Traditional medicine

Cardiac arrest: causes and consequences. Cardiac arrest: causes and mechanism of the clinical syndrome, first aid and principles of resuscitation Loss of consciousness cardiac arrest

Sudden cardiac arrest kills about 300,000 people worldwide each year. Once a year, at least, the media reports another death from sudden cardiac arrest: an athlete right on the field during a game or a schoolchild in physical education class. But many people die for the same reason, falling asleep and not waking up.

According to the Ministry of Health, in Russia alone, from 8 to 16 people per 10 thousand of the population die annually from sudden cardiac arrest, which is 0.1-2% of all adult Russians. In the whole country, 300 thousand people die this way every year. 89% of them are men. In 70% of cases, sudden cardiac arrest occurs outside the hospital. In 13% - at the workplace, in 32% - in a dream. In Russia, the chances of survival are low - only one person out of 20. In the USA, the probability that a person will survive is almost 2 times higher. The main cause of death is most often the lack of timely assistance.

Unfortunately, 22% of patients experience sudden death, the first manifestation of the disease. Sudden death most often occurs in older children and adolescents, but is rare in children under 10 years of age. Approximately 60% of sudden deaths occur at rest, the rest after heavy physical exertion.

Most people who experience sudden cardiac arrest have:

mental disorders in 45%;
asthma in 16%;
heart disease in 11%;
gastritis or gastroesophageal reflux disease (GERD) in 8%.

Causes of cardiac arrest

Among the causes, one can distinguish 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, persistent vomiting and diarrhea;
metabolic changes with deviation towards acidosis;
hypothermia (hypothermia) below 28 degrees;
acute hypercalcemia;
severe allergic reactions.

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;
suffered 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.

What happens during cardiac arrest

After a few seconds from its beginning, the following develops:

weakness and dizziness;
after 10-20 seconds - loss of consciousness;
after another 15-30 seconds, so-called tonic-clonic convulsions develop, breathing is rare and agonal;
comes at 2 minutes clinical death;
pupils dilate and stop responding to light;
the skin turns pale or takes on a bluish tint (cyanosis).

The chances of survival are slim. If the patient is lucky and there is a person nearby who can perform chest compressions, the likelihood of surviving sudden cardiac arrest syndrome increases. But for this it is necessary to “start” the heart no later than 5-7 minutes after it stops.

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 chance of survival.
Inability to detect pulsation on carotid artery- this sign in diagnosis depends on practical experience those around you. If it is absent, you can try to listen to heartbeats by placing your ear to your 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.

Signs of imminent sudden cardiac arrest

Danish scientists analyzed cases of sudden death from cardiac arrest. And it turned out that even before it stopped, the heart made it known that something was wrong with it.

35% of patients with sudden arrhythmia death syndrome had at least one symptom suggestive of heart disease:

fainting or near-fainting - in 17% of cases, and this was the most common symptom; chest pain;
dyspnea;
The patient had already undergone successful resuscitation of cardiac arrest. Likewise, 55% of people who died from hypertrophic cardiomyopathy, more than 1 hour before their sudden death, experienced: fainting (34%);
chest pain (34%);
shortness of breath (29%).

American researchers also point out that every second person who suffered sudden cardiac arrest experienced manifestations of cardiac dysfunction - and not an hour or two, but in some cases several weeks before the critical moment. Thus, chest pain and difficulty breathing 4 weeks before the attack were noted by 50% of men and 53% of women, and in almost all (93%) both symptoms occurred 1 day before sudden cardiac arrest.

Only one in five of these people consulted doctors. Of these, only a third (32%) managed to survive. But from the group that did not seek help at all, even fewer survived - only 6% of patients. The difficulty of predicting sudden death syndrome also lies in the fact that not all of these symptoms appear at the same time, so it is impossible to accurately track a critical deterioration in health.

74% of people had one symptom, 24% had two, and only 21% of cases had all three.

So, we can talk about the following main signs that may precede sudden cardiac arrest:

Chest pain: from an hour to 4 weeks before the attack.
Difficulty breathing, shortness of breath: from an hour to 4 weeks before the attack.
Fainting: shortly before the attack.

If these signs are present, you should contact a cardiologist and undergo an examination.

What are the consequences of cardiac arrest?

The consequences of circulatory arrest depend on the speed and correctness of treatment 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 elderly people and children, fractures of the ribs, sternum, and the development of pneumothorax are possible.

The mass of the brain and spinal cord together constitutes only about 3% of the total body mass. 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

Consequences from the brain can be:

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

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 drinking enough water. Daily walks for people with heart disease are no less important than taking pills.

Cardiac arrest is a complete cessation of organ activity with or without bioelectrical activity. The heart consists of many muscle fibers with a single mechanism. When muscle function is disrupted for any reason, sudden cardiac arrest occurs.

Peculiarities

The percentage of deaths due to cardiac arrest exceeds the number of deaths in road accidents, fires and cancer.

Cessation of organ activity leads to clinical death. If help is not provided to a person in time, death. According to WHO statistics, in 90% of cases it is not possible to save a person. Death occurs before the ambulance arrives.

What happens to organisms during cardiac arrest?

The blood circulation rate drops sharply.
Coming oxygen starvation.
Metabolism is disrupted.
All organs stop functioning.

