Sudden death of a person. Sudden cardiac (coronary) death. Heart attack mortality statistics

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 a carpet cleaner, is very caustic and can cause organ damage and may cause blindness 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 unpleasant odors. 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 you drink this remedy or it’s good to inhale it. If polish gets into your eyes, you can go blind, and if it gets on delicate skin, it can 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 lighting, 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 in the stomach or lungs, can cause serious problems with the 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 tissue necrosis internal organs, and when inhaled - loss of memory and fever.

21. Rodent poison can cause blood in urine and feces, metallic taste in the mouth, and since hemorrhage occurs in the brain, 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. If you taste them or inhale them enough a large number of, then you can get 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. The plastic used to make 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, motor oil poisoning can cause brain damage and breathing problems.

In medicine, sudden death from heart failure is regarded as death occurring naturally. This happens both to people who have had heart disease for a long time, and to people who have never used the services of a cardiologist. A pathology that develops quickly, sometimes even instantly, is called sudden cardiac death.

Often there are no signs of a threat to life, and death occurs within a few minutes. The pathology can progress slowly, starting with pain in the heart area, rapid pulse. The duration of the development period is up to 6 hours.

Cardiac death is distinguished between quick and instantaneous. The fulminant variant of coronary heart disease causes death in 80-90% of incidents. Also among the main causes are myocardial infarction, arrhythmia, and heart failure.

Read more about the reasons. Most of them are associated with changes in blood vessels and the heart (arterial spasms, hypertrophy of the heart muscle, atherosclerosis, etc.). Among the common prerequisites are the following:

• ischemia, arrhythmia, tachycardia, impaired blood flow;
• weakening of the myocardium, ventricular failure;
• free fluid in the pericardium;
• signs of heart and vascular diseases;
• heart injuries;
• atherosclerotic changes;
• intoxication;
• congenital defects of valves, coronary arteries;
• obesity, as a result poor nutrition and metabolic disorders;
  Not healthy image life, bad habits;
• physical overload.

More often, the occurrence of sudden cardiac death is provoked by a combination of several factors simultaneously. The risk of coronary death increases in people who:

• there are congenital cardiovascular diseases, ischemic heart disease, ventricular tachycardia;
• there was a previous case of resuscitation after a diagnosed cardiac arrest;
• a previous heart attack was diagnosed;
• pathologies are present valve apparatus, chronic failure, ischemia;
• facts of loss of consciousness were recorded;
• there is a reduction in blood ejection from the left ventricle by less than 40%;
• A diagnosis of cardiac hypertrophy was made.

Secondary significant conditions for increasing the risk of death are considered to be: tachycardia, hypertension, myocardial hypertrophy, changes in fat metabolism, diabetes. Bad influence are caused by smoking, weak or excessive physical activity

Signs of heart failure before death

Cardiac arrest is often a complication after suffering a cardiovascular disease. Because of this, the heart can suddenly stop its activity. After the first signs appear, death can occur within 1.5 hours.

Previous dangerous symptoms:

• shortness of breath (up to 40 movements per minute);
• pressing pain in the heart area;
• the skin becomes gray or bluish and becomes colder;
• convulsions due to hypoxia of brain tissue;
• separation of foam from the oral cavity;
• feeling of fear.

Many people experience symptoms of exacerbation of the disease within 5-15 days. Heart pain, lethargy, shortness of breath, weakness, malaise, arrhythmia. Shortly before death, most people experience fear. You should immediately contact a cardiologist.

Signs during an attack:

• weakness, fainting due to high speed ventricular contractions;
• involuntary muscle contraction;
• facial redness;
• pale skin (it becomes cold, bluish or gray);
• inability to determine pulse, heartbeat;
• lack of reflexes of the pupils, which have become wide;
• irregularity, convulsive breathing, sweating;
• loss of consciousness is possible, and after a few minutes breathing cessation.

In case of death, against the background of seemingly good health, symptoms could be present, just not clearly manifested.

