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 suddenness factor 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 the pathology is also possible, when arrhythmia, heart pain and other complaints appear, and the patient dies in the first six hours from the moment they occur.

The greatest risk of sudden coronary death can be traced in people aged 45-70 who have some form of disturbance in the vessels, heart muscle, and its 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, gender differences are smoothed out, and the ratio of men and women with this pathology becomes 2:1.

Most patients with sudden cardiac arrest finds themselves 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 a life can depend on the actions of others, so you can’t just walk past a person who suddenly fell on the street or passed out on a bus. You should at least try to conduct a basic one - an indirect heart massage and artificial respiration, after calling the doctors for help. Cases of indifference are not uncommon, unfortunately, therefore, the percentage of unfavorable outcomes due to late resuscitation takes place.

Causes of sudden cardiac death

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 materials 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 cause of cardiac arrest can be an acutely developed one, in which proper 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 against the background of atherosclerosis, and without it;
• with hypertension, vice,;
• Metabolic diseases (amyloidosis, hemochromatosis);
• Congenital and acquired;
• Injuries and tumors of the heart;
• Physical overload;
• Arrhythmias.

Risk factors are identified when the probability of acute coronary death becomes higher. The main such factors include ventricular tachycardia, an earlier 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 under which the risk of sudden death is increased are comorbidities, in particular, diabetes, obesity, myocardial hypertrophy, tachycardia of more than 90 beats per minute. Smokers are also at risk, those who neglect motor activity and, conversely, athletes. With excessive physical exertion, hypertrophy of the heart muscle occurs, a tendency to rhythm and conduction disturbances appears, therefore death from a heart attack is possible in physically healthy athletes during training, matches, and competitions.

diagram: distribution of causes of SCD at a young age

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

1. Patients undergoing resuscitation for cardiac arrest or;
2. Patients with chronic insufficiency and ischemia of the heart;
3. Persons with electrical ;
4. Those diagnosed with significant cardiac hypertrophy.

Depending on how quickly death occurred, instant cardiac death and fast 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 without obvious reasons. Other Patients noted one to two weeks before the attack, deterioration in health in the form of:

• More frequent pain attacks in the region of the heart;
• Rising ;
• A noticeable decrease in efficiency, feelings of fatigue and fatigue;
• More frequent episodes of arrhythmias and interruptions in the activity of the heart.

Before cardiovascular death, pain in the region of the heart sharply increases, many patients have time to complain about it and experience strong fear, as happens with myocardial infarction. Perhaps psychomotor agitation, the patient grabs 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 a strong emotional experience, 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, dizziness begins, 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, and the pulse on large vessels is also not determined. In a matter of minutes, clinical death occurs with all the signs characteristic of it. 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 stops.

The brain is most sensitive to 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, and the sooner 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, excessive physical exertion. 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, a rapid increase in the liver and jugular veins, pulmonary edema is possible, which accompanies shortness of breath up to 40 respiratory movements per minute, severe anxiety and convulsions.

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

Diagnosis of sudden death syndrome

Unfortunately, cases of post-mortem diagnosis of sudden death are not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. The autopsy did 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 coronarogenic nature of the pathology.

After the arrival of the ambulance and before the start of resuscitation, the patient's condition is diagnosed, which by this time is already unconscious. Breathing is absent or too rare, convulsive, it is impossible to feel the pulse, heart sounds are not detected during auscultation, the pupils do not react 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. With ventricular fibrillation, erratic waves of contractions appear on the ECG, the heart rate is above two hundred per minute, soon these waves are replaced by a straight line, indicating cardiac arrest.

With ventricular flutter, the ECG record resembles a sinusoid, gradually giving way to erratic fibrillation waves and an isoline. Asystole characterizes cardiac arrest, so the cardiogram will only show 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 a toxicological study for some drugs that can cause arrhythmia. 24-hour ECG monitoring, ultrasound examination of the heart, electrophysiological examination, and stress tests will definitely be carried out.

Treatment of 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 transport of the patient to a 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 owns her techniques - artificial respiration and chest compressions.

Video: performing basic cardiopulmonary resuscitation

The ambulance team, after diagnosing clinical death, begins an indirect heart massage and artificial ventilation of the lungs with an Ambu bag, provides 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, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart's activity 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 makes a blow to the precordial region and continues resuscitation.

defibrillation

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

After placing the patient in the hospital, the struggle for his life continues. It is necessary to stabilize the condition and begin treatment of 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, and normalize electrolyte disturbances. For this purpose, beta-blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensives or cardiotonic drugs, infusion therapy are prescribed:

• Lidocaine for ventricular fibrillation;
• Bradycardia is stopped by atropine or izadrin;
• Hypotension serves as a reason for intravenous administration of dopamine;
• Fresh frozen plasma, heparin, aspirin are indicated for DIC;
• Piracetam is administered to improve brain function;
• With hypokalemia - potassium chloride, polarizing mixtures.

