the main provoking factor in the occurrence of this syndrome is a violation of coronary blood flow.

For heart failure

In 85% of cases, immediate death is recorded in persons with structural abnormalities organ that pumps blood into the vessels. At the same time, sudden cardiac death looks like it occurs at lightning speed. clinical variant ischemic disease. Medical practice shows that a quarter of people who died instantly, before the onset of primary symptoms bradycardia and episodes of asystole are observed. Death from cardiac arrest occurs due to the launch of the following pathogenetic mechanisms:

• Reducing left ventricular fractional ejection by 25-30%. This syndrome greatly increases the risk of sudden coronary death.
• Ectopic focus of automatism in the ventricle (more than 10 ventricular extrasystoles per hour or unstable ventricular tachycardia), arising as a consequence of ventricular arrhythmias. The latter mostly develop against the background of acute transient myocardial ischemia. An ectopic focus of automatism is usually classified as a risk factor for sudden arrhythmic death.
• The process of spasm of the blood vessels of the heart, which leads to ischemia and contributes to the deterioration of the restoration of blood flow to damaged areas.

It is worth noting that the particularly significant electrophysiological mechanisms resulting in sudden coronary death in a person with heart failure, is tachyarrhythmia. At the same time, timely treatment of this condition using a defibrillator with a modified pulse configuration significantly reduces the number of deaths among patients who have suffered sudden cardiac arrest.

From a heart attack

Blood enters the heart through the coronary arteries. If their lumen closes, the formation of primary foci of necrosis and ischemia in the heart occurs. Acute manifestation cardiological pathology begins with damage to the vascular wall with further thrombosis and spasm of the arteries. As a result, the load on the heart increases, the myocardium begins to experience oxygen starvation, which affects its electrical activity.

As a result of a sudden coronary spasm, ventricular fibrillation occurs, a few seconds after which a complete cessation of blood circulation to the brain occurs. At the next stage, the patient experiences respiratory arrest, atony, and absence of corneal and pupillary reflexes. After 4 minutes from the onset of ventricular fibrillation and complete cessation of blood circulation in the body, irreversible changes occur in the brain cells. In general, death from a heart attack can occur in 3-5 minutes.

From a blood clot

In the venous bed, these pathological formations arise due to the uncoordinated work of the coagulation and anticoagulation systems. Thus, the onset of the appearance of a clot is caused by damage to the vascular wall and its inflammation against the background of thrombophlebitis. Perceiving the appropriate chemical signal, the coagulation system comes into action. As a result, fibrin threads form near the pathological area, in which blood cells become entangled, creating all the conditions for the blood clot to break off.

In arteries, the formation of clots occurs due to narrowing of the vascular lumen. So, cholesterol plaques block the path to free blood flow, resulting in the formation of a lump of platelets and fibrin threads. It is important to note that in medicine a distinction is made between floating and mural thrombi. Compared to the first type, the latter has a slight chance of breaking off and causing a blockage (embolism) of the vessel. In most cases, the causes of sudden cardiac arrest from a blood clot are due to the movement of a floating thrombus.

One of the serious consequences of the separation of such a clot is blockage pulmonary artery, which is expressed in severe cough, cyanosis skin. Often there is respiratory failure followed by cessation of cardiac activity. An equally serious consequence of blood clot separation is a violation cerebral circulation against the background of embolism great vessels heads.

Diagnosis of sudden death

A timely physical examination is the key to the success of further measures for cardiopulmonary resuscitation(CPR). Diagnosis of instant death is based on symptoms characteristic of the patient's natural death. Thus, absence of consciousness is determined if no external stimuli cause reactions on the part of the person being resuscitated.

Diagnosis of breathing disorders is noted when within 10-20 s. observation fails to detect coordinated movements of the sternum and the noise of the air exhaled by the patient. In this case, agonal breaths do not provide adequate ventilation of the lungs and cannot be interpreted as spontaneous breathing. During ECG monitoring, pathological changes characteristic of clinical death are detected:

• ventricular fibrillation or flutter;
• cardiac asystole;
• electromechanical dissociation.

Clinical manifestations

In 25% of cases, sudden death occurs instantly without any warning signs. Some patients, a week before clinical death, complain of various prodromal manifestations: increased pain in the sternum, general weakness, shortness of breath. It is important to note that today there are already methods of prevention heart attack based on early diagnosis warning symptoms of this condition. Immediately before the onset of sudden death, half of the patients experience an anginal attack. Clinical signs of a patient’s imminent death include:

• loss of consciousness;
• no pulse on carotid arteries;
• dilated pupils;
• lack of breathing or the appearance of agonal breaths;
• change in skin color from normal to gray with a bluish tint.

