What is sudden death?
Sudden death is the sudden, nonviolent, unanticipated, instantaneous, natural death of a patient who appears to be healthy and stable or improving. Sudden death has a sudden onset and rapid progression, with death occurring within one hour of the onset of symptoms.
Is sudden death a rare condition?
No, it is not. Sudden death occurs every day and can affect not only the elderly, but nowadays young people and even teenagers and children die suddenly repeatedly, and sudden death of athletes often occurs in sports arenas. We are familiar with Hyman, Gu Yue, Gao Xiumin and others who died one after another due to sudden cardiac death.
According to American statistics, sudden death accounts for 20% of all deaths from various causes, including car accidents, suicides, and malignant tumors, and is the second leading cause of death after tumor deaths (23%).
Seventy-five percent of sudden deaths are sudden cardiac deaths. In turn, 88% of sudden cardiac deaths are caused by malignant ventricular arrhythmias. In the United States, there are 2.5-3.5 million sudden cardiac deaths each year, and in China, according to incomplete statistics, there are 1.6 million sudden cardiac deaths each year.
Who is prone to sudden death?
The rate of sudden death in people with heart disease is 4-6 times higher than in the general population. Sudden cardiac death can occur in various heart diseases, among which coronary heart disease, heart failure, hypertrophic cardiomyopathy, hereditary ion channel disease, congenital heart disease, etc. are the most common.
1, coronary heart disease is the most common cause, autopsy confirmed that 90% of sudden cardiac death patients have coronary heart disease, while more than 50% of sudden cardiac death patients do not have clinical manifestations of coronary heart disease before sudden death occurs.
2, heart failure patients are prone to sudden death, and about 50% of heart failure patients die in the form of sudden death.
3, hypertrophic cardiomyopathy is the most common cause of sudden cardiac death under 35 years of age. Patients with hypertrophic cardiomyopathy in young or children who have repeated unexplained syncope have a high incidence of sudden cardiac death.
4, some hereditary ion channel disease, such as long QT syndrome, Brugada syndrome is also the main manifestation of recurrent malignant ventricular arrhythmias, sudden death, of which Brugada syndrome is the most common cause of sudden death in young men in Southeast Asia.
5, previous sudden cardiac death is prone to recurrence of sudden cardiac death. 30%-50% of survivors of sudden cardiac death may experience sudden death again within 1 year.
Of course, sudden death also often occurs in seemingly healthy young people and even children, and the tragedy of sudden death in athletes often occurs in the sports arena. Sudden death can also occur suddenly in seemingly healthy people due to a number of triggering factors.
Are there any triggers for sudden death? What triggers can cause sudden death?
Yes, there are. Sudden death can be triggered by excessive stress and fatigue, violent mood swings, continuous smoking, staying up late, prolonged bathing in too high a water temperature, straining to defecate, overeating, and cold weather. There are also some ion channel diseases such as long QT syndrome, which may be triggered by strenuous activities, ringing telephone at night, swimming, etc. Sudden death may be triggered. In addition, early morning is the high incidence of sudden death.
Are there any precursors before sudden death?
Yes. Most patients have signs days or even months before sudden cardiac death, i.e. chest tightness, chest pain, breath-holding, dizziness, panic, shortness of breath, heavy sweating, weakness, etc. Some patients also have similar digestive manifestations: nausea, vomiting, diarrhea.
What should I do if these auras appear?
Once these aura appear, you should go to the regular hospital immediately or early, otherwise irreversible tragedy may occur. Just a few days ago, an 86-year-old female patient in our hospital developed general discomfort with chest tightness and pressure, and was considered to have unstable angina, and was advised to be hospitalized immediately. -The first bout of ventricular tachycardia lasted for 10 seconds and returned to sinus rhythm on its own, while the second bout of ventricular tachycardia was induced by a particularly early ventricular tachycardia (R on T phenomenon) and rapidly metamorphosed into ventricular fibrillation, with the ventricular fibrillation wave becoming progressively weaker, and finally cardiac arrest and death, which lasted for a total of 13 minutes from the onset of ventricular tachycardia to death.
Once the above symptoms occur in young people, sudden death is more likely to occur than in older people; and young people work under great pressure and at a fast pace, they often ignore the aura symptoms, thinking that they are tired or not well rested at work, which leads to tragedy. Therefore, remind the majority of young and middle-aged friends must be alert to the above symptoms, once they appear, should be rushed to the regular hospital as soon as possible for examination and timely treatment.
What should be done when a bystander finds a patient with sudden death?
