Myocardial infarction is a lesion of the heart muscle caused by an acute disruption of its blood supply due to thrombosis (blockage) of one of the arteries of the heart with an atherosclerotic plaque.

In this case, the affected part of the muscle dies, that is, its necrosis develops. Cell death begins 20-40 minutes after blood flow stops.

Test yourself

Signs of a heart attack:

• Severe pain behind the sternum. It can spread to the left arm, shoulder, left half of the neck, and the interscapular space.
• Often the attack is accompanied by a feeling of fear.
• Taking nitroglycerin does not relieve pain.
• The attack can occur at rest, without visible reasons, the pain lasts from 15 minutes to several hours.

SOS

If these signs are present, you should urgently call " ambulance“, and before her arrival, take nitroglycerin tablets at a dosage of 0.5 mg at 15-minute intervals, but no more than three times, to avoid a sharp drop in pressure.

You should also chew an aspirin tablet. dosage 150-250 mg.

Important

Sometimes myocardial infarction is disguised as other diseases:

• The gastralgic version is similar to the picture " acute abdomen": abdominal pain, bloating, and with them - weakness, falling blood pressure, tachycardia. Only an electrocardiogram can clarify.
• The asthmatic variant proceeds without severe pain in the heart, the patient begins to choke, he is given drugs to make breathing easier, which do not make him feel better.
• The cerebral variant resembles a stroke, confusion of consciousness and speech occurs.
• A “silent” heart attack occurs completely without pain and most often occurs in patients with diabetes mellitus. Severe fatigue and shortness of breath after physical efforts, which were previously given without difficulty, may be its only signs.
• Angina pectoris is another mask of a heart attack, under which it “hides” in approximately 10% of patients. They only experience pain when walking. Often such patients independently come to the clinic, where the ECG registers their heart attack.

By the way

Only numbers

Reducing blood cholesterol levels by just 10% reduces mortality from heart attack by 15%!

Attention

Deformed endothelial cells in the blood signal an approaching heart attack, According to American scientists from the Scripps Institute.

They examined blood samples from 50 patients who were admitted to the hospital with complaints of chest pain — the main clinical sign heart attack. Scientists discovered the presence in their blood samples of a large number of exfoliated endothelial cells, which were also severely deformed.

The average age of the patients was 58.5 years. For comparison, the scientists selected 44 healthy volunteers who were younger than the control group patients, as well as 10 people over 50 years old. The results of the study showed that the number of circulating endothelial cells in the blood of sick people was 4 times higher than their number in the blood of healthy people. Cells found in blood healthy people, were not deformed.

Scientists believe that endothelial cells begin to peel off in large numbers from the inner walls of blood vessels about two weeks before a heart attack. This sign can be used as a biomarker of the onset of processes preceding a heart attack.

Patient Reminder

• The threat of a recurrent heart attack is increased by four main factors: atherosclerosis, high blood pressure, increased blood clotting and carbohydrate metabolism disorders. These risk factors can only be controlled with the help of properly selected drug therapy.
• To slow down further development atherosclerosis, it is important to prevent the formation of fatty plaques in the vessels. For this purpose, drugs from the statin group are prescribed. Beta blockers help the heart work more calmly. So-called angiotensin-converting enzyme inhibitors reduce the effect of the vasoconstrictor angiotensin and normalize blood pressure.
• You cannot change the dosage of medications at your own discretion. If any problems arise, the doctor will adjust the course of treatment.

For recovery after a heart attack proper diet is important: minimum fat, nothing fried or spicy, more fiber, dairy products, fruits, vegetables, fish.

Have to give up sausages and sausages, ready-made semi-finished products(dumplings, cutlets...) - they contain a lot of hidden fats that increase cholesterol levels. For the same reason Pates, liver dishes, offal, and caviar are prohibited. Milk fat is also dangerous: will have to be excluded butter; fatty cottage cheese, cheese, milk, kefir, sour cream, cream. When cooking chicken or turkey, all fat and skin must be removed from the carcass.

And of course minimum salt.

Vodka, cognac and other strong drinks are canceled. And here you can afford a glass of natural dry red wine, This good prevention atherosclerosis.

