One form of coronary artery disease is sudden coronary death. This is an unexpected death of a person due to a heart disease that occurs within a maximum of an hour after the onset of the first symptoms. In this case, the disease may not be diagnosed earlier, that is, the patient considered himself quite healthy.

More than 7 million people die each year from sudden cardiac death. This disease causes more than 90% of all sudden deaths. Sometimes it is instantaneous, and in some cases it occurs within the first hour.

📌 Read this article

Causes of sudden cardiac arrest

The disease can occur in a person of any age, even in a child or teenager. In a city of 1 million, 30 people die of sudden cardiac death every week.

If an elderly person has sudden coronary death, the causes for this it could be:

• pronounced atherosclerosis of the heart vessels, which has not been manifested before, for example, due to the patient's low mobility;

• cardiomyopathy, primarily hypertrophic;

• anomalies in the development of the coronary arteries or the conduction system of the heart.

Sudden death in young people in half of the cases occurs during normal wakefulness, in 20% - during intense exercise (sports activities), in a third - during sleep. Causes of sudden cardiac arrest at this age:

• early atherosclerosis of the arteries of the heart;

• myocarditis;

• long QT syndrome;

• heart disease - aortic valve stenosis;

• aortic rupture in Marfan's disease;

• sudden spasm of the heart arteries during stress and adrenaline rush.

Atherosclerosis of the coronary arteries

With the sudden death of children under 1 year old, the cause of this condition may be respiratory arrest. In other cases, death is caused by severe arrhythmias, for example, against the background of a prolonged QT interval. Often there are violations on the part of nervous system, abnormal development of the coronary arteries or elements of the conduction system.

The risk of sudden death is higher in people with similar cases in the family, especially in younger relatives.

In most patients, retrospectively, in a few days or even weeks, it is possible to identify symptoms that preceded sudden death:

• sudden weakness;

• unexpected chest pains;

• deterioration of health for an unknown reason;

• decrease in emotional background, anxiety;

• episodes of pallor, palpitations, rapid breathing.

When these symptoms appear, it is important to consult a doctor in time, undergo daily ECG monitoring and other studies, and begin intensive treatment.

About what are the causes of sudden coronary death, what methods will help to avoid fatal complications, see this video:

Risk factors

Conditions that increase the likelihood of sudden coronary death:

• smoking;

• violation of lipid metabolism (according to the biochemical analysis of blood);

• diabetes;

• low mobility;

• obesity;

• the first six months after myocardial infarction;

• ejection fraction less than 35% (according to echocardiography);

• more than 10 ventricular extrasystoles per hour (according to daily ECG monitoring);

• valve replacement surgery in the first six months after the intervention;

• taking medications that prolong the QT interval;

• bilateral deafness is one of the signs accompanying congenital lengthening of this interval.

When such conditions are detected, the patient should especially carefully monitor his well-being in order to notice the harbingers of sudden death in time.

First aid: can a person be saved?

If a patient develops sudden coronary death, urgent care should be provided by any person who happened to be nearby. Therefore, it is important to know the basic therapeutic measures for this serious condition.

If treatment is started in the first minutes after the patient lost consciousness, the success of resuscitation is possible in 90% of cases. Then the chance of survival decreases by 10% for each minute lost.

If a person witnesses sudden cardiac death, it is necessary to immediately call an ambulance and begin the simplest cardiopulmonary resuscitation. Immediate electrical defibrillation provides the greatest chance of survival. Such automatic devices are available at many foreign airports and other public places. In Russia, this practice is not accepted.

The main stages of first aid:

• lay the patient on a hard surface (preferably on the floor);

• evaluate patency oral cavity, clean it with a handkerchief, push the jaw forward;

• pinch the patient's nose and take 2 breaths into the mouth, trying to see if the chest rises at this time;

• inflict a short strong blow to the lower third of the sternum;

• in case of inefficiency, immediately begin a heart massage: 30 quick strong jolts with straightened arms, the hands of which are located on top of each other and rest on the patient's sternum;

• repeat artificial respiration and heart massage in a ratio of 30: 2 until the arrival of the ambulance or within 30 minutes.

