For the first time, sudden unexplained death syndrome in adults (SIDS) began to stand out as an independent disease in the 80s of the twentieth century, when American Center Disease control in Atlanta (USA) recorded an unusually high (25 per 100,000 people) rate of sudden death in young people, mainly from Southeast Asia. Death occurred mainly at night; autopsy did not reveal damage to the heart muscle or coronary vessels. Almost all of the dead were men between 20 and 49 years old. Moreover, in most cases, young people did not have overweight, they did not abuse smoking, alcohol, or drugs.
When comparing these data with statistical data accumulated in the countries of Southeast Asia and the Far East, it was noted that cases of sudden night death V at a young age(per year from 4 to 10 cases per 10,000 inhabitants, including in Laos - 1 case per 10,000 inhabitants; in Thailand - 26-38 per 100,000). Interestingly, this disease has hardly been described in African-Americans.
The first description of SVNS in medical literature appeared in 1917 in the Philippines, where it was called bangungut. In 1959, a report from Japan named the syndrome pokkuri. He was written about in Laos, Vietnam, Singapore and throughout Asia.
In 65% of cases, death occurs in front of witnesses; the remaining victims are found in sleeping and resting positions. In cases where people were present, 94% of deaths were observed within an hour of the onset of the agony. Immediately before death, all of his victims do not show any somatic complaints, so their tragic sudden death is a real shock for loved ones. Most victims of the syndrome die from ventricular arrhythmia, sometimes after several minutes of agony. Witnesses describe how the person initially sleeps normally, but then, out of the blue, begins to moan, wheeze, snore strangely, gasp, and ultimately dies. Attempts to wake a person in most cases are futile.
Accumulated to date medical facts With high degree probabilities indicate that SVNS most likely represents not one, but several diseases. In modern clinical medicine a number of diseases and syndromes have been identified that are closely associated with high risk sudden death at a young age. These include sudden infant death syndrome, long QT syndrome, sudden unexplained death syndrome, arrhythmogenic right ventricular dysplasia, idiopathic ventricular fibrillation, Brugada syndrome and a number of others.
Taking into account the fact that the probability of SVNS among family members of the deceased is about 40%, which allows us to hope for the identification of specific genetic markers this group of diseases. Thus, the inheritance of Brugado syndrome presumably has an autosomal dominant path with damage to the SCN5a gene on the 3rd chromosome. The same gene is affected in patients with the third molecular genetic variant of long QT interval syndrome (LQT3) and Lenegra syndrome - diseases also associated with a high risk of sudden arrhythmogenic death.
At present it is sufficiently defined large number risk factors that increase a person's likelihood of developing sudden cardiac arrest and sudden coronary death. Risk factors for development coronary disease hearts are smoking, cardiovascular diseases in the family history and increased level cholesterol.
Risk factors for sudden cardiac arrest?
At all times, people have been interested in: why does a person die? In fact, that's enough interesting question, to answer which we can consider several theories that can shed light on this situation. There are many on this topic different opinions, but in order to understand what death is and why a person is susceptible to it, it is necessary to uncover the mystery of old age. At the moment, a large number of scientists are struggling to solve this problem; completely different theories are being put forward, each of which, one way or another, has the right to life. But, unfortunately, none of these theories have been proven at the moment, and this is unlikely to happen in the near future.
As for opinions on the question “Why does a person die?”, they are all as diverse as they are similar. What these theories have in common is that natural death always comes with old age. A certain circle of scientists is of the opinion that old age as such begins at the moment of the emergence of life. In other words, as soon as a person is born, the invisible clock begins its reverse movement, and when the dial goes to zero, the person’s presence in this world will also cease.
There is an opinion that until a person reaches maturity, all processes in the body occur in the active stage, and after this moment they begin to fade away, along with this the number of active cells decreases, which is why the aging process occurs.
As for immunologists and some gerontologists who tried to find an answer to the question “Why does a person die?”, then, from their point of view, with age, autoimmune phenomena intensify in a person against the background of a decrease in the reaction of cells, which, in essence, leads to What immune system the body begins to “attack” its own cells.
Geneticists, naturally, say that the whole problem lies in genes, while doctors argue that human death is inevitable due to body defects that accumulate throughout a person’s life.
