This is a death that occurs as a result of situations not related to violence and external adverse factors.

In persons who did not consider themselves sick and who are in satisfactory condition, fatal symptoms occurred within 24 hours from the onset of fatal symptoms. In contrast to coronary heart disease and its characteristic sudden coronary death, for which this time is determined at 6 hours (at lately This interval is usually reduced to 2 hours).

In addition to the time criterion, according to the World Health Organization, sudden cardiac death must be, above all, unexpected. That is, death occurs as if against the background of complete well-being. Today we will talk about what is sudden cardiac death and how to avoid it?

Sudden cardiac death - causes

The category of sudden death includes those who died who, during the last month of their life, were not under the supervision of doctors due to problems with the functioning of the heart, their health was externally normal, and they led their usual lifestyle.

Of course, it is difficult to agree with the statement that these people were initially absolutely healthy. As you know, with cardiovascular diseases there is a risk of fatal complications without visible external manifestations.

In many medical treatises and from the personal observations of practicing doctors, including pathologists, it is known that in 94% of cases, sudden cardiac death occurs within one hour from the onset of the pain symptom.

Most often in the first hours of the night, or on Saturday afternoon, when there are changes in atmospheric pressure and geomagnetic activity. The critical months are January, May, November. In the ratio of men and women, the predominance fluctuates towards men.

The mechanisms of development and causes of occurrence are divided into the following groups:

1. In young people involved in sports.
2. In young people under 30 years of age during physical overload.
3. With anomalies in the development of valves, subvalvular structures, blood vessels and the conduction system of the heart.
4. In the presence of atherosclerosis of the heart vessels and hypertension
5. For cardiomyopathies.
6. For alcoholic illness (chronic and acute form).
7. For focal metabolic damage to the heart muscle and necrosis not related to the vessels of the heart.

Sudden death during exercise

Perhaps the most tragic is the death of young, well-trained people involved in sports. The official definition of “sudden death in sports” includes the occurrence of death during physical activity, as well as within 24 hours from the onset of the first symptoms that forced the athlete to reduce or stop training.

Outwardly healthy people may have pathologies that they were not aware of. Under conditions of intense training and acute overstrain of the entire body and myocardium, mechanisms are triggered that lead to cardiac arrest.

Physical activity causes the heart muscle to consume large amounts of oxygen by increasing blood pressure and heart rate. If the coronary arteries are unable to fully supply the myocardium with oxygen, then a chain of pathological metabolic disorders (metabolism and energy in the cell) of the heart muscle is triggered.

Hypertrophy develops (increase in cell volume and mass, under the influence of various factors) and dystrophy (structural changes in cells and intercellular substance) of cardiomyocytes. Ultimately, this leads to the development of electrical instability of the myocardium and fatal arrhythmias.

The causes of death during sports are divided into two categories.

Not related to physical overload:

• hereditary diseases (congenital anomaly left coronary artery, Marfan syndrome, birth defects, prolapse mitral valve);
• acquired diseases (obstructive hypertrophic cardiomyopathy, myocarditis, conduction disorders, sinus node weakness);

• inadequate use of the functional capabilities of a person during physical activity (non-coronarogenic myocardial microinfarctions develop in the myocardium);
• sinus node failure or complete atrioventricular block;
• extrasystoles that occur as a reaction to thermal and psycho-emotional stress.

The immediate cause of death is ventricular fibrillation, and after exertion. Pathologies that are asymptomatic are of particular importance.

Sudden cardiac death and abnormal development of cardiac tissue

With the increase in the number of deaths without visible reasons, in recent decades, work has appeared aimed at an in-depth study of heart defects associated with abnormal development connective tissue. The term dysplasia (from the Greek “dis” - disorder, “plasia” - form) refers to the abnormal development of tissue structures, organs or parts of the body.

Congenital connective tissue dysplasias are diseases that are inherited and are characterized by impaired development of tissues underlying the structure of the heart. The failure occurs during intrauterine development and early after the birth of the child. They were conditionally divided into two groups.

The first are developmental defects that are quite well known and manifest themselves not only in disturbances in the structure of the heart, but also in other organs and parts of the body. Their symptoms and manifestations are well known and studied (Marfan syndrome, Ehlers-Danlos syndrome, Holt-Omar syndrome).

The second ones are called undifferentiated, they are manifested by disturbances in the structure of the heart, without a clear specific symptoms. This also includes developmental defects, defined as “minor cardiac anomalies.”

The main mechanism of dysplasia of tissue structures cardiovascular system, is a genetically determined deviation in the development of the components of the connective tissue that makes up the valves, parts of the conduction system of the heart and myocardium.

Young people in whom such disorders can be suspected are distinguished by a thin physique, funnel chest, and scoliosis. Death occurs as a result of electrical instability of the heart.

There are three leading syndromes:

1. Arrhythmic syndrome is a variety of rhythm and conduction disturbances with the occurrence of fatal arrhythmias.
2. Valve syndrome is an anomaly in the development of the main heart valves with dilatation of the aorta and main pulmonary arteries, mitral valve prolapse.
3. Vascular syndrome is a violation of the development of vessels of various diameters from the aorta to the irregular structure of small coronary arteries and veins. Changes concern the diameter of blood vessels.
4. Abnormal chords are accessory or false ligaments in the cavities of the heart that close the valve leaflets.
5. Sinus of Valsava aneurysms are enlargements of the aortic wall near the semilunar valves. The pathogenesis of this defect involves the flow of additional blood into the chambers of the heart, which leads to overload. Boys get sick more often.

According to various publications, death from mitral valve prolapse is 1.9 cases per population.

Coronary heart disease

Coronary heart disease is an extremely common disease in the human population and is the main cause of death and disability in the population. developed countries peace. This is a syndrome that develops in the cardiac form of atherosclerosis and hypertension, which lead to absolute or relative failure of cardiac activity.

The term IHD was first coined in 1957 and defined the discrepancy between the need and blood supply of the heart. This discrepancy is due to blockage of the lumen of blood vessels by atherosclerosis, high blood pressure and spasm of the vascular wall.

As a result of insufficient blood circulation, heart attacks or local limited death develop muscle fibers hearts. IHD has two main forms:

• Chronic form (angina) - periodic attacks of pain in the heart caused by relative transient ischemia.
• Acute form ( acute heart attack hearts) acute ischemia with the development of a local focus of myocardial necrosis.

Acute necrosis (infarction) of the myocardium is form of ischemic heart disease which most often leads to death. There are several signs by which they are classified acute necrosis heart muscle. Depending on the extent of the lesion, there are:

• large-focal myocardial infarction;
• small focal myocardial infarction.

According to the time interval from the onset of symptoms to death:

• The first two hours from the onset of necrosis (the most acute period);
• From the time of onset of the disease to 10 days (acute period);
• from 10 days to 4-8 weeks (subacute period);
• from 4-8 weeks to 6 months (scarring period).

The likelihood of death is very high in the acute period and with extensive damage.

Acute coronary syndrome

Acute damage to the vessels supplying the heart muscle - ischemic changes in the myocardium for up to 40 minutes, previously interpreted as acute coronary, accounts for up to 90% in the structure of sudden cardiac death. The predominant number of patients with acute vascular insufficiency die from ventricular fibrillation.

Currently considered as an acute coronary syndrome.

The term “acute coronary syndrome” appeared in publications in the 80s of the twentieth century and was isolated from coronary heart disease and myocardial infarction as an independent clinical and morphological unit due to the needs of emergency care and one of the main causes of sudden cardiac death.

According to the definitions of foreign cardiologists, this term includes any signs that may indicate an incipient heart attack or an attack of unstable angina.

The need to distinguish acute coronary syndrome is due to the fact that it is at this stage that the mortality rate of patients with myocardial infarction is highest and the prognosis and outcome of the disease depend on the nature of the treatment tactics. This term is used in medicine in the first hours from the onset of an acute heart attack until an accurate diagnosis is determined.

Acute coronary syndrome is divided into two types, based on ECG readings:

1. Acute coronary syndrome without ST interval elevation and is characterized by unstable angina.
2. Acute coronary syndrome with ST interval elevation is an early myocardial infarction.

Based on the mechanism of formation of coronary syndrome, the following types are distinguished:

Endogenous type - cessation of blood flow as a result of closure of the lumen of the vessel by an atherosclerotic plaque and thrombotic masses formed on it.

This type of coronary syndrome is typical for young people with high mortality

Exogenous type - as a result of spasm of the arteries with and without the formation of blood clots. The second type of coronary death is typical for older people with a long course of chronic myocardial ischemia.

Cardiomyopathies

One of the most common sudden cardiac arrests is cardiomyopathies. This term refers to a group of diseases of the heart muscle of various origins that are associated with mechanical or electrical dysfunction. The main manifestation is thickening of the muscle fibers or expansion of the chambers of the heart. There are:

• Hypertrophic cardiomyopathy is a genetically determined disease that affects the heart muscle. The process progresses steadily and with a high degree of probability leads to sudden death. This type of cardiomyopathy, as a rule, is familial in nature, that is, close relatives in the family are sick, however, isolated cases of the disease occur. In% there is a combination of coronary atherosclerosis and hypertrophic cardiomyopathy
• Dilated cardiomyopathy is a lesion characterized by abnormal expansion of the heart cavity and impaired contractility of the left ventricle or both ventricles, which leads to changes in heart rate and death. Typically, dilated cardiomyopathy manifests itself quickly and more often affects men. Women are affected three times less than men.

