Sinusitis

Expert opinion: sudden cardiac arrest. Cardiac arrest and cerebral coma: clinical death from a medical point of view Causes leading to cardiac arrest

Cardiac arrest is the process by which an organ stops functioning. Various factors can cause this, and the result will be clinical, and then biological death person. It occurs due to cessation of blood circulation, which leads to oxygen starvation of the body. If you don't get help and get the heart beating in the first seven minutes, the victim will be brain dead. Stoppage can occur in both young people and the elderly.

Heart disease

Causes of heart pathology

Every person can experience cardiac arrest, and its causes lie in heart disease and diseases of other organs. The following factors cause cardiac arrest:

Cardiac. This category of pathologies is responsible for 90% of heart attacks. It includes:

rhythm disturbances;
Brugada syndrome;
ischemia;
heart attack;
thromboembolism of the pulmonary arteries;
rupture of aneurysm in the aorta, acute heart failure;
arrhythmogenic and cardiogenic shock.

"Obstructive syndrome sleep apnea"as an example. Because of this syndrome, a person experiences short-term cardiac arrest at night. It is caused by abnormal cardiac activity.

The second reason is cardiac risk factors, which increase the likelihood of sudden arrest in people with a diseased cardiovascular system. Factors include:

age from 50 years;
smoking;
frequent drinking;
overweight;
physical exhaustion of the body;
stress, hypertension;
diabetes;
high cholesterol.

Extracardiac – non-cardiac pathologies and do not directly affect the heart, but can cause cardiac arrest. Pathologies include:

asphyxia;
old age;
late stages of severe chronic pathologies;
various types of shock (caused by injury or burn);
poisoning with alcohol, drugs or medications;
violence, drowning, injuries, etc.

Reflex cardiac arrest is an example of a violent cause. Reflex cardiac arrest can be caused by a shock or occur due to electrical trauma.

SIDS. This sudden infant death syndrome requires separate consideration. It manifests itself when the child has not yet lived even a year. This mainly occurs at the age of 3 months. Cardiac arrest occurs during sleep at night. At the same time, the signs of cardiac arrest themselves do not appear in advance. There are factors that increase the risk of developing pathology:

how the baby lies on his stomach at night;
bed too soft;
sleeping in a hot and stuffy room;
maternal smoking;
prematurity of the child;
multiple pregnancy;
intrauterine hypoxia;
the fetus has developmental delay;
family predisposition;
in the first months after birth there was a severe infection.

These are the causes of cardiac arrest in humans.

Heart attack

Heart Attack Symptoms

It is important to know the symptoms of cardiac arrest. Sudden cardiac arrest is an unpredictable pathology, as it is difficult to notice. As the pathology develops, the patient feels well, experiencing slight discomfort.

The condition worsens suddenly, the person grabs his heart and falls, losing consciousness. This is where it is important to know the symptoms, because they will allow you to distinguish cardiac arrest from ordinary fainting, which has similar symptoms.

Symptoms of pathology:

no pulse can be felt in the arteries;
there is no breathing or within 2 minutes it manifests itself in the form of convulsive wheezing;
the pupil does not constrict when exposed to light;
the body acquires an unnaturally pale, bluish color.

You can determine cardiac arrest by symptoms if you know them and be able to notice them. Taken together, the condition looks like this: the patient falls, loses consciousness, turns pale, lips turn blue, and does not respond to braking or screams. If first aid is not provided to the victim within seven minutes, biological death will occur.

In a dream, death occurs differently from cardiac arrest. The person simply does not wake up and outwardly looks as if he is sleeping.

Types of cardiac arrest such as sudden death and death in sleep are very dangerous. Both require attention, because otherwise first aid will not be provided on time and the person will die.

Sudden cardiac arrest

Diagnosis of pathologies

How to determine cardiac arrest? How to make a diagnosis? Most people do not know the answers to these questions. And this is bad, since almost 70% of such cardiac arrests occur outside the walls of medical institutions.

Mostly, cardiac arrest causes people to feel ill at home, on the street or at work. Become witnesses ordinary people, not having medical education and unable to provide qualified assistance.

However, knowing the basic actions, when every minute counts, a person will not get confused and will do everything right. The procedure is as follows:

If a person suddenly loses consciousness, you need to lightly hit him on the cheeks, shake him up and call him loudly. This will allow you to understand how a person feels and whether he simply fainted.
The next step is a breath test. Place your ear to the victim’s chest or tilt his head back and extend his jaw, then place your cheek against the patient’s nostrils. This will allow you to feel and hear breathing, if any. Such methods are the most effective and allow you to do without improvised means and complicated ways. For example: using a mirror brought to the mouth to detect breathing.
Pulse check. To do this, find the carotid artery located between neck muscle, larynx and angle of the lower jaw. If you do not feel a pulse, you need to start chest compressions.

Heart rate

The arteries located in the wrist are not reliable indicator. The severity of the patient's condition must be assessed during the first 20 seconds from the moment cardiac activity stops. Therefore, looking for a pulse on the wrist is not only useless, but also harmful.

Treatment

As soon as the diagnosis is made and an ambulance is called, first aid should begin. The victim should be placed on a hard surface. Next comes into effect resuscitation measures ABC algorithm.

