The main causes of cardiac arrest – We treat the heart

The cause of the manifestation of the mechanism of a sudden organ stop is an excessively sharp violation of its performance. This is especially true of conductivity (time of passage of an electrical impulse), excitability (ability to be excited under the influence of impulses), as well as automatism (ability to automatically contract) the main human organ.

The main manifesting types of stopping depend on these abilities of the organ. A sharp cessation of heart function occurs in two ways. These include asystole, due to which there is a stop in about 5% of cases and fibrillation, which becomes 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 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 may occur due to reflex “orders” received from other organs. This sometimes occurs with surgery on organs such as the stomach, gall bladder, or intestines. With such a sudden stop, the proven fact is the role of either the vagus or trigeminal nerve.

Another option for the sudden termination of the body is asystole, which occurs against the background of:

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

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

With cardiac fibrillation, myocardial muscle fibers contract uncoordinated and fragmented. Because of this, the general contractile activity suddenly becomes ineffective, since the disparate sections of the muscle function independently. From ventricles, the release of blood is significantly reduced. Energy costs increase significantly, but this does not increase the efficiency of reductions.

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

Other mechanisms include cases in which the contractility of the heart muscle persists, but it becomes insufficient in order 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 another term – clinical death.

The reasons for the process are quite diverse. They can be associated with cardiovascular pathologies or extracardial (non-heart related) diseases:

  • Coronary heart disease or in the interpretation – ischemic disease. Many factors can provoke death in this disease, for example, alcohol abuse or heavy loads, it does not matter if they are physical or emotional.
  • Impaired heart rate. This may be tachycardia (rapid pulse, amounting to more than 100 beats) or bradycardia (slow heartbeat, below 60 beats). A very dangerous disease is atrial fibrillation. It manifests itself in a random, irregular heartbeat. In this case, the shock frequency reaches a value of 150.
  • Thrombosis. This is a rather dangerous condition, characterized by the appearance of blood clots in the veins on the legs. More often they occur in the lower leg. But the greatest danger is blood clots that have formed in large veins – the femoral or popliteal. The disease can aggravate the use of certain medications, such as hormonal contraceptives, or a genetic predisposition to excessive blood clotting.

A short stop can be caused by attacks of fibrillation, which in some cases end on their own. In medicine, there is also the term “apnea”, which clinically can be manifested not only by respiratory arrest in a dream.

With the manifestation of the syndrome at night, a 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 failure.

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 hidden heart defects. In this case, the factor of inattentive attitude to health with a sick heart is rare.

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.

Among the signs, the following should be highlighted:

  • Lack of pulse. This is the first and most important indicator of cardiac arrest. The pulse is not felt at the same time, it cannot be detected even at the locations of large arteries. In order to accurately determine whether heart contractions are present or absent, two fingers (the index finger along with the middle one) must be attached 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.
  • Respiratory arrest. This can be detected using a mirror or any other glass surface. Such an item is brought to the nose. If breathing is present, the surface will begin to fog. If such an object is not at hand, then you can check the victim’s breathing by lifting his head (throwing it back). In this case, it is necessary to examine whether his chest is moving. You can try to listen to the sound of breathing, leaning towards the victim and pressing your cheek.
  • Dilated pupils. With clinical death, they do not respond to the appearance of light. A beam of light should be directed into the eyes of the victim. If the pupils do not narrow, then this indicates a lack of heart function. If the pupils are still narrow, this indicates a recent cardiac death, which gives hope for a favorable outcome.
  • Change in skin color on the face. Usually the skin becomes grayish or bluish.
  • Loss of consciousness, cramps. An important symptom is fainting, lasting more than ten seconds.
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Sometimes sudden cardiac death is preceded by other signs – excessive fatigue, heartache, shortness of breath, nausea and vomiting. Not all of the above symptoms are present at the same time and may even be completely absent.

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Diagnostics

Most often, such a manifestation as a sudden cessation 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 face a fatal outcome, since this emergency condition requires immediate intervention. Therefore, it is highly desirable that each person knows how to provide first aid.

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

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

First aid

There are times when a stop occurs for a few seconds, and then a person comes to his senses. However, if the condition of the victim has not returned to normal and he is motionless, he should immediately be given first aid, without waiting for the arrival of the medical team.

