Sudden death syndrome: what every mother needs to know. Sudden infant death syndrome: what parents should know. Reasons, how to prevent the irreparable? Sudden unexplained death syndrome in sleep

Sudden infant death syndrome is the death of a child between 1 week and 1 year of age. As a rule, it comes unexpectedly. At the same time, at the autopsy there are also no signs various diseases or developmental abnormalities that could cause the baby’s death. The pathology is still not fully understood, and therefore the main triggers of the terrible syndrome have not been established. Scientists still continue to consider this phenomenon one of the most mysterious and tragic at the same time.

Statistics show that to a greater extent of this disease Boys suffer (approximately 60%), and the maximum mortality rate occurs in the 3-6th month of a child’s life. Moreover, most often children die late at night or early in the morning. The number of tragic cases also depends on the time of year. It has been proven that in winter and spring, due to common infections, deaths among children are recorded more often.

About pathology

Sudden infant death syndrome (SIDS) officially appeared in the early 60s of the 19th century, although it was noticed almost everywhere earlier. But only in the 80s a group of doctors began to conduct entire campaigns against the occurrence of this disease.

A dangerous disorder is often called exclusion syndrome. Typically, the risk group consists of: infectious diseases, tumors, various malformations and injuries. Often, the cause of death of a child can still be determined through a careful study of the medical history and autopsy results. But even such studies do not always provide detailed answers to all the pressing questions. So, sometimes even a completely healthy child may simply not wake up in the morning. In such cases, doctors talk about SIDS.

The risk of the syndrome increases sharply with a combination of three factors: genetic changes, the critical age of the child and external conditions inappropriate for healthy development. For example, a healthy baby, if there is a lack of oxygen during sleep, will definitely wake up and turn his head. In the case of pathology, the protective mechanism does not work: children bury their faces in the mattress, the oxygen content in the blood decreases, the child suffocates and dies. Smoking of his parents can also lead to the death of a newborn, since the bad habit also reduces the level of the protective reflex.

Causes of the syndrome

Numerous scientists and pediatricians have still not been able to come to a common decision and identify absolutely all the causes of the development of the disease. But experts have proven that most often death occurs due to dysfunction of the heart muscle or due to a disorder of the respiratory system. Thus, in any child’s sleep, the cough reflex is weakened and muscle tone decreases. With the syndrome, the sick baby’s body will not be able to cope with it. Suffocation will occur and death will occur.

There is evidence that SIDS may be a consequence of congenital brain stem disorders. This conclusion was made by a group of doctors from Boston. They believe that the pathology has nothing to do with the child’s sleep, and death occurs due to respiratory arrest.

Researchers in Texas believe that the dangerous condition occurs due to the loss of a special gene. It is responsible for the functioning of brain signals and is involved in regulating the breathing process during the accumulation of carbon dioxide. In this case, the baby may die due to relaxation of reflexes. The risks increase significantly if the room has poor ventilation or the child is constantly overheating.

Some scientists hypothesize that SIDS is caused by an unsafe sleeping area for the baby.. A mattress or pillow that is too soft can cause the death of a baby when sleeping on their stomach. They “block” the baby’s nose, causing breathing to stop. That is why many pediatricians advise choosing a hard mattress for a newborn and completely abandoning the pillow.

The time of year also influences the number of deaths. It has been proven that during cold weather, when the number of respiratory diseases especially increases, the death of newborns is recorded more often.

In asocial families, the threat to the child’s life increases significantly. Parents' bad habits and lack of favorable sanitary conditions can undermine the baby's health.

It has also been established that there is a genetic predisposition to the development of the syndrome. Its first signs are holding your breath or short-term cardiac arrests in infancy.

Risk factors

Scientists believe that the main cause of SIDS is a malfunction of the neurohumoral system. Also, almost all newborns experience sleep apnea. But if the disorder recurs several times in an hour and lasts about 15 seconds or more, you should immediately contact your pediatrician. Exactly the same as in the case of a dangerous syndrome arising due to disruption of the cardiac system.

Experts identify other common risk factors, which include:

• Male gender of the newborn;
• Age from 1 week to 1 year;
• Death of a blood relative from SIDS;
• Low baby weight at birth;
• Intrauterine diseases;
• Fetal hypoxia;
• Prematurity;
• Multiple births;
• Miscarriages and abortions;
• Trauma at birth;
• Mother's age is less than 16 years;
• Frequent overheating of the newborn;
• Poor ventilation of the room where the baby sleeps;
• Smoking near the baby;
• Cold season;
• Baby sleeps on his stomach;
• Too soft feather bed;
• Excessively tight swaddling.

There is also a version that infants who regularly experience psycho-emotional stress are most susceptible to pathology. Sometimes doctors are inclined to think that the death could have occurred as a result of the child and parents sleeping together.

Symptoms

The death of a child due to a dangerous pathology can last for 30 minutes, but the pathology develops at lightning speed. That is why it is important to know its first signs in order to try to help the child and save his life.

If you suspect a risk of developing sudden death syndrome, parents should definitely pay attention to the general condition of the baby. If you experience weakening or holding your breath for a long time, an unhealthy cough or unnatural facial movements, you must call an ambulance. Often the condition is accompanied by general weakness, decreased muscle tone, bluish skin.

More attention to the health of the newborn should be shown especially in cases where:

1. The baby's temperature is rapidly rising.
2. The baby refuses to eat.
3. The child becomes lethargic and inactive.
4. The newborn is sick with a respiratory disease.
5. The baby sleeps in conditions unsuitable for this.
6. The child falls asleep after prolonged crying or hysterics.

What can be confused with sudden infant death syndrome?

History knows of cases where the parents of a newborn child tried to pass off his violent death as sudden infant death syndrome. In this case, real investigations and forensic examinations were carried out, which helped to establish the real cause of the child’s death. So what can pathology be confused with?

Consequences of child abuse

The death of a newborn can occur not only due to any diseases or injuries, but also due to inadequate and cruel treatment of the child by his parents. Moreover, stories about beating one’s own children are only gaining momentum over the years.

Doctors are not always able to immediately establish the true cause of a child’s death at the scene of a tragedy. Injuries can be hidden, for example, if the baby is shaken. The newborn's brain vessels rupture, he loses consciousness, and a coma or clinical death occurs.

A repeated fatal case of SIDS may also prompt thoughts about child abuse in the family.

Accident, strangulation

Hormonal surges, lack of sleep and endless care for the baby can cause a mental breakdown in a new mother. In this state, women do not control their behavior and cease to adequately assess reality, which ultimately leads to the most dire consequences. That is why it is important that the mother really gets enough sleep and can at least sometimes rest during the day.

Sometimes, due to fatigue and their own inattention while parents sleep with their child, there is a risk of unintentional accidental suffocation. It especially increases when the mother is drunk or takes medication for insomnia for a long time.

Thus, back in the 19th century, a strict ban was declared on the co-sleeping of children and their parents, and the “accidental” death of a baby meant deliberate murder. Therefore, young parents should be more attentive and arrange for their child his own safe sleeping place.

Various types of infections

In newborns, many infectious diseases may have an atypical course. Therefore, sometimes, even with the most severe damage to internal organs, the symptoms remain almost invisible. This is especially true in premature babies. Therefore, before diagnosing SIDS, the pathologist must ensure that the death was not due to meningitis, pneumonia or other similar diseases.

Diagnosis of pathology

To diagnose the disease, doctors usually use special equipment that helps monitor the child’s condition. These are various cardiorespiratory monitors that detect abnormal heart rhythms; respiration monitors; respiratory monitors (they can even be installed at home under the bottom of a baby’s crib). The newborn also needs to undergo an x-ray, echoencephalogram and electrocardiogram.

Differential diagnosis

Differential diagnosis helps specialists exclude acute heart failure, kidney pathologies, botulism and forced asphyxia. If the autopsy results do not reveal any reason for the sudden death of the child, SIDS is diagnosed.

Treatment of the syndrome

Unfortunately, the treatment of this syndrome still causes difficulties for doctors. Therefore, first of all, specialists start from the main cause of the pathology. The main thing in treating the syndrome is to have time to help the baby in time.

What to do if a newborn becomes ill?

If parents notice that their baby is behaving differently - his breathing is disrupted or his pulse is irregular, it is necessary to immediately call doctors. But time cannot be lost, since every minute is valuable, so adults should try to independently restore the functioning of the cardiac and respiratory system. To do this, you need to give your child a massage:

• Run your fingers along the spine several times;
• Lightly trot the baby in your arms;
• Perform a relaxing massage on your hands, feet and earlobes.

These simple techniques can save a child's life. But if they do not bring a positive result, it is necessary to proceed with indirect massage of the heart and the entire chest. Movements should be smooth and easy, since the bones of a newborn are still very fragile. The main thing when providing assistance is to put aside panic and think only about a good outcome.

How to prevent the occurrence of a dangerous disease?

