asystole - is a type of cardiac arrest, which is characterized by the cessation of the heart rate from different departments.Asystole is conditional instant and comes after previous cardiac arrhythmias. With instant asystole on the background of absolute well-being and without heart rhythm disorders is a sudden cessation of electroexcitability heart, resembling a short circuit, the cause of which is an acute ischemia in coronary artery disease.
asystole, which comes after a long flowing ventricular fibrillation, is formed by the exhaustion of reserves of phosphates in cardiac tissues.For the normal passage of blood through the heart tissue requires its periodic excitability, as a result of ventricular fibrillation develop bystrotsirkuliruyuschie, chaotic and disorderly electrical processes in the system of the heart, which causes the instantaneous cessation of perfusion of the coronary vessels.Stocks ATP endogenous exhausted very quickly for a few seconds, and renewed at this point
most often asystole observed on the background of myocardial infarction, acute form of heart failure, abuse and overdose of antiarrhythmic agents that affect the activity of the heart.As a rule, asystole appears suddenly and requires immediate hospitalization and intensive care.If these events can occur death, although after helping in the ICU manage to save only 15% of patients.
asystole is characterized by the absence of symptoms of heart rate and electrical activity of the heart on the ECG, that is marked onset of clinical death.Asystole needs urgent resuscitation character holding events in which injected adrenaline, atropine, conduct pacing, indirect or direct cardiac massage and artificial ventilation.But the likelihood of a positive outcome in asystole is very low.
asystole may occur as atrial and ventricular.
ventricular asystole is a condition of the body, in which the stops electrical and mechanical activity of the ventricles of the heart in general and its stop.This pathology is characterized by cessation of circulation and clinical death.
As a rule, the emergence of ventricular asystole, and hemodynamically inefficient cardiac electrical activity mainly contribute to severe irreversible damage to the heart and circulatory disorders progressing.Therefore, can cause heart failure and cardiac causes noncardia origin.
the root cause electrical instability of the heart muscle include: coronary artery disease in acute and chronic;various injuries, postinfarction recovery of heart on the background of chronic heart failure.Furthermore, occurrence of primary cardiac arrest associated with elektronestabilnostyu cardiac muscle.Quite often asystole develops as a result of complications of acute myocardial form, significant myocardial damage with complete transverse blockade against the backdrop of ventricular fibrillation.
But in terms of predicting the instantaneous form of asystole is considered unfavorable.Cardiac arrest comes after VF has a positive outlook, especially against krupnovolnovoy VF unlike melkovolnovoy.
Causes of asystole may be heart failure and cardiogenic shock.Significantly increased risk of heart failure in unstable angina occurring.Approximately 12% of these patients develop sudden death and myocardial infarction.
Risk factors asystole in CHF is considered heart remodeling after myocardial with further education dilatation and hypertrophy of the heart chambers, as well as having an arrhythmia and the blockade of, multivessel disease, alcohol abuse, advanced age, smoking, hypertension, atherosclerosis with hereditary predisposition andhypercholesterolemia.
Other cardiac causes of asystole include: pericarditis, exudative genesis obstacles inflow or outflow of blood to the heart (thrombosis within the heart valve dysfunction or myxoma).As well as low emissions of blood, myocardium against flu or diphtheria, endocarditis infectious etiology of cardiomyopathy, aortic stenosis, trauma to produce tamponade, pacing open-heart catheterization and coronary angiography - it's all possible causes of cardiac arrest.
By noncardiac reasons that can cause asystole include: circulatory (hypovolemia, shock of different genesis, pneumothorax busy character in pulmonary diseases, chest trauma or mechanical ventilation, pulmonary embolism, vaso-vagal reflex properties).In addition, respiratory causes (hypoxemia and hypercapnia) and metabolic (hypothermia, acidosis, hyperkalemia);acute form of hypercalcemia giperadrenalinemiya, side effects when taking barbiturates, drugs, cardiac glycosides, and others. provoke asystole.
However, there are many other different factors causing cardiac arrest.This can be electrical accident as a result of electric shock, lightning;asphyxia;intoxication;sepsis;cerebrovascular complications of nature;Various diets which are based on fiber and receiving large quantities of liquid.
symptoms of sudden primary cardiac arrest is the first sign of cardiac ischemia, although it has in most cases certain precursors.For example, in a survey of patients after having been held resuscitation, 40% of patients were observed precursors asystole, 30% experienced chest pain, 32% complained of spinning head or loss of consciousness, and in 25% of observed difficulty breathing in the form of shortness of breath.All other cases are characterized by the development of asystole due to pathological conditions which have led to its formation.