Thanks to scientists from the USA who conducted research on this issue, it became known that people die while in the “kingdom of Morpheus”, mainly due to respiratory arrest. This occurs mainly in older people due to the loss of cells that control the breathing process, sending signals to the body to contract the lungs. In principle, such a problem can occur among a lot of people, its name is obstructive apnea, and this problem is the main one. But there cannot be such a cause of death as obstructive apnea. This is due to the fact that the person experiencing oxygen starvation(insufficiency), wakes up. And the cause of death is central sleep apnea. It should be noted that a person may even wake up, but still die due to lack of oxygen, which will result from a stroke or cardiac arrest. But, as mentioned earlier, this disease mainly affects older people. But there are also those who die before reaching old age. Therefore, a very reasonable question arises: why do people die young?
It's worth starting with what lately approximately 16 million girls in age category from 15 to 19 years old women become pregnant. At the same time, the risks of infant death are much higher than those of those girls who crossed the 19-year-old barrier. These problems are caused by both physiological and psychological factors.
Not the least reason is poor nutrition, and this is due to both obesity and problems associated with anorexia.
Regarding bad habits, such as abuse of alcohol, nicotine, and even more so drugs, then this problem every year affects younger and younger segments of the population, who not only put their future children at risk, but also themselves.
Still, the most common cause of death among the young population is unintentional injuries. The reason for this can also be alcohol and drugs, not counting youthful maximalism, which cannot be discounted. Therefore, until teenagers reach adulthood, all responsibility for moral and psychological education lies entirely with the parents.
In fact, the question of a person’s feelings after death has worried all of humanity throughout its existence, but only recently have they begun to say with confidence that all people at the moment of death experience definitely the same feelings. This became known thanks to people who experienced clinical death. Most of them claimed that even lying on operating table, being in an immobilized state, they continued to hear and sometimes see everything happening around them. This is possible due to the fact that the brain is the last thing to die, and this happens mainly due to lack of oxygen. Of course, there are stories about a tunnel at the end of which there is a bright light, but there is virtually no reliability of this particular information.
Having delved into the problem and understood it, we can confidently answer the question: why does a person die? Quite often people ask themselves similar questions, but you shouldn’t devote your entire life to the problem of death, because it is so short that there is no time to spend it on understanding those problems for which humanity is not yet ready.
Probably many would answer the question “how would you prefer to die?” They took me away - “to fall asleep and not wake up.” Indeed, such a transition to another world can be called painless, and, perhaps, the most desirable, but... Death is a natural process; the cause of death is not always natural. Accidents, traffic accidents and much more, which often does not give a healthy person a chance to survive, who in other circumstances could well live to old age and die a natural death. If we put aside the causes of violent death, then what is the likelihood of dying in your sleep and who is predisposed to this?
There are 24 hours in a day and we spend almost a third of them sleeping. If we think logically, then the probability of dying in a dream is according to “ natural reasons"is 1 chance out of 3. The indicator is quite high, but medical luminaries are more concerned about something else. There are deaths in dreams that cannot be controlled scientific explanation and to which there is still no answer. It's called sudden and unexplained death syndrome (SUDS).
It has been noted that this phenomenon is most often observed in adults, in particular among Asian men. No one knows what this is connected with and why exactly men of a certain age and origin are susceptible to such death. In the 80s, this reason was named the main one and even took the lead, taking it away from sudden infant mortality, as a result of which children under one year died for unknown reasons.
In 1917, for the first time, information about SVNS was published in the medical literature, which occurred in the Philippines and was called bangungut. Subsequently, for unknown reasons, similar deaths began to be recorded in Japan, Singapore, Laos and throughout Asia. An interesting fact is that before death a person does not experience any symptoms indicating illness, disease or any other factors. The man is in good health, and therefore his sudden death is simply a shock to his family and friends. According to eyewitnesses, the man first sleeps peacefully, and then suddenly begins to moan, snore unnaturally, suffocate and dies. Doctors call such signs agonal or near death. Even if the family managed to wake up the unfortunate man, this did not save him from death. At a subsequent autopsy, pathologists did not find any pathologies that could lead to death, including no signs of poisoning, allergies or hidden murder.
