Coronary insufficiency. Sudden death from acute coronary insufficiency: how to prevent? Primary coronary death

Date: 01.07.2020

According to the definition of the World Health Organization, sudden death is called deaths that occurred within 6 hours against the background of the onset of symptoms of impaired cardiac detail in practically healthy people or in people who have already suffered from, but their condition was considered satisfactory. Due to the fact that such death in almost 90% of cases occurs in patients with symptoms, the term "sudden coronary death" was introduced to denote the reasons.

Such deaths always occur unexpectedly and do not depend on whether the deceased had previously had cardiac pathologies. They are caused by violations of the contraction of the ventricles. Autopsy does not reveal diseases of the internal organs in such persons that could cause death. When examining the coronary vessels, approximately 95% reveal the presence of constrictions caused by atherosclerotic plaques, which could provoke life-threatening ones. Recently arisen thrombotic occlusions, capable of disrupting the activity of the heart, are observed in 10-15% of victims.

Prominent examples of sudden coronary death can be the deaths of famous people. The first example is the death of a famous French tennis player. The death occurred at night, and the 24-year-old man was found in his own apartment. Autopsy revealed cardiac arrest. Previously, the athlete did not suffer from diseases of this organ, and it was not possible to determine other causes of death. The second example is the death of a prominent businessman from Georgia. He was a little over 50, he always endured all the difficulties of business and personal life, moved to live in London, was regularly examined and led a healthy lifestyle. The lethal outcome came quite suddenly and unexpectedly, against the background of complete health. After the autopsy of the man's body, the reasons that could lead to death were never found.

There are no exact statistics on sudden coronary death. According to the WHO, it occurs in about 30 people per 1 million of the population. Observations show that it occurs more often in men, and the average age for this condition ranges from 60 years. In this article, we will familiarize you with the causes, possible precursors, symptoms, methods of providing emergency care and prevention of sudden coronary death.

Immediate causes

3-4 out of 5 cases of sudden coronary death are caused by ventricular fibrillation.

In 65-80% of cases, sudden coronary death is caused by primary death, in which these parts of the heart begin to contract very often and randomly (from 200 to 300-600 beats per minute). Because of this rhythm disturbance, the heart cannot pump blood, and the cessation of its circulation causes death.

In about 20-30% of cases, sudden coronary death is caused by bradyarrhythmia or ventricular asystole. Such rhythm disturbances also cause severe disturbance in blood circulation, this is fatal.

In about 5-10% of cases, sudden death is provoked. With such a rhythm disturbance, these chambers of the heart contract at a rate of 120-150 beats per minute. This provokes a significant overload of the myocardium, and its depletion causes a cessation of blood circulation with subsequent death.

Risk factors

The likelihood of sudden coronary death may increase with several major and minor factors.

The main factors are:

previously transferred;
previous severe ventricular tachycardia or cardiac arrest;
a decrease in the ejection fraction from the left ventricle (less than 40%);
episodes of unstable ventricular tachycardia or ventricular premature beats;
cases of loss of consciousness.

Secondary factors:

smoking;
alcoholism;
obesity;
frequent and intense stressful situations;
fast pulse (more than 90 beats per minute);
increased tone of the sympathetic nervous system, manifested by hypertension, dilated pupils and dry skin);
diabetes.

Any of the above conditions can increase the risk of sudden death. When several factors are combined, the risk of death increases significantly.

At-risk groups

The risk group includes patients:

have undergone resuscitation for ventricular fibrillation;
suffering from;
with electrical instability of the left ventricle;
with severe left ventricular hypertrophy;
with myocardial ischemia.

What diseases and conditions most often cause sudden coronary death?

Most often, sudden coronary death occurs in the presence of the following diseases and conditions:

hypertrophic;
dilated cardiomyopathy;
arrhythmogenic right ventricular dysplasia;
aortic stenosis;
abnormalities of the coronary arteries;
(WPW);
Burghada syndrome;
"Sports heart";
dissection of the aortic aneurysm;
TELA;
idiopathic ventricular tachycardia;
long QT syndrome;
cocaine intoxication;
taking medications that can cause arrhythmias;
severe imbalance in the electrolyte balance of calcium, potassium, magnesium and sodium;
congenital left ventricular divercules;
neoplasms of the heart;
sarcoidosis;
amyloidosis;
obstructive sleep apnea (stopping breathing during sleep).

Forms of sudden coronary death

Sudden coronary death can be:

clinical - accompanied by a lack of breathing, blood circulation and consciousness, but the patient can be resuscitated;
biological - accompanied by a lack of breathing, blood circulation and consciousness, but the victim can no longer be resuscitated.

Depending on the rate of onset, sudden coronary death can be:

instant - death occurs in a few seconds;
fast - death occurs within 1 hour.

According to the observations of specialists, instantaneous sudden coronary death occurs in almost every fourth death due to such a lethal outcome.

Symptoms

Harbingers

In some cases, 1-2 weeks before a sudden death occur so-called precursors: fatigue, sleep disturbances and some other symptoms

Sudden coronary death rarely occurs in people without heart pathologies and most often in such cases is not accompanied by any signs of deterioration in general well-being. Such symptoms may not appear in many patients with coronary heart disease. However, in some cases, the following signs may become precursors of sudden death:

increased fatigue;
sleep disturbances;
sensations of pressure or pain of a squeezing or pressing character behind the sternum;
increased sensation of suffocation;
heaviness in the shoulders;
faster or slower heart rate;
cyanosis.

Most often, the harbingers of sudden coronary death are felt by patients who have already suffered a myocardial infarction. They can appear in 1-2 weeks, be expressed both in a general deterioration in well-being, and in signs of angular pain. In other cases, they are observed much less frequently or absent altogether.

The main symptoms

Usually, the occurrence of such a condition has nothing to do with the previous increased psychoemotional or physical stress. With the onset of sudden coronary death, a person loses consciousness, his breathing first becomes frequent and noisy, and then decreases. The dying person has convulsions, the pulse disappears.

