Once a year, at least, the media report another death from sudden cardiac arrest: an athlete right on the field during a game or a schoolchild in physical education classes. But many people die for the same reason, falling asleep and not waking up. We figured out what it is, whether the cardiac arrest is really so sudden and whether it can be foreseen.

By "sudden death from cardiac arrest" is meant, in the absence of other options, the death of a person who was in a stable state within the next hour. Cardiac arrest is not uncommon, unfortunately. According to the Ministry of Health, only in Russia every year from 8 to 16 people die from sudden cardiac arrest for every 10 thousand of the population, and this is 0.1-2% of all adult Russians. In the country as a whole, 300 thousand people die like this in a year. 89% of them are men.

In 70% of cases, sudden cardiac arrest occurs outside the hospital. 13% - in the workplace, 32% - in a dream. In Russia, the chances of survival are small - only one person out of 20. In the United States, the probability that a person will survive is almost 2 times higher.

The main cause of death is most often the lack of timely assistance.

• Hypertrophic cardiomyopathy.

One of the most famous reasons why a person who does not complain about his health can die. Most often, the name of this disease flashes in the media in connection with the sudden death of famous athletes and little-known schoolchildren. So, in 2003, footballer Marc-Vivier Foe died of hypertrophic cardiomyopathy right during the game, footballer Miklos Feher in 2004, strongman Jesse Marunde in 2007, Russian hockey player Alexei Cherepanov in 2008, footballer Fabrice Muamba in 2012, January of this year - a 16-year-old schoolboy from Chelyabinsk ... The list goes on.

The disease often affects young people under the age of 30. At the same time, despite the "sports" history of the disease, most of the deaths occur at the time of minor loads. Only 13% of the deaths occurred during periods of increased physical activity.

In 2013, scientists found a gene mutation in which the myocardium thickens (most often we are talking about the wall of the left ventricle). In the presence of such a mutation, muscle fibers are not arranged in an orderly, but chaotically. As a result, a violation of the contractile activity of the heart develops.

Other causes of sudden cardiac arrest include:

• Ventricular fibrillation.

Chaotic and therefore hemodynamically ineffective contraction of individual parts of the heart muscle is one of the varieties of arrhythmia. This is the most common type of sudden cardiac arrest (90% of cases).

• Ventricular asystole.

The heart simply stops working, its bioelectric activity is no longer recorded. This condition accounts for 5% of sudden cardiac arrest.

• Electromechanical dissociation.

The bioelectric activity of the heart is preserved, but there is practically no mechanical activity, that is, the impulses go, but the myocardium does not contract. Doctors note that this condition practically does not occur outside the hospital.

Scientists point out that most people who have had sudden cardiac arrest also have the following conditions:

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

Literally in a few seconds from its beginning, the following develop:

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

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

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

In 35% of patients with sudden death syndrome from arrhythmia, there was at least one symptom that speaks of heart disease:

• fainting or light-headedness - in 17% of cases, and this was the most common symptom;
• chest pain;
• dyspnea;
• the patient has already undergone successful cardiac arrest resuscitation.

As well as 55% of people who died from hypertrophic cardiomyopathy, more than 1 hour before their sudden death, experienced:

• fainting (34%);
• chest pain (34%);
• shortness of breath (29%).

American researchers also point out that every second person who was overtaken by sudden cardiac arrest experienced manifestations of cardiac dysfunction - and not an hour or two, but in some cases several weeks before the critical moment.

So, chest pain and shortness of breath 4 weeks before the attack were noted by 50% of men and 53% of women, and in almost all (93%), both symptoms occurred 1 day before the sudden cardiac arrest. Only one in five of these people went to the doctor. Only one third of them managed to fall (32%). But from the group that did not seek help at all, even fewer survived - only 6% of patients.

The difficulty of predicting sudden death syndrome lies in the fact that not all of these symptoms appear at the same time, so it is impossible to accurately track a critical deterioration in health. 74% of people had one symptom, 24% had two, and only 21% of cases had all three.

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

• Chest pain: 1 hour to 4 weeks before the attack.
• Difficulty breathing, shortness of breath: 1 to 4 weeks before the attack.
• Fainting: shortly before the attack.

If these signs are present, it is necessary to consult a cardiologist and undergo an examination.

conclusions

• If you have chest pain and shortness of breath, you should see your doctor right away for a heart test. Remember: timely seeking medical help increases a person's chance of life 6 times in case of sudden cardiac arrest.
• A person who has sudden cardiac arrest needs immediate chest compressions.
• Do not try to give the victim any medication, including the popular nitroglycerin. It can worsen the patient's condition.

Hundreds of thousands of people die every year due to the sudden cessation of cardiac activity. This cause of death has become the most common factor in many countries around the world. Experts are confident that a sudden process in many cases could have been prevented if patients knew the root cause of the tragedy. To do this, you need to be more careful about your own health and, when the first signs of cardiac pathologies appear, contact a therapist, and, if necessary, a cardiologist.

Sudden cardiac arrest can happen to anyone

Types of pathology and development mechanism

The causal factor in the manifestation of the mechanism of sudden stop of an organ is an excessively sharp violation of its performance. This is especially true of conductivity (the time it takes for an electrical impulse to travel), excitability (the ability to be excited by impulses), as well as automatism (the ability to automatically contract) of the main human organ.

The main manifesting types of stopping depend on these abilities of the organ. The abrupt cessation of the work of the heart occurs in two ways. These include asystole, which causes arrest in about 5% of cases, and fibrillation, which is a causative factor in 90% of patients.

Asystole is defined as the cessation of the functioning of the heart due to the disappearance of its bioelectric activity. This pathological manifestation is possible in the case of a complete cessation of the contractile activity of the ventricles, which occurs in the relaxation phase, much less often - with the release of blood (in systole).

Such a cardiac arrest can occur due to a reflex "order" received from other organs. This sometimes occurs during surgery on organs such as the stomach, gallbladder, or intestines. With such a sudden stop, a proven fact is the role of either the vagus or the trigeminal nerve.

There can be many reasons for cardiac arrest.

Another option for the sudden termination of the organ's work is asystole, which occurs against the background of:

• hypoxia - insufficient supply of oxygen to the heart;
• the presence of a large amount of carbon dioxide in the blood;
• acidification of the body - acidosis;
• a decrease in the content of calcium in the body and, at the same time, an increase in extracellular calcium (change in the electrolyte balance).

If such processes manifest themselves together, then they negatively affect the main heart muscle - the myocardium. The depolarization process becomes impossible, namely, it is the basis of its contractile function. Asystole in the phase of myocardial contraction (systole) is accompanied by hypercalcemia.

With cardiac fibrillation, myocardial muscle fibers contract in an uncoordinated and disparate manner. Because of this, the general contractile activity suddenly becomes ineffective, since the scattered parts of the muscle function independently. The release of blood from the ventricles is significantly reduced. Energy costs increase significantly, but this does not improve the efficiency of reductions.