Based on the causes of occurrence, they are distinguished:

• cardiomyopathy of unknown origin;
• secondary or acquired dilated cardiomyopathies caused by viral infection, including AIDS, alcohol intoxication, lack of microelements

• Restrictive cardiomyopathy is a rare form characterized by thickening and proliferation of the inner lining of the heart.

Alcohol myocardial damage

Alcohol damage to the heart is the second leading cause of sudden heart failure. According to statistics, up to 20% of patients with chronic alcoholic illness, die from heart disease. In young patients with alcoholic heart disease, death occurs suddenly or suddenly in 11%, of which 41% of suddenly deceased people are under 40 years of age.

There is no clear pattern between the amount of alcohol consumed and the duration of intoxication and the degree of damage to the heart muscle. The sensitivity of the myocardium to ethanol is individual for each person.

A connection has been established with the development of high blood pressure and alcohol consumption. This mechanism is carried out by increasing vascular tone and the release of adrenaline into the blood. Heart rhythm disturbances with possible fibrillation appear.

Consequently, long-term consumption of excessive amounts of alcohol contributes alone, or in combination with myocardial ischemia, electrical instability of the heart and sudden cardiac death.

Hypertension and its role in the development of sudden cardiac death

In people suffering from a systematic increase in blood pressure, hypertrophy develops as a compensatory-adaptive reaction (increase in heart mass due to thickening of the muscle layer). This increases the risk of ventricular fibrillation and impaired blood circulation.

Arterial hypertension aggravates the development of atherosclerosis in the lumen of the coronary vessels. The incidence of hypertension in people who die suddenly reaches 41.2%.

Other causes of sudden death

Focal damage to the myocardium, as a result of disturbances in local metabolism in muscle fibers, includes dystrophic and irreversible changes in cardiomyocyte cells, without damage to the vessels supplying the heart.

The ability to contract the myocardium can be impaired as a result of changes in the structure of cells with disruption of their vital functions. The reasons for this phenomenon are extremely varied:

• disturbance of nervous regulation;
• changes in hormonal levels;
• disturbed electrolyte balance;
• damaging effects of viruses and bacterial toxins;
• action of autoimmune antibodies;
• influence of human metabolic products (nitrogen bases);
• the effect of ethanol and drugs.

The development of acute heart failure can occur in the acute period of the disease, during recovery, and even in the absence of toxic substances in the blood.

The connection between stress and sudden cardiac death is widely known. Under the influence

physical and psychological stress often cause cardiac arrhythmias and episodes of sudden, persistent loss of consciousness that lasts more than one minute (fainting). At the final stage of stress reactions, hormones such as adrenaline, glucocorticoids and catecholamines are released.

This leads to an increase in blood glucose and cholesterol levels and an increase in pressure in the arteries. All this leads to disruption of myocardial metabolism and becomes the basis for the so-called “biological suicide”

Why do men die more often?

If we summarize all of the above, we can conclude that men are more likely than women to suffer from one or another heart disease with a fatal outcome.

This is due to several factors:

1. Most genetically determined pathologies are transmitted according to an autosomal dominant mode of inheritance. This implies the transmission of symptoms and diseases from father to son.
2. In a woman's body, the sex hormones estrogens are present in greater quantities, which have a beneficial effect on the development of atherosclerosis and arterial hypertension.
3. Men are more involved in heavy work physical work and thus more susceptible to overload.
4. The prevalence of alcoholism and drug addiction among men is greater than among women.
5. The cost of living of men in all countries of the world is lower than that of women.

Signs and precursors of sudden cardiac death

The picture of clinical manifestations of sudden death develops very rapidly. In most cases, a tragic situation occurs on the street or at home, and therefore qualified emergency assistance is provided too late.

In 75% of cases, shortly before death, a person may experience chest discomfort or a feeling of shortness of breath. In other cases, death occurs without these signs.

Ventricular fibrillation or asystole is accompanied by severe weakness and presyncope. A few minutes later, loss of consciousness occurs due to lack of blood circulation in the brain, then the pupils dilate to the limit and do not respond to light.

Breathing stops. Within three minutes after circulatory arrest and ineffective myocardial contractions, brain cells undergo irreversible changes.

Symptoms appearing immediately before death:

• convulsions;
• noisy, shallow breathing;
• the skin becomes pale with a bluish tint;
• pupils become wide;
• The pulse in the carotid arteries cannot be felt.

Treatment of sudden cardiac death

The only treatment for sudden death is immediate resuscitation. Resuscitation consists of several stages:

1. Ensuring free passage of air through the respiratory tract. To do this, it is necessary to place the dying person on an elastic, hard surface, tilt his head back, extend the lower jaw, open his mouth, free the oral cavity from existing foreign objects and remove the tongue.
2. Carry out artificial ventilation lungs, mouth to mouth method.
3. Restoration of blood circulation. Before starting an indirect cardiac massage, you need to perform a “precordial blow.” To do this, sharply strike with your fist in the middle of the sternum, but not in the area of ​​the heart. Next, put your hands on the person’s chest and make pressure chest.

For an effective resuscitation process, the ratio of air inhalations into the patient’s mouth and rhythmic pressure on the chest should be:

• inhalation for 15 pressures, if one person is resuscitating;
• 1 breath and 5 pressures if two people are resuscitating.

Immediately transport the person to a hospital to provide qualified professional assistance.

How to avoid sudden death

Every person should consciously and responsibly treat the health of his heart, and know how he can harm his heart and how to protect it.

Regular medical examination.

First of all, these are systematic visits to the doctor, examinations and laboratory tests. If someone in the family has a pathology of the cardiovascular system, immediately inform the doctor to eliminate the risk of manifestations of genetically inherited diseases.

Refusal bad habits

Fundamental cessation of smoking, drug addiction, and excessive alcohol consumption. Moderate consumption of drinks with the effect of stimulating the nervous system (coffee, tea, energy drinks).

Tobacco smoke reduces the percentage of oxygen in the blood, which means the heart works in oxygen starvation mode. In addition, nicotine increases blood pressure and promotes spasm of the vascular wall. The ethanol contained in alcohol has a toxic effect on the heart muscle, causing dystrophy and exhaustion.

The tonic effect in these drinks leads to an increase in heart rate and increases blood pressure.

Normalization of diet and the fight against obesity.

Excess body weight is a factor that plays an important role in the development of heart and vascular diseases and the occurrence of sudden cardiac death. According to statistics, people who are overweight are more likely to suffer from hypertension and atherosclerosis.

Extra pounds make it difficult not only for the heart, but also for other organs. To know your ideal physiological weight, there is a formula: body mass index BMI = existing weight: (height in meters x 2).

Normal weight is considered:

• if you are between 18 and 40 years old - BMI= 19-25;
• from 40 years and over - BMI = 19-30.

Results are variable and depend on structural features skeletal system. Recommended moderate consumption in food table salt and animal fats. Products such as lard, fatty meat, butter, pickles and smoked products lead to the development of atherosclerosis and increased pressure in the blood vessels.

Healthy foods for the heart

Proper nutrition is the key to health and longevity; support your body with heart-healthy foods.

1. Red grape juice.
2. Low-fat milk.
3. Fresh vegetables and fruits (legumes, bananas, carrots, pumpkin, beets, etc.).
4. Sea fish.
5. Lean meat (chicken, turkey, rabbit).
6. Nuts.
7. Vegetable oils.

A healthy lifestyle is the answer to the question, how to avoid sudden death?

There are many diets designed to strengthen and maintain good heart condition. Regular exercise will strengthen the body and make you feel more confident and healthier.

Active lifestyle and physical culture

Regular dosed physical activity with an emphasis on “cardio training”:

1. Running in the fresh air.
2. Bicycle rides.
3. Swimming.
4. Cross-country skiing and skating.
5. Yoga class.
6. Morning exercises.

Conclusion

Human life is very fragile and can end at any moment due to reasons beyond our control. Heart health is an indisputable condition for a long, quality life. Paying more attention to yourself, not destroying your body with bad habits and poor nutrition is the basic principle of every educated, sane person. The ability to respond correctly to stressful situations, to be in harmony with yourself and the world, to enjoy every day you live, reduces the risk of sudden cardiac death and leads to a happy long life.

It seems that in these cases Her Majesty “Fate” is in charge of everything... Of course, it would be nice to be on the safe side: “the ability to react correctly to stressful situations, to “get along” with yourself and the world, and to try to enjoy every moment of life”...

A terrible diagnosis. We remember the death of a very young hockey player with such a diagnosis posthumously. Once again you are convinced that everything is good in moderation.