To learn how to properly perform cardiopulmonary resuscitation, see this video:

How to distinguish from a heart attack

Sudden cardiac arrest is not a myocardial infarction and not, although it can occur during the development of these diseases. Its main difference is the loss of consciousness, the cessation of the heartbeat, the absence of a pulse in the large arteries and respiration.

During a heart attack, the patient is conscious. His main complaint is increasing chest pain. With myocardial infarction, a sharp drop in pressure and increased heart rate, as well as loss of consciousness can develop. However, at this time, the patient's heart continues to beat.

Prevention of sudden death

If a person has at least one of the risk factors listed above, he should be attentive to his well-being. He should consult a cardiologist and undergo the necessary diagnosis and treatment to eliminate the likelihood of sudden cardiac arrest.

You can reduce the likelihood of death with an existing heart disease by following these recommendations:

• regular visits to a cardiologist;

• lifestyle changes;

• regular intake of prescribed medications;

• consent to invasive procedures and operations, if necessary (for example, coronary angiography, angioplasty, bypass surgery, or implantation of a pacemaker).

Sudden coronary death is associated with blockage or spasm of the heart vessels, causing a sharp oxygen starvation of the myocardium and the formation of a site of electrical instability in it. As a result, severe ventricular arrhythmias occur very quickly. They lead to inefficiency of contractions of the heart and its arrest.

The main signs of this condition are loss of consciousness, respiratory arrest and heartbeat. At the same time, cardiopulmonary resuscitation is started, having previously called " ambulance". To avoid sudden coronary death, you should be aware of its risk factors and precursors, and if they appear, immediately consult a doctor.

Read also

Coronary insufficiency is usually not detected immediately. The reasons for its appearance are lifestyle and the presence of concomitant diseases. The symptoms are similar to angina pectoris. It happens sudden, acute, relative. The diagnosis of the syndrome and the selection of the remedy depend on the type.

Under the influence of external factors, a pre-infarction state may occur. Signs are similar in women and men, it can be difficult to recognize them due to the localization of pain. How to relieve an attack, how long does it last? The doctor at the reception will examine the indications on the ECG, prescribe treatment, and also talk about the consequences.

The main causes of ischemia are the formation of plaques, thrombi or emboli. The mechanism of development of cerebral ischemia, cerebral myocardium is associated with blockage of the artery that feeds the organ. In some cases, the consequence is death.

Painless myocardial ischemia occurs, fortunately, not so often. Symptoms are mild, there may even be no angina pectoris. The criteria for heart damage will be determined by the doctor based on the results of the diagnosis. Treatment includes medication and sometimes surgery.

Content

The statistics of sudden death is disappointing: every year the number of people at risk increases. The reason for this is heart failure, which develops against the background of ischemia. Acute coronary insufficiency - what is it from the point of view of cardiologists, what is the origin of the term, the features of the disease? Find out how the disease is treated, will it be possible to prevent its occurrence and development?

What is acute coronary insufficiency

The heart needs “breathing” (oxygen supply) and nutrition (micronutrient supply). This function is performed by the vessels, through which the blood delivers to the body everything necessary for full-fledged work. These arteries are located around the heart muscle in the form of a crown (crown), so they are called coronary or coronary. If the blood flow is weakened due to external or internal vasoconstriction, the heart lacks nutrition and oxygen. This medical condition is called coronary insufficiency.

If the disruption of the arteries occurs slowly, heart failure becomes chronic form. Rapidly developing (within several hours or even minutes) “starvation” is acute form pathology. As a result, oxidation products accumulate in the heart muscle, which leads to malfunctions of the “motor”, vascular ruptures, tissue necrosis, cardiac arrest, and death.

In most cases, coronary insufficiency is associated with coronary disease. Often it develops against the background of such ailments as:

• heart defects;
• gout:
• trauma, cerebral edema;
• pancreatitis;
• bacterial endocarditis;
• syphilitic aortitis, etc.

Forms of pathology and their symptoms

The duration of attacks, their severity, conditions of occurrence are factors that determine the classification of the disease into mild, moderate, severe forms. The degree of vascular damage (the strength of spasms, their “contamination” with blood clots (thrombi), sclerotic plaques) is another reason that affects the formal division of acute coronary insufficiency.

