Acute coronary death: causes, emergency care and prognosis. Acute coronary insufficiency Sudden coronary death pathological anatomy

– this is asystole or ventricular fibrillation that occurs against the background of the absence of a history of symptoms indicating coronary pathology. The main manifestations include the absence of breathing, blood pressure, pulse in the great vessels, dilated pupils, lack of reaction to light and any types of reflex activity, marbling of the skin. After 10-15 minutes, the appearance of the cat's eye symptom is noted. The pathology is diagnosed on site based on clinical signs and electrocardiography data. Specific treatment is cardiopulmonary resuscitation.

ICD-10

I46.1 Sudden cardiac death, so described

General information

Sudden coronary death accounts for 40% of all causes of death in people over 50 but under 75 years of age without known heart disease. There are about 38 cases of SCD per 100 thousand population annually. With timely initiation of resuscitation in the hospital, survival is 18% and 11% for fibrillation and asystole, respectively. About 80% of all cases of coronary death occur in the form of ventricular fibrillation. Middle-aged men with nicotine addiction, alcoholism, and lipid metabolism disorders are more likely to suffer. Due to physiological reasons, women are less susceptible to sudden death from cardiac causes.

Causes

Risk factors for VCS do not differ from those for ischemic disease. Provoking influences include smoking, eating large amounts of fatty foods, arterial hypertension, and insufficient intake of vitamins. Non-modifiable factors – older age, male gender. Pathology can occur under the influence of external influences: excessive force loads, diving into icy water, insufficient oxygen concentration in the surrounding air, and acute psychological stress. The list of endogenous causes of cardiac arrest includes:

Atherosclerosis of the coronary arteries. Cardiosclerosis accounts for 35.6% of all SCDs. Cardiac death occurs immediately or within an hour after the onset of specific symptoms of myocardial ischemia. Against the background of atherosclerotic lesions, AMI is often formed, which provokes a sharp decrease in contractility, the development of coronary syndrome, and flicker.
Conduction disorders. Sudden asystole is usually observed. CPR measures are ineffective. Pathology occurs when there is organic damage to the conduction system of the heart, in particular the sinatrial, atrioventricular node or large branches of the His bundle. As a percentage, conduction failures account for 23.3% of the total number of cardiac deaths.
Cardiomyopathies. Detected in 14.4% of cases. Cardiomyopathies are structural and functional changes in the coronary muscle that do not affect the coronary artery system. Found in diabetes mellitus, thyrotoxicosis, and chronic alcoholism. May be of a primary nature (endomyocardial fibrosis, subaortic stenosis, arrhythmogenic pancreatic dysplasia).
Other states. The share in the overall morbidity structure is 11.5%. Includes congenital anomalies of the cardiac arteries, left ventricular aneurysm, and cases of VCS for which the cause could not be determined. Cardiac death can occur with pulmonary embolism, which causes acute right ventricular failure, accompanied by sudden cardiac arrest in 7.3% of cases.

Pathogenesis

Pathogenesis directly depends on the causes of the disease. With atherosclerotic lesions of the coronary vessels, complete occlusion of one of the arteries by a thrombus occurs, the blood supply to the myocardium is disrupted, and a focus of necrosis is formed. The contractility of the muscle decreases, which leads to acute coronary syndrome and cessation of cardiac contractions. Conduction disturbances provoke a sharp weakening of the myocardium. Near residual contractility causes a decrease in cardiac output, stagnation of blood in the chambers of the heart, and the formation of blood clots.

In cardiomyopathies, the pathogenetic mechanism is based on a direct decrease in myocardial performance. In this case, the impulse spreads normally, but the heart, for one reason or another, reacts poorly to it. The further development of the pathology does not differ from the blockade of the conduction system. With pulmonary embolism, the flow of venous blood to the lungs is disrupted. The pancreas and other chambers are overloaded, and blood stagnation is formed in the systemic circulation. A heart overflowing with blood under conditions of hypoxia is unable to continue working and it suddenly stops.

Classification

Systematization of SCD is possible based on the causes of the disease (AMI, blockade, arrhythmia), as well as on the presence of previous signs. In the latter case, cardiac death is divided into asymptomatic (the clinical picture develops suddenly against the background of unchanged health) and having previous signs (short-term loss of consciousness, dizziness, chest pain an hour before the development of the main symptoms). The most important for resuscitation measures is the classification according to the type of cardiac dysfunction:

Ventricular fibrillation. Happens in the vast majority of cases. Requires chemical or electrical defibrillation. It is a chaotic disordered contraction of individual fibers of the ventricular myocardium, unable to provide blood flow. The condition is reversible and can be easily managed with resuscitation measures.
Asystole. Complete cessation of heart contractions, accompanied by a cessation of bioelectrical activity. More often it becomes a consequence of fibrillation, but it can develop primarily, without previous flicker. Arises as a consequence of severe coronary pathology, resuscitation measures are ineffective.