Medical care for sudden death

Usually, most of cases of unexpected cardiac arrest occurring outside of hospital walls. For this reason, it is extremely important to master the technique of providing emergency care with the sudden onset of clinical death. This is especially true for subjects of society who, due to their job responsibilities, come into contact with a large number of people. Remember, competent resuscitation actions immediately in the first minutes after the onset of symptoms of cardiac arrest will help gain time before arrival medical workers.

Urgent Care

The main problem that occurs in unconscious persons is obstruction respiratory tract root of the tongue and epiglottis due to muscle atony. It must be said that this condition develops in any position of the body, and when the head is tilted forward, it develops in 100% of cases. Therefore, the first thing that needs to be done is to ensure proper airway patency. For this purpose, you need to use P. Safar’s triple technique, consisting of the following sequential actions:

1. Throwing back the head;
2. Moving the lower jaw forward;
3. Opening the mouth.

Once airway patency is ensured, you should proceed to artificial pulmonary ventilation (ALV). When providing first aid, this activity is carried out using the mouth-to-mouth method. So, one hand is placed on the victim’s forehead, while the other pinches his nose. Then the resuscitator fixes his own lips around the mouth of the person being revived and blows air, while controlling the excursion chest patient. When it is visible, you need to release the victim’s mouth, giving him a chance to exhale passively.

At the next stage, artificial maintenance of blood circulation is carried out, to ensure which an algorithm for performing indirect cardiac massage or chest compression is used. For this purpose, you need to correctly lay the person being resuscitated on a flat surface. Next, you should determine the compression points: by palpating the xiphoid process and moving away from it 2 transverse fingers upward.

The hand must be placed on the border of the middle and lower part of the sternum so that the fingers are parallel to the ribs. Pushes are performed with the limbs straightened at the elbows. Chest compression is performed at a frequency of 100 compressions per minute with a break for artificial ventilation. The depth of the shocks is about 4-5 cm. Measures to restore cardiac activity should be stopped if:

1. A pulse appeared in main arteries.
2. The actions taken do not have the desired effect within 30 minutes. In this case, the exception is following states requiring prolongation of resuscitation:

• hypothermia;
• drowning;
• drug overdose;
• electrical injury.

Resuscitation measures

Today, the CPR concept is based on strict rules, ensuring complete safety of the activities carried out for human life. In addition, an algorithm for the resuscitator’s actions in case of sudden cardiac arrest or sudden loss of respiratory function in the injured person is presented and scientifically substantiated. When these conditions develop main role Time plays: only a few minutes separate a person from death. The algorithm for performing cardiopulmonary resuscitation involves performing the following actions:

1. Determining the condition of the victim, on the basis of which the range of measures necessary for revival is selected;
2. Early initiation of CPR, which involves performing two manipulations: chest compressions and artificial ventilation.
3. If the second stage is ineffective, they proceed to defibrillation. The procedure involves applying an electrical impulse to the heart muscle. At the same time, the ranks direct current should be applied only if the electrodes are correctly positioned and are in good contact with the victim’s skin.
4. At this stage, as a rule, the victim is provided with specialized medical care, including the following early treatment measures:

• artificial ventilation with tracheal intubation;
• drug support, involving the use of:
• catecholamines (adrenaline, atropine);
• antidiuretic hormones (Vasopressin);
• antiarrhythmic drugs (Cordarone, Lidocaine);
• fibrinolytic agents (Streptokinase).
• intravenous drip administration of electrolyte or buffer solutions (for example, sodium bicarbonate is administered for acidosis)

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Article publication date: 05/26/2017

Article updated date: 12/21/2018

From this article you will learn: what acute (sudden) coronary death is, what are the reasons for its development, what symptoms develop with. How to reduce the risk of coronary death.

Sudden coronary death (SCD) is an unexpected death caused by cardiac arrest that develops within a short time (usually within 1 hour from the onset of symptoms) in a person with a pathology coronary arteries.

Coronary arteries are vessels that supply blood to the heart muscle (myocardium). If they are damaged, blood flow may stop, which leads to cardiac arrest.

VCS most often develops in adults aged 45–75 years, in whom coronary heart disease (CHD) is most common. The incidence of coronary death is approximately 1 case per 1000 population per year.

One should not think that the occurrence of cardiac arrest inevitably leads to the death of a person. Provided that emergency care is provided correctly, cardiac activity can be restored, although not in all patients. Therefore, it is very important to know the symptoms of VCS and the rules of cardiopulmonary resuscitation.

Causes of coronary death

VCS is caused by damage to the coronary arteries, leading to a deterioration in the blood supply to the heart muscle. The main cause of pathology of these blood vessels is atherosclerosis.