You should never forget about the heart; there are excellent biological supplements to support the cardiovascular system.

Even under Mishka Marked, there was a large article in Literature on this subject. It was written there that if within 10 minutes. If the intensive care unit doesn’t arrive and give you an electric shock, then that’s it, it’s a bummer. If he arrives later and the heart is saved, you will still be an idiot, because brain cells begin to die. Such conditions for the arrival of an ambulance exist only in Europe and the USA (perhaps Southern Canada and South Australia with New Zealand), but not in our decrepit Russia.

A resident of this unfortunate country, Tula (working - until I die - retired).

Adding to the previous one.

I have a friend who fled from Kazakhstan at one time, so his son served in the army (that is, he was healthy and came to demobilization healthy), got a job as a driver in a convoy, did not complain about his health (since he drove, that means he drank little ). I came home from work - bam! Heart stopped - 23 years old. The person I know is illiterate and doesn’t know what or how to do it. Buried and that's it

Yes, the mortality rate is now impressive... not so long ago, a colleague had a grief at work. Her husband came for dinner and died before her eyes. everything is lightning fast... and there are triplets left.... and they are only 4 years old... And there is also stress, everything is faster, no rest, nothing... the race is all ours... But I didn’t drink, didn’t smoke.. that’s life...

When heart pain appears. then you can’t hesitate here. But in order to get rid of pain in the heart for a long time, you need to limit yourself in many ways, and this is well said in the publication.

How scary it all is! Once again you will think about how important it is to take care of your health from childhood.

I know of such cases of sudden death from a heart attack among men, including relatives. Moreover, at a fairly old age and with a seemingly healthy lifestyle. Still, stress and nervous overexcitation play a dominant role here.

Hmmm... Life is short and unpredictable. Appreciate every day and take care of yourself.

It’s scary when death comes suddenly... And jokes with the heart are especially bad. It needs to be taken care of and pampered with healthy foods.

Unfortunately, I am also familiar with this cause of death. As a rule, everything happens very quickly and it is no longer possible to save the person.

Thanks for such a detailed article. I am glad that it is written, although it is understandable, but very complete and competent. You need to know about such things, because whoever is forewarned is forearmed.

I read it and I’m really scared to go to the gym...

Everyone has their own destiny, I also know many cases of sudden death among people leading healthy image life. All that remains is to appreciate every day you live, and the rest - no one is immune from anything.

I read it and was horrified... A very useful and well presented article. I wondered how long it had been since I checked my heart...

Did you read it and start using it or did you read it and forget?

and who said that you need to eat as much of it as possible?

I heard about this method of treatment with Bolotov’s salt, contraindications to it...

Publications on the site are the personal opinion of the authors and are for informational purposes only.

To practically resolve a particular problem, you need to contact a specialized specialist.

Reprinting is permitted only if an active indexed link is provided.

©18 Health Academy | All rights reserved

Experts talk about death during sleep

Regardless of why a person died - from carbon monoxide poisoning to serious brain disease, it is first important to clearly determine the cause of death. And this is exactly what is difficult. Forensic experts shared information about how they determine whether a death was violent or suicide, and how they determine the cause of death in young people.

If you were told that a friend died in a dream, this may mean that the cause of death has not been precisely established, or that loved ones want to keep it a secret. But if the deceased was a young, healthy person, then it is important to find answers to pressing questions.

For those who remain in this world and are deeply grieving over the loss of a loved one, it is very important to know why the loved one died in order to draw a line. And for family members of the deceased, this is especially important information, because awareness of heredity, which affects the risk of death in a dream, can potentially save the lives of his loved ones.

Deceased at home in a dream: actions

“If a loved one dies at home, especially in their sleep, the medical examiner should be notified of the fact afterward unless the death is supported by testimony,” says Dr. Candace Schopp, a forensic pathologist and medical examiner in Dallas County. (USA).

“Regardless of whether we accept a case for consideration or not, a lot depends on what medical history“What illness did the patient have and what were the circumstances of his death,” the expert adds.

“The age of the deceased is a very important factor in the case,” says Schopp. How younger man, the more often an autopsy is performed if the underlying causes of death are not known. If the victim is seriously aged (over 50 years old), or has a diagnosis and no signs of violent death, specialists are unlikely to perform an autopsy.

The younger the person, the more often an autopsy is performed.

Suicide version

Death under suspicious circumstances, with suspected suicide, at home, and even in a dream, is a completely different matter. “I will always check the version of suicide if a person died in bed. According to Schopp, the following key points give rise to thoughts of suicide:

• strange objects were found at the scene;
• there are ambiguities in the medical history;
• the deceased was very young;
• The deceased was in good health.

According to the forensic pathologist, experts also often consider the possibility of an accidental drug overdose. Recently, there has been an increase in the number of people taking prescription pain medications incorrectly. Among them, opioids (opiates) - narcotic analgesics - were often seen.

Accidents at home

Each year is marked by tragic deaths due to carbon monoxide poisoning, including at home and while sleeping. Dr. Patrick Lantz, a professor in the Department of Pathological Anatomy at Wake Forest University School of Medicine, a forensic expert and pathologist in the state of North Carolina (USA), talks about this.

Due to malfunctions of the gas boiler or water heater, carbon monoxide may be released throughout the house. “In this case, people can easily choke on smoke and die,” Lantz says.

Or sometimes the following situation happens: a person has a built-in garage in his house. He started the car to warm it up. And left the garage door closed. “ Carbon monoxide spreads quickly, and serious gas poisoning is possible,” Lanz is convinced.

Cases are different. Suppose someone gets an electric shock because the wire in an electrical household appliance, such as a hair dryer, is damaged. “The person may have touched the wire in the bathroom. He falls to the floor and falls asleep or falls on the bed. It’s not always possible to find a person near an electrical appliance,” says the expert.

According to Lantz, if you ever find a deceased person in bed, what you do will depend on the circumstances of the incident: “If the deceased had cancer or chronic cardiovascular disease, the best option would be to call a physician to the house.”

In any case, if death occurs suddenly and unexpectedly, it is important to call an ambulance (103) and the police (102). “There are times when a person is alive, but he can barely breathe and he has a pulse that you cannot determine. Therefore, it is important to consult a professional to understand whether the person really died in his sleep,” says Patrick Lantz.

If death occurs suddenly, it is important to call a medical team in Ukraine (103) and the police (102). There are times when a person is alive, but he is barely breathing and he has a pulse that you cannot determine. Therefore, it is important to contact a professional to understand whether a person is alive or not.

Questions of the heart in a dream

Adults who die of natural causes, including at home and in their sleep, and are sent for an autopsy are often people between 20 and 55. The reason for the autopsy is an unknown cause of death; Plus, they have very few facts and records in the medical record, Schopp says.

According to the expert, the following were often observed in such deceased people:

“And in the vast majority of cases, we encounter undiagnosed cardiovascular diseases in our practice,” she adds.

When a person dies suddenly at night or during the day, it is often due to something called cardiac arrhythmia, Schopp admits. In cases of severe cardiac arrhythmia, the propagation of the cardiac impulse in the heart may be impaired. Autopsy of the heart may reveal scarring, expert says.

“The patient’s heart may be enlarged while taking large quantity alcohol or due to obesity,” explains the forensic pathologist. In addition, the heart can be abnormal large sizes due to congenital heart diseases.

Family illnesses

It is very important to understand the reason for the unexpected death of a loved one, especially if they died before and in their sleep, Lantz says. “Firstly, it helps to correctly explain to the family why the person passed away,” explains the expert. “It is especially important to realize this if the hereditary factor plays a key role in the case,” he adds.

Genetic diseases that can lead to rapid death include channelopathies. This is a group of hereditary or acquired neuromuscular diseases associated with disruption of the structure and function of ion channels in the membranes of muscle cells or nerve fibers. Such diseases represent a violation of the flow of ions through cells, in particular:

The diseases are caused by mutations in ion channel genes.

Channelopathies are to blame for some cases of cardiac arrhythmia among young people, Schopp says. Often, as a result of channelopathies, a person dies in his sleep.

Brugada syndrome, for example, can lead to problems heart rate in the lower chamber of the heart. Brugada syndrome is often inherited among Asians. This disease may be asymptomatic. Sometimes people just don't know that this disease is life-threatening. This is a sudden death syndrome that occurs due to polymorphic ventricular tachycardia or fibrillation.

Fibrillation is an accelerated contraction of individual muscle fibers of the heart, disrupting their synchronous activity (heart rhythm) and pumping function. Polymorphic ventricular tachycardia is a rare form of ventricular tachycardia in which the amplitude of the ventricular complexes changes like a sinusoid, with complexes of minimal amplitude connecting phases of opposite polarity.

Associated symptoms:

Saving a life

Based on the results of the autopsy, experts can advise the loved ones of the deceased, who died at home and in his sleep, to undergo diagnostics to identify serious genetic diseases and speed up treatment if the disease is confirmed. Sometimes doctors only observe the disease, and in some situations treatment is prescribed immediately. If doctors diagnose certain types of arrhythmia, patients are offered to purchase an implantable defibrillator in the area of ​​the heart.

