Sudden warm death
Sudden warm death – the asistoliya or fibrillation of ventricles which arose against the background of absence in the anamnesis of the symptoms testifying to coronary pathology. The main manifestations include lack of breath, arterial pressure, pulse on the main vessels, expansion of pupils, lack of reaction to light and any kinds of reflex activity, a skin mramornost. In 10-15 minutes emergence of a symptom of a cat's eye is noted. Pathology is diagnosed on the place on clinical signs and data of an electrocardiography. Specific treatment – actions of warm and pulmonary resuscitation.
Sudden warm death
Sudden coronary death makes 40% of all causes of death of people is more senior 50, but 75 years which do not have the diagnosed heart diseases are younger. About 38 cases of VSS annually are the share of 100 thousand of the population. At the timely beginning of resuscitation actions in a hospital survival makes 18% and 11% at fibrillation and an asistoliya respectively. In the form of ventricular fibrillation about 80% of all cases of coronary death proceed. More often the men of middle age having nicotine addiction, alcoholism, violations of lipidic exchange suffer. Owing to the physiological reasons of the woman are less subject to sudden death from the kardialny reasons.
Reasons of sudden warm death
Risk factors on VKS do not differ from those for an ischemic disease. Smoking, the use of a large number of greasy food, arterial hypertension, insufficient receipt in an organism of vitamins is among provocative influences. Not modified factors – advanced age, a male. Pathology can arise under the influence of external influences: excessive power loadings, diving in ice water, insufficient concentration of oxygen in air, at acute psychological stress. Enter the list of the endogenous reasons of cardiac arrest:
- Atherosclerosis of coronary arteries. 35,6% of all VSS fall to the share of this disease. Warm death comes at once or within an hour after emergence of specific symptoms of ischemia of a myocardium. Against the background of atherosclerotic defeat OIM which provokes sharp decrease in sokratitelny ability, development of a coronary syndrome, blinking is quite often formed.
- Conductivity violations. The sudden asistoliya is usually observed. Actions of SLR are ineffective. Pathology arises at organic defeat of the carrying-out system of heart, in particular sinatrialny, atrioventricular knot or large branches of a bunch of Gis. In a percentage ratio failures of conductivity make 23,3% of total number of warm death.
- Cardiomyopathy. Come to light in 14,4% of cases. Represent the structural and functional changes of a coronary muscle which are not affecting system of coronary arteries. Are found at diabetes, a thyrotoxicosis, chronic alcoholism. Can have primary nature (endomiokardialny fibrosis, a subaortal stenosis, an aritmogenny dysplasia of PZh).
- Other states. A share in the general structure of incidence – 11,5%. Include congenital anomalies of cardiac arteries, aneurism of the left ventricle, and also cases of VKS which reason it was not succeeded to define. Warm death can be observed at a thrombembolia of a pulmonary artery which becomes the reason of the sharp right ventricular insufficiency, in 7,3% of cases which is followed by sudden cardiac arrest.
The pathogenesis directly depends on the reasons which caused a disease. At atherosclerotic defeat of coronary vessels there is full occlusion of one of arteries blood clot, blood supply of a myocardium is broken, formed the necrosis center. Sokratitelny ability of a muscle decreases that leads to emergence of a sharp coronary syndrome and the termination of kardialny reductions. Violations of conductivity provoke sharp weakening of work of a myocardium. Week residual sokratitelny ability becomes the reason of decrease in warm emission, stagnation of blood in cameras of heart, formation of blood clots.
At cardiomyopathies the pathogenetic mechanism is based on direct decrease in operability of a myocardium. At the same time the impulse extends normally, however heart is for one reason or another weak reacts to it. Further development of pathology does not differ from blockade of the carrying-out system. At TELA inflow of blue blood to lungs is broken. There is an overload of PZh and other cameras, stagnation of blood in a big circle of blood circulation is formed. The heart overflowed with blood in the conditions of a hypoxia appears incapable to continue work, there is its sudden stop.
Systematization of VSS is possible for causes of illness (OIM, blockade, arrhythmia), and also on existence of the previous signs. In the latter case warm death is subdivided on asymptomatic (the clinic develops suddenly against the background of not changed health) and having the previous signs (short-term loss of consciousness, dizziness, breast pains for an hour before development of the main symptomatology). The most important for holding resuscitation actions is classification by type of violation of warm activity:
- Fibrillation of ventricles. Takes place in absolute majority of cases. Demands carrying out a chemical or electric defibrillation. Represents the chaotic chaotic reductions of separate fibers of a myocardium of ventricles incapable to provide a blood-groove. The state is reversible, it is well stopped by means of resuscitation actions.
- Asistoliya. The complete cessation of warm reductions which is followed by a stop of bioelectric activity. Turns out to be consequence of fibrillation more often, however can initially develop, without the previous blinking. Arises as a result of heavy coronary pathology, resuscitation actions are ineffective.