The first step is to create a truly safe and comfortable place for your baby to sleep. Various studies by doctors over the years have proven that a newborn who sleeps on his stomach is at great risk every day. Babies should not be put to bed immediately after a tantrum or crying. More recently, it has become known that sleeping on one’s side can also trigger SIDS. Sleeping on your back is considered truly healthy. In this case, contraindications include only underdevelopment of the jaws or severe reflux of bile into the esophagus. It is difficult for such babies to burp, so when sleeping on their back there is a risk of vomit getting into the respiratory tract.

Breath monitoring

To reduce the number of deaths from a dangerous syndrome, scientists have created special breathing monitoring devices that can be used even at home. They not only completely control the child’s breathing, but also measure the pulse, as well as the amount of oxygen in the tissues. Such devices are similar to a baby monitor, which plays a specific sound signal in case of heart rhythm disturbances or long-term delays in breathing. Such observation is recommended for families whose children are at risk:

1. Premature, low birth weight infants;
2. Toddlers with recurrent sleep apnea;
3. Newborns with respiratory or cardiac dysfunction;
4. Children who have experienced loss of consciousness.

Prevention

In most cases, it is not possible to avoid the sudden death of a baby, but it is possible to reduce the risk of developing pathology. To do this, you need to be registered with a pediatrician and inform the doctor about all the child’s current illnesses. You should also follow these tips:

• Avoid overheating. The optimal temperature for newborns is 18-20 degrees, so you should not put your baby to sleep in a room where the temperature exceeds this value. At night it is better to dress the baby in cotton clothes and cover with a thin blanket.
• Remove all soft objects from the crib, including pillows and toys. Such measures will help protect your baby from possible suffocation. It is worth abandoning the sides, as they only collect dust and impair air circulation. And instead of a blanket, you can use a special sleeping bag for babies.
• Place the baby to sleep strictly on its back. It has been proven that such a recommendation reduces the risk of the syndrome.

• Before going to bed, the baby should be allowed to burp air if the feeding was very recent. Usually, for this purpose, the child is held as a “soldier”, pressed to himself in an upright position.
• It is worth refusing to co-sleep the baby with the parents, and if such a need nevertheless arises, then you should provide the child with enough free space to sleep. In this case, adults must be absolutely sober and not overly tired.
• It is not recommended to give up pacifiers before bed. But it is better to start using them from the second month of life, so that breastfeeding is not disrupted.

New parents should not be afraid of SIDS. It is in their power to do everything so that the child is born and grows up as a healthy and happy person. The main thing is to lead healthy image life and do not leave the baby alone.

Vaccination and SIDS

There is an opinion that vaccinations and vaccinations against many diseases significantly undermine the health of the child and lead to various disorders, including sudden death syndrome in infants. And indeed, the time of vaccination very often coincides with the peak incidence of sudden death of a newborn. But numerous studies have proven that in most cases these are just coincidences. Moreover, the absence of certain vaccinations, for example, against whooping cough, can only increase the risk of a dangerous pathology.

Help for parents who have lost a child

The death of relatives is a blow for any person. And when it comes to the death of your own child, surviving the tragic event becomes especially difficult. In this case, you only need to understand one thing: SIDS cannot be felt or predicted, which means the parents are not to blame for the death of the baby. You need to learn to live again, seek help from a psychologist. Almost all families subsequently manage to give birth and raise a healthy baby, and sometimes more than one. The main thing is to believe that the best is yet to come.

conclusions

In conclusion, it is worth saying that sudden and unexpected death of a newborn is extremely rare and it is almost impossible to predict the development of the syndrome. You just need to draw the attention of parents to the age at which the disease poses a huge danger to the life of their child. It is during this period that adults should be especially attentive to the baby. They also need to walk and play with the baby as often as possible, give up bad habits and monitor the condition of the baby’s sleeping place: remove all soft objects from his crib and replace the heavy blanket with a special lightweight sleeping bag. In this case, the risk of sudden infant death syndrome is sharply reduced, which means motherhood will truly bring only joy.

Video: about sudden infant death syndrome and its prevention

Sudden infant death syndrome (SIDS) is a concept applied to the unexpected death of a child of the first year, occurring in a dream without established causes. They talk about ADHD if the study of the medical record and place of death, as well as the pathological examination, do not provide a clear answer about the causes of the baby’s death. To assess the risk of sudden infant death, test algorithms (Magdeburg score table) are proposed, ECG and polysomnography are performed. Prevention of ADHD includes optimizing the child's sleep conditions, identifying children at risk, and providing home cardiorespiratory monitoring.

General information

Sudden infant death syndrome (SIDS, cot death, sudden infant death syndrome) - unexplained death infant in a dream in the absence of adequate reasons leading to death. As follows from the definition, the syndrome excludes the presence at the time of death of an infection, an accident, previously undetected congenital (including genetic) or acquired diseases or their consequences. Neither the study of the medical records of the deceased child, nor the examination of the place of death, nor the results of the autopsy make it possible to name the cause that explains the death.

The prevalence of SIDS in the world is 0.2-1.5 cases (in Russia - 0.43 cases) per 1000 children. Infants under 8 months of age are most at risk for SIDS; greatest number Sudden infant deaths occur between 2 and 4 months of age. 60% of children killed as a result of SIDS are boys. Typically, the sudden death of a child occurs in the time interval from midnight to 6 a.m., mainly in winter time of the year. ADHD accounts for up to 30% of deaths in children in the first year of life, which explains the ongoing concern of young parents and pediatric specialists about this problem.

Causes of ADHD

The problem of sudden infant death has been studied for several decades, but a clear explanation of the causes of this phenomenon has not been obtained. Theories of historical interest include an explanation of the mechanism of SDVS:

• accidental (accidental) suffocation (when the baby is in the parent's bed, unintentional suffocation with bedding);
• compression of the trachea by an enlarged thymus (asthma thymicum);
• lymphatic-hypoplastic diathesis (status thymico-lymphaticus).

At the present stage in pediatric neurology, sudden infant death syndrome is classified as a sleep disorder (parasomnia). The following are considered as basic hypotheses explaining the pathogenesis of ADHD:

1. Sleep apnea. Children at increased risk of developing sleep apnea include premature infants who have an immature respiratory system.
2. Cardiac rhythm disturbances (arrhythmias). A large-scale study that lasted for 20 years showed that the presence of a prolonged QT interval according to ECG data increases the risk of sudden infant death by 41 times. As a practical consequence of this discovery, ECG screening of newborns in some countries has resulted in beta blockers being prescribed to children with congenital long QT syndrome and an increased risk of SIDS.
3. Compression of the vertebral artery. One of the hypotheses explaining SDV is the assumption that the position of a sleeping child on his stomach with his head turned to the side causes compression of the vertebral artery, a decrease in brain stem perfusion and death from central apnea. The authors of this hypothesis propose using ultrasound scanning of extracranial vessels as a screening method for identifying children at risk of sudden death.
4. Other theories. The theory of impaired awakening response and ineffectiveness of “grasping” breathing in response to hypoxia and hypercapnia developing in a child has not yet found an unambiguous explanation. Perhaps the answer to ADHD lies in the disruption of the regulation of sleep, breathing and temperature homeostasis by the neurotransmitter serotonin. Proponents of other hypotheses try to explain the pathogenesis of sudden death of infants by an excess of endorphins, defects in beta-oxidation of fatty acids, insufficient maturity of control of cardiorespiratory functions by the central nervous system, etc.

Some authors propose to classify ADHD as an extreme manifestation of borderline conditions in newborns and children in the first year of life, which can occur under the influence of nonspecific factors that are minimal in severity.

Risk factors

Despite many hypotheses, none of them can serve as a universal explanation for the phenomenon of ADHD. However, long-term observations reveal a number of factors that significantly increase the risk of sudden death in infants. These include:

• young age of mother (under 20 years old),
• prematurity of the child and body weight less than 2500 g,
• male gender of the baby,
• artificial feeding,
• sleep on your stomach and on a soft surface,
• overheating during sleep,
• smoking in the house, etc.

There is no clear answer as to whether the risk of sudden infant death increases when a child sleeps in the same bed as his parents. Most researchers tend to see co-sleeping as a preventative factor due to the synchronization of the child’s breathing and heartbeat with the mother’s breathing and heartbeat, as well as the mother’s ability to quickly respond to the child’s respiratory arrest. On the other hand, the likelihood of ADHD increases due to the danger of excessive covering and overheating of the child, sleeping on a soft pillow, etc. Contrary to misconceptions, preventive vaccination of children is not the cause of sudden infant death.

Abortive SDVS

For infants who experience an apparent life-threatening episode in infancy and survive, the term abortive sudden infant death syndrome, or near-miss SIDS, is used. Characteristic features Obvious life-threatening episodes are sudden cessation of breathing, pale or cyanotic skin color, hypotension or muscle hypertonicity that occurs in a child for no apparent reason, in complete well-being. Obvious life-threatening episodes occur in 0.6% of infants during the first months of life.