Light

A mild form of coronary insufficiency occurs as a result of a reversible circulatory disorder during active emotional or physical stress. A person feels a slight pain, a sudden short-term "interception" of breathing, but the capacity at these moments is not violated. The attack lasts from a few seconds to two minutes, quickly stopped. Often the patient does not even attach importance to such a manifestation of heart failure, since the attack is of little concern, it passes without medical assistance.

Medium

Attacks of moderate severity occur during normal, but prolonged loads, for example, when a person walks for a long time or climbs a mountain (stairs). Insufficiency is not excluded during a strong emotional shock, experiences, disorders. When there is a syndrome of moderate coronary insufficiency, there is a pressing pain in the left side of the chest, the state of health deteriorates sharply, and the ability to work decreases. An attack of coronary heart failure lasts about ten minutes, is removed only by taking fast-acting nitroglycerin.

Severe disease

Coronary pain that occurs with a severe attack does not go away without medical intervention. It is so strong that a person is seized by the fear of death, he experiences additional emotional arousal, which only worsens his condition. A severe attack lasts from ten minutes to half an hour, leading to a heart attack, death. Tablets of validol or nitroglycerin will help until professional medical care, but the attack will not stop. In this situation, parenteral administration of painkillers and neuroleptic drugs is necessary.

Causes

Normal heart function is impossible without proper nutrition and sufficient oxygen. Acute coronary insufficiency is provoked by a violation of blood flow in the coronary vessels, their blockage, which leads to:

1. Coronarosclerosis. Detachment from the vessel wall of a cholesterol plaque. As a result, normal blood flow is simply blocked by this "obstacle".
2. vein thrombosis. With this pathology, a blood clot that has entered the coronary vessel closes its lumen.
3. Spasm of the coronary vessels. It is caused by increased release of catecholamines by the adrenal glands under the influence of nicotine, alcohol, and stress.
4. Vascular injury. As a result, the blood flow system is disrupted.
5. Inflammation of the vascular walls. It leads to deformation of the coronary arteries, narrowing of the lumen, disruption of the normal blood flow.
6. Tumors. Under their influence, the compression of the coronary vessels occurs mechanically. Spasms are possible as a result of intoxication.
7. Atherosclerosis. Leads to the development of coronary sclerosis - the formation of plaques inside the coronary arteries.
8. Poisoning. For example, ingested carbon monoxide, forms stable compounds with hemoglobin, which deprives red blood cells of the ability to carry oxygen.

Emergency care for a patient with a seizure

The heart pain that occurs with coronary insufficiency cannot be tolerated, and the attack must be stopped immediately. To do this, it is necessary to restore the normal blood supply to the heart. When there is an acute coronary syndrome, emergency care before the intervention of doctors consists in reducing (cessation) of physical activity and taking medications:

1. If you feel pain, you should immediately stop all active actions: the intensity of the work of the heart muscle decreases in a calm state, while the heart's need for oxygen also decreases. Already due to this, the pain will decrease, and the coronary blood supply will be partially restored.
2. Simultaneously with the cessation of active actions, the patient must take instantly acting drugs: validol, nitroglycerin. These funds remain the only urgent first aid during a heart attack.

A person with an attack of coronary insufficiency should be given first aid: put to bed, give a tablet (0.0005 g) of nitroglycerin under the tongue. Alternative - 3 drops alcohol solution(1%) of this medicine per sugar cube. If there is no nitroglycerin or it is contraindicated (for example, in glaucoma), it is replaced with validol, which has a milder vasodilating effect. It is necessary to attach a heating pad to the legs of the core, if possible, inhale with oxygen. Immediately call an ambulance.

Methods of treatment of acute coronary insufficiency

Treatment of this disease should be started as early as possible, only then the outcome will be favorable, otherwise a heart attack, ischemic cardiomyopathy, and death are possible. Coronary heart disease does not go away on its own. Drug therapy is carried out permanently, for a long time, has many nuances:

1. The fight against risk factors for coronary heart disease includes diet, exclusion of overeating, smoking, alcohol, competent alternation of rest with activity, normalization of weight.
2. Medical treatment consists in the prophylactic use of antianginal and antiarrhythmic drugs, drugs that dilate blood vessels (coronarolytics), anticoagulants, lipid-lowering and anabolic agents.