You'll have to change some habits too. If you used to smoke, cigarettes are now completely taboo.

Almost 80% of people who have had a heart attack can return to normal life.

To restore the functioning of the heart muscle, it is important to engage in physical therapy. Walking is an excellent restorative tool. After just one and a half to two months of training, you can walk at a pace of up to 80 steps per minute without shortness of breath or weakness. And over time, switch to very fast walking - up to 120 steps per minute.

Useful: climbing stairs, cycling, swimming. Dancing 2-3 times a week for 30-40 minutes.

However Make sure that your heart rate during exercise does not exceed more than 70% of the threshold. How to calculate this? From 220 you need to subtract your own age - this is the maximum heart rate. Then we calculate the percentages. For example, for a 60-year-old person, the threshold load is calculated as follows: 220-60 = 160 heartbeats per minute, and 70% will be 112. This figure should be a guideline. But, if at such a frequency they appear discomfort, the load needs to be reduced.

Attention! After a heart attack, lifting heavy objects is strictly contraindicated.

Drugs

Remember, self-medication is life-threatening; consult a doctor for advice on the use of any medications.

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 for no apparent reason (spontaneously), as a result of a primary violation of coronary blood flow caused by the formation of erosion, rupture, or 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 increase low-density lipoprotein (LDL) levels, high level triglycerides in the blood, arterial hypertension, smoking, sedentary lifestyle life, obesity, diabetes mellitus, 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 complain only 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 a picture of an “acute abdomen” is suspected, 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 mild symptoms and do not seek 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 noted the appearance 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, mitral valve insufficiency, thromboembolic complications, dysfunction of the papillary muscles, cardiac ruptures, aneurysm formation, and the development of pericarditis.

Doctor Chuguntseva M.A.

A heart attack is one of the types of coronary heart disease. The attack occurs due to insufficient or completely stopped blood supply to the myocardium. The most common cause of this effect is blood clots that form in blood vessels.

Acute pain in the heart area can be completely sudden. Depending on the degree of localization, the human body is able to return to life or begins coronary death. As a result of the pain syndrome, the heart muscles die, which affects the further functioning of the cardiovascular system.

Those at risk are mainly elderly people, active and passive smokers. Can cause a heart attack accompanying illnesses– alcoholism, diabetes, obesity, diseases blood vessels. According to statistics, heart attacks most often affect people who lead a sedentary lifestyle.

Symptoms of a heart attack

Harbingers of a heart attack can be a wide variety of pain that occurs not only in the heart area, but under the shoulder blades, in the abdomen or. Nagging pain in the extremities may also indicate problems with the functioning of the heart.

The main symptom of a heart attack is sharp, unbearable pain in the chest. The attack may last several minutes or not go away for hours. A heart attack can be primary (spontaneous) or repeated at regular intervals.

In medicine, there are five main types of heart attack, of which different symptoms. A typical form of heart attack develops with a sharp burning pain in the heart area.

In the asthmatic form there is sudden attack. The patient does not, his breathing quickens several times. The eyelids, fingers, lips and nose area acquire a rich blue tint. Basic skin suddenly turn pale. Such a heart attack may be accompanied by hemoptysis, coughing and noisy, uneven breathing.

The arrhythmic form is directly related to changes in heart rate. In a patient, the heartbeat becomes visually noticeable, and blood pressure decreases several times. This form heart attack most often leads to clinical death.

The cerebral form is accompanied sudden loss consciousness. Moreover, the initial heart attack is very reminiscent. The patient cannot pronounce words coherently, his speech becomes incomprehensible, coordination of movements is impaired, and sharp pain occurs in the chest area.

The abdominal form of heart attack is considered the rarest. Painful sensations in in this case arise not in the heart area, but in the abdominal cavity closer to the stomach. According to some signs, such an attack resembles an exacerbation of an ulcer or gastritis. A heart attack is accompanied by profuse sweating, rapid heart rate, tachycardia, arrhythmia, nausea and vomiting.