After 1-2 minutes, breathing stops, the pupils dilate and stop responding to light. Irreversible changes in the brain with sudden coronary death occur 3 minutes after the cessation of blood circulation.

When the above-described symptoms appear, diagnostic measures should be taken already in the very first seconds of their appearance, because in the absence of such measures, it is possible not to have time to reanimate the dying person.

To identify signs of sudden coronary death, you must:

make sure there is no pulse on the carotid artery;
check consciousness - the victim will not respond to pinching or blows to the face;
make sure that there is no reaction of the pupils to light - they will be dilated, but will not increase in diameter under the influence of light;
- at the onset of death, it will not be determined.

Even the presence of the first three diagnostic data described above will indicate the onset of clinical sudden coronary death. If they are identified, it is necessary to begin urgent resuscitation measures.

In almost 60% of cases, such deaths do not occur in a medical institution, but at home, at work and in other places. This greatly complicates the timely detection of such a condition and the provision of first aid to the victim.

Urgent care

Resuscitation should be carried out in the first 3-5 minutes after revealing signs of clinical sudden death. This requires:

Call the ambulance team if the patient is not in a hospital.
Restore airway patency. The victim should be laid on a rigid horizontal surface, tilt the head back and extend the lower jaw. Next, you need to open his mouth, make sure that there are no objects interfering with breathing. If necessary, remove vomit with a tissue and remove the tongue if it blocks the airway.
Begin artificial respiration "mouth-to-mouth" or mechanical ventilation (if the patient is in a hospital).
Restore blood circulation. In the conditions of a medical institution, this is carried out. If the patient is not in the hospital, then first you should inflict a precordial blow - a blow with a fist to a point in the middle of the sternum. After that, you can start chest compressions. Put the palm of one hand on the sternum, cover it with the other palm and begin to press on the chest. If performed by one person, then for every 15 pressures, 2 breaths should be taken. If 2 people are involved in saving the patient, then 1 breath is taken for every 5 pressures.

Every 3 minutes, it is necessary to check the effectiveness of emergency care - the reaction of the pupils to light, the presence of breathing and pulse. If the reaction of the pupils to light is determined, but breathing has not appeared, then resuscitation measures should be continued until the arrival of the ambulance. Respiratory recovery may be the reason for the termination of chest compressions and artificial respiration, since the appearance of oxygen in the blood promotes the activation of the brain.

After successful resuscitation, the patient is hospitalized in a specialized cardiac intensive care unit or cardiology department. In a hospital setting, specialists will be able to establish the causes of sudden coronary death, draw up a plan for effective treatment and prevention.

Potential complications in survivors

Even with successful cardiopulmonary resuscitation, survivors of sudden coronary death may experience the following complications of this condition:

chest injuries due to resuscitation;
serious deviations in the activity of the brain due to the death of some of its areas;
circulatory disorders and heart functioning.

It is impossible to predict the possibility and severity of complications after sudden death. Their appearance depends not only on the quality of cardiopulmonary resuscitation, but also on the individual characteristics of the patient's body.

How to avoid sudden coronary death

One of the most important measures for preventing sudden coronary death is giving up bad habits, in particular, smoking.

The main measures for the prevention of the onset of such deaths are aimed at the timely identification and treatment of persons suffering from cardiovascular diseases, and social work with the population, aimed at familiarizing with the groups and risk factors for such deaths.

Patients who are at risk of sudden coronary death are recommended:

Timely visit to the doctor and the implementation of all his recommendations for treatment, prevention and dispensary observation.
Rejection of bad habits.
Proper nutrition.
Dealing with stress.
The optimal mode of work and rest.
Compliance with the recommendations on the maximum permissible physical activity.

Patients from risk groups and their loved ones must be informed about the likelihood of such a complication of the disease as sudden coronary death. This information will make the patient more attentive to his health, and his environment will be able to master the skills of cardiopulmonary resuscitation and will be ready to perform such activities.

calcium channel blockers;
antioxidants;
Omega-3, etc.

implantation of a cardioverter-defibrillator;
radiofrequency ablation of ventricular arrhythmias;
operations to restore normal coronary circulation: angioplasty, coronary artery bypass grafting;
aneurysmectomy;
circular endocardial resection;
extended endocardial resection (can be combined with cryodestruction).

For the prevention of sudden coronary death, other people are recommended to lead a healthy lifestyle, regularly undergo preventive examinations (Echo-KG, etc.), which allow detecting heart pathologies at the earliest stages. In addition, you should consult a doctor in a timely manner if you experience discomfort or pain in the heart, arterial hypertension and pulse disorders.

Familiarization and training of the population in the skills of cardiopulmonary resuscitation is of no small importance in the prevention of sudden coronary death. Its timely and correct implementation increases the survivor's chances of survival.

Cardiologist Sevda Bayramova talks about sudden coronary death:

Dr. Dale Adler, a cardiologist at Harvard, explains who is at risk for sudden coronary death:

The diagnosis of sudden coronary death is understood as the sudden death of a patient, which is caused by cardiac arrest.

The disease is more likely to affect men, whose age is between 35-45 years. It occurs in 1 to 2 pediatric patients in every 100,000 people.

The main reason for the sun is a common severe atherosclerosis of the coronary vessels when two or more main branches are involved in the pathological process.

Doctors explain the development of sudden death as follows:

myocardial ischemia(in acute form). The condition develops due to the excessive demand of the heart muscle for oxygen (against the background of psychoemotional or physical overstrain, alcohol dependence);
asystole- stop, complete cessation of heart contractions;
reduction in coronary blood flow due to a sharp drop in blood pressure, including during sleep and at rest;
ventricular fibrillation- flickering and fluttering;
violation of the functioning of the electrical system of the organ... It starts to work irregularly and contracts at a life-threatening frequency. The body stops receiving blood;
among the reasons, the possibility of spasm of the coronary arteries is not excluded;
stenosis- damage to the main arterial trunks;
, postinfarction scars, ruptures and tears of blood vessels,.

