Death from a heart attack signs. Sudden coronary death: causes, how to avoid

According to the definition of the World Health Organization, sudden death include cases of death of practically healthy persons or patients whose condition was considered quite satisfactory. It is obvious that most people have certain deviations in the state of health that do not have a significant impact on everyday life and do not reduce its quality. In other words, pathological changes on the part of organs and systems, if they exist in such people, they are firmly compensated. Such representatives of humanity are classified as "practically healthy". It is in this group that the most common phenomenon is encountered, which scientists called sudden death. In this phrase, it is surprising not the second word (all people die sooner or later), but the first. Sudden is an unexpected death that occurs without any warning, in the midst of complete well-being. This catastrophe is not amenable to any prediction so far. She does not have harbingers and signs that could alert doctors. Studying numerous, more and more frequent, cases of sudden death, experts came to the conclusion that this event always has vascular causes, which allows us to classify it as a vascular accident.

A prominent businessman with a typical Georgian surname, from among the heirs of the collapsed wealth Soviet Union, all the hardships of the division of property had already endured and lived a healthy and proper life in London. He probably had enough money for a full-fledged medical examination, A personal doctors would not miss even a suspicious murmur in the region of the heart. Death came suddenly and completely unexpectedly. He was in his early 50s. An autopsy found no cause of death.

There are no exact statistics on sudden death, since there is no generally accepted definition of this concept. However, it is estimated that every 60-75 seconds in the US, 1 person dies from sudden cardiac arrest. The problem of sudden cardiac death, which has attracted the attention of cardiologists for many decades, has again become acute in last years when carried out World Organization Public health wide population studies have demonstrated an increasing incidence of sudden death in the adult, and not just the adult, population. It turned out that cases of sudden death are not so rare, and this problem requires close study.

During post-mortem examination (autopsy) of the dead, as a rule, it is not possible to detect signs of damage to the heart or blood vessels that could explain the sudden circulatory arrest. Another feature of sudden death is that, if timely assistance is provided, such patients can be revived, and in practice this happens quite often. Usually, resuscitation (resuscitation) is performed through artificial respiration and closed heart massage. Sometimes, to restore blood circulation, it is enough to hit the chest with a fist - in the region of the heart. If disaster strikes medical institution or in the presence of doctors of the ambulance service, then a high-voltage discharge is used to restore blood circulation electric current- defibrillation.

Sudden death, which is based on pathological changes in the heart, is commonly called sudden cardiac death. Cardiac causes account for the bulk of sudden deaths. The basis for such a judgment is statistical data indicating that pathological changes in the heart are noted, even if the victim never complained about his health. Atherosclerosis of the coronary arteries can be found in more than half of the people who died as a result of sudden circulatory arrest. Scars on the heart muscle, which indicate a previous heart attack, and an increase in the mass of the heart are found in 40-70% of cases. Such obvious reasons like fresh blood clots in coronary arteries in sudden cardiac death, it is extremely rare to find. With a careful study (it is clear that all cases of sudden death serve as the basis for a careful study), some kind of pathology can almost always be detected. However, that doesn't make sudden death any less mysterious. After all, all changes in the heart and blood vessels exist and form for a long time, and death comes suddenly and completely unexpectedly. Latest Methods research of cardio-vascular system (ultrasound scan, spiral computed tomography) reveal the most minor changes blood vessels and heart without any opening of the body. And these data show that certain changes can be found in almost all people who, fortunately, for the most part live safely into old age.

Since no damage to the cardiovascular system can be detected in cases of sudden death, it remains to be assumed that this catastrophe is associated with a dysfunction, and not with a change in the structure of the heart. This assumption was confirmed with the development and introduction into clinical practice of methods for long-term monitoring of the work of the heart (ECG registration for hours and days). It became clear that sudden death most often (65-80%) is directly related to ventricular fibrillation.

