There is instant death. Why does a person die? The most common causes of death. Causes of sudden human death. Diagnosis of sudden death syndrome

Sudden cardiac (coronary) death

Sudden cardiac death(sudden cardiac death; sudden coronary death)- naturally occurring fatal outcome of the disease of cardio-vascular system within one hour from the onset of its development in persons who were previously in a stable condition (in the absence of signs allowing another diagnosis).

TO sudden cardiac death include cases of sudden cessation of cardiac activity, which are characterized by the following symptoms:

Death occurred in the presence of witnesses within one hour after the onset of the first threatening symptoms
before death, the condition of the patients was assessed by others as stable and not causing serious concern
death occurred under circumstances excluding other causes (violent death, injuries, other fatal diseases)

ETIOLOGY

Causes of sudden cardiac death:

In the vast majority of cases (about 85–90%), the cause of sudden cardiac death is ischemic heart disease, and any of its clinical options, including asymptomatic course, when sudden death is the first and last clinical manifestation illnesses
any heart disease accompanied by severe myocardial hypertrophy (for example, hypertrophic cardiomyopathy, stenosis of the aortic mouth, etc.)
congestive heart failure of any origin
cardiogenic shock of any origin
cardiac tamponade of any origin
thromboembolism pulmonary artery
primary electrophysiological abnormalities, such as: long QT syndrome, prolongation of the QT interval (congenital and acquired forms); sick sinus syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia
non-atherosclerotic diseases coronary arteries
inflammatory, infiltrative, neoplastic and degenerative processes
congenital diseases
rhythm disturbances as a consequence of neurohumoral influences or disorders of the central nervous system (impaired autonomic regulation of the heart with a predominance of sympathetic activity; the most important marker of this condition is a decrease in variability sinus rhythm, as well as increasing the duration and dispersion of the Q-T interval)
sudden infant death syndrome and sudden death in children
concussion (heart contusion)
aortic dissection
intoxication or metabolic disorders

Those at greatest risk of sudden cardiac death are:

Patients with acute myocardial infarction, especially in the first hour of myocardial infarction (it should be noted that sudden death that occurs in the early (acute) phase of myocardial infarction, verified clinically or at autopsy, is regarded as “death from heart attack”; however, according to its mechanisms, clinical picture and the complex of necessary resuscitation measures, it fully corresponds to sudden cardiac death that develops in other forms of coronary heart disease, and is therefore discussed in this section)
patients with heart failure
patients with a history of myocardial infarction, especially those with cardiomegaly and congestive heart failure
patients with coronary heart disease with high grade ventricular arrhythmias
patients with coronary heart disease who have several main risk factors – arterial hypertension, hypertrophy of the left atrium, smoking, disorders of carbohydrate and fat metabolism, etc.

One of the most difficult aspects of this issue is identifying those who have increased risk sudden death. According to a number of authors, in approximately 40% of people who had out-of-hospital sudden death, the latter was the first clinical manifestation of the disease, and among patients with pre-existing heart disease, only half had a myocardial infarction diagnosed in the past. These data reflect not so much the low importance of risk factors as the difficulty of identifying the latter and the fact of insufficient examination of at-risk patients.

The most significant predictors of sudden death in patients with coronary heart disease:

The occurrence of high grade ventricular arrhythmias in patients with low exercise tolerance and a positive bicycle ergometer test
severe depression of the RS–T segment (more than 2.0 mm), pathological increase blood pressure and early achievement of maximum heart rate during load test
the presence of pathological Q waves or the QS complex on the ECG in combination with blockade of the left bundle branch and ventricular extrasystole
the presence of major risk factors in the patient (arterial hypertension, left atrial hypertrophy, smoking and diabetes mellitus) in combination with decreased exercise tolerance and a positive bicycle ergometer test

PATHOGENESIS

In most patients with coronary heart disease who die suddenly, including patients with asymptomatic disease, autopsy reveals significant atherosclerotic changes in the coronary arteries: narrowing of their lumen by more than 75% and multi-vessel damage to the coronary bed; atherosclerotic plaques, located predominantly in the proximal sections of the coronary arteries, are usually complicated, with signs of endothelial damage and the formation of parietal or (relatively rarely) blood clots completely occluding the lumen of the vessel - these changes, together with the possible dynamic occlusion (pronounced spasm) of the coronary arteries under these conditions vessels and an increase in myocardial oxygen demand are the cause of the development of acute focal ischemic damage to the heart muscle, which underlies sudden cardiac death.