Risk factors include the considered conditions:

suffered a heart attack, during which a large part of the myocardium was damaged. Coronary death occurs in 75% of cases after myocardial infarction. The risk persists for six months;
ischemic disease;
episodes of loss of consciousness without a specific reason - syncope;
dilated cardiomyopathy - the risk is a decrease in the pumping function of the heart;
hypertrophic cardiomyopathy - thickening of the heart muscle;
vascular disease, heart disease, heavy history, high cholesterol, obesity, tobacco smoking, alcoholism, diabetes mellitus;
ventricular tachycardia and ejection fraction up to 40%;
episodic cardiac arrest in the patient or in a family history, including heart block, decreased heart rate;
vascular anomalies and congenital defects;
unstable levels of magnesium and potassium in the blood.

Forecast and danger

In the first minutes of the disease it is important to take into account how critical the decrease in blood flow is.

If the patient does not receive immediate medical attention for acute coronary insufficiency, the worst prognosis develops - sudden death.

The main complications and dangers of sudden death are as follows:

skin burns after defibrillation;
recurrence of asystole and ventricular fibrillation;
overflow of the stomach with air (after artificial ventilation);
bronchospasm - develops after tracheal intubation;
damage to the esophagus, teeth, mucous membranes;
fracture of the sternum, ribs, damage to lung tissue, pneumothorax;
bleeding, air embolism;
damage to arteries with intracardiac injections;
acidosis - metabolic and respiratory;
encephalopathy, hypoxic coma.

How to treat angina pectoris, what drugs are prescribed to support the heart and what to do to relieve attacks - in our article.

Symptoms before the onset of the syndrome

Statistics show that about 50% of all incidents occur without the development of previous symptoms. Some patients feel dizzy and have a rapid heartbeat.

Considering the fact that sudden death rarely develops in persons without coronary pathology, the symptoms can be supplemented with the considered signs:

fatigue, a feeling of suffocation against the background of heaviness in the shoulders, pressure in the chest area;
changes in the nature and frequency of pain attacks.

First aid

Each person, in whose eyes a sudden death occurs, should be able to provide first aid. The basic principle is CPR - cardiopulmonary resuscitation... The technique is performed manually.

To do this, it is necessary to implement repeated compression of the chest, inhaling air into the respiratory tract. This will avoid brain damage due to lack of oxygen and will support the victim until the arrival of resuscitators.

The scheme of actions is presented in this video:

CPR tactics are shown in this video:

Differential diagnosis

The pathological condition develops suddenly, but there is a consistent development of symptoms. Diagnostics is carried out during the examination of the patient: presence or absence of a pulse on the carotid arteries, lack of consciousness, swelling of the cervical veins, cyanosis of the torso, respiratory arrest, tonic single contraction of skeletal muscles.

A positive reaction to resuscitation measures and a sharp negative reaction to their suspension indicate acute coronary heart failure.

The diagnostic criteria can be summarized as follows:

lack of consciousness;
on large arteries, including the carotid, the pulse is not felt;
heart sounds are not heard;
cessation of breathing;
lack of reaction of the pupils to the light source;
the skin becomes gray with a bluish tinge.

Treatment tactics

The patient can be saved only with emergency diagnostics and medical assistance.... The person is laid on a hard base on the floor, the carotid artery is checked. When cardiac arrest is detected, artificial respiration and cardiac massage are performed. Resuscitation begins with a single blow with a fist in the middle zone of the sternum.

The rest of the activities are as follows:

immediate implementation of a closed heart massage - 80/90 strokes per minute;
artificial ventilation of the lungs. Any available method is used. Airway patency is ensured. Manipulations are not interrupted for more than 30 seconds. Intubation of the trachea is possible.
defibrillation is provided: start - 200 J, if there is no result - 300 J, if there is no result - 360 J. Defibrillation is a procedure that is implemented using special equipment. The doctor acts on the chest with an electrical impulse in order to restore the heart rhythm;
a catheter is inserted into the central veins. Adrenaline is given - every three minutes 1 mg, lidocaine 1.5 mg / kg. In the absence of a result, repeated administration is shown in an identical dosage every 3 minutes;
in the absence of a result, Ornid 5 mg / kg is administered;
in the absence of a result - novocainamide - up to 17 mg / kg;
in the absence of a result - magnesium sulfate - 2 g.
in asystole, emergency administration of atropine 1 g / kg every 3 minutes is indicated. The doctor eliminates the cause of asystole - acidosis, hypoxia, etc.

The patient is subject to immediate hospitalization. If the patient regains consciousness, therapy is aimed at preventing relapse. The criterion for the effectiveness of treatment is the constriction of the pupils, the development of a normal reaction to light.

During the implementation of cardiopulmonary resuscitation, all drugs are administered quickly, intravenously. When veins are not available Lidocaine, Adrenaline, Atropine injected into the trachea, with an increase in dosage of 1.5-3 times. A special membrane or tube must be installed on the trachea. The preparations are dissolved in 10 ml of isotonic NaCl solution.

If it is impossible to use any of the presented method of drug administration, the physician decides on intracardiac injections... The resuscitator acts with a thin needle, strictly observing the technique.

Treatment is discontinued if there are no signs of efficacy within half an hour. resuscitation measures, the patient does not respond to medication, a persistent asystole with multiple episodes was revealed. Resuscitation does not begin when more than half an hour has passed from the moment the circulation stopped, or if the patient has documented a refusal to take measures.

Prophylaxis

The principles of prevention are that the patient who is suffering is attentive to their well-being. He must monitor changes in physical condition, actively take medications prescribed by a doctor and adhere to medical recommendations.