Atrial fibrillation often occurs suddenly

Fibrillation can only involve the atria. In this case, some impulses to the ventricles still pass, and blood circulation occurs at a fairly normal level. However, this often depletes energy reserves, which leads to cardiac arrest.

Other mechanisms include cases in which the contractility of the heart muscle remains, but it becomes insufficient to ensure full pushing into the blood vessels. Cardiac activity, in addition, may cease due to massive blood loss.

Cardiac arrest is often referred to as clinical death.

Factors due to which the stop occurs

The reasons for the process are quite varied. They can be associated with cardiovascular disease or extracardiac (non-heart) diseases:

• Ischemic heart disease or in decoding - ischemic disease. Many factors, such as alcohol abuse or heavy exertion, can provoke death in this disease, and it does not matter if they are physical or emotional.

A suddenly detached blood clot can cause cardiac arrest

• Violation of the heart rate. This can be tachycardia (a fast heart rate of more than 100 beats) or bradycardia (a slow heartbeat below 60 beats). Highly dangerous disease is an atrial fibrillation... It manifests itself as a disordered, irregular heartbeat. In this case, the frequency of impacts reaches 150.
• Thrombosis. This is a rather dangerous condition, characterized by the appearance of blood clots in the veins of the legs. Most often they occur in the lower leg area. But the most dangerous are blood clots that have formed in large veins - femoral or popliteal. The disease can be aggravated by taking certain medications, such as hormonal contraceptives, or a genetic predisposition to excessive blood clotting.

A short stop can be caused by bouts of fibrillation, which in some cases end on their own. In medicine, there is also the term "apnea", which clinically can manifest itself not only by stopping breathing during sleep. With the manifestation of the syndrome at night, sudden short-term cardiac arrest during sleep is also possible. According to research by the Research Institute of Cardiology, the manifestation of nocturnal bradycardia was detected in slightly less than 70% of patients suffering from respiratory arrest. In these people, a blood test indicated oxygen starvation.

The causes of cardiac arrest in young people (less than 35 years old) are most often latent heart defects. At the same time, the factor of inattention to health with a sick heart is rarely manifested.

Characteristic signs

There are some indicators that may indicate a stop of the main human organ - the heart. Having identified them, doctors determine what measures will help save the victim.

When the heart has stopped, the person will have no pulse

Among the signs, the following should be highlighted:

• Lack of pulse. This is the first and most important indicator of cardiac arrest. At the same time, the pulse cannot be felt, it cannot be detected even in the places where the large arteries are located. To accurately determine whether heartbeats are present or absent, two fingers (index together with the middle one) must be applied to the carotid artery. In the absence of a pulse, it is required to immediately begin the resuscitation process, without waiting for the arrival of the medical team.
• Stop breathing. You can reveal this with a mirror or any other glass surface. Such an object is brought to the nose. If breathing is present, the surface will start to fog up. If there is no such object at hand, then you can check the breathing of the victim by raising his head (throwing it back). In this case, it is necessary to examine whether his chest moves. You can try to listen to the sound of breathing by leaning towards the victim and pressing your cheek.
• Dilation of the pupils. At clinical death, they do not react to the appearance of light. A beam of light should be directed into the victim's eyes. If the pupils do not narrow, then this indicates a lack of heart function. If the pupils are still narrow, this indicates a cardiac death that occurred very recently, which gives hope for a favorable outcome.
• Discoloration of the skin on the face. Usually, the skin becomes grayish or bluish.
• Loss of consciousness, convulsions. Fainting that lasts more than ten seconds is an important symptom.

It is important to check if the person has breathing

Sometimes sudden cardiac death is preceded by other signs - excessive fatigue, heart pain, shortness of breath, nausea and vomiting. Not all of the above symptoms are present at the same time and may even be absent altogether.

Diagnostics

Most often, such a manifestation as a sudden cessation of the work of the heart does not happen in hospitals. When the victim is alone and there is no one to help him, then, most likely, he will be fatal, since this emergency condition requires immediate intervention. Therefore, it is highly desirable that everyone knows how to provide first aid.

V medical institutions to diagnose sudden cardiac death allows not only an external examination of the victim, but also the use of an electrocardiogram. The device records all data on the presence or absence of a heartbeat. In addition to it, a blood pressure monitor is used, which monitors blood pressure.

A doctor can only diagnose cardiac arrest based on breathing, unconsciousness, and a lack of pulse.

First aid

There are times when a stop occurs for a few seconds, and then a person wakes up. However, if the victim's condition has not returned to normal and he lies motionless, you should immediately provide him with first aid, without waiting for the arrival of the medical team.

If a person is unconscious, you must try to reanimate him.

The first step is to check if the person is conscious. To do this, you need to gently pull him by the shoulders, then ask loudly if everything is all right with him. People usually begin to strongly shake and beat the victim on the cheeks, which is strictly prohibited. If no reaction is observed, then the person's breathing should be checked.

In the absence of signs of life, resuscitation should be started immediately. To do this, you need to make sure that the surface on which the victim lies is solid. It is best that it is not a bench, but a floor or asphalt. Then you need to kneel down in front of the patient and put your palm in the middle part chest... It is advisable to first remove the clothing from the torso. Fingers should be directed towards the victim's head. The second hand must be placed on top of the first.

Before starting manipulations, you need to make sure that the shoulders are exactly above the patient's chest. Then you can start a heart massage (which is called indirect), slightly pressing on the chest, while the depth of pressure should be no more than five cm. It must be remembered that the arms should not be bent at the elbows. It is necessary to carry out 60-100 presses per minute.

Call an ambulance as soon as possible

Resuscitation must be continued until the ambulance arrives or the victim wakes up. However, if within half an hour, for some reason, the medical workers did not come, and the patient did not regain consciousness, then the manipulation can be stopped. It is believed that after this time all signs of biological death appear.

As soon as the ambulance arrives, the first thing they do is defibrillate to start the heart.

Effects

Unfortunately, only 30% of those affected survive as a result of cardiac arrest. And even in this case, they cannot live the same way as before, since their health was greatly damaged. Only 3–3.5% of people who have undergone a stop are fully recovering.

The consequences of such a sudden manifestation are highly dependent on the speed of first aid. The later the victim returned to life, the more severe the complications will appear. With a prolonged absence of oxygen entering the organs, ischemia (the medical name for oxygen starvation) may develop. Quite often, in patients who have suffered death in a dream from cardiac arrest, the brain, kidneys and liver are damaged. This is due to a lack of oxygen. Such violations negatively affect the future life of the victim.

You will learn how resuscitation is performed in case of sudden cardiac arrest by watching this video:

Prophylaxis

There are a number of preventive measures, they are summarized in the table.

An important action in preventive purposes is the cessation of smoking and abuse of alcoholic beverages.