ABC consists of three points.

Ensure airway patency. To do this, the person’s head is tilted back, and lower jaw put forward. After which, with a finger wrapped in a cloth, the oral cavity is cleared of vomit or mucus.
Create artificial ventilation lungs. This is done in two ways: “mouth to mouth” and “mouth to nose”. For the first method, pinch the victim's nose with two fingers and blow air into the mouth. To avoid contact with the patient's saliva, cover with a scarf or napkin.
Perform a closed cardiac massage. However, the heart must receive a precordial beat as soon as it stops. It is applied from a distance of approximately 25 cm with a fist to the sternum area, before starting a cardiac massage. It is effective only in the first half a minute after cardiac arrest and only in case of ventricular fibrillation.

These three steps, done correctly, will help save human life. Special attention It is worth paying attention to the order in which they are performed. The sequence is due to the fact that the brain prioritizes blood supply rather than ventilation of the lungs.

Heart massage

For cardiac massage to have an effect, it must be certain actions in the correct order.

First, find lower third sternum. Then measure up a distance from its bottom edge equal to two transverse fingers. Clasp your hands so that one hand is on top of the other. Straighten your arms to rest them on your lower third.

When pressing, it is important to keep your arms straight. This will avoid rib fractures, and the pressure applied will be optimal. To achieve a greater effect, it is recommended to bend the patient’s legs and raise them 35° above the floor.

Massage

Ambulance

What medications are administered to the patient first? The medical team uses special means to start the heart. One such drug most commonly used for cardiac arrest is epinephrine. There are also several other means for this: Atropine, Norepinephrine and others. All of them stimulate cardiac activity.

Then the heartbeat is diagnosed or an electrocardiogram is done. A defibrillator is then used to start the heart. The defibrillator has electrodes that are placed on the patient's chest. An electrical discharge is sent through them, which should start the heart.

The defibrillator is already used on the move in the ambulance. This is necessary for the patient to survive to the intensive care unit of the hospital. The defibrillator can also be used in the clinic.

Medicines for the heart

It is worth considering in detail the medications (Lidocaine, Adrenaline and others), their purpose and properties. After all, even though the defibrillator takes on the main function of starting the heart muscle, a much greater result is achieved in combination with the necessary drugs.

Necessary drugs - Adrenaline, Atropine, Lidocaine, sodium bicarbonate, magnesium sulfate and calcium:

Adrenaline is used to make the heart beat faster and stronger.
Atropine is excellent for asystole.
Lidocaine helps fight arrhythmia.
Sodium bicarbonate is used in cases of prolonged arrest, especially if there has been acidosis or hyperkalemia.
Magnesium sulfate stabilizes and stimulates heart cells.
Calcium helps cope with hyperkalemia.

At correct use Atropine, Lidocaine and other drugs give excellent results, multiplying the patient’s chances of survival.

Resuscitation and consequences

After delivering the patient by ambulance and injections (Lidocaine, Atropine, etc.), he should certain time be in intensive care. May be required surgery. In this case, during the operation, a pacemaker is implanted in the heart, which will maintain the heart rhythm.

Even after discharge, the patient must strictly follow the doctors’ instructions: give up bad habits, drink necessary pills and undergo periodic heart screenings.

Using glycosides and leading a healthy lifestyle, you can avoid a recurrence of this situation. And then the chance to live to see old age will increase significantly.

The consequences of cardiac arrest can be very serious. These include memory loss, hallucinations, seizures, headaches, blurred vision and hearing.

Help

Myths

Now on the Internet there are many myths associated with cardiac arrest. They feature cognac, SCP 001, a dream book, and the like. Let's try to dispel at least some of them.

Dreams

Let's start with the dream book. Many lovers traditional medicine We firmly believe that it is possible to predict and prevent cardiac arrest if you correctly interpret your dreams.

It is believed that stopping will occur if you see the heart from the outside in a dream. And you can prevent it if you take control of your sleep and present a different picture in accordance with the description in the book.

The result of such self-hypnosis is death. Therefore, you should not risk your health by relying on a book about dreams, but seek help from a doctor.

SCP 001

SCP 001 is a myth about a mysterious file containing terrible secrets. If you believe the data on the site, then when you visit it, a person will be faced with unique protection. If you scroll down the page and read the text of SCP 001, after a few seconds his heart stops.

Many people believe in SCP 001 and are seriously worried about it. However, so far there are no casualties, and, apparently, this is another joke in the series of “damned chain letters”

Cognac and heart

The myth about cognac. Many people who survived the shutdown love cognac. And many of them are sure that it is good for the heart. And that’s why they often use it more often than medications.

Cognac does not heal, but can lead to cardiac dysfunction. Therefore, its use leads to failures that will cause cardiac arrest.

So people suffering from heart disease should avoid consuming it.

More more information You will find information about cardiac arrest in the video:

What do you need to know to provide first aid for cardiac arrest?

“Man is mortal, but his main problem is that he is mortal suddenly,” these words, put by Bulgakov into Woland’s mouth, perfectly describe the feelings of most people. There is probably no person who is not afraid of death. But along with the big death, there is a small death - clinical. What is it, why do people who have experienced clinical death often see divine light, and is this not a delayed path to heaven - in the material on the site.