It should be noted that at autopsy only 10–15% of patients with coronary heart disease who died suddenly reveal macroscopic and/or histological features acute heart attack myocardium- this is explained by the fact that the formation of such signs requires at least 18–24 hours.

The results of electron microscopy show that already 20–30 minutes after the cessation of coronary blood flow:

The process of irreversible changes in the cellular structures of the myocardium begins, which is completed after 2–3 hours of coronary occlusion
severe irreversible disturbances in myocardial metabolism occur, leading to electrical instability of the heart muscle and fatal rhythm disturbances

The immediate causes of sudden cardiac death are:

ventricular fibrillation- this is frequent up to 200–500 per minute, but erratic, irregular excitation and reduction of individual muscle fibers; as a result of such chaotic activation of individual groups of cardiomyocytes, their simultaneous synchronous contraction becomes impossible; Ventricular asystole occurs and blood flow stops
cardiac asystole(cardiac asystole is often preceded by fibrillation and ventricular flutter) - this is a complete cessation of cardiac activity, its arrest (primary asystole is caused by a dysfunction of the automatism of the SA node, as well as pacemakers II and III order: AV junction and Purkinje fibers; in these cases, asystole is preceded by the so-called electromechanical dissociation of the heart, in which signs of minimal electrical activity heart in the form of a rapidly depleting sinus, nodal or rare idioventricular rhythm, but cardiac output is critically reduced; electromechanical dissociation quickly turns into cardiac asystole)

CLINICAL PICTURE

Most cases of sudden cardiac death occur during out-of-hospital conditions, which determines the most common fatal outcome of this form of coronary heart disease.

Sudden cardiac death may be provoked excessive physical or neuropsychic stress, but can occur at rest, for example, in sleep. Immediately before sudden cardiac death occurs approximately half of the patients experience a painful anginal attack often accompanied by fear near death. Near 1/4 of cases of sudden cardiac death occur at lightning speed and without visible warning signs; in other patients, 1–2 weeks before sudden death, various, not always specific, prodromal symptoms are observed, indicating an exacerbation of the disease: increased pain in the heart (sometimes of atypical localization), shortness of breath, general weakness and a significant decrease in performance and exercise tolerance, palpitations and interruptions in heart function, etc.

Immediately during sudden onset of ventricular fibrillation or cardiac asystole The patient develops severe weakness and dizziness. After a few seconds, as a result of complete cessation of cerebral blood flow, the patient loses consciousness, tonic contraction of skeletal muscles and noisy breathing appear.

On examination, the skin is pale with a grayish tint and cold to the touch. The pupils begin to dilate quickly. The pulse in the carotid arteries is not detected, heart sounds are not heard. After about 1.5 minutes, the pupils are maximally dilated. There is an absence of pupillary and corneal reflexes. Breathing quickly slows down, becomes agonal, very rare individual “convulsive breathing movements" After 2.5–3 minutes, breathing stops completely. It should be remembered that approximately 3 minutes after the onset of ventricular fibrillation or asystole, irreversible changes occur in the cells of the cerebral cortex.

TREATMENT

If sudden cardiac death occurs, immediately perform cardiopulmonary resuscitation, which includes airway management, artificial ventilation, chest compressions, electrical defibrillation and drug therapy (see. European Resuscitation Council algorithm).

PREVENTION OF SUDDEN CARDIAC DEATH

To reliably predict the risk of sudden death, an integrated approach is required, including calculating high-resolution ECG parameters, determining the nature of ectopia in daily monitoring ECG using the Holter method with temporary and spectral analysis autonomic regulation (analysis of R-R distribution), as well as determination Q-T dispersion interval. The dispersion of the Q-T interval is determined by the difference between the maximum and minimum QT interval in different leads, which is determined by the variability of the repolarization process. Modern stationary and portable electrocardiographic systems have a wide range of diagnostic capabilities, which combine all the versatility of methodological approaches to ECG analysis. It is important to know and use their undoubtedly high research potential in scientific research And clinical practice. Conducting a comprehensive study aimed at identifying patients at high risk of malignant ventricular arrhythmias and sudden death will allow timely adoption of adequate therapeutic measures in each specific case.