For the implementation of such goals, it is used pharmacological support: intake of antioxidants, preductal, aspirin, curantil, beta-blockers.

Patients with a high risk of developing VS should avoid conditions when an increased load on the cardiovascular system is presented. The constant observation of the exercise therapy doctor is shown, since motor loads are vital, but the wrong approach to their implementation is dangerous.

Smoking is prohibited, especially during stress or after physical exertion. It is not recommended to stay in stuffy rooms for a long time, it is better to avoid long flights.

If the patient realizes that he cannot to handle the stress, it is advisable to go through counseling with a psychologist in order to develop a method for an adequate response. Consumption of fatty, heavy food should be minimized, overeating is excluded.

Limiting your own habits, conscious control of your health- these are the principles that will help prevent acute coronary insufficiency as a cause of death and save life.

Every year, approximately 15% of the adult population of our country dies from various heart diseases. One of the most common cases is sudden coronary death (ICD), or in other words, sudden cardiac arrest. This ailment is most often affected by men under the age of 55. Sometimes a sudden cessation of cardiac activity is recorded in children under three years of age, and amounts to one case in one hundred thousand.

Sudden coronary death occurs due to malfunctions in the electrical heart system. These disorders lead to very rapid contractions of the heart, which in turn provoke flutter and fibrillation of the atria and ventricles. As a result of failures, blood ceases to flow to vital organs.

Without proper medical care, the death of the patient occurs within a few minutes. It can be brought back to life by carrying out cardiopulmonary resuscitation, which is performed manually or with portable defibrillators.

The principle of resuscitation is that under the action of squeezing the chest and filling the lungs with air through the mouth, the patient receives oxygen to nourish the brain and restore cardiac activity.

Classification and forms

A person can die not only from a long illness. Sudden coronary death is a prime example of this. This condition becomes a consequence of violations of the contractile functions of the left and right ventricles of the heart.

The International Classification of Diseases divides sudden coronary death into two forms:

Clinical VKS. This form allows the patient to return to life, even if he is unconscious and his breathing cannot be heard.
Biological videoconferencing. Carrying out cardiopulmonary resuscitation in such a situation will not help save the patient.

This disease has even been assigned a special code - ICD-10.

Based on the speed of the offensive, such a state is divided into instant and rapid. In the first case, the death is noted after a few seconds. If death occurs within an hour, then we are talking about a quick form.

Causes of occurrence

Having figured out what this is such an acute coronary death, an important question for patients suffering from cardiovascular diseases remains to determine the reasons why this happens. The main factors provoking the onset of VKS include:

aortocoronary heart attack, resulting in damage to the middle muscle layer of the heart - the myocardium;
the presence of coronary heart disease (CHD), which increases the risk of sudden cardiac death by 80%;
insufficient levels of potassium and magnesium in the body;
primary and secondary case of cardiomyopathy, contributing to the deterioration of the pumping function of the heart;
unhealthy lifestyle, alcoholism, overweight, diabetes mellitus;
congenital heart defects, cases of instant cardiac death in relatives;
coronary atherosclerosis of blood vessels.

Knowing the causes of acute coronary death, it is necessary to do everything possible to prevent the development of VKS.

Symptoms of sudden coronary death

Pathological anatomy identifies several characteristic symptoms for this condition, including:

strong heartbeat;
increasing shortness of breath;
attacks of pain near the heart;
a noticeable decrease in performance;
fast fatiguability;
frequent attacks of arrhythmia;
sudden dizziness;
loss of consciousness.

Some of these signs are especially common in people who have had a heart attack. They definitely need to be regarded as harbingers of an impending threat. They indicate an exacerbation of pathologies of the cardiovascular system. Therefore, at the first symptoms of impending danger, you should seek medical help as soon as possible. Otherwise, all this may end in disrepair.

Diagnostics

An important diagnostic measure for identifying problems in the work of the heart is an ECG. If there is a suspicion of VKS, during fibrillation on the electrocardiogram, the patient has erratic wave-like contractions. In this case, the heart rate can reach 200 beats per minute. When a straight line appears instead of waves, it indicates cardiac arrest.

If the resuscitation actions were successful, then the patient will have to undergo multiple laboratory tests in the hospital. In addition to donating blood and urine, a toxicological test can be carried out for drugs that can provoke arrhythmia.

Coronary angiography, daily ECG monitoring, ultrasound of the heart, electrophysiological examination and stress testing are mandatory.

Treatment

Only emergency care in case of sudden coronary death will help bring a person back to life. The patient must be positioned on a solid base and the carotid artery checked. If respiratory arrest is observed, cardiac massage should be alternated with artificial ventilation. Resuscitation involves inflicting a single blow in the middle of the sternum.

The emergency action algorithm is as follows:

indirect heart massage (up to 90 onslaught in 60 seconds);
artificial respiration (30 seconds);
defibrillation requiring the use of special equipment;
intravenous delivery of adrenaline and "Lidocaine" through an inserted catheter.

In the absence of a proper result, the patient is administered "Ornid", "Novocainamide", "Magnesium sulfate". In case of asystole, an emergency administration of the drug "Atropine" is required.

If a person managed to avoid a sudden death, further therapy implies the prevention of relapse.

Disease prevention

Informing patients at risk, as well as their family members, about the possible consequences of this dangerous condition, can be considered as preventive methods for preventing ICS.

The principles of prevention are as follows:

attentive attitude to your health;
timely reception of prescribed medications;
compliance with medical recommendations.

Pharmacological support helps to achieve a good effect. Typically, patients with heart disease are prescribed antioxidants and beta-blockers. Of the drugs, "Aspirin", "Curantil", "Preductal" can be used.

At the same time, it is very important to give up bad habits, if possible, avoid stress and excessive physical exertion. In the presence of cardiac pathologies, the patient should not stay for a long time in rooms where it is too stuffy.