Heart attack myocardium is the most serious complication coronary heart disease, because with this disease, disturbances in the blood supply to fairly large areas of the heart muscle can occur, which can provoke significant hemodynamic disturbances that are incompatible with life.

Instructions

The main symptom that allows one to suspect a myocardial infarction is an attack of pain, which is not the same as all previous pain attacks. The nature of the pain may vary from patient to patient depending on the size of the damage to the heart muscle, but this pain is much stronger than the pain during the next attack of angina, and is not influenced by those medications that were previously effective and were used to prevent and treat chest pain.

Helps and unusually determine myocardial infarction long duration attack, which lasts more than 5-10 minutes, while pain during the next attack of angina usually occurs during this time, especially when using drugs for its treatment that contain. Using validol or other similar drugs based on extracts from medicinal plants And sedatives, is effective only during an attack of palpitations, but is absolutely ineffective during developing myocardium. The prescription of these drugs only helps to calm the patient, which affects his subjective state, but has absolutely no effect on the size of the zone of cell necrosis during myocardial infarction.

The development of necrosis provokes the exclusion of some part of the heart muscle from pumping blood, which can cause the development of stagnation in the systemic and pulmonary circulation. Stagnation in the small circle is manifested by severe shortness of breath, which may be accompanied by a fever, indicating the possibility of developing cardiac asthma. Stagnation in big circle manifested by pronounced fluctuations in systemic arterial blood pressure. This is accompanied by the development of pronounced hemodynamic disturbances in the organs and tissues of the body. With significant areas of necrosis, dissection of the heart muscle (heart rupture) is possible, which leads to almost instantaneous pericardial tamponade due to the development of pericardial tamponade, in which it cannot contract at all. In this case, there arises acute attack heart pain, after which the patient almost instantly.

Due to frequent stress and many negative factors, with which the life of a modern person is full, myocardial infarction has become significantly younger. But an important reason for its development is a sedentary lifestyle, poor nutrition, abuse bad habits, tendency to atherosclerosis and high blood pressure, diabetes and obesity.

Instructions

The most common manifestation of myocardial infarction is severe symptoms, which are impossible not to pay attention to. And timely help when they appear can prevent irreversible changes in the heart muscle, and sometimes even save lives, since this disease is quite sad.

Most of Myocardial infarction is accompanied by severe, sharp pain in or behind the sternum. Often the pain radiates to the left arm, shoulder blade, neck and jaw. Due to the fear of death, a short-term increase in blood pressure appears, which drops very quickly, which is accompanied by heart rhythm disturbances, cold extremities and cold sticky sweat.

The pain can be squeezing or stabbing, but its intensity gradually increases as the attack of myocardial ischemia progresses, which, in the absence of medical attention, can turn into necrosis cardiac muscle.

The pain is most often localized behind the sternum, and it can radiate (radiate) to the left half of the chest, the left arm along its entire length and ring finger and the little finger of this hand, the spine, the left half lower jaw.

The patient may complain of severe general malaise, dizziness, and flashing of spots before - these indicate a general decrease in arterial blood levels. At the same time, patients may experience severe coldness of the extremities, which indicates the inability of the heart muscle to adequately provide blood supply to organs and tissues.

There may be attacks of difficulty breathing, during which patients experience severe motor restlessness, trying to find a position of the body that will make it easier. The attack may be accompanied by an unproductive, increasing cough, which progresses to an attack of cardiac asthma.

At the same time, patients may complain of pain in the epigastric region, which is especially typical for those with an atypical location of the area of ​​cardiac muscle necrosis. In these cases, an attack of cholecystitis may be mistakenly suspected, peptic ulcer stomach, acute pancreatitis.

Very rarely, during an attack, a short-term, almost imperceptible decrease in pain may be observed, indicating the development of a large focus of necrosis - the pain decreases with simultaneous necrosis of a significant area of ​​the heart muscle.

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note

If any of these signs appear, especially with increasing deterioration of the patient's condition, the lack of medical care can lead to tragic consequences.

Tip 6: Myocardial infarction: symptoms and signs of the disease

Myocardial infarction is the development of areas of necrosis of the heart muscle as a result of acute disruption of blood supply. The condition is life-threatening. Therefore, it is very important to recognize the first symptoms and signs of myocardial infarction in order to promptly seek qualified medical help.