Approaches to the prevention of sudden death are based, first of all, on influencing the main risk factors:

Threatening arrhythmias
myocardial ischemia
decreased left ventricular contractility

Numerous studies have shown the effectiveness of various beta blockers regarding the prevention of sudden death in post-infarction patients. The high preventive effectiveness of these drugs is associated with their antianginal, antiarrhythmic and bradycardic effects. Currently, it is generally accepted to prescribe continuous therapy with beta-blockers to all post-infarction patients who do not have contraindications to these drugs. Preference is given to cardioselective beta-blockers that do not have sympathomimetic activity. The use of beta-blockers can reduce the risk of sudden death not only in patients with coronary artery disease, but also hypertension. Treatment calcium antagonist Verapamil in post-infarction patients without signs of heart failure may also help reduce mortality, including sudden arrhythmic death. This is explained by the antianginal, antiarrhythmic and bradycardic effect of the drug, similar to the effect of beta-blockers. It seems very promising correction of left ventricular dysfunction as a direction in reducing the risk of sudden death - the preventive effectiveness of angiotensin-converting enzyme inhibitors in patients with coronary heart disease and heart failure. Reducing the incidence of sudden death can be achieved by primary prevention coronary heart disease through a comprehensive impact on the main risk factors: smoking, arterial hypertension, hypercholesterolemia, etc. Effectiveness has been proven secondary prevention complications of coronary heart disease with the use of anti-sclerotic drugs of the statin class.

Patients with life-threatening arrhythmias that cannot be treated with preventive measures drug therapy, shown surgical methods treatment:

Implantation of pacemakers for bradyarrhythmias
implantation of defibrillators for tachyarrhythmias and recurrent ventricular fibrillation
transection or catheter ablation of abnormal conduction pathways for ventricular preexcitation syndromes
destruction or removal of arrhythmogenic foci in the myocardium

As already noted, despite achievements achieved, identifying potential victims of sudden arrhythmic death in many cases fails. For those who have a defined high risk sudden stoppage of blood circulation, the latter cannot always be prevented by available means. Therefore, the most important aspect of the fight against fatal arrhythmias is the timely implementation of resuscitation measures in the event of the development of circulatory arrest. Due to the fact that sudden arrhythmic death in most cases occurs outside of medical institutions, it is very important that not only medical workers, but also the general population were familiar with the basics resuscitation care. This requires the organization of appropriate classes within the curriculum of schools, technical schools and universities. Equally important is the presence of specialized resuscitation teams equipped with appropriate equipment within emergency medical care institutions.

– this is asystole or ventricular fibrillation that occurs against the background of the absence of a history of symptoms indicating coronary pathology. The main manifestations include the absence of breathing, blood pressure, pulse in the great vessels, dilated pupils, lack of reaction to light and any types of reflex activity, marbling of the skin. Symptoms appear within 10-15 minutes cat eye. The pathology is diagnosed on site based on clinical signs and electrocardiography data. Specific treatment– cardiopulmonary resuscitation measures.

Sudden coronary death accounts for 40% of all causes of death in people over 50 but under 75 years of age without known heart disease. There are about 38 cases of SCD per 100 thousand population annually. With timely initiation of resuscitation in the hospital, survival is 18% and 11% for fibrillation and asystole, respectively. About 80% of all cases of coronary death occur in the form of ventricular fibrillation. Middle-aged men who have nicotine addiction, alcoholism, lipid metabolism disorders. Due to physiological reasons, women are less susceptible to sudden death from cardiac causes.

Causes

Risk factors for VCS do not differ from those for ischemic disease. Provoking influences include smoking, eating large amounts of fatty foods, arterial hypertension, and insufficient intake of vitamins. Non-modifiable factors – elderly age, male gender. Pathology may occur under the influence external influences: excessive force loads, diving into ice water, insufficient oxygen concentration in the surrounding air, with acute psychological stress. The list of endogenous causes of cardiac arrest includes:

