From a heart attack, death causes. Causes of sudden death - heart disease, thrombosis and hereditary factors

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

Article publication date: 05/26/2017

Article last updated: 05/29/2019

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

The coronary arteries are the vessels that supply blood to the heart muscle (myocardium). When they are damaged, blood flow can be stopped, which leads to cardiac arrest.

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

It should not be thought that the occurrence of cardiac arrest inevitably leads to the death of a person. Subject to the correct provision of emergency care, cardiac activity can be restored, although not in all patients. Therefore, it is very important to know the symptoms of VKS and the rules.

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 the pathology of these blood vessels is atherosclerosis.

Atherosclerosis is a disease that leads to the formation of plaques on the inner surface of the 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 elevated blood cholesterol levels. At the site of damage, cholesterol penetrates into the wall of the blood vessel, which leads a few years later to the formation of an atherosclerotic plaque. This plaque forms a protrusion on the arterial wall, which increases in size as the disease progresses.

Sometimes the surface of an atherosclerotic plaque is torn, which leads to the formation of a thrombus in this place, which completely or partially blocks the lumen of the coronary artery. It is the violation of the blood supply to the myocardium, which has arisen due to the overlap of the coronary artery with atherosclerotic plaque and thrombus, and is the main cause of VCS. Lack of oxygen causes dangerous heart rhythm disturbances, which lead to cardiac arrest. The most common violation of the heart rhythm in such situations is in which disorganized and chaotic contractions of the heart occur, not accompanied by the release of blood into the vessels. Provided proper assistance is provided immediately after cardiac arrest, it is possible to revive a person.

The following factors increase the risk of VCS:

• Previous myocardial infarction, especially within 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 coronary artery disease.
• Smoking.
• Arterial hypertension.
• Elevated blood cholesterol levels.
• The presence of heart disease in close relatives.
• Deterioration of the contractility of the left ventricle.
• The presence of certain types of arrhythmias and conduction disorders.
• Obesity.
• Diabetes.
• Addiction.

Symptoms

Sudden coronary death has pronounced symptoms:

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

These symptoms indicate cardiac arrest. The main ones are the absence of a pulse and respiration, dilated pupils. All these signs can be detected by a nearby person, 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 to the onset of irreversible changes in the body, after which the revival of the victim is no longer possible.

Before the cardiac arrest itself, some patients may feel harbingers, which include a sharp heart palpitations and dizziness. VKS predominantly develops without any previous symptoms.

Providing first aid to a person with sudden coronary death

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

The sequence of actions in the presence of cardiac arrest:

1. Make sure you and the victim are safe.
2. Check the consciousness of the victim. To do this, gently shake him by the shoulder and ask how he feels. If the victim responds, leave him in the same position and call an ambulance. Don't leave the victim alone.
3. If the patient is unconscious and unresponsive to treatment, 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 up. 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. Do not confuse normal breathing with the dying breaths that can be observed during the first moments after the cessation of cardiac activity.
5. If the person is breathing normally, call an ambulance and observe the victim until they arrive.
6. If the victim is not breathing or is not breathing normally, call an ambulance and begin chest compressions. 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 hand 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 a closed heart massage with a frequency of 100-120 compressions per minute.
7. If you know how to do mouth-to-mouth artificial respiration, then after every 30 compressions, take 2 artificial breaths. If you do not know how or do not want to perform artificial respiration, just continuously do chest compressions 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 is completely exhausted.

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Forecast

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

Most cardiac arrest survivors have some degree of damage to the central nervous system, and some are in a deep coma. The following factors influence the prognosis in such people:

• General health before cardiac arrest (for example, the presence of diabetes, cancer and other diseases).
• The time interval between cardiac arrest and the start of CPR.
• The 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 grams of salt is about 1 teaspoon.

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There are two types of fats - saturated and unsaturated. Saturated fats should be avoided as they raise bad cholesterol levels in the blood. They belong to:

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

A balanced diet should contain unsaturated fats, which increase blood levels of good cholesterol and help reduce atherosclerotic plaque 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 intake of sugar, as it can increase the risk of developing diabetes, which greatly increases the likelihood of coronary artery disease.

Physical activity

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

Regular exercise increases the efficiency of the cardiovascular system, lowers blood cholesterol, and also keeps blood pressure 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 makes the heart beat faster and use more oxygen. The higher the level of physical activity, the more positive effects 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, short breaks should be taken from prolonged sitting at the workplace.

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Normalizing and maintaining a healthy weight

The best way to lose weight is through a healthy diet and regular exercise. You need to reduce body weight gradually.