Clinical death from a medical point of view

The problems of studying clinical death as a borderline state between life and death remain one of the most important in modern medicine. Unraveling its many mysteries is also difficult because many people who have experienced clinical death do not fully recover, and more than half of patients with similar condition it is not possible to revive them, and they die for real - biologically.

So, clinical death is a condition accompanied by cardiac arrest, or asystole (a condition in which the heart stops contracting first). various departments heart, and then cardiac arrest occurs), respiratory arrest and deep, or transcendental, cerebral coma. Everything is clear with the first two points, but about whom it is worth explaining in more detail. Typically, doctors in Russia use the so-called Glasgow scale. The eye opening reaction, as well as motor and speech reactions are assessed using a 15-point system. 15 points on this scale correspond to clear consciousness, and minimum score– 3, when the brain does not respond to any type of external influence, corresponds to an extreme coma.

After stopping breathing and cardiac activity, a person does not die immediately. Consciousness turns off almost instantly, because the brain does not receive oxygen and oxygen starvation occurs. But nevertheless, in a short period of time, from three to six minutes, he can still be saved. Approximately three minutes after breathing stops, cell death in the cerebral cortex begins, the so-called decortication. The cerebral cortex is responsible for higher nervous activity and after decortication, resuscitation measures may be successful, but the person may be doomed to a vegetative existence.

After a few more minutes, cells in other parts of the brain begin to die - in the thalamus, hippocampus, cerebral hemispheres brain A condition in which all parts of the brain have lost functioning neurons is called decerebration and actually corresponds to the concept of biological death. That is, reviving people after decerebration is, in principle, possible, but the person will be doomed to remain on artificial ventilation and other life-sustaining procedures for the rest of his life.

The fact is that the vital (vital - website) centers are located in the medulla oblongata, which regulates breathing, heartbeat, cardiovascular tone, as well as unconditioned reflexes like sneezing. With oxygen starvation medulla oblongata, which is actually a continuation of the spinal cord, is one of the last parts of the brain to die. However, despite the fact that the vital centers may not be damaged, by that time decortication will have already occurred, making it impossible to return to normal life.

Other human organs, such as the heart, lungs, liver and kidneys, can survive without oxygen for much longer. Therefore, one should not be surprised by the transplantation, for example, of kidneys taken from a patient who is already brain dead. Despite brain death, the kidneys are still in working order for some time. And the muscles and intestinal cells live without oxygen for six hours.

Currently, methods have been developed that can increase the duration of clinical death to two hours. This effect is achieved using hypothermia, that is, artificial cooling of the body.

As a rule (unless, of course, it happens in a clinic under the supervision of doctors), it is quite difficult to determine exactly when cardiac arrest occurred. According to current regulations, doctors are required to carry out resuscitation measures: cardiac massage, artificial respiration within 30 minutes from start. If during this time it was not possible to resuscitate the patient, then biological death is declared.

However, there are several signs of biological death that appear within 10–15 minutes after brain death. First, Beloglazov's symptom appears (when pressure is applied to the eyeball, the pupil becomes like a cat's), and then the cornea of the eyes dries out. If these symptoms are present, resuscitation is not performed.

How many people survive clinical death safely?

It may seem that most people who find themselves in a state of clinical death come out of it safely. However, this is not the case; only three to four percent of patients can be resuscitated, after which they return to normal life and do not suffer from any mental disorders or loss of body functions.

Another six to seven percent of patients, being resuscitated, nevertheless do not fully recover and suffer various lesions brain. The vast majority of patients die.

Such sad statistics largely due to two reasons. The first of them is that clinical death can occur not under the supervision of doctors, but, for example, at the dacha, from where the nearest hospital is at least half an hour’s drive. In this case, doctors will arrive when it is no longer possible to save the person. Sometimes it is impossible to defibrillate in a timely manner when ventricular fibrillation occurs.

The second reason remains the nature of the damage to the body during clinical death. If we're talking about massive blood loss, resuscitation measures are almost always unsuccessful. The same applies to critical myocardial damage during a heart attack.

For example, if a person, as a result of a blockage in one of the coronary arteries more than 40 percent of the myocardium is affected, death is inevitable, because the body cannot live without heart muscles, no matter what resuscitation measures are taken.

Thus, it is possible to increase survival rate in case of clinical death mainly by equipping crowded places with defibrillators, as well as by organizing flying ambulance teams in hard-to-reach areas.

Clinical death for patients

If clinical death for doctors is emergency, in which it is necessary to urgently resort to resuscitation measures, then for patients it often seems to be the road to a brighter world. Many people who experienced clinical death talked about seeing the light at the end of the tunnel, some meeting their long-dead relatives, others looking at the earth from a bird's eye view.

“I had a light (yes, I know how it sounds), and I seemed to see everything from the outside. There was bliss, or something. No pain for the first time in so long. And after clinical death, there was a feeling that I had lived some kind of someone else’s life and now I’m just sliding back into my skin, my life - the only one in which I feel comfortable. It’s a little tight, but it’s a pleasant tightness, like a worn pair of jeans that you’ve been wearing for years,” says Lydia, one of the patients who suffered. clinical death.