Ventricular fibrillation - very frequent (up to 200 or more in 1 minute), erratic contraction of the ventricles of the heart - flutter. Flutter is not accompanied by effective contractions of the heart, so the latter ceases to perform its main, pumping, function. Blood circulation stops, death occurs. Sudden ventricular tachycardia - an increase in ventricular contractions of the heart up to 120-150 beats per minute - dramatically increases the load on the myocardium, quickly depletes its reserves, which leads to circulatory arrest.

This is what a breakdown looks like on an electrocardiogram normal rhythm in a state of ventricular flutter:

As a rule, trembling is followed by a complete cardiac arrest due to the depletion of its energy reserves. But fibrillation cannot be considered the cause of sudden death; rather, it is its mechanism.
It is considered that the most important causative factor sudden cardiac death is acute myocardial ischemia - a violation of the blood supply to the heart muscle caused by spasm or blockage of the coronary arteries. That's right: it is generally accepted, because nothing else comes to mind when experts consider the heart as an organ that consumes blood like an engine that consumes fuel. Indeed, oxygen starvation leads to disturbances in the ability of the heart muscle to contract, increases sensitivity to irritation, which contributes to rhythm disturbances. It has been found that violations nervous regulation work of the heart (imbalance of autonomic tone) can lead to disruption of the rhythm. It is precisely known that stress contributes to the occurrence of arrhythmias - hormones change the excitability of the heart muscle. It is also known that the lack of potassium and magnesium has a significant impact on the work of the heart and under certain conditions can lead to its stop. There is no doubt that some medicinal substances, toxic factors (for example, alcohol) can lead to damage to the conduction system of the heart or contribute to disorders contractility myocardium. But, in all clarity individual mechanisms violations normal operation heart, many cases of sudden death do not receive a satisfactory explanation. Let us recall at least the regularly repeated cases of death of young athletes.

24-year-old French tennis player Mathieu Montcourt, who on the night of Tuesday July 7, 2008 was found dead in his apartment in the suburbs of Paris, died of cardiac arrest.

As a rule, in this group of trained, well-developed physically young people, the medical supervision. It is unlikely that among professional athletes who have managed to achieve extraordinary success with their physical efforts, there are people suffering from serious illnesses heart and blood vessels. It is even more difficult to imagine coronary insufficiency in people who regularly endure huge physical exertion. The relatively high statistics of sudden death among athletes can only be explained by obvious overloads or the use of pharmacological agents that increase physical endurance (doping). According to statistics, in young people, sudden death is most often associated with sports (about 20%) or occurs during sleep (30%). The high frequency of cardiac arrest during sleep convincingly refutes the coronary nature of sudden death. If not in all cases, then in a significant part of them. During sleep come physiological changes rhythm, which are characterized by bradycardia - a decrease in heart rate to 55-60 beats per minute. In trained athletes, this frequency is even lower.

V. Turchinsky, an outstanding athlete and simply a handsome person who promotes and leads a healthy lifestyle, suddenly falls and dies before reaching the age of 50.

Several newspaper lines are honored with suddenly deceased famous athletes, politicians, artists. But many such disasters occur with ordinary people that are not reported in the newspapers.
- He after all was perfectly healthy! - the shocked relatives and acquaintances are amazed for several days. But the inexorable persuasiveness of what happened soon makes one believe the facts: if he died, then he was sick.

Sudden death significantly more often overtakes another category of patients - people suffering from mental illness. Researchers attribute this phenomenon to the use of psychotropic drugs, most of which affect the conduction system of the heart.

It is known that alcoholics are prone to sudden death. Everything is more or less clear here: ethanol destroys the myocardium and the conduction system of the heart. One day, deprived of energy and rhythmic control, the heart simply stops after another drinking bout.

It would seem that now the circle of victims has been determined: the risk group is made up of people with heart diseases that do not manifest themselves until a certain time, athletes for whom physical overload is part of their lifestyle, and numerous representatives of the population who abuse alcohol or drugs.

But in this series, deaths of young children stand apart - sudden infant mortality syndrome. British scientists, who studied 325 such cases, came to the conclusion that most often the danger occurs at the 13th week of life. Almost always, the death of an infant occurs in a dream; more often this happens in the cold season and when the baby is lying on his stomach. Some researchers link the sudden death of infants with smells (perfumes, tobacco smoke).