When the heart stops, there is little time to provide help. Only awareness of others about correct actions in such a situation.

Cardiac arrest can occur in at a young age during sleep. Moreover, it is not necessarily associated with the disease. A healthy person's heart can stop when sharp violation a single mechanism in a dream.

Heart failure

Types of cardiac arrest

The mechanisms of development of cardiac arrest are associated with dysfunction of the organ.

This applies to a greater extent to the following characteristics:

Excitability;
Automatism;
Conductivity.

The type of cessation of cardiac activity depends on them.

The organ stops work in two ways:

Asystole – 5% of cases;
Fibrillation - in 90% of cases.

Episodic asystole on ECG

The state of asystole is characterized by the cessation of ventricular contraction in the relaxation phase. Sometimes the work stops during the stroke phase, when blood is released into the aorta.

This situation can be caused not only by heart disease, but also surgical interventions to other organs.

This happens reflexively. In this case, the vagus and trigeminal nerves. With reflex asystole, the myocardium is not damaged and is in good shape.

In situations not associated with reflex transmission, asystole develops against the background of:

Hypoxia – oxygen starvation;
Excess carbon dioxide in the blood;
Acid-base balance disorders;
Abnormalities in electrolyte levels;
A decrease in total blood volume is hypovolemic shock.

The combination of these factors is especially dangerous. Metabolic disorders negatively affect the myocardium - the muscle layer that makes up the bulk of the heart's mass.

The myocardium contracts due to the process of depolarization - a decrease in the resting membrane potential. Even in cases of conduction disturbances, depolarization prevents the heart from stopping.

As a result of disturbances in metabolic reactions, myocardial cells lose active myosin, which is a source of energy for the organ mechanism.

If asystole occurs during the phase of myocardial contraction, the person’s calcium concentration in the blood plasma increases.

The most frequent sight cardiac dysfunction is organ fibrillation. The condition is associated with disruption of communication between cardiomyocytes in coordinated actions that carry out myocardial contractions. The work of muscle fibers loses synchrony. They begin to contract in different rhythms. This pathology affects the ejection of blood from the ventricles.

When fibrillation extends only to the atria, some impulses reach the ventricles. This allows you to maintain blood circulation at a normal level.

Short-term fibrillation may end on its own. However, ventricular tension does not provide proper dynamics. Energy reserves are depleted, leading to sudden cardiac arrest.

Atrial fibrillation

Other development mechanisms

Some scientists insist on identifying another form of cardiac arrest - electromechanical dissociation. This term stands for the absence of mechanical activity of the heart in the presence of electrical contractions.

There is an ECG on the monitor, but there is no blood circulation. Myocardial contractions continue, but the activity is insufficient to supply the vessels with blood.

With electromechanical dissociation, the pulse is not palpable and there is no blood pressure.

The ECG device records:

Correct contractions with low frequency;
Idioventricular ventricular rhythm is the intrinsic rhythm of the ventricles;
Loss of sinus and atrioventricular node activity.

This condition is caused by weak impulse activity in the heart.

In the 70s of the last century, the term “obstructive sleep apnea syndrome” appeared. Cardiac arrest occurs at night during sleep. The condition is accompanied by temporary cessation of breathing. This pathology is called nocturnal bradycardia. A blood test reveals a lack of oxygen in the plasma.

According to statistics, heart function is disrupted during sleep for the following reasons.

Stopping the rhythm and its disturbances – 49% of cases.
Impaired conduction of electrical impulses from the atria to the ventricles – 27%.
Atrial fibrillation – frequent and chaotic contractions of the atria – in 19%.
Combinations of several types of bradyarrhythmia (conduction disturbances in the heart muscle) – in 5%.

Obstructive sleep apnea syndrome is diagnosed using a special device. When using the device, patients note that the heart stopped for a few seconds: from 3 to 13. During the waking period, patients with this syndrome do not experience fainting or respiratory arrest.

What causes cardiac arrest during sleep?

A person's breathing reflex is disrupted. The respiratory organs transmit impulses to the heart muscles through the vagus nerve. This causes the cessation of cardiac activity.

Why does the heart stop - reasons

Most often, the cessation of organ function is associated with severe cardiac pathologies.

Cardiac arrest is preceded by:

Large blood loss during surgery;
Injury incompatible with life;
Oncology.

In other situations, the cessation of organ functioning is called sudden stop. If there are any deviations in the heart rhythm, the mechanism of the organ’s functioning is disrupted. A signal is transmitted to the heart in many pathologies not related to the functioning of the organ. The heart can stop due to many diseases.

Main reasons	Minor Factors	Indirect factors
tachycardia (ventricular fibrillation) – 90% of cases;	ischemia – local decrease in blood supply; myocardial diseases – myocarditis, cardiomyopathy; hypovolemia – decrease in circulating blood volume; severe oxygen starvation; violations metabolic processes; hypothermia; increased calcium concentration in the blood; renal and liver failure; meningitis; autoimmune diseases.	alcohol and drug addiction; smoking; excessive load on the heart; obesity; old age; genetic predisposition; high cholesterol in the blood.
ventricular asystole; electromechanical dissociation; myocardial infarction; blood clots in the arteries.