Surgical intervention and intravascular treatment is aimed at restoring normal blood flow in the coronary arteries:

• coronary bypass surgery - restoration of blood flow with the help of special shunts, bypassing the narrowed places on the vessels;
• stenting - installation of scaffolds in coronary vessels;
• angioplasty - opening the affected arteries with a special catheter;
• direct coronary atherectomy - reduction in the size of atherosclerotic plaques inside the vessels;
• rotational ablation (rotablation) - mechanical cleaning of ships with a special drill.

What is dangerous disease: possible complications and consequences

Acute coronary insufficiency as a cause of death is a common phenomenon. Ischemic disease is often asymptomatic, a person does not know about the pathology of the heart, does not pay attention to mild attacks. As a result, the disease progresses, leads to complications, without treatment of which sudden coronary death often occurs. In addition to this most severe consequence, the disease leads to the following complications:

• arrhythmias of all kinds;
• changes in the anatomy of the heart, myocardial infarction;
• inflammation of the pericardial sac - pericarditis;
• aortic aneurysm;
• rupture of the heart wall.

Prevention

Coronary heart disease is a disease that is easier to prevent than to cure. A number of preventive measures help to prevent its occurrence and development:

1. Regular exercise. Hiking, swimming with a gradual, gentle increase in activity, jogging.
2. A balanced diet with a small amount of animal fats.
3. Quit smoking and alcohol.
4. Exclusion of psycho-emotional (stress) loads.
5. Control blood pressure.
6. Maintaining normal weight.
7. Controlling the amount of cholesterol in the blood.

Video about the treatment of acute coronary syndrome

Do you want to know about the mortality statistics from acute heart failure and the severe consequences of this common ailment? Watch the video for the impressive numbers and compelling case for coronary insufficiency prevention. You will learn what is acute coronary heart disease, what are modern methods its treatment, how doctors restore coronary circulation and bring patients back to life.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual features specific patient.

Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!

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 impaired cardiac detail in practically healthy people or in persons 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 a little over 50, he always endured all the difficulties of business and personal life, moved to live in London, was regularly examined and kept healthy lifestyle life. 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 sympathetic department 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 patency respiratory tract. The victim should be placed on a rigid horizontal surface Tilt your head back and protrude your 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 effective treatment and prevention.

Possible complications in survivors

Even with successful events 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:

Diseases of cardio-vascular system 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.

A 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.

AT International classification 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 tachycardia ventricles (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 diseases of the heart and blood vessels. 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 sudden death - acute coronary insufficiency, arising and 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;
• thromboembolism pulmonary artery- 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 have had violent attack ischemic pain. Such pain appears sharply, it seems to compress the chest, gives it to the lower jaw, left hand and a spatula. But ischemic pains - 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 procedure hearts;
• 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.

Also important is the dosage exercise stress. At least 1-2 times a day you need to do exercises or walk on 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 - destruction of the center of the 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 surgery, 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%.

Sudden coronary death is sudden, unexpected death due to the cessation of the functioning of the heart (sudden cardiac arrest). In the US, it is one of the leading causes of natural death, claiming about 325,000 adult lives each year and accounting for half of all deaths from cardiovascular disease.

Sudden coronary death occurs most frequently between the ages of 35 and 45 and affects men twice as often. She is rarely seen in childhood and occurs in 1-2 out of 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 of the arteries in the heart become blocked, preventing enough oxygenated blood from being delivered to the heart. If insufficient oxygen is supplied to the heart with blood, 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. Fluttering or blinking of the ventricles (ventricular fibrillation) may occur, and the blood supply to the body stops. In the first minutes of the greatest importance is such a critical decrease in blood flow to the heart that the person loses consciousness. If not immediately provided medical care, then death may occur.

The pathogenesis of sudden cardiac death

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

Approximately 20-30% of patients have bradyarrhythmia and episodes of asystole before the onset of sudden cardiac death. Bradyarrhythmia may 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. The development of sudden cardiac death requires a combination of various factors, most often the following:

The development of severe 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, tension vascular wall, metabolic disorders.