• Atherosclerosis of the coronary arteries. Cardiosclerosis accounts for 35.6% of all SCDs. Cardiac death occurs immediately or within an hour after the onset of specific symptoms of myocardial ischemia. Against the background of atherosclerotic lesions, AMI is often formed, which provokes a sharp decrease in contractility, the development of coronary syndrome, and flicker.
• Conduction disorders. Sudden asystole is usually observed. CPR measures are ineffective. Pathology occurs when organic damage conduction system of the heart, in particular the synatrial, atrioventricular node or large branches of the His bundle. As a percentage, conductivity failures account for 23.3% of total number cardiac deaths.
• Cardiomyopathies. Detected in 14.4% of cases. Cardiomyopathies are structural and functional changes in the coronary muscle that do not affect the coronary artery system. Found in diabetes mellitus, thyrotoxicosis, chronic alcoholism. May be of a primary nature (endomyocardial fibrosis, subaortic stenosis, arrhythmogenic pancreatic dysplasia).
• Other states. Share in general structure morbidity – 11.5%. Include congenital anomalies cardiac arteries, left ventricular aneurysm, as well as cases of VCS, the cause of which could not be determined. Cardiac death can occur with pulmonary embolism, which causes acute right ventricular failure, accompanied by sudden cardiac arrest in 7.3% of cases.

Pathogenesis

Pathogenesis directly depends on the causes of the disease. At atherosclerotic lesion coronary vessels, one of the arteries is completely occluded by a thrombus, the blood supply to the myocardium is disrupted, and a focus of necrosis is formed. The contractility of the muscle decreases, which leads to acute coronary syndrome and cessation of cardiac contractions. Conduction disturbances provoke a sharp weakening of the myocardium. Ned residual contractility causes a decrease cardiac output, stagnation of blood in the chambers of the heart, formation of blood clots.

For cardiomyopathies pathogenetic mechanism based on a direct decrease in myocardial performance. In this case, the impulse spreads normally, but the heart, for one reason or another, reacts poorly to it. The further development of the pathology does not differ from the blockade of the conduction system. With pulmonary embolism, the flow of venous blood to the lungs is disrupted. The pancreas and other chambers are overloaded, blood stagnation is formed in big circle blood circulation A heart overflowing with blood under conditions of hypoxia is unable to continue working and it suddenly stops.

Classification

Systematization of SCD is possible based on the causes of the disease (AMI, blockade, arrhythmia), as well as on the presence of previous signs. In the latter case, cardiac death is divided into asymptomatic (the clinical picture develops suddenly against the background of unchanged health) and having previous signs (short-term loss of consciousness, dizziness, chest pain an hour before the development of the main symptoms). The most important for resuscitation measures is the classification according to the type of cardiac dysfunction:

1. Ventricular fibrillation. Happens in the vast majority of cases. Requires chemical or electrical defibrillation. It is a chaotic disordered contraction of individual fibers of the ventricular myocardium, unable to provide blood flow. The condition is reversible and can be easily managed with resuscitation measures.
2. Asystole. Complete cessation of heart contractions, accompanied by a cessation of bioelectrical activity. More often it becomes a consequence of fibrillation, but it can develop primarily, without previous flicker. Arises as a consequence of severe coronary pathology, resuscitation measures are ineffective.

Symptoms of sudden cardiac death

40-60 minutes before the arrest develops, previous signs may appear, which include fainting lasting 30-60 seconds, severe dizziness, loss of coordination, a decrease or increase in blood pressure. Characteristic pain behind the sternum is of a compressive nature. According to the patient, it feels like the heart is being squeezed in a fist. Precursor symptoms are not always observed. Often the patient simply falls while doing some work or physical exercise. Sudden death in sleep without prior awakening is possible.

Cardiac arrest is characterized by loss of consciousness. The pulse is not detected both on the radial and on main arteries. Residual breathing can persist for 1-2 minutes from the moment the pathology develops, but inhalations do not provide the necessary oxygenation, since there is no blood circulation. On examination, the skin is pale and bluish. Cyanosis of the lips, earlobes, and nails is noted. The pupils are dilated and do not respond to light. There is no reaction to external stimuli. During blood pressure tonometry, Korotkoff sounds are not heard.

Complications

Complications include the metabolic storm that occurs after successful resuscitation efforts. Changes in pH caused by prolonged hypoxia lead to disruption of receptor activity, hormonal systems. In the absence of the necessary correction, acute renal or multiple organ failure develops. The kidneys can also be affected by microthrombi formed during the onset of disseminated intravascular coagulation syndrome, myoglobin, which is released during degenerative processes in the striated muscles.

Poorly carried out cardiopulmonary resuscitation causes decortication (brain death). In this case, the patient’s body continues to function, but the cerebral cortex dies. Restoring consciousness in such cases is impossible. A relatively mild variant of cerebral changes is posthypoxic encephalopathy. It is characterized by a sharp decrease in the patient’s mental abilities and impaired social adaptation. Possible somatic manifestations: paralysis, paresis, dysfunction internal organs.

