Treatment and prevention of acute myocardial infarction. The first signs of myocardial infarction

The heart is the most important human organ. That is why it is extremely important that it is absolutely healthy. Unfortunately, with age, most people begin to develop various problems precisely in this area. Heart and vascular diseases are very common, and not only in our country. A system has been developed to fully coordinate the diagnosis and treatment of any disease. international classification according to ICD code.

Acute myocardial infarction occurs as a consequence of coronary heart disease.

Myocardial infarction

Myocardial infarction is the death of heart tissue as a result of the cessation of blood flow to the organ. In the system developed by the World Organization, this diagnosis can be found under the IBC code 10. These problems, unless we are talking about congenital pathologies, are the result of a disease of the body's vascular system. Acute myocardial infarction is a direct consequence of coronary heart disease.

Reasons for the development of ischemia

Coronary heart disease is characterized by the occurrence of a difference between the blood flow necessary for normal heart function and the actual flow of blood to the organ. Some causes of this disease do not depend on the patient, but many of the provoking factors can and should be excluded from the life of a person suffering from coronary artery disease as quickly as possible. Acute myocardial infarction (AMI) against the background of coronary artery disease can develop in the following cases:

– sclerotic plaques that affect the vessels of the coronary circulation begin to collapse over time, and as a result, blockage of the arteries supplying the heart occurs.
Thrombosis of the affected arteries.
The coronary arteries may undergo complete or partial spasm - most often a sign of cocaine use.

IN in this case In medicine, it is customary to use the term acute coronary syndrome (ACS). Doctors often diagnose a combination of several factors that cause AMI. The reasons why these problems arise are quite well studied. These most often include:

the presence of hereditary factors;
violation of nutritional standards and, as a result, obesity;
bad habits;
low physical activity;
blood diseases;
arterial hypertension and a number of other reasons.

According to the course of MI there are stages

Pre-infarction - its duration can be from several hours to several days. During this period, there is a decrease in the intervals between angina attacks. These attacks can constantly intensify, the pain is not expressed, and there is a gradual general deterioration in health.
The most acute - and turns into myocardial necrosis. The duration of this stage ranges from twenty minutes to two hours. Characteristic symptoms of the acute period are unbearable pain in the chest area, which radiates to the left arm or left shoulder blade; patients sometimes talk about pain in the upper abdomen and pain in the lower jaw. At this stage, it is impossible to relieve pain using Nitroglycerin. In addition to acute pain, other symptoms also appear at this time, such as discoloration skin, increased sweating, severe agitation associated with the fear of death.

Sometimes you can observe signs that are unusual for this disease: nausea, vomiting, difficulty breathing, blue lips, severe swelling. Patients with diabetes may experience no pain at all. If these symptoms are present, doctors talk about atypical forms of myocardial infarction.

Acute period - during this time the pain practically disappears. This happens because the nerve endings in the affected area are completely destroyed. The patient may experience increased body temperature and increased hypotension. This period lasts from two days to two weeks.
Subacute – takes from 4 to 8 weeks. It is characterized by the beginning of scar formation at the site of the necrotic lesion. The patient's temperature returns to normal, and the symptoms of heart failure become less pronounced.
Post-infarction period - the scar is fully formed, and the heart begins to adapt to new conditions.

Myocardial infarction does not have any one general classification. The most commonly used division of this disease is taking into account various parameters.

By area of the lesion:

small focal – death of cardiac tissue;
large-focal - the area affected by necrosis is quite large.

According to the frequency of the disease:

primary;
recurrent - a second heart attack occurs within eight weeks after the first;
repeated - if a heart attack occurs more than two months later.

By place of origin (topography):

right ventricular infarction;
left ventricular infarction. Here, infarction of the anterior wall of the left ventricle of the heart, infarction of the posterior or lateral wall and interventricular septum are distinguished. Left ventricular infarction is much more common. This happens due to the fact that this part of the heart bears the heaviest load of pumping blood.
atrial infarction

According to the depth of the lesion:

intramural (located deep in the myocardium);
subendocardial (myocardial necrosis adjacent to the outer lining of the heart);
subepicardial (myocardial necrosis adjacent to the epicardium, the inner lining of the heart);
transmural (the entire depth of the muscular wall of the heart is affected; this type of heart attack occurs only with).

According to the presence of complications:

uncomplicated;
complicated.

Very often, complications of myocardial infarction are observed already in the first hours of the disease. It could be different kinds arrhythmias, pulmonary edema, and cardiogenic shock, leading to death.

Diagnostics

Modern medicine today has every opportunity to quickly and accurately diagnose this disease.

The doctor receives the first data from the patient himself, who reports severe pain that he could not relieve with Nitroglycerin.
The next stage of the examination may be palpation (the presence of pulsation in the area of the cardiac apex) and auscultation (the presence of characteristic changes in the tones and rhythm of the heart).
Accurate data on the presence of a heart attack can be obtained by taking an electrocardiogram. This procedure is now carried out by an emergency doctor.
A blood test (the presence of cell destruction enzymes) can also show a typical picture of such heart damage.
X-ray examination of the coronary vessels using a contrast agent allows you to accurately determine the degree of blockage.
Computed tomography helps detect the presence of blood clots in the heart.

If the first signs of acute myocardial infarction appear, the patient must be provided with complete rest and urgently call ambulance. With this disease, the chance of saving a person’s life will depend on the speed of providing first emergency aid. During the first twenty minutes, the heart works using its internal reserves, and only then tissue necrosis begins. Upon arrival of the ambulance, the team will provide emergency first aid. It most often involves relieving pain. In acute myocardial infarction, pain can only be relieved with narcotic analgesics. Further, to prevent thrombosis, Aspirin or Heparin is used.

Treatment in a hospital. The patient is urgently admitted to intensive care cardiology department, where the already started treatment to maintain cardiac activity is continued. Thrombolytic therapy, which is aimed at dissolving blood clots and restoring the activity of the coronary arteries, plays the most important role in the early stages of the development of a heart attack. Anticoagulants are also used for the same purposes. Treatment will also include a number of medications to eliminate problems with arrhythmia. There are also minimally invasive surgical methods to restore sufficient blood supply to the heart. This may be the introduction of a wall or a catheter, which are inserted into the vessel and normalize its lumen. Typically, this surgical procedure is performed within the first 24 hours after the patient is admitted to the intensive care unit.