Conditions not associated with disease also lead to sudden cardiac arrest.

State	Description
Losing a large amount of blood	when more than 50% of the total volume is lost, the clotting of the substance is impaired, which can cause cardiac arrest.
Suffocation	Common situations: acute pulmonary failure, foreign body in the respiratory tract, allergic reaction with severe swelling.
Shock	the condition occurs as a result of injury, severe pain; anaphylactic shock occurs when allergic reaction immediate type in case of intolerance to the component.
Intoxication	the condition is associated with strong alcohol and drug intoxication; intoxication is caused by taking incompatible medications.
Hypothermia or overheating	body temperature drops sharply or rises to extreme limits.
High mental, physical activity	the heart may stop from psychological shock; excessive physical activity in an unprepared person.

Who is most susceptible to cardiac arrest?

At risk are:

How to stop the heart? Cardiac arrest can be caused by a combination of several factors.

People with heart and vascular diseases who have overweight and addiction to alcohol.

What can cause a newborn baby's heart to stop?

Sudden infant death syndrome (SIDS) affects children under one year of age. At risk are infants 2-4 months old. Respiratory and cardiac arrest occurs during sleep without previous health problems.

Factors that increase the risk of SIDS:

Habit of sleeping on your stomach;
Soft bed;
Stuffy room;
High room temperature;
The child was born premature;
Delays in fetal development during pregnancy;
Intrauterine hypoxia;
There were children with SIDS in the family;
After birth, the child suffered serious infections.

Heart massage for a child

Main signs of cardiac arrest

Sudden cardiac arrest occurs against the background wellness or minor chest discomfort. A person suddenly loses consciousness, which is one of the signs of the condition. Cardiac arrest is often confused with fainting. How to distinguish the condition from loss of consciousness?

Signs of cardiac arrest:

There is no pulse;
The person is not breathing;
Agony - breathing is frequent, hoarse, convulsive;
The pupils do not react to light;
Pale skin;
Convulsions may begin;
The chest does not rise;
Lips, earlobes, fingers turn blue.

When cardiac arrest occurs during sleep, the person appears to be sleeping peacefully, visually skin don't change. The main symptom in this case is lack of breathing.

If first aid is not provided within 7 minutes of the onset of symptoms, the brain dies. When after this time a person can be saved, he remains disabled. Therefore, it is extremely important to assess its condition.

To do this you need:

Call an ambulance;
Hit the cheeks, stir;
Check breathing;
Place your index finger and middle finger to large blood vessel– on the neck, in the groin – assess whether there is a pulse.

Signs of cardiac arrest

What medications cause cardiac arrest?

These include drugs that are prescribed to treat diseases of the organ.

The doctor prescribes the drug taking into account the characteristics:

Patient's age;
Diagnosis.

There may be side effects when taking medications that should not be ignored.

Overdose occurs in the following cases:

Exceeding the dose is a common situation - I forgot to take a pill, I take two at once;
Taking alcohol together with medications;
Combination with traditional methods of treatment: some herbs contain components that, if taken uncontrolled, cause an overdose;
Introduction general anesthesia while taking medications.

Which pills should you be wary of?

Medicines that cause critical illness:

Barbituric acid-based hypnotics;
Strong painkillers with narcotic effects;
Groups of β-blockers for high blood pressure;
Sedatives from the group of phenothiazines;
Of the cardiac drugs, glycoside drugs used to treat arrhythmia and decompensated heart failure can be dangerous.

According to statistics, 2% of cases of cardiac arrest are associated with the use of drugs.

The choice of medicine should be made by the doctor based on the individual characteristics of the patient, concomitant chronic diseases and age.

ECG with tachycardia

First aid for cardiac arrest

In 2 out of 3 cases, a person’s heart stops outside of a medical facility. The life of the victim depends on the awareness of the population regarding first aid.

What to do if symptoms indicate cardiac arrest?

Lay the victim face up on a flat, hard surface.
Tilt his head back a little and push his jaw out. Clear the airways of stuck tongue, food, and vomit.
Perform an indirect cardiac massage. Place your hands on top of each other so that you can press on your chest with your palms on outstretched arms. Perform about 30 rhythmic pressures.
Perform mouth-to-mouth ventilation. Before the procedure, you need to cover the victim’s mouth with a napkin or handkerchief. For ventilation, pinch the victim’s nose and inhale portions of air into the mouth. The purpose of the procedure is to stimulate the chest and circulate air in the lungs. This will help restore cardiac activity. When air is blown in, assess how high the chest rises.

Professional help

The medical team provides assistance on the spot or on the way to the hospital.

In case of cardiac arrest the following measures are taken:

When a person can be saved, he is sent to intensive care. The task of doctors is to find out the cause of cardiac arrest. For pulmonary disorders, the victim is treated in therapeutic department. If the cause is cardiovascular disease, restoration is carried out in cardiology.

Consequences of cardiac arrest

The development of complications depends on the duration of cessation of cardiac activity. If the victim is brought back to life after 3 minutes of extinction, the brain is likely undamaged.

After 7 minutes of clinical death, the brain dies. If the heart resumes functioning, neurological damage to the central nervous system develops.

