sudden death
Introduction
Introduction to sudden death In 1979, the International Society of Cardiology, the American Heart Association, and the 1970 World Health Organization defined sudden death as an immediate death or an unexpected death within 24 hours. The post-World Health Organization has determined that the deaths within 6 hours after the onset of illness are sudden death. At present, most scholars tend to limit the time of sudden death to within 1 hour of onset. It is characterized by sudden death, unexpected, natural or non-violent death, and the death is unclear. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: sudden cardiac death in the elderly, premature beats, convulsions and convulsions
Cause
Sudden cause
Coronary heart disease (30%):
It is the most common cause of sudden death. Coronary atherosclerotic heart disease is a coronary artery angiogenic atherosclerotic lesion that causes stenosis or obstruction of the vascular lumen, causing heart disease caused by myocardial ischemia, hypoxia or necrosis, often referred to as "coronary heart disease."
Myocarditis (20%):
Severe myocarditis can have diffuse myocardial lesions, leading to cardiogenic shock and sudden death. Myocarditis refers to inflammatory lesions of the myocardium caused by various causes. A variety of factors such as infection, physical and chemical factors can cause myocarditis, the degree of myocardial damage varies greatly, clinical manifestations vary, mild patients without any symptoms, and severe patients can develop heart failure, cardiogenic Shock even drowned.
Primary cardiomyopathy (10%):
The lesion is mainly invading the ventricle and may also involve the heart conduction system.
Rheumatic heart disease (10%):
Approximately 25% of patients with aortic stenosis can cause sudden death.
QT interval prolongation syndrome (5%):
Including congenital deafness, the common cause of secondary is hypokalemia, quinidine, amiodarone drugs.
Mitral valve prolapse syndrome (5%):
Often cause a rapid arrhythmia.
Congenital heart disease - coronary artery malformation (3%):
For example, the left coronary artery originates from the right coronary sinus or is connected to the right coronary artery.
Pre-excitation syndrome with atrial fibrillation (3%):
When the refractory period of the bypass is shorter, the more likely it is to become a malignant arrhythmia - ventricular fibrillation and sudden death.
Sick sinus syndrome (3%):
Due to coronary disease, myocarditis, cardiomyopathy, sinus node ischemia, degeneration, sinus node ischemia, necrosis, fibrosis.
Prevention
Sudden death prevention Pay attention to proper rest, do not master the combination of movement and rest, rest well, is conducive to the recovery of the body; exercise can enhance physical strength and enhance disease resistance, and the combination of the two can better recover. In order to reduce the incidence of sudden death, it is recommended that patients in the acute phase of myocardial infarction should not do rapid exercise of cutting magnetic lines to reduce the occurrence of arrhythmia and sudden death.
Complication
Sudden death complications Complications in the elderly, sudden cardiac death, premature convulsions and convulsions
If the rescue is not timely, it will lead to death, and premature beats and convulsions may occur.
Symptom
Sudden death symptoms common symptoms dyspnea arrhythmia fatigue dying to light reaction disappears sputum abnormalities
There may be no warning before the death, some patients have mental stimulation or mood swing before sudden death, some have pain in the precordial area, and may be accompanied by dyspnea, palpitations, extreme fatigue, or manifest as acute myocardial infarction with room Premature beats. When sudden death occurs, the heart loses effective contraction for 4-15 seconds to have fainting and convulsions, and the breathing slows down rapidly and becomes shallow, so that it stops. The heart sound disappeared, the blood pressure side was not enough, the pulse could not be touched, the skin appeared purpura, the pupil was dilated, and the reaction to light disappeared. Some patients can make abnormal snoring before death, but some can die quietly during sleep.
Examine
Sudden death check
First, for patients with sudden cardiac death
Generally, obvious incentives can be checked:
1 External incentives include overwork, emotional agitation, alcoholism, and excessive smoking.
2 Intrinsic incentives include cardiac insufficiency, angina pectoris, and internal environment disorders.
Second, ECG examination
(1) Electrocardiogram examination, the following three performances can occur:
1 ventricular fibrillation (or flutter) wave pattern.
