Prevention of sudden coronary death
Contents:
Description:
Primary prevention of a sudden cardiac death comes down to identification of persons to which it threatens. Low FVLZh and emergence of ventricular arrhythmia are most of all informative. For example, emergence more than 20 ventricular extrasystoles (zhES) for 1 h or a paroxysm of ZhT lasting less than 0,6 pages. Later this patient conduct an electrophysiologic research (EFI) for assessment of probability of emergence of VSS in the subsequent. The most part of AAP are not effective in primary prevention of VSS. So, at patients from incontinuous ZhT. dysfunctions of LZh after transferred IT or the ventricular arrhythmia revealed at EFI in primary prevention of VSS statement of a cardioverter defibrillator is more effective, than reception of AAP. In practice to persons who manage to be reanimated put a cardioverter defibrillator which interrupts episodes of PZhT or FZh (but does not prevent their emergence).
In some cases carry out also a local ablation of a myocardium (destruction by means of an electrode through which there is an energy bunch) which deletes aritmogenny substrate in case of PZhT at the most part of persons without organic pathology of heart. Ablation not always allows to avoid completely episodes of dangerous arrhythmia (as "initiators" of arrhythmia can be in network of cells of Purkinye or the leaving path from PZh), but prevents PZhT episodes in 50-80% of cases. Sometimes combine statement of a cardioverter defibrillator with carrying out an ablation of a zone of a myocardium responsible for emergence of arrhythmias.
For secondary prevention of a sudden cardiac death purpose of AAP of the 3rd class and sotalol is more effective, than AAP of the 1st class, from the point of view of an over-all mortality (and cardial at heart diseases), emergence of arrhythmias; ZhT recurrence at patients with existence in the anamnesis of faints (Obm), ZhT or FZh, zhES episodes more than 10 for an hour at Hm.
In general are important for prevention of a sudden cardiac death: training of sellers, police officers and patient's family in resuscitation bases (as to a half of death arises because of the absence of people who could reanimate the patient); existence of defibrillators in large supermarkets (in the developed countries it is norm); identification according to an ECG (or Hm) the person high risk of development of VSS; the prevention of the accelerated development of atherosclerosis; reception of antiagregant (aspirin) and AB; careful and reasonable purpose of AAP (in 15% of cases cause arrhythmias).