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

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

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

The main types of cessation of cardiac activity and the mechanisms of their development

The causes of cardiac arrest by the mechanism of development are hidden in a sharp violation of its functional abilities, especially excitability, automatism and conduction. The types of cardiac arrest depend on them. Cardiac activity can be stopped in two ways:

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

Asystole is a complete cessation of ventricular contraction in the diastole phase (with relaxation), rarely in systole. The "order" to stop can enter the heart from other organs reflexively, for example, during operations on gallbladder, stomach, intestines.

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

In this case, the role of the vagus and trigeminal nerves has been proven.

Another option is asystole in the background:

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

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

With asystole in the systole phase, hypercalcemia is observed.

Cardiac fibrillation is a disrupted communication between cardiomyocytes in coordinated actions to ensure overall myocardial contraction. Instead of synchronous work, causing systolic contraction and diastole, there are many scattered areas that contract on their own.

The frequency of contractions reaches 600 per minute and above

In this case, the release of blood from the ventricles suffers.

Energy costs are much higher than normal, and there is no effective reduction.

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

Other mechanisms of cardiac arrest

Some scientists insist on the isolation of electromechanical dissociation as a separate form of cessation of heart contractions. In other words, myocardial contractility is preserved, but insufficient to ensure the pushing of blood into the vessels.

In this case, the pulse and blood pressure are absent, but the ECG records:

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

The condition is caused by ineffective electrical activity of the heart.

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

Since the 70s of the last century, the term "Obstructive Sleep Apnea Syndrome" has appeared in medicine. Clinically, it manifested itself as a short-term cessation of breathing and cardiac activity at night. By now, a great deal of experience has been accumulated in the diagnosis of this disease. According to the Research Institute of Cardiology, nocturnal bradycardia was found in 68% of patients with respiratory arrest. At the same time, according to the analysis of blood, a pronounced oxygen starvation was observed.

The device allows you to register the respiratory rate and heart rate

The picture of heart damage was expressed:

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

The duration of cardiac arrest was recorded over 3 seconds (other authors point to 13 seconds).

During the waking period, not a single patient developed fainting or any other symptoms.

Researchers believe that the main mechanism of asystole in these cases is a pronounced reflex effect from the respiratory organs, coming along the vagus nerve.

Causes of cardiac arrest

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

The main cardiac factors are:

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

Extracardiac factors include:

oxygen deficiency (hypoxia) caused by anemia, asphyxia (asphyxiation, drowning); pneumothorax (the appearance of air between the pleural layers, unilateral compression of the lung); loss of a significant volume of fluid (hypovolemia) with trauma, shock, persistent vomiting and diarrhea; metabolic changes with deviation towards acidosis; hypothermia (hypothermia) below 28 degrees; acute hypercalcemia; severe allergic reactions.

Pneumothorax of the right lung sharply shifts the heart to the left, while the risk of asystole is high

Indirect factors that affect the stability of the body's defenses are important:

excessive physical overload of the heart; elderly age; smoking and alcoholism; genetic predisposition to rhythm disturbances, changes in electrolyte composition; transferred electrical injury.

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

The negative effect of drugs

Medicines that cause cardiac arrest are used to treat. In rare cases, intentional overdose is fatal. This should be proven to the judicial and investigative authorities. Prescribing drugs, the doctor focuses on the age, weight of the patient, diagnosis, warns about possible reaction and the need to return to the doctor or call an ambulance.

Overdose phenomena occur when:

non-compliance with the regimen (taking pills and alcohol); deliberately increasing the dose ("I forgot to drink in the morning, so I will take two at once"); combined with folk ways treatment (St. John's wort herb, shepherd's ears, self-prepared tinctures of lily of the valley, foxglove, adonis); general anesthesia against the background of continuous medication.

The use of the herb St. John's wort should be very limited, in terms of the strength of its action, it is compared with antitumor cytostatics

Most frequent reasons cardiac arrest is a technique:

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

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

Only a specialist can determine which drugs have the most optimal indications and have the least properties for accumulation and addiction. You should not do this on the advice of friends or on your own.

Diagnostic signs of cardiac arrest

Cardiac arrest syndrome includes the early signs of a near-death condition. Since this phase is considered reversible when conducting effective resuscitation measures, every adult should know the symptoms, since a few seconds are allowed to think:

Complete loss of consciousness - the victim does not respond to shouting, braking. It is believed that the brain dies 7 minutes after cardiac arrest. This is an average figure, but the time can vary from two to eleven minutes. The brain is the first to suffer from oxygen deficiency, the cessation of metabolism causes cell death. Therefore, there is no time to argue how long the victim's brain will live. The earlier resuscitation is started, the greater the chances of survival. The inability to determine the pulsation on the carotid artery - this symptom in the diagnosis depends on the practical experience of others. If it is absent, you can try to listen to the heartbeat, putting your ear to the bare chest. Disturbed breathing - accompanied by rare noisy breaths and intervals of up to two minutes. "In front of our eyes" there is an increase in skin color change from pallor to blue in color. Pupils dilate after 2 minutes of cessation of blood flow , there is no reaction to light (narrowing from a bright beam). Manifestation of seizures in certain muscle groups.

If the scene arrives " Ambulance", Then the asystole can be confirmed by the electrocardiogram.

What are the consequences of cardiac arrest?

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

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

The mass of the head and spinal cord together makes up only about 3% of the total body weight. And for their full functioning, up to 15% of the total cardiac output... Good compensatory capabilities make it possible to preserve the functions of the nerve centers while reducing the level of blood circulation to 25% of the norm. However, even indirect massage only maintains 5% of normal blood flow.

Read about the rules for conducting resuscitation measures, possible options in this article.

The consequences from the side of the brain can be:

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

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

This is due to the delay in care in a state of clinical death.

Prophylaxis

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

Rational nutrition, smoking cessation, alcohol, daily walks for people with heart disease are no less important than taking pills.

Monitoring drug therapy requires remembering possible overdose, slowing down the pulse. It is necessary to learn how to determine and count the pulse, depending on this, coordinate the dose of drugs with the doctor.

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

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

There are only 7 minutes to provide first aid and "start" the mechanism. After that, irreversible processes begin to develop, leading to the complete inoperability of the brain, death occurs. Anyone, both in old and young age, can face the problem of cardiac arrest.

Causes

Cardiac arrest is associated with diseases of the heart and other human organs. In this case, sudden death occurs. There are various reasons for cardiac arrest.

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

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

Insufficient oxygen supply. Most often this happens in the presence of concomitant cardiovascular disease mother. Lack of oxygen in the fetus can also develop with tuberculosis, emphysema, pneumonia, signs of anemia. Insufficient blood flow. The problem arises when the knots on the umbilical cord are tightened during childbirth, as well as during intrauterine development of the fetus. Cardiac arrest and fetal death can occur with detachment of the placenta, uterine cramps. Dysfunction of the central nervous system of the fetus. Asphyxia occurs with trauma to the skull (with compression, cerebral edema, fetal abnormalities). Obstruction of the respiratory tract in the fetus. If amniotic fluid or mucus from the cervical canal enters oral cavity fetus, asphyxia develops, leading to cardiac arrest of the child.

