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Causes of sudden death in adulthood and old age

In Mature and old age, are exposed to the major number of cases of sudden death, root causes include coronary heart disease in all its forms, hypertension, and their combination.
Coronary heart disease (CHD), or coronary heart disease, is an acute or chronic dysfunction of the heart resulting from a relative or absolute reduction of supply to the myocardium arterial blood. This dysfunction is often, though not always, associated with pathological process in the system of the coronary arteries. Thus, the basis of CHD is the mismatch between the desired infarction for normal operation the number of arterial blood and its actual quantity received by painfully altered the coronary arteries.
Classification of CHD proposed in 1984 by the staff of the national cardiology center and based on the recommendations of the who, considering CHD as transient acute and chronic pathological conditions caused organic lesions of coronary arteries (stenoziruty arteriosclerosis, thrombosis) or violations of their functional state (spasm, regulation violations tone).

Note. Ischemic state attack, caused by other factors (rheumatism, septic endocardit, periarteritis nodosa, systemic lupus erythematosus, cardiomyopathy and other), not related to CHD and is regarded as a secondary syndromes under the relevant nosologic forms. In these diseases is also possible occurrence of sudden death.

In the framework of this classification distinguishes the following clinical forms (options CHD): 1) myocardial infarction (krupnooptovye - transmural, small - necessarily, subendocardialnah, intramural). Myocardial infarction can be acute, recurrent, re; 2) angina (angina - first developed, progressive; angina at rest); 3) postinfarction cardiosclerosis (paced not earlier than after 8 weeks after myocardial infarction); focal degeneration of myocardium; 4) violations of heart rhythm; 5) acute coronary insufficiency, cardiac insufficiency of primary cardiac arrest, which may complicate any of these forms of ischemic heart disease and lead to rapid, sometimes sudden death.
Coronary heart disease can be either acute (when its duration does not exceed 8 weeks)or chronic, in which may be acute, often ending suddenly (sudden) death. Most forensic importance of these forms of CHD, as myocardial infarction (in all its variants), angina and acute coronary insufficiency, which often lead to sudden death.
The immediate cause of death of the disease are often the heart rhythm disturbances, specifically atrial fibrillation, coming against the background of acute myocardial ischemia. In myocardial infarction, sudden death is caused most often by cardiogenic shock.
A recent research found that the onset of sudden death from coronary heart disease, often seemingly surrounding instant, preceded by the period of myocardial hypoxia, continuing 2-5 hours During this period of the development of significant changes cardiomyocytes, first of all their focal necrosis, which can be detected by phase-contrast and polarization microscopy.
Morphological substrate of coronary heart disease is coronary arteries. It is known that no man after 40 years not free from atherosclerosis. However, not all people atherosclerosis of the "manifestations of age becomes a factor in the clinical manifestations of CHD.
It is established that in patients suffering from coronary heart disease and sudden deaths from coronary artery atherosclerosis begins in 20-30 years earlier and progresses at a much faster pace, flows through malignant, so-called fibroblast type of morphogenesis, lead to an early stenosis of the lumen of the coronary arteries.
More fast paced and greater severity of coronary atherosclerosis reduce the adaptation of the cardiovascular system to the changing conditions of the external and internal environment. Sudden death from coronary heart disease can be seen as the result of a sharp break in the coronary system, which arose in response to the complex external and internal impacts, out of the adaptive capabilities painful changed hearts.
In the development of atherosclerosis, by coronary heart disease and sudden death from it important are numerous risk factors, most important of which are: arterial hypertension, hypercholesterolemia, obesity and Smoking.