Symptoms of sudden cardiac death

40-60 minutes before the arrest develops, previous signs may appear, which include fainting lasting 30-60 seconds, severe dizziness, loss of coordination, a decrease or increase in blood pressure. Characteristic pain behind the sternum is of a compressive nature. According to the patient, it feels like the heart is being squeezed in a fist. Precursor symptoms are not always observed. Often the patient simply falls while doing some work or physical exercise. Sudden death in sleep without prior awakening is possible.

Cardiac arrest is characterized by loss of consciousness. The pulse is not detected in both the radial and main arteries. Residual breathing can persist for 1-2 minutes from the moment the pathology develops, but inhalations do not provide the necessary oxygenation, since there is no blood circulation. On examination, the skin is pale and bluish. Cyanosis of the lips, earlobes, and nails is noted. The pupils are dilated and do not react to light. There is no reaction to external stimuli. During blood pressure tonometry, Korotkoff sounds are not heard.

Complications

Complications include the metabolic storm that occurs after successful resuscitation efforts. Changes in pH caused by prolonged hypoxia lead to disruption of the activity of receptors and hormonal systems. In the absence of the necessary correction, acute renal or multiple organ failure develops. The kidneys can also be affected by microthrombi formed during the onset of disseminated intravascular coagulation syndrome, myoglobin, which is released during degenerative processes in the striated muscles.

Poorly performed cardiopulmonary resuscitation causes decortication (brain death). In this case, the patient’s body continues to function, but the cerebral cortex dies. Restoring consciousness in such cases is impossible. A relatively mild variant of cerebral changes is posthypoxic encephalopathy. It is characterized by a sharp decrease in the patient’s mental abilities and impaired social adaptation. Possible somatic manifestations: paralysis, paresis, dysfunction of internal organs.

Diagnostics

Sudden cardiac death is diagnosed by a resuscitator or other specialist with a medical education. Trained representatives of emergency response services (rescuers, firefighters, police), as well as people who happen to be nearby and have the necessary knowledge, can determine circulatory arrest outside the hospital. Outside the hospital, the diagnosis is made solely on the basis of clinical signs. Additional techniques are used only in ICU settings, where their application requires minimal time. Diagnostic methods include:

Hardware tutorial. On the cardiac monitor to which each patient in the intensive care unit is connected, large-wave or small-wave fibrillation is noted, and there are no ventricular complexes. An isoline may be observed, but this rarely happens. Saturation levels quickly decrease, blood pressure becomes undetectable. If the patient is on assisted ventilation, the ventilator signals that there are no attempts to inhale spontaneously.
Laboratory diagnostics. It is carried out simultaneously with measures to restore cardiac activity. Of great importance is a blood test for acid-base acid and electrolytes, which indicates a shift in pH to the acidic side (a decrease in the pH value below 7.35). To exclude an acute infarction, a biochemical study may be required, which will determine increased activity of CPK, CPK MB, LDH, and an increase in the concentration of troponin I.

Urgent Care

The victim is assisted on the spot, and transported to the ICU after the heart rhythm is restored. Outside health care facilities, resuscitation is carried out using the simplest basic techniques. In a hospital or ambulance setting, it is possible to use complex specialized techniques of electrical or chemical defibrillation. The following methods are used for revival:

Basic CPR. It is necessary to place the patient on a hard, flat surface, clear the airways, tilt the head back, and extend the lower jaw. Pinch the victim's nose, put a cloth napkin on his mouth, cover his lips with yours and exhale deeply. Compression should be performed using the entire body weight. The sternum should be pushed out by 4-5 centimeters. The ratio of compressions and breaths is 30:2, regardless of the number of resuscitators. If the heart rate and spontaneous breathing are restored, you need to lay the patient on his side and wait for the doctor. Self-transportation is prohibited.
Specialized assistance. In a medical institution, assistance is provided in a comprehensive manner. If ventricular fibrillation is detected on the ECG, defibrillation is performed with discharges of 200 and 360 J. It is possible to administer antiarrhythmics against the background of basic resuscitation measures. For asystole, adrenaline, atropine, sodium bicarbonate, and calcium chloride are administered. The patient must be intubated and transferred to artificial ventilation, if this has not been done previously. Monitoring is indicated to determine the effectiveness of medical actions.
Help after rhythm restoration. After restoration of sinus rhythm, mechanical ventilation is continued until consciousness is restored or longer if the situation requires it. Based on the results of the acid base analysis, the electrolyte balance and pH are corrected. 24-hour monitoring of the patient's vital activity and assessment of the degree of damage to the central nervous system are required. Restorative treatment is prescribed: antiplatelet agents, antioxidants, vascular drugs, dopamine for low blood pressure, soda for metabolic acidosis, nootropic drugs.

Prognosis and prevention

The prognosis for any type of SCD is unfavorable. Even with timely CPR, there is a high risk of ischemic changes in the tissues of the central nervous system, skeletal muscles, and internal organs. The probability of successful rhythm restoration is higher with ventricular fibrillation; complete asystole is less prognostically favorable. Prevention consists of early detection of heart disease, avoiding smoking and drinking alcohol, and regular moderate aerobic exercise (running, walking, jumping rope). It is recommended to avoid excessive physical activity (weightlifting).