Treatment in the post-resuscitation period lasts about a week. At this time, electrolyte disturbances, DIC, neurological disorders are likely, so the patient is placed in the intensive care unit for observation.

Surgery may consist in radiofrequency ablation of the myocardium - with tachyarrhythmias, the efficiency reaches 90% or more. With 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, they are plastic.

Unfortunately, it is not always possible to provide resuscitation within the first few minutes, but if it was possible to bring the patient back to life, then the prognosis is relatively good. According to research data, 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 that can cause an attack, as well as for those who have already experienced it and have been successfully resuscitated.

A cardioverter-defibrillator may be implanted to prevent a heart attack, especially effective for severe arrhythmias. At the right moment, the device generates the impulse necessary for the heart and does not allow it to stop.

Require medical support. Beta-blockers, calcium channel blockers, products containing omega-3 fatty acids are prescribed. Surgical prophylaxis consists in 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, giving up bad habits, proper nutrition.

Video: presentation on sudden cardiac death

Video: lecture on the prevention of sudden cardiac death

Cardiovascular disease is one of the most common causes of sudden death. Acute coronary death is 15-30% in the structure of all the condition is dangerous because it does not make itself felt for a long time. A person can live without even suspecting the presence of heart problems. Therefore, everyone should know why a fatal outcome occurs. And also have an idea about the provision of first aid to the victim. This is exactly what will be discussed in the article.

What is this state

The World Health Organization defines sudden or acute coronary death as death within 6 hours of the onset of symptoms. Moreover, this condition develops in people who considered themselves healthy and had no problems with the cardiovascular system.

Pathology of this nature is referred to as one of the varieties with an asymptomatic course. Sudden death in acute coronary insufficiency develops in 25% of patients with a "silent" course of coronary artery disease.

In the International Classification of Diseases, this pathology is in the section "Diseases of the circulatory system". The ICD-10 code for acute coronary death is I46.1.

Main reasons

There are a number of causes of acute coronary death. These include the following fatal changes in heart rate:

• ventricular fibrillation (70-80%);
• paroxysmal ventricular tachycardia (5-10%);
• slow heart rate and ventricular asystole (20-30%).

Separately, trigger or starting causes of death in acute coronary insufficiency are distinguished. These are factors that increase the risk of developing a fatal outcome of heart and vascular diseases. These include:

1. Acute myocardial ischemia. It is observed when they are blocked by a thrombus.
2. Excessive activation of the sympathoadrenal system.
3. Violation of the electrolyte balance in the cells of the heart muscle. Particular attention is paid to the reduced concentration of potassium and magnesium.
4. Action of toxins on the myocardium. Some medications can have an adverse effect on the heart muscle. For example, antiarrhythmic drugs of the first group.

Other causes of sudden death

The most common cause of sudden death is acute coronary insufficiency, which also occurs with arrhythmias of various kinds.

But sometimes patients die suddenly, never having arrhythmias or any other heart disease. And at autopsy, it is not possible to find a lesion of the heart muscle. In such cases, the cause may be one of the following diseases:

• hypertrophic or dilated cardiomyopathy - a pathology of the heart with thickening of the myocardium or an increase in the cavities of the organ;
• exfoliating aortic aneurysm - bag-like bulging of the vessel wall and its further rupture;
• pulmonary embolism - blockage of pulmonary vessels by blood clots;
• shock - a sharp decrease in blood pressure, accompanied by a deterioration in the supply of oxygen to the tissues;
• food entering the respiratory tract;
• acute circulatory disorders in the vessels of the brain.

Autopsy data

When examining the body by a pathologist in 50% of cases, the presence of atherosclerosis of the coronary arteries is determined. This condition is characterized by the formation of fatty plaques on the inner wall of the vessels of the heart. They block the lumen of the artery, preventing the normal flow of blood. Myocardial ischemia occurs.

Also characteristic is the presence of scars on the heart, which appear after a heart attack. Thickening of the muscle wall is possible - hypertrophy. Some have a massive proliferation of connective tissue in the muscle wall - cardiosclerosis.

In 10-15% of cases, blockage of the vessel by a fresh thrombus is possible. However, there is a small part of the dead, in whom the autopsy fails to determine the cause of death.

