1 Overview
Sudden death due to acute myocardial infarction is defined as a natural death with sudden loss of consciousness as a prodrome that occurs within a short time after an acute myocardial infarction. It can occur out of hospital or among survivors of acute myocardial infarction during hospitalization. Feng Baolin, Department of Cardiovascular Medicine, Second People’s Hospital of Neihuang, Henan Province, China
In patients with acute myocardial infarction, plaque rupture in the coronary arteries, secondary thrombosis or vasospasm can lead to acute blockage of the coronary arteries, which can cause acute cardiac insufficiency, cardiogenic shock, heart rupture and even fatal arrhythmias. Among these fatal arrhythmias such as ventricular tachycardia and ventricular fibrillation are closely related to the patient’s own autonomic dysfunction, but their effects depend on the superposition of other pathological and physiological factors. We know that an excessive increase in sympathetic activity on the basis of myocardial ischemia can promote ventricular malignant arrhythmias. In contrast, vagal tone is increased and has antifibrillatory effects. Among survivors of acute myocardial infarction during hospitalization, survivors of myocardial infarction patients tend to have low cardiac ejection fraction or complex ectopic excitation, and when combined with autonomic dysfunction, they have the highest risk of arrhythmogenic or non-arrhythmic sudden death.
In cardiovascular patients, especially after experiencing chest pain with l death sensation, it leaves a deep and indelible shadow on each patient’s psyche, resulting in most patients having anxiety symptoms, not only having stubborn sleep disorders and palpitations, but some patients even fear that they will never wake up once they go to sleep, so they dare not go to sleep, and this serious fear of sudden cardiac death can occur at any time. According to the statistics of our cardiology department, more than 90% of all hospitalized patients with acute myocardial infarction have autonomic dysfunction. Although some do their best to conceal it on the surface, autonomic dysfunction is actually present to varying degrees, manifested by excessive concern for their physical condition, involuntary convulsions during sleep, and involuntary twitching. The presence of autonomic dysfunction in patients with acute myocardial infarction not only directly affects the heart, but also causes restlessness in patients, severely burdens the heart, increases myocardial oxygen consumption, aggravates the condition, and even results in events such as malignant arrhythmias and heart rupture. Autonomic dysfunction has now become an independent correlate of increased risk in patients with acute myocardial infarction.
2 Measures
1) Strengthening psychological care
In the clinic, medical staff should communicate more with patients to reduce the psychological burden, let patients understand that their disease is not incurable, and establish the confidence to overcome the disease. In addition, we should seek the cooperation of family members and give affectionate care to minimize the occurrence of autonomic dysfunction and sudden death.
2) Minimize visitation and maintain a stable state of mind
Patients may have complex social relationships before the disease. Some relationships are more intimate with the patient, and the words will make the patient suddenly affectionate sprout, autonomic dysfunction, neuroendocrine dysregulation, affecting the recovery of heart patients, and even sudden death. There was a female acute myocardial infarction patient, his daughter from a distance to visit, emotional, ventricular fibrillation and died. In addition, some visitors are not lacking for the patient’s abhorrence, if the emotional control, the consequences are unimaginable. A male acute myocardial infarction patient, a colleague came to visit, because of the usual discord, new hatred and old hatred on the heart, the result is a death. Therefore, try to avoid visits during the patient’s hospitalization, and do not mention economic problems in front of the patient, so that he can maintain a peaceful state of mind, which is beneficial to the patient’s recovery.
3 Drug treatment
In order to reduce the occurrence of sudden death in patients with acute myocardial infarction, B-blockers, which have anti-arrhythmic and anti-ischemic properties, can be applied clinically to reduce the overall mortality rate and the incidence of sudden death after acute myocardial infarction. Amiodarone can also reduce arrhythmic death, and this product has good reliability and safety, complementing the efficacy of the above drug. In addition, if the patient has autonomic dysfunction, anxiolytic drugs and sedative drugs must be used to reduce the occurrence of sudden death to a greater extent.
4) Others
During the treatment of acute myocardial infarction, other measures including myocardial blood flow reconstruction and implantation of cardioverter-defibrillation devices are also required.