It is precisely this feature of clinical death, its ability to cause vivid images, is still the subject of much debate. With pure scientific point From a visual perspective, what is happening is described quite simply: brain hypoxia occurs, which leads to hallucinations in the actual absence of consciousness. What kind of images a person has in this state is a strictly individual question. The mechanism by which hallucinations occur has not yet been fully elucidated.

At one time the endorphin theory was very popular. According to her, much of what people feel during near-death experiences can be attributed to the release of endorphins due to extreme stress. Since endorphins are responsible for pleasure, and in particular even for orgasm, it is not difficult to guess what many people who experienced clinical death thought after it ordinary life just a burdensome routine. However, in recent years this theory was debunked because researchers found no evidence that endorphins were released during clinical death.

There is also a religious point of view. As, indeed, in any cases that are inexplicable from the standpoint of modern science. Many people (including scientists) are inclined to believe that after death a person goes to heaven or hell, and the hallucinations that those who experienced clinical death saw are only proof that hell or heaven exist, just like afterlife at all. It is extremely difficult to give any assessment to these views.

Nevertheless, not all people experienced heavenly bliss during clinical death.

“I suffered clinical death twice in less than one month. I didn’t see anything. When they returned me, I realized that I was nowhere, in oblivion. I had nothing there. I came to the conclusion that there you free yourself from everything by total loss yourself, probably, along with your soul. Now death doesn’t really worry me, but I enjoy life,” accountant Andrei cites his experience.

Overall, research has shown that when human death the body loses a little weight (literally a few grams). Adherents of religions hastened to assure humanity that at this moment from human body the soul is separated. However scientific approach states that the weight of the human body changes due to chemical processes occurring in the brain at the moment of death.

Doctor's opinion

Current standards require resuscitation within 30 minutes of the last heartbeat. Resuscitation stops when a person’s brain dies, namely upon EEG registration. I personally once successfully resuscitated a patient whose heart had stopped. In my opinion, the stories of people who have experienced clinical death are in most cases a myth or fiction. I have never heard such stories from our patients. medical institution. There were no such stories from colleagues either.

Moreover, people tend to call completely different conditions clinical death. Perhaps the people who supposedly suffered it did not actually die, they simply had syncope, that is, fainting.

The main cause that leads to clinical death (as well as, in fact, to death in general) remains cardiovascular diseases. Generally speaking, such statistics are not kept, but we must clearly understand that clinical death occurs first, and then biological death. Since the first place in mortality in Russia is occupied by heart and vascular diseases, it is logical to assume that they most often lead to clinical death.

Dmitry Yeletskov

anesthesiologist-resuscitator, Volgograd

One way or another, the phenomenon of near-death experiences deserves careful study. And it’s quite difficult for scientists, because in addition to the fact that it is necessary to establish which chemical processes in the brain lead to the appearance of certain hallucinations, it is also necessary to distinguish truth from fiction.

Cardiac arrest is the complete cessation of ventricular contractions or severe loss of pumping function. At the same time, electrical potentials disappear in myocardial cells, impulse pathways are blocked, and all types of metabolism are quickly disrupted. The affected heart is unable to push blood into the vessels. Stopping blood circulation poses a threat to human life.

According to WHO statistical studies, 200 thousand people in the world have cardiac arrest in a week. Of these, about 90% die at home or at work before receiving medical attention. This indicates a lack of awareness among the population about the importance of training in measures emergency care.

The total number of deaths from sudden cardiac arrest is greater than from cancer, fires, road accidents, and AIDS. The problem concerns not only older people, but also people of working age and children. Some of these cases are preventable. Sudden cardiac arrest does not necessarily occur as a consequence serious illness. Such a defeat is possible against the background full health, in a dream.

Main types of cessation of cardiac activity and mechanisms of their development

The causes of cardiac arrest according to the developmental mechanism are hidden in sharp violation its functional abilities, especially excitability, automaticity and conductivity. The types of cardiac arrest depend on them. Cardiac activity can stop in two ways:

asystole (in 5% of patients); fibrillation (in 90% of cases).

Asystole is a complete cessation of ventricular contraction in the diastole phase (during relaxation), rarely in systole. An “order” to stop can come to the heart from other organs reflexively, for example, during operations on the gall bladder, stomach, and intestines.

With reflex asystole, the myocardium is not damaged and has fairly good tone.

IN in this case the role of the vagus and trigeminal nerves has been proven.

Another option is asystole in the background:

general oxygen deficiency (hypoxia); increased carbon dioxide content in the blood; shift in acid-base balance towards acidosis; altered electrolyte balance (increase extracellular potassium, decreased calcium).

These processes taken together negatively affect the properties of the myocardium. The process of depolarization, which is the basis of myocardial contractility, becomes impossible, even if conduction is not impaired. Myocardial cells lose active myosin, which is necessary to obtain energy in the form of ATP.

With asystole, hypercalcemia is observed in the systole phase.

Cardiac fibrillation is an impaired communication between cardiomyocytes in coordinated actions to ensure overall myocardial contraction. In return synchronous operation, causing systolic contraction and diastole, many scattered areas appear that contract on their own.

The contraction frequency reaches 600 per minute and above

In this case, the ejection of blood from the ventricles is affected.