Symptoms of sudden warm death
In 40-60 minutes prior to development of a stop emergence of the previous signs to which the faint lasting 30-60 seconds, the expressed dizziness, an incoordination, decrease or rise in arterial pressure belongs is possible. Pains behind a breast of the squeezing character are characteristic. According to the patient, heart as if is squeezed in a fist. Symptoms predecessors are observed not always. Often the patient just falls during performance of any work or physical exercises. Sudden death in a dream without the previous awakening is possible.
The warm stop is characterized by consciousness loss. Pulse is not defined both on beam, and on the main arteries. Residual breath can remain for 1-2 minutes from the moment of development of pathology, but breaths do not provide necessary oxygenation as blood circulation is absent. At survey skin pale, cyanotic. Cyanosis of lips, lobes of ears, nails is noted. Pupils are expanded, do not react to light. There is no reaction to external irritants. At a tonometriya HELL Korotkov's tones are not listened.
The metabolic storm which is observed after the successful resuscitation actions is among complications. The changes of pH caused by a long hypoxia lead to violation of activity of receptors, hormonal systems. In the absence of necessary correction sharp renal or polyorgan failure develops. Kidneys can be also surprised the microblood clots which are formed at emergence of the DVS-syndrome, a myoglobin which emission happens at degenerate processes in cross-striped muscles.
Poor carried out warm and pulmonary resuscitation becomes the decortication reason (brain death). At the same time the body of the patient continues to function, however bark of big hemispheres perishes. Restoration of consciousness in such cases is impossible. Rather easy option of cerebral changes – post-hypoxemic encephalopathy. It is characterized by sharp decrease in mental capacities of the patient, violation of social adaptation. Somatic manifestations are possible: paralyzes, paresis, dysfunction of internals.
Sudden warm death is diagnosed by the resuscitator or other expert having medical education. The trained representatives of services of the emergency reaction (rescuers, fire, police), and also the people who incidentally were near and possessing necessary knowledge are capable to define a blood circulation stop out of a hospital. Out of hospital the diagnosis is exposed only on the basis of clinical signs. Additional techniques are used only in the conditions of ORIT where their application requires the minimum time. Are among methods of diagnostics:
- Hardware grant. On the cardiomonitor to which each patient of intensive care unit is connected, krupnovolnovy or melkovolnovy fibrillation is noted, ventricular complexes are absent. The isoline can be observed, but similar occurs seldom. Saturation indicators quickly decrease, arterial pressure becomes not defined. If the patient is on auxiliary ventilation, the device IVL signals about lack of attempts of an independent breath.
- Laboratory diagnostics. It is carried out along with the actions for restoration of kardialny activity. Blood test on KShchS and electrolytes in which the shift of pH in the sour party is noted (decrease in a hydrogen indicator lower than 7,35) is of great importance. For an exception of a sharp heart attack the biochemical research at which hyperactivity of KFK, KFK MV, LDG is defined can be required, concentration of a troponin of I increases.
Treatment of sudden warm death
Help to the victim is given on the place, transportation in ORIT is carried out after restoration of a warm rhythm. Out of MPI resuscitation is carried out by the elementary basic receptions. In the conditions of a hospital or the ambulance car use of difficult specialized techniques of an electric or chemical defibrillation is possible. Apply the following methods to revival:
- Basic SLR. It is necessary to lay the patient on a rigid plain surface, to clear airways, to throw back the head, to put forward the lower jaw. To hold to the victim a nose, to put a fabric napkin on a mouth, to clasp his lips with the lips and to make a deep exhalation. The compression should be carried out the weight of all body. The breast has to be pressed through on 4-5 centimeters. A ratio of compressions and breaths – 30:2 irrespective of number of reanimators. If the warm rhythm and independent breath were restored, it is necessary to lay the patient sideways and to wait for the doctor. Independent transportation is forbidden.
- Specialized help. In the conditions of medical institution help is given in detail. At identification on the ECG blinkings of ventricles make defibrillations categories on 200 and 360 J. Vozmozhno introduction of antiaritmik against the background of basic resuscitation actions. At an asistoliya enter adrenaline, atropine, sodium bicarbonate, chloride calcium. The patient is intubirut without fail and transferred to artificial ventilation of lungs if it was not made earlier. Monitoring for definition of efficiency of medical actions is shown.
- The help after restoration of a rhythm. After restoration of a sinusovy rhythm of IVL continue before restoration of consciousness or longer if it is demanded by a situation. By results of the analysis of KShchS make correction of electrolytic balance, pH. The round-the-clock monitoring of activity of the patient, assessment of extent of damage of the central nervous system is required. Recovery treatment is appointed: antiagregant, antioxidants, vascular medicines, dopamine at low HELL, soda at metabolic acidosis, nootropic means.
Forecast and prevention
The forecast at any version VSS adverse. Even at in due time begun SLR the risk of ischemic changes in TsNS fabrics, skeletal muscles, internals is high. The probability of successful restoration of a rhythm is higher at fibrillation of ventricles, the full asistoliya predictively is less favorable. Prevention consists in timely detection of heart diseases, an exception of smoking and alcohol intake, regular moderate aerobic trainings (run, walking, jumps through a jump rope). (Weightlifting) it is recommended to refuse excessive physical activities.