With all the clarity of the relationship between risk factors and tragic cases of sudden death, the majority of people who died suddenly have never had these factors. Sudden death made a habit of visiting quite healthy people.

Everyone knows about terrible poisons and try to be as far away from them as possible. It would never occur to anyone to put a jar of arsenic in the refrigerator or a nightstand in the kitchen. But all sorts of solvents, cleaners, fresheners and other means can be found a lot. But they are dangerous no less than potassium cyanide.

1. Antifreeze is dangerous because it does not have an unpleasant odor and tastes quite edible, but if you drink this remedy, you must urgently call ambulance. Drinking this fluid can lead to kidney failure and death.
2. If the windows are constantly freezing, then you will have to purchase anti-icing fluid, but you need to remember that it contains methanol, very, toxic substance, alcohol, the use of which can cause blindness and death.

3. Insecticides help control pests, but you can get poisoned by these products by spraying them in unventilated areas. The use of these remedies will lead to convulsions and coma.
4. Some artificial nail removers can cause serious consequences. When they are used, you can get methemoglobinemia and oxygen starvation.

5. Be careful with pipe cleaners, as the fumes of these products can kill if inhaled, burn internal organs.
6. Pain-relieving creams affect the area, but if you do not follow the instructions, you can damage your eyes.

7. Anionic detergent, known as carpet cleaner, is very caustic and can cause organ damage, blinding you if it gets into your eyes.
8. If you exceed the dose of iron tablets, you can get iron poisoning. If you do not get help within 24 hours, then the brain and liver will suffer. You can even die.

9. Toilet cleaners remove dirt and bad smell. When used, this remedy can damage internal organs and fall into a coma.
10. Pain pills, including paracetamol, aspirin, and ibuprofen, can cause death if overdosed. Internal organs simply refuse.

11. Furniture polish can cause coma if you drink this remedy or inhale it well. If the polish gets into your eyes, you can go blind, and if it gets on delicate skin- cause burns and irritation.
12. Perfume and cologne contain alcohol, ethanol and isopropanol. Both of these substances can cause nausea, anxiety, and seizures.

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

15. After drinking kerosene, a liquid that is used for ignition, in kerosene lamps and kerosene gases, you can get bloody stools, convulsions and burning sensations in the internal organs.
16. Moths are annoying, but you can’t eat anti-mole pills. You can get oxygen starvation and to whom.

17. Oil paints can damage the skin, if they enter the stomach and lungs, they can cause serious problems with the nervous system and cause death.
18. Codeine is sold by prescription, but when overdosed, it causes fatigue, drowsiness, intestinal cramps, and death.

19. Taking a large dose alcoholic beverages, we don’t just get drunk, but we get serious poisoning and even death if medical assistance is not provided in time.
20. If it turned out that someone swallowed paint thinner, then there is a risk of tissue necrosis internal organs, and if inhaled, memory loss and fever.

21. Poison for rodents can cause blood in the urine and feces, a metallic taste in the mouth, and as brain hemorrhage occurs, pallor of the skin and death.
22. Some skin-lightening creams contain mercury in such quantities that mercury poisoning can occur. 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 a large enough amount, you can get diarrhea, vomiting, coma and death.
24. Turpentine is a substance that is obtained from pine. If you taste it or take a deep breath, 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, which protects us from insect bites. If you use the repellent inside, you can earn vomiting, coughing and convulsions.

27. Baby creams for redness can be very dangerous in the hands of children. Never leave them within the reach of an infant. You risk even if you step aside for a minute.
28. You may have acne, which means you use special creams. Never taste these products and do not smear intensively on the skin - you will receive minimal 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 coats pans and pots to keep food from sticking, 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 BPA, which can cause cancer and hormonal problems in adolescents, accelerating the transition to puberty.
32. If herbicides are detrimental to one organic matter, then they can harm another. When taken internally, you can fall into a coma.

33. All refractory 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 covered with Scotchguard, which was produced before the year 2000, then you can suffer from malformations and other health problems.
36. The powder that is in the printer is also an unsafe material. If you print a lot 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 pets can get nose cancer.

