Why does "sudden death" target young people? Is there any way to reduce the tragedy?

At the end of the year, news of sudden deaths among young people appeared in the media again. In addition to being saddened, we also have questions: why are more and more young people being targeted by "sudden death"? Is there any way to reduce the occurrence of tragedies?

Why are more and more young people dying suddenly?

Young people today generally feel "overwhelmed" by life and work. Chronic fatigue caused by high stress is eroding the hearts of young people.

According to the "China Cardiovascular Disease Report 2018", the number of deaths due to cardiovascular and cerebrovascular diseases in my country accounts for more than 40% of the deaths of residents due to diseases. Although the overall incidence rate is higher among the elderly, cardiovascular disease is no longer exclusive to the elderly, and myocardial infarction is not uncommon in people in their thirties. Due to aging blood vessels, the elderly often have symptoms such as angina pectoris, which can cause "ischemic pre-adaptation" in the heart, thereby helping to activate other blood vessels in the body to supply blood. Young people rarely have symptoms of ischemia, and it is difficult to supply blood through collateral circulation in sudden situations, which often leads to sudden death.

Therefore, for young people, in addition to possible myocarditis and other diseases, they should also be alert to arteriosclerosis and other "old age diseases". Especially now young people are under great work pressure. On the one hand, too much pressure will increase blood pressure and increase the risk of cardiovascular and cerebrovascular diseases; on the other hand, stress, tension, staying up late, etc., can easily cause inflammatory reactions in the human body. If there are plaques in the heart and blood vessels, excessive inflammatory factors will cause the plaques to rupture, thereby causing risks such as angina pectoris, myocardial infarction, and heart failure.

Under the "chronic fatigue stress state" caused by long working hours, heavy burden, and engaging in two or more different jobs, the incidence and mortality rates of young coronary heart disease and young stress cardiomyopathy will increase.

Sudden cardiac death is the most serious consequence of stress response. Chronic fatigue stress is both the cause of heart disease in young people and the inducement of sudden cardiac death in young heart disease patients.

Sudden death is not unexpected

Wang Hongyu, chairman of the Vascular Medicine Committee of the Chinese Medical Education Association and director of the Vascular Disease Community Prevention and Treatment Center of Peking University Health Science Center, said that some of the sudden deaths among young and middle-aged people are caused by overwork or exercise, which are essentially overdrawing the limits of body functions. Most of the sudden deaths are caused by cardiovascular and cerebrovascular diseases, such as large-area myocardial infarction, malignant arrhythmia, ruptured aortic aneurysm, cerebral infarction and cerebral hemorrhage.

What is sudden death? Qiao Yan, deputy chief physician of the Cardiology Center of Beijing Anzhen Hospital, said that at present, the more recognized standard for sudden death is the World Health Organization's definition of "death within 6 hours after the onset of acute symptoms." The causes of sudden death are divided into cardiac causes and non-cardiac causes. Among them, sudden cardiac death is the most common. This is a clinical state of death that can be caused by different reasons. Acute myocardial infarction, coronary heart disease, aortic dissection, severe heart failure, obstructive hypertrophic cardiomyopathy, fulminant myocarditis, hereditary arrhythmias, etc. can all cause sudden death. Sudden death caused by non-cardiac reasons is common in cerebral hemorrhage, pulmonary embolism, asthma, etc.

Sudden death is an unexpected event. Although there are no clear warning signs, most sudden deaths have traces to follow.

Qiao Yan introduced that in more than 50% of cardiac arrests, the body will send out warning signals within 1 hour to 1 month before the occurrence. Among them, chest pain is the most common, accounting for about 56%; shortness of breath accounts for 13%; dizziness, syncope or palpitations account for 4%.

Taking myocardial infarction, the most common cause of sudden cardiac death, as an example, more than half of patients with acute myocardial infarction have prodromal symptoms 1-2 days or 1-2 weeks before the onset of the disease. The most common manifestations are aggravation of existing angina pectoris, prolonged attack time, or worsening effect of nitroglycerin; or sudden onset of prolonged angina pectoris in patients who have never had angina pectoris.