Mechanism of disease development

As a result of a study of people who died due to acute heart failure, it was found that most of them had atherosclerotic changes that affected the coronary arteries. As a result, myocardial circulation was disrupted and it was damaged.

Patients experience enlargement of the liver and neck veins, and sometimes pulmonary edema. Coronary circulatory arrest is diagnosed; after half an hour, abnormalities in the myocardial cells are observed. The whole process lasts up to 2 hours. After cardiac activity stops, irreversible changes occur in brain cells within 3-5 minutes.

Often cases of sudden cardiac death occur during sleep after breathing has stopped. In a dream, the chances of salvation are practically absent.

Statistics of mortality from heart failure and age characteristics

One in five people will experience this during their lifetime. Immediate death occurs in a quarter of victims. The mortality rate from this diagnosis exceeds the mortality rate from myocardial infarction by approximately 10 times. Up to 600 thousand deaths are reported annually due to this reason. According to statistics, after treatment for heart failure, 30% of patients die within a year.

More often, coronary death occurs in persons 40-70 years old with diagnosed vascular and cardiac disorders. Men are susceptible to it more often: at a young age 4 times, in the elderly – 7 times, by the age of 70 – 2 times. A quarter of patients do not reach the age of 60 years. The risk group includes not only elderly people, but also very young people. The cause of sudden cardiac death at a young age may be vascular spasms, myocardial hypertrophy, provoked by the use of narcotic substances, as well as excessive stress and hypothermia.

Diagnostic measures

90% of sudden cardiac death episodes occur outside of hospitals. It’s good if the ambulance arrives quickly and the doctors carry out a quick diagnosis.

Emergency doctors note the absence of consciousness, pulse, breathing (or its rare presence), and the absence of pupillary response to light. To continue diagnostic measures First, resuscitation actions are needed (indirect cardiac massage, artificial ventilation of the lungs, intravenous administration of medications).

After this, an ECG is performed. In case of a cardiogram in the form of a straight line (cardiac arrest), the administration of adrenaline, atropine, and other drugs is recommended. If resuscitation is successful, further laboratory examinations, ECG monitoring, and cardiac ultrasound are carried out. Based on the results, surgical intervention, implantation of a pacemaker, or conservative treatment with medications is possible.

Urgent Care

With symptoms of sudden death from heart failure, doctors have only 3 minutes to help and save the patient. Irreversible changes occurring in brain cells after this time period lead to death. Timely first aid can save lives.

The development of symptoms of heart failure is facilitated by a state of panic and fear. The patient must calm down by removing emotional stress. Call an ambulance (cardiology team). Sit comfortably, lower your legs down. Take nitroglycerin (2-3 tablets) under the tongue.

Cardiac arrest often occurs in crowded places. Those around you need to urgently call an ambulance. While waiting for her arrival, you need to provide the victim with an influx of fresh air, if necessary, perform artificial respiration and perform cardiac massage.

Prevention

To reduce mortality, preventive measures are important:

• regular consultations with a cardiologist, preventive procedures and prescriptions (special attention
• patients with hypertension, ischemia, weak left ventricle);
• giving up provoking bad habits, ensuring proper nutrition;
• control of blood pressure;
• systematic ECG (pay attention to non-standard indicators);
• prevention of atherosclerosis ( early diagnosis, treatment);
• implantation methods in risk groups.

Sudden cardiac death is a severe pathology that occurs instantly or in a short period of time. The coronary nature of the pathology is confirmed by the absence of injuries and the sudden and rapid cardiac arrest. A quarter of cases of sudden cardiac death are lightning fast, and without the presence of visible precursors.

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Sudden death for cardiac reasons: acute coronary insufficiency and others

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

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

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

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

Saving a life may depend on the actions of others, so you cannot simply walk past a person who has suddenly fallen on the street or lost consciousness on a bus. You need to at least try to carry out a basic one - indirect cardiac massage and artificial respiration, having first called doctors for help. Cases of indifference are not rare, unfortunately, and therefore the percentage of unfavorable outcomes due to late resuscitation occurs.

