Heart failure - Causes, symptoms and treatment. MF.
Causes of
Symptoms of cardiac arrest
How to determine if the heart has stopped
FIRST AID
Post-anesthesia
Complications and prognosis
Cardiac arrest is a complete cessation of cardiac activity caused by various factors and leading to a clinical( possibly reversible) and then biologicalirreversible) death of a person. As a result of the cessation of the pumping function of the heart, circulation of blood through the body stops and oxygen starvation of all human organs, especially the brain, occurs. In order to "start" the heart again, the caregiver does not have more than seven minutes, because after this time from the cardiac arrest, an irreversible brain death occurs.
Causes of cardiac arrest
Such a dangerous condition can occur because of heart disease, and then it is called sudden cardiac death, or diseases of other organs.
1. Cardiac( cardiac) diseases that can lead to cardiac arrest in 90% of all cases are its cause. These include:
- life-threatening disorders of the heart rhythm - paroxysmal ventricular tachycardia, frequent ventricular extrasystole, asystole( absence of contraction) of the ventricles, electromechanical ventricular dissociation( single unproductive contractions),
- Brugada syndrome,
- coronary heart disease - in about half of patientswith IHD there is a sudden cardiac death,
is an acute myocardial infarction, especially with the development of a complete blockade of the left bundle of the bundle,
- pulmonary thromboembolism
- rupture of the aortic aneurysm,
- acute heart failure,
- cardiogenic and arrhythmogenic shock.
2. Risk factors that increase the likelihood of sudden cardiac arrest in people with existing cardiovascular diseases:
is over 50 years old, although heart failure can develop in young adults,
- smoking,
- alcohol abuse,
- overweight,
- excessive physical activity,
- overwork,
- strong emotional experience,
- arterial hypertension,
- diabetes,
- increased cholesterol in the blood.
3. Extracardiac( out-of-cardiac) diseases:
- severe chronic diseases at later stages( oncological processes, respiratory diseases, etc.), natural old age,
- asphyxia, asphyxiation due to ingested foreign body in the upper respiratory tract,
- traumatic,anaphylactic, burn and other types of shock,
- poisoning with drugs, drugs and surrogates of alcohol,
- drowning, violent causes of death, injuries, severe burns, etc.
4. Specialmania deserves sudden infant death syndrome( SIDS), or the death of a baby "in the cradle."This is the death of a child under the age of one year, often about 2 to 4 months, due to cardiac arrest and breathing at night during sleep, without any previous serious health problems that could lead to death. Factors that increase the risk of sudden child death include:
- the position during a night's sleep on the stomach,
- sleep on too soft bed, on fluffy underwear,
- sleep in a stuffy, hot room,
- mother's smoking,
-preterm delivery with low fetal weight,
- multiple pregnancy,
- intrauterine hypoxia and fetal development delay,
- family predisposition if other children in the same family died for the same reason,
- transferred infections onfirst months of life.
Symptoms of cardiac arrest
Sudden cardiac death develops against a background of general well-being or a slight subjective discomfort. A person can sleep, eat or go to work. Suddenly, he gets sick, he grabs his hand on the chest with his left, loses consciousness and falls. From the usual loss of consciousness, cardiac arrest is distinguished by the following symptoms:
- lack of pulse on carotid arteries on the neck or on the femoral arteries in the groin,
- lack of respiration or agonistic respiratory movement for several seconds after cardiac arrest( no more than two minutes) - rare, short, convulsive, wheezingsighs,
- lack of pupillary response to light, normally the pupil constriction diminishes when light enters it,
- the sharp pallor of the skin with the appearance of cyanotic staining on the lips, face, ears, limbs or allbody.
It looks like this: a person fell unconscious, not reacting to shouting or braking, turned pale and blue, wheezed and stopped breathing. After 6 - 7 minutes, biological death will develop. If a person stops his heart in a dream, he looks peacefully asleep until he finds out that it can not be awakened.
The second option is more unfavorable, as those around can erroneously believe that a person is just asleep, and, accordingly, do not consider it necessary to take any measures to save a person's life. It also happens with young children, whose mothers see that the child is sleeping peacefully in his crib while biological death has already begun.
Diagnosis
About 2/3 of all cases of cardiac arrest occur outside the walls of medical institutions, that is, in everyday life. Therefore, in most cases, ordinary people who are not directly related to medicine are witnesses of such a dangerous condition. Nevertheless, any person should know how to recognize cardiac arrest and what activities need to be carried out. By this you, perhaps, save your life not only to your relative, but to a stranger on the street.
If you see that a person has lost consciousness, it is necessary to conduct a quick inspection:
- Slap him on the cheeks, loudly hail, pull him by the shoulder, and assess whether he reacts to it. It is possible that a person simply fainted.
- It should be assessed whether independent normal breathing is present, simply by applying the ear to the chest and listening to whether it breathes or bringing your cheek to the nostrils of the patient by tilting his head back and pushing the jaw to feel or hear his breathing, or see the movements of the chest. Do not waste precious time looking for a mirror, to attach it to the lips of the victim and see if it sweats from the breath that is exhaled from the mouth, as indicated in some pre-hospital care benefits.
- Feel the carotid artery on the neck between the angle of the lower jaw, the larynx and the neck muscle or the femoral artery in the groin. If there is no pulse, start an indirect heart massage. Do not waste time looking for peripheral arteries on the wrist, a reliable criterion for cardiac arrest is the lack of pulse only on large arteries.
All actions must be performed clearly, smoothly and quickly. An assessment of the severity of the condition and the initiation of resuscitation should be performed within the for 15 to 20 seconds of .In parallel, it is necessary to call for help and ask the people present to call an ambulance on the phone "03".