Atherosclerosis is a disease that leads to the formation of plaques on the inner surface of arteries (endothelium), narrowing the lumen of the affected vessels.

Atherosclerosis begins with damage to the endothelium, which can be caused by high blood pressure, smoking or increased blood cholesterol levels. At the site of damage, cholesterol penetrates into the wall of the blood vessel, which leads, several years later, to the formation of an atherosclerotic plaque. This plaque forms a bulge on the arterial wall that increases in size as the disease progresses.

Sometimes the surface of the atherosclerotic plaque is torn, which leads to the formation of a blood clot in this place, which completely or partially blocks the lumen of the coronary artery. It is the disruption of the blood supply to the myocardium, which occurs as a result of blocking of the coronary artery by an atherosclerotic plaque and thrombus, that is the main cause of VCS. Lack of oxygen causes dangerous heart rhythm disturbances, which lead to cardiac arrest. The most common heart rhythm disorder in such situations is ventricular fibrillation, which causes disorganized and chaotic contractions of the heart that are not accompanied by the release of blood into the vessels. Provided that assistance is provided correctly, it is possible to revive a person immediately after cardiac arrest.

The following factors increase the risk of VCS:

• Previously suffered myocardial disease, especially during the last 6 months. 75% of cases of acute coronary death are associated with this factor.
• Cardiac ischemia. 80% of cases of VCS are associated with ischemic heart disease.
• Smoking.
• Arterial hypertension.
• Increased blood cholesterol levels.
• Presence of heart disease in close relatives.
• Deterioration of left ventricular contractility.
• Availability certain types arrhythmias and conduction disorders.
• Obesity.
• Diabetes.
• Addiction.

Symptoms

Sudden coronary death has pronounced symptoms:

• the heart stops beating and blood is not pumped throughout the body;
• loss of consciousness occurs almost immediately;
• the victim falls;
• no pulse;
• no breathing;
• pupils dilate.

These symptoms indicate cardiac arrest. The main ones are the absence of pulse and breathing, dilated pupils. All these signs can be detected by a person nearby, since the victim himself at this moment is in a state of clinical death.

Clinical death is a period of time lasting from cardiac arrest until the onset of irreversible changes in the body, after which it is no longer possible to revive the victim.

Just before cardiac arrest, some patients may experience warning signs, which include rapid heartbeat and dizziness. VCS predominantly develops without any previous symptoms.

Providing first aid to a person with sudden coronary death

Victims with VCS cannot provide first aid to themselves. Since properly performed cardiopulmonary resuscitation can restore cardiac activity in some of them, it is very important that people around the injured person know and know how to provide first aid in such situations.

Sequence of actions in the presence of cardiac arrest:

1. Make sure you and the victim are safe.
2. Check the victim's consciousness. To do this, gently shake his shoulder and ask how he feels. If the victim answers, leave him in the same position and call ambulance. Do not leave the victim alone.
3. If the patient is unconscious and unresponsive, turn him onto his back. Then place the palm of one hand on his forehead and gently tilt his head back. Using your fingers under your chin, push your lower jaw upward. These actions will open the airways.
4. Assess for normal breathing. To do this, lean towards the victim's face and look at the movements of the chest, feel the movement of air on your cheek and listen to the sound of breathing. Normal breathing should not be confused with dying breaths, which can be observed during the first moments after the cessation of cardiac activity.
5. If the person is breathing normally, call an ambulance and monitor the victim until it arrives.
6. If the victim is not breathing or his breathing is abnormal, call an ambulance and begin closed cardiac massage. To perform it correctly, place one hand on the center of the sternum so that only the base of the palm touches the chest. Place your other palm on top of the first. Keeping your arms straight at the elbows, press on the victim’s chest so that the depth of its deflection is 5–6 cm. After each pressure (compression), allow the chest to fully straighten. It is necessary to carry out indoor massage heart rate with a frequency of 100–120 compressions per minute.
7. If you know how to do artificial respiration using the mouth-to-mouth method, then after every 30 compressions, take 2 artificial breaths. If you do not know how or do not want to perform artificial respiration, simply continuously perform closed cardiac massage at a frequency of 100 compressions per minute.
8. Carry out these activities until the ambulance arrives, until signs of cardiac activity appear (the victim begins to move, opens his eyes or breathes) or complete exhaustion.

Forecast

Sudden coronary death is a potentially reversible condition in which, provided timely assistance is provided, it is possible to restore cardiac activity in some victims.

Most patients who survive cardiac arrest have some degree of damage to the central nervous system, and some are in a deep coma. The prognosis for such people is influenced by the following factors:

• General state of health before cardiac arrest (for example, the presence of diabetes, cancer and other diseases).
• The time interval between cardiac arrest and the start of conduction.
• Quality of cardiopulmonary resuscitation.