The diagnosis of sudden coronary death refers to the unexpected death of a patient, the cause of which is cardiac arrest.

The disease most often affects men whose age is between 35-45 years. It occurs in 1-2 pediatric patients out of every 100,000 people.

The main cause of VS is the common severe atherosclerosis of the coronary vessels when two or more main branches are involved in the pathological process.

Doctors explain the development of sudden death as follows:

myocardial ischemia(in acute form). The condition develops due to the excessive need of the heart muscle for oxygen (against the background of psycho-emotional or physical stress, alcohol dependence);
asystole– stop, complete cessation of heart contractions;
reduction in coronary blood flow due to a sharp drop in blood pressure, including during sleep and at rest;
ventricular fibrillation– flickering and fluttering;
disruption of the functioning of the organ's electrical system. It begins to work irregularly and contracts with life-threatening frequency. The body stops receiving blood;
Among the reasons, the possibility of spasm of the coronary arteries cannot be excluded;
stenosis– damage to the main arterial trunks;
, post-infarction scars, ruptures and tears of blood vessels, .

Risk factors include the following conditions:

suffered a heart attack, during which a large area of the myocardium was damaged. Coronary death occurs in 75% of cases after myocardial infarction. The risk persists for six months;
ischemic disease;
episodes of loss of consciousness without a specific reason - syncope;
dilated cardiomyopathy – the risk is a decrease in the pumping function of the heart;
hypertrophic cardiomyopathy – thickening of the heart muscle;
vascular disease, heart disease, severe medical history, high cholesterol, obesity, smoking, alcoholism, diabetes mellitus;
ventricular tachycardia and ejection fraction up to 40%;
episodic cardiac arrest in the patient or in the family history, including heart block, decreased heart rate;
vascular anomalies and congenital defects;
unstable levels of magnesium and potassium in the blood.

Forecast and danger

In the first minutes of the disease it is important to consider how critically the blood flow has decreased.

If the patient does not receive immediate medical attention for acute coronary insufficiency, the worst prognosis develops - sudden death.

The main complications and dangers of sudden death are as follows:

skin burns after defibrillation;
recurrence of asystole and ventricular fibrillation;
overfilling of the stomach with air (after artificial ventilation);
bronchospasm - develops after tracheal intubation;
damage to the esophagus, teeth, mucous membrane;
fracture of the sternum, ribs, damage to lung tissue, pneumothorax;
bleeding, air embolism;
arterial damage due to intracardiac injections;
acidosis – metabolic and respiratory;
encephalopathy, hypoxic coma.

How to treat angina pectoris, what medications are prescribed to support the heart and what to do to relieve attacks - in our article.

Symptoms before the syndrome occurs

Statistics show that about 50% of all incidents occur without the development of previous symptoms. Some patients experience dizziness and rapid heartbeat.

Considering the fact that sudden death rarely develops in people who do not have coronary pathology, the symptoms can be supplemented with the following signs:

fatigue, a feeling of suffocation against the background of heaviness in the shoulders, pressure in the chest area;
change in the nature and frequency of pain attacks.

First aid

Every person who sees a sudden death occur must be able to provide first aid. The basic principle is to perform CPR – cardiopulmonary resuscitation. The technique is performed manually.

To do this, you should perform repeated compressions of the chest, inhaling air into the airways. This will avoid brain damage due to lack of oxygen and will support the victim until resuscitators arrive.

The action diagram is presented in this video:

CPR tactics are shown in this video:

Differential diagnosis

The pathological condition develops suddenly, but a sequential development of symptoms can be traced. Diagnostics is carried out during examination of the patient: presence or absence of pulse in the carotid arteries, lack of consciousness, swelling of the neck veins, cyanosis of the torso, respiratory arrest, tonic single contraction of skeletal muscles.

A positive reaction to resuscitation measures and a sharp negative reaction to their suspension indicate acute coronary heart failure.

Diagnostic criteria can be summarized as follows:

lack of consciousness;
the pulse cannot be felt in large arteries, including the carotid artery;
heart sounds cannot be heard;
respiratory arrest;
lack of reaction of the pupils to the light source;
the skin becomes gray with a bluish tint.

Treatment tactics

The patient can be saved only with emergency diagnosis and medical care.. The person is placed on a hard base on the floor, and the carotid artery is checked. When cardiac arrest is detected, artificial respiration and cardiac massage are performed. Resuscitation begins with a single blow to the middle zone of the sternum with a fist.