When myocardial infarction occurs, the typical symptoms are: sudden onset of severe and persistent squeezing pain behind the sternum or in front of the heart. The patient feels severe and persistent pain under the sternum or in front of the heart, or stuffy discomfort in the front of the heart, and the pain sometimes radiates to the arms or neck, accompanied by symptoms such as pale face, panic, shortness of breath and cold sweats.

However, some patients with myocardial infarction do not feel pain, and they will experience shock or acute heart failure once the attack occurs. A small number of patients feel pain in the upper abdomen, which is easily misdiagnosed as acute abdomen such as gastric perforation and acute pancreatitis. Other patients experience pain in the neck, mandible, pharynx and teeth, which is also easy to be misdiagnosed.

In addition, signs of myocardial infarction may also include mental disorders (seen in elderly patients); indescribable discomfort and fever; gastrointestinal symptoms such as nausea, vomiting, and abdominal distension; arrhythmia (occurring within 1-2 weeks before onset, more common within 24 hours); heart failure, manifested by symptoms such as difficulty breathing, cough, cyanosis, and irritability.

Qiao Yan said that according to clinical data, sudden death often occurs between 6 am and noon. When people sleep at night, their bodies are controlled by the vagus nerve, and when they wake up in the morning, they are controlled by the sympathetic nerve. When they just wake up, the regulation of the body's nerve function is still unstable, and the sympathetic nerve, under the regulation of adrenaline and the endocrine system, will cause blood pressure to rise. The fluctuation of blood pressure is an important factor leading to cardiovascular accidents.

Staying up late for a long time increases the risk of death

The most common negative behavior that causes sudden death is long-term lack of sleep.

Sleep is an important cornerstone of health, especially closely related to cardiovascular health. The American Heart Association has listed lack of sleep as one of the risk factors that seriously threaten heart health. The ideal sleep time for people is 6.5-8 hours. Death and sleep time have a U-shaped relationship. Too little or too much sleep will increase the risk of death.

Studies have shown that long-term lack of sleep increases the risk of coronary heart disease and stroke, as well as the risk of sudden death. Many people stay up late to stay awake by drinking strong tea, coffee or smoking, but the excitement of the sympathetic nerves will increase the heart rate, thereby increasing the burden on the heart. Even if you make up for sleep after staying up late, your physiological rhythm has been disrupted, and the quality of sleep cannot be compensated, which will also increase the risk of coronary heart disease. In addition, people who sit still for a long time while staying up late may also increase the risk of lower limb venous thrombosis. If the thrombus breaks off and embolizes the pulmonary artery with the blood flow, it can also cause sudden death.

If you are clearly feeling tired, you must stop and let your body rest.

Excessive exercise leads to ventricular fibrillation, which is the most terrible

In addition to long-term lack of sleep, another major cause of sudden death is excessive exercise that exceeds the body's tolerance. Many sports-related sudden deaths occur during marathon events.

The vast majority of sudden deaths during exercise are related to cardiovascular problems. Generally speaking, the main cause of sudden death during exercise in people aged 35 to 40 is coronary heart disease; the most common causes of sudden death during exercise in young people under 35 are hypertrophic cardiomyopathy and congenital coronary artery malformations, followed by myocarditis, arrhythmogenic right ventricular cardiomyopathy, mitral valve prolapse, coronary heart disease, aortic valve stenosis, dilated cardiomyopathy, arrhythmias caused by ion channel diseases, aortic dissection and other congenital heart diseases.

When people do strenuous exercise, their sympathetic nerves are extremely excited, the myocardial contractility is strengthened, the heart rate is accelerated, and the blood pressure rises to meet physiological needs. However, this leads to a disorder in the electrophysiological activity of the heart, which can easily lead to fatal arrhythmias such as ventricular fibrillation, and sudden death occurs.

Recommendation: Warm up thoroughly before exercise; replenish water, energy and electrolytes appropriately during exercise to maintain normal body physiological functions; do not persist blindly. Once symptoms such as pale face, cyanosis of lips, sweating, fainting, chest pain, chest tightness, chest pressure, dizziness, headache, extreme fatigue, etc. appear, stop exercising immediately.