Main symptoms

Often, sudden death in acute coronary insufficiency does not come so suddenly. It is usually preceded by some symptoms.

According to relatives, many patients before death noted a deterioration in general well-being, weakness, poor sleep, and breathing problems. Some had a severe attack of ischemic pain. Such pain appears sharply, as if it squeezes the chest, gives it to the lower jaw, left arm and shoulder blade. But ischemic pain is a rare symptom before death from acute coronary insufficiency.

Many patients suffered from high blood pressure or mild coronary heart disease.

In 60% of cases, death due to heart disease occurs at home. It has nothing to do with emotional shock or physical exertion. Cases of sudden death in a dream from acute coronary insufficiency are noted.

Diagnostic methods

If a person who was threatened with death from acute coronary insufficiency has been resuscitated, he is given a series of examinations. This is necessary for the appointment of appropriate treatment, which eliminates the threat of relapse.

To do this, use the following diagnostic methods:

• electrocardiography (ECG) - with its help, the contractility of the heart muscle and the conduction of impulses in it are recorded;
• phonocardiography - it characterizes the work of the heart valves;
• echocardiography - ultrasound examination of the heart;
• ECG with stress tests - to detect angina pectoris and decide on the need for surgical intervention;
• Holter monitoring - ECG, which is removed 24 hours a day;
• electrophysiological study.

The value of electrophysiological research

The latter method is the most promising in the diagnosis of cardiac arrhythmias. It is the stimulation of the inner lining of the heart with electrical impulses. This method not only allows you to establish the cause of the threat of death, but also makes it possible to predict the likelihood of a recurrence of an attack.

In 75% of the percentage of survivors, persistent ventricular tachycardia is determined. Such a result in an electrophysiological study suggests that the probability of a repeated attack of the threat of death is about 20%. This is provided that the tachycardia is stopped by antiarrhythmic drugs. If the rhythm disturbance cannot be eliminated, a repeated threat of death occurs in 30-80% of cases.

If ventricular tachycardia cannot be induced by pacing, the chance of a relapse is about 40% in the presence of heart failure. With preserved heart function - 0-4%.

Emergency care: basic concepts

The first aid for acute coronary death is Basic resuscitation techniques everyone should know in order to be able to help a person before the ambulance arrives.

There are three main stages:

• A - ensuring the patency of the respiratory tract;
• B - artificial respiration;
• C - indirect heart massage.

But before starting to take any action, check the presence of consciousness in the victim. To do this, they call him loudly several times and ask how he feels. If the person does not respond, you can lightly shake him by the shoulders several times and lightly hit him on the cheek. Lack of reaction suggests that the victim is unconscious.

After that, check the pulse on the carotid artery and spontaneous breathing. Only in the absence of pulsation of blood vessels and respiration can one begin to provide first aid.

Emergency care: stages

Stage A begins with cleansing the victim's mouth of saliva, blood, vomit, and other things. To do this, wrap two fingers with some kind of tissue and remove the contents of the oral cavity. After providing the patency of the upper respiratory tract. I put one hand on the forehead of the patient and throw their head back. The second lift the chin and put forward the lower jaw.

If there is still no breathing, go to step B. The palm of the left hand is still on the victim's forehead, and the fingers close the nasal passages. Next, you need to take a normal breath, clasp the lips of the victim with your lips and exhale the air into his mouth. In order to ensure personal hygiene, it is recommended to put a napkin or cloth over the patient's mouth. Inhalations are carried out with a frequency of 10 - 12 per minute.

In parallel with artificial respiration, an indirect heart massage is performed - stage C. Hands are placed on the sternum between its middle and lower parts (just below the level of the nipples). The hands lie one on top of the other. After that, pressing is done with a frequency of 100 times per minute, to a depth of 4-5 cm. The elbows should be straightened, and the main emphasis falls on the palms.

If there is only one resuscitator, pressing and breathing alternate with a frequency of 15 to 2. When two people provide assistance, the ratio is 5 to 1. Every two minutes, you need to control the intensity of resuscitation, checking the pulse on the carotid artery.

Primary prevention

Any disease is easier to prevent than to cure. And most often, when symptoms appear before death from acute heart (coronary) insufficiency, it is too late to do anything.

All preventive measures are divided into two large groups: primary and secondary:

• Primary prevention of acute coronary death is to prevent the development of coronary heart disease.
• Secondary measures are aimed at its treatment and prevention of complications.

First of all, you need to modify your lifestyle. Change the diet, giving up fried and fatty foods, smoked meats and spices. Preference should be given to vegetable fats, vegetables with a high fiber content. Limit coffee and chocolate intake. It is obligatory to give up bad habits - smoking and alcohol.