In 50-70% of cases in such children, it is possible to identify a correlation between an obvious life-threatening episode and some pathological condition: convulsive syndrome, myopathy, respiratory tract infections, gastroesophageal reflux disease, congenital developmental anomalies, metabolic diseases, etc. Therefore, children who have had an abortion SDV, it is necessary to conduct a comprehensive examination with the participation of various pediatric specialists: pediatrician, pediatric neurologist, cardiologist, gastroenterologist, pulmonologist, pediatric otolaryngologist, etc.

Of the instrumental studies, EEG, polysomnography, transcranial ultrasound, ECG, ultrasound of the child’s heart, Holter ECG monitoring, and chest radiography can be of greatest diagnostic value. Laboratory methods may include infectious diagnostics (ELISA, PCR, microbiological examination), determination of blood CBS, biochemical blood test, etc.

Assessing the risk of developing ADHD

The lack of reliable knowledge about the causes of sudden infant death makes it possible to assess the degree of risk exclusively using statistical methods. Thus, to identify children at risk, the Magdeburg SIDS score table has been proposed, highlighting as criteria:

• mother's age,
• baby's weight at birth,
• baby's sleeping position
• features of bedding,
• mother smoking,
• duration of breastfeeding.

Among the objective methods for identifying children at risk for the development of ADHD, ECG and polysomnography are not at the forefront. The algorithm proposed by I.A. Kelmanson, contains 6 clinical and 12 morphological signs that allow post-mortem differential diagnosis of sudden infant death syndrome and life-threatening diseases and is of interest mainly to pathologists.

Prevention

If an obvious life-threatening episode occurs, it is necessary to take the child in your arms, stir him, vigorously massage his hands, feet, earlobes, and back along the spine. Usually these actions are enough for the child to start breathing again. If breathing has not been restored, it is necessary to urgently call an ambulance and begin artificial respiration and closed heart massage.

Prevention of ADHD includes primary and secondary measures. The principles of primary prevention are based on antenatal measures (giving up bad habits before pregnancy, rational nutrition of the mother, sufficient physical activity, prevention of premature birth, early registration and management of pregnancy under the supervision of an obstetrician-gynecologist, etc.).

Primary prevention measures also include optimizing the sleeping conditions of an infant: sleeping on the back, using a sleeping bag that prevents the child from turning onto his tummy on his own, sleeping on a thick mattress, avoiding overheating, sufficient access to fresh air, maintaining temperature and humidity conditions, the absence of strong odors and tobacco smoke.

Secondary prevention of ADHD involves identifying high-risk groups and carrying out targeted measures (restorative treatment,

Sudden infant death syndrome (SIDS) is the unexpected death of an apparently healthy child under the age of 1 year as a result of respiratory arrest for an unexplained reason.

Description of sudden infant death syndrome

Cases of infant death due to unexplained causes have been repeatedly described in the medical literature, but SIDS was introduced as a postmortem diagnosis only in the late 60s of the twentieth century.

Sudden death in a dream occurs due to various factors (the presence of developmental defects in the child, infectious diseases and injuries undetected by parents), but these factors can be identified by studying the history of the disease and an autopsy. When the research carried out does not allow us to explain the cause of the baby’s death, SIDS is indicated in the death certificate (this is a diagnosis of exclusion).

ICD 10 classifies sudden infant death syndrome as a class of conditions characterized as unspecified, arising from an unknown cause (code R95.0 with an autopsy indication, and code R95.9 without such an indication).

Analyzing the causes and risks of this phenomenon in children under one year of age, pediatricians around the world began in the 80s to conduct campaigns to help reduce the number of deaths in the cradle. Medicine is still not able to answer why sudden infant death occurs during sleep, but thanks to the recommendations of pediatricians, the number of cases of SIDS in the United States has dropped by half, and in Russia has decreased by 75%.

Statistics

Some researchers believe that the problem is an “achievement” of civilization, since the number of SIDS in developed countries is much higher than in third world countries.

An active search for the cause of the unexpected death of children has been carried out since the 80s, but general statistics are missing. According to studies from 1999 in some developed countries, per 10,000 children under the first year of life, there are:

• Germany – 8 cases;
• Italy – 10;
• Russia – 4;
• USA – 8;
• Sweden – 5.

Data changes every year; in developed countries, pediatricians and parents learn to prevent the death of children under one year old due to SIDS. Statistics over the years indicate a decrease in the number of deaths: in 1963 in Europe, the mortality rate of children from SIDS was 2-3 cases per 1000, by 2000 - 4 cases per 10,000.

Thanks to a careful study of tragic situations, some patterns have been established:

• In 90% of cases, sudden death of children occurred before reaching six months of age;
• SIDS is more common during the cold season;
• In 60% of cases, SIDS victims are boys;
• Sudden infant death syndrome is not associated with vaccinations.

According to the results of studies, sudden infant death in 92% of cases occurs in babies sleeping separately from their parents. The data is indirectly confirmed by statistics - unexplained deaths in infants in African and Asian countries, where traditional co-sleeping between mother and child is practiced, is detected 2 times less often than in Europeans, where a newborn usually sleeps alone.

Etiology

The death of a baby is always a tragedy, and parents do their best to prevent it by eliminating possible preconditions. Without knowing the cause of the phenomenon, it is impossible to exclude negative factors, and this instills panic in mothers of absolutely healthy children.

There are several hypotheses explaining the mechanism of SIDS, causes and risk factors. It is precisely established that the phenomenon arises as a result of a lack of synchronization of the respiratory and cardiovascular activities of the child’s organism, which is imperfect from the point of view of physiology. According to doctors, disorders develop:

1. As a result of an increase in the Q-T interval (this is the contraction of the ventricles of the heart and the ejection of blood from the ventricles into the aorta and pulmonary trunk, recorded by ECG). Physiological electrical instability is recorded in children under 6 months (the peak occurs at 2 months). An increase in the Q-T interval was detected in 30-35% of cases of sudden death of a child under one year of age.
2. Due to cessation of respiratory movements. Periods of sleep apnea (lasting 3-20 seconds) occur in many healthy babies. Due to such a delay, oxygen does not reach the brain; as a result of a long pause, the heart rhythm is disrupted. A significant increase in the interval between respiratory movements is usually observed in premature infants. When caring for such children, it is recommended to use a special device (breath recorder). It has an effect on the problem with the duration of apnea and maternal smoking.
3. Due to a deficiency of serotonin receptors (a neurotransmitter called the “happiness hormone”). Although the autopsy does not give a clear answer as to why the sudden death occurred, according to doctors, the causes of death may lie precisely in the lack of serotonin receptors in the area of ​​the brain responsible for the synchronous activity of the cardiovascular and respiratory systems.
4. As a result of imperfect thermoregulation observed in children under 3 months of age. The immaturity of a certain group of brain cells leads to instability of body temperature, so the slightest change in the microclimate in the bedroom can provoke overheating of the child and affect the activity of his cardiovascular and respiratory systems.

There are other hypotheses for the origin of SIDS - genetic (variations in the NOS1AP gene associated with the syndrome have been found), infectious (symptoms of some diseases are observed in children 1-2 weeks before the tragedy). The sudden death of a child in the cradle may be associated with compression of the vertebral artery, etc.

Risk factors

SIDS has not been studied enough, but thanks to the studies conducted, the following risk groups have been identified:

1. Children sleeping on their stomachs. Previously, due to the immaturity of the digestive tract and colic, pediatricians advised placing the baby on his stomach while sleeping. After a change in the official recommendation, the supine position became the norm for sleeping babies; “death in the crib” is 2 times less common in Western Europe and the USA.
2. Overheating and hypothermia during sleep. It is recommended to replace the baby blanket as a contributing factor to overheating with a specially designed overnight bag.
3. The likelihood of developing SIDS increases in babies whose crib has a soft base (the interaction of these factors has not been fully studied, but statistics confirm the presence of a high risk in this group).
4. A family history of the problem of causeless cardiac and respiratory arrest in the newborn's siblings.
5. Artificial feeding.
6. Prenatal stress.
7. Babies infected before the age of six months with human respiratory syncytial virus (which is a major factor in lower respiratory tract diseases in children younger age, epidemics in temperate climates often occur in winter).

The SIDS risk group also includes children born:

• premature;
• as a result of long (more than 16 hours) or complicated labor;
• after a short period (less than a year) after the previous birth;
• a mother with bad habits (smoking, drinking alcohol, drugs);
• in a woman who was not observed by a doctor during pregnancy, or the gestation period was accompanied by an infectious disease.

The high-risk group includes infants under 6 months, the maximum number of cases was recorded in children from 2 to 4 months. The likelihood of sudden infant death is present in babies under one year of age (the second dangerous age is the 9th month of life).

The death of a newborn in the first hours and weeks of life often occurs due to asphyxia, infections, malformations and birth injuries, and low birth weight (80% of cases).

Many women who survived the tragedy consider these factors questionable, since they prepared for the birth of the baby, led a healthy lifestyle, and the child had high Apgar scores. However, this only indicates insufficient knowledge of the interaction of risk factors and respiratory and cardiac arrest (the main cause of death among newborns).