Deviations are divided into degrees:

Lungs;
Average;
Heavy.

TO complications of lung and medium degree include:

Partial memory loss;
Decreased vision;
Severe headaches;
Hallucinations.

Complications after resuscitation occur in 75-80% of victims. In 70% of elderly and young people, consciousness and mental functions are restored after 3 hours of resuscitation.

Severe consequences:

Coma;
Complete loss of memory and reflexes;
Vegetative state – loss of consciousness.

The prognosis after cardiac arrest is unfavorable. Only 30% of people survive and only 10% of them recover without serious consequences. The chance of survival increases with timely help. The risk of complications is minimal if the duration of clinical death does not exceed 3 minutes.

Video: Cardiac arrest. First aid.

Cardiac arrest is a complete cessation of cardiac activity, caused by various factors and leading to clinical (possibly reversible) and then biological (irreversible) death of a person. As a result of the cessation of the pumping function of the heart, blood circulation throughout the body stops and oxygen starvation occurs in all human organs, especially the brain. In order to “start” the heart again, the person providing assistance has no more than seven minutes, because after this time, irreversible brain death occurs from cardiac arrest.

Causes of cardiac arrest

This dangerous condition may occur due to heart disease, and then it is called sudden cardiac death, or diseases of other organs.

1. Cardiac (heart) diseases that can lead to cardiac arrest are its cause in 90% of all cases. These include:

Life-threatening heart rhythm disturbances - paroxysmal ventricular tachycardia, frequent ventricular extrasystole, ventricular asystole (lack of contractions), electromechanical dissociation of the ventricles (single non-productive contractions),
- Brugada syndrome,
- coronary heart disease - approximately half of patients with ischemic heart disease experience sudden cardiac death,
- acute myocardial infarction, especially with developed complete blockade of the left bundle branch,
- pulmonary embolism,
- rupture of aortic aneurysm,
- acute heart failure,
- cardiogenic and arrhythmogenic shock.

2. Risk factors that increase the likelihood of sudden cardiac arrest in people with existing medical conditions cardiovascular system:

Age over 50 years, although cardiac arrest can also develop in young people,
- smoking,
- alcohol abuse,
- overweight,
- excessive physical activity,
- overwork,
- strong emotional experiences,
- arterial hypertension,
- diabetes mellitus,
- increased cholesterol in the blood.

3. Extracardiac (non-cardiac) diseases:

Heavy chronic diseases on late stages(oncological processes, respiratory diseases, etc.), natural old age,
- asphyxia, suffocation as a result of foreign body entering the upper respiratory tract,
- traumatic, anaphylactic, burn and other types of shock,
- poisoning with medications, drugs and alcohol substitutes,
- drowning, violent causes of death, injuries, severe burns, etc.

4. Special attention deserves sudden infant death syndrome (SIDS), or the death of an infant “in the cradle.” This is the death of a child under the age of one year, usually around 2–4 months, caused by cardiac arrest and breathing at night during sleep, without any previous serious health problems that could lead to death. Factors that increase the risk of sudden infant death include:

Sleeping position on your stomach at night
- sleeping on a bed that is too soft, on fluffy linen,
- sleeping in a stuffy, hot room,
- mother's smoking
- prematurity, premature birth with low fetal weight,
- multiple pregnancy,
- intrauterine hypoxia and fetal growth retardation,
- family predisposition if other children in the same family died for the same reason,
- previous infections in the first months of life.

Symptoms of cardiac arrest

Sudden cardiac death develops against a background of general good health or slight subjective discomfort. A person can sleep, eat, or go to work. Suddenly he feels bad, he grabs his left chest with his hand, loses consciousness and falls. The following signs distinguish cardiac arrest from ordinary loss of consciousness:

- no pulse on the carotid arteries in the neck or on the femoral arteries in the groin,
- lack of breathing or agonal type breathing movements for several seconds after cardiac arrest (no more than two minutes) - rare, short, convulsive, wheezing sighs,
- lack of pupillary response to light, normally the pupil constricts when light enters it,
- severe pallor of the skin with the appearance of a bluish discoloration on the lips, face, ears, limbs or throughout the body.

It roughly looks like this: a person fell unconscious, not responding to shouts or braking, turned pale and blue, wheezed and stopped breathing. After 6 - 7 minutes it will develop biological death. If a person's heart stops in his sleep, he appears to be sleeping peacefully until he discovers that he cannot be awakened.

The second option is more unfavorable, since others may mistakenly believe that the person is simply sleeping, and, accordingly, do not consider it necessary to take any measures to save the person’s life. The same thing happens with small children, whose mothers see that the child is sleeping peacefully in his crib, while biological death has already occurred.

Diagnostics

About 2/3 of all cases of cardiac arrest occur outside the walls of medical institutions, that is, in everyday life. Therefore, in most cases, witnesses to such a dangerous condition are ordinary people who are not directly related to medicine. However, anyone should know how to recognize cardiac arrest and what measures to take. By doing this, you may save the life not only of your relative, but also of a stranger on the street.

If you see that a person has lost consciousness, it is necessary to conduct a quick examination:

Lightly hit him on the cheeks, call out loudly, shake him by the shoulder, and evaluate whether he reacts to this. It is quite possible that the person simply fainted.