Rehabilitation

Myocardial infarction is a serious disease that can lead to disability or even death. A negative prognosis is usually more common in people who have a second heart attack. Considering this circumstance, a person who has suffered an acute heart attack must pay close attention to subsequent rehabilitation, which begins almost immediately after passing through the most acute stage of the heart attack. After a heart attack, it is much more difficult for the heart to perform its functions, so the patient will have to undergo a whole.

Such actions may include:

Constant reception medicines to reduce blood clotting and dilate blood vessels.
Normalizing cholesterol levels in the blood.
Monitor your performance blood pressure.
Recover whenever possible contractile functions hearts.
Improving motor activity.
Return to work capacity.

All measures intended to restore the patient require the joint efforts of the doctor and the patient. Exactly A complex approach will provide an opportunity to as soon as possible come back to active life. A patient who has had a heart attack must completely abstain from any bad habits. Review your diet and avoid any stressful situations. Cardiologists recommend that all survivors of this disease constantly engage in physical therapy. After inpatient treatment, it is advisable for patients to continue their recovery in specialized sanatoriums or rehabilitation centers. It is here that qualified specialists have every opportunity to provide effective physical and psychological assistance.

Occurs when there is insufficient blood supply to the heart muscle (myocardium) and occurs with the development of death of myocardial cells and the formation of an area of necrosis (death) of the myocardium. The incidence of heart attacks increases with age. People over 50 years of age develop a heart attack 5 times more often than older people at a young age. It is also observed more often in men than in women. Mainly left ventricular infarction occurs, because the most falls on him huge pressure, infarctions of the right side of the heart are quite rare.

1. Developed without visible reasons(spontaneously), as a result of a primary violation of coronary blood flow caused by the formation of erosion, rupture, crack of an atherosclerotic plaque.

2. Developed due to a lack of oxygen flow to the heart muscle.

3. Sudden death, including cardiac arrest. This type is diagnosed before it becomes possible to collect blood samples or before an increase in the level of biochemical markers of necrosis in the blood is noted.

4a. Myocardial infarction associated with a PCI (percutaneous coronary intervention) procedure.

4b. Associated with coronary stent thrombosis.

5. Myocardial infarction associated with coronary bypass surgery (CABG).

Risk factors for myocardial infarction include: increased levels of low-density lipoproteins (LDL), high levels of triglycerides in the blood, arterial hypertension, smoking, sedentary lifestyle, obesity, diabetes mellitus, and previous myocardial infarction.

The first signs preceding myocardial infarction.

More than half of people with a myocardial infarction may experience symptoms within days or even weeks. However, in most cases no one pays attention to them. Patients rarely seek medical help. Approximately 30% of patients still come to the doctor with complaints, but in many cases they are interpreted incorrectly.

As a rule, the first signs include pain or discomfort in the left half of the chest, pain radiates to the left half of the neck, lower jaw, and left arm. Pain or discomfort may be localized in the upper abdomen. Pain syndrome can be associated with physical activity, eating, emotional stress, but quite often pain can occur spontaneously, without a clear connection with the provoking factor. The duration of the pain syndrome is from 5 to 20 minutes or more. The pain is relieved or its intensity decreases when taking nitroglycerin.

If there were previously symptoms of angina pectoris, that is, characteristic pain appeared during physical activity and was relieved by taking nitroglycerin, before myocardial infarction the disease changes its course to a more aggressive one. The pain is more intense, attacks become longer (more than 10-15 minutes), the area of pain irradiation can expand, attacks can occur with much less physical activity than before. Angina at rest may be associated with angina pectoris; attacks of pain and burning in the chest may appear at rest and at night. May appear increased fatigue, weakness, lethargy, sweating, dizziness, possible shortness of breath. This condition is called unstable angina. Unstable angina requires emergency hospitalization in the cardiology department.

If you consult a doctor in a timely manner, you can prevent the development of myocardial infarction.

Is it possible to predict the onset of myocardial infarction?

The onset of a heart attack can be predicted if its cause is a gradual narrowing of the lumen of the vessels supplying the heart, or the so-called “unstable plaque” appears, which is typical for atherosclerotic vascular lesions. If the reason becomes complete occlusion thrombus, it is impossible to predict the onset of a heart attack, because blood instantly stops flowing to the heart muscle and myocardial necrosis forms. As noted above, the nature of the pain appears or changes; it occurs during exercise or at rest, after eating or during emotional stress, and is accompanied by general weakness, a feeling of “fear,” dizziness, and heart rhythm disturbances are possible. Shortness of breath may appear as an equivalent of pain. Quite often, myocardial infarction develops spontaneously without any warning signs.

What processes occur in the body during a heart attack?

Myocardial infarction occurs when sharp decline blood flow to the heart muscle. As a rule, this occurs due to complete or partial occlusion (blockage) by a blood clot coronary artery. A thrombus can occur at the site of a rupture of the so-called unstable atherosclerotic plaque, rich in inflammatory elements. Usually patients have several of them. The cause of a blood clot may also be a defect (erosion) in the wall of the coronary artery. In these cases, proper blood flow is disrupted. In the area of the defect or plaque, blood stagnates, which leads to the formation of blood clots, which over time close the lumen of the vessel, or the blood clot breaks off and complete occlusion occurs. In most cases, occlusion occurs at the site of stenosis (narrowing) of the coronary artery. In turn, the thrombus itself can be a source of smaller thrombi (emboli), which enter the distal sections and obstruct the myocardial microvessels, causing microinfarctions (small foci of necrosis). Small emboli prevent the restoration of blood supply to the myocardium (reperfusion) after eliminating the occlusion of a large artery.

The coronary arteries supply the entire heart muscle, and as a result of the blockage, the supply of oxygen to the area of the heart muscle for which this artery is responsible is stopped. As a result, a focus of necrosis is formed in this area, which leads to dysfunction of the affected area of the myocardium. With a small area of damage, the correct course of nerve impulses in the heart is disrupted, which leads to the appearance of various rhythm disturbances. With a large affected area, contractility is impaired, in which the heart can no longer cope with the load, which leads to the development of acute heart failure and life-threatening rhythm disturbances.

With myocardial necrosis, the contents of the dead cell enter the general bloodstream and can be determined in blood samples. Markers of myocardial necrosis appear, such as troponin I and T, creatine phosphokinase MB fraction, myoglobin.

The stages of myocardial infarction are distinguished:

1. Pre-infarction period.

2. The most acute stage. Lasts the first 5-6 hours from the onset of signs of a heart attack. At this stage, the supply of oxygen to the heart muscle stops.

3. Acute stage. Characterized by the presence of areas of necrosis. It lasts up to 14 days and the occurrence of complications depends on the area of the lesion.