39. Lead paint is rarely used today, but that doesn't mean lead poisoning is uncommon, since you have old newspapers and books 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 respiratory problems.

When it's quite healthy man suddenly passes away, they talk about a sudden inexplicable death. To the question "why?" doctors shrug helplessly, and relatives shed tears. But in some cases, the tragedy can be avoided by winning back a few trump cards from the evil fate in advance!

3 ways to cheat fate

According to statistics, one person suddenly dies every 40 minutes. In most cases, the tragedy happens to men aged 45-54 who did not complain about their health, lived full life and made bright plans for the future. Death comes quickly, like a lightning strike. For the relatives of the deceased, the incident comes as a shock. However, analyzing such cases, doctors came to the conclusion that cardiac arrest is most often the cause of sudden death. How does it happen that a heart that has been working without interruption for decades suddenly stops forever?

Fatigue or a call from the other world?

In most cases, the cause of sudden death is myocardial infarction or severe arrhythmia, turning into cardiac arrest. These are manifestations coronary disease heart (angina pectoris) - a condition when the heart muscle does not have enough oxygen.

Such a disease does not develop suddenly. Fatal manifestations are preceded by months and years. If you hear in time alarm bell and start treatment, the tragedy is avoided. If you give up on the symptoms of malaise, continuing to work without sparing your stomach, the heart will sooner or later fail.

Signs of a threatened heart attack may include:

• increasing in 1-2 weeks fatigue, weakness, decreased performance;
• periodic interruptions in the work of the heart, a feeling of fading, increased tremors in the chest;
• shortness of breath, feeling short of breath;
• chest pain that may radiate to the abdomen, back, left shoulder blade, arm, lower jaw;
• hand numbness.

Characteristic for is a deterioration in well-being during physical exertion (climbing stairs, brisk walking), with excitement, and also after smoking.

Such symptoms cannot be attributed to fatigue, age or magnetic storms. To give up on them means to sign a sentence for yourself. When discomfort in the area of ​​\u200b\u200bthe heart, it is necessary to sit or lie down, if possible, dissolve a nitroglycerin tablet under the tongue. Immediately after improvement, apply for medical care. When burning pain in the chest, you need to call an ambulance as soon as possible and swallow ½ aspirin tablet. This is the case when a minute decides fate.

It's not beer that kills people...

According to international studies, alcohol greatly increases the risk of sudden death among men. And everyone can save themselves from this risk! Not only leads to fatal consequences. Even once taken, it can kill a healthy and strong man in his prime.

Blood thickens, coagulation processes are disrupted, which contributes to the formation blood clots- blood clots. In addition, the drunk falls asleep, as a rule, in awkward posture, does not feel the need to roll over to the other side, to release the numb arm or leg. Compression of blood vessels doubles the risk of thrombosis. Waking up with a hangover, a person rises sharply, a blood clot breaks off and makes its fatal journey from the veins lower extremities into the vessels of the lungs. Blockage of the latter leads to instant death - a person simply suffocates.

In addition to thrombosis, acute alcohol poisoning can cause:

• toxic damage to the heart muscle, leading to the development of life-threatening arrhythmias and cardiac arrest;
• paralysis respiratory center then the person falls asleep and never wakes up.

Stress: good or bad

Could this tragedy have been prevented? Probably yes. Indeed, literally the day before the incident, he promised his wife to finally take a vacation and wave to Zheleznovodsk on a ticket. But time was lost, and the man fell victim to nervous overload.

Destroys the body, and is based on a simple chemical reaction. When a person is faced with a difficulty, the adrenal glands produce stress hormones: adrenaline, norepinephrine, cortisol. These substances are a secret weapon, a doping that allows you to perform super tasks when necessary. If the problem is solved, we feel the taste of victory and even some euphoria from success. It is the hormones of joy that are released into the blood: endorphins and enkephalins. Under their influence, we quickly recover and are ready for new challenges.