An analysis of reports on sudden infant mortality for 2006-2008 shows that the baby’s breathing in each case of SIDS stopped as a result of simultaneous exposure to four risk factors more often than one.

Prevention Methods

Prevention of SIDS begins before the birth of the child: the expectant mother should stop drinking alcohol, not smoke and follow the recommendations of the doctor who monitors her during pregnancy.

1. Activities after the birth of the baby are reduced to eliminating possible risk factors and include:
2. Properly equipped sleeping place for the child. The mattress must be firm, the use of a pillow is not allowed, and toys should be removed from the crib while sleeping. It is recommended to replace the blanket with a sleeping bag, but if this is not possible, the child should be placed at the foot of the crib to eliminate the possibility of accidentally limiting oxygen access.
3. Correct baby position during sleep. Until the child has learned to roll over well on his own (this happens after 4-5 months, that is, during the period when the risk of SIDS decreases), he should be put to sleep on his back, and not on his side, and especially not on his stomach.
4. Maintaining optimal temperature conditions. The baby should not be overcooled or overheated; it should not be swaddled so as not to impair breathing.
5. Long-term continuation of breastfeeding (at least up to 4 months). According to statistics, the lack of milk in the mother and an early transition to artificial feeding often provokes the occurrence of SIDS.
6. Strengthening the immune system. For the full development of the baby, parents should carry out daily gymnastics, hardening and give the child a massage. Eliminating harsh stimuli for a while baby sleep

(loud sounds, intense smells, bright lights).

Let's look at it in detail:

Co-sleeping as a method of prevention

According to research, the likelihood of infant death is directly related to co-sleeping. These data are quite contradictory - according to statistics, the occurrence of SIDS is more often observed in those countries where the child sleeps alone (the baby’s crib can be in the parent’s room or in different rooms). But there is also evidence that co-sleeping is dangerous for babies. The researchers did not take into account the influence of other factors (parental smoking, prone position, pillow and soft mattress, etc.), did not provide convincing arguments, and simply stated an increase in cases depending on the mother and baby sleeping together.

Based on these data, it was concluded that the baby should sleep alone. To control your baby's breathing and heart rate, it is recommended to use a baby monitor. If it is not possible to purchase a device, the child is given a separate crib located near the mother’s bed.

Co-sleeping is allowed if parents have the opportunity to completely eliminate dangerous factors, properly arrange the child’s sleeping place and comply with the basic condition - the baby’s head should not be covered under any circumstances, even an adult’s hand prevents the flow of air.

Symptoms and first aid

Lack of breathing is the first and main symptom of SIDS. If it does not resume within 5 seconds, artificial respiration must be performed. The chest of a baby lying on his back should rise while air is blown in.

The likelihood of SIDS cannot be predicted; the baby may die unexpectedly even if the recommendations are fully followed, so at least one parent should be able to provide first aid. If at some point the baby suddenly stopped breathing, and the actions of adults helped restore breathing, an ambulance must still be called.

Komarovsky about SIDS

One of the most tragic things for a young family where a baby has recently been born can be a special syndrome of “death in the crib,” or SIDS (sudden infant death syndrome) of an infant. A similar term in pediatrics refers to the death from unknown causes of relatively healthy children under one year of age.

This problem has been studied for many years, and although the exact cause of this phenomenon is not clear, today the main leading causes have been put forward, and certain influences have been identified that can act as provocateurs of this pathology. In connection with this phenomenon, parents should be vigilant at an early age of the baby, constantly monitoring his condition.

What is Sudden Infant Death Syndrome?

This syndrome is not classified as a disease; it is a post-mortem report given by pathologists after an autopsy, when neither the results of the study nor any data on the baby’s medical card provide obvious reasons for death.

This condition is not indicated if, during the autopsy, developmental defects were discovered that had not previously manifested themselves (and affected the heart and breathing), or if death occurred due to accidents.

SIDS is not a new condition, the sudden death of infants has been recorded since ancient times, but even today an explanation for this sad phenomenon has not been found, and leading experts around the world are actively studying this fact, making attempts to explain the ongoing lethal changes. According to statistics, SIDS is not typical for children of Asian origin, and among Europeans, children die twice as often as among Indian and African families.

Characteristics of SIDS infants

According to doctors, SIDS most often occurs while the baby is sleeping, and on the eve of death there were no alarming symptoms or diseases; such cases occur with a frequency of up to 6 children per 1000 births.

According to post-mortem changes and retrospective analyses, certain patterns of tragic events were identified. Thus, children under six months are most often susceptible to SIDS; the critical period occurs between the second and fourth months of life. Moreover, episodes of death predominate during the cold period, with a peak occurring in January-February, but according to data to date, such a pattern is not so clearly visible.

Up to 60% of children who die as a result of SIDS are classified as male, but it is impossible to predict this in advance, as well as to prevent it through any treatment. And SIDS itself has nothing to do with the child’s vaccinations or other medical procedures. Doctors consider the state of prematurity and immaturity to be one of the leading risk factors for such a tragedy.

How is such a diagnosis made?

It was the medical term SIDS that was introduced into pediatric practice in the 60s of the last century, but there were descriptions of similar episodes earlier. By the mid-90s, doctors, first in Europe and America, and then throughout the world, began an active preventive campaign. But today, such a diagnosis is made by the method of exclusion on a pathological examination, when any painful causes have not been completely confirmed.

Although children are adapted to life in a new environment and have a high ability to adapt at an early age, nevertheless, they can sometimes die from the effects of critical external changes or internal processes (malformations of organs and systems, injuries - intentional and accidental, infections, tumor growth).

Often there are no external reasons for death, but analysis of the medical record and autopsy reveal previously unaccounted for problems and pathologies. But if there are no changes in the body, and the death occurred in a dream, and the day before the children were completely healthy, SIDS is diagnosed.

Critical age for development of sudden infant death syndrome

Having retrospectively studied and analyzed hundreds of stories of SIDS, experts have come to certain conclusions regarding the age most dangerous for death “in the cradle” " Thus, these facts are noted:

• The development of SIDS is not typical for the first month of life,
• Most often, death occurs between 2 and 4 months after birth,
• The 13th week of life is considered the most critical.
• Up to 90% of deaths in the cradle occur in the first half of life,
• After a year, episodes of SIDS are extremely rare, although they cannot be completely excluded.

note

The literature contains descriptions of sudden death in children of preschool and school age, as well as in adolescence, especially during sports and physical activity, as well as at complete rest and even in sleep.

Probable mechanisms of development of the syndrome

Although the exact mechanism of this condition has not been studied, scientists suggest certain stages in the formation of SIDS. Thus, for death in the cradle, it is important to combine certain genetic characteristics (heredity), against the background of critical age and the influence of external unfavorable factors.

Children who are laid down to sleep on soft beds, when there is a lack of oxygen (acute hypoxia), immediately wake up to change position or give signals to their parents by crying or grunting. If for some reason these mechanisms do not work and the defense reflexes are not activated, then the baby may bury his face in the fabric, which leads to a decrease in blood oxygen levels and a sharp increase in CO2 levels. This leads to a state of initial depression, and then suppression of consciousness, up to complete cessation of breathing and cardiac activity.

The baby will breathe until the CO2 level reaches critical limits, when blackout occurs. If you don’t stir him up at this moment, death occurs. Accordingly, all factors that lead to hypoxia, both in the surrounding air and those that affect the breathing mechanism and reflex activity, are dangerous in terms of the development of SIDS.

Sudden infant death syndrome: causes and theories of development

Although the age of children during which the development of SIDS is most dangerous has been determined, the exact cause of this fact has not yet been identified.

However, during the research, doctors noted some features in children who died from the syndrome. Thus, according to the autopsy data, underdevelopment of the brain areas in the arcuate nucleus and reticular formation, as well as the brain stem areas where the respiratory and vasomotor centers are located, was revealed among all the children. But to date, the syndrome has not been studied exactly; there are explanation mechanisms and theories of origin that most closely describe the events leading to death in reality. Let's discuss the most common theories.

Respiratory dysfunction

During infants' sleep, they are characterized by periods of apnea (temporary stops in breathing) associated with the immaturity of the brain structures of the regulatory center of the brain stem. As a result of such delays, CO2 accumulates in the blood, with a sharp decrease in the level of O2, which under normal conditions excites the inhalation center, leading to faster and deeper breathing of the baby. If such an exciting impulse does not arrive from the brain, the child may die. .

Due to the immaturity of the respiratory center, breath holds of up to 10-15 seconds are not so rare, sometimes parents themselves note them, but if this occurs more than once an hour, and the periods exceed a 15 second interval, this is a reason to consult a doctor

The second most common theory is the cardiac hypothesis of SIDS, associated with disturbances in the rhythm of contractions, which threatens asystole (cardiac arrest during its relaxation phase). So, this is possible if a child’s heart has rhythm disturbances with extrasystoles (extrasystoles, extra contractions) or with the development of blockades (impaired conduction of impulses along nerve branches). In addition, a decrease in heart rate below 70 beats per minute, as well as an unstable, floating heart rate, are dangerous. This theory may be confirmed by the discovery of special genetic mutations in children who died from SIDS, leading to changes in the structure of special channels in the heart muscle. It is due to them that deaths occur.