An implantable cardioverter defibrillator (ICD) is a pacemaker-type device that continuously monitors the heart's rhythm. If the device detects a rhythm disorder that is not too serious, it generates a series of painless electrical impulses to correct the rhythm.

If this does not help or the rhythm disturbance is severe enough, the ICD device generates a small electrical shock called cardioversion. If this does not help or the rhythm disturbance is very severe, the ICD device generates an even stronger electrical shock, called defibrillation.

Prevention and diagnosis of loved ones of the deceased

Diseases of the wall of the aorta, the large, central artery that carries blood from the heart to the body, can lead to rupture of the aorta and sudden death. Aortic aneurysm is often a hereditary disease. This is an expansion of the lumen of a blood vessel or heart cavity, caused by pathological changes in their walls or developmental anomalies.

“Usually family members are asked to do in the event of an aneurysm of the deceased, including in a dream:

• echocardiogram;
• computed tomography;
• magnetic resonance imaging (MRI).

When doctors see that the aorta is beginning to dilate, they suggest using preventive surgery methods,” Lanz reports. “And then sudden death can be prevented,” the doctor clarifies.

Schopp says that when hereditary diseases are a possible cause of death, representatives of her institution call loved ones. “Sometimes I personally explain everything clearly over the phone,” she says. “In the autopsy report, I indicate that this is a genetic mutation that is inherited, and I recommend that immediate family members (especially parents, brothers, sisters, children) go for a consultation with a therapist and get diagnosed,” says the expert.

Mental health issues

When doctors take mental health issues into account, it means they want to determine whether a person died of natural causes or not, especially if it happened at home and in their sleep. “Forensic experts have to do a lot of research on this and talk to the loved ones of the deceased,” says Lantz.

Typically, forensic experts ask similar questions to loved ones of the deceased:

• Perhaps the person was depressed?
• Has he ever taken drugs or serious sedatives?
• Did he sometimes voice his attitude towards suicide attempts and suicidal thoughts?

If family members answer yes to at least one of these questions, forensic experts decide to perform an autopsy.

“If we receive such information about the characteristics of the deceased, for example: that he was depressed; suicidal tendencies were evident, I think that any expert would say to do an autopsy. The age of the deceased does not play a role in this case. Specialists then want to rule out the possibility of suicide,” he says.

Associated diseases:

Brain diseases

According to Lanz, brain diseases that can lead to sudden death, including at home and in sleep, are the following:

What is a cerebral aneurysm? This is a weakening of the wall of one of the blood vessels in my head. Due to the way blood circulates in the head, this “weakness” causes the walls of the vessel to bulge. As with overinflated balloon, such a bulge can lead to rupture, resulting in a cerebral hemorrhage.

According to Lanz, in the case of infections such as meningitis and encephalitis, there may be fatal consequences for the human body. In general, with the development of such serious diseases, obvious symptoms are observed that should be taken into account.

“Epilepsy is known as a disease that causes death in one's sleep,” says Schopp. Perhaps this is due to the fact that the amount of oxygen decreases to the brain, and this provokes epileptic seizure. According to her, the patient usually has a history of such attacks of epilepsy.

Causes of death in supposedly healthy people

According to Schopp, the incidence of sudden death among apparently healthy people in their beds at home and in their sleep depends on how people understand the word “healthy.” Obesity is a common cause of unexpected death, says forensic pathologist Schopp. “For example, I meet many people in my practice who have serious coronary insufficiency. In addition, I often observe patients at work who have clogged arteries. Such phenomena are “getting younger,” the doctor admits.

The incidence of sudden death among apparently healthy people in their beds depends on how people understand the word “healthy.”

Coronary insufficiency is a concept that means a decrease or complete cessation of coronary blood flow with insufficient supply of oxygen and nutrients to the myocardium.

According to Schopp, sometimes a person, due to his low income and living conditions, may not have any entries in his medical record for 15 years due to the fact that he could not see a doctor.

“It’s quite rare for people to die suddenly and unexpectedly in their bed in their sleep,” Lanz is convinced. “Sometimes this happens. In most cases where death comes completely without warning, forensic experts study such incidents very carefully. We would like autopsies to be carried out more often, so that the relatives of the deceased can be better informed,” the doctor hopes.

Instructions for medications

And it seems unfair to others when a cheerful person dies in full bloom, healthy man, a woman at the top of her creative career. “The doctors couldn’t help him,” complain the relatives of the deceased man, accusing doctors of failing to foresee the danger to his health. Others say that this is fate, everything is decided for us from above. And yet, is such a sudden death so accidental?

All that can be said is that sudden death makes itself known in advance. If you pay attention to the symptoms of a possible deterioration in your condition, you can delay your death for many more decades.

Causes of sudden death

1. Heart failure . A spasm occurs in a large blood vessel that supplies blood to the heart muscle. Men under 40 years of age are at risk. Death occurs as a result of unexpected stress.
2. Extensive heart attack . The vessel ruptures, cardiogenic occurs. Men over 40 years of age are at risk.
3. Thrombosis of large arteries . This disease begins against the background of varicose veins and develops after heart bypass surgery. Men over 50 and women suffering from dilatation of the veins of the lower extremities are more susceptible to thrombosis than others. Women are predisposed to acute thrombosis when using hormonal contraceptives.

All diseases that lead to sudden death usually belong to the cardiovascular group. The heart hurts, but it all starts because of the blood vessels. A person is healthy and resilient, his body systems are resistant to negative impact, and begin to give signals of disorder when it can no longer be ignored. A person experiences painful symptoms when the blood vessels narrow by 70 percent, when the heart rate suffers and pain is felt.

An unhealthy diet, constant stress, and unacceptable environmental conditions contribute to the oxidation of the internal environment of the human body. In the most weak points Cholesterol build-ups form on the walls of blood vessels. These plaques-growths are soft at first, and then they become denser, collect salts, and the diameter of the vessel narrows, the vessel becomes fragile. Such vessels and arteries are called “glass” because at some point they can burst if blood pressure increases, for example, as a result of stress or high physical activity.

They choose death, winning: who is at risk?

Sudden death creeps up more often on assertive, aggressive men who place bets and strive to win against all odds. Of course, everyone loves to win, but there is a percentage of men who are almost unable to cope with their own defeat. As they say, they will die to win. Their life flows like a fast, full-flowing river, they cannot afford to rest, and they do not have the correct concept of rest. These include high-ranking workaholics. They relieve nervous tension only with the help of alcohol. They often consume spicy, high-calorie foods in excess, and eat in large quantities, also to relieve stress to some extent. They can often be identified by the fat pad above the stomach, although other parts of the body may remain thin. If such a man does nothing to improve his own figure, it resembles the figure of a pregnant woman.

These people have a paradoxical nervous system. Their state of anger is not accompanied by redness of the face,

like most people, on the contrary, they become pale. This sign indicates narrowing of blood vessels. It is the spasm of blood vessels that will one day cause their death. All men love to brag about their own health, without thinking about strengthening and maintaining it. Men who are at risk think that taking care of their health means showing their weakness. They are sure that visiting a doctor is a ridiculous and despicable activity. But in reality, the behavior of such men is somewhat similar to the manners of an ostrich when it hides its head in the sand. Perhaps this is a fear that doctors will find evidence of some disease in their body.

More often, representatives of this group are zealous materialists who are confident in the power of medicine, especially surgery. Maybe they once came across the slogan “jogging against a heart attack,” which was used as a preventive measure cardiovascular diseases, but he could never seduce them. Here is an example of the ex-President of Russia Yeltsin, who underwent coronary artery bypass surgery, when he danced and drank alcohol in front of the guard of honor - this is another matter. After the operation, Boris Yeltsin lived for a relatively long time (ten years after such an operation), but for some reason supporters of his lifestyle have long been dead. And why?

Restoration of blood circulation to the heart is performed by angioplasty, or coronary artery bypass surgery. Angioplasty involves removing a sclerotic growth from the wall of a vessel and installing a spring-stent into it. The operation helps restore blood circulation and eliminate pain. But if the patient continues to live his previous life, does not change his diet, the accumulation of fats on the walls of blood vessels occurs as before, therefore foreign bodies the formation of blood clots is stimulated. Patients take blood thinning medications, but after a while another attack of pain appears,

and then it is necessary to put the tent in another vessel. It happens that the formed blood clot breaks off after physical overexertion, blocks a large-diameter artery, and therefore a quick death occurs.

Coronary artery bypass grafting is the formation of a bypass vessel from a vein, bypassing the blocked part of the vessel. If the body rejects this alternative blood supply or the vessel becomes clogged with clots, then surgery is required again. In addition to everything, the vein does not have such elastic walls as arteries, so it contracts with difficulty and quickly loses its tone. A prolonged state of anemia during surgery is very harmful to the brain. These patients demonstrate inappropriate behavior, do not feel pain, as usual, do not have a critical view of the state of their health, they show off, committing unjustified actions.