It is quite different when a person is constantly in a state of anxiety. Accumulating in large quantities, stress hormones have destructive action on the tissue, narrow the blood vessels, make the heart beat hard, raise the pressure. A person loses the ability to rejoice, sleeps poorly, becomes aggressive and irritable. Such nervous exhaustion very often ends in a cardiovascular catastrophe: a stroke or a heart attack.

What if our whole life is a continuous overcoming? You can make stress work for you! You need to find a use for stress hormones, throw out adrenaline. The best way to do this is exercise. sports goals can be different: hit the ball in a basketball basket, knock out all the targets in the shooting range, or put a chess checkmate on a neighbor. The main thing is that in impromptu competitions there must be a winner!

The second important step is to learn to enjoy life in all its manifestations. Noticing pleasant little things, you accumulate those very hormones of joy that help to strengthen your shaky health. Laughter, kindness, love, chocolate and good old comedy - this is a simple recipe for dealing with stress!

And of course, the third way to drive the “bony” away is to monitor your health. Excess weight, poor nutrition, smoking, distrust of the doctor and refusal to timely treatment can play a bad joke even with the most zealous optimist!

Natalia DOLGOPOLOVA,
doctor
Mr. "Stoletnik" No. 23, 2013

Sudden death due to cardiac causes: from acute coronary insufficiency and others

Sudden cardiac death (SCD) is one of the most severe cardiac pathologies that usually develops in the presence of witnesses, occurs instantly or in short span 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 sudden stop heart strikes 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 - indirect massage hearts and artificial respiration by first calling for medical 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

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 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 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 are ventricular tachycardia, already had an episode of cardiac arrest earlier, cases of loss of consciousness, postponed, 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 considered concomitant pathology, in particular, diabetes, obesity, myocardial hypertrophy, tachycardia more than 90 beats per minute. Risk also smokers, 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 identified groups of people with high risk VSS. 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 worsening of 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 arrhythmia 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. Maybe 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 a dream.

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 hear heart sounds due to their absence, the pulse is large vessels also not defined. 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 a lack of oxygen, and if the heart does not work, then 3-5 minutes are enough for it to begin in its cells. irreversible changes. This circumstance calls for an immediate resuscitation and the sooner chest compressions are provided, the better 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 spasm of unchanged vessels, which is facilitated by the use of some drugs(cocaine), hypothermia, excessive physical activity. 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, sharp 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 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.

important instrumental method The diagnosis of SCD is the 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 prehospital stage, already in a hospital, the patient will undergo numerous laboratory examinations, starting with routine urine and blood tests and ending with a toxicological study for some drugs that can cause arrhythmia. Will definitely be held daily monitoring ECG, ultrasound examination heart, electrophysiological study, stress tests.

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 the hospital.

At the pre-hospital stage, the possibilities of resuscitation are limited, usually it is carried out by specialists emergency care that 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 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 most best method it will stop, 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, the patient is administered adrenaline and atropine in any available way at intervals of 3-5 minutes, antiarrhythmic drugs, pacing 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, antihypertensive drugs or cardiotonic, infusion therapy:

• Lidocaine for ventricular fibrillation;
• Bradycardia is stopped by atropine or izadrin;
• Hypotension is the reason for intravenous administration 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, so the patient is placed in the ward for observation intensive care.

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 for a long time after coronary death.

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

A cardioverter-defibrillator may be implanted to prevent a heart attack, and is especially effective for serious 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 are prescribed calcium channels, products containing omega-3 fatty acid. Surgical prophylaxis consists in operations aimed at eliminating arrhythmias - ablation, resection of the endocardium, cryodestruction.

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

Video: presentation on sudden cardiac death

Video: lecture on the prevention of sudden cardiac death

What pills can be poisoned? Any medications, if used improperly, can lead to severe poisoning and intoxication. In severe cases, instant death can occur. This article discusses an overdose of fatal pills, symptoms of poisoning with various drugs, methods of first aid, components of treatment in a hospital setting.

Reasons for the development of drug poisoning

Drug overdose can develop for many reasons. It most often develops in people who take drugs without consulting a doctor or change their dosage without permission. Below are the main reasons why pill poisoning can develop.