Complications

Even a successful resuscitation is not a guarantee that a person will not develop complications after VKS. Most often they appear as:

circulatory disorders;
failures in the work of the heart;
disorders of the nervous system;
chest injuries.

It is almost impossible to predict the severity of complications. Their occurrence largely depends on the quality of the resuscitation performed and the individual characteristics of the human body.

Forecast

Coronary death is a reversible condition, but with emergency medical attention. Many patients after cardiac arrest suffer from CNS disorders. Some patients remain in a coma. In such situations, the forecast depends on the following factors:

the quality of resuscitation measures;
the patient's state of health before the cessation of cardiac activity;
the time interval from the onset of cardiac arrest to the start of resuscitation.

To avoid such problems, patients should lead a healthy lifestyle, attend exercise therapy classes and adhere to the instructions of the attending physician. It is very important to eat right, to observe the regime of work and rest. Such simple recommendations will help you feel good and eliminate the risks of acute coronary death.

You may also be interested in:

Sudden cardiac death (SCD) is one of the most severe cardiac pathologies that usually develops in the presence of witnesses, occurs instantly or in a short period of time and has as the main cause of the coronary arteries.

The factor of surprise plays a decisive role in making such a diagnosis. As a rule, in the absence of signs of an impending threat to life, instant death occurs within a few minutes. A slower development of pathology is also possible, when arrhythmias, heart pains and other complaints appear, and the patient dies in the first six hours after their onset.

The greatest risk of sudden coronary death is traced in persons 45-70 years old, who have some form of disturbance in blood vessels, heart muscle, heart rhythm. Among young patients, there are 4 times more men; in old age, the male sex is susceptible to pathology 7 times more often. In the seventh decade of life, sex differences are smoothed out, and the ratio of men and women with this pathology becomes 2: 1.

The majority of patients with sudden cardiac arrest occurs at home, a fifth of cases occur on the street or in public transport. Both there and there are witnesses to the attack, who can quickly call an ambulance, and then the likelihood of a positive outcome will be much higher.

Saving lives can depend on the actions of others, so you cannot just walk past a person who suddenly fell on the street or passed out on the bus. You need to at least try to carry out a basic one - an indirect heart massage and artificial respiration, having previously called for the help of doctors. Cases of indifference are not rare, unfortunately, therefore, the percentage of unfavorable outcomes due to late started resuscitation takes place.

Causes of sudden cardiac death

the main cause of SCD is atherosclerosis

The causes that can cause acute coronary death are very numerous, but they are always associated with changes in the heart and its vessels. The lion's share of sudden deaths is caused when fatty arteries form in the coronary arteries that impede blood flow. The patient may not be aware of their presence, they may not present complaints as such, then they say that a completely healthy person suddenly died of a heart attack.

Another reason for cardiac arrest can be acutely developed, in which correct hemodynamics is impossible, the organs suffer from hypoxia, and the heart itself cannot withstand the load and.

The causes of sudden cardiac death are:

Cardiac ischemia;
Congenital anomalies of the coronary arteries;
arteries with endocarditis, implanted artificial valves;
Spasm of the arteries of the heart, both with and without atherosclerosis;
with hypertension, defect,;
Metabolic diseases (amyloidosis, hemochromatosis);
Congenital and acquired;
Injuries and tumors of the heart;
Physical overload;
Arrhythmias.

The risk factors are highlighted when the probability of acute coronary death becomes higher. The main such factors include ventricular tachycardia, a previous episode of cardiac arrest, cases of loss of consciousness, transferred, a decrease in the left ventricle to 40% or less.

Secondary, but also significant conditions, in which the risk of sudden death is increased, is considered concomitant pathology, in particular, diabetes, obesity, myocardial hypertrophy, tachycardia of more than 90 beats per minute. Smokers, those who neglect physical activity and, conversely, athletes are also at risk. With excessive physical exertion, hypertrophy of the heart muscle occurs, there is a tendency to disturbances in rhythm and conduction, therefore, physically healthy athletes may die from a heart attack during training, a match, or at competitions.

diagram: distribution of causes of SCD at a young age

For closer observation and targeted examination identified groups of people with a high risk of SCD. Among them:

Patients who have undergone resuscitation for cardiac arrest or;
Patients with chronic heart failure and ischemia;
Individuals with electrical;
Those diagnosed with significant cardiac hypertrophy.

Depending on how quickly death occurred, instant cardiac death and rapid death are distinguished. In the first case, it occurs in a matter of seconds and minutes, in the second - within the next six hours from the onset of the attack.

Signs of sudden cardiac death

In a quarter of all cases of sudden death of adults, there were no previous symptoms; it occurred for no apparent reason. Other patients noted for one to two weeks before the attack worsening of health in the form of:

More frequent pain attacks in the heart area;
Build-up;
A noticeable decrease in performance, feelings of fatigue and rapid fatigability;
More frequent episodes of arrhythmias and interruptions in the activity of the heart.

Before cardiovascular death, pain in the heart area sharply increases, many patients have time to complain about it and experience severe fear, as happens with myocardial infarction. Perhaps psychomotor agitation, the patient grasps the region of the heart, breathes noisily and often, catches air with his mouth, sweating and redness of the face are possible.

Nine out of ten cases of sudden coronary death occur outside the home, often against the background of strong emotional distress, physical overload, but it happens that the patient dies from acute coronary pathology in his sleep.

With ventricular fibrillation and cardiac arrest against the background of an attack, severe weakness appears, the head begins to spin, the patient loses consciousness and falls, breathing becomes noisy, convulsions are possible due to deep hypoxia of the brain tissue.

On examination, pallor of the skin is noted, the pupils dilate and stop responding to light, it is impossible to listen to heart sounds due to their absence, the pulse on large vessels is also not detected. In a matter of minutes, clinical death occurs with all its characteristic signs. Since the heart does not contract, the blood supply to all internal organs is disrupted, therefore, within a few minutes after loss of consciousness and asystole, breathing disappears.