Diagnostics

Sudden cardiac death is diagnosed by a resuscitator or other specialist with a medical education. Trained representatives of emergency response services (rescuers, firefighters, police), as well as people who happen to be nearby and have the necessary knowledge, can determine circulatory arrest outside the hospital. Outside the hospital, the diagnosis is made solely on the basis clinical signs. Additional techniques are used only in ICU settings, where their use requires minimum time. Diagnostic methods include:

• Hardware tutorial. On the cardiac monitor to which each patient in the intensive care unit is connected, large-wave or small-wave fibrillation is noted, and there are no ventricular complexes. An isoline may be observed, but this rarely happens. Saturation levels quickly decrease, blood pressure becomes undetectable. If the patient is on assisted ventilation, ventilator indicates that there are no attempts to inhale spontaneously.
• Laboratory diagnostics. It is carried out simultaneously with measures to restore cardiac activity. Great importance has a blood test for acid base and electrolytes, which shows a shift in pH to the acidic side (a decrease in the pH value below 7.35). To exclude acute infarction, a biochemical study may be required to determine increased activity CPK, CPK MB, LDH, the concentration of troponin I increases.

Urgent Care

The victim is assisted on the spot, and transported to the ICU after the heart rhythm is restored. Outside health care facilities, resuscitation is carried out using protozoa basic techniques. In a hospital or ambulance setting, it is possible to use complex specialized techniques of electrical or chemical defibrillation. The following methods are used for revival:

1. Basic CPR. It is necessary to place the patient on a hard, flat surface, clean Airways, throw back your head, extend your lower jaw. Pinch the victim's nose, put a cloth napkin on his mouth, cover his lips with yours and make deep exhale. Compression should be performed using the entire body weight. The sternum should be pushed out by 4-5 centimeters. The ratio of compressions and breaths is 30:2, regardless of the number of resuscitators. If the heart rate and spontaneous breathing recovered, you need to lay the patient on his side and wait for the doctor. Self-transportation is prohibited.
2. Specialized assistance. In a medical institution, assistance is provided in a comprehensive manner. If ventricular fibrillation is detected on the ECG, defibrillation is performed with discharges of 200 and 360 J. It is possible to administer antiarrhythmics against the background of basic resuscitation measures. For asystole, adrenaline, atropine, sodium bicarbonate, and calcium chloride are administered. Patient in mandatory intubated and transferred to artificial ventilation, if this has not been done previously. Monitoring is indicated to determine the effectiveness of medical actions.
3. Help after rhythm restoration. After restoration of sinus rhythm, mechanical ventilation is continued until consciousness is restored or longer if the situation requires it. Based on the results of the acid-base balance analysis, a correction is made electrolyte balance, pH. 24-hour monitoring of the patient's vital activity and assessment of the degree of damage to the central nervous system are required. Appointed rehabilitation treatment: antiplatelet agents, antioxidants, vascular drugs, dopamine for low blood pressure, soda for metabolic acidosis, nootropic drugs.

Prognosis and prevention

The prognosis for any type of SCD is unfavorable. Even with timely CPR, there is a high risk ischemic changes in the tissues of the central nervous system, skeletal muscles, and internal organs. The probability of successful rhythm restoration is higher with ventricular fibrillation; complete asystole is less prognostically favorable. Prevention consists of early detection of heart disease, avoiding smoking and drinking alcohol, and regular moderate aerobic exercise (running, walking, jumping rope). From excessive physical activity(weightlifting) it is recommended to refuse.

Article publication date: 05/26/2017

Article updated date: 12/21/2018

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

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

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

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

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

Causes of coronary death

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

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

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

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

The following factors increase the risk of VCS:

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

Symptoms

Sudden coronary death has pronounced symptoms:

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

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

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

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

Providing first aid to a person with sudden coronary death

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

Sequence of actions in the presence of cardiac arrest:

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

Forecast

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

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

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

Prevention

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

Healthy and balanced diet

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

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

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

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

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

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

Physical activity

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

Regular physical exercise increases the efficiency of the cardiovascular system, reduces blood cholesterol levels, and also keeps blood pressure levels within normal limits. They also reduce the risk of developing diabetes.