To give up smoking

If a person smokes, giving up 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 most cases of coronary artery thrombosis in people under the age of 50 years.

Restriction on the consumption of alcoholic beverages

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

Blood pressure control

BP can be controlled through a healthy diet, regular exercise, weight management, and, if necessary, medication to lower it.

Aim to keep blood pressure below 140/85 mm Hg. Art.

Diabetes control

Patients with diabetes have an increased risk of coronary artery disease. To control blood glucose levels, a balanced diet, physical activity, weight normalization and the use of hypoglycemic drugs prescribed by a doctor are useful.

Adults are a phenomenon that is being introduced into the daily life of a modern person. It occurs more and more frequently. But no one can say for sure that the deceased was seriously ill. That is, in fact, death occurs suddenly. There are a number of causes and risk groups that can influence this phenomenon. What does the public need to know about sudden death? Why does it arise? Is there any way to avoid it? All features will be presented below. Only if you know about the phenomenon all the information known at the moment, you can try to somehow avoid a collision with a similar situation. In fact, everything is much more complicated than it seems.

Description

Sudden Adult Death Syndrome is a phenomenon that began to spread in 1917. It was at this moment that such a term was first heard.

The phenomenon is characterized by death, and causeless, of a person with good health. Such a citizen, as already mentioned, did not have any serious diseases. In any case, the person himself did not complain about certain symptoms, and also did not receive treatment from a doctor.

There is no exact definition of this phenomenon. Exactly like the real mortality statistics. Many doctors argue about the reasons why this phenomenon appears. Sudden adult death syndrome is a mystery that is still unsolved. There are many theories according to which they die. About them - further.

Risk group

The first step is to figure out who is most often exposed to the phenomenon being studied. The thing is that the syndrome of sudden death of the adult generation quite often occurs in Asians. Therefore, these people are at risk.

It is also not uncommon for SIDS (sudden unexplained death syndrome) to occur in people who work long hours. That is, workaholics. In any case, this assumption is made by some physicians.

The risk group includes, in principle, all people who:

• unhealthy family environment;
• hard work;
• constant stress;
• there are serious illnesses (but then usually death is not sudden).

Accordingly, the majority of the world's population is exposed to the studied phenomenon. No one is safe from him. According to doctors, during the autopsy, it is impossible to establish the cause of the death of a person. That is why death is called sudden.

Nevertheless, as already mentioned, there are several assumptions according to which the mentioned phenomenon arises. Sudden death syndrome in an adult can be explained in several ways. What are the assumptions about this topic?

man against chemistry

The first theory is the effect of chemistry on the human body. Modern humans are surrounded by a variety of chemicals. They are everywhere: in furniture, medicines, water, food. Literally at every step. Especially in food.

There is very little natural food. Every day the body receives huge doses of chemicals. All this cannot go unnoticed. And so there is a syndrome of sudden death in adults. The body simply cannot withstand the next charge of chemistry that surrounds a modern person. As a result, life activity stops. And death comes.

The theory is supported by many. Indeed, as practice has shown, over the past century, unexplained deaths have begun to occur quite often. It was during this period that the progress of human development is observed. Therefore, we can consider the impact of environmental chemistry on the body as the first and most likely cause.

Waves

The following theory can also be scientifically explained. We are talking about electromagnetic waves. It's no secret that a person is under the influence of magnetism all his life. Pressure surges are very well felt by some people - they begin to feel bad. This proves the negative impact of electromagnetic waves on humans.

At the moment, scientists have proven that the Earth is the second planet in the solar system in terms of the power of radio emissions produced. The body, being constantly in such an environment, gives a kind of failure. Especially when combined with exposure to chemicals. This is where Sudden Adult Death Syndrome comes in. In fact, electromagnetic waves cause the body to stop performing functions to ensure human life.

It's all about the breath

But the following theory may seem somewhat non-standard and even absurd. But it is still actively promoted around the world. Quite often, sudden death syndrome occurs in a dream in an adult. Regarding this phenomenon, some put forward incredible assumptions.

The thing is that during sleep the human body functions, but in an "economical" mode. And a person in such periods of rest sees dreams. Horror can make the body refuse to function. More specifically, breathing is disturbed. It stops because of what it sees. In other words, out of fear.

That is, a person does not realize in a dream that everything that happens is not reality. As a result, he dies in life. As already mentioned, a somewhat improbable theory. But it has its place. By the way, the syndrome of sudden death in infants in a dream is explained in a similar way. Scientists say that if during the rest the child dreams that he is in the womb, then breathing will stop. And the baby "forgets" to breathe, since oxygen must be supplied to him through the umbilical cord. But all this is just speculation.

infection

What else can be heard? What are the causes of Sudden Adult Death Syndrome? The following assumption is generally like a fairy tale. But it is sometimes expressed.