Prevention

Since the main cause of VCS is coronary heart disease caused by atherosclerosis, the risk of its occurrence can be reduced by preventing these diseases.

Healthy and balanced diet

A person needs to limit salt intake (no more than 6 g per day), as it increases blood pressure. 6 g of salt is approximately 1 teaspoon.

There are two types of fats – saturated and unsaturated. You need to avoid products containing saturated fats, as they increase the level of bad cholesterol in the blood. These include:

• meat pies;
• sausages and fatty meats;
• butter;
• salo;
• hard cheeses;
• confectionery;
• products containing coconut or palm oil.

A balanced diet should contain unsaturated fats, which increase levels of good cholesterol in the blood and help reduce atherosclerotic plaque in the arteries. Foods rich in unsaturated fats:

1. Oily fish.
2. Avocado.
3. Nuts.
4. Sunflower, rapeseed, olive and vegetable oils.

You should also limit your sugar intake, as it can increase your risk of developing diabetes, which greatly increases your risk of coronary artery disease.

Physical activity

Combining a healthy diet with regular exercise is the best way to maintain normal weight body, which reduces the risk of developing high blood pressure.

Regular exercise improves work efficiency of cardio-vascular system, reduce blood cholesterol levels, and also keep blood pressure levels within normal limits. They also reduce the risk of developing diabetes.

Everyone benefits from 30 minutes of aerobic exercise 5 days a week. These include brisk walking, jogging, swimming and any other exercise that causes the heart to beat faster and use more oxygen. The higher the level of physical activity, the more positive consequences a person receives from it.

It has been scientifically proven that people who lead a sedentary lifestyle have more high risk heart disease, diabetes and sudden coronary death. Therefore, you should take short breaks from prolonged sitting at your workplace.

Normalizing and maintaining a healthy weight

The best way to get rid of excess weight is a balanced diet and regular exercise. You need to reduce body weight gradually.

To give up smoking

If a person smokes, quitting this bad habit reduces the risk of developing coronary artery disease and coronary death. Smoking is one of the main risk factors for atherosclerosis, causing the majority of cases of coronary artery thrombosis in people under the age of 50 years.

Limiting alcohol consumption

Do not exceed the maximum recommended doses of alcohol. Men and women are advised to drink no more than 14 standard drinks per week. It is strictly forbidden to drink large quantities of alcoholic beverages for a short time or drink to the point of intoxication, as this increases the risk of SCD.

Blood pressure control

You can control your blood pressure through a healthy diet, regular exercise, normalizing your weight and, if necessary, taking medications to reduce it.

You should strive to keep your blood pressure below 140/85 mm Hg. Art.

Diabetes control

Patients with diabetes have an increased risk of coronary artery disease. To control blood glucose levels, a balanced diet, physical activity, normalization of weight, and the use of glucose-lowering medications prescribed by a doctor are useful.

Definition of the concept

Sudden death - natural (non-violent) death that occurred unexpectedly within 6 hours (according to some sources - 24 hours) from the onset of acute symptoms.

Clinical death is a reversible condition that lasts from the moment of cessation of vital functions (blood circulation, breathing) until the onset of irreversible changes in the cerebral cortex. This is the period when the viability of brain neurons remains under conditions of anoxia. Therefore, the determining criterion for the success of cardiopulmonary resuscitation is the restoration of full brain function.

The duration of the period of clinical death depends on the victim’s body temperature: when it increases, it is reduced to 1-2 minutes due to an increase in oxygen consumption by tissues due to the predominance of the processes of oxyhemoglobin dissociation over its formation; when decreased (under conditions of hypothermia) - extended to 12 minutes due to a decrease in oxygen consumption by tissues. IN exceptional cases(drowning in ice water) the time of clinical death can be 30-60 minutes or more.

Under normothermia, the period of clinical death is 3-5 minutes, acting as a limiting factor in resuscitation: if cardiopulmonary resuscitation is started within 5 minutes from the moment of circulatory arrest and ends with the restoration of spontaneous circulation and breathing, there is every chance of restoring full thinking without neurological deficit.

Social death- a partially reversible condition characterized by irreversible loss of function of the cerebral cortex (decortication) while maintaining vegetative functions(synonym: vegetative state).

Biological death characterized by an irreversible condition important organs when revitalization of the body as an integral system is impossible.

With the development of resuscitation as a science and a branch of medicine, the concept arose "brain death"- complete and irreversible cessation of all brain functions, recorded with a beating heart against the background of artificial pulmonary ventilation (ALV), infusion and drug therapy. In modern understanding, brain death is considered the legal equivalent of human death.

