Diseases of the cardiovascular system are one of the most common causes of sudden death. Acute coronary death is 15-30% in the structure of all deaths. This condition is dangerous because it does not make itself felt for a long time. A person can live without even knowing about the presence of heart problems. Therefore, everyone should know why death occurs. And also have an idea about providing first aid to the victim. This is what will be discussed in the article.
What is this condition
The World Health Organization defines sudden, or acute, coronary death as a fatal outcome after a maximum of 6 hours after the first symptoms of the disease. Moreover, this condition develops in people who considered themselves healthy and did not have any problems with the cardiovascular system.
A pathology of this nature is attributed to one of the varieties of coronary heart disease (CHD) with an asymptomatic course. Sudden death in acute coronary insufficiency develops in 25% of patients with a "mute" course of IHD.
In the International Classification of Diseases, this pathology is in the section "Circulatory system diseases". The ICD-10 code for acute coronary death is I46.1.
Main reasons
There are a number of causes of acute coronary death. These include the following fatal changes in heart rate:
- ventricular fibrillation (70-80%);
- paroxysmal tachycardia of the ventricles (5-10%);
- slow heart rate and ventricular asystole (20-30%).
Separately, trigger or trigger causes of death in acute coronary insufficiency are distinguished. These are factors that increase the risk of death of diseases of the heart and blood vessels. These include:
- Acute myocardial ischemia. It is observed with spasm of the coronary vessels, blockage of their thrombus.
- Excessive activation of the sympathoadrenal system.
- Violation of electrolyte balance in the cells of the heart muscle. Particular attention is paid to a reduced concentration of potassium and magnesium.
- The effect of toxins on the myocardium. Taking certain 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 occurs with coronary heart disease and various types of arrhythmias.
But sometimes patients die suddenly, never having rhythm disturbances or any other heart diseases. 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 a thickening of the myocardium or an increase in organ cavities;
- stratified 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 flow 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, a pathologist in 50% of cases determines the presence of atherosclerosis of the coronary arteries. 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, interfering with the normal flow of blood. Myocardial ischemia occurs.
Also characteristic is the presence of scars on the heart that appear after a heart attack. Perhaps a thickening of the muscle wall - hypertrophy. In some, a massive proliferation of connective tissue in the muscle wall is determined - cardiosclerosis.
In 10-15% of cases, a blockage of the vessel with a fresh blood clot is possible. However, there is a small part of the dead who, at autopsy, still fail to find out the cause of death.
Main symptoms
Often, sudden death in acute coronary insufficiency does not come so suddenly. Usually it is preceded by some symptoms.
According to relatives, many patients before death noted a deterioration in overall health, weakness, poor sleep, and breathing problems. Some had a severe attack of ischemic pain. Such pain appears sharply, as if it compresses the chest, gives to the lower jaw, left arm and shoulder blade. But ischemic pain is a rare symptom before dying from acute coronary insufficiency.
Many patients suffered from mild hypertension or 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 was able to be reanimated, he will undergo a series of examinations. This is necessary to prescribe an appropriate treatment that eliminates the threat of relapse.
To do this, use the following diagnostic methods:
- electrocardiography (ECG) - with its help, contractility of the heart muscle and conduction of impulses in it are recorded;
- phonocardiography - it characterizes the work of heart valves;
- echocardiography - an ultrasound scan of the heart;
- ECG with stress tests - to identify angina pectoris and resolve the issue of the need for surgical intervention;
- Holter monitoring - ECG, which is removed 24 hours a day;
- electrophysiological study.
The importance of electrophysiological research
The latter method is the most promising in the diagnosis of cardiac arrhythmias. It is a stimulation of the inner lining of the heart by 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 relapse.
In 75% of survivors, persistent ventricular tachycardia is determined. This result from an electrophysiological study suggests that the probability of a second attack of the threat of death is about 20%. This is provided that tachycardia is stopped by antiarrhythmic drugs. If the rhythm disturbance cannot be eliminated, the repeated threat of death occurs in 30-80% of cases.