Heart surgery: bravado in life

In reality, operations to restore cardiac circulation do not prolong life, but improve the patient’s condition for a certain period (five years): there is no pain, blood supplies the body unhindered. The patient is prescribed a large list medicines aimed at preventing a. But be that as it may, the shunt becomes clogged again. Then comes the critical period. If there are several affected vessels, then this process is accelerated.

How else can you prevent heart disease? This should also be taken into account, because a whole heart is better than an operated one.

The slightest pain indicates insufficient nutrition of the heart muscle; this is a signal of impaired blood flow. This gives every reason to carefully reconsider your lifestyle. The first is to include physical education classes. The simplest exercise is to walk daily for a distance of at least three kilometers. Patients who have had a heart attack

those who are familiar with the slightest heart pain should drive less often. It is useful for them to walk as much as possible, during and after work, especially on vacation and on weekends.

Another component of heart health is proper nutrition. As yogis are sure, any disease can be cured with the help of diet. Gluttony can manifest itself due to the substitution of normal relationships in the family, the so-called appeasement of a partner delicious dishes. If a woman truly believes that the way to a man lies through his stomach, then she is thereby preparing the premature grave of her husband, and the life of a widow for herself. To avoid acidification of the blood and damage to blood vessels, a person must practice a diet that matches his constitution, take dietary supplements rich in calcium, lecithin, silicon, fish oil, vitamins E and C.

Please note

Harbingers of possible sudden death and impending cardiac spasm are:

• short-term severe weakness, dizziness, ;
• after stress, jumping, in which a person’s face turns pale;
• pallor after physical activity, pallor after drinking too much alcohol, with conflicts in communication;
• Instead of increasing blood pressure during physical activity, it decreases.

The sudden death of a person from your social circle is an alarming signal and a reason to think about your own health. The condition of blood vessels can be determined using coronary cardiography. This examination reveals vessels affected by plaques by 50% or more.

www.nebolei.ru

According to the definition of the World Health Organization, sudden death refers to deaths that occur within 6 hours against the background of the appearance of symptoms of a cardiac disorder in practically healthy people or in people who already suffered from it, but their condition was considered satisfactory. Due to the fact that such death in almost 90% of cases occurs in patients with symptoms, the term “sudden coronary death” was introduced to designate the causes.

Such deaths always occur unexpectedly and do not depend on whether the deceased previously had cardiac pathologies. They are caused by disturbances in ventricular contraction. At autopsy, no diseases are detected in such persons internal organs which could cause death. When examining the coronary vessels, approximately 95% are diagnosed with narrowings caused by atherosclerotic plaques, which could provoke life-threatening complications. Newly occurring thrombotic occlusions that can impair cardiac activity are observed in 10-15% of victims.

Vivid examples of sudden coronary death can be the deaths of famous people. The first example is the death of a famous French tennis player. The death occurred at night, and a 24-year-old man was found in his own apartment. An autopsy revealed cardiac arrest. The athlete had not previously suffered from diseases of this organ, and other causes of death could not be determined. The second example is the death of a major businessman from Georgia. He was a little over 50, he always steadfastly endured all the difficulties of business and personal life, moved to live in London, was regularly examined and led a healthy lifestyle. The death occurred completely suddenly and unexpectedly, against the background of complete health. After an autopsy of the man's body, the causes that could have led to his death were not discovered.

There are no exact statistics on sudden coronary death. According to WHO, it occurs in approximately 30 people per 1 million population. Observations show that it occurs more often in men, and middle age for this condition ranges between 60 years. In this article we will introduce you to the causes, possible harbingers, symptoms, methods of providing emergency care and prevention of sudden coronary death.

Immediate causes

The cause of 3-4 out of 5 cases of sudden coronary death is ventricular fibrillation.

In 65-80% of cases, sudden coronary death is caused by primary death, in which these parts of the heart begin to contract very often and randomly (from 200 to 300-600 beats per minute). Due to this rhythm disturbance, the heart cannot pump blood, and the cessation of blood circulation causes death.

In approximately 20-30% of cases, sudden coronary death is caused by bradyarrhythmia or ventricular asystole. Such rhythm disturbances also cause serious violation in the blood circulation, this is fatal.

In approximately 5-10% of cases, sudden death is provoked. With this rhythm disturbance, these chambers of the heart contract at a speed of 120-150 beats per minute. This provokes a significant overload of the myocardium, and its depletion causes circulatory arrest with subsequent death.

Risk factors

The likelihood of sudden coronary death may increase due to some major and minor factors.

Main factors:

• previously transferred;
• previous severe ventricular tachycardia or cardiac arrest;
• decrease in left ventricular ejection fraction (less than 40%);
• episodes of unsustained ventricular tachycardia or ventricular extrasystole;
• cases of loss of consciousness.

Minor factors:

• smoking;
• alcoholism;
• obesity;
• frequent and intense stressful situations;
• rapid pulse (more than 90 beats per minute);
• increased tone sympathetic division nervous system, manifested by hypertension, dilated pupils and dry skin);
• diabetes mellitus

Any of the above conditions can increase the risk of sudden death. When several factors are combined, the risk of death increases significantly.

At-risk groups

Patients at risk include:

• those who underwent intensive care for ventricular fibrillation;
• suffering from ;
• with electrical instability of the left ventricle;
• with severe left ventricular hypertrophy;
• with myocardial ischemia.

What diseases and conditions most often cause sudden coronary death?

Most often, sudden coronary death occurs in the presence of the following diseases and conditions:

• hypertrophic;
• dilated cardiomyopathy;
• arrhythmogenic dysplasia of the right ventricle;
• aortic stenosis;
• coronary artery anomalies;
• (WPW);
• Burgad's syndrome;
• “athletic heart”;
• aortic aneurysm dissection;
• TELA;
• idiopathic ventricular tachycardia;
• long QT syndrome;
• cocaine intoxication;
• taking medications that can cause arrhythmia;
• severe disturbance of the electrolyte balance of calcium, potassium, magnesium and sodium;
• congenital divercula of the left ventricle;
• neoplasms of the heart;
• sarcoidosis;
• amyloidosis;
• obstructive sleep apnea (stopping breathing during sleep).

Forms of sudden coronary death

Sudden coronary death can be:

• clinical – accompanied by a lack of breathing, blood circulation and consciousness, but the patient can be resuscitated;
• biological - accompanied by a lack of breathing, blood circulation and consciousness, but the victim can no longer be resuscitated.

Depending on the speed of onset, sudden coronary death can be:

• instantaneous - death occurs in a few seconds;
• fast - death occurs within 1 hour.

According to the observations of specialists, instantaneous sudden coronary death occurs in almost every fourth person who died as a result of such a fatal outcome.

Symptoms

Harbingers

In some cases, 1-2 weeks before sudden death, so-called precursors occur: fatigue, sleep disturbances and some other symptoms

Sudden coronary death occurs quite rarely in people without heart pathologies and most often in such cases is not accompanied by any signs of deterioration general well-being. Such symptoms may not appear in many patients with coronary diseases. However, in some cases, the following signs may become harbingers of sudden death:

• increased fatigue;
• sleep disorders;
• sensations of pressure or pain of a squeezing or oppressive nature behind the sternum;
• increased feeling of suffocation;
• heaviness in the shoulders;
• increased or slow heart rate;
• cyanosis.

Most often, the warning signs of sudden coronary death are felt by patients who have already suffered a myocardial infarction. They can appear in 1-2 weeks, expressed as general deterioration well-being, and in signs of angiotic pain. In other cases, they are observed much less frequently or are absent altogether.

Main symptoms

Typically, the occurrence of such a condition is in no way connected with previous increased psycho-emotional or physical stress. When sudden coronary death occurs, a person loses consciousness, his breathing first becomes frequent and noisy, and then slows down. The dying person has convulsions and the pulse disappears.

After 1-2 minutes, breathing stops, the pupils dilate and stop responding to light. Irreversible changes in the brain during sudden coronary death occur 3 minutes after the cessation of blood circulation.

Diagnostic measures when the above-described signs appear should be carried out in the very first seconds of their appearance, because In the absence of such measures, there may be no time to resuscitate a dying person.

To identify signs of sudden coronary death, you must:

• make sure there is no pulse in the carotid artery;
• check consciousness - the victim will not respond to pinches or blows to the face;
• make sure that the pupils do not react to light - they will be dilated, but will not increase in diameter under the influence of light;
• – when death occurs, it will not be determined.

Even the presence of the first three diagnostic data described above will indicate the onset of clinical sudden coronary death. If they are detected, it is necessary to begin urgent resuscitation measures.

In almost 60% of cases, such deaths do not occur in conditions medical institution, and at home, at work and other places. This greatly complicates the timely detection of such a condition and the provision of first aid to the victim.