Much attention should be paid to Sudden Infant Death Syndrome (SIDS). Cardiac arrest in children aged 2-4 months (no older than a year) and death during sleep for no apparent reason and serious illnesses... Risk factors for SIDS include: fetal hypoxia, multiple pregnancies, prematurity, bad habits of the mother, soft baby bed with a pillow, improper body position during sleep, previous infectious diseases.

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

Warning signs

The clinical manifestation of cardiac arrest is manifested with a deterioration in general well-being. The syndrome occurs suddenly, the patient loses consciousness. At the same time, following symptoms cardiac arrest:

lack of pulse in large arteries (neck, thigh, groin); complete cessation of breathing or signs of agonal (dying) noisy breathing for two minutes; pallor and blue discoloration of the skin; the appearance of seizures (15-30 seconds after loss of consciousness); dilated pupils when exposed to light (after two minutes).

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

Diagnostics

Sudden cardiac arrest should be ascertained immediately. the patient is in an emergency condition. Most often, trouble happens outside of hospitals, so everyone should know how to assess the condition of the victim and how to provide first aid.

First of all, a quick external examination of a person who has lost consciousness is performed. It is necessary to find out if there was a usual fainting. By braking the shoulder, lightly hitting the cheeks, it is possible to recognize whether the victim is conscious. If signs of fainting are not observed, and the person is still unconscious, then his breathing should be checked. The pulse is also felt on the carotid artery. In the absence of breathing and pulse, you must immediately start chest compressions. In parallel, an ambulance team is called.

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

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

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

First aid and treatment

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

put forward lower jaw the victim forward, throw his head back, with a finger wrapped in a cloth, try to eliminate all foreign objects in the mouth (sunken tongue, mucus, vomiting); artificial ventilation of the lungs (by the "mouth-to-mouth" or "mouth-to-nose" method); indirect heart massage, starting with a precordial blow to the chest area (such a blow is contraindicated when assisted by an unqualified specialist).

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

First aid is provided until the victim develops a pulse, spontaneous breathing. If a person does not regain consciousness, then resuscitation measures continue until the arrival of an ambulance.

Recovery heart rate Doctors use impulse therapy (defibrillation), artificial respiration, and pure oxygen through an endotracheal tube or oxygen mask.

Emergency medications include drugs to improve the conduction of impulses, increasing the number of heart contractions, drugs for arrhythmias.

Surgery to suspend the heart consists in drawing fluid from the pericardium (for cardiac tamponade), and in a puncture pleural cavity(in the presence of pneumothorax).

Consequences and possible complications

If the heartbeat is started on time, then the patient survives. In this case, the following consequences of cardiac arrest are observed:

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

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

Possible hearing impairment, vision, memory loss, frequent headaches, convulsions, hallucinations. Short-term cardiac arrest in 80% of victims ends with the development of postresuscitation disease, characterized by prolonged loss of consciousness (more than 3 hours). In severe cases, serious damage to the brain function is possible with the further development of coma and the vegetative state of the patient.

Cardiac arrest is a serious problem that affects not only the elderly, but also young people. After the cessation of cardiac activity, only 30% of people survive, of which only 3.5% can return to normal life without serious consequences. Healthy way life, regular check-ups by doctors and taking care of your health help prevent severe cardiovascular disease.

How to cure hypertension forever ?!

In Russia, from 5 to 10 million calls to an ambulance occur annually medical assistance about the increase in pressure. But the Russian cardiac surgeon Irina Chazova claims that 67% of hypertensive patients do not even suspect that they are sick!

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

Clinical death can quickly become biological if certain first aid steps are not taken. In order to provide this very help, you need to know the signs of cardiac arrest, their manifestations and coordination of actions to resuscitate a person. The importance of such knowledge is confirmed by statistics, according to which about 200 thousand people die from cardiac arrest per week worldwide, while 90% of deaths could be reversible with proper first aid.

Why does the heart stop beating

The cause of cardiac arrest is often a violation of the functional abilities of this organ. Medicine distinguishes two main pathways leading to clinical death:

1. Ventricular fibrillation accounts for 90% of reported clinical deaths. In this condition, the heart muscles succumb to rapid chaotic contraction, which is not accompanied by the release of blood flow.
2. The share of asystole accounts for only 5%, in which the muscles of the heart stop contracting completely. This leads to the initial oxygen starvation of the cells, then to clinical death.
3. The remaining 5% includes electromechanical dissociation and damage to the muscles of the heart, which lead to cardiac arrest in an accident, surgery, etc.
   It should be noted that the following factors significantly increase the risk of myocardial arrest:

• elderly age;
• bad habits (smoking, alcohol);
• excess weight;
• prolonged stay in a state of stress;
• the presence of hypertension or hypotension;
• diabetes.

Learn more about cardiac arrest in sleep

It happens that cardiac arrest occurs during sleep. Often, pathologies of the cardiovascular system become the cause of clinical death in a dream, but it happens that the heart also stops in healthy people... In medicine, this "micro-death" is called obstructive sleep apnea syndrome. According to studies that were carried out in the 70s, the duration of nocturnal cardiac fading (in 68% of subjects with respiratory arrest) can reach up to 13 seconds, while a person does not show any signs of myocardial arrest, but body cells experience oxygen starvation.

Special attention should be paid to the syndrome of sudden infant mortality, which in the common people is called the "lullaby death of an infant." The age contingent susceptible to this syndrome is infants 2–4 months old, whose heart stops at night without any previous health problems. Factors that increase the risks of developing such a tragedy include:

• sleeping baby in a prone position;
• high temperature and stuffiness in the room where a small child sleeps;
• prematurity of the baby;
• the presence of intrauterine hypoxia in a child;
• transference infectious disease in the first months of life.

Signs of cardiac arrest

Cardiac arrest is preceded by characteristic signs, by which it is possible to determine that the body is amenable to irreversible processes.

1. The man faints. In an unconscious state, short-term cramps of the whole body or limbs may occur.
2. Breathing becomes agonal (up to two minutes there are rare respiratory movements in the form of short, sharp, convulsive wheezing) or absent at all.
3. The pulse cannot be felt on the main blood vessels.
4. There is no reaction of the pupils to light irritation. It is checked by means of a flashlight glowing into the pupil; when the heart stops, they are expanded and do not narrow when direct light hits.
5. Facial skin becomes bluish gray as blood circulation stops.

Since only 5-7 minutes is allowed to restore the functioning of the myocardium, seeing the first signs of cardiac arrest, it is necessary to quickly assess the condition of a person, for this you should:

• call out, pat on the cheeks;
• if there is no reaction, feel the heartbeat and pulse;
• check for breathing;
• be sure to call an ambulance.

What first aid should be provided in case of cardiac arrest and lack of breathing

If a person has the above-described signs indicating non-functioning of the myocardium, then first aid should be provided for cardiac and respiratory arrest. Such assistance is divided into:

• emergency first aid;
• medical.