On-site CPR and electric defibrillation (if there is a defibrillator around) should be performed immediately in a race against time. The earlier a patient in cardiac or respiratory arrest is detected, the earlier CPR can be started and the higher the survival rate will be. Three seconds after ventricular fibrillation or cardiac arrest occurs, a person feels dizzy due to lack of oxygen to the brain; 10-20 seconds later, loss of consciousness occurs; and 6 minutes later irreversible damage to brain cells occurs and the person enters the brain death phase. Time is life, every minute of delay, the success rate of resuscitation decreases by 7-10%, so the resuscitation must be every second. Generally, the best golden rescue time is 4 to 6 minutes, if not rescued within 6 minutes, the patient then enters the biological death stage, the hope of survival is extremely slim.
Once encountered with sudden death, people often seem to be confused, panic, the first reaction is to call 120, but this approach will delay the patient’s rescue, miss the best time to rescue, is a big misunderstanding of the rescue of sudden death.
For patients in cardiac arrest, we should not rush to the hospital “every second”, but should immediately carry out resuscitation in situ. Quickly undo the patient’s shirt and use your fist to hit the heart 1-2 times (for some defibrillation), and the heartbeat may be restored. If several punches are ineffective, immediately switch to chest cardiac compressions and artificial respiration. While administering first aid, the person next to you should immediately call the 120 emergency number for hospital assistance for further defibrillation and advanced CPR treatment, because ventricular tachycardia can easily metamorphose into ventricular fibrillation, and ventricular fibrillation can easily become cardiac arrest, and defibrillation is the only effective treatment, and defibrillation must be effective during ventricular tachycardia and ventricular fibrillation.
Can sudden death be prevented?
Yes. Because once sudden death occurs, the chances of successful resuscitation are very low. The United States, which has the highest level of sudden death, has 2.5 to 3.5 million sudden cardiac deaths each year, and has invested a great deal of work and money in sudden death research, but only 5% of these patients are lucky enough to survive. Simple prevention, on the other hand, can significantly reduce the incidence of sudden death.
How to prevent it?
1. Regular medical checkups. Whether heart patients or people who feel healthy, they should have regular medical checkups. To find some patients with potential risk of sudden cardiac death, such as Brugada syndrome, long QT syndrome and other patients, can be detected by general electrocardiogram examination or electrophysiological examination.
2. Develop the habit of seeking medical attention in a timely manner. Especially in winter, when the number of episodes of chest tightness and chest pain increases, the degree of aggravation or the duration of prolongation, it should attract sufficient attention, immediately go to the doctor, preferably to do coronary angiography, according to the results of the angiography and then develop a treatment plan, so that it can largely avoid serious consequences.
3.Healthy lifestyle.
(1) Balanced diet: eat more coarse grains and vegetables rich in plant fiber, increase the intake of vitamins, control sweets, low-salt diet, eat less fried, fried, smoked, baked and pickled foods, and meals should not be too full. Control weight to prevent obesity.
(2) quit smoking: the incidence of coronary heart disease in smokers is 3.6 times higher than in nonsmokers. Continuous smoking can directly lead to sudden death.
(3) Avoid excessive mental stress: mental stress can raise blood pressure and increase the burden on the heart. Excessive mental tension can also induce arrhythmias, and emotional agitation in the elderly can easily induce myocardial infarction, cerebral hemorrhage, cerebral infarction and other accidents.
(4) Regular life, regular living: wake up on time, eat regularly, exercise in moderation, sleep on time, rest properly, and pay attention to the combination of work and rest.
(5) moderate exercise, avoid excessive: moderate physical exercise can improve cardiovascular function, so that the body’s blood circulation and microcirculation is improved. Walking is the easiest and safest exercise.
(6) It is important to keep warm in cold weather to avoid getting cold; it is not advisable to drink a lot of cold drinks quickly to avoid inducing coronary artery spasm.
(7) Keep your bowels open. Avoid the sudden death of myocardial ischemia induced by forceful bowel movement.
(8) Carry first-aid drugs with you. Such as aspirin, nitroglycerin and other drugs, once it happens, you can immediately shed nitroglycerin and immediately chew 0.3g aspirin tablets.
4. Patients who feel uncomfortable and are not convenient to be hospitalized can have telemetry ECG monitoring (telephone ECG), which enables timely transmission of ECG signals to doctors when they are uncomfortable and gives professional diagnosis and treatment strategies.
What should doctors and society do?
Doing effective CPR resuscitation before taking to the hospital can greatly increase the success rate of resuscitation and reduce the risk of death. Since danger and disaster may strike at any time, it is important to promote and popularize CPR methods and related first aid knowledge. In China, the lack of first aid knowledge related to sudden death has become a common phenomenon. It is urgent to popularize the relevant knowledge and improve the first aid measures in some important places (such as external automatic defibrillators). At the same time, placing external automatic defibrillators in some important public places such as airports, train stations, movie cities and large shopping centers, and providing training on CPR and defibrillation to police officers, firefighters, taxi drivers and ordinary citizens can improve the success rate of sudden death rescue and save more patients and families from disaster.