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

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

Normalizing and maintaining a healthy weight

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

To give up smoking

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

Limiting alcohol consumption

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

Blood pressure control

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

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

Diabetes control

Patients with diabetes have an increased risk of coronary artery disease. A balanced diet is helpful for controlling blood glucose levels. physical activity, normalization of weight and the use of glucose-lowering medications prescribed by a doctor.

Everyone knows about terrible poisons and tries to stay as far away from them as possible. It would never occur to anyone to put a jar of arsenic in the refrigerator or kitchen cabinet. But you can find a lot of all kinds of solvents, cleaners, fresheners and other products. But they are no less dangerous than potassium cyanide.

3. Insecticides help fight pests, but you can become poisoned by spraying them in unventilated areas. The use of these drugs will lead to convulsions and coma.
4. Some artificial nail remover solvents may cause serious consequences. When consuming them, you can get methemoglobinemia and oxygen starvation.

5. Be careful with pipe cleaners, as the fumes from these products can kill if inhaled and burn internal organs.
6. Numbing creams work on the area where they are applied, but if you do not follow the instructions, you can damage your eyes.

7. Anionic detergent, known as carpet cleaner, is very caustic and can cause organ damage, and you can be blinded if it gets in your eyes.
8. If you exceed the dose of iron tablets, you can get iron poisoning. If you don't get help within 24 hours, your brain and liver will suffer. You might even die.

9. Toilet bowl cleaners remove dirt and bad smell. If consumed, this drug can damage internal organs and cause you to fall into a coma.
10. Pain pills, including paracetamol, aspirin and ibuprofen, can cause death if overdosed. The internal organs will simply fail.

11. Furniture polish can cause coma if drunk. this remedy or it’s good to inhale it. If polish gets in your eyes, you can go blind, and if it gets on your delicate skin– cause burns and irritation.
12. Perfume and cologne contain alcohol ethanol and isopropanol. Both of these substances can cause nausea, anxiety and seizures.

13. Don't drink mouthwash. It can cause diarrhea, dizziness and coma.
14. Gasoline is dangerous due to its fumes, inhaling which can cause dizziness, low blood pressure, pain in the eyes, ears, nose and throat.

15. Drinking kerosene, the liquid that is used for ignition, in kerosene lamps and kerosene gases, can cause bloody stools, cramps and a burning sensation in the internal organs.
16. Moths are annoying, but you can’t eat anti-moth tablets. You can get oxygen starvation and coma.

17. Oil paints can damage the skin and, if ingested or ingested, can cause serious problems With nervous system and cause death.
18. Codeine is sold as prescribed by a doctor, but in overdose it causes fatigue, drowsiness, intestinal cramps and death.

19. Taking a large dose alcoholic drinks, we not only get drunk, but get seriously poisoned and even die if medical assistance is not provided in time.
20. If it turns out that someone swallowed paint thinner, then there is a risk of necrosis of the tissues of internal organs, and if inhaled, memory loss and fever.

21. Rodent poison can cause blood in the urine and stool, a metallic taste in the mouth, and as brain hemorrhage occurs, pale skin and death.
22. Some skin lightening creams contain mercury in such quantities that it can cause poisoning. The gums may bleed, there will be bloody stools, vomiting and death.

23. Most deodorants or antiperspirants contain aluminum salts and ethanol. Tasting or inhaling large enough amounts can cause diarrhea, vomiting, coma and death.
24. Turpentine is a substance that is obtained from pine. If you taste it or inhale deeply, you can get bloody stool and die.

25. Everyone knows that thermometers contain mercury. You should not taste it, as it is a highly toxic metal.
26. Repellents contain insect poison that protects us from their bites. Ingestion of the repellent may cause vomiting, coughing and convulsions.

27. Anti-redness creams for babies can be very dangerous in the hands of children. Never leave them within the reach of an infant. You take a risk even if you step away for a minute.
28. You may have acne, which means you use special creams. Never taste these products or apply them intensively to the skin - you will minimally get contact dermatitis.

29. Calamine lotion is used for skin diseases, but it contains zinc oxide, which can cause chills, nausea and high temperature.
30. Teflon is used to coat pans and pots to prevent food from burning, but when heated, it can lead to cancer and other health problems. Do not leave cooked food on the Teflon surface for a long time.

31. Contains the plastic from which it is made plastic bottles, contains bisphenol, which can cause cancer and hormonal problems in adolescents, accelerating the transition to puberty.
32. If herbicides are destructive to one organic matter, then they can harm another. If they are consumed internally, you can fall into a coma.