Energy expenditure is significantly higher than normal, and effective reduction does not occur.

If fibrillation affects only the atria, then individual impulses reach the ventricles and blood circulation is maintained at a sufficient level. Attacks of short-term fibrillation can end on their own. But such ventricular tension cannot provide hemodynamics for a long time, energy reserves are depleted and cardiac arrest occurs.

Other mechanisms of cardiac arrest

Some scientists insist on identifying electromechanical dissociation as a separate form of cessation of cardiac contractions. In other words, myocardial contractility is preserved, but is not sufficient to ensure the pushing of blood into the vessels.

In this case, there is no pulse and blood pressure, but the following is recorded on the ECG:

regular contractions with low voltage; idioventricular rhythm (from the ventricles); loss of activity of the sinus and atrioventricular nodes.

The condition is caused by ineffective electrical activity hearts.

In addition to hypoxia, impaired electrolyte composition and acidosis, hypovolemia (decreased total blood volume) is important in pathogenesis. Therefore, such signs are more often observed with hypovolemic shock and massive blood loss.

Since the 70s of the last century, the term “obstructive sleep apnea syndrome” has appeared in medicine. Clinically, it was manifested by short-term cessation of breathing and cardiac activity at night. To date, extensive experience has been accumulated in diagnostics of this disease. According to the Research Institute of Cardiology, nocturnal bradycardia was found in 68% of patients with respiratory arrest. At the same time, a blood test showed severe oxygen starvation.

The device allows you to record respiratory rate and heart rhythm

The picture of heart damage was expressed:

in 49% - sinoatrial block and pacemaker arrest; in 27% - atrioventricular block; in 19% - blockade with atrial fibrillation; in 5% - a combination different forms bradyarrhythmias.

The duration of cardiac arrest was recorded as more than 3 seconds (other authors indicate 13 seconds).

During the waking period, no patient experienced fainting or any other symptoms.

Researchers believe that the main mechanism of asystole in these cases is pronounced reflex influence from the respiratory system, arriving via the vagus nerve.

Causes of cardiac arrest

Among the causes can be identified directly cardiac (cardiac) and external (extracardiac).

The main cardiac factors are:

myocardial ischemia and inflammation; acute obstruction pulmonary vessels due to thrombosis or embolism; cardiomyopathy; high blood pressure; atherosclerotic cardiosclerosis; rhythm and conduction disturbances due to defects; development of cardiac tamponade with hydropericardium.

Extracardiac factors include:

oxygen deficiency (hypoxia) caused by anemia, asphyxia (suffocation, drowning); pneumothorax (the appearance of air between the layers of the pleura, unilateral compression of the lung); loss of a significant volume of fluid (hypovolemia) due to injury, shock, incessant vomiting and diarrhea; metabolic changes with abnormalities towards acidosis; hypothermia (hypothermia) below 28 degrees; acute hypercalcemia; severe allergic reactions.

Pneumothorax right lung sharply shifts the heart to the left, with a high risk of asystole

Indirect factors that influence the stability of the body’s defenses are important:

excessive physical stress on the heart; old age; smoking and alcoholism; genetic predisposition to rhythm disturbances, changes in electrolyte composition; electrical trauma.

A combination of factors significantly increases the risk of cardiac arrest. For example, drinking alcohol in patients with myocardial infarction causes asystole in almost 1/3 of patients.

Negative effects of drugs

Medicines that cause cardiac arrest are used for treatment. IN in rare cases deliberate overdose causes death. This must be proven to the judicial and investigative authorities. When prescribing medications, the doctor takes into account the patient’s age, weight, diagnosis, and warns about a possible reaction and the need to see a doctor again or call an ambulance.

Overdose occurs when:

non-compliance with the regime (taking pills and alcohol); deliberately increasing the dose (“I forgot to drink this morning, so now I’ll take two at once”); combination with folk ways treatment (St. John's wort, shepherd's ear, self-prepared tinctures of lily of the valley, foxglove, adonis); general anesthesia against the background of continuous medication use.

The use of St. John's wort herb should be very limited; its potency is comparable to antitumor cytostatics

Most common reasons cardiac arrest is performed by:

sleeping pills from the group of barbiturates; narcotic drugs for pain relief; a group of β-blockers for hypertension; drugs from the group of phenothiazines prescribed by a psychiatrist as a sedative; tablets or drops of cardiac glycosides, which are used to treat arrhythmias and decompensated heart failure.

It is estimated that 2% of asystole cases are drug related.

Determine which medications have the most optimal indications and have least properties accumulation, addiction, can only be achieved by a specialist. You should not do this on the advice of friends or on your own.

Diagnostic signs of cardiac arrest

Cardiac arrest syndrome includes early signs state of clinical death. Since this phase is considered reversible with effective resuscitation measures, every adult should know the symptoms, since a few seconds are allotted for reflection:

Complete loss of consciousness - the victim does not respond to shouting or braking. It is believed that the brain dies 7 minutes after cardiac arrest. This is an average figure, but the time can vary from two to eleven minutes. The brain is the first to suffer from oxygen deficiency; the cessation of metabolism causes cell death. Therefore, there is no time to speculate on how long the victim’s brain will live. The earlier resuscitation is started, the greater the chances of survival. Inability to detect pulsation on carotid artery- this sign in diagnosis depends on practical experience those around you. In its absence, you can try to listen to heartbeats by placing your ear to the bare chest. Impaired breathing - accompanied by rare noisy breaths and intervals of up to two minutes. “Before our eyes” there is an increase in the change in skin color from pallor to blueness. The pupils dilate after 2 minutes of cessation of blood flow , there is no reaction to light (constriction from a bright beam). Manifestation of cramps in individual muscle groups.