The brain is most sensitive to a lack of oxygen, and if the heart does not work, then 3-5 minutes are enough for irreversible changes to begin in its cells. This circumstance requires the immediate start of resuscitation measures, and the sooner the chest compressions are provided, the higher the chances of survival and recovery.

Sudden death due to concomitant atherosclerosis of the arteries, then it is more often diagnosed in the elderly.

Among young such attacks can occur against the background of a spasm of unchanged vessels, which is facilitated by the use of certain drugs (cocaine), hypothermia, and unbearable physical activity. In such cases, the study will show no changes in the vessels of the heart, but myocardial hypertrophy may well be detected.

Signs of death from heart failure in acute coronary pathology will be pallor or cyanosis of the skin, rapid enlargement of the liver and cervical veins, possible pulmonary edema, which accompanies shortness of breath up to 40 respiratory movements per minute, severe anxiety and convulsions.

If the patient has already suffered from chronic organ failure, but edema, cyanosis of the skin, an enlarged liver, expanded borders of the heart with percussion can indicate the cardiac genesis of death. Often, the patient's relatives, upon arrival of the ambulance team, themselves indicate the presence of a previous chronic illness, can provide doctors' records and hospital discharge, then the issue of diagnosis is somewhat simplified.

Diagnostics of the sudden death syndrome

Unfortunately, cases of postmortem diagnosis of sudden death are not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. An autopsy does not find any pronounced changes in the heart that could cause death. The unexpectedness of what happened and the absence of traumatic injuries speak in favor of the coronary character of the pathology.

After the arrival of the ambulance team and before the start of resuscitation measures, the patient's condition is diagnosed, who by this moment is already unconscious. Breathing is absent or too rare, convulsive, the pulse cannot be felt, during auscultation, heart sounds are not detected, the pupils do not respond to light.

The initial examination is carried out very quickly, usually a few minutes are enough to confirm the worst fears, after which the doctors immediately begin resuscitation.

An important instrumental method for diagnosing SCD is ECG. When ventricular fibrillation occurs on the ECG, irregular waves of contractions occur, the heart rate is higher than two hundred per minute, and soon these waves are replaced by a straight line, which indicates cardiac arrest.

With ventricular flutter, the ECG recording resembles a sinusoid, gradually alternating with random waves of fibrillation and an isoline. Asystole characterizes cardiac arrest, so the cardiogram will show only a straight line.

With successful resuscitation at the prehospital stage, already in a hospital, the patient will have to undergo numerous laboratory examinations, starting with routine urine and blood tests and ending with toxicological studies for some drugs that can cause arrhythmias. Daily monitoring of the ECG, ultrasound examination of the heart, electrophysiological examination, stress tests will certainly be carried out.

Treatment for sudden cardiac death

Since cardiac arrest and respiratory failure occur in sudden cardiac death syndrome, the first step is to restore the functioning of the life support organs. Emergency care should be started as early as possible and includes cardiopulmonary resuscitation and immediate transportation of the patient to the hospital.

At the prehospital stage, the possibilities of resuscitation are limited, usually it is carried out by emergency specialists who find the patient in a variety of conditions - on the street, at home, at the workplace. It is good if at the time of the attack there is a person nearby who knows her techniques - artificial respiration and chest compressions.

Video: Performing Basic Cardiopulmonary Resuscitation

The ambulance team, after diagnosing clinical death, begins indirect heart massage and artificial ventilation of the lungs with an Ambu bag, providing access to a vein into which medications can be injected. In some cases, intratracheal or intracardiac administration of drugs is practiced. It is advisable to inject drugs into the trachea during its intubation, and the intracardiac method is used most rarely - if it is impossible to use others.

In parallel with the main resuscitation actions, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart at the moment. If ventricular fibrillation is detected, then the best method for stopping it will be, and if the necessary device is not at hand, then the specialist strikes the precordial region and continues resuscitation measures.

defibrillation

If cardiac arrest is stated, there is no pulse, on the cardiogram there is a straight line, then during general resuscitation actions, adrenaline and atropine are administered to the patient at intervals of 3-5 minutes, antiarrhythmic drugs, cardiac stimulation is established, after 15 minutes sodium bicarbonate is added intravenously.

After the patient is admitted to the hospital, the struggle for his life continues. It is necessary to stabilize the condition and start treating the pathology that caused the attack. You may need a surgical operation, the indications for which are determined by doctors in the hospital based on the results of examinations.

Conservative treatment includes the introduction of drugs to maintain pressure, heart function, normalization of electrolyte metabolism disorders. For this purpose, beta-blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensive drugs or cardiotonic drugs, infusion therapy are prescribed:

Lidocaine for ventricular fibrillation;
Bradycardia is treated with atropine or izadrin;
Hypotension prompts intravenous dopamine;
Fresh frozen plasma, heparin, aspirin are indicated for disseminated intravascular coagulation;
Piracetam is administered to improve brain function;
In hypokalemia - potassium chloride, polarizing mixtures.

Treatment in the postresuscitation period lasts about a week. At this time, electrolyte disturbances, disseminated intravascular coagulation syndrome, neurological disorders are likely, so the patient is admitted to the intensive care unit for observation.

Surgery may consist in radiofrequency ablation of the myocardium - with tachyarrhythmias, the efficiency reaches 90% and higher. If there is a tendency to atrial fibrillation, a cardioverter defibrillator is implanted. Diagnosed atherosclerosis of the arteries of the heart as a cause of sudden death requires carrying out; in case of heart valve defects, their plastic is performed.

Unfortunately, it is not always possible to provide resuscitation measures within the first few minutes, but if it was possible to bring the patient back to life, then the prognosis is relatively good. As research data show, the organs of persons who have suffered sudden cardiac death do not have significant and life-threatening changes, therefore, maintenance therapy in accordance with the underlying pathology allows you to live after coronary death for a long time.