Urgent Care

Resuscitation should be carried out within the first 3-5 minutes after identifying signs of clinical sudden death. To do this you need:

1. Call an ambulance if the patient is not in a medical facility.
2. Restore airway patency. The victim should be laid on a hard horizontal surface, tilt his head back and extend his lower jaw. Next, you need to open his mouth and make sure there are no objects interfering with breathing. If necessary, remove vomit with a tissue and remove the tongue if it blocks the airway.
3. Start mouth-to-mouth artificial respiration or mechanical ventilation (if the patient is in a hospital setting).
4. Restore blood circulation. This is done in a medical facility. If the patient is not in the hospital, then first a precordial blow should be applied - a blow with a fist to a point in the middle of the sternum. After this, you can begin indirect cardiac massage. Place the palm of one hand on the sternum, cover it with the other palm and begin pressing the chest. If performed by one person, then for every 15 pressures you should take 2 breaths. If 2 people are involved in saving the patient, then for every 5 pressures take 1 breath.

Every 3 minutes it is necessary to check the effectiveness of emergency aid - the reaction of the pupils to light, the presence of breathing and pulse. If the reaction of the pupils to light is determined, but breathing does not appear, then resuscitation measures should be continued until the ambulance arrives. Restoring breathing may become a reason to stop chest compressions and artificial respiration, since the appearance of oxygen in the blood promotes activation of the brain.

After successful resuscitation, the patient is hospitalized in a specialized cardiac intensive care unit or cardiology department. In a hospital setting, specialists will be able to determine the causes of sudden coronary death and draw up a plan effective treatment and prevention.

Possible complications in survivors

Even with successful cardiopulmonary resuscitation, survivors of sudden coronary death may experience the following complications of this condition:

• chest injuries due to resuscitation;
• serious deviations in brain activity due to the death of some of its areas;
• disorders of blood circulation and heart function.

It is impossible to predict the possibility and severity of complications after sudden death. Their appearance depends not only on the quality of cardiopulmonary resuscitation, but also on the individual characteristics of the patient’s body.

How to avoid sudden coronary death

One of the most important measures to prevent sudden coronary death is giving up bad habits, in particular smoking.

The main measures to prevent the occurrence of such deaths are aimed at the timely identification and treatment of people suffering from cardiovascular diseases, and social work with the population aimed at familiarizing them with the groups and risk factors for such deaths.

Patients who are at risk of sudden coronary death are recommended to:

1. Timely visit to the doctor and implementation of all his recommendations for treatment, prevention and clinical observation.
2. Quitting bad habits.
3. Proper nutrition.
4. Fighting stress.
5. Optimal work and rest regime.
6. Compliance with recommendations on maximum permissible physical activity.

Patients at risk and their relatives must be informed about the likelihood of such a complication of the disease as sudden coronary death. This information will make the patient more attentive to his health, and those around him will be able to master the skills of cardiopulmonary resuscitation and will be ready to perform such activities.

• calcium channel blockers;
• antioxidants;
• Omega-3, etc.

• implantation of a cardioverter-defibrillator;
• radiofrequency ablation of ventricular arrhythmias;
• operations to restore normal coronary circulation: angioplasty, coronary artery bypass grafting;
• aneurysmectomy;
• circular endocardial resection;
• extended endocardial resection (can be combined with cryodestruction).

To prevent sudden coronary death, other people are recommended to lead a healthy lifestyle and regularly undergo preventive examinations (, Echo-CG, etc.), which make it possible to identify heart pathologies at the earliest stages. In addition, you should promptly consult a doctor if you experience discomfort or pain in the heart, arterial hypertension and pulse irregularities.

Of no small importance in the prevention of sudden coronary death is awareness and training of the population in cardiopulmonary resuscitation skills. Its timely and correct execution increases the victim's chances of survival.

Cardiologist Sevda Bayramova talks about sudden coronary death:

Dr. Dale Adler, a cardiologist at Harvard, explains who is at risk for sudden coronary death:

Sudden death occurs as a result of a fast-flowing latent or clinically pronounced painful condition. As medical practice shows, sudden death in adults often occurs due to acute coronary insufficiency, congenital or acquired cardiac and vascular pathologies. Find out what symptoms may indirectly indicate a hidden threat.

What is sudden death

According to international medical recommendations, the death of a person within 6 hours after the appearance of the first symptoms of a pathological condition is considered sudden. Instant death, or translated into English sudden death, occurs without a known cause. In addition, there are no morphological signs on the basis of which an appropriate diagnosis of the patient’s sudden death can be made at autopsy.

However, during a post-mortem examination of a person, a pathologist, having compared all available data, can make a logical conclusion about the instantaneous or violent death of the person. In most cases, instant death is supported by changes in organs in which continuation of life for the shortest period of time is impossible.

Causes of sudden death

Statistics show that the main cause of most deaths is heart disease: ischemic pathology, the onset of ventricular fibrillation. At the same time, when answering what causes instant death, experts often call chronic illnesses, which last for a long time in hidden form, after which they suddenly worsen and lead to the unexpected death of a person. One of these deadly diseases is cancer.

In most cases, oncology develops asymptomatically and makes itself felt when the patient is often considered hopeless. Thus, malignant liver disease is the main cause of unexpected deaths in China. To others insidious disease A disease that can lead to sudden death is AIDS, which claims millions of lives in Africa every year. In addition, it is worth mentioning separately about Mexico. This is the only country in which cirrhosis of the liver is the main cause of high mortality in the population.

At a young age

Today, young men and women are exposed to the negative influence of modern lifestyle every day. From TV screens and the covers of fashion magazines, the cult of a slender (often dystrophic) body, accessibility and promiscuity is imposed on young people. Therefore, it is quite clear that the mortality rate of people just starting their career life path, will grow over time. The main causes of instant death among boys and girls under 25 years of age are considered to be:

• alcohol;
• smoking;
• promiscuity;
• drug addiction;
• poor nutrition;
• psychological sensitivity;
• hereditary diseases;
• severe congenital pathologies.

In a dream

Unexpected death in this condition occurs due to the loss of special cells responsible for the contractility of the lungs. Thus, scientists from the USA were able to prove that people die in their sleep in most cases due to central sleep apnea. In this case, a person may even wake up, but still leave this mortal world due to oxygen starvation caused by a stroke or cardiac arrest. As a rule, elderly people are susceptible to this syndrome. There are no specific treatments for central sleep apnea.

Sudden infant death

This syndrome was first described in the early 60s of the last century, although cases of instant death of infants were recorded earlier, but they were not subjected to such a thorough analysis. Young children have very high adaptive abilities and incredible resistance to a variety of negative factors, because death infant is considered to be an exceptional situation. However, there are a number of external and internal reasons that can lead to sudden child death:

• elongation QT interval;
• apnea (the phenomenon of periodic breathing);
• deficiency of serotonin receptors;
• overheat.

Risk factors

Due to the fact that the main cardiogenic cause Since coronary disease is an instant death, it is quite logical to assume that the syndromes accompanying this heart pathology can be fully attributed to conditions that can increase the likelihood of sudden death. With all this, it has been scientifically proven that this connection is mediated through the underlying disease. Clinical risk factors for development clinical death among patients with ischemic syndrome are:

• acute myocardial infarction;
• post-infarction macrofocal sclerosis;
• unstable angina;
• heart rhythm disturbance due to ischemic changes (rigid, sinus);
• ventricular asystole;
• myocardial damage;
• episodes of loss of consciousness;
• damage to the coronary (heart) arteries;
• diabetes mellitus;
• electrolyte imbalance (eg, hyperkalemia);
• arterial hypertension;
• smoking.

How does sudden death occur?

This syndrome develops in a matter of minutes (less often hours) without any warning in the midst of complete well-being. In most cases, instant death affects young men aged 35 to 43 years. Moreover, often during the pathological examination of the deceased, vascular causes of sudden death are discovered. Thus, studying the increasing cases of instant death, experts came to the conclusion that the main provoking factor in the occurrence of this syndrome is a violation of coronary blood flow.

For heart failure

In 85% of cases, immediate death is recorded in individuals with structural abnormalities of the organ that pumps blood into the vessels. In this case, sudden cardiac death looks like a lightning-fast clinical variant of coronary disease. Medical practice shows that in a quarter of those who died instantly, before the onset primary symptoms bradycardia and episodes of asystole are observed. Death from cardiac arrest occurs due to the launch of the following pathogenetic mechanisms:

• Reducing left ventricular fractional ejection by 25-30%. This syndrome greatly increases the risk of sudden coronary death.
• Ectopic focus of automatism in the ventricle (more than 10 ventricular extrasystoles per hour or unstable ventricular tachycardia), arising as a consequence of ventricular arrhythmias. The latter mostly develop against the background of acute transient myocardial ischemia. An ectopic focus of automatism is usually classified as a risk factor for sudden arrhythmic death.
• The process of spasm of the blood vessels of the heart, which leads to ischemia and contributes to the deterioration of the restoration of blood flow to damaged areas.

It is worth noting that tachyarrhythmia is a particularly significant electrophysiological mechanism resulting in sudden coronary death in a person with heart failure. At the same time, timely treatment of this condition using a defibrillator with a modified pulse configuration significantly reduces the number of deaths among patients who have suffered sudden cardiac arrest.

