Enjoy the Spring Festival with peace of mind - Help you understand the three-level protection against "heartbreak"

The Spring Festival travel rush is known as the largest and most cyclical migration in human history. In the trilogy of "going home, staying at home, and leaving home", the weather is changeable, the journey is bumpy, and the body and mind are exhausted. In addition, with the arrival of the new crown epidemic, how to prevent the "heart" of the human engine from being injured and conquer sudden cardiac death, the biggest culprit threatening human life, has become an important part of whether people can spend the New Year with peace of mind. Previous data show that 80% of sudden cardiac deaths occur outside the hospital, while the success rate of cardiopulmonary resuscitation on the spot is less than 1%; this is related to the fact that the citizen penetration rate of cardiopulmonary resuscitation technology is less than 1%, and the cardiopulmonary resuscitation emergency equipment is less than 1%. Establishing a three-level protection of prevention and treatment of heart care in normal times, timely monitoring of heart, and emergency rescue of heart can be said to be an important "heart" guarantee for people to spend the New Year with peace of mind during the Spring Festival travel rush.

First-level "heart" prevention: Find the culprits and accomplices of "heartbreak"

Emphasis should be placed on cardiac physical examination and screening to identify the culprit and accomplice of the heart attack, including personal history, family history, physical examination, electrocardiogram, etc. Among them, electrocardiogram, especially dynamic electrocardiogram, is considered to be the most effective means of screening for sudden death in the population. For those with obvious family history of cardiomyopathy and sudden cardiac death, ultrasound and other screening methods are used to screen for "asymptomatic left ventricular dysfunction". For patients with left ventricular ejection fraction ≤ 35%, regardless of whether they have ischemic or non-ischemic cardiomyopathy, they are considered to be at high risk of SCD [2]. Genetic screening should be performed on first-degree relatives (including parents, children and siblings) of cardiac arrest survivors with genetic diseases. The following groups are high-risk patients: (1) direct relatives with a history of cardiovascular and cerebrovascular disease and sudden death; (2) patients with clearly diagnosed cardiovascular and cerebrovascular diseases, such as myocardial hypertrophy, coronary heart disease, valvular heart disease, fatal arrhythmias, cerebrovascular disease, etc.; (3) patients with multiple risk factors for cardiovascular and cerebrovascular diseases, such as hypertension, diabetes, hyperlipidemia, smoking, obesity, high work pressure, etc. Develop good living habits and reduce accomplices: quit smoking and limit alcohol consumption, eat a low-fat and low-salt diet, reduce staying up late and overwork, and exercise moderately. Understand the indications and contraindications for exercise. Avoid strenuous exercise when suffering from COVID-19, influenza, acute tonsillitis, and diarrhea. It is strictly forbidden to exercise vigorously after a full meal, etc., investigate the root cause of sadness, uncover the "death god" trump card, and do a good job of first-level "heart" prevention according to individual differences.

Secondary "heart" prevention: medical warnings and medical advice that understand "heartbreak"

Recognize cardiac distress signals and seek medical attention in time: In addition to paying attention to high-risk groups and medical history, special symptoms that have appeared recently should also be taken seriously. Before cardiac arrest, 50% of patients will experience prodromal symptoms such as chest pain, chest tightness, headache, syncope, shortness of breath, gastrointestinal discomfort, diarrhea, cold sweats, and extreme fatigue in recent weeks, which are distress signals sent by the body. Special attention should be paid to the early warning signs of cardiac arrest (three pains, two fasts, and one loss): "three pains" refer to sudden severe chest pain, headache, and abdominal pain, "two fasts" refer to sudden severe rapid heartbeats and rapid breathing, and "one loss" refers to sudden loss of consciousness or transient loss of consciousness, such as syncope, whole body convulsions or persistent loss of consciousness, and no response to calls. If the above situation occurs, call 120 in time and rush to the doctor. It is to discover risks-recognize the "death" signal, curb the arrival of the "death", and do a good job of secondary "heart" prevention according to different people. For suitable patients, an implantable cardioverter defibrillator (ICD) can be implanted to move the threshold forward before sudden cardiac death occurs, thus "strangling ventricular fibrillation" as a type of cardiac arrest in the cradle. ICDs can prevent sudden cardiac death and benefit patients who have experienced cardiac arrest (secondary prevention) and those who have not experienced cardiac arrest but are at risk of sudden death (primary prevention). Based on this, Chinese experts have proposed a 1.5-level prevention concept that is more in line with my country's national conditions. ICD implantation should be recommended for patients with four related risk factors: (1) syncope or presyncope, (2) non-sustained ventricular tachycardia (NSVT), (3) frequent premature ventricular beats (PVCs), and (4) low left ventricular ejection fraction (LVEF <25%). Authoritative clinical research results have confirmed that ICD implantation can reduce the risk of death by half (all-cause mortality is reduced by 49%) for 1.5-level prevention patients with the above risk factors.