Pathogenetic mechanisms of development of sudden cardiac death in IHD:

Reducing the ejection fraction of the left ventricle is 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 greater 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 as a result ventricular arrhythmia may 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 may be mediated by the influence of the sympathetic nervous system, activity vagus nerve, the state of the vascular wall, the processes of activation and aggregation of platelets.

Rhythm disturbances in patients with structural anomalies 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 myocardial infarction.

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

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

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

Rhythm disturbances in patients without structural anomalies of the heart and blood vessels

The causes of ventricular tachycardia and ventricular fibrillation at the molecular level can be the following disorders:

Neurohormonal disorders.

Violations 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 type breathing (noisy, rapid breathing); 3. absence of a 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. change in skin color, the appearance of a pale gray color of the skin of the face.

If the patient is under 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 excitations of individual muscle fibers of the ventricles. At the beginning of the wave, fibrillation is usually high-amplitude, occurring at a frequency of about 600 min-1. At this stage, the prognosis for defibrillation is more favorable compared to the prognosis at the next stage. Further, the flicker waves become low-amplitude with a wave frequency of up to 1000 and even more per 1 min. The duration of this stage is about 2-3 minutes, then the duration of flicker waves increases, their amplitude and frequency decrease (up to 300-400 min-1). At this stage, defibrillation is not always effective. 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, the ST interval, the T wave, there is no isoline. Most often, ventricular flutter turns into their flicker. The 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 during electromechanical dissociation of the heart is shown in fig. 2.

Rice. 2

Urgent care

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

Cardiopulmonary resuscitation should begin before the patient enters the hospital. Cardiopulmonary resuscitation includes pre-hospital and hospital stages.

In order to provide assistance to prehospital stage diagnostics needs to be done. Diagnostic measures must be taken within 15 seconds, otherwise it will not be possible to resuscitate the patient. As diagnostic measures:

Feel for a pulse. It is best to palpate the carotid artery on the side of the neck and on both sides. There is no pulse during VCS.

Checking consciousness. The patient will not respond to painful blows and pinches.

Check reaction to light. The pupils dilate on their own, but do not react to light and what is happening around.

Check for BP. With VKS, this cannot be done, since it does not exist.

It is necessary to measure the pressure already in the course of resuscitation, since it takes a long time. The first three measures are enough to confirm clinical death and start resuscitating the patient.

Prehospital stage of cardiopulmonary resuscitation

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

Basic life support (urgent oxygenation)

Restoration of airway patency.

Maintaining breathing (artificial ventilation of the lungs).

Maintaining blood circulation (indirect cardiac massage).

Further actions aimed at maintaining life (restoration of spontaneous circulation)

Introduction medications and liquids.

Intravenous route of administration medicines.

Perhaps the introduction of drugs into a peripheral vein.

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

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

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

Endotracheal route of drug administration.

If tracheal intubation is performed earlier than venous access is provided, then atropine, adrenaline, lidocaine can be passed through the probe into the trachea.

The preparations 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 must be below the end of the endotracheal tube.

After the introduction of the drug, it is necessary to sequentially perform 2-3 breaths (while stopping the indirect heart 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.

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

Optimal for ECG recording is a three-channel electrocardiograph in automatic or manual mode.

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 an energetic fist to the heart (precordial punch) and, in the absence of a pulse in the carotid arteries, proceed to cardiopulmonary resuscitation.

The fastest, most effective, and generally accepted method of stopping ventricular tachycardia and ventricular fibrillation is electrical defibrillation. Method of electrical defibrillation.

Tactics in electromechanical dissociation.

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

Measures to eliminate the causes of electromechanical dissociation.

Tactics in asystole.

Carry out general resuscitation.

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

Intravenous injection of atropine at a dose of 1 mg every 3-5 minutes.

Perform pacing.

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

In case of efficiency resuscitation necessary:

Ensure adequate ventilation of the lungs.

Continue the introduction of antiarrhythmic drugs for prophylactic purposes.

To diagnose and treat the disease that caused sudden cardiac death.

rhythm heart violation resuscitation