It should be assessed whether there is an independent normal breathing, to do this, simply put your ear to the chest and listen to whether he is breathing, or bring your cheek to the patient's nostrils, after throwing his head back and extending his jaw, in order to feel or hear his breathing, or see the movements of the chest. You should not waste precious time looking for a mirror in order to put it to the victim’s lips and see if it fogs up from the air exhaled from the patient’s mouth, as indicated in some manuals for providing first aid.

Feel the carotid artery in the neck between the angle of the lower jaw, larynx and neck muscle or femoral artery in the groin. If there is no pulse, begin chest compressions. You should not waste time looking for peripheral arteries in the wrist; a reliable criterion for cardiac arrest is the absence of a pulse only in the large arteries.

All actions must be carried out clearly, smoothly and quickly. Assessment of the severity of the condition and initiation of resuscitation measures should be carried out within 15 – 20 seconds. At the same time, you need to call for help and ask people present nearby to call an ambulance by calling “03”.

First aid and treatment

Providing first emergency first aid in case of cardiac arrest

The victim is placed on a hard surface. After establishing the fact of cardiac arrest, you must immediately begin resuscitation measures according to the ABC algorithm:

- A ( air open the way)– restoration of airway patency. To do this, the person providing assistance needs to wrap a piece of cloth around the finger and push it out. lower jaw the victim forward, tilting his head back and try to eliminate possible foreign bodies in the oral cavity (vomit, mucus, remove a sunken tongue, etc.).

- B (breath support) – artificial ventilation lungs using the “mouth to mouth” or “mouth to nose” method. With the first technique, you should pinch the patient's nose with two fingers and start blowing air into it. oral cavity, monitoring the effectiveness by movements of the chest - raising the ribs when filling with air and lowering when the patient passively “exhales”. It is acceptable to use a thin napkin or handkerchief placed on the victim’s lips to exclude direct contact with his saliva. According to the latest recommendations, the person providing assistance has the right not to contact biological fluids the victim, such as saliva, blood in the oral cavity, in order to avoid harm to the health of the person providing assistance, for example, the threat of infection with tuberculosis, HIV infection in the presence of blood in the oral cavity, etc. Moreover, for the brain it is more important to quickly provide blood access to its vessels using heart massage than to start ventilation of the lungs.

- C (circulation support)– closed cardiac massage. Before starting a cardiac massage, specialists apply a precordial blow to the sternum with a fist from a distance of 20–30 cm. However, it is effective only during the first 30 seconds from the moment the heart stops and is dangerous for breaking the ribs and sternum. Therefore, it is better not to deliver a precordial blow to a person who is not a physician. Moreover, Western resuscitation doctors believe that a shock is useful only in case of ventricular fibrillation, and in case of asystole it can be dangerous.

Heart massage carried out like this. It is necessary to visually determine the lower third of the sternum, measuring the distance two transverse fingers above its lower edge, clasp the fingers of the hands, placing one hand on top of the other, place the straightened hands on the found third of the sternum and begin rhythmic compression of the chest with a frequency of 100 per minute. If there is one resuscitator, the frequency of compressions on the sternum and the frequency of air blowing into the lungs is 15:2, and if there are two resuscitators - 5:1. In the latter case, the resuscitator performing compressions on the sternum should count the number of compressions out loud, after every fifth - the first resuscitator performs one air injection.

Important: the arms should be kept straight, and compression should be applied in such a way as to avoid accidental fracture of the ribs, as this negatively affects intrathoracic pressure, which has a decisive role in the effectiveness of cardiac massage. To increase passive flow to the heart, bend at the groin lower limbs can be raised 30 - 40° above the surface.

The described measures continue until a pulse appears in the carotid arteries, spontaneous breathing appears, or until the patient comes to his senses. If this does not happen, the victim should continue to be resuscitated until the ambulance arrives or within 30 minutes, since after this time biological death occurs.

Medical care for cardiac arrest

Upon arrival of the medical team, medications are administered (adrenaline, norepinephrine, atropine, etc.), an electrocardiogram is taken or heartbeats are diagnosed using a monitor when applying defibrillator electrodes and defibrillation is carried out - an electrical discharge in order to start and restore the heart rhythm. The activities carried out end up in the ambulance on the way to intensive care unit hospital.

Further lifestyle

A patient who has suffered cardiac arrest and survived should remain in intensive care for some time and then be carefully examined in the cardiology department of the hospital. At this time, the cause that caused cardiac arrest is established, optimal treatment to prevent recurrence of this condition, and also resolve the issue of the need for implantation artificial pacemaker if there are violations heart rate.

After discharge from the hospital, the patient must be careful in everyday life - give up bad habits, eat right, avoid stress and excessive physical activity, and constantly take medications prescribed by the doctor.

To prevent sudden infant death syndrome, parents infant must fulfill the following recommendations- put the baby to sleep at night in a well-ventilated room, on a bed with a firm mattress, without pillows, duvets and without toys in the crib. You should not swaddle your baby tightly at night, as this restricts his movements, prevents him from taking a comfortable position during sleep, and prevents him from waking up when breathing stops during sleep (sleep apnea). You should not put your baby to sleep on his stomach. Some experts are sure that co-sleeping significantly reduces the risk of death in the cradle, since the child feels his mother nearby, and tactile sensations on the skin have a beneficial effect on his respiratory and cardiovascular centers in the brain. Of course, parents should not smoke, drink alcohol or use drugs, so as not to lose vigilance and sensitivity during the baby's night sleep.