33. All fireproofing materials contain polybrominated diphenyl ethers, which can cause many health problems. In Europe, the use of these substances is prohibited.
34. Sleeping pills can kill.

35. If you have items in your home that are covered with Scotchgard, which was produced before 2000, you may suffer from birth defects and other health problems.
36. The powder that is in the printer is also an unsafe material. If you print a lot with a laser printer, do it in a well-ventilated area.

37. Coal tar is a carcinogen, which means it causes cancer.
38. Formaldehyde is used in the woodworking industry; if you inhale the fumes of this substance, you can feel irritation in the nose and eyes, and nasal cancer can occur in pets.

39. Lead paint is rarely used today, but that doesn't mean lead poisoning is uncommon because you have old newspapers and books stored in your attic, or even the paint itself.
40. Motor oil can damage organs, especially the lungs. In addition, in case of poisoning motor oil There may be brain damage and breathing problems.

Doctors are sounding the alarm. Around the world, cases of unexplained death of young people aged 18 to 30 are increasingly being recorded. The concept of “sudden infant death syndrome” has been known to science for quite some time, but experts insist that the time has come to introduce medical reference books the new term is sudden adult death syndrome.

From the history

The term sudden death first appeared in 1917 in the Philippines, where the syndrome was called “bangungut”. Then, in 1959, Japanese doctors called it “smoke”; specialists from Laos, Vietnam and Singapore also wrote about a similar phenomenon.

But as an independent disease, sudden cardiac death syndrome began to stand out in the 80s of the 20th century, thanks to American researchers. At this time, the American Center for Disease Control in Atlanta recorded an unusual high level mortality (25 cases per 100,000 people) among young people from South-East Asia. It was noted that their deaths mostly occurred at night, and all the dead were men aged 20 to 49 years. Moreover, most of them were outwardly absolutely healthy, did not suffer from excess weight and did not have bad habits(alcohol, smoking, drugs).

Having compared the data obtained with information from colleagues from the countries of the Far East and Southeast Asia, the researchers found that it is in these regions that cases of such pathology are very common, and more often among individuals young. At the same time, such a syndrome practically does not occur among African-Americans.

Causes of sudden death in a dream

Scientists have found that sudden cardiac death is typical in the predawn and early morning hours. The fact is that in a lying position, the flow of venous blood to the heart increases, as a result of which the heart muscle requires even more oxygen. If a person has any heart disease, the heart is obviously insufficiently supplied with oxygen and in this case may simply not withstand the load.

Harbingers of the syndrome may include pressing or squeezing pain behind the sternum or in the heart area, tachycardia ( rapid heartbeat) or bradycardia (rare heartbeat), decreased blood pressure, bluish skin, weak pulse. A fairly common symptom is stopping breathing during sleep (apnea).

Sudden death itself can be suspected by the following manifestations: sudden loss of consciousness, convulsions, slowing of breathing until it stops. Within three minutes after the onset of unexpected cardiac arrest, irreversible changes develop in the cells of the central nervous system.

Risk factors for sudden cardiac death

It is difficult to say for what exact reason a person’s heart suddenly stops beating during sleep. As a rule, autopsies in such situations do not show serious violations structures and structure of the heart. However, doctors are prepared to warn with a list of the most common causes of heart failure, which significantly increases the risk that you will experience sudden cardiac death at night.

First of all, this is a violation of blood flow in the heart area, coronary heart disease, disruption of the structure and function of the main heart muscle, blood clots and blockage of arteries, congenital and chronic diseases cardiovascular system, overweight and diabetes. IN separate group Risk factors include previous heart attacks or cardiac arrest, and frequent episodes of loss of consciousness.

Official statistics claim that all cases of unexpected death during sleep can be divided into three big reasons: primary arrhythmia (47%), ischemic factors (43%) and insufficiency of the pumping function of the heart (8%).

Precursors of sudden cardiac death

Cardiologists and physiologists have compiled a small list of conditions that may precede sudden arrhythmic death and should seriously alert both the person and his loved ones.

• unexpected cases of severe weakness, sweating and dizziness, which quickly end.
• unnatural pallor of a person against the background of surges in blood pressure.
• pallor after physical exertion, during stress and emotional overstimulation.
• reduced, not high blood pressure after any physical activity.

If at least one such episode occurs, you should seek help from a cardiologist and carry out necessary examinations and, if necessary, treatment.