Causes of sudden cardiac death

the main cause of SCD is atherosclerosis

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

Another cause of cardiac arrest may be acutely developed, in which proper hemodynamics are impossible, the organs suffer from hypoxia, and the heart itself cannot withstand the load and.

The causes of sudden cardiac death are:

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

Risk factors have been identified when the likelihood of acute coronary death becomes higher. The main such factors include ventricular tachycardia, a previous episode of cardiac arrest, cases of loss of consciousness, previous cardiac arrest, and a decrease in the left ventricle to 40% or less.

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

Diagram: distribution of causes of SCD at a young age

For more careful monitoring and targeted examination groups of people at high risk of SCD have been identified. Among them:

1. Patients who have undergone resuscitation due to cardiac arrest or;
2. Patients with chronic failure and cardiac ischemia;
3. Persons with electric;
4. Those diagnosed with significant cardiac hypertrophy.

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

Signs of sudden cardiac death

In a quarter of all cases of sudden death of adults, there were no previous symptoms; it occurred without obvious reasons. Other One to two weeks before the attack, patients noted a deterioration in their health in the form of:

• More frequent pain attacks in the heart area;
• Rise ;
• A noticeable decrease in performance, feelings of tiredness and fatigue;
• More frequent episodes of arrhythmia and interruptions in cardiac activity.

Before cardiovascular death, pain in the heart area increases sharply, many patients manage to complain about it and experience strong fear, as happens with myocardial infarction. Psychomotor agitation is possible, the patient grabs the heart area, breathes noisily and frequently, gasps for air, sweating and redness of the face are possible.

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

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

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

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

Sudden death due to accompanying atherosclerosis of the arteries, then it is more often diagnosed in older people.

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

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

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

Diagnosis of sudden death syndrome

Unfortunately, cases post-mortem diagnosis sudden death is not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. At autopsy they did not find any pronounced changes in the heart, which could cause death. The unexpectedness of what happened and the absence traumatic injuries speak in favor of the coronarogenic nature of the pathology.

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

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

An important instrumental method for diagnosing SCD is the ECG. With ventricular fibrillation, erratic waves of contractions appear on the ECG, the heart rate is above two hundred per minute, and soon these waves are replaced by a straight line, indicating cardiac arrest.

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

With successful resuscitation at the prehospital stage, already in a hospital setting the patient will undergo numerous laboratory examinations, starting with routine urine and blood tests and ending with a toxicological study for certain drugs that can cause arrhythmia. 24-hour ECG monitoring will be required. ultrasound examination heart, electrophysiological study, stress tests.

Treatment of sudden cardiac death

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

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

Video: Performing basic cardiopulmonary resuscitation

Ambulance team after diagnosis clinical death begins indirect cardiac massage and artificial ventilation lungs with an Ambu bag, provides access to a vein into which medications can be administered. In some cases, intratracheal or intracardiac administration of drugs is practiced. It is advisable to administer drugs into the trachea during intubation, and the intracardiac method is used most rarely - when it is impossible to use others.

In parallel with the main resuscitation actions, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart’s activity in this moment. If ventricular fibrillation is detected, then the most the best method its relief will become, and if the necessary device is not at hand, then the specialist delivers a blow to the precordial area and continues resuscitation measures.

defibrillation

If cardiac arrest is determined, there is no pulse, and there is a straight line on the cardiogram, then during general resuscitation the patient is given any in an accessible way adrenaline and atropine at intervals of 3-5 minutes, antiarrhythmic drugs, cardiac pacing is established, after 15 minutes sodium bicarbonate is added intravenously.

After the patient is admitted to the hospital, the fight for his life continues. It is necessary to stabilize the condition and begin treatment of the pathology that caused the attack. May need surgery, the indications for which are determined by doctors in the hospital based on the results of examinations.