Such an unusual phenomenon did not pass by scientists and in 1992 they conducted a two-year study in Thailand, studying the causes and likelihood of death in sleep in other groups of the population. They managed to find out the following:
All deaths from SVNS were male;
Age from 20 to 49 years;
No one was overweight;
No serious illnesses were reported during the previous year; everyone was in good health;
Alcohol, smoking, drugs or other risk factors did not threaten their lives;
Throughout the entire day preceding death, they exhibited normal performance;
After the onset of agony, the person died within 24 hours;
Although death occurred in a dream, in 63% of cases it occurred in front of relatives or friends; in other cases, men were found in positions of sleep and rest;
In 94% of cases where witnesses were present, death occurred within one hour.
When asked what the probability of sudden death among family members of the deceased was, it was found to be about 40%. In 19% of those killed, the man's relatives died the same way. It is also interesting that the occurrence of such cases fatal outcome, not the same throughout the year. The greatest peak occurs between March and May, and very rarely from September to November. This gives the impression of being a seasonal phenomenon.
The reasons why men pass away in Thailand have not yet been identified, and SIDS is considered a “potentially serious public health problem.” Along with murder, poisoning, accidents and heart attacks, the syndrome kills about 3,000 men a year, aged 20 to 50.
One of possible reasons Such death is considered to be a combination of physical and mental stress, which for some reason triggers the SIDS mechanism. But not all scientists share this point of view, because they do not find an evidence base, and therefore the reasons remain unclear.
If you do not take into account the SVNS, which according to for unknown reasons, takes the lives of a certain group of the population, then what is the likelihood of other people dying in their sleep.
If death comes at the end life path, then this is natural, but very often it threatens those who are too early to visit the “bright tunnel”. This threat is very real for people who snore in their sleep. They do not take it seriously and believe that they do not snore because they do not hear it themselves, but only learn from the words of close people.
Brief pauses in breathing during sleep are called apnea. For those who experience such phenomena, the risk of sudden death increases by 2-3 times. It is precisely these stops that “those who like to snore” are often subject to.
During sleep, a sleeping person stops breathing. Such moments can be observed up to 10 times in 1 hour! This leads to a slowdown in heart rate, the level of oxygen in the blood drops, and the oxygen level in the blood rises sharply and strongly. blood pressure, adrenaline is released. All this can provoke severe attack arrhythmias, stroke or heart attack. At such moments, it is common for a person to wake up, but, unfortunately, this does not always happen.
Do not put off visiting your doctor if you are experiencing following symptoms: you snore in your sleep; have difficulty falling asleep and sleeping; you sweat a lot; often get up at night to go to the toilet; During the day you feel overwhelmed.
Don't rush to die - you still have a lot to do on earth!
Sudden cardiac death (SCD) is one of the most severe cardiac pathologies, which usually develops in the presence of witnesses, occurs instantly or in a short period of time and has as the main cause the coronary arteries.
The factor of surprise plays a decisive role in making such a diagnosis. As a rule, in the absence of signs of an impending threat to life, instantaneous death occurs within a few minutes. A slower development of the pathology is also possible, when arrhythmia, heart pain and other complaints appear, and the patient dies in the first six hours from the moment of their occurrence.
The greatest risk of sudden coronary death is observed in people 45-70 years old who have some form of disturbances in the blood vessels, heart muscle, and its rhythm. Among young patients, there are 4 times more men; in old age, men are susceptible to pathology 7 times more often. In the seventh decade of life, gender differences are smoothed out, and the ratio of men and women with this pathology becomes 2:1.
Most patients with sudden cardiac arrest occur at home; a fifth of cases occur on the street or in public transport. In both places there are witnesses to the attack who can quickly call an ambulance, and then the likelihood of a positive outcome will be much higher.
Saving a life may depend on the actions of others, so you cannot simply walk past a person who has suddenly fallen on the street or lost consciousness on a bus. You need to at least try to carry out the basic - indirect massage heart and artificial respiration, after calling doctors for help. Cases of indifference are not rare, unfortunately, which is why the percentage unfavorable outcome due to late started resuscitation occur.
the main cause of SCD is atherosclerosis
The causes that can cause acute coronary death are very numerous, but they are always associated with changes in the heart and its blood vessels. The lion's share of sudden deaths occurs when coronary arteries fatty tissues are formed, obstructing blood flow. The patient may not be aware of their presence, may not make any complaints as such, then they say that it is completely healthy person died suddenly of a heart attack.