Prevention of sudden coronary death is needed for people with chronic diseases of the cardiovascular system, which can cause an attack, as well as for those who have already experienced it and have been successfully resuscitated.

To prevent a heart attack, a cardioverter defibrillator can be implanted, which is especially effective for severe arrhythmias. At the right time, the device generates the necessary impulse for the heart and does not allow it to stop.

Requires drug support. Beta blockers, calcium channel blockers, and omega-3 fatty acids are prescribed. Surgical prophylaxis consists of operations aimed at eliminating arrhythmias - ablation, endocardial resection, cryodestruction.

Non-specific measures for the prevention of cardiac death are the same as for any other cardiac or vascular pathology - a healthy lifestyle, physical activity, rejection of bad habits, proper nutrition.

Video: sudden cardiac death - concept and honey. animation

Video: lecture on prevention of sudden cardiac death

Sudden coronary death is sudden, unexpected death due to the loss of functioning of the heart (sudden cardiac arrest). In the United States, it is one of the leading causes of natural deaths, killing about 325,000 adults annually and accounting for half of all deaths from cardiovascular disease.

Sudden coronary death most often occurs between the ages of 35 and 45, and is twice as likely to affect men. It is rare in childhood and affects 1–2 in 100,000 children each year.

Sudden cardiac arrest is not a heart attack (myocardial infarction), but can occur during a heart attack. A heart attack occurs when one or more arteries in the heart become blocked, blocking the delivery of sufficient oxygenated blood to the heart. If not enough oxygen is supplied to the heart with blood, then damage to the heart muscle occurs.

In contrast, sudden cardiac arrest occurs due to a malfunction of the electrical system of the heart, which suddenly begins to work irregularly. The heart begins to beat at a life-threatening rate. Flutter or fibrillation of the ventricles (ventricular fibrillation) may occur and blood stops flowing to the body. In the first minutes, the most important is such a critical decrease in blood flow to the heart that a person loses consciousness. Failure to provide immediate medical attention can result in death.

Pathogenesis of sudden cardiac death

Sudden cardiac death occurs in a number of heart diseases, as well as in various rhythm disturbances. Cardiac arrhythmias can occur against the background of structural abnormalities of the heart and coronary vessels or without these organic changes.

Approximately 20-30% of patients have bradyarrhythmias and episodes of asystole before the onset of sudden cardiac death. Bradyarrhythmia can appear due to myocardial ischemia and then it can become a provoking factor for the occurrence of ventricular tachycardia and ventricular fibrillation. On the other hand, the development of bradyarrhythmias may be mediated by pre-existing ventricular tachyarrhythmias.

Despite the fact that many patients have anatomical and functional disorders that can lead to sudden cardiac death, this condition is not recorded in all patients. For the development of sudden cardiac death, a combination of various factors is necessary, most often the following:

Development of pronounced regional ischemia.

The presence of left ventricular dysfunction, which is always an unfavorable factor in relation to the occurrence of sudden cardiac death.

The presence of other transient pathogenetic events: acidosis, hypoxemia, vascular wall tension, metabolic disorders.

Pathogenetic mechanisms of the development of sudden cardiac death in IHD:

Decreased left ventricular ejection fraction less than 30-35%.

Left ventricular dysfunction is always an unfavorable predictor of sudden cardiac death. The assessment of the risk of arrhythmia after myocardial infarction and SCD is based on the determination of left ventricular function (LVEF).

LVEF less than 40%. The risk of SCD is 3-11%.

LVEF is more than 40%. The risk of SCD is 1-2%.

Ectopic focus of automatism in the ventricle (more than 10 ventricular extrasystoles per hour or unstable ventricular tachycardia).

Cardiac arrest due to ventricular arrhythmias can be caused by chronic or acute transient myocardial ischemia.

Spasm of the coronary arteries.

Spasm of the coronary arteries can lead to myocardial ischemia and worsen the results of reperfusion. The mechanism of this action can be mediated by the influence of the sympathetic nervous system, the activity of the vagus nerve, the state of the vascular wall, the processes of activation and aggregation of platelets.

Arrhythmias in patients with structural abnormalities of the heart and blood vessels

In most cases, sudden cardiac death is recorded in patients with structural anomalies of the heart, which are the result of congenital pathology or may occur as a result of a previous myocardial infarction.

Acute thrombosis of the coronary arteries can lead to an episode of unstable angina pectoris and myocardial infarction, as well as to sudden cardiac death.

In more than 80% of cases, sudden cardiac death occurs in patients with coronary artery disease. Hypertrophic and dilated cardiomyopathies, heart failure, and valvular heart disease (eg, aortic stenosis) increase the risk of sudden cardiac death. In this case, the most significant electrophysiological mechanisms of sudden cardiac death are tachyarrhythmias (ventricular tachycardia and ventricular fibrillation).

Treatment of tachyarrhythmias with an automated defibrillator or cardioverter-defibrillator implantation reduces the incidence of sudden cardiac death and mortality rates in patients who have experienced sudden cardiac death. The best prognosis after defibrillation in patients with ventricular tachycardia.

Arrhythmias in patients without structural abnormalities of the heart and blood vessels

The following disorders can cause ventricular tachycardia and ventricular fibrillation at the molecular level:

Neurohormonal disorders.

Disorders of the transport of potassium, calcium, sodium ions.

Dysfunction of sodium channels.

Diagnosis criteria

The diagnosis of clinical death is made on the basis of the following main diagnostic criteria: 1. lack of consciousness; 2. lack of breathing or sudden onset of agonal breathing (noisy, rapid breathing); 3. absence of pulse in the carotid arteries; 4. dilated pupils (if drugs were not taken, neuroleptanalgesia was not performed, anesthesia was not given, there is no hypoglycemia); 5. discoloration of the skin, the appearance of a pale gray color of the skin of the face.

