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CARDIAC ARREST AND SUDDEN CARDIAC DEATH (DEFINITIONS (Electromechanical…
CARDIAC ARREST AND SUDDEN CARDIAC DEATH
post mortem
diagnosis of sudden cardiac death (scd) is important because we can to overlook cases of violent death without morphological changes e.g. intoxications
Before diagnosis must be
excluded
:
violent death
:–occult trauma; drowning; chocking, drug addition, iatrogenic disorders
natural death
: – diseases
Time between the onset of final symptoms and death.
„Aborted sudden death” –
patients who suffer but survive cardiac arrest (reanimation)
sudden cardiac death (scd)
is natural (non-violent) death
due to cardiac causes, heralded by
rapid loss of counsciousness within 1 hour of the onset of acute symptoms.
preexisting heart disease may or may not have been known to be present, but the
time and mode of death are unexpected
.
KEY ELEMENTS OF DEFINITION:
– „Natural (non-violent)”
– „Rapid – very rapid”
– „Unexpected”
Time References And Symptoms By Myerburg R.J., Castellanos A.
A. PRODROMES:
Cardiovascular symptoms:
chest
pain
palpitations
dyspnea
weakness
Days to month
B. ONSET OF TERMINAL EVENT:
Abrupt change in clinical status:
arrhythmias
hypotension
chest
pain
dyspnoea
lightheadedness
Instaneous to 1 hour
C.
CARDIAC ARREST
Loss of effective circulation
Loss of consciousness
Minutes to weeks
D. BIOLOGICAL DEATH:
Failure of resuscitation
or
failure of electrical mechanical
or CNS function after initial resuscitation
SUDDEN DEATH
PATHOPHYSIOLOGY
CEREBRAL
:
SAH – aneurysm – rupture
Epilepsy
RESPIRATORY
:
Respiratory tract
obstruction
Vomits
Blood
Food
Bronchial
asthma
CARDIOVASCULAR
Mechanical cardiac arrest:
hemopericardium
– cardiac tamponade
aortic
aneurysms rapture
– haemorrhage
massive haemorrhage
massive
pulmonary thromboembolism
„saddle”
Arrhythmic cardiac arrest: (VT) [10%],
(VF) [70%]
,
Asystole
[15%]
, Electromechanical dissociation [5%]
DEFINITIONS
Cardiovascular collapse – A (sudden) loss of effective blood flow due to factors that may revert spontaneously or only with interventions (e.g. cardiac arrest)
Shock – A life – threatening circulatory condition resulting in an imbalance between oxygen supply and oxygen demand at the cellular level
Cardiac arrest – Abrupt cessation of cardiac pump function, which
may be reversible but will lead to death in the absence of prompt intervention
Death –Irreversible cessation of all biological functions
Premature ventricular complexes (
PVCs
)– Premature occurrence of a
QRS complex that is abnormal in shape and has a duration exceeding the dominant complex QRS
– greater than 120 milisec T wave is large and opposite
Ventricular tachycardia (
VT
)- Erises distal to the biffurcation of the Hiss bundle –
it erises in distal conduction system or ventricular muscle
Ventricular fibrillation (VF) - Result of disintegration of a single spiral wave into many self- perpetuating waves
Electromechanical dissociation (EMD)
Pulsless electrical activity = Failure of electromechanical coupling: Continued electrical rhytmicity of the heart in the absence of effective mechanical function
Primary:
end stage in advanced heart disease
acute ischemic events
Mechanisms:
– abnormal intracellular Ca2+ metabolism
– intracellular acidosis – ATP depletion
Secondary:
massive pulmonary embolism
exsanguination
acute malfunction of prosthetic values
cardiac tamponade
PATHOLOGICAL FINDINGS IN SUDDEN CARDIAC DEATH DUE TO CORONARY HEARD DISEASE
The coronary arteries:
–
Chronic atherosclerosis
(ATSCL)
–
Acute lesions
– complications o ATSCL:
Plaque fissuring
Plaque erosion
Platelet aggregates
Thrombus
– (fresh) recent Thrombus organizing
Coronary
artery spasm
Ventricular myocardium:
–
Heald myocardial infarction
–
Ventricular aneurysm
–
Acute myocardial infarction
–
Left ventricular hypertrophy
MYOCARDIAL DISEASES AND HEART FAILURE
CHRONIC CONGESTIVE HEART FAILURE: Cardiomyopathy:
Ischemic
Idiopathic congestive
Alcoholic
Hypertensive
Post-myocarditis
Post-Partum
ACUTE CARDIAC FAILURE:
Massive acute myocardial infarction
Acute myocarditis
Acute alcoholic cardiac dysfunction
Mechanical disruptions of cardiac
structures
– free ventricular wall – septum
– papillary muscle
– chordae tendineae – leaflet
DISEASES OF CARDIAC VALVES
– Valvular aortic stenosis/insufficiency
– Mitral valve disruption
– Mitral valve prolapse
– Endocarditis
– Prosthetic value dysfunction
VENTRICULAR FIBRILLATION OF UNKNOWN OR UNCERTAIN CAUSE
„Idiopathic” ventricular fibrillation
Polymorphic ventricular tachycardia
Nonspecific fibro-fatty infiltration in previously healthy
victim (variation of RV dysplasia)
ELECTRICAL INSTABILITY RELATED TO NEUROHORMONAL AND CENTRAL NERVOUS SYSTEM INFLUENCES
Catecholamine – dependent lethal arrhythmias
CNS – Related:
psychic stress, emotional extremes
disease of the cardiac nerves
congenital QT interval prolongation