Experts summarize tips to prevent sudden death

Fan Li, deputy director of the General Hospital of the People's Liberation Army, summarized the strategies for preventing sudden death as "preventing four highs."

First, grasp the high-risk moments. In the early morning or when you wake up, the body secretes the most catecholamines and adrenaline, which can easily lead to a fast heart rate and high blood pressure. In addition, when you get up in the morning, you are busy washing, eating, defecating, and rushing to work, which makes it the most stressful and prone to accidents.

Second, avoid high-risk factors, such as binge drinking, overeating, stress, cold stimulation, etc.

The third is self-examination by high-risk groups. For example, patients with heart disease and hypertension are at high risk of sudden death, and they can understand their health status through physical examination.

Fourth, master the efficient methods of first aid, such as taking nitroglycerin immediately, and have a rescue system that can be contacted at any time.

How to help after witnessing a sudden death

If the heart stops beating for more than 4-6 minutes, the brain tissue of the sudden death patient will be permanently damaged, and if it stops beating for more than 10 minutes, the patient will be brain dead. Therefore, the first 4 minutes after a sudden death is the golden time for rescue. If someone suddenly falls to the ground, loses consciousness, stops breathing, or gasps for breath, try to help by following the steps below.

Step 1: If you are alone, call the emergency number 120 or 999 first, briefly explain the situation and your location. If there are other people present, ask them to call the emergency number.

Step 2: Let the patient lie on his back on a hard surface, keep his head, neck and torso straight and without twisting, and immediately perform external chest compressions. The specific method of operation is: kneel on one side of the patient with your hands overlapping, place the center of the base of your palms on the midpoint of the line connecting the two nipples in the center of the chest, and press down vertically and quickly with force, with a compression amplitude of at least 5 cm, and repeat this rhythmically. The compression and relaxation time are roughly equal, and the frequency is 100-120 times per minute. Those who have not received CPR training can only press without mouth-to-mouth breathing, and persist until the arrival of professional emergency personnel. These few minutes of external chest compressions can allow the oxygen in the patient's blood to maintain a minimum oxygen supply to the brain and avoid brain death.

Those who have received CPR training can press the patient's forehead with one hand to tilt the head back, and at the same time use the index and middle fingers of the other hand to lift the chin upwards so that the line connecting the tip of the chin and the earlobe is perpendicular to the ground to open the airway. Perform artificial respiration twice for every 30 chest compressions, and repeat this process. If there is foreign matter or vomit in the patient's mouth, clear it out first.

Step 3: If the place you are in is equipped with an automated external defibrillator (AED), use the AED immediately after chest compressions and follow the voice prompts to increase the success rate of rescue.

Of course, whether the patient can be saved in the end depends on the treatment after resuscitation. If the early first aid is effective, the damage to the brain and important organs will be less, and the subsequent treatment will be smoother.

Knowledge: How to use an automated external defibrillator (AED)

1. Obtain and turn on the AED. Open the AED cover and follow the visual and audible prompts (some models require you to press the power button first).

2. Attach electrodes to the patient. Usually, two electrode pads are attached to the upper right chest and the outside of the left nipple of the left chest. The specific positions can be referred to the pattern on the AED case and the picture instructions on the electrode pads.

3. Insert the electrode board plug into the AED host jack.

4. Start analyzing the heart rhythm and defibrillate if necessary. Press the "Analyze" button (some models will give a voice prompt after inserting the electrode pads and automatically start analyzing the heart rate), and the AED will start analyzing the heart rate. After the analysis is completed, the AED will issue a recommendation on whether to perform defibrillation. When there is an indication for defibrillation, do not contact the patient and press the "Discharge" button for defibrillation.

5. After defibrillation, the AED will analyze the heart rhythm again. If the effective heart rhythm has not been restored, the operator should perform 5 cycles of cardiopulmonary resuscitation and then analyze the heart rhythm again. In other words, defibrillation and cardiopulmonary resuscitation should be repeated until emergency personnel arrive.