Causes

In the vast majority of cases, the cause of sudden death is ischemic heart disease (acute coronary insufficiency or myocardial infarction), complicated by electrical instability. Less common are causes such as acute myocarditis, acute myocardial dystrophy (in particular, alcohol etiology), pulmonary embolism, closed injury heart, electrical injury, heart defects. Sudden death occurs in neurological diseases, as well as during surgical and other interventions (catheterization of large vessels and cavities of the heart, angiography, bronchoscopy, etc.). There have been cases of sudden death with the use of certain medications (cardiac glycosides, procainamide, beta blockers, atropine, etc.).

Risk factors for sudden death:

New-onset Prinzmetal angina

The most acute stage of myocardial infarction (70% of cases of ventricular fibrillation occur in the first 6 hours of the disease with a peak in the first 30 minutes)

Rhythm disturbances: rigid sinus rhythm (intervals R-R less 0.05 s.)

Frequent (more than 6 per minute), group, polytopic, allorhythmic ventricular extrasystoles

Prolongation of the QT interval with early R/T extrasystoles and episodes of polymorphic ventricular tachycardia

Ventricular tachycardia, especially emanating from the left ventricle, alternating and bidirectional

WPW syndrome with paroxysms of flutter and high-frequency atrial fibrillation with aberrant QRS complexes

Sinus bradycardia

Atrioventricular blocks

Damage to the interventricular septum (especially in combination with damage to the anterior wall of the left ventricle)

Administration of cardiac glycosides into acute phase myocardial infarction, thrombolytics (reperfusion syndrome)

Alcohol intoxication, episodes of short-term loss of consciousness.

Mechanisms of occurrence and development (pathogenesis)

The most common mechanism of sudden death is ventricular fibrillation (fluttering), much less often - asystole and electromechanical dissociation (the latter occur in shock, heart failure and AV block). Analysis of long-term ECG monitoring data carried out at the time of sudden circulatory arrest confirms that in 80-90% of cases the mechanism of the latter is ventricular fibrillation of the heart, which is often preceded by episodes of paroxysmal ventricular tachycardia, turning into ventricular flutter. Thus, it has been shown that the most common cause of sudden cardiac death is ventricular fibrillation.

The cessation of circulation causes rapid death due to anorexia of the brain if circulation and breathing are not restored within three to a maximum of five minutes. A longer interruption in the blood supply to the brain leads to irreversible changes in it, which predetermines an unfavorable prognosis even if cardiac activity is restored at a later period.

In the pathogenesis of VCS, as we have already said, stress situations, excessive excitation of the sympathoadrenal system, hypoxia and (or) myocardial ischemia, activation of SRO, disturbances in the system of vascular-platelet hemostasis with the development of microcirculatory block, increased heart function, increased myocardial demand for oxygen and, as a consequence, the development of electrical instability of the myocardium.

Clinical picture (symptoms and syndromes)

Warning symptoms:

- pronounced pain syndrome;

- tachycardia or bradycardia accompanied by hemodynamic

disorders;

- breathing disorders;

- sudden decrease in blood pressure;

— rapid increase cyanosis of the skin

Clinical signs of sudden cardiac arrest include:

Loss of consciousness;

No pulse on large arteries(carotid and femoral);

Absence of heart sounds;

Stopping breathing or the appearance of agonal breathing;

Dilation of the pupils, lack of their reaction to light;

Change in skin color (gray with a bluish tint).

Diagnostics

To diagnose sudden cardiac arrest, it is sufficient to state the above four signs. Only the patient can be saved immediate diagnosis and emergency medical care. In any case sudden loss consciousness, the following scheme for emergency measures is recommended:

The patient is placed on his back without a pillow on a rigid base;

Check for the presence of a pulse in the carotid or femoral artery;

If cardiac arrest is detected, external cardiac massage and artificial respiration are immediately started.

Treatment

Urgent Care

Cardiopulmonary resuscitation begins if there are signs of clinical death.

1. Main features:

Absence of pulse in the carotid artery;

Lack of breathing;

Dilated pupils that do not respond to light.

2. Additional signs:

Lack of consciousness;

Pale (earthy-gray color), cyanosis, or marbling of the skin;

Atony, adynamia, areflexia.

According to the latest recommendations of the American Heart Association and the European Council on Resuscitation (2005), in case of sudden circulatory arrest, a complex of cardiopulmonary and cerebral resuscitation (CPCR), developed by P. Safar, is performed, which consists of 3 consecutive stages.

Based on the above, the provision of emergency assistance at the scene of the incident is of decisive importance. Its methods should be mastered not only by doctors, but also by people who, due to their profession, find themselves near the victim first (law enforcement officers, transport drivers, etc.).