Overweight people need to lose weight, as excessive weight increases the risk of diseases of the cardiovascular and endocrine systems.

Dosed physical activity is also important. At least 1-2 times a day you need to do exercises or walk in the fresh air. Swimming, jogging for short distances are shown, but not weightlifting.

Secondary prevention

Secondary prevention of sudden death is taking medications that slow the progression of coronary heart disease. The following groups of drugs are most often used:

• beta blockers;
• antiarrhythmic;
• antiplatelet agents;
• anticoagulants;
• preparations of potassium and magnesium;
• antihypertensive.

There are also surgical methods for the prevention of sudden cardiac death. They are used in individuals at high risk. These methods include:

• aneurysmectomy - removal of an artery aneurysm;
• myocardial revascularization - restoration of the patency of the coronary vessels;
• radiofrequency ablation - the destruction of the focus of disturbed heart rhythm with the help of electric current;
• implantation of an automatic defibrillator - a device is installed that automatically regulates the heart rate.

The Importance of Regular Medical Examination

Every person should undergo a medical examination and blood test at least once a year. This will allow you to identify the disease at an early stage, before the onset of symptoms.

If you have high blood pressure, you should consult your doctor. He will prescribe the necessary drugs. The patient should take them regularly, and not just when the pressure rises.

If the level of cholesterol and low-density lipoproteins is elevated in the blood, consultation with a specialist is also indicated. He will help you find a way to control this condition with a diet alone or by prescribing additional medications. This will prevent the development of atherosclerosis and blockage of the coronary vessels with fatty plaques.

Regular blood tests are a simple method of preventing coronary artery disease, and hence acute coronary death.

Forecast

The probability of reviving the patient depends on the timing of first aid. It is important to organize specialized resuscitation ambulance teams, which arrive at the scene in 2-3 minutes.

Survival among those successfully resuscitated in the first year of life is 70%. It is obligatory to find out the cause of stopping death and its elimination. If no specific therapy is given, the chance of recurrence is 30% in the first year and 40% in the second year. If antiarrhythmic therapy or surgical treatment is carried out, the probability of recurrence is 10 and 15%, respectively.

But the most effective way to prevent an episode of acute coronary death is to install a pacemaker. It reduces the risk of this condition to 1%.

According to the definition of the World Health Organization, sudden death is a death that occurs within 6 hours against the background of the onset of symptoms of a violation of cardiac detail in apparently healthy people or in people who already suffered from, but their condition was considered satisfactory. Due to the fact that such death occurs in patients with signs in almost 90% of cases, the term "sudden coronary death" was introduced to indicate the causes.

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. At autopsy, such persons do not reveal diseases of the internal organs that could cause death. When examining coronary vessels, approximately 95% reveal the presence of narrowing caused by atherosclerotic plaques, which could provoke life-threatening. Recent thrombotic occlusions that can disrupt the activity of the heart are observed in 10-15% of victims.

Vivid examples of sudden coronary death can be cases of fatal outcomes of famous people. The first example is the death of a famous French tennis player. The fatal outcome came at night, and the 24-year-old man was found in his own apartment. An 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 major businessman from Georgia. He was in his early 50s, had 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 full health. After the autopsy of the man's body, the causes that could lead to death were never found.

There are no exact statistics on sudden coronary death. According to WHO, it occurs in about 30 people per 1 million 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 acquaint you with the causes, possible precursors, symptoms, ways to provide emergency care and prevent sudden coronary death.

Immediate causes

The cause of 3-4 out of 5 cases of sudden coronary death is ventricular fibrillation.

In 65-80% of cases, sudden coronary death is caused by primary, 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 disorder, 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, which leads to death.

In about 5-10% of cases, sudden onset of 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 circulatory arrest with subsequent death.

Risk factors

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

Main factors:

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

secondary factors:

• smoking;
• alcoholism;
• obesity;
• frequent and intense stressful situations;
• frequent 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:

• who underwent resuscitation for ventricular fibrillation;
• suffering from;
• with electrical instability of the left ventricle;
• with severe hypertrophy of the left ventricle;
• 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 dysplasia of the right ventricle;
• aortic stenosis;
• anomalies of the coronary arteries;
• (WPW);
• Burgada's syndrome;
• "sports heart";
• dissection of an aortic aneurysm;
• TELA;
• idiopathic ventricular tachycardia;
• long QT syndrome;
• cocaine intoxication;
• taking medications that can cause arrhythmia;
• pronounced violation of the electrolyte balance of calcium, potassium, magnesium and sodium;
• congenital diverticula of the left ventricle;
• 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, circulation and consciousness, but the patient can be resuscitated;
• biological - accompanied by a lack of breathing, 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 experts, 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, so-called precursors occur: 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 diseases. However, in some cases, the following signs may become harbingers of a sudden death:

• increased fatigue;
• sleep disorders;
• sensations of pressure or pain of a compressive or oppressive nature behind the sternum;
• increased feeling of suffocation;
• heaviness in the shoulders;
• quickening or slowing of the heart rate;
• cyanosis.