Changes in rhythm are typical for healthy children, but they do not have critical stops or interruptions, the heart works stably.

Changes in brain structures

In the medulla oblongata (the region of the brainstem), the respiratory and cardiac centers are located, and as a result of research, scientists identified enzymatic defects that led to disruption of the formation of special mediators (substances that transmit impulses from cell to cell in the nervous system). These mediators are poorly released in the brainstem region, and they are especially affected in the presence of passive smoking (if the mother or father is a smoker). The birth of a child from a smoking mother sharply increases the risk of SIDS, which has been proven for a long time.

Also, some of the children who died from SIDS had damage to brain structures and changes in cells in the brain stem, which were the result of intrauterine hypoxia. In addition, changes in brain ultrasound data were also noted, revealing pathologies in the cerebral arteries that supply the brain stem. This also speaks in favor of the hypoxic theory of damage to the respiratory and heart centers.

It is believed that a certain position of the baby's head during sleep led to pinching of the artery, and insufficient development of the neck muscles did not allow him to change position and turn the head. Such skills are formed after 4 months, and therefore this theory is also confirmed.

Deterioration of blood flow to the brain occurs when children are laid on their side, which reduces blood flow through the cerebral arteries to the brainstem, which slows down the pulse and breathing.

Stress theory

Some scientists are inclined to think that SIDS is formed as a result of stress on the body of infants, and leads to post-mortem changes in the body, which are found in all dead children. They provide evidence of their opinion:

• Minor hemorrhages (bleedings) in the thymus and lungs,
• Lesions of the outer heart membrane,
• Stress ulcerations and erosions of the digestive tract,
• Shrinkage of lymphoid elements,
• Decreased blood viscosity.

Such phenomena are formed against the background of a massive release of stress hormones - cortisol, adrenaline and norepinephrine - into the blood by the adrenal glands.

According to researchers, external manifestations of such a stress syndrome in children could include lacrimation, changes in the size of the liver and spleen, hypertrophy of the tonsils, weight loss or a mild rash. Such changes are typical for children 2-3 weeks before the onset of SIDS, but often they are not detected, being mistaken for transient physiological phenomena.

Theories of infectious influence and immune shifts

For the overwhelming number of children who died suddenly, doctors noted the manifestation of any infections a week or even earlier, and the children, under the supervision of a doctor, could receive. According to scientists who support these ideas, microbes release toxins or certain factors that lead to blocking of protective mechanisms and innate reflexes (awakening from sleep during hypoxia), which makes SIDS more likely. Most often, toxins are blamed for the development of death, which intensified or provoked inflammatory changes in the body, and children, due to their age and immaturity of the immune system, are not able to protect their reflex reactions from suppressive influences.

Another group of scientists compared the presence of antibodies to pathogens in children who died from SIDS and other infants. A significant number of victims had antibodies to enterobacteria and clostridia, and these antibodies did not provide full immune protection, since they belonged to class A. Against the background of provocateurs, such as the effects of overheating, tobacco smoke, toxins, the defense mechanisms against these microbes were blocked, which threatened to suppress breathing and cardiac activity.

A number of authors find a connection between infection of the stomach of children with ulcer-producing bacteria () and SIDS. These conclusions were made on the basis that in babies who died from the syndrome, the stomach tissues were massively infected with this microbe, in comparison with children who had other factors of death in infancy. These bacteria are capable of producing nitro compounds (ammonium), which block the respiratory center. When regurgitating, children could inhale a certain amount of microbes from the contents of the stomach, which led to the absorption of ammonium into the blood and suppression of the respiratory center.

Gene mutation theory

More recently, the results of DNA studies of healthy children and those who died as a result of SIDS were made public. According to these data, a sharp increase in the risk of death was shown in those babies who had special mutations in the genes responsible for the formation of the immune system and certain of its components. But this mechanism cannot be realized on its own; it requires the influence of provoking factors in the form of external influences and metabolic disorders within the body.

Theory of thermoregulation problems

According to scientists, the basic vital centers of the medulla oblongata are immature at birth, and their maturation occurs by a period of three months. If the area responsible for thermoregulation in the brain stem is deficient, then children's temperatures may be below normal, and sharp fluctuations in values ​​are typical. Body temperature reaches stability just by 4 months of life (critical age for SIDS). In the period of the second to fourth month, while the changes come to stable operation, fluctuations can be significant, which gives inadequate temperature reactions. Against the background of problems with the climate of the room and if they are wrapped up too tightly, children simply overheat, which inhibits the activity of the respiratory and heart centers in the medulla oblongata, which leads to SIDS.

This is a death that occurs as a result of situations not related to violence and external adverse factors.

In persons who did not consider themselves sick and who were in satisfactory condition, fatal symptoms occurred within 24 hours from the onset of fatal symptoms. In contrast to coronary heart disease and its characteristic sudden coronary death, for which this time is determined to be 6 hours (lately this interval has been reduced to 2 hours).

In addition to the time criterion, according to the World Health Organization, sudden cardiac death must be, above all, unexpected. That is, death occurs as if against the background of complete well-being. Today we will talk about what is sudden cardiac death and how to avoid it?

Sudden cardiac death - causes

The category of sudden death includes those who died who, during the last month of their life, were not under the supervision of doctors due to problems with the functioning of the heart, their health was externally normal, and they led their usual lifestyle.

Of course, it is difficult to agree with the statement that these people were initially absolutely healthy. As you know, with cardiovascular diseases there is a risk of fatal complications without visible external manifestations.

In many medical treatises and from the personal observations of practicing doctors, including pathologists, it is known that in 94% of cases, sudden cardiac death occurs within one hour from the onset of the pain symptom.

Most often in the first hours of the night, or on Saturday afternoon, when there are changes in atmospheric pressure and geomagnetic activity. The critical months are January, May, November. In the ratio of men and women, the predominance fluctuates towards men.

The mechanisms of development and causes of occurrence are divided into the following groups:

1. In young people involved in sports.
2. In young people under 30 years of age during physical overload.
3. With anomalies in the development of valves, subvalvular structures, blood vessels and the conduction system of the heart.
4. In the presence of atherosclerosis of the heart vessels and hypertension
5. For cardiomyopathies.
6. For alcoholic illness (chronic and acute form).
7. For focal metabolic damage to the heart muscle and necrosis not related to the vessels of the heart.

Sudden death during exercise

Perhaps the most tragic is the death of young, well-trained people involved in sports. The official definition of “sudden death in sports” includes the occurrence of death during physical activity, as well as within 24 hours from the onset of the first symptoms that forced the athlete to reduce or stop training.

Outwardly healthy people may have pathologies that they were not aware of. Under conditions of intense training and acute overstrain of the entire body and myocardium, mechanisms are triggered that lead to cardiac arrest.

Exercise causes the heart muscle to consume large amounts of oxygen by increasing blood pressure and heart rate. If the coronary arteries are unable to fully supply the myocardium with oxygen, then a chain of pathological metabolic disorders (metabolism and energy in the cell) of the heart muscle is triggered.

Hypertrophy (increase in the volume and mass of cells, under the influence of various factors) and dystrophy (structural changes in cells and intercellular substance) of cardiomyocytes develops. Ultimately, this leads to the development of electrical instability of the myocardium and fatal arrhythmias.

The causes of death during sports are divided into two categories.

Not related to physical overload:

• hereditary diseases(congenital anomaly of the left coronary artery, Marfan syndrome, birth defects, mitral valve prolapse);
• acquired diseases (obstructive hypertrophic cardiomyopathy, myocarditis, conduction disorders, weakness of the sinus node);

• inadequate use of the functional capabilities of a person during physical activity (non-coronarogenic myocardial microinfarctions develop in the myocardium);
• sinus node failure or complete atrioventricular block;
• extrasystoles that occur as a reaction to thermal and psycho-emotional stress.

The immediate cause of death is ventricular fibrillation, and after exertion. Special meaning have pathologies that are asymptomatic.

Sudden cardiac death and abnormal development of cardiac tissue

With the increase in the number of deaths for no apparent reason, in recent decades, work has appeared aimed at an in-depth study of heart defects associated with abnormal development of connective tissue. The term dysplasia (from the Greek “dis” - disorder, “plasia” - form) refers to the abnormal development of tissue structures, organs or parts of the body.

Congenital connective tissue dysplasias are diseases that are inherited and are characterized by impaired development of tissues underlying the structure of the heart. The failure occurs during the period of intrauterine development and early stage after the birth of the child. They were conditionally divided into two groups.

The first are developmental defects that are quite well known and manifest themselves not only in disturbances in the structure of the heart, but also in other organs and parts of the body. Their symptoms and manifestations are well known and studied (Marfan syndrome, Ehlers-Danlos syndrome, Holt-Omar syndrome).