Cardiac nocturnal death in healthy people

When a person dies unexpectedly and, at first glance, for no reason at night, it leaves his loved ones in shock and complete bewilderment. However, pathologists are convinced that the concept of “health” in this case is quite subjective.

Forensic pathologist and medical examiner in Dallas County, USA, Dr. Candace Schopp believes that the incidence of apparently healthy people dying in their beds at night depends on how they themselves understand the word “healthy.”

According to him, obesity is often the cause of sudden death. coronary insufficiency or clogged arteries. Similar diagnoses during life, they may not bother the patient, or the person simply does not find the time and opportunity to see a doctor, mistakenly believing himself to be healthy.

First aid

If you find yourself near a person who is suddenly having a life-threatening attack, call immediately. emergency assistance, open the windows in the room (to increase the access of oxygen), ask the person not to move under any circumstances and try to remain conscious for as long as possible.

If possible health care in case of unexpected cardiac death, it should be provided as early as possible - in the first 5-6 minutes after cardiac arrest and disappearance of signs of life.

Resuscitation measures include chest compressions (rhythmic pressure on the chest with a certain frequency, which helps push out blood and all the cavities of the heart), artificial respiration(mouth to mouth). In conditions medical institution it is possible to carry out defibrillation (applying electric shocks to the chest special apparatus), which is a very successful way to restore heart rhythm.

If measures to provide first aid to the patient are successful, he is hospitalized in the cardiology or intensive care unit for examination and identification of the causes of similar condition. In the future, such people should regularly attend appointments with a cardiologist and follow all preventive recommendations.

Non-drug prevention of the causes of cardiac death can be considered the abandonment of any bad habits, proper nutrition and playing sports, positive emotions, avoiding stress and emotional stress

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However, certain physical diagnoses often cause misunderstanding and even hostility from others. This may affect people with fibromyalgia, diabetes and migraine headaches. Their journey to getting a correct diagnosis and treatment can sometimes be very challenging, increasing the likelihood of stress. Certain changes in habitual behavior may be a consequence of certain endocrine disorders and pathologies.

Violence is like an infection

Some experts suggest viewing violence as an infectious disease. For example, he has his own “ incubation period", often quite lengthy. It is quite easy to become infected with violence, because people adopt and reproduce the behavior patterns of those around them. Violence even has its own list of risk factors, for example, poverty and insufficient education.

That is why an integrated approach is needed in the fight against all types of violence, in which each organization will have its own role. This problem must also involve law enforcement agencies, and medicine, and social services. Well, propaganda among the population and work to improve the living conditions of certain segments of the population are also important.

The difficulty is that many methods of treating breast tumors are aimed precisely at blocking one or more of these receptors, but in the case of triple-negative cancer such therapy will be powerless. Doctors will most likely suggest chemotherapy instead. But the exact treatment plan will depend on the size of the tumor and its extent.

Relapse

In this case, there is a special list of factors that can influence the frequency of relapses after recovery. This:

• The tumor is too big
• Diagnosis at a young age
• Lumpectomy without subsequent radiation
• Damage to the lymph nodes.

The risk of relapse is highest in the first years after recovery; after 5 years it decreases significantly. Also, people with three times this form of cancer are more prone to metastases.

According to statistics, this type of cancer accounts for approximately 10-20% of the total number of diagnosed breast tumors.

Symptoms

A certain group of women are much more susceptible to triple negative cancer. This:

• Patients under 50 years of age
• People with particular susceptibility to type 1 breast cancer
• Women who have not breastfed
• Overweight women
• Patients with very dense breasts

Signs of triple negative cancer generally do not differ from general symptoms malignant tumor breasts This is a lump in the breast area, discharge from the nipple, redness or pain in the mammary glands.

Treatment and prevention

As we have already said, hormone therapy in this case is not at all effective, so another treatment plan is proposed: surgery, radiation or chemotherapy. The surgery may involve a lumpectomy (removal of individual breast tissue) and mastectomy (removal of one or both breasts if necessary). Triple negative cancer is considered a more severe form of the disease, but it can be cured. The success of treatment directly depends on the stage of diagnosis of the disease.

Main preventive measures are: giving up bad habits, proper and rational nutrition, physical activity and maintaining normal weight bodies. In addition, every woman should undergo a breast cancer screening - ultrasound or mammogram - once a year.