From a heart attack

Blood enters the heart through the coronary arteries. If their lumen closes, primary foci of necrosis and ischemia form in the heart. Acute manifestation of cardiac pathology begins with damage to the vascular wall with further thrombosis and spasm of the arteries. As a result, the load on the heart increases, the myocardium begins to experience oxygen starvation which affects him electrical activity.

As a result of a sudden coronary spasm, ventricular fibrillation occurs, a few seconds after which a complete cessation of blood circulation to the brain occurs. At the next stage, the patient experiences respiratory arrest, atony, absence of corneal and pupillary reflexes. After 4 minutes from the onset of ventricular fibrillation and complete cessation of blood circulation in the body, irreversible changes occur in the brain cells. In general, death from a heart attack can occur in 3-5 minutes.

From a blood clot

In the venous bed, these pathological formations arise due to the uncoordinated work of the coagulation and anticoagulation systems. Thus, the onset of the appearance of a clot is caused by damage to the vascular wall and its inflammation against the background of thrombophlebitis. Perceiving the appropriate chemical signal, the coagulation system comes into action. As a result, fibrin threads form near the pathological area, in which blood cells become entangled, creating all the conditions for the blood clot to break off.

In arteries, the formation of clots occurs due to narrowing of the vascular lumen. Thus, cholesterol plaques block the path of free blood flow, resulting in the formation of a lump of platelets and fibrin threads. It is important to note that in medicine a distinction is made between floating and mural thrombi. Compared to the first type, the latter has a slight chance of breaking off and causing a blockage (embolism) of the vessel. In most cases, the causes of sudden cardiac arrest from a blood clot are due to the movement of a floating thrombus.

One of severe consequences separation of such a clot is a blockage pulmonary artery, which is expressed in severe cough, cyanosis skin. Often there is respiratory failure followed by cessation of cardiac activity. An equally serious consequence of the detachment of a blood clot is a violation of cerebral circulation due to embolism of the main vessels of the head.

Diagnosis of sudden death

A timely physical examination is the key to the success of further cardiopulmonary resuscitation (CPR) measures. Diagnosis of instant death is based on symptoms characteristic of the patient's natural death. Thus, absence of consciousness is determined if no external stimuli cause reactions on the part of the person being resuscitated.

Diagnosis of breathing disorders is noted when within 10-20 s. observation fails to detect coordinated movements of the sternum and the noise of the air exhaled by the patient. In this case, agonal breaths do not provide adequate ventilation of the lungs and cannot be interpreted as spontaneous breathing. During ECG monitoring, it is detected pathological changes, characteristic of clinical death:

• ventricular fibrillation or flutter;
• cardiac asystole;
• electromechanical dissociation.

Clinical manifestations

In 25% of cases, sudden death occurs instantly without any warning signs. Some patients, a week before clinical death, complain of various prodromal manifestations: increased pain in the sternum, general weakness, shortness of breath. It is important to note that today there are already methods for preventing heart attacks based on early diagnosis warning symptoms of this condition. Immediately before the onset of sudden death, half of the patients experience an anginal attack. Clinical signs of a patient’s imminent death include:

• loss of consciousness;
• absence of pulse in the carotid arteries;
• dilated pupils;
• lack of breathing or the appearance of agonal breaths;
• change in skin color from normal to gray with a bluish tint.

Medical care for sudden death

Typically, most cases of unexpected cardiac arrest occur outside the hospital. For this reason, it is extremely important to master the technique of providing emergency care in case of sudden clinical death. This is especially true for subjects of society who, due to their official duties, are in contact with a large number people. Remember, competent resuscitation actions immediately in the first minutes after the onset of symptoms of cardiac arrest will help gain time before arrival medical workers.

Urgent Care

The main problem that arises in unconscious persons is obstruction of the airways by the root of the tongue and the epiglottis due to muscle atony. I must say that this state develops in any position of the body, and when the head is tilted forward it develops in 100% of cases. Therefore, the first thing that needs to be done is to ensure proper airway patency. For this purpose, you need to use P. Safar’s triple technique, consisting of the following sequential actions:

1. Throwing back the head;
2. Moving the lower jaw forward;
3. Opening the mouth.

Once airway patency is ensured, you should proceed to artificial pulmonary ventilation (ALV). When providing first aid, this activity is carried out using the mouth-to-mouth method. So, one hand is placed on the victim’s forehead, while the other pinches his nose. Then the resuscitator fixes his own lips around the mouth of the person being revived and blows air, while controlling the excursion of the patient's chest. When it is visible, you need to release the victim’s mouth, giving him a chance to exhale passively.

At the next stage, artificial maintenance of blood circulation is carried out, to ensure which an algorithm for performing indirect cardiac massage or chest compression is used. For this purpose, you need to correctly lay the person being resuscitated on a flat surface. Next, you should determine the compression points: by palpating the xiphoid process and moving away from it 2 transverse fingers upward.

The hand must be placed on the border of the middle and lower part of the sternum so that the fingers are parallel to the ribs. Pushes are performed with the limbs straightened at the elbows. Chest compression is performed at a frequency of 100 compressions per minute with a break for artificial ventilation. The depth of the shocks is about 4-5 cm. Measures to restore cardiac activity should be stopped if:

1. A pulse appeared in the main arteries.
2. The actions taken do not have the desired effect within 30 minutes. The exception is the following conditions that require prolongation of resuscitation:

• hypothermia;
• drowning;
• overdose medicines;
• electrical injury.

Resuscitation measures

Today, the concept of CPR is based on strict rules that ensure complete safety of the activities carried out for human life. In addition, an algorithm for the resuscitator’s actions in case of sudden cardiac arrest or sudden loss of respiratory function in the injured person is presented and scientifically substantiated. When these conditions develop main role Time plays: only a few minutes separate a person from death. The algorithm for performing cardiopulmonary resuscitation involves performing the following actions:

1. Determining the condition of the victim, on the basis of which the range of measures necessary for revival is selected;
2. Early start CPR, which involves performing two manipulations: chest compressions and artificial ventilation.
3. If the second stage is ineffective, they proceed to defibrillation. The procedure involves applying an electrical impulse to the heart muscle. In this case, direct current discharges should be applied only if the electrodes are correctly positioned and have good contact with the victim’s skin.
4. At this stage, as a rule, the victim is provided with specialized medical care, including the following early treatment measures:

• artificial ventilation with tracheal intubation;
• drug support, involving the use of:
• catecholamines (adrenaline, atropine);
• antidiuretic hormones (Vasopressin);
• antiarrhythmic drugs (Cordarone, Lidocaine);
• fibrinolytic agents (Streptokinase).
• intravenous drip administration of electrolyte or buffer solutions (for example, sodium bicarbonate is administered for acidosis)

Video

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

Sudden cardiac death (SCD) is one of the most severe cardiac pathologies, which usually develops in the presence of witnesses, occurs instantly or in a short period of time and has as the main cause the coronary arteries.

The factor of surprise plays a decisive role in making such a diagnosis. As a rule, in the absence of signs of an impending threat to life, instantaneous death occurs within a few minutes. A slower development of the pathology is also possible, when arrhythmia, heart pain and other complaints appear, and the patient dies in the first six hours from the moment of their occurrence.

The greatest risk of sudden coronary death is observed in people 45-70 years old who have some form of disturbances in the blood vessels, heart muscle, and its rhythm. Among young patients, there are 4 times more men; in old age, men are susceptible to pathology 7 times more often. In the seventh decade of life, gender differences are smoothed out, and the ratio of men and women with this pathology becomes 2:1.

Most patients experience sudden cardiac arrest at home; a fifth of cases occur on the street or on public transport. In both places there are witnesses to the attack who can quickly call an ambulance, and then the likelihood of a positive outcome will be much higher.

Saving a life may depend on the actions of others, so you cannot simply walk past a person who has suddenly fallen on the street or lost consciousness on a bus. You need to at least try to carry out the basics - indirect cardiac massage and artificial respiration, having first called doctors for help. Cases of indifference are not rare, unfortunately, and therefore the percentage of unfavorable outcomes due to late resuscitation occurs.

Causes of sudden cardiac death

the main cause of SCD is atherosclerosis

The causes that can cause acute coronary death are very numerous, but they are always associated with changes in the heart and its blood vessels. The lion's share of sudden deaths is caused when fatty tissues form in the coronary arteries, obstructing blood flow. The patient may not be aware of their presence, may not make any complaints as such, then they say that it is completely healthy person died suddenly of a heart attack.

Another cause of cardiac arrest may be acutely developed, in which proper hemodynamics are impossible, the organs suffer from hypoxia, and the heart itself cannot withstand the load and.

The causes of sudden cardiac death are:

• Coronary heart disease;
• Congenital anomalies of the coronary arteries;
• arteries with endocarditis, implanted artificial valves;
• Spasm of the arteries of the heart, both against the background of atherosclerosis and without it;
• for hypertension, defect,;
• Metabolic diseases (amyloidosis, hemochromatosis);
• Congenital and acquired;
• Heart injuries and tumors;
• Physical overload;
• Arrhythmias.