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

Main symptoms

Usually, the occurrence of such a condition is in no way connected with the previous increased psycho-emotional or physical stress. With the onset of sudden coronary death, a person loses consciousness, his breathing first becomes frequent and noisy, and then slows down. 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.

Diagnostic measures with the appearance of the above signs should be carried out already in the very first seconds of their appearance, because. in the absence of such measures, it may not be possible to resuscitate a dying person in time.

To identify signs of sudden coronary death, it is necessary:

• make sure that there is no pulse on the carotid artery;
• check consciousness - the victim will not respond to pinches or blows to the face;
• make sure that the pupils do not react 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. When they are detected, urgent resuscitation measures must be initiated.

In almost 60% of cases, such deaths occur not in a medical institution, but at home, at work and 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 the detection of signs of clinical sudden death. For this you need:

1. Call an ambulance if the patient is not in a medical facility.
2. Restore airway patency. The victim should be laid on a hard horizontal surface, tilt his head back and put forward 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 airways.
3. Start artificial respiration "mouth to mouth" or mechanical ventilation (if the patient is in a hospital).
4. Restore circulation. In the conditions of a medical institution, this is carried out. If the patient is not in the hospital, then a precordial blow should first be applied - a punch to a point in the middle of the sternum. After that, you can proceed to an indirect heart massage. Put the palm of one hand on the sternum, cover it with the other palm and begin to press 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 for every 5 pressures, 1 breath is taken.

Every 3 minutes, it is necessary to check the effectiveness of emergency care - the reaction of pupils to light, the presence of breathing and pulse. If the reaction of the pupils to light is determined, but breathing does not appear, then resuscitation should be continued until the ambulance arrives. Restoration of breathing can be a reason to stop chest compressions and artificial respiration, since the appearance of oxygen in the blood contributes to 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.

Possible 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;
• disorders of blood circulation and functioning of the heart.

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 to prevent sudden coronary death is to give up bad habits, in particular, smoking.

The main measures to prevent the onset of such deaths are aimed at the timely detection and treatment of people suffering from cardiovascular diseases, and social work with the population, aimed at familiarizing themselves with the groups and risk factors for such deaths.

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

1. Timely visits to the doctor and the implementation of all his recommendations for treatment, prevention and follow-up.
2. Rejection of bad habits.
3. Proper nutrition.
4. The fight against stress.
5. Optimum mode of work and rest.
6. Compliance with the recommendations on the maximum permissible physical activity.

Patients at risk and their relatives must be informed about the likelihood of such a complication of the disease as the onset of 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 (may be combined with cryodestruction).

For the prevention of sudden coronary death, the rest of the 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.

Of no small importance in the prevention of sudden coronary death is familiarization and training of the population in the skills of cardiopulmonary resuscitation. Its timely and correct implementation increases the chances of survival of the victim.

Cardiologist Sevda Bayramova talks about sudden coronary death:

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

Each organ of the human body performs a specific function. In the structural hierarchy, the heart occupies one of the leading positions in ensuring viability.

If there is a violation of cardiac activity, there is a risk of developing threatening conditions. About 80% of circulatory arrest is associated with the occurrence of ventricular fibrillation, the remaining violations are associated with asystole and electromechanical dissociation.

The causes on the basis of which acute coronary insufficiency and sudden death occur are the primary factor that triggers a cascade of pathological mechanisms.

The essence of pathology

Acute coronary insufficiency is a condition in which the myocardial demand for oxygen and nutrients exceeds the supply of important substances.

The severity of the process is characterized by the sudden onset of a shortage of the necessary components.

Since the work of the heart muscle requires high energy consumption, reserve reserves are quickly exhausted in the myocardium and cells begin to die primarily from a lack of oxygen. Dead tissue is not able to perform its function. The site of necrosis, located in the path of the conduction system of the heart, provokes the occurrence of arrhythmia. Cell death, covering a large part of the myocardium, entails a direct violation of the contractile function. Thus, acute coronary insufficiency is a dangerous condition, on the basis of which sudden cardiac arrest can quickly occur.

