The sudden cessation of the heart muscle, accompanied by a lack of bioelectric activity, is called the "heart asystole" in medicine. What it is? What are the causes of this condition? How to provide emergency care to people in case of cardiac arrest? You can get answers to all these questions later in the article.
Types of cardiac asystole
Asystole of the heart, the causes of which we are considering, is conditionally divided into instantaneous and occurring as a result of an existing heart rhythm disturbance.
In the first case, against the background of well-being and the absence of cardiac arrhythmias, it suddenly loses electroexcitability, which resembles a short circuit. The cause of this is most often acute cardiac ischemia, the appearance of which, incidentally, is caused by obesity, smoking, diabetes mellitus and arterial hypertension.
And in the second case, with a prolonged state of fibrillation (disparate and uncoordinated contraction of the heart muscle fibers), rapidly circulating random electrical impulses arise that disrupt the movement of blood through the coronary vessels and, as a result, deprive the heart of the ability to contract, which leads to its arrest.
Causes of Cardiac arrest
About 5% of severe cardiac pathologies lead to the fact that the patient develops asystole of the heart. The causes of this life-threatening condition lie most often in the occurrence of an acute form of myocardial infarction or pulmonary thromboembolism.
An overdose of cardiac glycosides, antiarrhythmic drugs or anesthesia, which affect the functioning of the named muscle, can also provoke asystole. Electrical trauma, intracardiac manipulation, or general severe metabolic disturbances can also lead to cardiac arrest.
Features of ventricular asystole
It should be mentioned that it is precisely the asystole of the ventricles of the heart (a complete stop of their contractions), in contrast to the atrial asystole compatible with life, that leads to the death of the patient.
This pathology does not apply to those rhythm disturbances that are provoked by increased ectopic excitability. The causes of its occurrence are conduction disturbances with parallel inhibition of the ability of the ventricles to rhythmically contract.
Most often, the aforementioned condition may be the result of fluttering or ventricular fibrillation and occurs after them, and in some cases it is provoked by electromechanical dissociation or ventricular tachycardia.
Manifestations of asystole of the heart in children
Asystole of the heart in children is most often provoked by injuries, poisoning and various types of respiratory distress (for example, airway obstruction, inhalation of smoke, drowning or infection).
By the way, it was noticed that in 15-20% of young patients, cardiac arrest is preceded by fibrillation or ventricular tachycardia. But the most common sign that a child is threatened with the development of asystole is the presence of bradyarrhythmia (a significant reduction in heart rate).
If children or adolescents have severe congenital heart pathologies before asystole, they can first observe the occurrence of frequent shallow breathing, hypotension and impaired consciousness. In some situations, cardiac arrest is preceded by a collapse with a short (less than five seconds) seizure.
How is cardiac asystole manifested on an ECG?
Asystole of the heart on the ECG is detected in the form of an almost straight line reflecting its electrical activity.
The characteristic signs of this condition include the wrong rhythm of the atria, the inability to calculate the frequency of their contractions, while there are no ventricular contractions. In some cases, when the atria continues to contract for some time after stopping the ventricles, atrial R.'s can be detected on the cardiogram.
An auxiliary element for the diagnosis of asystole can be the arrhythmia preceding this condition. So, if it manifests itself in the form of early polytopic ventricular extrasystoles and ventricular tachycardia, then followed by ventricular fibrillation and flutter, and increasing blockade usually indicates the approach of asystole.
Asystole of the heart: symptoms
The signs that help determine that the patient has a heart condition are probably known to everyone, but we will repeat them all the same.
- In large arteries there is no pulse. To verify this, folded index and middle fingers should check its presence in the carotid artery (it is groped in the fossa next to the thyroid cartilage of the larynx (Adam's apple). If there is no pulse, then a person has asystole of the heart.
- Emergency help is also needed if the pupils do not respond to the flashlight directed into the eyes. Normally, they should narrow, and if this does not happen, then the myocardium is not functioning.
- The absence of breathing, which occurs after 2 minutes, also indicates cardiac arrest. after the disappearance of the pulse. This can be checked by holding a mirror to the lips of the victim.
- No less eloquent is the complexion of the skin. If it acquires a grayish or bluish tint (especially the lips, tip of the nose and earlobes) - this is a signal of a serious circulatory disturbance.
- And, finally, if the patient who faints cannot be brought to his senses for more than 10-20 seconds with the help of ammonia, pats on the cheeks or loud noises, this can also be a sign of asystole.
All of these symptoms are dangerous to human life, so they require urgent resuscitation, which should be provided before the arrival of the ambulance crew. Remember that you have a maximum of 10 minutes to save a life (the brain of a person still lives so much time after a cardiac arrest).