First aid for clinical death

If a person fainted with you or was found unconscious, and checking for signs indicates clinical death, then the following resuscitation steps should be taken, since life can be saved only within 5-7 minutes after the end of the functioning of the heart muscles.

1. Place the person on a firm, level surface. Call an ambulance.
2. Monitor airway patency. To do this, you need to carefully throw the patient's head back, but before that, check if there are vomit masses in the mouth, since it is quite possible that the loss of consciousness was preceded by a gag reflex.
3. Perform an indirect heart massage. During it, the arms should be straightened, not bent at the elbows. On the right side of the chest, lay the left (the weaker one) hand, palm down. Place your palm perpendicularly right hand... After placing the arms with a "cross", it is necessary to make five presses with straightened arms. You should not press hard, as there is a risk of breaking the ribs, which will further worsen the person's condition. Normally, in 60 seconds, 100 presses should be made.
4. Give artificial respiration. To do this, after ensuring airway patency, place a clean cloth (handkerchief or napkin) on the victim's mouth / nose. There are two methods of performing the procedure: mouth-mouth and mouth-nose. Holding your mouth or nose (depending on the method chosen), blow air into the lungs of the lying person by mouth.
5. Pre-medical resuscitation actions involve combining artificial respiration and chest compressions. Ideally, they are performed by two people, one of whom inhales air into the lungs after the fifth pressure of the second person. If one person is engaged in resuscitation, then after completing fifteen clicks, you need to take one breath into the lungs, then they will again return to indirect massage.

First aid

Resuscitation should be continued until the arrival of the ambulance team. Doctors will inject the victim with drugs that promote the "establishment" of the myocardium and will try to induce a heartbeat by means of an electric discharge. Further, the patient is taken to an ambulance, followed by hospitalization and treatment.

Version: MedElement Disease Handbook

Cardiac arrest with successful cardiac recovery (I46.0)

Cardiology

general information

Short description

Heart failure- complete cessation of the effective activity of the heart with the presence or absence of bioelectric activity. Cardiac arrest syndrome includes ventricular fibrillation and asystole, which have a common clinical picture.

There are 3 types of conditions that develop after the cessation of heart activity:

1. Reversible - Tolinen death: there are no irreversible changes in vital organs and systems, in particular in the central nervous system.

2. Partially reversible - withsocial death: with the nonviability of the cerebral cortex, changes in other tissues are still reversible.

3. Irreversible - biological death: all tissues turn out to be unviable and irreversible changes develop in them.

Resuscitation in the terminal stage of any incurable disease has no prospects and should not be applied.
An absolute contraindication to revitalization is pronounced hypostatic spots in the sloping parts of the body, which are a reliable sign of biological death.

Clinical death is diagnosed based on signs of death.

The main signs are:
- lack of consciousness;
- lack of breathing;
- lack of pulse in the carotid artery - in adults, on the femoral or brachial artery - in infants;
- ECG signs of asystole, ventricular fibrillation on the monitor.

Additional signs:
- discoloration of the skin (very pale or cyanotic);
- dilated pupils.

The presence of any three of the four main signs in any combination gives the right to diagnose clinical death and start with cardiopulmonary and cerebral resuscitation ( SLTSR).

Classification

Types of cardiac arrest:

1. Ventricular fibrillation- uncoordinated contractions of the muscle fibers of the heart. Vigorous fibrillar contractions are noted with preserved myocardial tone, sluggish fibrillar contractions - with atony.

2. Asystole- complete cessation of ventricular contractions. It can occur both suddenly (reflexively), with the preserved tone of the myocardium, and gradually - with the development of its atony. Most often, cardiac arrest occurs in diastole and very rarely in systole.

Based on taking into account the degree and nature of conduction disturbances, a rational classification of types of cardiac arrest.

First group conduction disturbances of the heart include disturbances in the conduction of excitations between different parts of the heart, while the excitability and contractility of the myocardium inside each part of the heart are preserved.

This group includes:
- asystole of the whole heart due to disorders and complete blockade conduction between the sinus node and the atria;
- ventricular asystole as a result of complete transverse blockade;
- pronounced ventricular bradycardia (less than 30 beats per minute) with incomplete blockade of conduction between the atria and ventricles or in the presence of rare automatism of idioventricular origin.

Second group cardiac conduction disturbances include disturbances in the conduction of excitation within the conduction system of the ventricles, due to which the coordination of the contractions of the ventricular myocardium is disturbed.

This group includes:
- fibrillation and flutter of the ventricles;
- paroxysmal tachycardia associated with a violation of intraventricular or intraatrial conduction.

Third group cardiac conduction disturbances is the most profound conduction disturbance, the spread of which encompasses all the terminal branches of the conducting system inside the myocardium. In this state of the heart, excitability and contractility are completely lost, it is characterized by a loss of muscle tone - myocardial atony.

Etiology and pathogenesis

Both cardiac and non-cardiac causes can lead to cardiac arrest.

Heart conditions that can lead to cardiac arrest

I. Ischemic disease hearts

Possible causes of myocardial electrical instability:

Acute or chronic ischemia myocardium;

Damage to the myocardium;

Postinfarction heart remodeling with the development of chronic heart failure.

II. Other cardiac causes:

1. Trauma (often with the development of tamponade).

2. Severe aortic stenosis.

3. Direct pacing, catheterization of cardiac cavities, coronary angiography (asystole is one of the possible complications).

4. Infective endocarditis.

5. Cardiomyopathy (hypertrophic cardiomyopathy, dilated cardiomyopathy, alcoholic cardiopathy, "athlete's heart").

6. Syndrome of low emission.

7. Myocarditis (for example, with diphtheria, flu).

8. Pericardial effusion (cardiac tamponade with the development of electromechanical dissociation and asystole occurs when a large amount of fluid accumulates).

9. Obstruction of the inflow or outflow of blood from the heart - intracardiac thrombosis, myxoma or dysfunction of the prosthetic valve.

III. Extracardiac causes that can lead to cardiac arrest.

1. Circulatory:

Hypovolemia (especially as a result of blood loss);

Anaphylactic, bacterial, or hemorrhagic shock;

Tension pneumothorax, especially in patients with pulmonary disease, chest trauma, or artificial ventilation lungs;

Vaso-vagal reflex (cardiac arrest when hitting the anterior abdominal wall);

Large branch thromboembolism pulmonary artery.

2. Respiratory:

Hypercapnia;

Hypoxemia.

3. Metabolic:

Hyperkalemia;

Acute hypercalcemia (hypercalcemic crisis in primary hyperparathyroidism);

Hypothermia (decrease in body temperature below 28 ° C);

Cardiac tamponade with uremia;

Hyperadrenalinemia (hyperproduction and increased release of catecholamines into the blood at the height of severe psychoemotional stress).

4. Side effects when taking the following drugs:

Barbiturates;

Narcotic analgesics;

Anesthesia products;

Beta-blockers;

Non-dihydropyridine calcium antagonists;

Phenothiazine derivatives;

Preparations that lengthen Q-T interval(disopyramide, quinidine);

Overdose of cardiac glycosides.