As already mentioned, an incredible, fabulous theory. You do not need to believe in this assumption. Rather, such a story is an ordinary "scarecrow", which was invented with the aim of at least somehow explaining the syndrome of sudden death in adults.

Overwork

Now some information that is more like the truth. The thing is that, as already mentioned, Asians are at risk of people prone to sudden death syndrome. Why?

Scientists have come up with a hypothesis. Asians are people who work constantly. They work very hard. And so the body at one fine moment begins to deplete. It "burns out" and "turns off". As a result, death occurs.

That is, in fact, the sudden death of an adult occurs due to the fact that the body is overworked. Work is often the culprit. As statistics show, if you pay attention to Asians, then many die right at the workplace. Therefore, you should not work for wear all the time. This pace of life negatively affects health. A person, except for fatigue, does not observe any other signs.

stress

Also among the most common theories regarding death without cause, stress is distinguished. Another assumption that you can believe. As already mentioned, people who are constantly in a nervous environment, not only have a high risk of diseases and cancer, they are also classified as a risk group of the population that may experience sudden death syndrome.

The theory is explained in almost the same way as in the case of constant work and stress - the body "wears out" from stress, then "turns off" or "burns out". As a result, death occurs for no apparent reason. The effect of stress cannot be detected at autopsy. In the same way as the negative impact of intense systematic and incessant work.

Results

What conclusions follow from all of the above? Sudden nocturnal death syndrome, as well as daytime death in adults and children, is an inexplicable phenomenon. There are a huge number of various theories that allow one or another group of people to be classified as at risk. Doctors and scientists to this day cannot find an exact explanation for this phenomenon. Just like putting forward a clear definition of sudden death syndrome.

Only one thing is clear - so that there is no high risk of dying for no apparent reason, it is necessary to lead a healthy lifestyle, be less nervous and have more rest. In today's conditions to bring the idea to life is very problematic. In any case, doctors recommend at least minimizing tension and the amount of stress. Workaholics need to understand that they need to rest too. Otherwise, such people may suddenly die.

If you lead the most healthy lifestyle, then the likelihood of sudden death is minimized. Every person should remember this. No one is immune from this phenomenon. Scientists are trying to study it as best as possible and find the exact cause of this phenomenon. So far, as already emphasized, this has not been done. It remains only to believe in numerous theories.

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

What is this state

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

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

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

Main reasons

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

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

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

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

Other causes of sudden death

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

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

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

Autopsy data

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

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

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

Main symptoms

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

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

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

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

Diagnostic methods

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

To do this, use the following diagnostic methods:

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

The value of electrophysiological research

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

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

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

Emergency care: basic concepts

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

There are three main stages:

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

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

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

Emergency care: stages

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

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

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

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

Primary prevention

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

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

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

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

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

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

Secondary prevention

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

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

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

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

The Importance of Regular Medical Examination

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

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

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

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

Forecast

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

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

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

Acute coronary insufficiency is a condition of the body in which there is a complete or partial blockage of the blood supply to the heart muscle.

This pathology often leads to sudden coronary death. This article will talk about what causes this condition, how to diagnose and treat, how to provide emergency care.

Acute coronary syndrome (ACS) is another name for this pathology. Basically, it begins as a result of atherosclerotic vascular lesions.

The pathogenesis (development mechanism) of this disease consists in the deposition of cholesterol in the walls of the arteries, due to which they lose their elasticity, blood flow becomes difficult. The disease code according to ICD-10 is 124.8.

With a partial violation of the blood supply to the myocardium, there is a lack of oxygen, the cells receive less of the substances necessary for vital activity. This condition is called coronary heart disease. With complete blockage of blood flow, a heart attack develops.

Reasons why ACS may occur:

• thrombotic stenosis;
• stratification of the walls of the arteries;
• vasospasm;
• fibrosis;
• the presence of a foreign body (embolus) in the blood supply system;
• inflammation of the serous membrane of the heart (endocarditis);
• narrowing of the lumen of the vessels.

Violation of the blood supply to the myocardium is also possible due to injuries in the region of the heart (for example, a stab wound), undergone surgical operations.