4. Subacute stage. Starts from 14 days and up to 30 days. During this period, the dead myocardial cells are replaced by scar tissue, and the remaining areas that were less damaged restore their function.

5. Scar stage. It begins at the end of the first month and is characterized by the formation of a scar. This part of the heart is not involved in work and no nerve impulse is carried through it. As a result, other parts of the heart take on part of the load, and the nerve impulse changes its normal course, so a common complication are arrhythmias.

6. Post-infarction period. Dense connective tissue develops at the site of the scar.

The first signs of myocardial infarction itself

There are typical and atypical forms of myocardial infarction.

Regular, classic version The course of myocardial infarction is characterized by a painful attack, which is very similar to an attack of angina pectoris. The pain is burning, squeezing, pressing in nature. There is discomfort, a feeling of compression or pressure behind the sternum. Pain can radiate to the left arm, left shoulder blade, left shoulder, jaw. There is a feeling of fear of death, anxiety, increased sweating. But a characteristic difference from other pain in the heart is that the pain is intense and lasts longer. Taking nitroglycerin does not reduce pain. In some cases, even taking narcotic analgesics also does not help. Sometimes patients only complain of aching or nagging pain in the left shoulder or left shoulder blade.

The ECG shows signs of myocardial ischemia various localizations, possible tachycardia, rhythm disturbances.

Atypical forms of myocardial infarction:

Astamitic option. It often develops with repeated myocardial infarction and occurs in elderly patients. The pain attack is mild or may be absent altogether. The only sign of a heart attack may be severe shortness of breath, even suffocation.

Abdominal option. Characterized by pain in the upper abdomen, tension in the anterior abdominal wall, nausea and vomiting may occur. Therefore, if you suspect a painting “ acute abdomen“It is necessary to perform an ECG to exclude myocardial infarction.

Arrhythmic option. The pain attack may also be minor or even absent. A heart attack is manifested by a variety of rhythm disturbances.

Cerebrovascular variant. It occurs mainly in the elderly and clinically manifests itself as a disorder cerebral circulation. Dizziness, fainting, nausea, and vomiting come to the fore.

Low-symptomatic or painless form. It is observed quite often. This is due to the fact that patients do not pay attention to little severe symptoms and don't ask for help. This type of onset of myocardial infarction is more often observed in patients with diabetes mellitus, in women, in the elderly, and after a cerebrovascular accident.

First aid for signs of a heart attack

Stop physical activity and try to calm the patient;

Sit or lay down the patient;

Provide access fresh air, loosen buttons, belts, collar;

Call emergency medical assistance;

Measure blood pressure. If systolic pressure is above 100 mm Hg, give 1 tablet of nitroglycerin under the tongue or take 1 inhalation under the tongue; if the patient’s condition improves, repeat taking nitroglycerin after 10 minutes, then every 10 minutes until the ambulance arrives; If you have very low blood pressure, nitroglycerin cannot be taken;

Be ready to start resuscitation measures before the arrival of emergency medical services: chest compressions, artificial ventilation lungs.

Is it possible to stop the development of a heart attack?

If you notice the appearance of characteristic symptoms and immediately seek medical help, you can prevent the development of myocardial necrosis, and therefore possible severe complications and death.

In case of timely early diagnosis myocardial infarction, thrombolytic therapy or PCI is performed, which is determined by the clinical situation and the nature of changes on the ECG.

Forecast

The fatal outcome of myocardial infarction is approximately 25-35%, more often prehospital stage or in the first hours in the hospital.

The prognosis in people after myocardial infarction largely depends on the time it takes to restore blood flow in the artery. Restoration of perfusion within the first 1-2 hours is the most favorable prognostic sign. If the cause is eliminated for the first time within 4-6 hours, the area of myocardial damage will be small and the likelihood of complications will also be low. Longer periods of restoration of blood flow can subsequently lead to such complications as rhythm and conduction disturbances, the development of heart failure, insufficiency mitral valve, thromboembolic complications, papillary muscle dysfunction, cardiac rupture, aneurysm formation, development of pericarditis.

Doctor Chuguntseva M.A.

Myocardial infarction is a focus of necrosis of the heart muscle that develops against the background of an acute circulatory disorder in the coronary arteries. If we talk about myocardial lesions in general, infarction is the most common pathology. This condition is a direct indication for hospitalization of the patient in a specialized department, since without the provision of qualified medical care it can lead to death.

Considering the danger of pathology, it is better to prevent it than to treat it. That is why, if you suspect heart disease (IHD) or other disorders of the heart, it is important to immediately seek help from a specialist in order to prevent the formation of a disease such as myocardial infarction.

Causes

To understand what a heart attack is, it is extremely important to understand the reasons that cause it. One of the most important reasons against which this condition develops can be confidently called atherosclerosis. This is a disease whose pathogenetic basis is a violation of fat metabolism in the body.

Against the background of excess cholesterol and lipoproteins, they are deposited in the lumen of blood vessels with the formation characteristic plaques. In case of blockage of the coronary arteries, a heart attack occurs. In more detail, there are three main components of atherosclerosis, which can cause circulatory disorders in the coronary arteries, namely:

Narrowing of the lumen of blood vessels as a result of the deposition of plaques on their walls. This also leads to a decrease in the elasticity of the vascular wall.
Vasospasm, which may occur against the background severe stress. In the presence of plaques, this can lead to acute coronary circulatory disorders.
Separation of plaque from the vascular walls can cause arterial thrombosis and, worse, myocardial infarction (damage).

Thus, atherosclerosis is the main cause of myocardial infarction, which is a rather dangerous condition and should be mandatory be subject to correction.

The risk of developing a disease such as a heart attack is significantly increased by the following factors:

Bad heredity. Pathologies play a role of cardio-vascular system from close relatives.
Poor nutrition and sedentary lifestyle. These factors lead to the formation of a condition such as obesity in a person.
Obesity. Excess fat leads to direct deposition of plaques on the walls of blood vessels.
Bad habits. Drinking alcohol and smoking lead to vasospasm.
Endocrine disorders. Patients with diabetes are more prone to changes in cardiac circulation. This is due to the negative effect of this disease on blood vessels.
A history of heart attacks.

Blood pressure disorders, manifested by persistent hypertension, constant stress can also cause a heart attack.

Symptoms

The symptoms of myocardial infarction directly depend on its stage. During the damage stage, patients may not have any complaints, but some have unstable angina.