The remaining activities are as follows:

immediate implementation of closed cardiac massage – 80/90 compressions per minute;
artificial ventilation. Any available method is used. Airway patency is ensured. Manipulations are not interrupted for more than 30 seconds. Tracheal intubation is possible.
defibrillation is provided: start - 200 J, if there is no result - 300 J, if there is no result - 360 J. Defibrillation is a procedure that is implemented using special equipment. The doctor applies an electrical impulse to the chest to restore heart rhythm;
A catheter is inserted into the central veins. Adrenaline is given - 1 mg every three minutes, lidocaine 1.5 mg/kg. If there is no result, repeated administration is indicated in an identical dosage every 3 minutes;
if there is no result, ornid 5 mg/kg is administered;
if there is no result – novocainamide – up to 17 mg/kg;
if there is no result - magnesium sulfate - 2 g.
in case of asystole, emergency administration of atropine 1 g/kg every 3 minutes is indicated. The doctor eliminates the cause of asystole - acidosis, hypoxia, etc.

The patient must be hospitalized immediately. If the patient has regained consciousness, therapy is aimed at preventing relapse. The criterion for the effectiveness of treatment is the constriction of the pupils and the development of a normal reaction to light.

During cardiopulmonary resuscitation, all drugs are administered quickly, intravenously. When there is no access to a vein, "Lidocaine", "Adrenaline", "Atropine" injected into the trachea, increasing the dosage by 1.5-3 times. A special membrane or tube must be installed on the trachea. The drugs are dissolved in 10 ml of isotonic NaCl solution.

If it is not possible to use any of the presented methods of drug administration, the physician decides to perform intracardiac injections. The resuscitator uses a thin needle, strictly observing the technique.

Treatment is stopped if there are no signs of effectiveness within half an hour resuscitation measures, the patient does not respond to medication, persistent asystole with multiple episodes was revealed. Resuscitation does not begin when more than half an hour has passed since the blood circulation stopped or if the patient has documented a refusal to take measures.

Prevention

The principles of prevention are that the patient suffering is attentive to his well-being. He must monitor changes in his physical condition, actively take medications prescribed by his doctor, and adhere to medical recommendations.

To achieve such goals it is used pharmacological support: taking antioxidants, preductal, aspirin, chimes, beta-blockers.

Patients at high risk of developing VS should avoid conditions that place increased stress on the cardiovascular system. Constant supervision of a physical therapy doctor is indicated, since physical activity is vital, but the wrong approach to its implementation is dangerous.

Smoking is prohibited, especially during times of stress or after physical activity. It is not recommended to stay in stuffy rooms for a long time; it is better to avoid long flights.

If the patient realizes that he is unable to to handle the stress, it is advisable to undergo consultation with a psychologist in order to develop a method of adequate response. Consumption of fatty, heavy foods should be kept to a minimum, overeating should be excluded.

Limiting your own habits, conscious control of your health status- these are the principles that will help prevent acute coronary insufficiency as a cause of death and save life.

Content

The statistics on sudden mortality are disappointing: every year the number of people at risk is increasing. The reason for this is heart failure, which develops against the background of ischemia. Acute coronary insufficiency - what is it from the point of view of cardiologists, what is the origin of the term, features of the disease? Find out how the disease is treated, will it be possible to prevent its occurrence and development?

What is acute coronary insufficiency

The heart needs “breathing” (oxygen supply) and nutrition (provision of microelements). This function is performed by vessels through which blood delivers to the organ everything necessary for proper functioning. These arteries are located around the heart muscle in the form of a crown (crown), which is why they are called coronary or coronary. If blood flow is weakened due to external or internal vasoconstriction, the heart lacks nutrition and oxygen. This condition is medically called coronary insufficiency.

If arterial dysfunction occurs slowly, heart failure becomes chronic. “Starvation” that develops rapidly (over several hours or even minutes) is an acute form of pathology. As a result, oxidation products accumulate in the heart muscle, which leads to malfunctions of the “motor”, rupture of blood vessels, tissue necrosis, cardiac arrest, and death.

In most cases, coronary insufficiency accompanies ischemic disease. It often develops against the background of such ailments as:

heart defects;
gout:
trauma, cerebral edema;
pancreatitis;
bacterial endocarditis;
syphilitic aortitis, etc.

Forms of pathology and their symptoms

The duration of attacks, their severity, conditions of occurrence are factors that determine the classification of the disease into mild, moderate, and severe forms. The degree of vascular damage (the strength of spasms, their “clogging” with blood clots (thrombi), sclerotic plaques) is another reason that influences the formal division of acute coronary insufficiency.

Lightweight

A mild form of coronary insufficiency occurs as a result of a reversible circulatory disorder during active emotional or physical stress. A person feels slight pain, a sudden short-term “interception” of breathing, but his capacity at these moments is not impaired. The attack lasts from several seconds to two minutes and is quickly relieved. Often the patient does not even attach importance to this manifestation of heart failure, since the attack is of little concern and goes away without medication.

Moderate

Attacks of moderate severity occur during normal but prolonged exertion, for example, when a person walks for a long time or climbs a mountain (stairs). Insufficiency during times of severe emotional shock, worries, and disorders is not excluded. When moderate coronary insufficiency syndrome is observed, pressing pain occurs in the left side of the chest, well-being sharply worsens, and ability to work decreases. An attack of coronary heart failure lasts about ten minutes and is relieved only by taking fast-acting nitroglycerin.