The second ones are called undifferentiated, they are manifested by disturbances in the structure of the heart, without clear specific symptoms. This also includes developmental defects defined as “minor cardiac anomalies.”

The main mechanism of dysplasia of the tissue structures of the cardiovascular system is genetically determined deviations in the development of the components of the connective tissue that make up the valves, parts of the conduction system of the heart and myocardium.

Young people in whom such disorders can be suspected are distinguished by a thin physique, funnel chest, and scoliosis. Death occurs as a result of electrical instability of the heart.

There are three leading syndromes:

1. Arrhythmic syndrome is a variety of rhythm and conduction disturbances with the occurrence of fatal arrhythmias.
2. Valve syndrome is an anomaly in the development of the main heart valves with dilatation of the aorta and main pulmonary arteries, mitral valve prolapse.
3. Vascular syndrome is a disorder of the development of vessels of various diameters from the aorta to the irregular structure of small coronary arteries and veins. Changes concern the diameter of blood vessels.
4. Abnormal chords are accessory or false ligaments in the cavities of the heart that close the valve leaflets.
5. Aneurysms of the sinuses of Valsava are enlargements of the aortic wall near the semilunar valves. The pathogenesis of this defect involves the flow of additional blood into the chambers of the heart, which leads to overload. Boys get sick more often.

According to various publications, death from mitral valve prolapse is 1.9 cases per population.

Cardiac ischemia

Coronary heart disease is an extremely common disease in the human population and is the main cause of death and disability in the developed countries of the world. This is a syndrome that develops in the cardiac form of atherosclerosis and hypertension, which lead to absolute or relative failure of cardiac activity.

The term IHD was first coined in 1957 and defined the discrepancy between the need and blood supply of the heart. This discrepancy is due to blockage of the lumen of blood vessels by atherosclerosis, high blood pressure and spasm of the vascular wall.

As a result of insufficient blood circulation, heart attacks or local limited death of the muscle fibers of the heart develop. IHD has two main forms:

• Chronic form (angina) - periodic attacks of pain in the heart caused by relative transient ischemia.
• Acute form (acute cardiac infarction) is acute ischemia with the development of a local focus of myocardial necrosis.

Acute myocardial necrosis (infarction) is a form of ischemic heart disease that most often leads to death. There are several signs by which acute necrosis of the heart muscle is classified. Depending on the extent of the lesion, there are:

• large-focal myocardial infarction;
• small focal myocardial infarction.

According to the time interval from the onset of symptoms to death:

• The first two hours from the onset of necrosis (the most acute period);
• From the time of onset of the disease to 10 days (acute period);
• from 10 days to 4-8 weeks (subacute period);
• from 4-8 weeks to 6 months (scarring period).

The probability of death is very high in the acute period and with extensive damage.

Acute coronary syndrome

Acute damage to the vessels supplying the heart muscle - ischemic changes in the myocardium for up to 40 minutes, previously interpreted as acute coronary, accounts for up to 90% in the structure of sudden cardiac death. The predominant number of patients with acute vascular insufficiency die from ventricular fibrillation.

Currently, it is considered as acute coronary syndrome.

The term “acute coronary syndrome” appeared in publications in the 80s of the twentieth century and was isolated from coronary heart disease and myocardial infarction as an independent clinical and morphological unit due to the needs of emergency care and one of the main causes of sudden cardiac death.

According to the definitions of foreign cardiologists, this term includes any signs that may indicate an incipient heart attack or an attack of unstable angina.

The need to distinguish acute coronary syndrome is due to the fact that it is at this stage that the mortality rate of patients with myocardial infarction is highest and the prognosis and outcome of the disease depend on the nature of the treatment tactics. This term is used in medicine in the first hours from the onset of an acute heart attack until an accurate diagnosis is determined.

Acute coronary syndrome is divided into two types, based on ECG readings:

1. Acute coronary syndrome without ST interval elevation and is characterized by unstable angina.
2. Acute coronary syndrome with ST interval elevation is an early myocardial infarction.

Based on the mechanism of formation of coronary syndrome, the following types are distinguished:

Endogenous type - cessation of blood flow as a result of closure of the lumen of the vessel by an atherosclerotic plaque and thrombotic masses formed on it.

This type of coronary syndrome is typical for young people with high mortality

Exogenous type - as a result of spasm of the arteries with and without the formation of blood clots. The second type of coronary death is typical for older people with a long course of chronic myocardial ischemia.

Cardiomyopathies

One of the most common sudden cardiac arrests is cardiomyopathies. This term refers to a group of diseases of the heart muscle of various origins that are associated with mechanical or electrical dysfunction. The main manifestation is thickening of the muscle fibers or expansion of the chambers of the heart. There are:

• Hypertrophic cardiomyopathy is a genetically determined disease that affects the heart muscle. The process progresses steadily and with a high degree of probability leads to sudden death. This type Cardiomyopathy, as a rule, is familial in nature, that is, close relatives are sick in the family, however, isolated cases of the disease occur. In% there is a combination of coronary atherosclerosis and hypertrophic cardiomyopathy
• Dilated cardiomyopathy is a lesion characterized by abnormal expansion of the heart cavity and impaired contractility of the left ventricle or both ventricles, which leads to changes in heart rate and death. Typically, dilated cardiomyopathy manifests itself quickly and more often affects men. Women are affected three times less than men.

Based on the causes of occurrence, they are distinguished:

• cardiomyopathy of unknown origin;
• secondary or acquired dilated cardiomyopathies caused by viral infection, including AIDS, alcohol intoxication, lack of microelements

• Restrictive cardiomyopathy is a rare form characterized by thickening and proliferation of the inner lining of the heart.

Alcohol myocardial damage

Alcohol damage to the heart is the second leading cause of sudden heart failure. According to statistics, up to 20% of patients with chronic alcohol disease die from cardiac pathology. In young patients with alcoholic heart disease, death occurs suddenly or suddenly in 11%, of which 41% of suddenly deceased people are under 40 years of age.

There is no clear pattern between the amount of alcohol consumed and the duration of intoxication and the degree of damage to the heart muscle. The sensitivity of the myocardium to ethanol is individual for each person.

A connection has been established with the development of high blood pressure and alcohol consumption. This mechanism is carried out by increasing vascular tone and the release of adrenaline into the blood. Heart rhythm disturbances with possible fibrillation appear.

Consequently, long-term consumption of excessive amounts of alcohol contributes alone, or in combination with myocardial ischemia, electrical instability of the heart and sudden cardiac death.

Hypertension and its role in the development of sudden cardiac death

In people suffering from a systematic increase in blood pressure, hypertrophy develops as a compensatory-adaptive reaction (increase in heart mass due to thickening of the muscle layer). This increases the risk of ventricular fibrillation and impaired blood circulation.

Arterial hypertension aggravates the development of atherosclerosis in the lumen of the coronary vessels. The incidence of hypertension in people who die suddenly reaches 41.2%.

Other causes of sudden death

Focal damage to the myocardium, as a result of disturbances in local metabolism in muscle fibers, includes dystrophic and irreversible changes in cardiomyocyte cells, without damage to the vessels supplying the heart.

The ability to contract the myocardium can be impaired as a result of changes in the structure of cells with disruption of their vital functions. The reasons for this phenomenon are extremely varied:

• disturbance of nervous regulation;
• changes in hormonal levels;
• disturbed electrolyte balance;
• damaging effects of viruses and bacterial toxins;
• action of autoimmune antibodies;
• influence of human metabolic products (nitrogen bases);
• the effect of ethanol and drugs.

The development of acute heart failure can occur in the acute period of the disease, during recovery, and even in the absence of toxic substances in the blood.

The connection between stress and sudden cardiac death is widely known. Influenced

physical and psychological stress often cause cardiac arrhythmias and episodes of sudden, persistent loss of consciousness that lasts more than one minute (fainting). At the final stage of stress reactions, hormones such as adrenaline, glucocorticoids and catecholamines are released.

This leads to an increase in blood glucose and cholesterol levels and an increase in pressure in the arteries. All this leads to disruption of myocardial metabolism and becomes the basis for the so-called “biological suicide”

Why do men die more often?

If we summarize all of the above, we can conclude that men are more likely than women to suffer from one or another heart disease with a fatal outcome.

This is due to several factors:

1. Most genetically determined pathologies are transmitted according to an autosomal dominant mode of inheritance. This implies the transmission of symptoms and diseases from father to son.
2. In a woman’s body, the sex hormones estrogens are present in greater quantities, which have a beneficial effect on the development of atherosclerosis and arterial hypertension.
3. Men are more involved in heavy physical work and are thus more susceptible to overload.
4. The prevalence of alcoholism and drug addiction among men is greater than among women.
5. The cost of living of men in all countries of the world is lower than that of women.

Signs and precursors of sudden cardiac death

Painting clinical manifestations sudden death develops very rapidly. In most cases, a tragic situation occurs on the street or at home, and therefore qualified emergency assistance is provided too late.