In the acute stage, the following manifestations are observed:

Severe pain in the heart area or behind the sternum. Irradiation is possible. The nature of the pain varies from person to person, but most often it is pressing. The severity of pain directly depends on the size of the lesion.
Sometimes there is no pain at all. In this case, the person turns pale, blood pressure rises greatly, and the heart rhythm is disturbed. Also, with this form, the formation of cardiac asthma or pulmonary edema is often observed.
At the end of the acute period, against the background of necrotic processes, there may be a significant increase in temperature, as well as an increase in hypertensive syndrome.

In the case of an erased course, manifestations are completely absent, and the presence of a problem can only be suspected when an ECG is performed. This is why it is so important to undergo preventive examinations from specialists.

It should be said about atypical forms of the acute period. In this case, the pain syndrome may be localized in the throat or fingers. Very often, such manifestations are typical for older people with concomitant cardiovascular pathologies. It is worth noting that an atypical course is possible only in the acute stage. Subsequently, the clinical picture of myocardial infarction in most patients is the same.

In the subacute period, with myocardial infarction, gradual improvement occurs, the manifestations of the disease gradually become easier, until they disappear completely. Subsequently, the condition normalizes. There are no symptoms.

First aid

Understanding what it is - the occurrence of myocardial infarction, it is important to realize that first aid plays an important role. So, if you suspect this condition, it is important to take the following steps:

Call an ambulance.
Try to calm the patient down.
Ensure free access of air (get rid of tight clothing, open the windows).
Place the patient in bed so that the upper half of the body is higher than the lower half.
Give a nitroglycerin tablet.
If you lose consciousness, begin performing cardiopulmonary resuscitation (CPR).

It is important to understand that the disease called myocardial infarction is life-threatening condition. And the development of complications and even the life of the patient depends on the correctness of first aid, as well as the speed of initiation of medical measures.

Classification

Heart attacks are classified according to the following criteria:

Size of the lesion.
Depth of damage.
Changes in the cardiogram (ECG).
Localization.
Presence of complications.
Pain syndrome.

Also, the classification of myocardial infarction can be based on stages, of which four are distinguished: damage, acute, subacute, scarring.

Depending on the size of the affected area - small- and large-focal infarction. It is more favorable to involve a smaller area, since complications such as cardiac rupture or aneurysm are not observed. It is worth noting that, according to studies, more than 30% of people who have suffered a small-focal heart attack are characterized by transformation of the hearth into a large-focal one.

According to ECG abnormalities, two types of disease are also noted, depending on whether there is a pathological Q wave or not. In the first case, instead of a pathological wave, a QS complex may form. In the second case, the formation of a negative T wave is observed.

Considering how deep the lesion is located, the following types of disease are distinguished:

Subepicardial. The affected area is adjacent to the epicardium.
Subendocardial. The affected area is adjacent to the endocardium.
Intramural. An area of necrotic tissue is located inside the muscle.
Transmural. In this case, the muscle wall is affected to its entire thickness.

Depending on the consequences, uncomplicated and complicated types are distinguished. Another important point, which determines the type of heart attack - the location of pain. There is a typical pain syndrome localized in the heart or behind the sternum. In addition, atypical forms are noted. In this case, the pain may radiate (give) to the scapula, lower jaw, cervical region spine, stomach

Stages

The progression of myocardial infarction is usually rapid and cannot be predicted. Nevertheless, experts identify a number of stages that the disease goes through:

Damage. During this period, there is a direct disruption of blood circulation in the heart muscle. The duration of the stage can range from one hour to several days.
Spicy. The duration of the second stage is 14-21 days. During this period, the beginning of necrosis of some of the damaged fibers is noted. The rest, on the contrary, are being restored.
Subacute. The duration of this period varies from several months to a year. During this period, the final completion of the processes that began in the acute stage occurs, with a subsequent decrease in the ischemic zone.
Scarring. This stage can continue throughout the patient’s life. Necrotic areas are replaced by connective tissue. Also during this period, in order to compensate for myocardial function, hypertrophy of normally functioning tissue occurs.

The stages of myocardial infarction play a very important role in its diagnosis, since changes in the electrocardiogram depend on them.

Variants of the disease

Depending on the characteristic manifestations There are several options possible for myocardial infarction, namely:

Anginous. It is characteristic that for myocardial infarction, it is the most common option. It is characterized by the presence of severe pain, which is not relieved by taking nitroglycerin. The pain may radiate to the left shoulder blade, arm or lower jaw.
Cerebrovascular. In this case, the pathology is characterized by manifestations of cerebral ischemia. The patient may complain about severe dizziness, nausea, severe headaches, and the occurrence of fainting. Neurological symptoms make it quite difficult to make a correct diagnosis. The only symptoms myocardial infarction are characteristic changes on the ECG.
Abdominal. In this case, the localization of pain is atypical. The patient has severe pain in the epigastric region. Characterized by vomiting and heartburn. The abdomen is very swollen.
Asthmatic. Symptoms come to the fore respiratory failure. Severe shortness of breath is expressed, a cough with foamy sputum may appear, which is a sign of left ventricular failure. The pain syndrome is either completely absent or appears before shortness of breath. This option is typical for older people who already have a history of a heart attack.
Arrhythmic. The main symptom is a violation heart rate. The pain syndrome is mild or completely absent. In the future, shortness of breath and a decrease in blood pressure may occur.
Erased. At this option manifestations are completely absent. The patient does not make any complaints. The disease can be detected only after an ECG.

Given the abundance of options possible for this disease, its diagnosis is an extremely difficult task and is most often based on an ECG examination.

Diagnostics

For this disease, specialists use a number of diagnostic techniques:

Collection of medical history and complaints.
Study of the activity of specific enzymes.
General blood test data.
Echocardiography (EchoCG).
Coronary angiography.

In the medical history and life history, the doctor pays attention to the presence of concomitant pathologies of the cardiovascular system and heredity. When collecting complaints, you need to pay attention to the nature and localization of pain, as well as other manifestations characteristic of atypical course pathology.

ECG is one of the most informative methods for diagnosing this pathology. When conducting this survey The following points can be appreciated:

Duration of the disease and its stage.
Localization.
Extent of damage.
Depth of damage.

At the stage of damage, a change in the ST segment is observed, which can occur in the form of several options, namely:

If the anterior wall of the left ventricle is damaged in the area of the endocardium, the location of the segment below the isoline is observed, in which the arc is directed downward.
If the anterior wall of the left ventricle is damaged in the area of the epicardium, the segment, on the contrary, is located above the isoline, and the arc is directed upward.