If ventricular tachycardia cannot be caused by stimulation, the likelihood of a second attack is about 40% in the presence of heart failure. With preserved heart function - 0-4%.
Emergency care: basic concepts
First aid for acute coronary death is cardiopulmonary resuscitation. Everyone should know the basic methods of resuscitation in order to be able to provide assistance to a person before the ambulance arrives.
There are three main stages:
- A - ensuring airway patency;
- B - artificial respiration;
- C - indirect heart massage.
But before you begin to take any action, check for the presence of consciousness in the victim. To do this, he is called loudly several times and asked how he feels. If a person does not respond, you can shake him slightly on the shoulders several times and gently hit on the cheek. The lack of reaction indicates 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 we begin to provide first aid.
Emergency care: stages
Stage A begins with a cleansing of the victim’s oral cavity from saliva, blood, vomit, and more. To do this, wrap two fingers with some kind of tissue and remove the contents of the oral cavity. After provide patency of the upper respiratory tract. I put one hand on the patient’s forehead and throw my head back. The second one lifts the chin and advances the lower jaw.
If breathing is still absent, go to stage B. The palm of the left hand still lies on the forehead of the victim, and the fingers close the nasal passages. Next, you need to take a regular breath, grab the lips of the victim’s lips and exhale air into his mouth. In order to ensure personal hygiene, it is recommended to put a napkin or cloth on the patient's mouth. Inhalations are conducted at a frequency of 10 - 12 per minute.
In parallel with artificial respiration, an indirect heart massage is performed - stage C. The hands are placed on the sternum between its middle and lower parts (just below the level of the nipples). Hands lie one on top of the other. After making pressures 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 palm of your hand.
If there is one resuscitator, pressing and inhaling alternate with a frequency of 15 to 2. When two people help, the ratio is 5 to 1. Every two minutes you need to monitor 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 dying from acute heart (coronary) insufficiency, it’s too late to do anything.
All preventive measures are divided into two large groups: primary and secondary:
- The 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, it is necessary to modify the lifestyle. Change the diet, refusing fried and fatty foods, smoked meats and spices. Vegetable fats, high fiber vegetables should be preferred. Limit coffee and chocolate. Refusal of bad habits - smoking and alcohol is obligatory.
Overweight people need to lose weight, since excessive weight increases the risk of diseases of the cardiovascular and endocrine system.
Metered exercise is also important. At least 1-2 times a day you need to do exercises or walk in the fresh air. Shown swimming, jogging at short distances, but not weightlifting.
Secondary prevention
Secondary prevention of sudden death consists in taking medications that slow the progression of coronary heart disease. Most often, the following groups of drugs are used:
- beta blockers;
- antiarrhythmic;
- antiplatelet agents;
- anticoagulants;
- potassium and magnesium preparations;
- antihypertensives.
There are also surgical methods for the prevention of sudden cardiac death. They are used in people at high risk. These methods include:
- aneurysmectomy - removal of an artery aneurysm;
- myocardial revascularization - restoration of patency of the coronary vessels;
- radiofrequency ablation - destruction of the focus of the disturbed heart rhythm with the help of electric current;
- implantation of an automatic defibrillator - a device is installed that automatically regulates the heart rate.
The Importance of Regular Medical Examination
Each person should undergo a medical examination and take a blood test at least once a year. This will 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 only with increasing pressure.
If blood levels of cholesterol and low density lipoproteins are elevated, specialist advice is also indicated. He will help you find a way to control this condition with a single diet or by prescribing additional medications. This will prevent the development of atherosclerosis and blockage of coronary vessels with fatty plaques.
Regular blood tests are a simple way to prevent coronary heart disease, and therefore acute coronary death.
Forecast
The probability of a patient's recovery depends on the timing of first aid. It is important to organize specialized resuscitation ambulance crews who arrive at the scene in 2-3 minutes.
The survival rate among successfully resuscitated during the first year of life is 70%. It is mandatory to find out the cause of stopping death and its elimination. If specific therapy is not performed, the probability of relapse is 30% during the first year and 40% in the second year. If antiarrhythmic therapy or surgical treatment is carried out, the probability of relapse 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%.