Typically, cardiac arrest occurs in patients who are seriously ill for a long time.In this case, the compound significantly affect cardiac and noncardiac factors.At the same time patients experience hypotension, tachycardia, chest pain, dyspnea, and fever.In addition, they become restless and then all this causes a disturbance of consciousness.
ventricular asystole is characterized by the sudden disappearance of the pulse, heart sounds and pressure.In the near future there is a loss of consciousness, the patient becomes pale and breathing is interrupted.After stops blood circulation in the brain, that is forty-five seconds, extend pupils that peak for one minute and forty-five seconds.Asystole ECG confirmed by the absence of electrical activity of the heart, but resuscitation must be initiated before the results of an ECG study.
Typically, asystole is regarded as clinical death of the patient, which is a reversible stage of dying.This lack of symptoms manifested heartbeats, breathing and self-reflections on the impact of external nature.However, there is a possibility of the potential recovery of body functions resuscitation techniques.
Against asystole in the absence of circulation continues breaths agonistic properties, characterized by infrequent, short, deep breathing convulsive movements involving skeletal muscles.This range of motion can be weak and poor, that is, external breathing somewhat reduced.
The examination electrocardiographic asystole observed undulating contour line, there is no pulsation of the great arteries, can be stored atrial activity, unlike the ventricles.This asystole with P-wave may be a response to pacing.
treatment of asystole
Specialized treatment of asystole is the optimal ventilation of lungs via intubation and access to the central or peripheral veins through which the bolus injected epinephrine hydrochloride and atropine.This is because very rarely oppressed supraventricular and ventricular pacemakers due to increased parasympathetic tone.
In case of failure of adrenaline in normal doses, administered his bolus every five minutes, then increase the dose of five milligrams of the introduction of every three minutes.Basically all drugs must be administered intravenously and quickly.When drugs are administered in a peripheral vein, they are diluted with saline.In cases where there is no access to the veins, then Epinephrine, Lidocaine, atropine administered into the trachea in a dose which doubles.But the injection into the heart is allowed only after failure or inability of other routes of administration.
have minimal contractile activity of the heart is exposed to endocardial pacing, transdermal or transesophageal type.
pacing is performed at acute infarction, bradycardia, tachyarrhythmia, Digitalis overdose of drugs and inadequate circulation.In addition, both mechanical ventilation and chest compressions, while trying to eliminate the causes of asystole: hypoxia, hyperkalemia, acidosis, hypothermia, an overdose of medication therapy, cardiac tamponade, and pulmonary embolism.
If developing hypovolemia, then quickly restore the bcc (the volume of blood that is involved in the circulation).When pneumothorax catheter, leave it open, and then replace it with drainage.In the presence of cardiac tamponade pericardiocentesis is performed, and in the future - drainage catheter or pericardiotomy.In the case of intracardiac thrombosis and myxoma appointed emergency surgery.
To treat hypoxia apply mechanical ventilation, if asystole occurred as a result of an overdose of drugs, then appoint an etiological therapy.Hyperkalemia treated with injection of calcium chloride and sodium hydrogen carbonate (be sure to enter in different veins), and mixtures of glucose and insulin.For treatment of acidosis intensive mechanical ventilation and in the same dosages administered intravenously Sodium bicarbonate.
All resuscitation was stopped after half an hour if no efficiency of their conduct.In this case, there will be no consciousness, breathing arbitrary, the heart is inactive, and the pupils very much dilated and do not react to light.
further therapeutic measures are performed in the intensive care unit, where watching the electrocardiogram, respiration, bcc, hemodynamics, electrolytes.With the help of medication support closer to the normal blood pressure, Reopoliglyukin introduced to improve the rheological properties of blood and spend an intensive treatment of the underlying pathology.But to prevent brain damage around the head and neck put bubbles with ice and maintained at a temperature in the ear canal outside within 34 degrees.
asystole a complete cessation of the mechanical and electrical operation of the heart.It is the second in a row cause of sudden death occurs.Very often VF leads to asystole.Symptomatic picture of a pathological condition consists of symptoms that characterize the clinical death.The prognosis of heart failure worse in some contrast to atrial fibrillation, asystole have been considered secondary to chronic heart disease.
Emergency resuscitation aid in case of asystole consist of chest compressions and rescue breathing.Then injected epinephrine hydrochloride and calcium chloride.If necessary, these drugs enter the intracardiac.
In the future hold elektrotransvenoznuyu or transthoracic pacing.Then low molecular weight liquid jet injected into the subclavian vein large central and sodium bicarbonate, glucose, Panangin insulin.