In the acute stage, the appearance of a pathological Q wave is noted. If the transmural variant occurs, the QS segment is formed. With other options, the formation of a QR segment is observed.

The subacute stage is characterized by normalization of the location of the ST segment, but the pathological Q wave remains, as well as negative T wave. In the cicatricial stage, the presence of a Q wave and the formation of compensatory myocardial hypertrophy may be noted.

To determine the exact location pathological process It is important to assess which leads the changes are detected on. In the case of localization of the lesion in the anterior sections, signs are noted in the first, second and third chest leads, as well as in the first and second standard leads. There may be changes in lead AVL.

Lesions of the lateral wall almost never occur independently and are usually a continuation of damage to the posterior or anterior walls. In this case, changes are recorded in the third, fourth and fifth chest leads. Also, signs of damage must be present in the first and second standard. During a heart attack back wall changes are observed in lead AVF.

A small focal infarction is characterized only by changes in the T wave and ST segment. Pathological teeth are not detected. The large-focal variant affects all leads and reveals the Q and R waves.

When conducting an ECG, the doctor may encounter certain difficulties. Most often this is due to the following characteristics of the patient:

The presence of scar changes causes difficulties in diagnosing new areas of damage.
Conduction disorders.
Aneurysm.

In addition to the ECG, a number of additional research to complete the definition. A heart attack is characterized by an increase in myoglobin in the first few hours of the disease. Also in the first 10 hours there is an increase in an enzyme such as creatine phosphokinase. Its contents return to full normal only after 48 hours. Afterwards, to make a correct diagnosis, it is necessary to evaluate the amount of lactate dehydrogenase.

It is also worth noting that during myocardial infarction there is an increase in troponin-1 and troponin-T. A general blood test reveals the following changes:

Increase in ESR.
Leukocytosis.
Increase in AsAt and AlAt.

EchoCG may reveal impaired contractility of cardiac structures, as well as thinning of the walls of the ventricles. Carrying out coronary angiography is advisable only if occlusive lesions of the coronary arteries are suspected.

Complications

Complications of this disease can be divided into three main groups, which can be seen in the table.

According to the time of occurrence, late and early complications are distinguished. The later ones include the following:

Dressler's syndrome.
Endocarditis.
Chronic heart failure.
Innervation disorders.

In addition to classic complications, gastric ulcers and other acute gastrointestinal pathologies, mental disorders, and others may occur.

Treatment

The first thing you need to understand is to achieve maximum effect treatment should be started as quickly as possible. Initially, reperfusion therapy (thrombolysis, angioplasty) is necessary. The goals of treatment are:

Relief of pain syndrome. Initially, nitroglycerin is used sublingually for this purpose. If there is no effect, intravenous administration of this drug is possible. If this does not help, morphine is used to relieve pain. In order to enhance its effect, it is possible to use droperidol.
Restoring normal blood flow. The effect of using thrombolytics directly depends on how early they were started. therapeutic measures. The drug of choice is streptokinase. In addition to it, it is possible to use urokinase, as well as tissue plasminogen activator.
Additional treatment. Also used for heart attacks are aspirin, heparin, ACE inhibitors, antiarrhythmic drugs and magnesium sulfate.

In any case, therapy for myocardial infarction should be comprehensive and begin as quickly as possible. In the absence of adequate drug therapy perhaps not only early development complications, but also death.

If coronary artery disease is diagnosed, surgery may be necessary. Methods such as balloon angioplasty, stenting and bypass surgery are used.

Prevention

Considering the causes of myocardial infarction, one can easily understand that if preventive measures, the risk of developing the disease is greatly reduced. For the purpose of prevention, the following rules must be observed:

Control your body weight. the main objective- prevent obesity, because this factor is decisive in the formation of atherosclerosis - one of the main causes of myocardial infarction.
Dieting. Reducing salt intake, as well as reducing the intake of fats from food, can not only reduce the risk of obesity, but also normalize blood pressure.
Maintaining an active lifestyle. Adequate physical exercise contribute to the normalization of metabolic processes, weight loss, and overall strengthening of the body. If there is a history of a heart attack or other cardiovascular pathologies, you should consult your doctor about the amount of exercise.
Rejection of bad habits.
Cholesterol control.
Pressure control.
Measuring sugar levels.
Carrying out preventive examinations with a specialist.

Thus, given the etiology of myocardial infarction, we can say with confidence that prevention plays an important role. If you follow the above recommendations, the risk of developing the disease is reduced significantly.

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Myocardial infarction and cerebral stroke are firmly ranked first in the world in mortality. We are used to hearing that one of our neighbors, colleagues, or relatives suffered a heart attack. For us, this disease is present somewhere nearby.

What it is? Myocardial infarction is a form of coronary heart disease (CHD), which can be considered a complication, since it is a condition in which the heart muscle experiences a severe lack of oxygen and nutrients.

Thus, in 2011, 13 million people died from heart attacks worldwide. This is more than the populations of Denmark and Israel combined. If we take our country, then in Russia the mortality rate from acute myocardial infarction has broken all possible and impossible records and, according to 2012 data, amounted to 587 cases per 100 thousand population, including old people and infants. This means that within a year, every one of the 165 people you know or pass by will die from a heart attack.

In Russia, 43% of men who die from this disease die in the prime of life, or, as dry statistics say, “at economically active age.” If we take developed countries, then this figure is four times lower.

A third of patients with a heart attack die in the first 24 hours from the onset of the disease. This is partly caused by delaying emergency hospitalization until they “get it,” since 50% of them die before meeting doctors.

But even if the patient managed to be taken to the hospital and treated, then after discharge, which was done according to all the rules and with normalization of tests, 5-15% of those discharged will die within a year, and each subsequent year will claim the life of every 20th person (5 % in year). Therefore, coronary heart disease, and its most dangerous manifestation – myocardial infarction – is a very serious disease.

More men fall ill and die than women. Thus, myocardial infarction in women and men (incidence) correlates, according to various sources, from 1:2 to 1:6, depending on age. What kind of disease is this, how does it manifest itself, and how to treat it?

Acute myocardial infarction - what is it?

Acute myocardial infarction is the rapid death or necrosis of a part of the heart muscle due to a severe lack of blood supply to this area.

To avoid confusion, it should be said that a heart attack is a standard pathological process caused by blockage of a vessel bringing arterial blood to an organ. Thus, an infarction of the kidney and spleen occurs. Got a cerebral infarction given name- stroke.

And myocardial infarction is so significant in terms of the number of victims that it is simply called a heart attack. Why does this pathology develop?