In 75% of cases, shortly before death, a person may experience chest discomfort or a feeling of shortness of breath. In other cases, death occurs without these signs.

Ventricular fibrillation or asystole is accompanied by severe weakness and presyncope. After a few minutes, loss of consciousness occurs due to lack of blood circulation in the brain, then the pupils dilate to the limit and do not respond to light.

Breathing stops. Within three minutes after circulatory arrest and ineffective myocardial contractions, brain cells undergo irreversible changes.

Symptoms appearing immediately before death:

• convulsions;
• noisy, shallow breathing;
• the skin becomes pale with a bluish tint;
• pupils become wide;
• The pulse in the carotid arteries cannot be felt.

Treatment of sudden cardiac death

The only treatment for sudden death is immediate resuscitation. Resuscitation consists of several stages:

1. Ensuring free passage of air through the respiratory tract. To do this, it is necessary to place the dying person on an elastic, hard surface, tilt his head back, extend the lower jaw, open his mouth, free the oral cavity from existing foreign objects and remove the tongue.
2. Carry out artificial ventilation using the mouth-to-mouth method.
3. Restoration of blood circulation. Before starting an indirect cardiac massage, you need to perform a “precordial blow.” To do this, sharply strike with your fist in the middle of the sternum, but not in the area of ​​the heart. Next, place your hands on the person’s chest and perform chest compressions.

For an effective resuscitation process, the ratio of air inhalations into the patient’s mouth and rhythmic pressure on the chest should be:

• inhalation for 15 pressures, if one person is resuscitating;
• 1 breath and 5 pressures if two people are resuscitating.

Immediately transport the person to a hospital to provide qualified professional assistance.

How to avoid sudden death

Every person should consciously and responsibly treat the health of his heart, and know how he can harm his heart and how to protect it.

Regular medical examination.

First of all, these are systematic visits to the doctor, examinations and laboratory research. If someone in the family has a pathology of the cardiovascular system, immediately inform the doctor about this to eliminate the risk of manifestations of genetically inherited diseases.

Rejection of bad habits

Fundamental cessation of smoking, drug addiction, and excessive alcohol consumption. Moderate consumption of drinks with the effect of stimulating the nervous system (coffee, tea, energy drinks).

Tobacco smoke reduces the percentage of oxygen in the blood, which means the heart works in oxygen starvation mode. In addition, nicotine increases blood pressure and promotes spasm of the vascular wall. The ethanol contained in alcohol has a toxic effect on the heart muscle, causing dystrophy and exhaustion.

The tonic effect in these drinks leads to an increase in heart rate and increases blood pressure.

Normalization of diet and the fight against obesity.

Excess body weight is a factor that plays an important role in the development of heart and vascular diseases and the occurrence of sudden cardiac death. According to statistics, people who are overweight are more likely to suffer from hypertension and atherosclerosis.

Extra pounds make it difficult not only for the heart, but also for other organs. To know your ideal physiological weight, there is a formula: body mass index BMI = existing weight: (height in meters x 2).

Normal weight is considered:

• if you are between 18 and 40 years old - BMI = 19-25;
• from 40 years old and over - BMI = 19-30.

Results are variable and depend on structural features skeletal system. Moderate consumption of table salt and animal fats is recommended. Products such as lard, fatty meat, butter, pickles and smoked foods lead to the development of atherosclerosis and increased pressure in the blood vessels.

Healthy foods for the heart

Proper nutrition is the key to health and longevity; support your body with heart-healthy foods.

1. Red grape juice.
2. Low-fat milk.
3. Fresh vegetables and fruits (legumes, bananas, carrots, pumpkin, beets, etc.).
4. Sea fish.
5. Lean meat (chicken, turkey, rabbit).
6. Nuts.
7. Vegetable oils.

A healthy lifestyle is the answer to the question, how to avoid sudden death?

There are many diets designed to strengthen and maintain good heart condition. Regular exercise will strengthen the body and make you feel more confident and healthier.

Active lifestyle and physical culture

Regular dosed physical activity with an emphasis on “cardio training”:

1. Running in the fresh air.
2. Bicycle rides.
3. Swimming.
4. Cross-country skiing and skating.
5. Yoga class.
6. Morning exercises.

Conclusion

Human life is very fragile and can end at any moment due to reasons beyond our control. Heart health is an indisputable condition for a long, quality life. Pay more attention to yourself, do not destroy your body bad habits and poor nutrition is the basic principle of every educated, sane person. The ability to respond correctly to stressful situations, to be in harmony with yourself and the world, to enjoy every day you live, reduces the risk of sudden cardiac death and leads to a happy long life.

It seems that in these cases, Her Majesty “Fate” is in charge of everything... Of course, it would be nice to be on the safe side: “the ability to react correctly to stressful situations, to “get along” with yourself and the world, and to try to enjoy every moment of life”...

A terrible diagnosis. We remember the death of a very young hockey player with such a diagnosis posthumously. Once again you are convinced that everything is good in moderation.

You should never forget about the heart; there are excellent biological supplements to support the cardiovascular system.

Even under Mishka Marked, there was a large article in Literature on this subject. It was written there that if within 10 minutes. If the intensive care unit doesn’t arrive and give you an electric shock, then that’s it, screw it. If he arrives later and the heart is saved, you will still be an idiot, because brain cells begin to die. Such conditions for the arrival of an ambulance exist only in Europe and the USA (perhaps Southern Canada and South Australia with New Zealand), but not in our decrepit Russia.

A resident of this unfortunate country, Tula (working - until I die - retired).

Adding to the previous one.

I have a friend who ran away from Kazakhstan at one time, so his son served in the army (that is, he was healthy and came to demobilization healthy), got a job as a driver in a convoy, did not complain about his health (since he drove it, that means he drank little ). I came home from work - bam! Heart stopped - 23 years old. The person I know is illiterate and doesn’t know what or how to do it. Buried and that's it

Yes, the mortality rate is now impressive... not so long ago, a colleague suffered a tragedy at work. Her husband came for dinner and died before her eyes. everything is lightning fast... and there are triplets left.... and they are only 4 years old... And there is also stress, everything is faster, no rest, nothing... the race is all ours... But I didn’t drink, didn’t smoke.. that’s life...

When heart pain appears. then you can’t hesitate here. But in order to get rid of pain in the heart for a long time, you need to limit yourself in many ways, and this is well said in the publication.

How scary it all is! Once again you will think about how important it is to take care of your health from childhood.

I know of such cases of sudden death from a heart attack among men, including relatives. Moreover, at a fairly old age and with a seemingly healthy lifestyle. Still, stress and nervous overexcitation play a dominant role here.

Hmmm... Life is short and unpredictable. Appreciate every day and take care of yourself.

It’s scary when death comes suddenly... And jokes with the heart are especially bad. It needs to be taken care of and pampered with healthy foods.

Unfortunately, I am also familiar with this cause of death. As a rule, everything happens very quickly and it is no longer possible to save the person.

Thanks for such a detailed article. I am glad that it is written, although it is understandable, but very complete and competent. You need to know about such things, because whoever is forewarned is forearmed.

I read it and I’m really scared to go to the gym...

Everyone has their own destiny, I also know many cases of sudden death in people leading a healthy lifestyle. All that remains is to appreciate every day you live, and the rest - no one is immune from anything.

I read it and was horrified... A very useful and well presented article. I wondered how long it had been since I checked my heart...

Did you read it and start using it or did you read it and forget?

and who said that you need to eat as much of it as possible?

I heard about this method of treatment with Bolotov’s salt, contraindications to it...

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To practically resolve a particular problem, you need to contact a specialized specialist.

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Experts talk about death during sleep

Regardless of why a person died - from carbon monoxide poisoning to serious brain disease, it is first important to clearly determine the cause of death. And this is exactly what is difficult. Forensic experts shared information about how they determine whether a death was violent or suicide, and how they determine the cause of death in young people.

If you were told that a friend died in a dream, this may mean that the cause of death has not been clearly established, or that loved ones want to keep it a secret. But if the deceased was a young, healthy person, then it is important to find answers to pressing questions.

To those who remain to live in this world and deeply mourn the loss loved one, it is very important to know why a loved one died in order to draw a line. And for family members of the deceased this is especially important information, because awareness of heredity, which affects the risk of death in a dream, can potentially save the lives of his loved ones.

Deceased at home in a dream: actions

“If a loved one dies at home, especially in their sleep, the medical examiner should be notified of the fact afterward unless the death is supported by testimony,” says Dr. Candace Schopp, a forensic pathologist and medical examiner in Dallas County. (USA).

“Regardless of whether we accept a case for consideration or not, a lot depends on what medical history the patient had an illness and what were the circumstances of his death,” the expert adds.

“The age of the deceased is a very important factor in the case,” says Schopp. The younger the person, the more often an autopsy is performed if the underlying causes of death are not known. If the victim is seriously aged (over 50 years old), or has a diagnosis and no signs of violent death, specialists are unlikely to perform an autopsy.

The younger the person, the more often an autopsy is performed.