If a " Ambulance", then asystole can be confirmed by an electrocardiogram.

What are the consequences of cardiac arrest?

The consequences of circulatory arrest depend on the speed and correctness of emergency care. Long-term oxygen deficiency of organs causes:

irreversible foci of ischemia in the brain; affects the kidneys and liver; with vigorous massage in the elderly and children, fractures of the ribs, sternum, and the development of pneumothorax are possible.

Weight of the head and spinal cord together they make up only about 3% of the total body weight. And for their full functioning, up to 15% of the total is needed cardiac output. Good compensatory capabilities make it possible to preserve functions nerve centers when the level of blood circulation decreases to 25% of normal. However, even indirect massage allows you to maintain only 5% of normal level blood flow

On the rules of resuscitation measures, possible options read this article.

Consequences from the brain can be:

memory impairment of a partial or complete nature (the patient forgets about the injury itself, but remembers what happened before it); blindness accompanies irreversible changes in the visual nuclei, vision is rarely restored; paroxysmal convulsions in the arms and legs, chewing movements; various types of hallucinations (auditory, visual).

Statistics show actual revival in 1/3 of cases, but full recovery functions of the brain and other organs occurs only in 3.5% of cases of successful resuscitation

This is due to the delay in assistance in cases of clinical death.

Prevention

Cardiac arrest can be prevented by following the principles of a healthy lifestyle, avoiding factors that affect blood circulation.

A balanced diet, quitting smoking, alcohol, and daily walks are no less important for people with heart disease than taking pills.

Control over drug therapy requires remembering a possible overdose and a decrease in heart rate. It is necessary to learn how to determine and count the pulse, depending on this, coordinate the dosage of medications with your doctor.

Unfortunately, the time to provide medical care in case of cardiac arrest is so limited that it is not yet possible to achieve full resuscitation measures in out-of-hospital conditions.

Dmitry Grigorenko

27-04-2017, 11:16

There can be quite a large number of reasons why a person begins to develop cardiac arrest. One of these may be obstructive sleep apnea syndrome. For some reason in medical literature not given of great importance this disorder. This disease causes sleep apnea. This is due to a short-term decrease in the load on the upper respiratory tract while a person is sleeping. Because of this, air will not enter the lungs during sufficient quantity. Therefore, a sleeping person will have temporary difficulty or complete cessation of breathing. This apnea syndrome can occur due to snoring and becomes a complex form of it.

What happens in the body during sleep apnea

With sleep apnea syndrome, cardiac arrhythmia occurs due to the fact that the body is in a hypoxic state, which occurs during periods of stoppages and breathing problems. That is, the heart begins to work more intensely under conditions oxygen starvation myocardium. Most often, arrhythmias are recorded during periods of night sleep. Their frequency may begin to increase from the moment the load from apnea syndrome increases. Typically, the occurrence of cardiac arrhythmia coincides in time with respiratory arrest. These are constant and frequent disorders breathing during sleep can lead to depletion of the heart muscle, as well as aggravation of situations with existing heart diseases.

Frequent pauses in breathing

With frequent and prolonged stoppages of breathing, as well as if a person already has a severe form of heart disease, this can lead to a disease such as heart block. This is observed in more than 10% of patients who suffer from apnea. Short stop hearts in a dream can last from 2 seconds to a minute. This symptom most often appears in people who suffer from coronary disease heart and some lung diseases.

If apnea is not diagnosed in time and treated, it can lead to sudden death in a dream.

Complete cessation of cardiac activity under the influence various factors called cardiac arrest. In some cases, reversible clinical death develops, and in others, irreversible biological death. Blood does not circulate through the vessels, the pumping mechanism of the heart does not work, which causes oxygen starvation of all human systems.

There are only 7 minutes to provide first aid and “start” the mechanism. After this, irreversible processes begin to develop, leading to complete inoperability of the brain, and death occurs. Any person, both elderly and young, can face the problem of cardiac arrest. at a young age.

Reasons

Cardiac arrest is associated with diseases of the heart and other human organs. In this case, sudden death occurs. The causes of cardiac arrest can be different.

Heart (cardiac) diseases: disturbances in the rhythm of heart contractions, coronary artery disease, thromboembolism, myocardial infarction, Brugada syndrome, rupture of aortic aneurysm, heart failure. Factors that increase the likelihood of cardiac arrest in people with heart and vascular diseases: old age, abuse of bad habits, overweight, stress and overwork, intense physical activity, hypertension, increased content blood sugar and cholesterol. Extracardiac (extracardiac) diseases: chronic diseases in severe form, asphyxia, anaphylactic, post-traumatic and burn shock, acute poisoning, violent influence.

In some cases, cardiac arrest occurs in the fetus while still in the womb. Fetal death occurs under the influence of several factors.