Causes of myocardial infarction, risk factors

If the coronary vessels that carry blood to the heart are healthy, then a heart attack will not develop. After all, its cause is three next friend events follow each other, and a prerequisite is the presence of atherosclerosis and plaque inside the vessel:

External release of adrenaline and acceleration of coronary blood flow. This is an ordinary situation, for example, anxiety at work, stress, high blood pressure, or physical activity, which may be very small;
Increased blood velocity in the lumen coronary vessel damages and ruptures atherosclerotic plaque;
After this, at the site of the rupture, the blood forms a durable clot, which falls out when the blood interacts with the plaque substance. As a result, blood flow below the accident site either stops or sharply decreases.

Most often, newly formed, “young” and unstable plaques disintegrate. The problem is that old plaques “sit” firmly, even if they block 70% of the lumen of the vessel, and young plaques that block 40% may be the cause. What causes plaques to form?

Risk factors

It is unlikely that new studies can add another risk factor to the existing ones. All of them are well studied:

age of men over 40 years, women over 50 years;
the presence of heart attacks or sudden cardiac death in relatives;
smoking;
overweight or obesity. The easiest way to determine it is by waist circumference: the norm for men is no more than 102, and for women – no more than 88 cm;
physical inactivity and decreased physical activity;
hypercholesterolemia – increased content of cholesterol, its atherogenic fraction;
presence of a diagnosis of arterial hypertension, or essential hypertension;
diabetes;
constant stress.

As you can see, only the first two factors cannot be changed in any way - they are unmodifiable. But the rest can be handled quite well!

In the same case, when a heart attack develops, how does it proceed? What are its symptoms?

The first signs and symptoms of myocardial infarction

Signs of myocardial infarction can be very diverse. But when making a diagnosis, looking ahead, we will say that in addition to the external picture of the disease, ECG data are taken into account, as well as the results of laboratory tests of some enzymes contained in the muscles that enter the blood during a heart attack

Characteristic first signs of a heart attack

The main sign is sharp pain in the chest (70-90% of all cases). It lasts more than 20 minutes, “rolling” in attacks. Each subsequent attack is stronger than the previous one.

The nature of the pain is excruciating, pressing, gnawing, squeezing. It is immediately clear that the pain is “serious because it has never happened before”;
Localization of pain is usually behind the sternum, or in the projection of the heart (50%). In 25% of cases, pain occurs in the periphery: left jaw, shoulder blade on the left, left hand and brush, left shoulder, spine, and even pharynx;
The severity of pain, or intensity, varies. In severe cases, patients cannot endure and groan, but sometimes the pain is weak or absent altogether. Most often, this happens when diabetes mellitus, against the background of sensory impairment due to. There is “exorbitant” pain, which is not relieved even by morphine and promedol, or is relieved incompletely;
The pain lasts no less than 20 minutes (minimum), but can last for several days, it is not relieved by nitroglycerin, or disappears after a short time with renewal;
An attack is caused by physical activity, from defecation and making the bed to heavy work and sexual intercourse, stress, leaving the house in the cold, swimming in an ice hole, periods of sleep apnea, eating a large meal, and even moving the body from sitting to lying down.

To top it all off, we can say that a heart attack can occur at all, without any provocation, in the midst of complete rest.

What symptoms accompany a heart attack?

Most often, such characteristic accompaniments of acute coronary syndrome occur as:

anxiety, general weakness, or excitement;
fear of death, sweating, sallow complexion, severe pallor;
gastrointestinal symptoms: nausea, diarrhea, vomiting and bloating;
cardiac symptoms: pulse lability, thready pulse, decreased blood pressure;
may appear cold sweat.

Atypical course options

In addition to the classic, “anginal” myocardial infarction with severe chest pain, you need to be able to diagnose the main “masks”, or atypical variants. These include:

Abdominal option. There is complete confidence that the problem is in the “stomach”. Pain occurs in the abdomen, in the projection of the stomach, in the right hypochondrium, accompanied by nausea and vomiting, bloating;
Asthmatic, which can be a manifestation of acute cardiac asthma: suffocation, shortness of breath, as well as a cough with pink, foamy sputum. More often it indicates acute stagnation in the pulmonary circulation. This happens often during repeated processes;
Arrhythmic option. Almost all symptoms are reduced to heart rhythm disturbances, the pain is mild;
Cerebral, “stroke-like” variant. It causes “floaters” before the eyes, intense dizziness, stupor, fainting, nausea and vomiting.

These variants can be expected in diabetes, in patients with a history of heart attacks, and in old age.

Stages of myocardial infarction

In order to know the “enemy in person”, let’s get acquainted with the periodicity of the disease. What happens in the heart muscle? There are several stages of the disease:

Development, or acute period, up to 6 hours after onset. It is characterized by the most striking symptoms, including on the ECG. By the 6th hour, the formation of the zone of myocardial necrosis ends. This is a critical time. Later, it is no longer possible to restore dead cells.
Acute period – up to 7 days. This is the time when greatest number complications, and in the myocardium there are processes of remodeling, or destruction of dead tissue by macrophages and the formation of pink, young connective tissue at the site of necrosis. She is good to everyone, but, alas, she cannot contract like a muscle;
The period of healing, or scarring. The scar thickens and “matures”; this period ends a month after the attack;
From a month onwards after a heart attack, PICS, or post-infarction cardiosclerosis, is determined. All those problems that have persisted by this period (arrhythmia, heart failure) will most likely remain.

Knowledge about the first symptoms of myocardial infarction is simply necessary for everyone. Here are the amazing numbers:

If you do not consult a doctor, 28% of patients die in the first hour of a heart attack. During the first 4 hours, 40% of patients die; after 24 hours, half of all patients will be dead;
Even if we take Moscow, then within the first 6 hours from the beginning about 8% of all patients end up in a specialized department, and in the USA this is 80%.

Why don’t people call an ambulance immediately, or at least half an hour after the onset of severe, unusual pain? Because Russian people are not accustomed to the fuss around them, and the patience of the Russian people is limitless. However, if you suspect a heart attack, you should immediately do the following:

Pull yourself together;
Put the patient in bed or on the sofa, prohibit him from getting up;
Place nitroglycerin under the tongue, then after 3 minutes again (if the pain does not go away), and then another one;
While the nitroglycerin is working, an ambulance is called;
If possible, open the window and ventilate the room;
If you have equipment, you need to measure your blood pressure, count your pulse, and check it for arrhythmia;
Let the person know that they are not going to abandon him, reassure him. This is very important because with a heart attack there may be a fear of death;
The patient can be given aspirin powder at a dose of 325 mg;
When low pressure You can raise your legs by placing something under them.