Risk factors have been identified when the likelihood of acute coronary death becomes higher. The main such factors include ventricular tachycardia, a previous episode of cardiac arrest, cases of loss of consciousness, previous history, reduction of the left ventricle to 40% or less.

Secondary, but also significant conditions under which the risk of sudden death is increased are considered concomitant pathology, in particular, diabetes, obesity, myocardial hypertrophy, tachycardia more than 90 beats per minute. Smokers, those who neglect physical activity and, conversely, athletes are also at risk. With excessive physical exertion, hypertrophy of the heart muscle occurs, a tendency to rhythm and conduction disturbances appears, so death from a heart attack is possible in physically healthy athletes during training, a match, or competitions.

Diagram: distribution of causes of SCD at a young age

For more careful monitoring and targeted examination groups of people at high risk of SCD have been identified. Among them:

1. Patients who have undergone resuscitation due to cardiac arrest or;
2. Patients with chronic failure and cardiac ischemia;
3. Persons with electric;
4. Those diagnosed with significant cardiac hypertrophy.

Depending on how quickly death occurred, instant cardiac death and rapid death are distinguished. In the first case, it occurs in a matter of seconds and minutes, in the second - within the next six hours from the onset of the attack.

Signs of sudden cardiac death

In a quarter of all cases of sudden death of adults, there were no previous symptoms; it occurred without obvious reasons. Other One to two weeks before the attack, patients noted a deterioration in their health in the form of:

• More frequent pain attacks in the heart area;
• Rise ;
• A noticeable decrease in performance, feelings of fatigue and fatigue;
• More frequent episodes of arrhythmia and interruptions in cardiac activity.

Before cardiovascular death, pain in the heart area increases sharply, many patients manage to complain about it and experience strong fear, as happens with myocardial infarction. Maybe psychomotor agitation, the patient grabs the area of ​​the heart, breathes noisily and quickly, catches air with his mouth, sweating and redness of the face are possible.

Nine out of ten cases of sudden coronary death occur outside the home, often in the context of severe emotional experience, physical overload, but it happens that the patient dies from acute coronary pathology in his sleep.

When ventricular fibrillation and cardiac arrest occur during an attack, severe weakness appears, dizziness begins, the patient loses consciousness and falls, breathing becomes noisy, and convulsions are possible due to deep hypoxia of the brain tissue.

Upon examination, pale skin is noted, the pupils dilate and stop responding to light, heart sounds cannot be heard due to their absence, and the pulse in large vessels is also not detected. In a matter of minutes, clinical death occurs with all its characteristic signs. Since the heart does not contract, the blood supply to all internal organs is disrupted, so within a few minutes after loss of consciousness and asystole, breathing disappears.

The brain is most sensitive to a lack of oxygen, and if the heart is not working, then 3-5 minutes are enough for irreversible changes to begin in its cells. This circumstance requires the immediate start of resuscitation measures, and the sooner chest compressions are provided, the higher the chances of survival and recovery.

Sudden death due to accompanying atherosclerosis of the arteries, then it is more often diagnosed in older people.

Among young such attacks can occur against the background of spasm of intact blood vessels, which is facilitated by the use of certain narcotic drugs(cocaine), hypothermia, overwhelming physical activity. In such cases, the study will show no changes in the vessels of the heart, but myocardial hypertrophy may well be detected.

Signs of death from heart failure in acute coronary pathology will be pallor or cyanosis of the skin, rapid enlargement of the liver and neck veins, possible pulmonary edema, which is accompanied by shortness of breath up to 40 respiratory movements per minute, severe anxiety and convulsions.

If the patient has already suffered from chronic organ failure, but edema, cyanosis of the skin, an enlarged liver, and expanded borders of the heart during percussion may indicate a cardiac origin of death. Often, when the ambulance team arrives, the patient’s relatives themselves indicate the presence of a previous chronic illness; they can provide doctors’ records and hospital extracts, then the diagnostic issue is somewhat simplified.

Diagnosis of sudden death syndrome

Unfortunately, cases of post-mortem diagnosis of sudden death are not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. An autopsy does not find any pronounced changes in the heart that could cause death. The unexpectedness of the incident and the absence of traumatic injuries speak in favor of the coronarogenic nature of the pathology.

After the arrival of the ambulance team and before the start of resuscitation measures, the condition of the patient, who by this time is already unconscious, is diagnosed. Breathing is absent or too rare, convulsive, the pulse cannot be felt, heart sounds cannot be detected on auscultation, the pupils do not respond to light.

The initial examination is carried out very quickly, usually a few minutes are enough to confirm the worst fears, after which doctors immediately begin resuscitation.

An important instrumental method for diagnosing SCD is the ECG. With ventricular fibrillation, erratic waves of contractions appear on the ECG, the heart rate is above two hundred per minute, and soon these waves are replaced by a straight line, indicating cardiac arrest.

With ventricular flutter, the ECG recording resembles a sinusoid, gradually giving way to random fibrillation waves and an isoline. Asystole characterizes cardiac arrest, so the cardiogram will show only a straight line.

With successful resuscitation at the prehospital stage, already in a hospital setting the patient will face numerous laboratory examinations, starting with routine urine and blood tests and ending with toxicological testing for certain drugs that can cause arrhythmia. Will definitely be held daily monitoring ECG, ultrasound examination heart, electrophysiological study, stress tests.

Treatment of sudden cardiac death

Since sudden cardiac death syndrome causes cardiac arrest and respiratory failure, the first step is to restore the functioning of life support organs. Emergency care should be started as early as possible and includes cardiopulmonary resuscitation and immediate transportation of the patient to the hospital.

At the prehospital stage, the possibilities of resuscitation are limited; it is usually carried out by emergency specialists who find the patient in a variety of conditions - on the street, at home, at the workplace. It’s good if at the time of the attack there is a person nearby who knows her techniques - artificial respiration and chest compressions.

Video: Performing basic cardiopulmonary resuscitation

After diagnosing clinical death, the ambulance team begins chest compressions and artificial ventilation of the lungs with an Ambu bag, providing access to a vein into which medications can be injected. In some cases, intratracheal or intracardiac administration of drugs is practiced. It is advisable to administer drugs into the trachea during intubation, and the intracardiac method is used most rarely - when it is impossible to use others.

In parallel with the main resuscitation actions, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart’s activity in at the moment. If ventricular fibrillation is detected, then the best method for stopping it will be, and if the necessary device is not at hand, then the specialist delivers a blow to the precordial area and continues resuscitation measures.

defibrillation

If cardiac arrest is determined, there is no pulse, and there is a straight line on the cardiogram, then during general resuscitation the patient is administered adrenaline and atropine by any available method at intervals of 3-5 minutes, antiarrhythmic drugs, cardiac pacing is established, after 15 minutes sodium bicarbonate is added intravenously.

After the patient is admitted to the hospital, the fight for his life continues. It is necessary to stabilize the condition and begin treatment of the pathology that caused the attack. May need surgery, the indications for which are determined by doctors in the hospital based on the results of examinations.

Conservative treatment includes the administration of drugs to maintain blood pressure, heart function, and normalize disorders electrolyte metabolism. For this purpose, beta blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensive drugs or cardiotonics, and infusion therapy are prescribed:

• Lidocaine for ventricular fibrillation;
• Bradycardia is treated with atropine or isadrine;
• Hypotension is the reason for intravenous administration of dopamine;
• Fresh frozen plasma, heparin, aspirin are indicated for DIC syndrome;
• Piracetam is administered to improve brain function;
• For hypokalemia - potassium chloride, polarizing mixtures.

Treatment in the post-resuscitation period lasts about a week. At this time, electrolyte disturbances, disseminated intravascular coagulation, and neurological disorders are likely, so the patient is placed in the intensive care unit for observation.

Surgical treatment may involve radiofrequency ablation of the myocardium - for tachyarrhythmias, the effectiveness reaches 90% or higher. If there is a tendency to atrial fibrillation, a cardioverter-defibrillator is implanted. Diagnosed atherosclerosis of the heart arteries as a cause of sudden death requires valvular heart surgery.

Unfortunately, it is not always possible to provide resuscitation measures within the first few minutes, but if it was possible to bring the patient back to life, then the prognosis is relatively good. As research data show, the organs of people who have suffered sudden cardiac death do not have significant and life-threatening changes, therefore maintenance therapy in accordance with the underlying pathology allows them to live for a long time after coronary death.

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

To prevent a heart attack, a cardioverter defibrillator may be implanted, which is especially effective for serious arrhythmias. IN right moment the device generates the impulse the heart needs and does not allow it to stop.

Requires medication support. Beta blockers, calcium channel blockers, and products containing omega-3 fatty acids are prescribed. Surgical prevention consists of operations aimed at eliminating arrhythmias - ablation, endocardial resection, cryodestruction.

Nonspecific measures to prevent cardiac death are the same as for any other cardiac or vascular pathology - a healthy lifestyle, physical activity, giving up bad habits, proper nutrition.

Video: Presentation on Sudden Cardiac Death

Video: lecture on the prevention of sudden cardiac death