Insufficient oxygen supply. Most often this occurs in the presence of concomitant cardiovascular diseases mother. Lack of oxygen in the fetus can also develop with tuberculosis, emphysema, pneumonia, and signs of anemia. Insufficient blood flow. The problem occurs when knots on the umbilical cord are tightened during childbirth, as well as when intrauterine development fetus Cardiac arrest and fetal death can occur due to placental abruption or uterine convulsions. Dysfunction of the fetal central nervous system. Asphyxia occurs due to skull injuries (compression, cerebral edema, fetal development abnormalities). Airway obstruction in the fetus. When hit amniotic fluid or mucus from cervical canal V oral cavity of the fetus, asphyxia develops, leading to cardiac arrest of the child.

Much attention should be paid to sudden infant death syndrome (SIDS). Cardiac arrest in children aged 2-4 months (not older than one year) and death during sleep without visible reasons And serious illnesses. Risk factors for SIDS include: fetal hypoxia, multiple pregnancies, prematurity, bad habits mothers, a soft baby bed with a pillow, incorrect body position during sleep, previous infectious diseases.

According to research, up to 90% of cases of cardiac arrest are associated with ventricular fibrillation, in which muscle fibers begin to contract in a chaotic manner. The second most important cause of sudden cardiac arrest is ventricular asystole (complete cessation of myocardial activity).

Warning signs

The clinical manifestation of cardiac arrest occurs with a deterioration in general health. The syndrome occurs suddenly, the patient loses consciousness. At the same time, there are following symptoms cardiac arrest:

absence of pulse in large arteries (neck, thigh, groin area); complete cessation of breathing or signs of agonal (death) noisy breathing for two minutes; pallor and blueness skin; the appearance of convulsions (15-30 seconds after loss of consciousness); dilation of the pupils when exposed to light (after two minutes).

After 6-7 minutes, in the absence of assistance to the victim, biological death occurs.

Diagnostics

Sudden cardiac arrest must be diagnosed immediately, because the patient is in emergency condition. Most often, trouble happens outside of hospital settings, so every person should know how to assess the condition of the victim and how to provide first aid.

First of all, a quick external examination of the unconscious person is performed. It is necessary to find out whether there was a simple fainting. By shaking the shoulder and lightly hitting the cheeks, you can determine whether the victim is conscious. If there are no signs of fainting and the person is still unconscious, then it is necessary to check his breathing. The pulse in the carotid artery is also felt. If there is no breathing or pulse, you must immediately begin indirect massage hearts. At the same time, an ambulance is called.

In a hospital setting, cardiac arrest can be diagnosed during an external examination of the patient, as well as using an electrocardiogram (ECG). The ECG machine records the absence of cardiac activity.

Depending on the examination results, the following types of cardiac arrest are distinguished:

asystole (straight line on the ECG, most often in diastole); ventricular fibrillation (uncoordinated contraction muscle fibers); electromechanical dissociation - ineffective heart (single peaks on the ECG, lack of myocardial contraction).

First aid and treatment

Sudden cardiac arrest requires immediate assistance to the victim; any delay will cause his death. To do this, a person lies down on a hard, flat surface, and the following actions are performed:

push the victim’s lower jaw forward, throw his head back, with a finger wrapped in a cloth, try to remove all foreign objects in the mouth (sunken tongue, mucus, vomit); artificial ventilation (mouth-to-mouth or mouth-to-nose method); indirect cardiac massage, starting with a precordial blow to the chest area (such a blow is contraindicated when assisted by an unqualified specialist).

For massage determined bottom part chest (at a distance of two fingers above the lower edge of the sternum), fingers crossed into a lock. Rhythmic pressure is applied to the chest with a frequency of 100 compressions in 60 seconds. After every fifth pressure, air is blown into the victim. Throughout the massage, the arms remain straight, and the pressure force should not be too great, the patient’s legs are raised 30-400 from the floor.

First aid is provided until the victim exhibits a pulse and spontaneous breathing. If the person does not regain consciousness, then resuscitation measures continue until the ambulance arrives.

For recovery heart rate doctors use pulse therapy(defibrillation), mechanical artificial respiration and admission pure oxygen through an endotracheal tube or oxygen mask.

To urgent medications These include drugs to improve the conduction of impulses, increase the number of heart contractions, and drugs for arrhythmia.

Surgical intervention for cardiac arrest consists of collecting fluid from the pericardium (in case of cardiac tamponade), and puncture pleural cavity(in the presence of pneumothorax).

Consequences and possible complications

If heartbeat launched in time, the patient survives. In this case, the following consequences of cardiac arrest are observed:

ischemic damage to the brain and other organs (liver, kidneys) due to impaired blood circulation; pneumothorax (air in the pleural cavity), rib fracture caused by improper or overuse strong massage hearts.

The degree of complications after cardiac arrest depends on the time the brain was left without oxygen. If first aid was provided within the first 3-4 minutes, then brain functions will be almost completely restored without serious consequences. With prolonged hypoxia (more than 7 minutes), the likelihood of developing neurological complications increases significantly.