First aid and treatment
Provision of first urgent first aid for cardiac arrest
The victim is placed on a hard surface. After establishing the fact of cardiac arrest, immediate resuscitation should be started according to the ABC algorithm:
- A( air open the way) - restoring airway patency. To do this, the caregiver must wrap his finger with a piece of tissue, push the lower jaw of the victim forward, throw his head back and try to eliminate possible foreign bodies in the oral cavity( vomit, mucus, remove the sunken tongue, etc.).
- B( breath support) - artificial lung ventilation by mouth-to-mouth or mouth-to-nose. In the first technique, the patient's nose should be clamped with two fingers and start blowing air into his mouth, controlling the effectiveness of the movements of the chest - lifting the ribs when filling with air and lowering with a passive "expiration" of the patient. It is acceptable to use a thin napkin or a handkerchief applied to the lips of the victim to exclude direct contact with his saliva. According to the latest recommendations, the caregiver has the right not to contact the affected person's biological fluids, such as saliva, blood in the oral cavity, to avoid harm to the health of the caregiver, for example, the threat of contracting tuberculosis, HIV infection in the presence of blood in the oral cavity, etc. Moreover, it is more important for the brain to quickly provide access to blood vessels to his vessels with the help of heart massage, rather than begin ventilation of the lungs.
- With( circulation support) - closed cardiac massage. Specialists before the beginning of cardiac massage apply a precardial punch to the sternum from a distance of 20 to 30 cm. However, it is effective only during the first 30 seconds from the moment of cardiac arrest and is dangerous by fracture of the ribs and sternum. Therefore, it is better not to apply a precordial blow to a person who is not a medic. Moreover, Western doctors - reanimatologists believe that the stroke is useful only with ventricular fibrillation, and with asystole may be dangerous.
Heart massage is performed as follows. It is necessary to visually determine the lower third of the sternum by measuring the distance to two transverse fingers above its lower edge, to connect the fingers of the hands to the lock, placing one hand on the other, placing the brushes of straightened hands on the third of the sternum and starting rhythmic compression of the chest with a frequency of 100 per minute. In the presence of a single reanimator, the frequency of pressing the sternum and the frequency of air injection into the lungs is 15: 2, and in the presence of two resuscitators - 5: 1.In the latter case, the resuscitator carrying out pressing on the sternum should read the number of clicks aloud, after every fifth - the first resuscitator carries out one blowing of air.
Important: should be kept in the straightened state, and compression should be performed in such a way as to avoid accidental fracture of the ribs, as this negatively affects the intrathoracic pressure, which is crucial in the effectiveness of heart massage. To increase passive flow to the heart, the lower extremities bent in the groin can be raised 30-40 ° above the surface.
The described measures continue until a pulse appears on the carotid arteries, there is no independent breathing or until the patient regains consciousness. If this does not happen, continue to reanimate the victim should be before the arrival of an ambulance or within 30 minutes, since after this time biological death occurs.
Medical assistance for cardiac arrest
Upon arrival of the medical care team, the administration of medications( epinephrine, noradrenaline, atropine, etc.), electrocardiogram or cardiac diagnosis using a monitor when applying defibrillator electrodes and defibrillation-electric discharge to start and restoreheartbeat. The conducted measures are in the ambulance on the way to the intensive care unit of the hospital.
Further way of life
A patient who has undergone heart failure and survivor should be kept in intensive care for a while, and then carefully examined in the cardiological department of the hospital. At this time, the cause of cardiac arrest is established, the optimal treatment is selected to prevent the repeat of this condition, and the question of the necessity and implantation of an artificial pacemaker in the presence of cardiac rhythm disturbances is also solved.
After discharge from the hospital, the patient must be careful in everyday life - to abandon bad habits, eat right, avoid stress and excessive physical exertion, constantly take medication prescribed by the doctor.
For the prevention of sudden infant death syndrome, the parents of an infant should follow the following recommendations: to lay the baby on a night's sleep in a well-ventilated room, on a bed with a solid mattress, without pillows, duvets and without toys in the crib. Do not swaddle the baby tightly at night, as this fetters his movements, prevents him from taking a comfortable pose during sleep and prevents spilling when breathing stops in sleep( night apnea).Do not put the baby to sleep on your stomach. Some experts believe that joint sleep significantly reduces the risk of death in the cradle, as the child feels the mother nearby, and the tactile sensations of the skin have a beneficial effect on his respiratory and cardiovascular center in the brain. Of course, parents should not smoke, drink alcohol or drugs, so as not to lose their vigilance and sensitivity during the night sleep of the baby.
Complications of cardiac arrest
The possibility of development of consequences after cardiac arrest depends on the time during which the brain was in a state of acute shortage of oxygen. So, if restoration of vital functions was carried out within the first 3.5 minutes, the functions and subsequent activity of the brain, most likely, will not suffer. In the case of a longer hypoxia of the brain( 6 to 7 minutes or more), neurologic symptoms may develop, from mild to severe brain damage in post-resuscitative disease.
Mild to moderate disorders include memory loss, decreased vision and hearing, persistent headaches, convulsive syndrome, hallucinations.
Post-anesthetic disease develops in 75 to 80% of cases of successful resuscitation after cardiac arrest. In 70% of patients with this disease, there is a lack of consciousness for no more than 3 hours, and then a complete restoration of consciousness and mental functions. Some patients experience severe brain damage, coma and a subsequent vegetative condition.
Prognosis for
The prognosis for cardiac arrest is unfavorable, as about 30% of patients survive, and only in 10% complete restoration of body functions is possible without adverse consequences.
The chances for a patient's survival are significantly increased if first aid is provided in a timely manner and cardiac activity was restored within the first three minutes after cardiac arrest.
Doctor therapist Sazykina O.Yu.