The initial stage of SLCR is measures for basic life support, the main goal of which is emergency oxygenation. It is carried out in three successive stages:

Control and restoration of airway patency;

Artificial maintenance of respiration;

Artificial maintenance of blood circulation.

To restore airway patency, P. Safar's triple technique is used, including throwing back the head, opening the mouth and pushing the lower jaw forward.

The first thing to do is to make sure that the victim is unconscious: call him, ask loudly: “What happened?”, say: “Open your eyes!”, pat him on the cheeks, gently shake his shoulders.

The main problem that arises in unconscious persons is obstruction of the airways by the root of the tongue and the epiglottis in the laryngopharyngeal region due to muscle atony. These phenomena occur in any position of the patient (even on the stomach), and when the head is tilted (chin to chest), obstruction of the airways occurs in almost 100% of cases.

Therefore, after it is established that the victim is unconscious, it is necessary to ensure the airway is open.

When performing manipulations on the respiratory tract, you need to remember about possible damage to the spine in the cervical region. The greatest likelihood of such injury can occur when:

Road injuries (a person was hit by a car or was in a car during a collision);

Falls from heights (including divers).

Such victims should not tilt (bend their neck forward) or turn their head to the sides. In these cases, it is necessary to perform a moderate traction on yourself, followed by holding the head, neck and chest in one plane, excluding hyperextension of the neck when performing a triple technique, ensuring minimal tilting of the head and simultaneous opening of the mouth and moving the lower jaw forward. When providing first aid, the use of collars that secure the neck area is indicated.

Ventilation is carried out using the mouth-to-mouth method.

After performing a triple maneuver on the respiratory tract, one hand is placed on the victim’s forehead, ensuring that the head is tilted back. Having pinched the nose of the person being revived with your fingers and pressing your lips tightly around his mouth, you need to blow air, watching the excursion of the patient’s chest (Fig. 3a). When lifting it, it is necessary to release the victim’s mouth, giving him the opportunity to make a full passive exhalation. The tidal volume should be 500-600 ml (6-7 ml/kg), the respiratory rate should be 10 per minute in order to prevent hyperventilation.

Errors during mechanical ventilation.

Clear airway is not ensured

Air tightness is not ensured

Underestimation (late start) or overestimation (start of LCCR with intubation) of the value of mechanical ventilation

Lack of control of chest excursions

Lack of control of air entering the stomach

Attempts at drug stimulation of breathing

To ensure artificial maintenance of blood circulation, an algorithm for performing chest compression (indirect cardiac massage) is used.

1. Place the patient correctly on a flat, hard surface. Determine the compression points - palpation of the xiphoid process and retreat two transverse fingers upward. Place your hand with the palmar surface on the border of the middle and lower third of the sternum, fingers parallel to the ribs, and the other hand on it.

2. The option of placing the palms - “lock”.

3. Proper execution compression: pushes are performed straightened in elbow joints hands, transferring part of your body weight to them.

The ratio of the number of compressions and the number of artificial breaths for both one and two resuscitators should be 30:2. Chest compression is carried out at a frequency of 100 compressions per minute, with a depth of 4-5 cm, pausing for breaths (in non-intubated patients, it is unacceptable to blow air at the time of chest compression - there is a risk of air getting into the stomach).

Criteria for stopping resuscitation.

1. The appearance of a pulse in the main arteries (stop chest compression) and/or breathing (stop mechanical ventilation) is a sign of restoration of independent circulation

2. Ineffective resuscitation within 30 minutes. The exceptions are conditions in which it is necessary to prolong resuscitation:

Hypothermia (hypothermia);

Drowning in ice water;

Overdose of medications or drugs;

Electrical injury, lightning damage.

Signs of the correctness and effectiveness of compression are the presence of a pulse wave in the main and peripheral arteries.

To detect the possible restoration of spontaneous circulation in the victim, every 2 minutes of the ventilation-compression cycle, pause (for 5 seconds) to determine the presence of a pulse in the carotid arteries.

After restoration of blood circulation, the patient, lying on a stretcher, is transported (under cardiac monitoring) to the nearest cardiac intensive care unit, subject to the continuation of therapeutic measures that ensure life activity.

Obvious signs of biological death: maximum dilation of the pupils with the appearance of the so-called dry herring shine (due to the drying of the cornea and the cessation of tear production); the appearance of positional cyanosis, when a bluish discoloration is detected along the posterior edge of the ears and the back of the neck, on the back; rigidity of the muscles of the limbs, not reaching the severity of rigor mortis.

In conclusion, it should be noted that the most significant factor influencing the outcome of sudden cardiac arrest is improving the organization of care for this state. Therefore, the American Heart Association proposed an algorithm for organizing first aid, called the “chain of survival.” It will save the lives of many victims.