People with the following conditions are at increased risk of developing ACS:

• ischemia, transferred earlier;
• myocardial dystrophy and myocarditis (inflammation of the muscle tissue of the heart);
• tachycardia;
• diabetes;
• hypertension;
• congenital tendency to sudden cardiac arrest;
• pathology of the vascular system (thrombophlebitis, thromboembolism).

Other risk factors include:

• obesity, malnutrition (leading to the accumulation of cholesterol);
• smoking, cocaine use;
• low physical activity;
• advanced age (the risk of ACS increases after 45 in men, 55 in women).

First signs and symptoms

Approximately half of the cases of coronary insufficiency do not show any symptoms. The person feels a slight dizziness, he has an accelerated heartbeat. In other cases, the signs of pathology appear in the complex.

Symptoms of acute coronary insufficiency before death include:

• pressing or painful, often;
• pain is projected to other parts of the body (stomach, shoulder blades, arms, etc.);
• profuse sweat;
• convulsions;
• foaming from the mouth;
• nausea, sometimes with vomiting;
• slow breathing, shortness of breath;
• sudden pallor;
• severe dizziness, sometimes with loss of consciousness;
• causeless weakness.

Pathology rarely occurs in people who do not have any cardiovascular disease.

A person who has frequent angina attacks may confuse its symptoms with ACS. However, there are some differences. With a normal violation of the heart, pain lasts 5-10 minutes, and with a coronary syndrome, they last a longer time - up to 6 hours.

Angina is characterized by discomfort and tightness in the chest. The pain in ACS can be so strong that it blocks any movement.

Methods for diagnosing pathology

Upon admission of the patient to the clinic, the doctor conducts an examination and makes a preliminary diagnosis.

The main factors on the basis of which coronary insufficiency is diagnosed:

• lack of pulse;
• blocking of breath;
• the patient is unconscious;
• pupils do not react to light;
• the face becomes earthy.

To confirm the diagnosis, the following studies are carried out:

• coronary angiography;
• echocardiography;
• scintigraphy of the heart muscle.

Electrocardiography shows changes in the electrical characteristics of the heart when pathologies are detected. Violation of blood flow in the coronary arteries is characterized by a typical deviation of the electrocardiogram.

Coronary angiography (angiography of the arteries adjacent to the myocardium) gives a visual picture of their narrowing. This analysis is carried out using a contrast agent visible on x-rays. Through a vein in the patient's leg, a catheter with a reagent is inserted into the coronary region. After that, a series of pictures are taken, according to which the doctor determines whether there is an obstruction of the vessels.

With the help, changes in the structure of the myocardium, its valvular apparatus are examined. The operation of the valves directly affects the blood circulation process.

Heart muscle scintigraphy is a new informative technique based on the principle of nuclear scanning. A substance with special radionuclides that accumulate in the heart muscle is injected into the patient's blood. When passing through the myocardium, the reagent shows areas of impaired blood flow.

Additionally, blood is taken from the patient for analysis. Due to a heart attack, which is often a consequence of ACS, the heart tissue partially dies. In this process, special substances are released, the presence of which in the blood indicates a coronary syndrome.

Urgent Care

Acute coronary insufficiency is often the cause of sudden death. To save a person, you need to quickly provide him with first aid.

If signs of ACS are detected, it is necessary to restore normal blood flow. If a person is unconscious, before the arrival of doctors, resuscitation is carried out manually.

To do this, they do it by combining it with artificial respiration. Massage is performed by rhythmic pressure on the chest area, 5-6 times in a row. Then you need to inhale air into the lungs of the patient. These actions are repeated until the arrival of the team of doctors.

If a person is conscious, but feels severe pain in the region of the heart, he should immediately be provided with a state of rest. To do this, you need to stop all physical activity. This stabilizes the rhythm of the heartbeat.

Then the patient is given medicines that facilitate the work of the heart (nitroglycerin, isoket). The tablet is placed under the tongue for resorption. Immediately after these measures, an ambulance is called.

Treatment

After examining the patient, the doctor determines the methods of treatment based on the tests. This may be drug therapy, surgery.

In addition, it is necessary to follow a diet, motor mode, eliminate bad habits.

Stenting and balloon angioplasty

Stenting and balloon angioplasty are treatments that involve percutaneous intervention in vessels clogged with cholesterol in order to improve blood supply. With its help, normal blood flow in the myocardium is restored without open heart surgery.

During the operation, a special device, a stent, is inserted into the blocked artery. This is a metal cylinder in the form of a mesh, capable of contracting and expanding.

A stent expands the walls of an artery, allowing blood to move freely through it.