What can cause

Most cases of acute insufficient blood supply to the myocardium occur against the background of an existing chronic pathology:

1. The presence of blood clots in the venous bed (varicose veins). The detached clot closes the lumen of the artery, disrupts the blood flow of this zone. This mechanism is observed in any thromboembolism, but is most dangerous in the case of overlapping of the pulmonary, cerebral and coronary vessels.
2. Atherosclerotic lesions of the coronary branches narrow the lumen of the arteries. The impact of additional factors (spasm, trauma, local inflammation) leads to complete blockage of the vessel.
3. Stress, alcohol, nicotine intoxication lead to the release of biologically active substances, leading to the occurrence of coronary spasm.
4. Mechanical compression of the coronary arteries from the outside with a nearby tumor or metastasis.
5. Coronary arteritis (due to initial edema and subsequent sclerotic wall changes after recovery).
6. Vascular injury.

Possible outcomes

Ischemic changes due to impaired cardiac blood supply may not have significant clinical manifestations. With further aggravation of the situation, an increase in symptoms occurs up to the development of threatening conditions.

An extreme option for a sharp deterioration in the condition is sudden coronary death.

Manifestations of insufficiency of coronary circulation

Clinical variability in insular coronary insufficiency depends on the level and degree of ischemia.

Significant manifestations are noted in the form of angina pectoris. Patients note chest pains of varying degrees of intensity, with possible irradiation to the scapula, shoulder, shoulder girdle and hand.

Symptoms may be excessively pronounced, lasting more than an hour. At the same time, patients are covered by a feeling of panic, fear of dying.

Such a clinic makes it possible to suspect an incipient heart attack.

Deficiency of blood supply to the myocardium further leads to the development of heart failure, which is accompanied by pallor of the skin, cyanosis.

Stagnation of blood in the lungs leads to sweating of the plasma into the alveoli, pulmonary edema develops, which aggravates the situation.

Insufficient supply of oxygen to the brain turns into a critical loss of consciousness.

If the blood supply to the myocardium is completely and rapidly cut off, the heart becomes incapable of adequate contraction. Sudden coronary death develops without a previous visible deterioration in the condition.

Priority Actions

Treatment of cardiovascular disorders is divided into stages. The initial and simple, carried out with a minimum set of medicines is the provision of self-help.

The lack of qualified skills does not detract from the importance of the activities.

Often timely taking the necessary pills at the very beginning of clinical manifestations becomes a salvation for the patient.

It should be noted that all existing universal self-help algorithms are the basis for drawing up an individual action plan for a particular patient.

For a patient with chronic cardiac pathology, advice on self-help in emergency situations is provided by his attending physician.

Among the basic medicines, nitroglycerin in tablet form or spray is used, aspirin or clopidogrel is indicated for the prevention of complications.

In the medicine cabinet of patients with arterial hypertension should be antihypertensive drugs (enalapril, anaprilin).

Resuscitation measures

Acute coronary insufficiency can cause sudden clinical death. Any person who witnesses a circulatory arrest can save the victim's life. To do this, it is enough to master the basic skills of cardiopulmonary resuscitation.

First of all, if such a situation arises, you should call the number "03" or "112". Depending on the mobile operator of the calling person, ambulance numbers are dialed as "030" for MTS, Megafon, Tele-2 and "003" for Beeline.

The assisting hands are placed on the lower third of the sternum, straightened at the elbows, the hands are crossed and compressions begin. The depth of pressure is about 1/3–1/2 of the chest (5–6 cm for an adult victim). They try to achieve a frequency of compressions up to 100 times per minute.

Cardiac massage is accompanied by mechanical ventilation with a frequency of 30 pressures per 2 breaths. When performing with two people, it is important to remember that the person performing the compressions must count down the compressions in reverse order, starting from 5, this is done out loud. Such an organization helps to coordinate the actions of both rescuers.

Further actions

Sudden coronary death, with adequate initial measures and a favorable set of circumstances, may not lead to the development of biological dying of the organism.

But before the patient's condition stabilizes and improves, the patient needs qualified medical care.

Paramedics, and then doctors, administer intravenous infusion of drugs, it may be necessary to use thrombolytic drugs, connect apparatus oxygenation and implement other intensive care measures.

Every year, a huge number of deaths from sudden cardiac arrest are recorded, even among relatively young people.

Preventive measures help prevent the development of threatening conditions, so it is important to timely identify existing deviations, observe the exercise regime, proper nutrition and give up bad habits.

CARDIAC ISCHEMIA.

CEREBROVASCULAR

DISEASES

Ischemic heart disease (CHD) and cerebrovascular disease are the main causes of death in patients with cardiovascular disease in economically developed countries.