2 ventricular arrest, ECG straight line or only atrial wave.
3 ECG mechanical separation, ECG showed a slow deformed QRS wave, but did not produce effective myocardial mechanical contraction.
(2) atypical ECG changes
The main changes in early ECG are:
1 huge towering T wave, combined with clinical can make an early diagnosis.
2 Progressive ST segment changes, the early ST segment becomes straight, and the upward oblique elevation can reach 0. 1 mV or more), and the straight ST segment is connected to the towering T wave to form a so-called "high-sensitivity T wave", ST segment Progressive changes can develop into a one-way curve with the back of the bow.
3 Early QRS wave changes, due to the acute myocardial depolarization delay, "acute injury block", VA T 0. 45 seconds, QRS time limit can be extended to 0. 12 seconds, and often R wave amplitude increased, there are also significant depression .
Diagnosis
Sudden death diagnosis
Differential diagnosis
It is clinically necessary to identify sudden death caused by other causes:
(1) Heart disease
Coronary heart disease is the most common cause of sudden death in the elderly. The literature shows that the average incidence of sudden death from coronary heart disease in China is 28.7/100,000, accounting for 45.1% of the total mortality of coronary heart disease. These deaths are often severely blocked in the trunk or branches of the coronary arteries. They are often under-recognized or restricted by medical conditions. Many people have not done an electrocardiogram or coronary angiography and have not been diagnosed. The disease has not been treated in a timely and effective manner. Often under certain causes, acute large-area myocardial infarction can easily lead to sudden death. In addition, other heart diseases, such as myocardial ischemia, aortic dissection, aortic stenosis, malignant arrhythmia, etc., are also the cause of sudden death.
(2) pulmonary embolism
Due to the continuous improvement of inspection methods, combined with the autopsy of the deceased, in recent years, the incidence of pulmonary embolism is getting higher and higher, and it plays an important role in the cause of sudden death in the elderly. Because most of the elderly have hypercoagulable state, a considerable number of patients have varicose veins, phlebitis or thrombosis of the lower extremities. Some patients have long bedtime, less activity, and are prone to pulmonary embolism. Once a blockage of the larger branch of the pulmonary artery occurs, fatal consequences can occur and the success rate of rescue is low.
(3) cerebrovascular disease
Mainly brain hemorrhage. Most patients with cerebral hemorrhage have a basis for vascular disease, and hypertension, diabetes, and atherosclerosis are common causes. Under the stimulation of emotions, alcohol and tobacco, it can often cause a sharp rise in blood pressure, resulting in rupture of blood vessels. The amount of bleeding is less urgent and sent to the hospital for treatment, which can save life. However, many patients, due to the large amount of bleeding, form cerebral palsy, oppress the life center, and will soon die. Therefore, when a patient has a threat such as headache or nausea, he must pay attention to it.
(4) Digestive diseases
Among them, hemorrhagic necrotizing pancreatitis causes more sudden death, and upper gastrointestinal bleeding can also cause sudden death. Patients with gastrointestinal bleeding often have a history of esophageal varices, peptic ulcers, large doses of medication, or stress. Sudden bleeding at night causes shock or vomit to block the throat and cause suffocation, etc., which is often the main cause of sudden death from upper gastrointestinal bleeding.
(5) hypoglycemia
It is also common for elderly diabetic patients to die suddenly due to severe hypoglycemia at night. The reason is that a considerable part of elderly diabetic patients are not treated properly, or do not eat in time after receiving hypoglycemic agents; some patients have large changes in blood glucose levels, and hypoglycemia often occurs at night. Once severe hypoglycemia occurs, due to inhibition of the central nervous system and sympathetic nervous system at night, the vagus nerve tension is too high. If -blockers are used at the same time, the stress ability will be further reduced, and factors such as deep sleep will often cause palpitation. Typical symptoms of hypoglycemia such as hunger and sweating are not easily noticeable and cause sudden death.