The first step is to check whether the person is conscious. To do this, you need to gently pull his shoulders, then loudly ask if everything is okay with him. People usually begin to shake violently and hit 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, one must immediately begin resuscitation. To do this, make sure that the surface on which the victim lies is solid. It is best that this is not a shop, but a floor or asphalt.

Then you need to kneel down in front of the patient and put your palm in the middle part of the chest. It is advisable to first free the torso from clothing. Fingers should be directed towards the victim’s head.

The second hand must be placed on top of the first.

Before starting the manipulation, it is necessary to make sure that the shoulders are exactly above the patient’s chest. Then you can start a heart massage (which is called indirect), pressing lightly on the chest, while the depth of pressure should not be more than five cm. It must be remembered that hands should not be bent at the elbows. It is necessary to carry out 60–100 pressures per minute.

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

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

Aftermath

Unfortunately, only 30% of survivors survive due to cardiac arrest. And even in this case, they can’t live the same way as before, as their health has been greatly damaged. Only 3–3,5% of people who have had a stop are fully recovering.

The consequences of such a sudden manifestation strongly depend 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) can develop. Quite often, in patients who have died in a dream from a cardiac arrest, the brain, kidneys and liver are damaged.

Prevention

Types of pathology and development mechanism

What we see in films in a straight line is not the only option for stopping the myocardium. Often, electrical activity is observed, but there is no normal blood circulation.

Types of cardiac arrest are as follows:

  • ventricular fibrillation – the so-called chaotic, erratic contractions of individual myocytes. As a result, the heart trembles, but the pumping function is lost. In this case, electrical defibrillation is effective.
  • asystole – this variety is characterized by a complete absence of contractions and electrical activity. A direct contour is observed on the cardiogram.
  • electromechanical dissociation – in this case, separate QRS complexes are observed on the ECG, however, contractions do not occur, blood pressure is absent.

Heart failure complications

According to the theory of pathology, after about a seventh minute of cardiac arrest, the brain begins to die. The optimal time to save lives without critical consequences for mental and physical health is considered to be a period of time up to 3-4 minutes from the onset of clinical death. People rescued in the seventh minute and later develop complications of varying severity.

Short-term cardiac arrest is characterized by mild to moderate impaired brain activity:

  1. Regular painful sensations in the head that persist for a long time.
  2. Loss of visual function, up to blindness.
  3. Problems with memory, hearing, concentration.
  4. Convulsive seizures.
  5. Disorder of the psyche and consciousness, manifested by auditory and visual hallucinations

Severe brain damage includes:

  • coma;
  • complete inability to mental activity, loss of all brain functions, inability to self-service;
  • paralysis of the whole body or its individual parts.

According to the protocol, resuscitation measures are performed within 30 minutes, if during this time it is not possible to restore the activity of the heart, biological death is officially recorded.

Ideally, it is advisable to start the heart before the expiration of 7 minutes after stopping, but it is not always possible to do this at such times, therefore the state of clinical death often leads to the development of the following complications:

  • various disorders of brain activity;
  • foci of ischemia (circulatory disorders) in the kidneys, brain, liver.

In patients who survived clinical death, in most cases memory, hearing, and vision are not restored, and it is difficult to perform basic household skills. The formation of foci of ischemia can lead to renal and liver failure and the development of other pathologies. Due to serious disturbances in cerebral circulation, some patients fall into a coma and do not regain consciousness even after the heart begins to work.

Sudden Infant Death Syndrome

Sometimes isolated cases of death of healthy breast babies are recorded at night in a dream, with no apparent reason at the age of 2 to 5 months. The cardiac arrest in a newborn is explained by the following reasons:

  • insufficient physiological maturation of the cardiovascular system of the newborn;
  • the birth of a child from multiple pregnancy;
  • transferred hypoxia inside the womb is one of the common causes of sudden cardiac arrest in the fetus;
  • oxygen deficiency during childbirth;
  • early birth occurred, the baby is premature;
  • infectious damage to the unborn embryo or baby in the first weeks of life;
  • abnormal development of the fetus in the womb;
  • pregnancy proceeding with pathologies.

There are a number of factors contributing to cardiac arrest in young children:

  • smoky, stale, hot air in the room of a sleeping child;
  • the baby is sleeping on his stomach;
  • the bed is very soft, the child falls into it, it is covered with a fluffy blanket, sleeping on a pillow;
  • a young inexperienced mother puts the baby to sleep next to her, she may accidentally crush him in a dream;
  • parents drink alcohol, can not adequately monitor the baby.
Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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