Severe form of the disease

Coronary pain that occurs during a severe attack does not go away without medical intervention. It is so strong that a person is seized by the fear of death, he experiences additional emotional arousal, which only worsens his condition. A severe attack lasts from ten minutes to half an hour, leading to a heart attack and death. Validol or nitroglycerin tablets will help until professional medical help is needed, but the attack will not stop. In this situation, parenteral administration of painkillers and antipsychotic drugs is necessary.

Causes

Normal heart function is impossible without adequate nutrition and sufficient oxygen. Acute coronary insufficiency is provoked by a disruption of blood flow in the coronary vessels, their blockage, which leads to:

Coronary sclerosis. Detachment of cholesterol plaque from the vessel wall. As a result, normal blood flow is simply blocked by this “obstacle.”
Vein thrombosis. With this pathology, a blood clot that has entered the coronary vessel closes its lumen.
Spasm of coronary vessels. It is caused by increased release of catecholamines by the adrenal glands under the influence of nicotine, alcohol, and stress.
Vascular injuries. As a result, the blood flow system is disrupted.
Inflammation of the vascular walls. Leads to deformation of the coronary arteries, narrowing of the lumens, and disruption of normal blood flow.
Tumors. Under their influence, compression of the coronary vessels occurs mechanically. Spasms are possible as a result of intoxication.
Atherosclerosis. Leads to the development of coronary sclerosis - the formation of plaques inside the coronary arteries.
Poisoning. For example, carbon monoxide that enters the body forms stable compounds with hemoglobin, which deprives red blood cells of the ability to carry oxygen.

Emergency care for a patient having a seizure

Heart pain that occurs with coronary insufficiency cannot be tolerated, and the attack must be stopped immediately. To do this, it is imperative to restore normal blood supply to the heart. When acute coronary syndrome is observed, emergency care before medical intervention consists of reducing (cessation) physical activity and taking medications:

If you feel pain, you should immediately stop all active activities: the intensity of work of the heart muscle decreases in a calm state, and the heart’s need for oxygen also decreases. Due to this alone, the pain will decrease, and the coronary blood supply will be partially restored.
Simultaneously with the cessation of active actions, the patient should take instantly acting medications: validol, nitroglycerin. These drugs remain the only emergency first aid for a heart attack.

A person with an attack of coronary insufficiency needs to be given first aid: put to bed, given a tablet (0.0005 g) of nitroglycerin under the tongue. An alternative is 3 drops of an alcohol solution (1%) of this medicine on a sugar cube. If nitroglycerin is not available or is contraindicated (for example, with glaucoma), it is replaced with validol, which has a milder vasodilator effect. It is necessary to apply a heating pad to the legs of the core, and, if possible, inhale oxygen. Call an ambulance immediately.

Treatment methods for acute coronary insufficiency

Treatment of this disease must begin as early as possible, only then the outcome will be favorable, otherwise a heart attack, ischemic cardiomyopathy, and death are possible. Coronary heart disease does not go away on its own. Drug therapy is inpatient, long-term, and has many nuances:

The fight against risk factors for coronary heart disease includes diet, avoidance of overeating, smoking, alcohol, proper alternation of rest with activity, and normalization of weight.
Drug treatment consists of the prophylactic use of antianginal and antiarrhythmic drugs, drugs that dilate blood vessels (coronary lytics), anticoagulants, lipid-lowering and anabolic agents.

Surgical intervention and intravascular treatment are aimed at restoring normal blood flow in the coronary arteries:

coronary bypass surgery - restoration of blood flow with the help of special shunts, bypassing narrowed places on the vessels;
stenting – installation of frames in coronary vessels;
angioplasty - opening of the affected arteries with a special catheter;
direct coronary atherectomy – reducing the size of atherosclerotic plaques inside the vessels;
rotational ablation (rotablation) – mechanical cleaning of ships with a special drill.

Why the disease is dangerous: possible complications and consequences

Acute coronary insufficiency as a cause of death is a common phenomenon. Coronary artery disease is often asymptomatic, a person does not know about heart pathology, and does not pay attention to mild attacks. As a result, the disease progresses and leads to complications, without treatment of which sudden coronary death often occurs. In addition to this most serious consequence, the disease leads to the following complications:

arrhythmias of all types;
changes in cardiac anatomy, myocardial infarction;
inflammation of the pericardial sac - pericarditis;
aortic aneurysm;
rupture of the heart wall.

Prevention

Coronary heart disease is a disease that is easier to prevent than to cure. A number of preventive measures help prevent its occurrence and development:

Regular exercise. Walking, swimming with a gradual, gentle increase in load, jogging.
Balanced diet with a small amount of animal fats.
Quitting smoking and alcohol.
Elimination of psycho-emotional (stressful) stress.
Blood pressure control.
Maintaining normal weight.
Controlling the amount of cholesterol in the blood.