This completes your participation in first aid for acute myocardial infarction, and all that remains is to wait for the cardiac team. Doctors immediately give oxygen, record an ECG, administer narcotic analgesics in case of severe pain, and one hundred percent certainty In the diagnosis, thrombolysis is performed at home to dissolve the blood clot and allow blood to “break through” to the affected area of the heart muscle.

Remember: necrosis (necrosis) is completed after 6 hours, so only within this time it is necessary to restore blood flow (recanalize) the thrombus. Therefore, the ideal option would be for doctors to arrive not later than first hours after the onset of illness.

But how to diagnose a heart attack? What helps doctors make the correct diagnosis?

Diagnosis of heart attack - ECG, tests and ultrasound

First of all, a diagnosis of heart attack is assumed, based on the patient’s complaints, examination and medical history (presence of risk factors, angina). Instrumental diagnostics classic acute coronary thrombosis is quite simple.

In the diagnosis of acute myocardial infarction, determining the level of enzymes is of great help: CPK-MB, creatine phosphokinase, which increases 3 hours after the onset of necrosis, reaches a maximum by the end of the first day, and after another day returns to normal. Troponins are examined and a troponin test is performed. In the general blood test, ESR and leukocytosis increase.

Cardiac ultrasound and other research methods are also used in diagnosis.

Complications of a heart attack, features

It is known that, in principle, a person does not die from an uncomplicated heart attack. Death occurs from complications. What are the complications of coronary thrombosis? Isn't a dead section of the heart enough? It turns out not enough. A heart attack can be complicated by:

Pulmonary edema (shortness of breath, cyanosis, cold sweat, cough with foamy sputum, wheezing, foam at the mouth);
Cardiogenic shock, which develops against the background of an extensive heart attack and is associated with a decrease in cardiac function, includes pain and arrhythmic shock;
Ventricular fibrillation, which is the most dangerous rhythm disorder. Without defibrillation, death is inevitable. Develops already in the first hours after the onset of a heart attack;
Ventricular extrasystoles, idioventricular rhythm and other arrhythmias;
Impulse conduction disorders and severe blockades;
Asystole (complete electrical “silence” of the heart);
Rupture of the heart (wall of the left ventricle). Occurs with an extensive transmural zone of necrosis;
Intracavitary thrombosis;
Rupture of the interventricular septum and separation of papillary muscles and heart valves.

In addition to these very severe complications, some of which are certainly fatal, myocardial necrosis in the right ventricle may occur as a complication of necrosis on the left.

To top it all off, after a large number of muscle structures enter the bloodstream, Dressler's syndrome develops, associated with autoimmune inflammation, and is manifested by fever, polyarthritis and pericarditis. It occurs 2 weeks after a heart attack.

In order to avoid complications, including fatal ones, hospitalization for myocardial infarction is needed as early as possible.

Treatment of myocardial infarction, drugs

Competent treatment of acute myocardial infarction has its own goals. We will not talk here about pain relief, oxygen supply, or actions in case of sudden cardiac arrest. We will talk about the principles of treatment of ordinary and uncomplicated myocardial infarction in the most general and accessible form.

Thrombolysis

If you try to dissolve a fresh thrombus, then the chances of restoring 55% of the necrosis zone are available in the first 1.5 hours from the onset of a heart attack; by the end of the 6th hour this percentage drops to 15%. If you consult a doctor later, thrombolysis is pointless.

Think about it: a delay in thrombolysis of half an hour shortens the patient's life by a year, and an hour's delay leads to an increase in the risk of death by 20% per year even 5 years after a heart attack.

Heparin and anticoagulants

It is known that a week of heparin use reduces mortality by 60%. At the same time, blood fluidity increases and thrombotic complications, for example, inside the chambers of the heart, are prevented. Low molecular weight heparins are currently used.

Antiplatelet therapy

Prevents the formation of new blood clots. For this, “cardiac” aspirin is used in a dose of 75 to 325 mg. Clopidogrel, which is prescribed after illness for a year, is highly effective.

Nitrates

These drugs facilitate the work of the heart, reduce vascular spasm and reduce the load on the heart, improving the outflow from it, since blood is deposited in the vessels of the skin and muscles. The drugs are taken both in the form of an inhalation spray and in the form of tablets and infusions.

BAB (beta-blockers)

They protect the heart from increased work in case of adrenaline release into the blood. As a result, the need for raw oxygen does not increase, ischemia does not occur, and there is no heartbeat. This mode of heart operation can be called “energy saving”.

ACE inhibitors

In addition to the fact that angiotensin-converting enzyme inhibitors prevent an increase in blood pressure, they reduce the myocardial oxygen demand, and also prevent the appearance of atherosclerotic plaques and slow down their growth. As a result, they reduce the risk of recurrent heart attack and mortality.

In addition to these drugs, which are prescribed in various combinations to almost all patients, statins are prescribed that correct fat metabolism (after discharge), calcium blockers, and aldosterone receptor blockers in patients with a pronounced decrease in systolic output.

Surgical treatment of heart attack

In case of acute myocardial infarction, the following can be performed:

PCBA, or percutaneous balloon coronary angioplasty. It allows you to restore blood flow and implant a stent, and is an alternative to thrombolysis. The disadvantage is the impossibility of performing PCI after 12 or more hours from the onset of a heart attack, as well as the high cost. The purpose of the operation is to mechanically expand the vessel in the area of thrombosis, “press” the thrombus into the wall of the vessel and install a rigid tube - a stent.
CABG, or coronary artery bypass grafting. As a rule, it is carried out no earlier than a week after the development of thrombosis, due to the high risk early complications. The purpose of the operation is to build new vascular “bridges” and improve myocardial vascularization.
Intra-aortic balloon counterpulsation. This is a method of unloading the heart in both systole and diastole by installing a balloon in the aorta. It is performed in case of cardiogenic shock, septal rupture and is regarded as a temporary effect before surgery.

We have talked enough about what it is - myocardial infarction, and what the consequences and prognosis may be if you do not apply for it in a timely manner. urgent help. Rehabilitation after myocardial infarction aims to reduce the social, physical and even psychological consequences of the disease, and prevent the possibility of relapse and other fatal complications.

It is known that, unlike a stroke, after a heart attack, about 80% return to normal (everyday) life after six months, and in the case of mild course– in 2-3 months. As for professional rehabilitation, patients who have suffered a heart attack can no longer work as pilots, machinists, dispatchers, or in other responsible jobs.