Another cause of cardiac arrest may be acutely developed, in which proper hemodynamics are impossible, the organs suffer from hypoxia, and the heart itself cannot withstand the load and.
The causes of sudden cardiac death are:
Risk factors have been identified when the likelihood of acute coronary death becomes higher. The main such factors include ventricular tachycardia, a previous episode of cardiac arrest, cases of loss of consciousness, previous cardiac arrest, and a decrease in the left ventricle to 40% or less.
Secondary, but also significant conditions under which the risk of sudden death is increased are considered concomitant pathologies, in particular diabetes, obesity, myocardial hypertrophy, tachycardia more than 90 beats per minute. Smokers and those who neglect motor activity and, conversely, athletes. With excessive physical exertion, hypertrophy of the heart muscle occurs, a tendency to rhythm and conduction disturbances appears, so death from a heart attack is possible in physically healthy athletes during training, a match, or competitions.
Diagram: distribution of causes of SCD at a young age
For more careful monitoring and targeted examination groups of people at high risk of SCD have been identified. Among them:
Depending on how quickly death occurred, instant cardiac death and rapid death are distinguished. In the first case, it occurs in a matter of seconds and minutes, in the second - within the next six hours from the onset of the attack.
In a quarter of all cases of sudden death of adults, there were no previous symptoms; it occurred without obvious reasons. Other One to two weeks before the attack, patients noted a deterioration in their health in the form of:
Before cardiovascular death pain in the heart area increases sharply, many patients manage to complain about it and experience severe fear, as happens with myocardial infarction. Psychomotor agitation is possible, the patient grabs the heart area, breathes noisily and frequently, gasps for air, sweating and redness of the face are possible.
Nine out of ten cases of sudden coronary death occur outside the home, often against the background of strong emotional distress, physical overload, but it happens that the patient dies from acute coronary pathology in a dream.
When ventricular fibrillation and cardiac arrest occur during an attack, severe weakness appears, dizziness begins, the patient loses consciousness and falls, breathing becomes noisy, and convulsions are possible due to deep hypoxia of the brain tissue.
On examination, the skin is pale, the pupils dilate and stop responding to light, heart sounds cannot be heard due to their absence, and the pulse in large vessels is also not detected. In a matter of minutes, clinical death occurs with all its characteristic signs. Since the heart does not contract, the blood supply to everyone is disrupted. internal organs, therefore, within a few minutes after loss of consciousness and asystole, breathing disappears.
The brain is most sensitive to a lack of oxygen, and if the heart is not working, then 3-5 minutes are enough for its cells to begin irreversible changes. This circumstance requires immediate resuscitation measures, and the sooner chest compressions are provided, the higher the chances of survival and recovery.
Sudden death due to accompanying atherosclerosis of the arteries, then it is more often diagnosed in older people.
Among young such attacks can occur against the background of spasm of intact blood vessels, which is facilitated by the use of certain drugs (cocaine), hypothermia, excessive physical activity. In such cases, the study will show no changes in the vessels of the heart, but myocardial hypertrophy may well be detected.
Signs of death from heart failure in acute coronary pathology will be pallor or cyanosis of the skin, rapid enlargement of the liver and neck veins, possible pulmonary edema, which is accompanied by shortness of breath up to 40 breathing movements per minute, severe anxiety and convulsions.
If the patient has already suffered from chronic organ failure, but edema, cyanosis of the skin, an enlarged liver, and expanded borders of the heart during percussion may indicate a cardiac origin of death. Often the patient’s relatives, when the ambulance team arrives, themselves indicate the presence of a previous chronic illness; they can provide doctors’ records and hospital extracts, then the issue of diagnosis is somewhat simplified.
Unfortunately, cases of post-mortem diagnosis of sudden death are not uncommon. Patients die suddenly, and doctors can only confirm the fact of a fatal outcome. At autopsy they did not find any pronounced changes in the heart, which could cause death. The unexpectedness of what happened and the absence traumatic injuries speak in favor of the coronarogenic nature of the pathology.