Cardiac Emergency Rules
So, if you have discovered a person's heart asystole, treatment of the patient, or rather urgent emergency care is reduced to the following:
- Call an ambulance.
- Using a napkin, free the victim’s nose and mouth from vomiting, foreign bodies or mucus.
- Lay the person on his back, but so that his head is slightly thrown back.
- Give his legs a slightly elevated position with folded clothes or a pillow.
- Blow air into the victim’s lungs either from the mouth into the mouth (a handkerchief can be thrown over it) or from the mouth into the nose. After one blow, massage the heart.
- To do this, place the palm of a weaker hand so that it rests with the base on the lower edge of the sternum of the victim. On top of it, place the other palm perpendicularly and with the whole weight of the body, on outstretched arms, do rhythmic shocks with sharp movements (5 pressures). The interval between them is no more than a second. After each push of the hand, remove from the chest so as not to interfere with the blood flow freely into the heart. In a minute you need to make at least 100 shocks.
Some More Emergency Tips
It is better if the resuscitation measures described above are performed by two people at once - one blows air and the other performs a heart massage.
It is important to remember that if the patient can be saved, but it will take more than ten allotted minutes, he may develop serious neurological disorders. Therefore, be collected and, most importantly, calm, only in this way the asystole of the heart (what you now, of course, understand) will be defeated.
Every 2 minutes, check the patient's condition - his breathing, pulse and the reaction of the pupils, as soon as breathing appears, emergency care can be stopped. If a pulse appears, but there is still no breathing, continue ventilation.
Even if you are unable to bring the victim back to life, do not stop giving him emergency care. It can only be stopped when emergency doctors arrive. They will use their methods to maintain the patient's life.
Possible complications after cardiac arrest
As already mentioned above, rescuers have little time to help a person who has heart asystole. This is only 10 minutes. And, unfortunately, even in the case of a favorable outcome, the victim may show the consequences of cardiac arrest, for example:
- ischemic damage to the brain, liver or kidneys due to insufficient blood supply to these organs during clinical death;
- fracture of ribs as a result of strong pressure during a heart massage;
- air entering the cavity between the pleura sheets covering the lungs and chest (in medicine, this pathology is called pneumothorax).
But you understand that a saved life all the same means more broken ribs, which means that without hesitation provide urgent help to a needy person.
Features of emergency care in a child
Unfortunately, for children of the first years of life, the resuscitation measures described in the article are especially relevant and, therefore, parents should be well aware of what to do in cases when their baby has developed heart asystole (which is such an action that is somewhat different from that used in adults, of course, you understand).
And most importantly, do not succumb to panic and act very quickly, since the time mentioned above in a child is reduced to 5 minutes. Call an ambulance first.
- Then the baby needs to be laid on the table, undressed or swaddled and his mouth freed from mucus and foreign objects.
- Pads of the index and middle finger attach to the lower chest. Press them on the chest intensively, but gently, with a frequency of 120 shocks in 1 min.
- During the push, the sternum should be shifted to the depth of the finger.
- Every 15 pressures, make 2 blows into the baby’s mouth and nose with a tissue.
Asystole of the heart: treatment in the intensive care unit
Specialized resuscitation measures for cardiac arrest in a hospital are carried out by means of tracheal intubation (a flexible plastic tube is placed in it through which mechanical ventilation of the lungs is carried out) and a bolus (that is, fast, as opposed to a dropper) injection of “Adrenaline hydrochloride” and “ Atropine".
If the ineffectiveness of the usual doses is detected, these drugs begin to be administered every 5 minutes. inkjet. Then the dose is gradually increased to 5 mg and is administered every 3 minutes.
In situations where there is no access to veins, drugs are injected into the trachea, and their dosage is doubled. Injections into the heart are carried out only if other methods of drug administration are not possible.
Is it possible to prevent asystole?
We are talking in the article how dangerous asystole of the heart is, what is this condition that can easily lead a person to death. But is it possible to avoid such an outcome? And how to prevent it?
In some cases, doing this is absolutely real. It is only necessary to observe some preventive rules. So, regardless of the diagnosis, patients with cardiac pathologies should strictly follow the instructions of the attending physician - not to violate the dosage of the drugs and the timeliness of their use, monitor the level of physical activity and avoid the use of certain drugs specified by the specialist.
If necessary, such patients are also prescribed medical devices in the form of cardioverter defibrillators or pacemakers supporting an adequate heart rate. And relatives of the patient should be prepared for an emergency and know how to act in a particular case.
All the details of primary prevention are necessarily discussed in detail with a cardiologist and are binding.