Conservative treatment

Today, this concept is based on the following factors that determine the maximum safety of human life. First of all, this is the identification of risk zones where emergencies may occur; identification of types of emergency situations; creation of a primary health care system for prehospital stage. The latter includes: mastering modern assistance skills; equipping subjects of the primary health care system and risk areas with modern equipment that is necessary to provide assistance; coordination of interaction between the primary health care system and specialized services. According to the derived sequence, a model was developed for analyzing factors influencing survival in an emergency situation - the so-called “chain of survival”

A strict algorithm of actions of the resuscitator in the event of cardiac arrest and/or loss of respiratory function in the victim is justified and presented. Groups of people who require special attention have been identified: people aged 45 to 60 years and people whose professions are associated with high psycho-emotional stress.

1. When a resuscitation situation develops, time plays the most important role in providing assistance, since only a few minutes separate the victim from death. Therefore, the first leading step is early access to the victim. The purpose of this stage is to determine the condition of the victim and then select an algorithm for providing assistance.

2. The next stage of the algorithm is the early start of cardiopulmonary resuscitation. This stage includes: clearing the airways, artificial ventilation, indirect massage heart, oxygen supply. That is, at this stage, CPR is performed, which consists of two manipulations: closed cardiac massage and artificial ventilation.

Closed cardiac massage (CCM) is rhythmic compression of the chest. ZMS is performed in the absence of a pulse in the main arteries. The manipulation creates positive pressure in the chest during the compression phase. The valves of the veins and heart provide antegrade flow of blood into the arteries. When the chest returns to its original shape, blood returns to it from the venous part of the circulatory system. A small amount of blood flow is ensured by compression of the heart between the sternum and the spine. During chest compressions, blood flow is 25% of normal cardiac output. According to the recommendations, it is suggested to carry out one breath for every 5 compressions if there are two resuscitators. If there is one resuscitator, 15 compressions should be accompanied by one breath (combination 15:1 or 30:2). The compression rate should be approximately 100 per minute. Studies have been conducted on the use of high-frequency chest compressions with a frequency of more than 100 compressions per minute. One of the studies, where indirect massage was carried out with a frequency of 120 compressions per minute, showed the great effectiveness of this technique, which made it possible to offer the possibility of a high-frequency mode of CPR.

3. If the second stage is ineffective, it is recommended to move on to the third stage of the chain - early defibrillation. During defibrillation, the heart is exposed to an electrical impulse, which depolarizes the membrane of most myocardial cells and causes a period of absolute refractoriness - a period during which an action potential cannot be caused by a stimulus of any intensity. If defibrillation is successful, the chaotic electrical activity of the heart is interrupted. In this case, pacemakers of the first order (cells of the sinus node) are the first to be able to depolarize spontaneously and provide sinus rhythm. During a shock, only a portion of the induced energy is applied to the heart due to varying levels of chest wall resistance. The amount of energy required during defibrillation (defibrillation threshold) increases with time since cardiac arrest and various medications. For defibrillation in adult resuscitation, empirically selected shocks of 200 J for the first two shocks and 360 J for subsequent shocks are used. Direct current discharges must be applied at correct positioning electrodes and good contact with the skin. The polarity of the electrodes is not critical. In an anterior position (more often used in resuscitation), the electrode placed on the sternum is placed on top part the right half of the chest under the collarbone. The electrode placed on the apex of the heart is located slightly lateral to the point of normal projection of the apical impulse, but not on the mammary gland in women. In case of failure, an anterior-posterior arrangement of electrodes can be used - on the anterior (“sternal” electrode) and posterior surface of the chest. The shape of the pulse generated by the defibrillator is also important. The first defibrillators produced a pulse that had a rectangular shape and two multidirectional phases.

The next stage of pulse shape modification was the removal of the negative phase and the formation of a monophasic rectangular pulse shape.

However, as a result of long-term use of devices generating a pulse of this configuration, especially in implantable cardioverter-defibrillators, their ineffectiveness has been shown when the defibrillation threshold increases. Most patients with implanted cardioverter-defibrillators received cordarone, which increased the defibrillation threshold. In a certain number of patients, the defibrillation threshold increased due to inflammatory reaction at the site of electrode implantation and, accordingly, an increase in tissue resistance. It was noted that in such patients, despite the discharge produced when an arrhythmia occurred, the arrhythmia did not stop. This observation led to another modification of the pulse configuration. The return of the second negative phase of the pulse was determined first, and the rectangular shape was changed to a cone-shaped exponential curve in both phases of the pulse.