CARDIAC ISCHEMIA

IHD is a group of diseases caused by absolute or relative insufficiency of the coronary circulation.

IHD develops with atherosclerosis of the coronary arteries, i.e. is a cardiac form of atherosclerosis and hypertension.

It was singled out as an independent nosological group (1965) due to its great social significance.

Atherosclerosis and hypertension in IHD are considered as background diseases.

All other variants of ischemic myocardial damage associated with congenital anomalies of the coronary arteries, arteritis, thromboembolism of the coronary arteries, anemia, CO poisoning, etc., are regarded as complications of these diseases and do not apply to IHD.

Risk factors for the development of coronary artery disease.

A. Hypercholesterolemia (dyslipoproteinemia).

b. Smoking.

V. Arterial hypertension.

In addition, physical inactivity, obesity, cholesterol diet, stress, decreased glucose tolerance, male gender, age, etc.

Pathogenesis.

The main link in the pathogenesis of IHD is the discrepancy between the level of myocardial oxygen supply and the need for it, due to atherosclerotic changes in the coronary arteries.

In V3 patients with IHD, one coronary artery is affected, in V3 - two arteries, in the rest - all three. The first 2 cm of the left anterior descending and circumflex arteries are more often affected. More than 90% of patients with coronary artery disease have stenosing atherosclerosis of the coronary arteries with a degree of stenosis of more than 75% of at least one main artery.

The severity of ischemic myocardial damage in coronary artery disease depends not only on the prevalence and nature of coronary artery damage, but also on the level of metabolism and functional burden of the myocardium, so coronary artery disease on the background of hypertension, as a rule, is more severe.

Causes of ischemic myocardial injuryischemic heart disease.

A. Thrombosis of the coronary arteries.

Microscopic picture: The lumen of the coronary artery is narrowed due to an atherosclerotic plaque, in the center of which fat-protein masses, needle-like cholesterol crystals and lime deposits are visible (stage of atherocalcinosis). The plaque cover is represented by hyalinized connective tissue. The lumen of the artery is obturated with thrombotic masses consisting of fibrin, leukocytes, and erythrocytes (mixed thrombus).

b. Thromboembolism(with separation of thrombotic masses from the proximal sections of the coronary arteries).

V. Prolonged spasm.

G. Functional myocardial overvoltage under conditionscoronary artery stenosis and insufficient collateral blood supply.

Ischemic myocardial damage can be reversible and irreversible.

A. Reversible ischemic damage develops in the first 20-30 minutes after the onset of ischemia, and after the cessation of exposure to the factor that caused them, they completely disappear.

b. Irreversible ischemic damage to cardiomyocytes begins with ischemia lasting more than 20-30 minutes.

The first 18 hours from the moment of development of ischemia, morphological changes are recorded only using electron microscopy (EM), histochemical and luminescent methods. An EM sign that makes it possible to differentiate reversible and irreversible ischemic damage at early stages is the appearance of calcium in mitochondria.

After 18 - 24 hours, micro- and macroscopic signs of necrosis appear, i.e. myocardial infarction develops.

IBS classification.

IHD flows in waves, accompanied by coronary crises, i.e. episodes of acute (absolute) coronary insufficiency. In this regard, acute and chronic coronary artery disease are isolated.

Acute LAN (AIBS) is characterized by the development of acute ischemic damage to the myocardium; three nosological forms are distinguished:

Sudden cardiac (coronary) death.

Acute focal ischemic myocardial dystrophy.

Myocardial infarction.

Chronic ischemic heart disease (HIBS) is characterized by the development of cardiosclerosis as an outcome of ischemic damage; two nosological forms are distinguished:

Postinfarction macrofocal cardiosclerosis.

Diffuse small focal cardiosclerosis.

Acute ischemic heart disease

1. Sudden cardiac (coronary) death.

In accordance with WHO recommendations for this form; should be attributed to death occurring within the first 6 hours after the onset of acute ischemia, most likely due to ventricular fibrillation, and the absence of signs to associate sudden death with another disease.

In most cases, an ECG and an enzyme blood test either do not have time to be carried out, or their results turn out to be uninformative.

At autopsy, they usually find heavy(with stenosis of more than 75%), widespread (with damage to all arteries) atherosclerosis; blood clots in the coronary arteries are detected in less than half of the dead.

Main the cause of sudden cardiac death is ventricular fibrillation, which can be detected microscopically with the use of additional methods (in in particular, when dyed Rego) in the form recontraction of myofibrils up to the appearance of gross contractures and ruptures.