• Self-medication, taking drugs that are not agreed with the attending physician. Sometimes people drink drugs on the advice of friends, neighbors, relatives.
• Taking large doses of the drug in critical or emergency situations. For example, with an increase in body temperature, people, trying to bring it down quickly, drink large doses of drugs, combine them with each other. Such uncontrolled use of drugs often leads to fatal poisoning.
• A person taking drugs that are contraindicated for him due to age or health status. For example, the drug aspirin (acetylsalicylic acid) is deadly for children, it causes Reye's syndrome in them and leads to rapid death from internal bleeding.
• A fatal overdose of pills can develop in children who have eaten pills left by adults. Kids love to taste everything, they are interested in everything. All medicines that are at home should be kept in inaccessible place for children.
• An overdose of drugs for the purpose of suicide (suicide). Most often, people use sleeping pills and tranquilizers for this purpose. From them comes a relatively easy death from an overdose.
• Drug poisoning due to taking them together with alcoholic beverages.
• Dangerous drug combination. In the instructions for the drugs, you should carefully read the list of drugs with which they cannot be combined.
• Intentional murder. Medicines can deliberately poison a person. Some drugs in large doses are potent poisons for a person.

Please note that for each person, the lethal dosage of any drug is purely individual. It depends on the weight and age of the person, whether he has any diseases.

Features of the clinical picture in case of drug overdose

Anyone can get poisoned by pills to death. Fatal outcome possible with a certain dose of any drug. Below we will look at the symptoms of poisoning by the most common medications.

Sleeping pills, sedatives

sleeping pills and sedatives dangerous to human life. You can get an overdose of them unintentionally, during some stressful situation. A person, wanting to calm down or fall asleep after an emotional overstrain, may take a large dose of medication, striving to fast action drug.

to potent sedatives and sleeping pills relate:

• bubbled;
• phenobarbital;
• bromital;
• medinal;
• teraligen;
• barbital.

These substances enter digestive system are rapidly absorbed and act. They can cause the death of a person in 15-30 minutes. The following are the symptoms that develop with an overdose of sleeping pills.

• Increased drowsiness, weakness and lethargy. On initial stage poisoning with a person, you can still establish contact, talk, ask something from him. Then develops deep dream, in severe cases - coma. As a rule, when poisoned by these drugs, people die in their sleep.
• A decrease in all reflexes develops due to depression of the central nervous system.
• Hyperthermia. For poisoning sleeping pills characterized by an increase in body temperature up to 40 degrees.
• Perhaps the development of vomiting in a dream. Due to a decrease in the severity of the swallowing and vomiting reflex, aspiration of vomit into Airways and respiratory arrest develops.
• Slow breathing. The person begins to breathe slowly and shallowly, with a frequency of less than 10 breaths per minute. This change is associated with inhibition of the respiratory center in the brain. When poisoned with sleeping pills, you can die from respiratory arrest.
• Bradycardia (slow heart rate) and hypotension (low blood pressure).
• Perhaps the development of seizures and hallucinations.

tranquilizers

Severe overdose of tranquilizers often results in death. These drugs act on the central and peripheral nervous system, as well as on breathing and heart function. Tranquilizers are taken strictly according to the prescription, and even a slight deviation from the dosage prescribed by the doctor can cause poisoning. Below is a list of drugs in this group:

• elenium;
• napoton;
• seduxen;
• diazepam;
• oxazepam;
• tazepam;
• eunoctin;
• librium;
• radedorm.

The clinical picture of poisoning with tranquilizers is the same as with poisoning with sleeping pills.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs. These drugs include:

• paracetamol (efferalgan, panadol);
• acetylsalicylic acid (aspirin);
• analgin;
• ibuprofen (nurofen);
• ketorolac (ketanov, ketolong);
• nimesulide (nimesil);
• indomethacin.

The drugs in this group have analgesic and anti-inflammatory effects. Some reduce body temperature (paracetamol, ibuprofen). Aspirin is used to thin the blood.