In the case of balloon angioplasty, the narrowed artery is expanded with a balloon that is inflated with air. Balloon angioplasty is often combined with stent placement.

thrombolysis

Thrombolysis is a type of vascular therapy in which blood flow is restored by lysis (dissolution) of blood clots.

The patient is injected intravenously with a drug that dissolves a blood clot that interferes with blood circulation. The process of destruction of the thrombus takes place within 3-6 hours.

For thrombolysis, fibrinolytics are used: streptodecase, streptokinase, urokinase, etc.

Bypass coronary arteries

Coronary artery bypass grafting is an operation aimed at restoring the movement of blood in the arteries adjacent to the heart. For this, shunts are used - vascular prostheses.

The essence of the method is that with the help of shunts a circular path is laid, bypassing the narrowing section. It is directed from the cardiac aorta to the working artery.

The role of shunts is performed by veins removed from the patient's thigh or sternum. They are hemmed above and below the blocked area.

Prescribing medications

Drug therapy is carried out in cases where there are no serious heart lesions requiring surgical intervention.

Treatment is carried out in a complex, using several groups of drugs.

These include:

• analgesics of central action, eliminating pain syndrome (fentanyl, tramadol, promedol);
• means of antiplatelet and anticoagulant action. They thin the blood and prevent platelets from sticking together. These are heparin, syncumar, warfarin;
• beta blockers. They block adrenaline receptors, thereby relaxing the heart muscle. Regulate blood flow within the myocardium. These are anaprilin, carvedilol, metoprolol;
• lipid-lowering drugs. They inhibit the enzyme that promotes the formation of cholesterol. These include: Rosuvastatin, Vascular, Liprimar, Atomax;
• nitrates. They have a vasodilating effect, reduce myocardial oxygen demand. These are Nitroglycerin, Nitrong, Sustak-forte.

Prevention

Preventive measures to prevent ACS are to maintain a healthy lifestyle.

The following rules must be observed:

• avoid smoking, alcoholic beverages;
• switch to proper nutrition, rich in vegetables, fruits, herbs, cereals;
• do gymnastics, take walks;
• monitor the psycho-emotional state.

You should regularly check your blood pressure, control the level of cholesterol in the blood.

Consequences and complications

ACS often causes sudden coronary death. The situation is complicated by the fact that a person does not know about the disease if it is asymptomatic.

There are other consequences of acute coronary insufficiency, which are expressed in the form of such pathologies:

• violation of the heart rhythm;
• cardiosclerosis;
• heart failure;
• re-infarction.

Prognosis and survival

Survival of people who have undergone ACS largely depends on timely medical care.

More than 20% have a fatal outcome due to its failure. Another important factor is the severity of the disease. Mortality is higher in patients with. With a small-focal lesion of the heart muscle, the chances of survival are greater.

Survival prognosis for ACS: 80% of patients survive the first year, in the next five years the indicator decreases by 5%, half of those who have had acute coronary insufficiency survive within ten years.

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

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

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

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

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

Causes of sudden cardiac death

main cause of SCD is atherosclerosis

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

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

The causes of sudden cardiac death are:

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

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

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

diagram: distribution of causes of SCD at a young age

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

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

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

Signs of sudden cardiac death

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

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

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

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

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

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

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

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

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

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

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

Diagnosis of sudden death syndrome

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

After the arrival of the ambulance and before the start of resuscitation, the patient's condition is diagnosed, which by this time is already unconscious. Breathing is absent or too rare, convulsive, it is impossible to feel the pulse, heart sounds are not detected during auscultation, the pupils do not react to light.

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

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

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

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

Treatment of sudden cardiac death

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

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

Video: performing basic cardiopulmonary resuscitation

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

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

defibrillation

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

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

Conservative treatment includes the introduction of drugs to maintain pressure, heart function, and normalize electrolyte disturbances. For this purpose, beta-blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensives or cardiotonic drugs, infusion therapy are prescribed:

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

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

Surgery may consist in radiofrequency ablation of the myocardium - with tachyarrhythmias, the efficiency reaches 90% or more. With a tendency to atrial fibrillation, a cardioverter-defibrillator is implanted. Diagnosed atherosclerosis of the arteries of the heart as a cause of sudden death requires carrying out; in case of heart valve defects, they are plastic.

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

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

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

Require medical support. Beta-blockers, calcium channel blockers, products containing omega-3 fatty acids are prescribed. Surgical prophylaxis consists of operations aimed at eliminating arrhythmias - ablation, endocardial resection, cryodestruction.

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

Video: sudden cardiac death - concept and honey. animation

Video: lecture on the prevention of sudden cardiac death