The development of fibrillation is associated with electrolyte (in particular, an increase level extracellular potassium) and metabolic disorders leading to the accumulation of arrhythmogenic substances - lysophosphoglycerides, cyclic AMP, etc. The role of the trigger in the onset of fibrillation is played by changes in Purkinje cells (a kind of cardiomyocytes located in the subendocardial regions and performing a conductive function) observed during early ischemia.

2. Acute focal ischemic myocardial dystrophy.

Acute ischemic dystrophy is a form of acute ischemic heart disease that develops in the first 6-18 hours after the onset of acute myocardial ischemia.

Clinical diagnostics.

A. Based on characteristic ECG changes.

b. In the blood (more often 12 hours after the onset of ischemia), there may be a slight increase in the concentration of enzymes from the damaged myocardium - creatinine phosphokinase (CPK) and aspartate aminotransferase (ACT).

Morphological diagnostics.

A.Macroscopic picture:(at autopsy) ischemic lesions are diagnosed using potassium tellurite and tetrazolium salts, which do not stain the ischemic zone due to a decrease in the activity of dehydrogenases.

b.Microscopic picture: with 1LIK-reaction, the disappearance of glycogen from the ischemic zone is detected, in the remaining cardiomyocytes, glycogen stained in crimson.

V. Electron microscopic carTina: find vacuolization of mitochondria, destruction of their cristae, sometimes calcium deposits in mitochondria.

Causesof death: ventricular fibrillation, asystole, acute heart failure.

3. Myocardial infarction.

Myocardial infarction - a form of acute coronary artery disease, characterized by the development of ischemic myocardial necrosis, detected both micro- and macroscopically - Develops after 18-24 hours from the onset of ischemia.

Clinical diagnostics.

A. According to the characteristic changes on the ECG.

b. According to the expressed fermentemia:

° the level of creatinine phosphokinase reaches a peak by 24 hours,

o the level of lactate dehydrogenase - on the 2-3rd day.

By the 10th day, the level of enzymes is normalized.

Morphological diagnostics.

A.Macroscopic picture: a center of yellow-white color (more often in the anterior wall of the left ventricle) of a flabby consistency of irregular shape, surrounded by a hemorrhagic corolla.

b.Microscopic picture: an area of ​​necrosis with lysis of nuclei and clumpy disintegration of the cytoplasm of cardiomyocytes, surrounded by a zone of demarcation inflammation, in which full-blooded vessels, hemorrhages, and accumulations of leukocytes are determined.

From the 7th - 10th day, granulation tissue develops in the necrosis zone, the maturation of which ends by the 6th week with the formation of a scar.

During a heart attack, the stages of necrosis and scarring are distinguished.

Classification of myocardial infarction.

Depending on the time of occurrence, there are: primary infarction, recurrent (developing within 6 weeks after the previous one) and recurrent (developing 6 weeks after the previous one).

By localization, they distinguish: infarction of the anterior wall of the left ventricle, apex and anterior parts of the interventricular septum (40-50%), posterior wall of the left ventricle (30-40%), lateral wall of the left ventricle (15-20%), isolated infarction of the interventricular septum ( 7 - 17%) and extensive infarction.

3, In relation to the membranes of the heart, there are: subendocardial, intramural and transmural (capturing the entire thickness of the myocardium) infarction.

Complications of a heart attack and causes of deathty.

A. Cardiogenic shock.

b. Ventricular fibrillation.

V. Asystole.

d. Acute heart failure.

e. Myomalacia and rupture of the heart.

e. Acute aneurysm.

and. Parietal thrombosis with thromboembolic complications.

h. Pericarditis.

Arrhythmias are the most common cause of death in the first few hours after a heart attack.

Death from rupture of the heart (often in the area of ​​acute aneurysm) and tamponade of the cavity of the heart shirt often occurs on the 4th - 10th day.

Chronic ischemic heart disease

1. Large focal cardiosclerosis develops at the end of a myocardial infarction.

Macroscopic picture: in the wall of the left ventricle, a dense focus of irregular shape is determined, the myocardium is hypertrophied.

Microscopic picture: a focus of sclerosis of irregular shape, pronounced hypertrophy of cardiomyocytes along the periphery. When stained for connective tissue (according to Van Gieson), the scar turns red, cardiomyocytes turn yellow.

*Sometimes complicated by development chronic aneurysmhearts.

macroscopicpainting: the heart is enlarged. The wall of the left ventricle in the region of the apex (anterior, posterior wall, interventricular septum) is thinned, whitish, represented by scar connective tissue, swells. The myocardium around the bulge is hypertrophied. Often, parietal thrombi occur in the cavity of the aneurysm.