5. Various reasons:

Electrical injury (electric shock, lightning strike, complication of electrical impulse therapy with inadequate use);

Asphyxia (including drowning);

Sepsis, severe bacterial intoxication;

Cerebrovascular complications, in particular bleeding;

Modified dietary programs to combat obesity based on fluid and protein intake.

The pathogenesis of cardiac arrest

The factors causing electrical instability of the myocardium may be acute or chronic ischemia, damage, postinfarction remodeling of the heart with the development of chronic heart failure.

Experimentally revealed the following mechanisms of development of electrical instability of the myocardium:

1.At the cellular and tissue level heterogeneity of the contractile myocardium appears as a result of alternation of cardiomyocytes with different activity of oxidoreductases, their disseminated damage, hypertrophy, atrophy and apoptosis. The development of interstitial edema and the phenomena of cardiosclerosis, which disrupt the consolidation of myocardial cells into a functional syncytium, is observed.

2. At the level of subcellular structures:

Violations of Ca 2+ -binding ability and focal dissociation of the glycocalyx;

Decrease and zonal saturation of the plasma membrane with cholesterol;

Change in the density of beta-adrenergic receptors and the ratio of the activity of conjugated adenylate cyclase and phosphodiesterase;

A decrease in the volumetric density of the T-system and a violation of its contacts with the cisterns of the sarcoplasmic reticulum;

Modification of insert discs with noncrushes separation;

Proliferation of mitochondria and their functional association in a large area of ​​the most adapted cardiomyocytes.

The severity of the revealed changes positively correlates with significant violations of the conduction of electrical impulses in the myocardium.

The main factors leading to cardiac arrest are local focal deceleration and fragmentation of the excitation wave, which propagates in an electrically inhomogeneous medium, whose individual areas differ in different duration of action potentials and refractory periods, the rate of spontaneous diastolic depolarization, etc.

Mechanical stretching of myocardial fibers due to dilatation of the heart chambers is also of great importance; cardiac muscle hypertrophy and disorders neurohumoral regulation heart rate, electrolyte metabolism, acid-base state; hypercatecholaminemia.

It is possible to alternate periods of asystole and sharp bradycardia with episodes of ventricular fibrillation or ventricular tachycardia.

In heart disease, asystole can also occur as an outcome of bradyarrhythmias and conduction blockade, mainly sinus node dysfunction and atrioventricular blockade. Particularly dangerous is the distal (trifascicular) form of III degree AV block, which often develops with extensive anterior myocardial infarction with lesion interventricular septum and has an extremely poor prognosis (in the absence of appropriate treatment, deaths can reach 80%). The blockade contributes to a sharp decrease in cardiac output and the development of pulmonary edema and cardiogenic shock.

With extracardiac causes, the pathogenesis of dying is different: with a large blood loss, the activity of the heart fades away gradually; with hypoxia, asphyxia and irritation vagus nerves instant cardiac arrest is possible.

Massive pulmonary embolism leads to circulatory collapse and death within minutes in about 10% of cases; some patients die after some time with progressive right ventricular failure and hypoxia.

The use of modified dietary programs aimed at weight loss with the use of proteins and fluids can lead to the development of primary degeneration of the atrioventricular conduction system with sudden death in the absence of severe coronary atherosclerosis; often at the same time a trifascicular atrioventricular block is found.

In a number of conditions (hypothermia, hyperkalemia, acute myocarditis, inadequate use of a number drugs) the development of asystole can be mediated by stopping or blocking the sinus-atrial node with subsequent oppression of downstream pacemakers or sick sinus syndrome, usually accompanied by a dysfunction of the conducting system.

Fibroids and inflammatory processes in the area of ​​the sinus-atrial or atrioventricular nodes can sometimes lead to sudden death in people with no previous signs of heart disease.

In cerebrovascular disorders, sudden cardiac arrest is more often mediated by subarachnoid hemorrhage, sudden changes in intracranial pressure, or damage to the brainstem.

The pathogenesis of cardiac arrest can vary within the range of a single etiological factor. For example, reflex cessation of breathing can occur during mechanical asphyxia, as a result of direct compression of the carotid sinuses. In a different situation, large vessels of the neck, trachea can be squeezed, a fracture of the cervical vertebrae can be observed, which causes a slightly different pathogenetic shade of the direct mechanism of cardiac arrest. When drowning, water can quickly flood the tracheobronchial tree, turning off the alveoli from the blood oxygenation function; in another version, the mechanism of death is determined by the primary spasm of the glottis and critical level hypoxia.

The most varied causes of "anesthetic death":

Reflex cardiac arrest as a result of insufficient atropinization of the patient;

Asystole as a consequence of the cardiotoxic action of barbiturates;

Pronounced sympathomimetic properties of some inhalation anesthetics (fluorothane, chloroform, trichlorethylene, cyclopropane).

During anesthesia, the primary catastrophe can occur in the field of gas exchange ("hypoxic death").

In traumatic shock, the main pathogenetic factor is blood loss. However, in a number of observations in traumatic shock, primary disorders of gas exchange (trauma and wounds of the chest) come to the fore; intoxication of the body with products of cellular decay (extensive wounds and crush injuries), bacterial toxins (infection); fat embolism; shutdown of the vital functions of the heart and brain as a result of their direct trauma.

Epidemiology

Of the 200,000 cardiac arrest patients who receive cardiopulmonary resuscitation, about 70,000 (30%) survive. However, only 10% (or 3.5% of the total population) of the survivors are able to return to their previous way of life. Such a low rate is due to pronounced neurological disorders that occur in patients during the period of cessation of blood circulation and in the process of resuscitation.

Factors and risk groups

1. Ischemic heart disease (CHD).

2. Drinking alcohol by a patient with coronary artery disease (15-30% of cases of cardiac arrest).

3. Advanced age.

4. Hypercholesterolemia Increased content cholesterol in the blood.
, atherosclerosis Atherosclerosis - chronic illness characterized by lipoid infiltration of the inner lining of elastic and mixed type arteries with subsequent development in their wall connective tissue... Clinically manifested by general and / or local circulatory disorders
family history.

5. Arterial hypertension.

6. Left ventricular hypertrophy.

7. Smoking.

8. Taking some drugs: barbiturates, anesthetics, narcotic analgesics, calcium antagonists, beta-blockers, tricyclic antidepressants, phenothiazine derivatives, cardiac glycosides, drugs that lengthen the Q-T interval (quinidine, disopyramide).

9. Anaphylactic, bacterial or hemorrhagic shock.

10. Hypothermia (decrease in body temperature below 28 o C).

11. TELA PE - pulmonary embolism (blockage of the pulmonary artery or its branches by blood clots, which form more often in large veins lower limbs or pelvis)
.

12. Cardiac tamponade Cardiac tamponade - compression of the heart with blood or exudate accumulated in the pericardial cavity
.