Often the symptoms of myocardial infarction are atypical. In the abdominal form, the patient is bothered by pain in the upper abdomen, nausea, vomiting, bloating, hiccups, that is, all signs indicate the development acute pancreatitis.

In the asthmatic form of myocardial infarction, shortness of breath rapidly progresses, which cannot be relieved with conventional medications.

Patients with diabetes mellitus may have asymptomatic form myocardial infarction. There is no retrosternal pain. Impaired sensitivity is one of the signs of diabetes. This is why recognizing a heart attack by symptoms becomes problematic.

The cerebral form of myocardial infarction is characterized by impaired consciousness, dizziness, and other neurological symptoms.

In patients suffering from osteochondrosis thoracic spine, the pain syndrome behind the sternum is accompanied by a girdling pain throughout the spine, which intensifies with the slightest movement.

Cardiogenic shock develops when there is extensive damage to the heart muscle. The patient loses consciousness, skin and lips, pulse.

There are many main causes of myocardial infarction. With atherosclerosis, the vessels supplying the heart instantly become clogged cholesterol plaque. The blood flow stops. Arterial spasm can occur due to instability of blood pressure, after stress, use large quantity food, alcoholic drinks, physical activity.

How can you help a patient with myocardial infarction?

All those around them can do is unbutton the shirt collar, open the window, lay the patient on a bed with a high headboard and put a nitroglycerin tablet under his tongue. Then you need to urgently call an ambulance. The emergency doctor will provide emergency assistance, and in conditions

The heart muscle stops receiving oxygen and nutrients from the blood, resulting in ischemic necrosis. Symptoms of a heart attack can be severe, burning pain that radiates to the shoulder blade, left arm or sternum and is accompanied by feelings of anxiety, fear and shortness of breath.

Causes of myocardial infarction

Most often, myocardial infarction develops in men over 50 years of age. This is due to their lifestyle, as well as the development of atherosclerosis. Every year, a heart attack kills almost 35% of patients in its acute course.

Atherosclerosis- the main cause of acute myocardial infarction. You can often find a combination of atherosclerosis and thrombosis. Arterial hypertension, diabetes mellitus, nicotine and alcohol abuse, as well as stress can also contribute to the development of the disease. Most often, myocardial infarction is diagnosed in the left ventricle of the heart.

Symptoms of myocardial infarction

Many patients may experience a condition called pre-infarction. During this period, patients develop progressive angina, which is not relieved by medications.

But in most cases, myocardial infarction occurs acutely, with painful sensations in the chest, which radiate under the shoulder blade, into the left arm, jaw. The pain can be bursting, burning, pressing or sharp. The pain becomes more intense over the affected area.

Most often, the pain lasts from several minutes to several hours and occurs in waves, then subside, then reappears. Nitroglycerin in this case does not relieve pain. The patient feels general weakness, fear and excitement.

In atypical cases, the patient may experience cold sweat, pallor of the skin, blood pressure rises, which can sharply drop to a critical level, arrhythmia or tachycardia often occurs.

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 the developed countries– then there 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?

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What it is?

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 and 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 cholesterol, its atherogenic fraction;
• having a diagnosis arterial hypertension, or 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, let’s say that in addition to the external picture of the disease, ECG data is taken into account, as well as the results laboratory research some enzymes contained in 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;
• Cold sweat may appear.

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:

1. 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;
2. 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;
3. Arrhythmic option. Almost all symptoms boil down to a disorder heart rate, pain is mild;
4. 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 development

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 the most acute period, up to 6 hours after the start. 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?

Diagnostics - 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.

Danger of complications

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 for sudden stop hearts. 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.

Surgery

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 inability to perform PCI after 12 or more hours from the onset of a heart attack, as well as high price. 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 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.

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 in order to compensate physical exercise 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 lipoprotein content high density in 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 by various combinations atypical forms 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.

By prevalence pathological process There are large and small focal infarctions.

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. Differs more light current 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 lab tests: 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 bed rest is required for 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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