Three levels of "heart" prevention: weapons and martial arts to restrain "heartbreak"

Restraining cardiac arrest and performing cardiopulmonary resuscitation is the key to saving lives in the third-level "heart" prevention. It can prevent acute cardiac arrest from developing into sudden cardiac death. It mainly includes: family prevention, community prevention, and the construction of a professional emergency medical service system. Sudden cardiac death (SCA) occurs suddenly, and loss of consciousness can occur in about 10 seconds. If timely treatment is given within the golden period of 4-6 minutes, the patient can survive, otherwise it may develop into sudden cardiac death (SCD). The dreaded word "sudden death" seems to appear more and more frequently in our field of vision, and it is getting younger and younger! From athletes, famous actors, to police, drivers, programmers, doctors, and every ordinary and even healthy person, sudden death has occurred indiscriminately. Timely intervention - get rid of the threat of "death" - master cardiopulmonary resuscitation skills to save lives, spend the New Year peacefully and happily, and immediately perform cardiopulmonary resuscitation (CPR). First, judge the "three stops" when judging cardiac arrest: judge whether consciousness has stopped (when facing a patient who suddenly falls to the ground or is motionless, pat the shoulders hard to call the patient to see if he or she responds), judge whether breathing has stopped (if the patient has stopped being conscious, quickly judge whether the patient's chest and abdomen have risen and fallen), and judge whether the heart has stopped (put the index finger and middle finger together and straighten them and place them in the depression next to the Adam's apple to judge whether there is a pulsation); secondly, calling for help in cardiac arrest embodies the "three calls": call for help and ask for help (Please Mr./Ms. XXX, assist me in completing the rescue...), call for help and dial the phone (Please Mr./Ms. XXX, assist in calling 120 (specify the time, place, and situation), call for help and get a sharp weapon (Please Mr./Ms. XXX, assist in finding an AED, abdominal compression cardiopulmonary resuscitation device (AACD-CPR)); immediately carry out cardiopulmonary resuscitation to rescue cardiac arrest on the basis of judging and calling for help.

The "three methods" of cardiopulmonary resuscitation are used in the rescue of cardiac arrest: rescue airway opening method (usually the head tilt and chin lift method is used. For patients suspected of head and neck trauma, the jaw support method is used to open the airway, and at the same time, foreign objects in the patient's upper respiratory tract are cleared in the patient's mouth and nasal cavity; use the abdominal pressure cardiopulmonary resuscitation device to attach it to the upper and middle abdomen of the patient with cardiac arrest, and press inward and upward quickly for 3-5 times in a row (40-50 kg) to produce the Heimlich effect and clear the upper and lower respiratory tract), rescue artificial respiration method (during artificial mouth-to-mouth respiration, pinch the patient's nostrils to prevent air leakage, and the first aider covers the patient's mouth completely with his mouth to form a seal, and blows slowly 3-5 times. Each blow should last for more than 1 second to ensure that the chest rises and falls during ventilation. Use an abdominal lifting and compression cardiopulmonary resuscitation device to attach it to the upper abdomen of the patient with cardiac arrest, and perform 3-5 slow abdominal lifting and compression artificial respirations continuously, with each lifting and compression time ≥ 1 second, and perform abdominal lifting and compression reciprocatingly (lifting 10-30kg and pressing 40-50kg) to cause the diaphragm to move up and down, and achieve external abdominal artificial respiration, which is especially suitable for patients with cardiac arrest who are not suitable for artificial respiration), rescue and establish a circulation method (chest compressions must be fast and powerful, with a compression frequency of 100-120 times/min and a compression depth of 5-6cm for adults. After each compression, the chest cavity fully recovers, and the compression and relaxation ratio is roughly equal. Try to avoid interruptions in chest compressions. Before establishing an artificial airway, adults For single-person CPR or two-person CPR, the compression/ventilation ratio is 30:2. After establishing an advanced airway (such as endotracheal intubation), compression and ventilation may not be synchronized, and the ventilation frequency is 10 times/min; use an abdominal compression CPR device to attach it to the upper and middle abdomen of the patient with cardiac arrest; perform abdominal compression at a rate of 100 times/min, with a pulling force of 10 to 30 kg and a compression force of 40 to 50 kg, to produce a heart pump and lung pump effect of changes in intra-abdominal and thoracic pressure, to achieve artificial circulation and respiration; before preparing for external defibrillation, start abdominal compression CPR at an appropriate time, including reducing the interruption time of chest compression, to ensure high-quality CPR).

(Author: Professor Wang Lixiang, doctoral supervisor, national health science expert, expert in cardiopulmonary resuscitation)