Complications of cardiac arrest

The possibility of developing consequences after cardiac arrest depends on the time during which the brain was in a state of acute shortage oxygen. So, if recovery vital functions was carried out within the first 3.5 minutes, the functions and subsequent activity of the brain will most likely not be affected. In the case of a longer time of brain hypoxia (6 - 7 minutes or more), neurological symptoms may develop, from mild to severe brain damage in post-resuscitation illness.

Mild to moderate disorders include memory loss, decreased vision and hearing, persistent headaches, seizures, and hallucinations.

Post-resuscitation illness develops in 75–80% of cases of successful resuscitation after cardiac arrest. In 70% of patients with this disease, there is an absence of consciousness for no more than 3 hours, and then complete restoration of consciousness and mental functions. Some patients experience severe brain damage, coma and subsequent vegetative state.

Forecast

The prognosis for cardiac arrest is unfavorable, since about 30% of patients survive, and only in 10% is it possible to fully restore body functions without adverse consequences.

The patient's chances of survival are significantly increased if first aid is provided in a timely manner and cardiac activity is restored within the first three minutes after cardiac arrest.

General practitioner Sazykina O.Yu.

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 public awareness of the importance of emergency response training.

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 of a 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 a sharp violation of its functional abilities, especially excitability, automatism 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 this case, the role of the vagus and trigeminal nerves was proven.

Another option is asystole in the background:

general oxygen deficiency (hypoxia); increased carbon dioxide content in the blood; a shift in acid-base balance towards acidosis; altered electrolyte balance (increased 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 conductivity 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. Instead of synchronous work causing systolic contraction and diastole, many separate 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 of the heart.

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 of different forms of 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, one can distinguish directly cardiac (cardiac) and external (extracardiac).

The main cardiac factors are:

myocardial ischemia and inflammation; acute obstruction of 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 of the 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 overload of the heart; old age; smoking and alcoholism; genetic predisposition to rhythm disturbances, changes in electrolyte composition; previous 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 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 traditional methods of treatment (St. John’s wort, shepherd’s ears, self-prepared tinctures of lily of the valley, foxglove, adonis); general anesthesia against the background of continuous drug intake.

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.

Only a specialist can determine which medications have the most optimal indications and have the least accumulation and addiction properties. 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 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. The inability to detect pulsation in the carotid artery - this sign in diagnosis depends on the practical experience of others. 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 an ambulance arrives at the scene of the incident, 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.

The mass of the brain and spinal cord together constitutes only about 3% of the total body mass. And for their full functioning, up to 15% of the total cardiac output is required. Good compensatory capabilities make it possible to preserve the functions of nerve centers when the level of blood circulation decreases to 25% of normal. However, even indirect massage can maintain only 5% of the normal level of 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 complete restoration of brain and other organ functions 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.

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 old and young, can face the problem of cardiac arrest.

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, excess weight, stress and overwork, intense physical activity, hypertension, high blood sugar and cholesterol. Extracardiac (extracardiac) diseases: severe chronic diseases, asphyxia, anaphylactic, post-traumatic and burn shock, acute poisoning, violent exposure.

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 of the 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 the cervical canal into the 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 for no apparent reason or serious illness. 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 studies, 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 considered to be 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 of the 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 chest compressions. 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 of 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, and try to eliminate everything with a finger wrapped in a cloth. foreign objects in the mouth (sunken tongue, mucus, vomiting); 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.

To restore heart rhythm, doctors use pulse therapy(defibrillation), mechanical artificial respiration and the supply of 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 in puncture of the 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 stop heart disease 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 the cessation of cardiac activity, only 30% of people survive, of which only 3.5% can return to life. normal life without serious consequences. A healthy lifestyle, regular medical examinations and taking care of your health help prevent severe cardiovascular diseases.

How to cure hypertension forever?!

In Russia, every year there are from 5 to 10 million calls to emergency medical care for high blood pressure. But Russian heart surgeon Irina Chazova claims that 67% of hypertensive patients do not even suspect that they are sick!

How can you protect yourself and overcome the disease? One of the many recovered patients, Oleg Tabakov, told in his interview how to forget about hypertension forever...

Main symptom heart attack is sharp pain in the chest, pain may radiate to the left arm and shoulder or to the neck and jaw area. The cause of a heart attack can be coronary arterial disease, angina pectoris (angina pectoris) or a more serious condition - coronary thrombosis, in which the lumen of the coronary artery is completely closed. Complete obstruction of an artery means that the part of the heart muscle that received its blood supply from that artery can no longer function or be nourished—a condition called myocardial infarction. This can lead to cardiac arrest.

Chest pain can usually be caused by physical activity or emotional stress. In most cases, the pain lasts a few minutes and then subsides. As a rule, patients suffering from angina pectoris carry with them either a spray or nitroglycerin tablets, however, this medicine should be in the first aid kit to provide emergency assistance. If the attack is not stopped by nitroglycerin, then the same treatment should be carried out as for myocardial infarction.