If the patient is on ECG monitoring, then at the time of clinical death, the following changes are recorded on the ECG:

Ventricular fibrillation is characterized by chaotic, irregular, sharply deformed waves of various heights, widths and shapes. These waves reflect the excitation of individual muscle fibers of the ventricles. At the beginning of the wave, fibrillation is usually high-amplitude, occurring with a frequency of about 600 min-1. At this stage, the prognosis during defibrillation is more favorable compared to the prognosis at the next stage. Further, the blinking waves become low-amplitude with a wave frequency of up to 1000 and even more in 1 min. The duration of this stage is about 2-3 minutes, then the duration of the flickering waves increases, their amplitude and frequency decrease (up to 300-400 min-1). Defibrillation is not always effective at this stage. It should be emphasized that the development of ventricular fibrillation is often preceded by episodes of paroxysmal ventricular tachycardia, sometimes bidirectional ventricular tachycardia ("pirouette" type). Often, before the development of ventricular fibrillation, frequent polytopic and early extrasystoles (type R to T) are recorded.

With ventricular flutter on the ECG, a curve is recorded that resembles a sinusoid with frequent rhythmic, rather large, wide and similar waves, reflecting the excitation of the ventricles. It is impossible to isolate the QRS complex, ST interval, T wave, there is no isoline. Most often, ventricular flutter turns into their fibrillation. An ECG picture of ventricular flutter is shown in Fig. one.

Rice. one

With asystole of the heart, an isoline is recorded on the ECG, any waves or teeth are absent. With electromechanical dissociation of the heart, a rare sinus, nodal rhythm can be recorded on the ECG, which turns into a rhythm, followed by asystole. An example of an ECG for electromechanical dissociation of the heart is shown in Fig. 2.

Rice. 2

Urgent care

In the event of sudden cardiac death, cardiopulmonary resuscitation is performed - a set of measures aimed at restoring the body's vital activity and removing it from a state bordering on biological death.

Cardiopulmonary resuscitation should begin even before the patient is admitted to the hospital. Cardiopulmonary resuscitation includes prehospital and hospital stages.

In order to provide assistance at the prehospital stage, it is necessary to carry out diagnostics. Diagnostic measures should be performed within 15 seconds, since otherwise it will not be possible to resuscitate the patient. As diagnostic measures:

Feel for a pulse. It is best to feel the carotid artery on the side of the neck and on both sides. With videoconferencing, there is no pulse.

Consciousness check. The patient will not respond to painful punches and pinches.

Check the reaction to light. The pupils dilate by themselves, but they do not react to light and what is happening around.

Check for the presence of blood pressure. With videoconferencing, this cannot be done, since it does not exist.

It is necessary to measure pressure already in the course of resuscitation, since this takes a lot of time. The first three measures are enough to confirm clinical death and begin to resuscitate the patient.

Pre-hospital stage of cardiopulmonary resuscitation

Before hospitalization of the patient, measures of cardiopulmonary resuscitation are carried out in two stages: basic life support (urgent oxygenation) and further actions aimed at maintaining life (restoration of spontaneous circulation).

Elementary life support (emergency oxygenation)

Restoration of airway patency.

Breathing support (artificial lung ventilation).

Maintaining blood circulation (chest compressions).

Further life-sustaining actions (restoration of spontaneous circulation)

Administration of medications and fluids.

Intravenous route of drug administration.

It is possible to inject drugs into a peripheral vein.

After each bolus injection, it is necessary to raise the patient's hand to accelerate the delivery of the drug to the heart, accompanying the bolus with the introduction of a certain amount of fluid (to push it through).

For access to the central vein, it is preferable to catheterize the subclavian or internal jugular vein.

The introduction of drugs into the femoral vein is associated with their slow delivery to the heart and a decrease in concentration.

Endotracheal route of drug administration.

If the trachea is intubated earlier than the venous access is provided, then atropine, adrenaline, lidocaine can be through a tube into the trachea.

The drugs are diluted with 10 ml of isotonic sodium chloride solution and their doses should be 2-2.5 times greater than with intravenous administration.

The end of the probe should be below the end of the endotracheal tube.

After the administration of the drug, it is necessary to perform successively 2-3 breaths (while stopping the indirect cardiac massage) to distribute the drug along the bronchial tree.

Intracardiac route of drug administration.

It is used when it is impossible to administer drugs in another way.

With intracardiac injections, large coronary arteries are damaged in 40% of cases.

ECG recording is carried out for the purpose of differential diagnosis between the main causes of circulatory arrest (ventricular fibrillation-70-80%, ventricular asystole-10-29%, electromechanical dissociation-3%).

A three-channel electrocardiograph in automatic or manual mode is optimal for ECG recording.

Management of ventricular fibrillation and hemodynamically ineffective ventricular tachycardia.

If ventricular fibrillation or hemodynamically ineffective ventricular tachycardia is detected in the absence of a defibrillator, it is necessary to apply a vigorous punch to the heart area (precordial beat) and, if there is no pulse in the carotid arteries, proceed to cardiopulmonary resuscitation.

The fastest, most effective and generally accepted method of terminating ventricular tachycardia and ventricular fibrillation is electrical defibrillation. Electrical defibrillation technique.

Electromechanical dissociation tactics.

Electromechanical dissociation is the absence of pulse and respiration in a patient with preserved electrical activity of the heart (the rhythm is visible on the monitor, but no pulse).

Measures to eliminate the causes of electromechanical dissociation.

Tactics for asystole.

General resuscitation measures are carried out.

Intravenously inject epinephrine at a dose of 1 mg every 3-5 minutes.

Intravenously inject atropine at a dose of 1 mg every 3-5 minutes.

Carry out pacing.

At the 15th minute of resuscitation, inject sodium bicarbonate.

If the resuscitation measures are effective, it is necessary:

Ensure adequate ventilation.

Continue with prophylactic antiarrhythmic drugs.

Diagnose and treat the disease that caused sudden cardiac death.

heart rhythm violation resuscitation