How to determine cardiac arrest. Cardiac arrest during sleep. What is sudden cardiac arrest

And yet, if its symptoms appear, it is better not to postpone a visit to the doctor.

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Usually people who have encountered this problem complain that their heart seems to stop for a few seconds. In some cases, this may be accompanied by a feeling of a heartbeat, a feeling of lack of air. The reason for this extrasystoles is extraordinary heart contractions. An impulse arises in the heart, due to which one beat occurs earlier than necessary, and the next one at its proper time. Accordingly, the pause between contractions lengthens - this causes unpleasant symptoms.

Extrasystole is the most common type of arrhythmia. Extraordinary heart contractions periodically occur in 70-80% of people over 50 years of age. They also happen to young people, including athletes with a trained heart. Because of this, many people think that such rhythm disturbances are harmless. However, this is not quite true. Extrasystole can be caused for various reasons and, accordingly, have different consequences. Based on this, they make a decision about the study.

To treat or not to treat?

● No therapy needed. If interruptions in rhythm are isolated, they occur rarely, and the person has no other heart problems, there is really no need to treat extrasystole. In this case it is called functional. It may be caused excessive consumption coffee or alcohol, stress. In women, cases of extrasystole are often observed during menstruation. People with vegetative-vascular dystonia. By the way, they are especially difficult to tolerate extraordinary heartbeats.

IN in this case a person just needs to lead a healthy lifestyle, be less nervous, give up stimulants like coffee and alcohol - and everything will return to normal by itself. Foods rich in magnesium and potassium will also help with this: cereals, lettuce, persimmons, dried apricots, citrus fruits.

● Taking medications is necessary if “freezing” appears when there is already heart disease: other types of arrhythmia, coronary disease or heart disease, cardiomyopathy, etc. Harmless, at first glance, extrasystoles in this case can seriously aggravate the course of the underlying disease and even pose a risk to life, leading to fibrillation of the atria or ventricles of the heart. Therefore, they must be eliminated whenever possible.

As a rule, treatment is also necessary if a person has more than 200 extrasystoles per day.

Even if there is no heart damage, such frequent interruptions can worsen a person’s quality of life. In addition, during extrasystoles, the ejection of blood from the heart decreases, and because of this, the blood supply to many organs, including the brain, deteriorates.

● You need to treat, but not the heart. Sometimes heart failure itself does not require treatment, but is a sign of another illness, which in turn requires therapy. For example, extrasystoles often occur with hyperthyroidism - increased function thyroid gland. Its hormones, produced in excess, poison the body, and the heart reacts to this.

Small disruptions in rhythm are a reason to think about osteochondrosis of the cervical spine; they can be a sign of neurosis. In this case, it is enough to eliminate the main problem: to compensate for violations in thyroid gland, remove muscle tension in cervical spine, take a course of sedatives. After this, the heart, as a rule, begins to beat evenly.

So that there is no confusion

As you can see, there are many options, and determining on your own whether heart failure is dangerous is quite problematic. Cardiologists agree on one thing: if you periodically feel heartbeats and pauses following them, it is better not to guess, but to consult a specialist. This is also important because not everything that is perceived as cardiac arrest is actually extrasystoles. For example, many people often confuse heart pain (which almost always indicates a problem that requires treatment) or intercostal neuralgia with interruptions.

A banal ECG will help eliminate confusion - with frequent extrasystoles, such an examination will be enough to detect them. If fading occurs less frequently or, for example, only in the evening, it makes sense to conduct 24-hour Holter monitoring. A compact device that is attached to the body and records the heart rhythm will give answers to all questions.

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

Clinical death from a medical point of view

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

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

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

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

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

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

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

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

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

How many people survive clinical death safely?

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

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

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

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

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

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

Clinical death for patients

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

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

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

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

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

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

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

In general, studies have shown that at the time of human death, the body loses a small amount of weight (literally a few grams). Adherents of religions hastened to assure humanity that at this moment from human body the soul is separated. However scientific approach states that the weight of the human body changes due to chemical processes occurring in the brain at the moment of death.

Doctor's opinion

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

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

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

Dmitry Yeletskov

anesthesiologist-resuscitator, Volgograd

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

Let's expose! Do we start the heart with a defibrillator? October 8th, 2013

There was a post recently and its readers criticized it quite a bit. What do you say about this?

Myth: If the heart stops, it can be started again with a defibrillator.

Such scenes in Hollywood movies always end well. The hero lies on a hospital bed without moving and only rhythmic sound signals notify that all is not lost. And then, suddenly, the signal gets stuck on one note, and an ominous straight line appears on the monitor.