It is better to treat patients suffering from angina with sedation, as this prevents the occurrence of stress during dental intervention. When conducting local anesthesia preference is given to prilocaine ( Citanest ) with felypressin instead of adrenaline.

The pain of myocardial infarction is much stronger and longer lasting than that of angina pectoris. Collapse and cardiac arrest may occur. Quite often, myocardial infarction is accompanied by nausea and vomiting, which can cause airway obstruction. The skin is pale, cold sticky sweat appears, the pulse is weak, blood pressure is reduced, and breathing is difficult.

Required actions;

resuscitation actions

important functions

sufficient quantity

Cardiac arrest is the most serious complication of collapse. It may be a consequence of angina pectoris.

Signs of cardiac arrest:

bluish color

Call an ambulance immediately.

Begin and continue until the ambulance arrives with resuscitation actions aimed at maintaining vital body functions.

Stroke- a very severe form of collapse, which can be fatal. A stroke is caused by a sudden loss of blood supply to the brain due to a ruptured vessel or blockage by a blood clot. The very first symptom is an acute headache, which may be followed by partial paralysis and collapse.

If this happens during dental treatment, then the patient must be brought into a horizontal position, loosen the collar, create oxygen access and call an ambulance, and be ready to carry out resuscitation actions.

Cardiac arrest: causes and consequences

Cardiac arrest is an extremely life-threatening condition. It often comes on suddenly even in young people. healthy people. What are the main causes of cardiac arrest and how can you help the victim?

Cardiac arrest is the complete cessation of effective cardiac activity.

To save the life of a person who has had a cardiac arrest, there are approximately 5-7 minutes. After this time, even if it is possible to resume cardiac activity, the consequences can be very serious, including complete disability.

Cardiac arrest: how to recognize

Cardiac arrest has fairly clear clinical symptoms, knowledge of which can allow timely implementation of emergency resuscitation measures.

After stopping, the heart stops pumping blood, which naturally causes the disappearance of the pulse in all large arteries. 10-20 seconds after the heart stops, a person loses consciousness, and after 30-60 seconds breathing disappears. During cardiac arrest, the pupils are wide and do not react to light, the skin of the face takes on a gray-blue color.

Remember, resuscitation measures should be carried out as early as possible, but nevertheless not before you are sure that in front of you there really is a person with cardiac arrest.

Options and causes of cardiac arrest

It is customary to identify several main causes of cardiac arrest.

Ventricular asystole . Absent during asystole electrical activity heart - a straight line is recorded on the monitor or ECG film. The cause of asystole can be any serious disease of the cardiovascular system, but more often it is severe heart attack myocardium or pulmonary embolism. Other causes of asystole include: electrical trauma (including from a lightning strike), overdose of cardiac glycosides, intracardiac manipulation, anesthesia and serious metabolic disorders.
Ventricular fibrillation. The most common type of cardiac arrest: up to 90% of cases occur. With this pathology, individual muscle fibers of the ventricles of the heart begin to contract asynchronously and very quickly, which is a completely ineffective option from a hemodynamic point of view - the heart stops pumping blood. Rapid and erratic contraction quickly depletes the heart's reserves, and it stops all activity. The causes of fibrillation are similar to those presented above.
Electromechanical dissociation . A variant of stopping the mechanical activity of the heart while maintaining its electrical activity. This pathology occurs in severe metabolic disorders - hyperkalemia, acidosis, hypoxia, as well as hypothermia. strangulation, drowning, chest trauma (for example, with valvular pneumothorax), cardiac tamponade, overdose or inappropriate combination of certain cardiac drugs.

Cardiac arrest: consequences

Despite the fact that the spinal cord and brain together make up no more than 2-3% of body weight, they account for about 15% of cardiac output.

Existing regulatory processes make it possible to preserve the functions of the central nervous system at a blood circulation level of up to 25% of normal, however, indirect cardiac massage, which is most often used when it stops, provides only 5% of normal flow.

That is why the speed of restoration of normal heartbeat plays a key role: the sooner cardiac activity is resumed, the less likely development of complications.

Among the consequences from the central nervous system are:

amnesia - memory impairment of various types (possible loss of all events preceding the injury or only partial loss of memory for events occurring immediately before cardiac arrest);
blindness - occurs due to damage to the visual part of the brain; in some cases, the function of the damaged part of the brain is taken over by other parts and vision is restored;
cramps are enough frequent consequences cardiac arrest, usually the convulsions are isolated in nature, for example, periodic repeated spasms of the limb or involuntary chewing movements;
hallucinations - may accompany seizures; visual, auditory and other types of hallucinations are possible.

The prognosis for cardiac arrest depends on the time elapsed from cardiac arrest to successful outcome cardiopulmonary resuscitation. Thus, with a five-minute cardiac arrest and half-hour resuscitation, complete recovery after cardiac arrest is observed in approximately 50% of cases.

If the time of cardiac arrest exceeded 6 minutes, and resuscitation lasted longer than 15 minutes, the chances of restoring the person’s vital functions are extremely small.