13. Pneumothorax.

14. Electrical injury (electric shock, lightning strike, complication of electrical impulse therapy).

15. Asphyxia.

16. Catheterization of cardiac cavities.

17. Coronary angiography Coronary angiography - X-ray examination of the coronary arteries of the heart after filling them with a contrast agent, for example, through a catheter passed into the ascending aorta
.

Clinical picture

Clinical diagnostic criteria

Lack of pulse in the central arteries, loss of consciousness, respiratory arrest, bilateral mydriasis

Symptoms, course

"Symptoms-precursors" of cardiac arrest:

1. Sudden pallor or cyanosis Cyanosis is a bluish tinge of the skin and mucous membranes caused by insufficient oxygen saturation of the blood.
skin, especially the face.

2. Acute arterial hypotension Arterial hypotension - a decrease in blood pressure by more than 20% from the initial / usual values ​​or in absolute figures - below 90 mm Hg. Art. systolic pressure or 60 mm Hg. mean arterial pressure
(BP is below 60 mm Hg).

3. Sudden sharp bradycardia Bradycardia is a decreased heart rate.
(Heart rate less than 40 / min.).

4. Supraventricular or ventricular tachycardia Tachycardia - increased heart rate (more than 100 in 1 min.)
(Heart rate more than 120 per minute, arising from paroxysms Paroxysm - sudden, usually recurring, onset or worsening of symptoms for a relatively short period of time
).

5. Ventricular premature beats Extrasystole is a form of heart rhythm disturbance, characterized by the appearance of extrasystoles (contraction of the heart or its parts, which occurs earlier than the next contraction should normally occur)
: single or group extrasystoles, allorhythmias like bigeminy Bigeminia is a form of allorhythmy in which an extrasystole (contraction of the heart or its parts, which occurs earlier than the next contraction should normally occur) follows each normal heartbeat
... Attention!

Clinical manifestations of cardiac arrest(almost always the same, regardless of etiology):

Lack of pulse in the central arteries (carotid or femoral);

Loss of consciousness and development convulsive syndrome(after 10 - 20 s.);

Cessation of breathing (after 15 - 30 s.);

Bilateral mydriasis Pupil dilation
(after 60 - 90 s.).

In identifying the listed symptoms, observation of the patient, in particular, monitoring control, helps.

Palpation of the pulse on the carotid arteries should be methodologically correct: the pressure on the artery should be applied not with the tops of the fingers, but with the pads of the terminal phalanges, which are more sensitive.

Having unbend the patient's head and holding it by the forehead with one hand, the doctor with two fingers of the other hand gropes for the apex of the thyroid cartilage. After that, the fingers are displaced into the carotid triangle (between the trachea and the sternocleidomastoid muscle) and the carotid artery is pressed against the transverse processes of the 4-5 cervical vertebrae. The pressure should be soft, not rough. This manipulation is given no more than 5 seconds, so as not to delay the onset of resuscitation, but also not to miss bradycardia. With the present, but weakened pulse, there is no reason to start a heart massage.

The doctor needs to be able to distinguish his own pulse from a weak pulse of the patient, as well as to palpate the pulse at femoral artery sick.

Of these signs, one must be careful about assessing the size of the pupil and its response to light during the period of resuscitation. A wide pupil is an indicator of cerebral hypoxia. The lack of response to light in the dilated pupil is usually detected after 1.0 - 1.5 minutes. This time should be considered as half of the elapsed time for the potential reversibility of posthypoxic changes in the cortical structures of the brain.
If the patient's pupil is initially narrow (with the exception of the effect of narcotic analgesics), this may indicate that the circulation stopped less than one minute before the arrival of the doctor. In this case, a favorable outcome of resuscitation measures is very likely.

Cessation of breathing or loss of consciousness, as the first signs of cardiac arrest, often go unnoticed if the patient was under anesthesia, in a coma, or on mechanical ventilation.

Listening to heart sounds, measuring blood pressure in case of suspected cardiac arrest do not make sense and, conversely, can lead to a loss of time and a delay in the start of resuscitation measures.

Diagnostics

Electrocardiography

During resuscitation, an ECG may be required to clarify the nature of cardiac abnormalities (asystole or fibrillation).

The state of clinical death on the ECG is manifested either by the complete disappearance of the complexes, or by fibrillar oscillations of a gradually decreasing frequency and amplitude, mono- and bipolar complexes with no differentiation between the initial (QRS complexes) and the final (T wave) parts.

For some time, there may also be more coordinated rare (25-40 per minute) deformed, broadened QRS complexes (idioventricular rhythm - the terminal rhythm of a dying heart).
In acute thromboembolism of the pulmonary artery against the background of circulatory arrest or cardiac tamponade, the electrical activity of the heart in the initial minutes remains satisfactory (electromechanical dissociation), gradually dying out.

The presence of asystole must be confirmed in at least two ECG leads; when recording an ECG through the defibrillator electrodes, it is necessary to rearrange them and re-evaluate the ECG.

The ECG may erroneously show a straight line if the electrodes are disconnected or if the monitor has been inadvertently desensitized (these factors must be controlled). T The opposite is also possible: if the monitor's sensitivity is too high, interference can be mistaken for chaotic electrical activity typical of ventricular fibrillation.

Rice. Periods of ventricular asystole against the background of accelerated left atrial rhythm with impaired atrioventricular conduction

Echo-KG
When conducting Echo-KG, asystole is manifested by the absence of ventricular contractions.

The absence of heart contractions, despite the resuscitation measures, makes it possible to formulate a prognosis and determine at what point resuscitation should be stopped.
Infrequent atrial movements and / or mitral valve can continue even after death, so it is important to base the prognosis on ventricular contractions. It is also necessary to make sure that mechanical ventilation and chest compressions are stopped during the ultrasound scan, since respiratory support can cause displacement of the walls of the ventricles.

M-mode can be helpful in documenting a lack of cardiac activity. It is necessary to establish an M-mode line through the wall of the left ventricle when imaging in a parasternal section along the long axis or in a sub-xiphoid section. In asystole, the graph of movement in time is a straight line.

Differential diagnosis

In order to provide adequate resuscitation, it is extremely important to establish whether clinical death has developed against the background of ventricular fibrillation or asystole (electromechanical dissociation).

With immediate registration of an electrocardiogram, conduct an emergency differential diagnosis relatively uncomplicated. If impossible ECG proceed from the nature of the onset of clinical death and the response to resuscitation measures.

With a far-reaching blockade of conduction and the onset of asystole due to extracardiac reasons, blood circulation is usually disrupted gradually and the symptoms can be prolonged in time: first, there is a clouding of consciousness, then motor excitement with moaning, wheezing, then tonic-clonic seizures - Morgagni-Adams syndrome - Stokes (MAC).

With ventricular fibrillation, clinical death always occurs suddenly and simultaneously, accompanied by a typical single tonic contraction of skeletal muscles. Breathing persists for 1-2 minutes against the background of a lack of consciousness and pulse in the carotid arteries.