Poisoning is not for death NSAIDs most often develops as a result of an overdose in order to accelerate their action. For example, feeling severe pain, the person takes a larger amount of medicine.

Please note that when used by children acetylsalicylic acid(aspirin) rapid death may develop. Children do not have the enzyme to process this drug. They develop Reye's syndrome. Therefore, this drug is strictly prohibited for children.

Symptoms of poisoning with NSAID drugs resemble intestinal poisoning. The patient has a stomach ache, vomiting and diarrhea, general weakness, dizziness. It is also possible a decrease in body temperature, the development of hand trembling, the appearance of a feeling of anxiety and restlessness. By themselves, drugs in this group rarely lead to lethal outcome. Dangerous are the complications that can be provoked by taking these drugs in large dosages, namely:

• gastrointestinal bleeding. All NSAIDs irritate the gastric mucosa and duodenum. If you drink a lot of these drugs, integrity damage may develop. vascular wall in the submucosa of these organs. Gastrointestinal bleeding manifested by dark vomiting, black stools (chalky), pallor and blue skin, strong weakness, drowsiness, rapid heart rate and lowering blood pressure. A person may die due to large blood loss;
• acute pancreatitis is a non-infectious inflammation of the pancreas, in which necrotic death of its tissues develops. This pathology can be caused by an overdose of NSAIDs. The patient develops severe girdle pain in the abdomen, nausea, vomiting, flatulence and diarrhea. Small purple hemorrhagic spots may appear on the skin of the abdomen. Body temperature rises to 39 degrees. This disease is without surgical intervention leads to death;
• acute liver failure may develop as a result of a large number drugs that the liver is unable to neutralize. The patient's skin, mucous membranes and sclera of the eyes turn yellow, pain appears in the right hypochondrium. Consciousness may be impaired. Death may occur due to liver failure;
• kidney failure, in which the kidneys are unable to cope with their function and purify the blood. This pathology can occur with toxic damage nephrons (structural units of the kidneys) with anti-inflammatory drugs.

Antibiotics

Antibiotics are drugs that are widely used in the treatment of bacterial infectious diseases. They are appointed by a doctor who negotiates with the patient the rules for both admission and dosing.

The table below shows the features clinical picture with an overdose of various antibacterial agents.

Group name antibacterial drugs and medicines	Symptoms and signs
Penicillins, cephalosporins (amoxil, ceftriaxone, cefodox)	nausea, vomiting and diarrhea; attacks of general convulsions (as in an epileptic seizure); redness and itching of the skin (acute urticaria); arrhythmia (due to an imbalance of potassium in the blood); mental agitation or falling into a stupor.
Tetracycline	severe pain in the stomach; nausea, profuse vomiting; arrhythmia; convulsions; angioedema.
Levomycetin	nausea and vomiting; headache; anorexia (lack of appetite); heartburn; diarrhea; When using this drug in large doses, the development of acute cardiovascular insufficiency is possible.
Fluoroquinolones	kidney failure (edema, decreased amount of urine) disruption of the heart, breathing; fainting, impaired consciousness.

Antihistamines

Antihistamines are used for allergic pathologies. They may be assigned to allergic dermatitis, hives, atopic dermatitis etc. These drugs block the production of histamine, the main mediator that triggers allergic reactions. Some drugs also have a slight hypnotic effect. When treating them, a person is forbidden to drive a car.

The drugs in this group include:

• loratadine;
• suprastin;
• diphenhydramine;
• diazolin;
• pipolfen.

Symptoms of poisoning antihistamines appear in 15-30 minutes. When used lethal dose a person can die in an hour.

Overdose antihistamines primarily affected nervous system. Symptoms of poisoning with these drugs include:

• feeling severe dryness V oral cavity and eyes, thirst;
• increase in body temperature up to 38-39 degrees;
• nausea followed by vomiting;
• first, a general excitation develops, which sharply changes with lethargy;
• hand trembling;
• convulsions of the type of epilepsy;
• tachycardia, possibly a violation of the heart rhythm;
• change in blood pressure, at first it rises sharply, and then also quickly decreases to critical numbers;
• incoordination, staggering;
• increased drowsiness;
• gradual falling into a deep coma.