After the arrival of the ambulance team and before the start of resuscitation measures, the condition of the patient, who by this time is already unconscious, is diagnosed. Breathing is absent or too rare, convulsive, the pulse cannot be felt, heart sounds cannot be detected on auscultation, the pupils do not respond to light.
The initial examination is carried out very quickly, usually a few minutes are enough to confirm the worst fears, after which doctors immediately begin resuscitation.
Important instrumental method Diagnosis of SCD is an ECG. With ventricular fibrillation, erratic waves of contractions appear on the ECG, the heart rate is above two hundred per minute, and soon these waves are replaced by a straight line, indicating cardiac arrest.
With ventricular flutter, the ECG recording resembles a sinusoid, gradually giving way to random waves of fibrillation and an isoline. Asystole characterizes cardiac arrest, so the cardiogram will show only a straight line.
At successful resuscitation on prehospital stage, already in a hospital setting the patient will face numerous laboratory examinations, starting with routine urine and blood tests and ending with toxicological testing for certain drugs that can cause arrhythmia. Will definitely be held daily monitoring ECG, ultrasound examination of the heart, electrophysiological study, stress tests.
Since sudden cardiac death syndrome causes cardiac arrest and respiratory failure, the first step is to restore the functioning of life support organs. Emergency care should be started as early as possible and includes cardiopulmonary resuscitation and immediate transportation of the patient to the hospital.
At the prehospital stage, resuscitation options are limited; it is usually carried out by specialists emergency care, which find the patient in a variety of conditions - on the street, at home, at the workplace. It’s good if at the time of the attack there is a person nearby who knows her techniques - artificial respiration and chest compressions.
Ambulance team after diagnosis clinical death begins indirect cardiac massage and artificial ventilation lungs with an Ambu bag, provides access to a vein into which medications can be administered. In some cases, intratracheal or intracardiac administration of drugs is practiced. It is advisable to administer drugs into the trachea during intubation, and the intracardiac method is used most rarely - when it is impossible to use others.
In parallel with the main resuscitation actions, an ECG is taken to clarify the causes of death, the type of arrhythmia and the nature of the heart’s activity at the moment. If ventricular fibrillation is detected, then the most the best method its relief will become, and if the necessary device is not at hand, then the specialist delivers a blow to the precordial area and continues resuscitation measures.
defibrillation
If cardiac arrest is determined, there is no pulse, and there is a straight line on the cardiogram, then during general resuscitation the patient is administered adrenaline and atropine by any available method at intervals of 3-5 minutes, antiarrhythmic drugs, cardiac pacing is established, after 15 minutes sodium bicarbonate is added intravenously.
After the patient is admitted to the hospital, the fight for his life continues. It is necessary to stabilize the condition and begin treatment of the pathology that caused the attack. May need surgery, the indications for which are determined by doctors in the hospital based on the results of examinations.
Conservative treatment includes the administration of drugs to maintain blood pressure, heart function, and normalize electrolyte metabolism disorders. For this purpose, beta blockers, cardiac glycosides, antiarrhythmic drugs, antihypertensive drugs or cardiotonics, infusion therapy:
Treatment in the post-resuscitation period lasts about a week. At this time it is likely electrolyte disturbances, DIC syndrome, neurological disorders, so the patient is placed in the intensive care unit for observation.
Surgical treatment may involve radiofrequency ablation of the myocardium - for tachyarrhythmias, the effectiveness reaches 90% or higher. If there is a tendency to atrial fibrillation, a cardioverter-defibrillator is implanted. Diagnosed atherosclerosis of the heart arteries as a cause of sudden death requires valvular heart surgery.
Unfortunately, it is not always possible to provide resuscitation measures within the first few minutes, but if it was possible to bring the patient back to life, then the prognosis is relatively good. As research data show, the organs of people who have suffered sudden cardiac death do not have significant and life-threatening changes, therefore maintenance therapy in accordance with the underlying pathology allows them to live for a long time after coronary death.
Prevention of sudden coronary death is needed for people with chronic diseases cardiovascular system, which can cause an attack, as well as for those who have already survived it and were successfully resuscitated.