Doctors burst in. One of them constantly shouts: “Defibrillator! We are losing him! And then a few discharges, dramatic music, and certainly someone’s cry “LIVE, DAMMIT YOU!”, and miraculously the heart begins to beat. The hero is saved!

And everything would be fine, but... the problem is that a defibrillator cannot be used to restart a stopped heart. Alas.

In medicine, a straight line on the monitor is called asystole and means the absence of heart contractions. The idea that these contractions can be restored by electric shock seems absolutely sound.

In order to understand why this is not so, we must first understand how the heartbeat occurs.

The heart typically receives 60-100 beats per minute from stimulating cells in the upper wall of the right atrium (sinoatrial node). These specialized cells create an electrical differential between the inside and outside of the cell membrane. At a certain moment, an impulse is sent down the heart muscle, causing it to contract. This electrical signal travels throughout the heart.

You are probably thinking, if the heart contracts from the impulses it creates, then why can’t it be made to contract with the help of outside influence? Let's figure it out.

The sinoatrial node creates an electrical differential using electrolytes such as potassium, sodium and calcium. We will not quote the lecture for medical students, however, for some understanding of why shock therapy does not work, we will briefly summarize what is happening in our body.

The electrical charge of these electrolytes passes through the cell walls using channels named after the electrolytes themselves—sodium channels, calcium channels, and so on.

Before contraction, potassium is mainly found inside the cells, while sodium and calcium are found outside. Blood pressure (if you didn't have it, you would simply die) occurs when sodium penetrates into cells. This causes potassium to move out of the cells, creating an electrical potential.

When this potential becomes high enough, calcium channels open. When calcium channels are open, sodium and calcium rush into the cells, creating a certain charge. When a charge is formed, the heart sends out an impulse called depolarization.

Move the slider and change the transparency of the heart.

Where is this impulse created by the sinoatrial node directed? It immediately passes into the atrium. Then a pulse is formed in another cellular node, called the atrioventricular node. All this allows the lower part of the heart to receive blood from upper section. The atrioventricular node transmits the impulse below, to the His bundle, and further along two pathways called the right and left bundles.

It is this electrical conductivity that doctors look for when peering at the monitor. Simply put, this impulse causes a contraction, which creates the pulse. However, sometimes the presence of an impulse does not mean anything. It happens that normal electrical conductivity is reflected on the monitor, but there is no pulse. This phenomenon is called pulseless electrical activity(PEA). This is one reason why doctors still have to check pulse and blood pressure even if a person is connected to a heart monitor.

If someone goes into cardiac arrest and has no pulse, an electric shock may be needed, depending on how the conduction system works. During cardiac arrest, there may be several types of electrical rhythms. Let's look at the most common ones and figure out why electric shocks sometimes work.

The most common heart rhythm during cardiac arrest is called ventricular fibrillation (arrhythmic contraction of the muscle fibers of the atrium). When the sinoatrial node fails to fire, many other cells in the heart try to do so. As a result, multiple areas of the heart are shaken simultaneously from different directions. Instead of measured beats, we see a heart attack.

With this rhythm, the heart cannot pump blood through itself. The only way to make all these various areas hearts work in unison again - an electric shock more powerful than those they create.

When you run that kind of electricity through those cells, it activates all the electrolytes from the cells at the same time. The only hope (and it's really just hope) is that normal functioning cardiac electrolytes, organizedly passing through cell membranes, will resume.

In a state of asystole, a person does not have such an electrical differential that can be shown by a heart monitor. In reality, there are simply no electrolytes inside the cell that can create an impulse. In such a situation, the discharge will not help. Thus, if asystole (the complete absence of ventricular contractions) occurs before you can use a defibrillator, all you can do is burn the heart high temperature from the category.

It is a myth that you can overcome asystole with a defibrillator. To do this, the heart must produce a certain electrical impulse.

Or these other revelations: did you know, but VAZ is a mystery - What do you think? The original article is on the website InfoGlaz.rf Link to the article from which this copy was made -

There are a large number of factors in our troubled world that can lead to the death of a person. A huge number of people die every day. Causes of death can be natural (old age, incurable disease) or violent (accident, fire, drowning, war, etc.). However, today there remains one cause of death that claims a large number of lives every year. Although in this case death can be prevented - this heart failure, which often occurs suddenly, even in completely healthy people. We are taught how to provide first aid, however, as practice shows, when faced with such a situation, not everyone can immediately perform necessary measures for the salvation of man. In order to do everything correctly, you need to know what you are faced with in this case.

How to determine that the heart has stopped. Symptoms of cardiac arrest.

There are several main signs by which cardiac arrest can be determined.

