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Paro Cardíaco Súbito o Muerte Súbita

¿Qué es y cómo se trata?

En el paro cardíaco súbito, el corazón deja de latir de modo abrupto e imprevisto por un problema en el sistema eléctrico del corazón. A veces, una arritmia –un ritmo cardíaco irregular– puede hacer que la frecuencia cardíaca cambie a una frecuencia rápida y grave, denominada taquicardia ventricular (TV), y si se acelera demasiado, es inestable e irregular, puede convertirse en un ritmo mucho más peligroso denominado fibrilación ventricular (FV). Con la fibrilación ventricular, el corazón vibra rápidamente y no puede bombear sangre a todo el cuerpo. La persona pierde la consciencia rápidamente, no respira, y si no recibe tratamiento inmediato con un desfibrilador, puede sufrir daño cerebral. Se trata de una emergencia médica grave y con riesgo de muerte. Las probabilidades de sobrevivir a un paro cardíaco súbito disminuyen entre 7 y 10% con cada minuto que pasa sin que se aplique una descarga eléctrica de socorro. Después de los 10 minutos, pocos intentos de reanimación tienen éxito. En más del 90% de los casos la muerte sobreviene de modo abrupto e imprevisto. La diferencia con un ataque cardíaco consiste en que en éste hay un problema de “conexión” provocado por una o más obstrucciones en los vasos sanguíneos del corazón, que evitan el paso del flujo adecuado. Parte del músculo cardíaco muere, pero el paciente está consciente y respira.

¿Por qué se produce?

El paro cardíaco súbito puede ser el resultado de una enfermedad arterial coronaria o de otros problemas cardíacos, y ocurrirle a personas de cualquier edad, género y raza, e incluso a aquellos que parecen gozar de buena salud. Hay casos de atletas profesionales con un nivel de entrenamiento óptimo, que murieron repentinamente durante un evento deportivo debido a un paro cardíaco súbito.

¿Cuales son los factores de riesgo?

La mayoría de las enfermedades cardíacas y de los vasos sanguíneos pueden derivar en un paro cardíaco súbito. Entre los factores que aumentan el riesgo se encuentran: antecedentes familiares de cardiopatías, hipertensión, colesterol alto, obesidad, diabetes, sedentarismo, fumar, consumo excesivo de alcohol, y la edad. Otros aspectos que influyen son antecedentes personales o familiares de arritmias o de paro cardíaco súbito; ataque cardíaco o insuficiencia cardíaca previas; abuso de drogas.

¿Cuales son los síntomas?

Si bien no existen signos de advertencia antes de un paro cardíaco súbito, es posible que con anterioridad se presenten síntomas como fatiga o debilidad, dificultad para respirar, desmayos, mareos o aturdimiento, palpitaciones y/o dolor en el pecho. Pero el primero y con frecuencia el único síntoma de un paro cardíaco súbito, es la pérdida de consciencia debido a la falta de sangre en el cerebro.

¿Cómo se diagnostica?

El paro cardíaco súbito se diagnostica después de haber ocurrido un episodio y en un electrocardiograma puede aparecer como fibrilación ventricular. Si una persona presenta algunos de los factores de riesgo indicados, el médico puede sugerirle ciertos exámenes, como el electrocardiograma, que evalúan el sistema eléctrico del corazón, o el ecocardiograma, que controla la forma en que éste bombea mediante ultrasonido, para crear imágenes de su corazón a medida que late. También hay estudios que analizan cómo los impulsos eléctricos viajan a través del músculo cardíaco.

¿Cuál es el tratamiento?

Cuando se produce un paro cardíaco, es necesario realizar técnicas de reanimación cardiopulmonar (RCP) y usar un desfibrilador durante los primeros minutos, para restituir la actividad eléctrica del corazón y revivir su función de bombeo.

  • RCP: es la realización de presiones en el pecho con respiración asistida, un paso importante para que la terapia de desfibrilación externa sea efectiva.
  • Desfibrilación: es el uso de un aparato (desfibrilador) que envía una descarga eléctrica fuerte al corazón, para detener la arritmia y restituir el latido normal. Hay dos tipos de desfibriladores: los externos, que utilizan paletas para generar la descarga desde el exterior del cuerpo; y los cardioversores implantables, que son dispositivos similares a los marcapasos: detectan las arritmias y envían descargas de socorro.

Prevención 

Las recomendaciones son hacer vida sana, ejercicios, dieta baja en grasas y alta en fibras, no fumar, entre otros. Pero la terapia con el desfibrilador detiene eficazmente el 95% o más de los ritmos cardíacos peligrosamente rápidos. Por otro lado, solo una de cada veinte personas sobrevive a un episodio de ataque cardíaco súbito. Con un desfibrilador, la proporción es exactamente a la inversa.