Defibrillation is one of the most effective methods of restoring an adequate rhythm of myocardial contractions during the most common reason VVS - ventricular fibrillation of the heart. Analysis of many studies on sudden death outside medical institutions, shows that the survival rate of patients decreases by 10% with each minute of delay in electrical defibrillation, however, adequately carried out primary resuscitation (second stage) can slow down the process and increase the time until irreversible cardiac arrest develops. The global community has already taken the path to ensure this stage by using simple automatic external defibrillators, the operation of which does not require high qualifications, special knowledge and skills. It is enough to place them in areas at risk of an emergency, and the device, provided it is connected to the victim, will itself determine the need for a discharge, its magnitude and even the need further actions. The effectiveness of using automatic external defibrillators has now been proven both in specially designed studies and according to statistical data.

4. Correct implementation of the first three stages allows you to preserve the life of the victim until the arrival of specialized services and the provision of qualified assistance.

The fourth stage of the fight for a person’s life with SCD is the stage of specialized medical care, which consists of early treatment. At this stage also important factor time will appear. This stage includes: adequate ventilation of the lungs (mainly with tracheal intubation), drug support (catecholamines, antiarrhythmic drugs, electrolyte and buffer solutions), as well as, if necessary, cardiac stimulation.

Adequate ventilation through invasive mechanical ventilation using tracheal intubation has been shown to improve prognosis with CPR in some studies. However, early intubation is preferable but remains controversial.

Drug support consists of vasoactive therapy, including: epinephrine, norepinephrine, dopamine, dobutamine, vasopressin, endothelin 1, isoproterenol, ephedrine, phenylephrine, angiotensin II, serotonin, nitroglycerin and combinations of drugs. Of all the above drugs, the CPR protocol includes adrenalin as a standard of conduct resuscitation measures. The second drug of choice for resuscitation, according to the latest recommendations of 2005, is vasopressin. A limitation of the study is the small number of observations (40 patients). It is recommended to use 40 units per injection, corresponding to 1 mg of adrenaline. One study of the comparative effectiveness of adrenaline and vasopressin during resuscitation showed significant superiority of the use of vasopressin.

Support with electrolyte and buffer solutions is not recommended in everyday practice. Based on existing recommendations, the use of this type of drug support is used in a specific resuscitation situation. For solutions of potassium and magnesium, these are hypokalemia and -hypomagnesemia, for sodium bicarbonate - previous acidosis, hyperkalemia, and the use of tricyclic antidepressants.

Antiarrhythmic support is one of the most important parts of medical CPR support, given the underlying cause of SCD—ventricular fibrillation or ventricular tachycardia. For a long time, the standard of antiarrhythmic support was a class 1B drug, lidocaine, and only at the end of the resuscitation protocol was it possible to use procainamide, bretylium tosylate, and cordarone. To date, the ARREST and ALIVE studies have led to changes in recommendations for antiarrhythmic CPR support. Convincing data on the superiority of the use of cordarone in drug support of resuscitation measures allowed us to recommend this technique for routine use instead of lidocaine.

One of the most interesting and controversial issues For many years, the possibility and effectiveness of fibrinolytic therapy in case of ineffective resuscitation has been evident. Many small studies have been conducted on the use of fibrinolytic therapy for ineffective resuscitation, and a website has been created where all cases of the use of fibrinolytic therapy to optimize the effect of resuscitation measures are collected. However, this issue has not been resolved to date. The use of fibrinolytic therapy when resuscitation fails is a matter of choice for the resuscitator and is not supported by guidelines.

The criteria for the effectiveness of resuscitation measures are:

Constriction of the pupils with the appearance of their reaction to light;

The appearance of a pulse in the carotid and femoral arteries;

Determination of maximum blood pressure at 60-70 mm Hg;

Reduction of pallor and cyanosis;

Sometimes - the appearance of independent respiratory movements.

When a hemodynamically significant spontaneous rhythm is restored, 200 ml of a 2-3% solution of sodium bicarbonate (Trisol, Trisbuffer), 1-1.5 g of diluted potassium chloride or 20 ml of panangin in a bolus, 100 mg of lidocaine in a bolus are administered intravenously (then infusion at a rate of 4 mg/min), 10 ml of 20% sodium hydroxybutyrate solution or 2 ml of 0.5% relanium solution in a stream. In case of overdose of calcium antagonists - hypocalcemia and hyperkalemia - 2 ml of 10% calcium chloride solution is administered intravenously.

If there are risk factors for sudden death (see above), it is recommended to administer lidocaine (80-100 mg intravenously, 200-500 mg intramuscularly) in combination with ornid (100-150 mg intramuscularly); with a decrease in blood pressure - 30 mg of prednisolone intravenously.

Cardiac glycosides are not administered in cases of sudden death.