At acute form massive thromboembolism of the pulmonary artery, clinical death occurs suddenly, usually at the time of physical exertion. The first manifestations are often respiratory arrest and a sharp cyanosis of the skin of the upper half of the body.

Cardiac tamponade is usually observed against a background of severe pain syndrome. There is a sudden cessation of blood circulation, there is no consciousness, there is no pulse in the carotid arteries, breathing persists for 1-3 minutes and gradually fades away, there is no convulsive syndrome.

In patients with Morgagni-Adams-Stokes syndrome, a timely started closed heart massage helps to improve blood circulation and respiration, and consciousness begins to recover. After the termination of cardiopulmonary resuscitation for a certain period, the positive effects persist.

In case of pulmonary embolism, the response to resuscitation measures is indistinct; to obtain a positive result, as a rule, a sufficiently long cardiopulmonary resuscitation is required.

In patients with cardiac tamponade, achieving a positive effect due to cardiopulmonary resuscitation is impossible even for a short period; the symptoms of hypostasis in the lower parts are growing rapidly.

In patients with ventricular fibrillation, a clear positive reaction is noted for timely and correct cardiopulmonary resuscitation, with a short-term cessation of resuscitation measures, a rapid negative dynamics.

Cardiopulmonary resuscitation is often ineffective in cardiac arrest as a result of extracardiac causes and in severe systemic lesions (hypoxemia, hypovolemia, sepsis, etc.).

In many conditions leading to asystole (tension pneumothorax, prosthetic valve dysfunction, intracardiac thrombosis, etc.), the achievement of lasting success is possible only after emergency surgery.

Complications

Various complications of resuscitation are associated with deviations from the method of cardiopulmonary resuscitation.

1.Asphyxia and irreversible cardiac arrest- may be due to prolonged tracheal intubation (longer than 15 seconds).

2. The gap parenchyma Parenchyma is a set of basic functioning elements of an internal organ, limited by the connective tissue stroma and capsule.
lungs, tense pneumothorax Pneumothorax is the presence of air or gas in the pleural cavity.
- occur during forced air injection under pressure and are more often recorded in young children.

3. As a result of unskilled external massage, it is possible broken ribs(more common in older people).
In the case when, during a closed heart massage, the point of maximum pressure on the sternum is too displaced to the left, along with a fracture of the ribs, the lung tissue is damaged; when the point of maximum pressure is shifted downward, liver rupture is possible; when displaced upwards, a fracture of the sternum.
These complications are considered gross errors in the revitalization technique.

4. Regurgitation Regurgitation is the movement of the contents of a hollow organ in a direction opposite to physiological as a result of contraction of its muscles.
gastric contents in Airways - a complication that is especially common in cases where tracheal intubation has not been performed. The occurrence of regurgitation is associated with the ingress of air into the stomach during its forced inhalation. As a rule, this can happen in the case of insufficient throwing back of the head, when the entrance to the trachea is partially blocked by the root of the tongue, and the main part of the air enters not the lungs, but into the stomach and overstresses it. In unconscious patients, stomach contents drain from the relaxed cardiac sphincter into the lungs.

5. Postresuscitation disease. Functional dysfunctions and pathological changes that have arisen at one stage or another of the terminal state remain in the body even after successful resuscitation. Moreover, the deepening of these disorders and even the development of new pathological processes that were absent during the death of the organism are possible.
The main reason for the repeated deterioration of patients' condition after successful resuscitation is hypoxia Hypoxia (syn. Anoxia) is a condition that occurs when there is an insufficient supply of oxygen to the tissues of the body or a violation of its utilization in the process of biological oxidation.
any origin:
- very deep (with clinical death);
- very long (in severe stages of traumatic, hemorrhagic, septic shock).

Stages of the course of postresuscitation disease

Stage I
Comes in the first 6-8 hours after resuscitation. The main body functions (blood circulation and respiration) are unstable. This stage is characterized by a reduced volume of circulating blood (BCC), low blood flow to the right half of the heart and the resulting low cardiac output (one-time), which aggravates a further decrease in the BCC.
Hypoperfusion of peripheral tissues (low blood flow through them), intense work of external respiration and hyperventilation are observed.
Hypoxia develops Hypoxia (syn. Anoxia) is a condition that occurs when there is an insufficient supply of oxygen to the tissues of the body or a violation of its utilization in the process of biological oxidation.
mixed type and glycolysis is activated, as evidenced by an excess of lactic acid in arterial blood.

Due to hypoxia, the following phenomena are observed:
- supported elevated level catecholamines, glucocorticoids;
- the activity of anabolic hormones decreases;
- disorders in the blood coagulation system;
- activation of the kinin-kallikrein system;
- increased concentration of proteolytic enzymes in blood plasma;
- high toxicity of blood plasma;
- violations of the rheological properties of blood.
These changes lead to a deepening of hypoxia, increased breakdown of adipose tissue, tissue proteins, impaired exchange of water and electrolytes, increased acidosis Acidosis is a form of violation of acid-base balance in the body, characterized by a shift in the ratio between acid anions and base cations towards an increase in anions
.
In stage I, some compensatory reactions are overly strained, as a result of which some of them turn into damaging factors. In particular, a significant activation of fibrinolysis, protecting the body from disseminated intravascular coagulation syndrome, can cause coagulopathic bleeding, which can lead to death. Other causes of death at this stage are sudden cardiac arrest, pulmonary edema, and cerebral edema.

Stage II
In stage II, there is a relative stabilization of body functions according to clinical data. However, metabolic disorders deepen, decreased BCC and peripheral circulatory disorders persist, although they are less pronounced.
As a rule, there is a decrease in the volume of urine in relation to the volume of infusions, active excretion of potassium in the urine and sodium retention in the body.
Blood clotting disorders deepen: fibrinolysis in blood plasma slows down, against which the development of DIC syndrome is possible Consumption coagulopathy (DIC syndrome) - impaired blood clotting due to massive release of thromboplastic substances from tissues
... The toxicity of blood plasma increases, the concentration of proteolytic enzymes in it increases.

Stage III

Comes at the end of the first - the beginning of the second day after resuscitation. Characterized by defeat internal organs... Deepening hypoxia and hypercoagulation can cause the development of acute pulmonary failure, liver and kidney damage. Possible psychoses, secondary bleeding from the upper gastrointestinal tract.

Stage IV
It develops on the 3-5th day after resuscitation. In the case of a favorable course, there is an improvement in the condition of patients and the elimination of previously developed functional disorders. With an unfavorable course, there is a progression of the processes that have arisen in Stage III processes. Inflammatory and septic complications (pneumonia, wound suppuration, purulent peritonitis, etc.) are added, which develop due to a decrease in the body's resistance against the background of pronounced disorders of cellular and humoral immunity in conditions of prolonged hypoxia. Disorders of microcirculation and exchange deepen.

Stage V
It occurs as a result of an unfavorable outcome of the disease (sometimes after many days, weeks) and with prolonged artificial ventilation. It is characterized by irreversible changes in the organs.

Treatment abroad