Sudden death occurs in completely healthy people

According to the definition of the World Health Organization, sudden death includes cases of death of practically healthy individuals or patients whose condition was considered quite satisfactory. It is obvious that most people have certain health conditions that do not have a significant impact on daily 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 persistently compensated in nature. Such representatives of humanity are classified as “virtually healthy.” It is in this group that the phenomenon that scientists call sudden death occurs most often. What is surprising in this phrase is 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 has so far defied any prediction. It has no precursors or signs that could alert doctors. Studying numerous, increasingly common, 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 disaster.

A major businessman with a typical Georgian surname, one of the heirs to the wealth of the collapsed Soviet Union, had already endured all the hardships of the division of property and lived a healthy and correct life in London. He probably had enough money for a full-fledged medical examination, and personal doctors would not miss even a suspicious murmur in the heart area. Death came suddenly and completely unexpectedly. He was a little over 50. An autopsy did not reveal any cause of death.

There are no accurate statistics on sudden death because there is no generally accepted definition of this concept. However, it is estimated that every 60-75 seconds in the United States, 1 person dies from unexpected cardiac arrest. The problem of sudden cardiac death, which has attracted the attention of cardiologists for many decades, has become acute again in recent years, when large population-based studies conducted by the World Health Organization demonstrated an increasing incidence of sudden death among adults, and not only adults. It turned out that cases of sudden death are not so rare, and this problem requires close study.

During a pathological examination (autopsy) of the deceased, as a rule, it is not possible to detect signs of damage to the heart or blood vessels that could explain the sudden stop of blood circulation. Another feature of sudden death is that if timely assistance is provided, such patients can be revived, and in practice this happens quite often. Typically, resuscitation is performed using artificial respiration and closed massage hearts. Sometimes, to restore blood circulation, a punch to the chest, in the area of the heart, is enough. If a disaster occurs in medical institution or in the presence of emergency doctors, 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 usually called sudden cardiac death. Cardiac causes account for the majority 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 has never complained about his state of health. Atherosclerosis coronary arteries can be found in more than half of people who died as a result of sudden cessation of blood circulation. Scars on the heart muscle, which indicate a previous heart attack, and an increase in heart mass are found in 40-70% of cases. Such obvious causes as fresh blood clots in the coronary arteries in sudden cardiac death can be found extremely rarely. With careful examination (it is clear that all cases of sudden death serve as the basis for careful examination), it is almost always possible to detect some pathology. However, this does not make sudden death any less mysterious. After all, all changes in the heart and blood vessels exist and are formed long time, and death occurs suddenly and completely unexpectedly. Latest methods cardiovascular research ( ultrasound scanning, spiral computed tomography) detect the smallest changes in 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 well into old age.

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

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

This is what a disruption of the normal rhythm into a state of ventricular flutter looks like on an electrocardiogram:

As a rule, flutter is followed by complete cardiac arrest due to depletion of its energy reserves. But fibrillation cannot be considered the cause of sudden death; rather, it is its mechanism.

It is generally accepted that the most important causative factor of 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. Exactly so: 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 disruptions in the ability of the heart muscle to contract and increases sensitivity to irritation, which contributes to rhythm disturbances. It has been established that disturbances in the nervous regulation of the heart (imbalance of autonomic tone) can lead to rhythm disruption. It is known for sure that stress contributes to the occurrence of arrhythmia - hormones change the excitability of the heart muscle. It is also known that a lack of potassium and magnesium has a significant effect on the functioning of the heart and, under certain conditions, can lead to heart failure. 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 impaired myocardial contractility. But, despite the clarity of the individual mechanisms of disturbances in the normal functioning of the heart, many cases of sudden death do not receive a satisfactory explanation. Let us recall the regularly recurring cases of death of young athletes.

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

As a rule, this group of trained, physically well-developed young people has fairly good medical supervision. It is unlikely that among professional athletes who have managed to achieve extraordinary success through their physical efforts, there are people suffering from serious illnesses heart and blood vessels. It's even harder to imagine coronary insufficiency in people who regularly undergo enormous physical activity. The relatively high statistics of sudden death among athletes can only be explained by obvious overload or use of pharmacological agents, increasing 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 incidence 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. Comes during sleep 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 is an outstanding athlete and simply a beautiful person who promotes and leads healthy image life, suddenly falls and dies before reaching 50 years of age.

Several newspaper lines are awarded to famous athletes, politicians, and artists who suddenly died. But many similar disasters occur with ordinary people, which are not written about in the newspapers.

- He was completely healthy! – shocked relatives and friends are amazed for several days. But the inexorable convincingness of what happened soon makes one believe the facts: if he died, it means he was sick.

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

It is known that alcoholics are susceptible to sudden death. Here everything is more or less clear: ethyl alcohol destroys the myocardium and the conduction system of the heart. One day, deprived of energy and rhythmic control, the heart simply stops after another binge.

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

But in this series, cases of death 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 in the 13th week of life. Almost always, the death of an infant occurs during sleep; More often this happens in the cold season and when the baby is lying on his stomach. Some researchers associate sudden death of infants with odors (perfumes, tobacco smoke).

Despite the clarity of the connection between risk factors and tragic cases of sudden death, the majority of people who died suddenly never had these factors. Sudden death has become a habit of visiting completely healthy people.