Drugs to lower blood pressure

Heart pill poisoning is very common in the general population. At heart attack or a sharp rise in blood pressure, a person can take many different drugs, fearing for his life.

Also, an overdose of such drugs can develop in older people who can forget that they took the drug and take it again.

Please note that when taking beta-blockers (for example, anaprilin) ​​by people who suffer from bronchial asthma, rapid death may develop.

Names of popular antihypertensive drugs:

• captopril;
• lozap;
• enalapril;
• amiodarone;
• anaprilin;
• magnesium sulfate;
• metoprolol;
• nebivolol;
• nifedipine.

In case of poisoning antihypertensive drugs the patient falls sharply arterial pressure, nausea and vomiting may develop, consciousness is disturbed. This condition is deadly, it can lead to respiratory arrest and heartbeat.

What to do in case of drug overdose

At the slightest suspicion of an overdose of any drug, you should urgently call an ambulance. By phone, inform the dispatcher about what happened, list the symptoms of the patient and accurately name your location.

Remember that trying to cure a person of a drug overdose on your own is very dangerous. He may die in your arms and there is nothing you can do to help him. In order not to endanger his life, immediately seek medical help.

What to do while waiting for doctors? The arrival time of the ambulance team depends on many factors (for example, traffic congestion, the availability of free doctors at the time of the call). While waiting for the ambulance crew, you need to start providing the poisoned person with the first first aid at home. It is from her that the prognosis for the life of the patient may depend. Below are its main components.

In order to clear the stomach of the rest of the drugs you have drunk, you need to drink a liter of water in one gulp and provoke vomiting. For best result this washing should be repeated several times.

This procedure is not carried out with:

• disturbed consciousness of the patient;
• the appearance of black or bloody vomiting.

It is not necessary to add potassium permanganate solution or any other components to the gastric lavage solution. You can't know which chemical reaction they will enter with the drugs that poisoned the person.

Cleansing enema

An enema is made on the basis of ordinary boiled water. The temperature of the bowel lavage fluid should be neutral (room temperature).

Sorbents

These drugs will help bind and flush out any medications that are left in the digestive tract.

Sorbents that are taken in liquid form act faster (for example, smectite or atoxyl). But if you don’t have these at home, give the patient any other sorbent, even activated charcoal will do.

Before you give a person to drink the drug, read the dosing rules that are listed in the instructions for it.

Drink

The liquid will reduce the concentration of the drug in the blood and accelerate its excretion by the kidneys, reduce dehydration. You can drink mineral water or plain water, tea with sugar.

Actions in case of loss of consciousness

If the patient loses consciousness, you need to monitor him until the arrival of the doctors so that he does not choke on vomit or his tongue. Turn his head to the side, in this position the risk of aspiration is minimal.

To improve blood flow to the head and heart, lift his legs and fix them in this position.

Before the arrival of doctors, monitor the presence of his pulse and breathing. If they stop, start an indirect closed heart massage.

What to do with the development of seizures

The only thing you can do is hold the person's head so that he does not hit her on the floor.

Remember that a person during a convulsive attack should not put anything in his mouth, especially his fingers.

medical treatment

Doctors from the ambulance, having arrived at the call, will conduct a quick examination and assessment of the condition of the poisoned person. Show them the drug that he took, and as accurately as possible name the number of pills he took. You should also describe the amount of assistance that you yourself managed to provide to the victim.

Medics will try to stabilize the condition of the victim and take him to the nearest hospital. In case of drug poisoning, treatment is carried out in the condition of the toxicological department. sick in critical condition hospitalized in the intensive care unit (reanimation).

Treatment may include hemodialysis, antidotes, drips, and respiratory and cardiac support. What will happen to a person and what result to expect from treatment, only a doctor can say after examining the patient and objective evaluation his condition.

Drug poisoning can be fatal. Treatment of this condition is carried out in a hospital setting. The forecast depends on the number taken drug, active substance timeliness of seeking medical help. Self heal drug overdose it is forbidden.