Video about the treatment of acute coronary syndrome

Do you want to know about mortality statistics from acute heart failure and the serious consequences of this common disease? Watch the video for some impressive numbers and a compelling case for preventing coronary artery disease. You will learn what acute coronary heart disease is, what modern methods of treating it are, what methods doctors use to restore coronary circulation and bring patients back to life.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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From this article you will learn: what acute (sudden) coronary death is, what are the reasons for its development, what symptoms develop with. How to reduce the risk of coronary death.

Article publication date: 05/26/2017

Article updated date: 05/29/2019

Sudden coronary death (SCD) is an unexpected death caused by cardiac arrest that occurs within a short time (usually within 1 hour of the onset of symptoms) in a person with coronary artery disease.

Coronary arteries are vessels that supply blood to the heart muscle (myocardium). If they are damaged, blood flow may stop, which leads to cardiac arrest.

VCS most often develops in adults aged 45–75 years, in whom coronary heart disease (CHD) is most common. The incidence of coronary death is approximately 1 case per 1000 population per year.

One should not think that the occurrence of cardiac arrest inevitably leads to the death of a person. Provided that emergency care is provided correctly, cardiac activity can be restored, although not in all patients. Therefore, it is very important to know the symptoms of VKS and the rules.

Causes of coronary death

VCS is caused by damage to the coronary arteries, leading to a deterioration in the blood supply to the heart muscle. The main cause of pathology of these blood vessels is atherosclerosis.

Atherosclerosis is a disease that leads to the formation of plaques on the inner surface of arteries (endothelium), narrowing the lumen of the affected vessels.

Atherosclerosis begins with damage to the endothelium, which can be caused by high blood pressure, smoking or increased blood cholesterol levels. At the site of damage, cholesterol penetrates into the wall of the blood vessel, which leads, several years later, to the formation of an atherosclerotic plaque. This plaque forms a bulge on the arterial wall that increases in size as the disease progresses.

Sometimes the surface of the atherosclerotic plaque is torn, which leads to the formation of a blood clot in this place, which completely or partially blocks the lumen of the coronary artery. It is the disruption of the blood supply to the myocardium, which occurs as a result of the blocking of the coronary artery by an atherosclerotic plaque and thrombus, that is the main cause of VCS. Lack of oxygen causes dangerous heart rhythm disturbances, which lead to cardiac arrest. The most common heart rhythm disorder in such situations is in which disorganized and chaotic contractions of the heart occur, not accompanied by the release of blood into the vessels. Provided that assistance is provided correctly, it is possible to revive a person immediately after cardiac arrest.

The following factors increase the risk of VCS:

Previously suffered myocardial disease, especially during the last 6 months. 75% of cases of acute coronary death are associated with this factor.
Cardiac ischemia. 80% of cases of VCS are associated with ischemic heart disease.
Smoking.
Arterial hypertension.
Increased blood cholesterol levels.
Presence of heart disease in close relatives.
Deterioration of left ventricular contractility.
The presence of certain types of arrhythmia and conduction disorders.
Obesity.
Diabetes.
Addiction.

Symptoms

Sudden coronary death has pronounced symptoms:

the heart stops beating and blood is not pumped throughout the body;
loss of consciousness occurs almost immediately;
the victim falls;
no pulse;
no breathing;
pupils dilate.

These symptoms indicate cardiac arrest. The main ones are the absence of pulse and breathing, dilated pupils. All these signs can be detected by a person nearby, since the victim himself at this moment is in a state of clinical death.

Clinical death is a period of time lasting from cardiac arrest until the onset of irreversible changes in the body, after which it is no longer possible to revive the victim.

Just before cardiac arrest, some patients may experience warning signs, which include rapid heartbeat and dizziness. VCS predominantly develops without any previous symptoms.

Providing first aid to a person with sudden coronary death

Victims with VCS cannot provide first aid to themselves. Since properly performed cardiopulmonary resuscitation can restore cardiac activity in some of them, it is very important that people around the injured person know and know how to provide first aid in such situations.

Sequence of actions in the presence of cardiac arrest:

Make sure you and the victim are safe.
Check the victim's consciousness. To do this, gently shake his shoulder and ask how he feels. If the victim responds, leave him in the same position and call an ambulance. Do not leave the victim alone.
If the patient is unconscious and unresponsive, turn him onto his back. Then place the palm of one hand on his forehead and gently tilt his head back. Using your fingers under your chin, push your lower jaw upward. These actions will open the airways.
Assess for normal breathing. To do this, lean towards the victim's face and look at the movements of the chest, feel the movement of air on your cheek and listen to the sound of breathing. Normal breathing should not be confused with dying breaths, which can be observed during the first moments after the cessation of cardiac activity.
If the person is breathing normally, call an ambulance and monitor the victim until it arrives.
If the victim is not breathing or his breathing is abnormal, call an ambulance and begin closed cardiac massage. To perform it correctly, place one hand on the center of the sternum so that only the base of the palm touches the chest. Place your other palm on top of the first. Keeping your arms straight at the elbows, press on the victim’s chest so that the depth of its deflection is 5–6 cm. After each pressure (compression), allow the chest to fully straighten. It is necessary to perform closed cardiac massage with a frequency of 100–120 compressions per minute.
If you know how to do artificial respiration using the mouth-to-mouth method, then after every 30 compressions, give 2 artificial breaths. If you do not know how or do not want to perform artificial respiration, simply continuously perform closed cardiac massage at a frequency of 100 compressions per minute.
Carry out these activities until the ambulance arrives, until signs of cardiac activity appear (the victim begins to move, opens his eyes or breathes) or complete exhaustion.