No pulse in large arteries. In order to determine the pulse, it is necessary to apply the average and forefinger to the carotid artery and, if a pulse is not detected, resuscitation measures should be started immediately.
Lack of breathing. Breathing can be determined using a mirror, which must be brought to the nose, as well as visually - by breathing movements chest.
Dilated pupils that do not respond to light. It is necessary to shine a flashlight into the eyes and, if there is no reaction (the pupils do not constrict), this will indicate the cessation of myocardial function.
Blue or gray complexion. If the natural pinkish color of the skin changes, this is important sign, which indicates a circulatory disorder.
Loss of consciousness that occurs for 10-20 seconds. Loss of consciousness is associated with ventricular fibrillation or asystole. Determined by patting the face or using sound effects (loud clapping, screaming).

How to save a person. How much time do you have? First aid and medical care for cardiac arrest.

If you find yourself close to a person who has had a this disease, the main thing on your part is not to hesitate. You have only 7 minutes so that cardiac arrest occurs for the victim without serious consequences. If it is possible to return a person within 7-10 minutes, then the patient will most likely have mental and neurological disorders. Delayed assistance will lead to profound disability of the victim, who will remain incapacitated for life.

The main task in providing assistance is to restore breathing, heart rate and starting the circulatory system, since oxygen enters cells and tissues with blood, without which the existence of vital organs, especially the brain, is impossible.

Before providing assistance, it is necessary to make sure that the person is unconscious. Help the victim, try to call him loudly. If all else fails, it is worth providing first aid, which includes several basic steps.

The first step is to place the patient on a hard surface and tilt his head back.
After this, clear the airways foreign bodies and mucus.
The next step is artificial ventilation (mouth to mouth or nose)
Indirect (external) heart massage. Before proceeding to this stage, it is necessary to perform a “precordial blow” - you should hit with your fist in middle part sternum. The main thing is that the blow is not directly to the heart area, as this can aggravate the situation of the victim. A precordial blow helps to immediately resuscitate the patient or increases the effect of cardiac massage. After preparatory procedure If the patient cannot be resuscitated, proceed to external massage.

Every two to three minutes, it is necessary to check the condition of the victim - pulse, breathing, pupils. As soon as breathing appears, you can stop resuscitation, but if only a pulse appears, you need to continue artificial ventilation lungs. Heart massage must be done until the skin color begins to acquire a normal, natural color. If it is not possible to bring the patient back to life, then assistance can be stopped only when a doctor arrives, who can give permission to stop resuscitation.

It is important to remember that these activities are only the initial stage of assistance to the victim, which must be done before the doctors arrive.

Emergency doctors use special methods to further support the life of the victim. The main task of doctors is restoration of the patient's breathing. For this they use mask ventilation. If this method does not help or its use is impossible, then they resort to trachea incubation - this method is the most effective in ensuring patency respiratory tract. However, only a specialist can install the tube into the trachea.

To start the heart, doctors use a defibrillator - a device that affects electric shock on the heart muscle.

Specialists also come to the aid of doctors medical supplies. The main ones are:

Atropine- used for asystole.
Epinephrine(adrenaline) - necessary to strengthen and increase heart rate.
Bicarbonate of soda- it is often used for prolonged arrest, especially in cases where the cardiac arrest was caused by acidosis or hyperkalemia.
Lidocaine , amiodarone And bretylium tosylate- are antiarrhythmic drugs.
Magnesium sulfate helps stabilize heart cells and stimulates their activation
Calcium used for hyperkalemia.

Causes of cardiac arrest

There are several main causes of cardiac arrest

The first place is taken ventricular fibrillation. In 70-90% of cases it is this reason is a consequence of cardiac arrest. Muscle fibers, of which the walls of the ventricles are made, begin to contract chaotically, which leads to interruptions in the supply of blood to organs and tissues.

Second place - ventricular asystole- complete cessation of electrical activity of the myocardium, which accounts for 5-10% of cases.

Other reasons include:

ventricular paroxysmal tachycardia with absence of pulse in large vessels;
electromechanical dissociation- electrical activity in the form of rhythmic QRS complexes without corresponding ventricular contractions;

There is also genetic predisposition- This Romano-Ward syndrome, which is associated with inheritance of ventricular fibrillation.