An important component of rehabilitation is the treatment of post-infarction depression, which occurs in every 20th patient.

Physical rehabilitation involves increasing physical activity, which, with a competent approach (physical therapy), can reduce mortality by a quarter.

The main thing in rehabilitation is the identification of four functional classes and the correspondence of programs to their capabilities.

Patients should have different levels of physical activity, depending on the severity of the condition, the presence of post-infarction angina, and arrhythmias. Thus, class 1 has no restrictions at home, and in patients of class 4, any physical activity provokes angina attacks.

Also important is nutrition, prevention of weight gain, taking antiplatelet agents, statins under control biochemical tests blood, support normal level blood pressure and treatment concomitant diseases– for example, diabetes or arterial hypertension.

This is the only way to reduce the risk of recurrent myocardial infarction and its long-term complications.

What is myocardial infarction

Myocardial infarction - clinical form, at which it occurs acute disorder blood supply and, as a result, necrosis (heart attack, necrosis) of a section of the heart muscle, accompanied by circulatory disorders.

Myocardial infarction in 90% of cases occurs due to long-term progression. Men aged 42-67 years are most often affected. The heart is supplied with blood through the right and left coronary arteries, which arise from the base of the aorta. As a result, the vessels form plaques that block the lumen of the coronary arteries.

Normally, the coronary arteries, due to their expansion, are capable of increasing coronary blood flow 5-6 times to compensate for physical activity and stress. When the arteries narrow, this compensatory mechanism does not work: any load leads to oxygen “starvation” (ischemia) of the myocardium.

Myocardial infarction can develop without load, with a sharp blocking of coronary blood flow, for example, with rupture and thrombosis of an atherosclerotic plaque, as well as with a sharp spasm of the coronary artery.

Clinical signs of a heart attack appear if the lumen of the artery decreases by more than 80%. Necrosis of the bloodless myocardium occurs 30-90 minutes after the cessation of blood supply. Therefore, doctors have only 1-2 hours to prevent the death of the heart muscle using drugs and/or intervention aimed at opening the blocked artery. Without this, irreversible damage develops - myocardial necrosis, which forms within 15-60 days.

Myocardial infarction - extremely dangerous condition, mortality reaches 35%.

Causes of myocardial infarction

In 95% of cases, the disease manifests itself against the background of atherosclerotic lesions of the coronary arteries. In the remaining cases, necrosis develops due to a sharp spasm of the coronary arteries. There are factors that contribute to the progression and increase the risk of developing myocardial infarction:

smoking;
past infections;
low levels of high-density lipoproteins in the blood;
sedentary lifestyle;
elderly age;
poor environmental conditions in the place of residence;
excess body weight;
, ;
history of myocardial infarction;
congenital underdevelopment of the coronary arteries;
long-term use;
oncological diseases.

Symptoms of myocardial infarction

Here are the classic signs of a heart attack:

acute strong pressing, bursting pain behind the sternum, radiating to the neck, left shoulder, between the shoulder blades;
shortness of breath, cough;
feeling of fear;
pale skin;
increased sweating.

Symptoms for atypical forms of myocardial infarction

Abdominal form - characterized by pain in the upper abdomen (episgastric region), hiccups, bloating, nausea and vomiting.

Asthmatic form - occurs after 50 years and is manifested by intense shortness of breath, suffocation, dry and wet, medium and coarse wheezing in the lungs.

Painless form - occurs in 1% of cases, usually in patients with. It manifests itself as weakness, lethargy, and lack of subjective sensations. A previous heart attack is detected by routine electrocardiography (ECG).

The cerebral form is characterized by impaired blood supply to the brain. In 40% of cases it occurs with infarction of the anterior wall of the left ventricle. Clinic: dizziness, impaired consciousness (muscle paresis), disorientation in time and space, loss of consciousness.

The collaptoid form is a manifestation of cardiogenic shock, which is the most dangerous complication of myocardial infarction. Clinic: sharp drop in blood pressure, dizziness, darkening of the eyes, profuse sweating, loss of consciousness.

The edematous form is manifested by shortness of breath, weakness, edema, accumulation of fluid in the chest and abdomen (ascites), enlargement of the liver and spleen (hepatomegaly) due to increasing right ventricular failure.

The combined form is characterized various combinations atypical forms of heart attack.

Classification of myocardial infarction by stages

The most acute stage lasts up to 120 minutes from the cessation of blood supply.

The acute stage lasts up to 10 days; at this stage, the heart muscle has already collapsed, but the formation of necrosis has not begun.

The subacute stage lasts up to 2 months. Characterized by the formation of scar tissue (necrosis).

The post-infarction stage lasts up to six months. During this period, the cardiac scar is finally formed, the heart adapts to new operating conditions.

Based on the prevalence of the pathological process, large and small focal infarctions are distinguished.

Large-focal (transmural, or extensive) infarction - damage to a large area of the myocardium. The process is developing very quickly. In 70% of cases, changes in the heart are irreversible. The patient can avoid severe complications of a large-focal infarction, in particular if health care will be provided no later than 3-4 hours.

Small focal infarction - damage to small areas of the heart muscle. It is characterized by a milder course and less pronounced pain syndrome than macrofocal. In 27% of cases, a small-focal infarction develops into a large-focal one. Occurs in every fourth patient. The prognosis is favorable, complications occur in 5% of cases, usually with delayed treatment.

Diagnosis of myocardial infarction

The disease is diagnosed, with using ECG. Additionally, cardiac ultrasound, coronary angiography, myocardial scintigraphy and laboratory tests are prescribed: general analysis blood, cardiotropic proteins in the blood (MB-CPK, AST, LDH, troponin).

Treatment of myocardial infarction

At the slightest suspicion of myocardial infarction (retrosternal pain), you need to call an ambulance.

The disease is treated only in a hospital and even in a block intensive care. Strict required bed rest within 3-7 days. Then motor activity expanded on an individual basis. Medicines prescribed include painkillers (Morphine, Fentanyl), antiplatelet drugs ( Acetylsalicylic acid, Clopidogrel), anticoagulants (Heparin, Enoxaparin), thrombolytic drugs (Streptokinase, Alteplase), beta-blockers (Propranolol).

The most effective and promising method of treatment is emergency (up to 6 hours) opening of a blocked coronary artery using balloon angioplasty with the installation of a coronary stent. In some cases, urgent coronary artery bypass grafting is performed.

The recovery (rehabilitation) period lasts up to six months. During this time, patients gradually increase physical activity starting with 10 steps a day. Medications accepted for life.

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