Click on photo to enlarge

Forecast

Sudden coronary death is a potentially reversible condition in which, provided timely assistance is provided, it is possible to restore cardiac activity in some victims.

Most patients who survive cardiac arrest have some degree of damage to the central nervous system, and some are in a deep coma. The prognosis for such people is influenced by the following factors:

General state of health before cardiac arrest (for example, the presence of diabetes, cancer and other diseases).
The time interval between cardiac arrest and the start of cardiopulmonary resuscitation.
Quality of cardiopulmonary resuscitation.

Prevention

Since the main cause of VCS is coronary heart disease caused by atherosclerosis, the risk of its occurrence can be reduced by preventing these diseases.

Healthy and balanced diet

A person needs to limit salt intake (no more than 6 g per day), as it increases blood pressure. 6 g of salt is approximately 1 teaspoon.

Click on photo to enlarge

There are two types of fats – saturated and unsaturated. You need to avoid foods containing saturated fats, as they increase the level of bad cholesterol in the blood. These include:

meat pies;
sausages and fatty meats;
butter;
salo;
hard cheeses;
confectionery;
products containing coconut or palm oil.

A balanced diet should contain unsaturated fats, which increase levels of good cholesterol in the blood and help reduce atherosclerotic plaque in the arteries. Foods rich in unsaturated fats:

Oily fish.
Avocado.
Nuts.
Sunflower, rapeseed, olive and vegetable oils.

You should also limit your sugar intake, as it can increase your risk of developing diabetes, which greatly increases your risk of coronary artery disease.

Physical activity

Combining a healthy diet with regular exercise is the best way to maintain a healthy body weight, which reduces the risk of developing high blood pressure.

Regular physical exercise increases the efficiency of the cardiovascular system, reduces blood cholesterol levels, and also keeps blood pressure levels within normal limits. They also reduce the risk of developing diabetes.

Everyone benefits from 30 minutes of aerobic exercise 5 days a week. These include brisk walking, jogging, swimming and any other exercise that causes the heart to beat faster and use more oxygen. The higher the level of physical activity, the more positive consequences a person receives from it.

It has been scientifically proven that people who lead a sedentary lifestyle have a higher risk of heart disease, diabetes and sudden coronary death. Therefore, you should take short breaks from prolonged sitting at your workplace.

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Normalizing and maintaining a healthy weight

The best way to get rid of excess weight is a balanced diet and regular exercise. You need to reduce body weight gradually.

To give up smoking

If a person smokes, quitting this bad habit reduces the risk of developing coronary artery disease and coronary death. Smoking is one of the main risk factors for atherosclerosis, causing the majority of cases of coronary artery thrombosis in people under the age of 50 years.

Limiting alcohol consumption

Do not exceed the maximum recommended doses of alcohol. Men and women are advised to drink no more than 14 standard drinks per week. It is strictly forbidden to drink large quantities of alcoholic beverages for a short time or drink to the point of intoxication, as this increases the risk of SCD.

Blood pressure control

You can control your blood pressure through a healthy diet, regular exercise, normalizing your weight and, if necessary, taking medications to reduce it.

You should strive to keep your blood pressure below 140/85 mmHg. Art.

Diabetes control

Patients with diabetes have an increased risk of coronary artery disease. To control blood glucose levels, a balanced diet, physical activity, normalization of weight, and the use of glucose-lowering medications prescribed by a doctor are useful.

Coronary insufficiency is a pathological condition in which coronary blood flow is partially reduced or completely stopped. As a result, the heart muscle will receive insufficient nutrients and oxygen. This condition is the most common manifestation of IHD. Most often, acute coronary insufficiency is behind a heart attack. Sudden coronary death is also directly related to this pathological process.

There are two types of deficiency:

resting coronary insufficiency;
coronary tension insufficiency.

It is important to know what acute and chronic coronary insufficiency is, its symptoms and treatment, in order to notice its development in a person in time and deliver him to a medical facility for emergency care.

Causes

Coronary insufficiency syndrome can occur for various reasons. Most often it is caused by spasms, atherosclerotic and thrombotic stenosis.

Main reasons:

coronaritis;
vascular damage;
pulmonary stenosis;
anaphylactic shock;
obstruction of arterial patency. This can happen due to absolute or partial blockage of blood vessels, spasm, thrombosis, etc.