Conservative treatment includes the administration of drugs to maintain blood pressure, heart function, and normalize disorders electrolyte metabolism. For this purpose, beta blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensive drugs or cardiotonics, infusion therapy:

• Lidocaine for ventricular fibrillation;
• Bradycardia is treated with atropine or isadrine;
• Hypotension is the reason for intravenous administration of dopamine;
• Fresh frozen plasma, heparin, aspirin are indicated for DIC syndrome;
• Piracetam is administered to improve brain function;
• For hypokalemia - potassium chloride, polarizing mixtures.

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

Surgery may involve radiofrequency ablation of the myocardium - for tachyarrhythmias, the effectiveness reaches 90% or higher. If there is a tendency to atrial fibrillation, a cardioverter-defibrillator is implanted. Diagnosed atherosclerosis of the heart arteries as a cause of sudden death requires valvular heart surgery.

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

Prevention of sudden coronary death is needed for people with chronic diseases of cardio-vascular system, which can cause an attack, as well as for those who have already survived it and were successfully resuscitated.

To prevent a heart attack, a cardioverter defibrillator may be implanted, which is especially effective for serious arrhythmias. IN right moment the device generates the impulse the heart needs and does not allow it to stop.

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

Nonspecific measures to prevent cardiac death are the same as for any other cardiac or vascular pathology- healthy lifestyle, physical activity, rejection of bad habits, proper nutrition.

Video: Presentation on Sudden Cardiac Death

Video: lecture on the prevention of sudden cardiac death

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.

That's how 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 unusually high mortality rate (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 this pathology are very common, and more often among young people. 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 the lying position the inflow to the heart increases. venous blood, 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, and 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. Already 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 of cardio-vascular system, overweight And diabetes. A separate group of risk factors includes 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, the causes of sudden death are often obesity, 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, medical assistance for unexpected cardiac death 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 this 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 giving up any bad habits, proper nutrition and exercise, positive emotions, avoiding stress and emotional stress.

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The parameters of your body that show the risk of heart disease have been named (spoiler: it’s not weight)

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 infection. 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 in the fight against all types of violence it is necessary A complex approach, 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 are generally no different from common symptoms malignant breast tumor. 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, correct and balanced diet, physical activity and maintenance normal weight bodies. In addition, every woman should undergo a breast cancer screening - ultrasound or mammogram - once a year.

Sudden cardiac (coronary) death

Sudden cardiac death(sudden cardiac death; sudden coronary death)- a naturally occurring fatal outcome of a disease of the cardiovascular 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 a different diagnosis to be made).

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); weakness syndrome sinus node, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia
non-atherosclerotic coronary artery disease
inflammatory, infiltrative, neoplastic and degenerative processes
congenital diseases
rhythm disturbances as a result of neurohumoral influences or disorders of the central nervous system (impaired autonomic regulation of the heart with a predominance sympathetic activity; the most important marker of this condition is a decrease in sinus rhythm variability, as well as an increase in 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, left atrial hypertrophy, smoking, carbohydrate and fat metabolism and 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 show macroscopic and/or histological signs of acute myocardial infarction- 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 automaticity of the SA node, as well as pacemakers of the 2nd and 3rd 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 of the heart still remain in the form of a rapidly depleting sinus, nodal or rare idioventricular rhythm, but cardiac output is critically reduced; electromechanical dissociation quickly enough 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 tolerance physical activity, palpitations and interruptions in heart function, etc.

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

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, and very rare individual “convulsive breathing movements” appear. 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, cardiopulmonary resuscitation is immediately performed, which includes restoring patency respiratory tract, 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 temporal and spectral analysis of autonomic regulation (analysis of R-R distribution), as well as determination Q-T dispersion interval. QT interval dispersion 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. Carrying out comprehensive research 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 stop 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 emergency services in the institutions medical care specialized resuscitation teams equipped with appropriate equipment.