Suicide version

Death under suspicious circumstances, with suspected suicide, at home, and even in a dream, is a completely different matter. “I will always check the version of suicide if a person died in bed. According to Schopp, the following key points lead to thoughts of suicide:

• strange objects were found at the scene;
• there are ambiguities in the medical history;
• the deceased was very young;
• The deceased was in good health.

According to the forensic pathologist, experts also often consider the possibility of an accidental drug overdose. Recently, there has been an increase in the number of people taking prescription pain medications incorrectly. Among them, opioids (opiates) - narcotic analgesics - were often seen.

Accidents at home

Each year is marked by tragic deaths due to carbon monoxide poisoning, including at home and while sleeping. Dr. Patrick Lantz, a professor in the Department of Pathological Anatomy at Wake Forest University School of Medicine, a forensic expert and pathologist in the state of North Carolina (USA), talks about this.

Due to malfunctions of the gas boiler or water heater, carbon monoxide may be released throughout the house. “In this case, people can easily choke on smoke and die,” Lantz says.

Or sometimes the following situation happens: a person has a built-in garage in his house. He started the car to warm it up. And left the garage door closed. “Carbon monoxide spreads quickly and serious gas poisoning is possible,” Lantz said.

Cases are different. Suppose someone was electrocuted because a wire in an electrical household appliance, for example, in a hairdryer. “The person may have touched the wire in the bathroom. He falls to the floor and falls asleep or falls onto the bed. It’s not always possible to find a person near an electrical appliance,” says the expert.

According to Lantz, if you ever find a deceased person in bed, your actions will depend on the circumstances of the incident: “If the deceased had cancer or chronic cardiovascular disease, the best option would be to call a physician to the house.”

In any case, if death occurs suddenly and unexpectedly, it is important to call an ambulance (103) and the police (102). “There are times when a person is alive, but he can barely breathe and he has a pulse that you cannot determine. Therefore, it is important to consult a professional to understand whether the person really died in his sleep,” says Patrick Lantz.

If death occurs suddenly, it is important to call a medical team in Ukraine (103) and the police (102). There are times when a person is alive, but he is barely breathing and he has a pulse that you cannot determine. Therefore, it is important to contact a professional to understand whether a person is alive or not.

Questions of the heart in a dream

Adults who die of natural causes, including at home and in their sleep, and are sent for an autopsy are often people between 20 and 55. The reason for the autopsy is an unknown cause of death; Plus, they have very few facts and records in the medical record, Schopp says.

According to the expert, the following were often observed in such deceased people:

“And in the vast majority of cases, we encounter undiagnosed cardiovascular diseases in our practice,” she adds.

When a person dies suddenly at night or during the day, it is often due to something called cardiac arrhythmia, Schopp admits. In cases of severe cardiac arrhythmia, the propagation of cardiac impulses in the heart may be impaired. Autopsy of the heart may reveal scarring, expert says.

“The patient’s heart may be enlarged while taking large quantity alcohol or due to obesity,” explains the forensic pathologist. In addition, the heart can be abnormal large sizes due to congenital heart diseases.

Family illnesses

It is very important to understand the reason for the unexpected death of a loved one, especially if he died before and in his sleep, Lantz says. “Firstly, it helps to correctly explain to the family why the person passed away,” explains the expert. “It is especially important to realize this if the hereditary factor plays a key role in the case,” he adds.

Genetic diseases that can lead to rapid death include channelopathies. This is a group of hereditary or acquired neuromuscular diseases associated with disruption of the structure and function of ion channels in the membranes of muscle cells or nerve fibers. Such diseases represent a violation of the flow of ions through cells, in particular:

The diseases are caused by mutations in ion channel genes.

Channelopathies are to blame for some cases of cardiac arrhythmia among young people, Schopp says. Often, as a result of channelopathies, a person dies in his sleep.

Brugada syndrome, for example, can cause abnormal heart rhythms in the lower chamber of the heart. Brugada syndrome is often inherited among Asians. This disease may be asymptomatic. Sometimes people just don't know that this disease is life-threatening. This is a sudden death syndrome that occurs due to polymorphic ventricular tachycardia or fibrillation.

Fibrillation is an accelerated contraction of individual muscle fibers of the heart, disrupting their synchronous activity (heart rhythm) and pumping function. Polymorphic ventricular tachycardia is a rare form of ventricular tachycardia in which the amplitude of the ventricular complexes changes like a sinusoid, with complexes of minimal amplitude connecting phases of opposite polarity.

Associated symptoms:

Saving a life

Based on the results of the autopsy, experts can advise the loved ones of the deceased, who died at home and in his sleep, to undergo diagnostics to identify serious genetic diseases and speed up treatment if the disease is confirmed. Sometimes doctors only observe the disease, and in some situations treatment is prescribed immediately. If doctors diagnose certain types of arrhythmia, patients are offered to purchase an implantable defibrillator in the area of ​​the heart.

An implantable cardioverter defibrillator (ICD) is a pacemaker-type device that continuously monitors the heart's rhythm. If the device detects a rhythm disorder that is not too serious, it generates a series of painless electrical impulses to correct the rhythm.

If this does not help or the rhythm disturbance is severe enough, the ICD device generates a small electrical shock called cardioversion. If this does not help or the rhythm disturbance is very severe, the ICD device generates an even stronger electrical shock, called defibrillation.

Prevention and diagnosis of loved ones of the deceased

Diseases of the wall of the aorta, the large, central artery that carries blood from the heart to the body, can lead to rupture of the aorta and sudden death. Aortic aneurysm is often a hereditary disease. This is an expansion of the lumen of a blood vessel or heart cavity caused by pathological changes their walls or developmental anomalies.

“Usually family members are asked to do in the event of an aneurysm of the deceased, including in a dream:

• echocardiogram;
• computed tomography;
• magnetic resonance imaging (MRI).

When doctors see that the aorta is beginning to dilate, they suggest using preventive surgery methods,” Lanz reports. “And then sudden death can be prevented,” the doctor clarifies.

Schopp says that when hereditary diseases served possible reason death, then representatives of her institution call relatives. “Sometimes I personally explain everything clearly over the phone,” she says. “In the autopsy report, I indicate that this is a genetic mutation that is inherited, and I recommend that immediate family members (especially parents, brothers, sisters, children) go for a consultation with a therapist and get diagnosed,” says the expert.

Mental health issues

When doctors take mental health issues into account, it means they want to determine whether a person died of natural causes or not, especially if it happened at home and in their sleep. “Forensic experts have to do a lot of research on this and talk to the loved ones of the deceased,” says Lantz.

Typically, forensic experts ask similar questions to loved ones of the deceased:

• Perhaps the person was depressed?
• Has he ever taken drugs or serious sedatives?
• Did he sometimes voice his attitude towards suicide attempts and suicidal thoughts?

If family members answer yes to at least one of these questions, forensic experts decide to perform an autopsy.

“If we receive such information about the characteristics of the deceased, for example: that he was depressed; suicidal tendencies were evident, I think that any expert would say to do an autopsy. Age of the deceased in in this case does not play a role. Specialists then want to rule out the possibility of suicide,” he says.

Associated diseases:

Brain diseases

According to Lanz, brain diseases that can lead to sudden death, including at home and in sleep, are the following:

What is a cerebral aneurysm? This is a weakening of the wall of one of the blood vessels in the head. Due to the way blood circulates in the head, this “weakness” causes the walls of the vessel to bulge. As with overinflated balloon, such a bulge can lead to rupture, resulting in a cerebral hemorrhage.

According to Lanz, in the case of infections such as meningitis and encephalitis, there can be fatal consequences for the human body. In general, with the development of such serious diseases, obvious symptoms are observed that should be taken into account.

“Epilepsy is known as a disease that causes death in one's sleep,” says Schopp. This may be due to the fact that the amount of oxygen to the brain decreases, and this provokes an epileptic seizure. According to her, the patient usually has a history of such attacks of epilepsy.

Causes of death in supposedly healthy people

According to Schopp, the incidence of sudden death among apparently healthy people in their beds at home and in their sleep depends on how people understand the word “healthy.” Obesity is a common cause of unexpected death, says forensic pathologist Schopp. “For example, I meet many people in my practice who have serious coronary insufficiency. In addition, I often observe patients at work who have clogged arteries. Such phenomena are “getting younger,” the doctor admits.

The incidence of sudden death among apparently healthy people in their beds depends on how people understand the word “healthy.”

Coronary insufficiency is a concept that means a decrease or complete cessation of coronary blood flow with insufficient supply of oxygen and nutrients to the myocardium.

According to Schopp, sometimes a person, due to his low income and living conditions, may not have any entries in his medical record for 15 years due to the fact that he could not see a doctor.

“It’s quite rare for people to die suddenly and unexpectedly in their bed in their sleep,” Lanz is convinced. "Sometimes it happens. In most cases where death comes completely without warning, forensic experts study such incidents very carefully. We would like autopsies to be carried out more often, so that the relatives of the deceased can be better informed,” the doctor hopes.

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