Symptoms

The most common cause of death from vascular and heart diseases is coronary insufficiency. This is due to the fact that both the heart and blood vessels are damaged almost equally. In medicine, this phenomenon is called sudden coronary death. All the symptoms of this disease are complex, but the main and most significant is the attack of angina.

sometimes the only symptom of coronary insufficiency is severe pain in the heart or behind the sternum, which lasts about 10 minutes;
stiffness. Occurs during times of increased physical stress;
pale skin;
dyspnea;
cardiopalmus;
breathing slows down and becomes more shallow;
vomiting, nausea, salivation increases;
urine is light in color and is released in larger quantities.

Acute form

Acute coronary insufficiency is a pathological condition that develops as a result of spasm of the blood vessels that saturate the heart muscle with blood. A spasm can develop in a person both in a state of complete physical rest and during heightened emotional and physical stress. loads Sudden death is directly related to this disease.

Clinical syndrome of acute coronary insufficiency is popularly called angina pectoris. The attack develops due to a lack of oxygen in the tissues of the heart. Oxidation products will not be excreted from the body, but will begin to accumulate in tissues. The nature and strength of the attack directly depends on several factors:

reaction of the walls of the affected vessels;
area and extent of atherosclerotic lesions;
irritating force.

If attacks develop at night, in a state of complete rest and are difficult, this indicates that serious vascular damage has occurred in the human body. As a rule, pain occurs suddenly in the heart area and lasts from two to twenty minutes. Radiates to the left half of the body.

Chronic form

Occurs in humans due to angina pectoris and atherosclerosis of blood vessels. In medicine, there are three degrees of the disease:

initial degree of chronic coronary insufficiency (CCI). A person experiences infrequent attacks of angina. They are provoked by psycho-emotional and physical. loads;
pronounced degree of CCN. The attacks become more frequent and more intense. The reason is moderate physical activity;
severe degree of CCN. Seizures occur in a person even in a calm state. There is arrhythmia and severe pain in the heart area.

The patient's condition will gradually worsen as the blood vessels narrow. If the metabolic disorder lasts for a very long time, then new deposits will appear on the plaques that have already formed on the walls of the arteries. The flow of blood to the heart muscle will decrease significantly. If chronic coronary insufficiency is not treated appropriately, sudden death may occur.

Sudden death

Sudden death is a rapid death due to vascular and cardiac diseases, occurring in individuals whose condition can be called stable. In 85–90% of cases, the cause of this condition is ischemic heart disease, including without significant symptoms.

cardiac asystole;
ventricular fibrillation.

When examining the patient, pallor of the skin is noted. They are cold and have a grayish tint. The pupils gradually become wider. Pulse and heart sounds are practically undetectable. Breathing becomes agonal. After three minutes the person stops breathing. Death comes.

Diagnostics

electrocardiogram;
coronary angiography (coronary angiography);
Cardiac MRI (magnetic resonance imaging).

Treatment

Treatment of coronary insufficiency must begin as early as possible to achieve favorable results. It doesn’t matter what causes this condition, but it requires qualified treatment. Otherwise, death may occur.

Treatment of coronary insufficiency syndrome should be carried out only in hospital settings. The therapy is quite lengthy and has a lot of nuances. The first thing that needs to be done is to combat the risk factors for IHD:

avoid overeating;
correctly alternate periods of rest and activity;
follow a diet (especially important for the heart);
increase physical activity;
do not smoke or drink alcoholic beverages;
normalize body weight.

Drug therapy:

antianginal and antiarrhythmic drugs. Their action is aimed at preventing and relieving attacks of angina pectoris, treating heart rhythm disorders;
anticoagulants (they occupy an important place in the treatment of acute insufficiency, as they are intended to thin the blood);
anti-bradykinin honey. facilities;
vasodilator honey agents (Iprazide, Aptin, Obzidan, etc.);
lipid-lowering drugs;
anabolic drugs.

Surgical and intravascular treatments are used to restore blood flow in the coronary arteries. These include the following methods:

coronary bypass surgery;
stenting;
angioplasty;
direct coronary atherectomy;
rotational ablation.

Prevention

Proper treatment will help eliminate acute coronary insufficiency, but it is always easier to prevent the disease than to treat it. There are preventive measures that make it possible to prevent the development of this disease:

It is necessary to exercise regularly. You can go swimming, walk more. Loads should be increased gradually;
Avoid stressful situations. Stress is everywhere in our lives, but it is the heart that suffers the most from it, so we must try to avoid such situations to protect it;
balanced diet. The amount of animal fats in the diet should be reduced;

Coronary insufficiency is a very complex and dangerous disease that can lead to human death. Therefore, it is important to know all its main symptoms and first signs in order to provide the patient with emergency care. Treatment of this disease is long-term and must be carried out in a timely manner to prevent sudden death. It is especially necessary to note that the OKN has become significantly “younger” over the past few years. Now it affects people of working age. The sooner the disease or condition that may trigger its development is treated, the more favorable the prognosis will be.

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Diseases with similar symptoms:

Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disrupted, and the heart ceases to fully perform its main function - supplying oxygen to all organs and tissues.