Possible deterioration of hearing, vision, memory loss, frequent headaches, convulsions, hallucinations. Short-term cardiac arrest in 80% of victims ends in the development of post-resuscitation illness, characterized by prolonged loss of consciousness (more than 3 hours). In severe cases it is possible serious defeat brain function With further development coma and vegetative state of the patient.

Cardiac arrest is serious problem, which is faced not only by the elderly, but also by people at a young age. After cardiac arrest, only 30% of people survive, of which only 3.5% can return to normal life without serious consequences. Healthy image life, regular medical examinations and taking care of your health help prevent severe cardiovascular diseases.

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There can be quite a large number of reasons why a person begins to develop cardiac arrest. One of these may be obstructive sleep apnea syndrome. For some reason, the medical literature does not attach much importance to this disorder. This disease causes sleep apnea. This is due to a short-term decrease in the load on the upper respiratory tract while a person is sleeping. Because of this, air will not enter the lungs in sufficient quantities. Therefore, a sleeping person will have temporary difficulty or complete cessation of breathing. This apnea syndrome can occur due to snoring and becomes a complex form of it.

What happens in the body during sleep apnea

With sleep apnea syndrome, cardiac arrhythmia occurs due to the fact that the body is in a hypoxic state, which occurs during periods of stoppages and breathing problems. That is, the heart begins to work more intensely under conditions of oxygen starvation of the myocardium. Most often, arrhythmias are recorded during periods of night sleep. Their frequency may begin to increase from the moment the load from apnea syndrome increases.
Typically, the occurrence of cardiac arrhythmia coincides in time with respiratory arrest. These constant and frequent breathing disorders during sleep can lead to depletion of the heart muscle, as well as aggravation of situations with existing heart diseases.

Frequent pauses in breathing

With frequent and prolonged stoppages of breathing, as well as if a person already has a severe form of heart disease, this can lead to a disease such as heart block. This is observed in more than 10% of patients who suffer from apnea. Brief cardiac arrest during sleep can last from 2 seconds to a minute. This symptom most often appears in people who suffer from coronary heart disease and certain lung diseases.
If sleep apnea is not diagnosed and treated promptly, it can lead to sudden death during sleep.

Cardiac arrest claims a large number of lives every year. Often this happens suddenly. It may well happen healthy person. Fortunately, when similar situation death can still be prevented. You just need to notice and diagnose cardiac arrest in time and do everything right.

Cardiac Arrest Clinic

How can you tell if a person's heart has stopped?

1) There is no pulse in large arteries.

To identify this symptom, index and middle finger apply to the carotid artery.

2) No breathing.

Its absence is determined visually ( rib cage motionless) or using a mirror (it is brought to the victim’s nose).

3) Dilated pupils that do not respond to light.

Forcefully lift your eyelid and shine a flashlight into your eyes. If the pupil does not constrict and remains motionless, this means that the myocardium is not functioning.

4) Blueness or grayness of the face.

If the pinkish tint of the skin becomes sallow, then blood circulation is impaired. This is an important sign of cardiac arrest.

5) Loss of consciousness.

Explained by ventricular fibrillation or asystole.

How to save a person?

To return a person from the “other world” without serious consequences, all activities must be carried out within the first seven minutes. If the heart fails to restart during this time period, the victim may remain disabled for life, with serious mental and neurological disorders, or die.

Main tasks:

restore breathing;
start the circulatory system;
restore heart rhythm.

First aid is provided only when the person is unconscious. Move the person, call out loudly. If there is no reaction, then proceed with rehabilitation measures. Stages:

1) Lay the victim on a hard surface and tilt his head back.

2) Release from foreign objects and mucus in the human respiratory tract.

3) Perform artificial ventilation (mouth-to-nose or mouth).

4) Punch middle part sternum. But not directly to the heart. This stage is called the “precordial stroke.” It may happen that this procedure will be sufficient to resuscitate the patient.

5) If the precordial stroke does not help, proceed to chest compressions.

Every two to three minutes check the victim’s pulse, pupils, and breathing. As soon as breathing is restored, stop resuscitation. If only the pulse has returned, artificial respiration must continue. Resuscitation must not be stopped until the doctor arrives. Even if nothing works out, the patient does not come to his senses, but you must continue. After the ambulance arrives, the victim is transferred to medical workers. They will continue resuscitation efforts.

Causes of cardiac arrest

The following reasons are identified:

1) Ventricular fibrillation. Chaotic contraction of muscle fibers leads to a disruption of blood circulation in the body.

2) Ventricular asystole. The myocardium stops working.

3) Ventricular paroxysmal tachycardia.

4) Electromechanical dissociation.

5) Romano-Ward syndrome (genetic predisposition to ventricular fibrillation).

Risk factors for cardiac arrest in a completely healthy person:

hypothermia;
taking cardiac glycosides, adrenergic blockers, analgesics; anesthesia;
electrical injury;
lack of oxygen due to drowning or suffocation;
coronary heart disease;
anaphylactic and hemorrhagic shock;
atherosclerosis;
left ventricular hypertrophy;
arterial hypertension;
smoking;
age.

If one or more factors occur, you need to be careful about your health and regularly visit a cardiologist. Unfortunately, only thirty percent of victims survive cardiac arrest. And only about four percent continue to live without consequences. The main reason for such statistics is untimely assistance.