In addition, it is quite healthy person cardiac arrest is possible, the cause of which may be the following factors:

Hypothermia (body temperature drops below 28 degrees)
Electrical injury
Medicines: cardiac glycosides, adrenergic blockers, analgesics, as well as anesthetics
Drowning
Lack of oxygen, for example due to suffocation
Cardiac ischemia . People with coronary artery disease who abuse alcohol are at great risk, since cardiac arrest in this case occurs in almost 30% of cases
Atherosclerosis
Arterial hypertension and left ventricular hypertrophy
Anaphylactic and hemorrhagic shock
Smoking
Age

If one or more factors are present, you should be more careful about your health. It is advisable to undergo regular examinations with a cardiologist. To monitor the functioning of the heart, it is possible to use the Cardiovisor device, with the help of which you will always be aware of the condition of your main organ. Regular performance monitoring of cardio-vascular system will allow you to live a full life.

Consequences of cardiac arrest

To our deepest regret, only 30% of people survive cardiac arrest, and what’s worst, to a normal life, without serious harm to health, only 3.5% is returned. Basically, this happens due to the fact that timely assistance was not provided.

The consequences of cardiac arrest greatly depend on how quickly assistance is provided to the victim. The later the patient is brought back to life, the greater the likelihood serious complications. Lack of oxygen to vital organs for a long time leads to ischemia(oxygen starvation). Most often, patients who have suffered cardiac arrest experience ischemic damage brain, liver and kidneys, which greatly influence a person’s subsequent life.

Vigorous cardiac massage may result in rib fractures and pneumothorax.

Cardiac arrest in children

Cardiac arrest in children- this is a fairly rare phenomenon, which, unfortunately, is becoming more common every year. The causes of this pathology in children are different and very often are revealed only after an autopsy. Most often, this is a genetic predisposition that is associated with abnormal functioning of the cardiovascular system. How to predict and prevent danger? Often in children, cardiac arrest is heralded by bradycardia. Often respiratory failure or shock may lead to cardiac arrest. Also, factors of this pathology in children include coronary heart disease.

If, after all, a child experiences cardiac arrest, timely the right help, correct resuscitation measures on the part of doctors, since they are the ones who will influence the future health of the child. Such measures include properly performed artificial ventilation, oxygenation (enrichment of tissues and organs with oxygen), control of temperature, blood pressure, and blood glucose levels.
When performing external cardiac massage, it is necessary to remember that children’s ribs are not so strong and, most importantly, do not overdo it with pressure on them. Depending on the child’s age, pressure is applied with two or three fingers, and for newborns indirect massage hearts do thumbs, clasping the baby’s chest with your hands. Only thanks to the correct approach of doctors is the child’s survival and normal health in the future possible.
None of us are completely protected from this terrible phenomenon. However, we can protect ourselves and minimize the likelihood of myocardial arrest. By using the service,

Your heart will never give you unpleasant surprises. After all, regular monitoring of heart function is important step towards health!

Rostislav Zhadeiko, especially for the project.

To the list of publications

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

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

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

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

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

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

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

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

In this case, the role of the wandering and trigeminal nerves.

Another option is asystole in the background:

general oxygen deficiency (hypoxia);
high content 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 conduction is not impaired. Myocardial cells lose active myosin, which is necessary to obtain energy in the form of ATP.

With asystole, hypercalcemia is observed in the systole phase.

Heart fibrillation- is a disrupted connection between cardiomyocytes in coordinated actions to ensure overall myocardial contraction. Instead of synchronous work causing systolic contraction and diastole, many separate areas appear that contract on their own.

The contraction frequency reaches 600 per minute and above

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

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

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

Other mechanisms of cardiac arrest

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

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

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

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

The device allows you to record respiratory rate and heart rhythm

The picture of heart damage was expressed:

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

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

During the waking period, none of the patients experienced fainting states 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 through the vagus nerve.

Causes of cardiac arrest

Among the causes, one can distinguish directly cardiac (cardiac) and external (extracardiac).

The main cardiac factors are:

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

Extracardiac factors include:

oxygen deficiency (hypoxia) caused by anemia, asphyxia (suffocation, drowning);
pneumothorax (the appearance of air between the layers of the pleura, unilateral compression of the lung);
loss of a significant volume of fluid (hypovolemia) due to injury, shock, persistent vomiting and diarrhea;
metabolic changes with a 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, with a high risk of asystole

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

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

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

Negative effects of drugs

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

Overdose occurs when:

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

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

Most common reasons cardiac arrest is performed by:

sleeping pills from the group of barbiturates;
narcotic drugs for pain relief;
groups of β-blockers for hypertension;
medicines 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 cases of asystole are associated with medicines.

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

Diagnostic signs of cardiac arrest

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

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

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

What are the consequences of cardiac arrest?

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

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

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

Consequences from the brain can be:

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

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

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

Prevention

Cardiac arrest can be prevented by following the principles healthy image life, avoiding factors affecting blood circulation.

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

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

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