To prevent a heart attack, a cardioverter defibrillator may be implanted, which is especially effective for serious arrhythmias. At the right moment, the device generates necessary for the heart impulse and does not allow him to stop.
Requires medication support. Beta blockers and blockers are prescribed calcium channels, products containing omega-3 fatty acids. Surgical prevention consists of operations aimed at eliminating arrhythmias - ablation, endocardial resection, cryodestruction.
Nonspecific measures to prevent cardiac death are the same as for any other cardiac or vascular pathology – healthy image life, physical activity, giving up bad habits, proper nutrition.
Death in a state of sleep– not such a rare occurrence; according to medical statistics, sleep accounts for approximately one in three deaths.
For ancient man the answer was obvious. Strictly speaking, our distant ancestors did not see the fundamental difference between sleep and death at all: both the person falling asleep and the dying soul leaves the body, for some reason it could not or did not want to return - here you have death in a dream... of course, today Such an “explanation” will no longer suit anyone.
Most often, people suffering from heart disease die in their sleep. This is explained by the fact that we sleep lying down, and in this position the flow to the heart increases venous blood, and then the heart muscle needs an order of magnitude more oxygen, and the sick heart is already poorly supplied with it - this is why during a heart attack it is recommended not to put the patient to bed, but to place him in a semi-sitting position - i.e., in a dream, when the person lies for several hours , there is a greater chance that a diseased heart will not withstand the load. In addition, if a heart attack occurs while awake, there is a greater chance that the person will immediately receive help (if it does not lead to cardiac arrest, he himself can do something - for example, urgently take medicine), but if the attack happened in a dream , a person may not even have time to wake up, and there is no one nearby who could help - after all, loved ones are also sleeping.
Another risk group for death in sleep- these are children under the age of one year, there is even such a concept in medicine - sudden infant death syndrome. The reasons for this phenomenon are not completely clear, but it is known that this happens much more often to children whose mothers were sick with something or often experienced stress during pregnancy, or smoked, drank alcohol, or drugs. Premature babies are at risk; complicated labor, especially breech presentation, increases the risk by 2 times, and labor that lasts more than 16 hours increases the risk by 7 times; maternal age less than 20 years is also a risk factor. Often the cause of sudden death of a baby is sleeping on the stomach (in this case, the baby may suffocate), a blanket that is too warm, or a soft base of the bed.
But it also happens that a completely healthy adult dies in his sleep.- most of these cases occur between the ages of 20 and 49, for unknown reasons this happens to men much more often than to women, and to Mongoloids more often, to representatives of other races, and for the most part these are not cases that can be written off deterioration in health overweight, alcohol or drugs, the autopsy also did not provide any explanation. As a rule, witnesses (if any) describe the following: a person was sleeping peacefully - and suddenly began to moan in his sleep, wheeze, choke (i.e. agonal symptoms) and eventually died. If a person was woken up when agonal signs appeared, it did not help: if he did not die immediately, then this happened either within an hour (in 94%) of cases) or within 24 hours.
As already mentioned, Asians most often suffer from this, and this phenomenon is even reflected in the folklore of Asian peoples - for example, in Thailand there is a legend about “laithai”, the ghost of a widow who steals the souls of sleeping men (to protect yourself from this ghost, it is recommended to temporarily sleep, “disguise” yourself with feminine cosmetics).
Plays a certain role hereditary predisposition – this often happens to those whose brothers or other relatives died in this way. Most often, such tragedies happen in the spring, and least often in the fall.
To some extent, a group of researchers from the University of California, led by Professor J. Feldman, managed to shed light on the reasons for this phenomenon: in one of the parts of the brain stem (the so-called pre-Botzinger complex) there is a group of neurons that issue “commands” that provide breath. During sleep, these neurons can turn off and “forget” to give the “command”, then breathing stops. Usually a person wakes up immediately, breathing is restored - and nothing bad happens, but with age, more and more neurons in this group die, and accordingly, regulation becomes worse and worse - an unfavorable “scenario” is more and more likely (as a rule, breathing stops in the REM sleep phase) .
True, this explanation applies more to older people, and sudden death in a dream, as already mentioned, overtakes mature and even young people. Nor does this study explain why it occurs primarily among Asian men... In short, there are still many questions to be answered!
