Myocardial infarction is a medical emergency, most often caused by coronary artery thrombosis. The risk of death is especially high in the first 2 hours from its onset. It most often develops in men between the ages of 40 and 60. In women, symptoms of a heart attack are about one and a half to two times less common.
During a myocardial infarction, blood flow to a certain part of the heart is greatly weakened or stops altogether. In this case, the affected part of the muscle dies, that is, its necrosis develops. Cell death begins 20–40 minutes after the blood flow stops.
Myocardial infarction, the first aid for which should be provided in the very first minutes of the onset of symptoms indicating this condition, can subsequently determine a positive outcome for this disease. Today, this pathology remains one of the main causes of death from cardiovascular diseases.
Causes of myocardial infarction
In myocardial infarction, one of the coronary vessels is blocked by a thrombus. This triggers the process of irreversible changes in the cells and after 3-6 hours from the onset of occlusion, the heart muscle in this area dies.
The disease can occur against the background of coronary heart disease, as well as with. The main causes contributing to the occurrence of myocardial infarction are: overeating, malnutrition, excess animal fats in food, lack of physical activity, hypertension, bad habits.
Depending on the size of the dead area, a large and small focal infarction is distinguished. If necrosis captures the entire thickness of the myocardium, it is called transmural.
Heart attack - symptoms
The main symptom of myocardial infarction in men and women is severe chest pain. The pain is so severe that the patient's will is completely paralyzed. A person has the thought of imminent death.
The first signs of a heart attack:
- Stitching pain behind the chest is one of the first signs of a heart attack. This pain is very sharp and feels like being stabbed with a knife. It can last more than 30 minutes, sometimes hours. Pain can radiate to the neck, arm, back and shoulder blades. Also, it can be not only constant, but also intermittent.
- Fear of death . This unpleasant sensation is actually not such a bad sign, as it indicates the normal tone of the central nervous system.
- Shortness of breath, pallor, fainting. Symptoms occur because the heart is not able to actively push blood to the lungs, where it is saturated with oxygen. The brain tries to compensate by sending out signals that speed up breathing.
- Another important hallmark of myocardial infarction is lack of reduction or cessation of pain at rest or when taking nitroglycerin (even repeated).
Not always the disease manifests itself in such a classic picture. Atypical symptoms of myocardial infarction may also be observed, for example, instead of chest pains, a person may feel simple discomfort and interruptions in the work of the heart, there may be no pain at all, but abdominal pain and shortness of breath (shortness of breath) may be present - this picture is atypical, it is especially difficult in diagnostics.
The main differences between pain in myocardial infarction are:
- severe intensity of pain;
- longer than 15 minutes;
- pain does not stop after taking nitroglycerin.
Heart attack symptoms in women
It is in women that pain during an attack is localized in the upper abdomen, back, neck, jaw. It happens that a heart attack is very similar to heartburn. Very often, a woman first has weakness, nausea, only after that pain occurs. These types of symptoms of myocardial infarction often do not arouse suspicion in women, so there is a risk of ignoring a serious illness.
Symptoms of myocardial infarction in men are closer to the classic set, which allows for a faster diagnosis.
Myocardial infarction: first aid
In the presence of these signs, it is necessary to urgently call an ambulance, and before her arrival, take nitroglycerin tablets at a dosage of 0.5 mg, but not more than three times, at a 15-minute interval, in order to avoid a sharp drop in pressure. Nitroglycerin can be given only with normal pressure indicators, when it is contraindicated. It is also worth chewing an aspirin tablet with a dosage of 150-250 mg.
The patient should be placed in such a way that the upper torso is slightly higher than the lower, which will reduce the load on the heart. Unfasten or remove tight clothing and provide fresh air to avoid choking attacks.
In the absence of a pulse, breathing and consciousness, the patient should be laid on the floor and begin immediate resuscitation, such as artificial respiration and chest compressions.
Prevention
- You should stop smoking. Smokers are twice as likely to die from heart attacks.
- If it turns out that, then it is better to limit animal fats, which are abundant in butter, egg yolk, cheese, lard, and liver. Give preference to vegetables and fruits. Milk and cottage cheese must be fat free. Useful fish, chicken meat.
- High blood pressure also contributes to the development of a heart attack. By controlling hypertension, you can prevent a heart attack.
- Excess weight increases the load on the heart - bring it back to normal.
Consequences of myocardial infarction
The consequences of myocardial infarction mainly occur with extensive and deep (transmural) damage to the heart muscle.
- is the most common complication of myocardial infarction;
- heart failure;
- arterial hypertension;
- aneurysm of the heart, rupture of the interventricular septum;
- recurrent (constantly recurring) pain syndrome occurs in about 1/3 of patients with myocardial infarction.
- Dressler syndrome.
(Visited 19 481 times, 1 visits today)
In which, as a result of complete or partial insufficiency of blood supply to a section of the heart muscle, its necrosis (death) develops. This leads to disturbances in the work of the entire cardiovascular system and threatens the life of the patient.
The main and most common cause of myocardial infarction is a violation of blood flow in the coronary arteries, which supply the heart muscle with blood and, accordingly, oxygen. Most often, this violation occurs against a background in which atherosclerotic plaques form on the walls of blood vessels. These plaques narrow the lumen of the coronary arteries, and can also contribute to the destruction of the walls of blood vessels, which creates additional conditions for the formation of blood clots and arterial stenosis.
Risk factors for myocardial infarction
The main risk factor for myocardial infarction is atherosclerosis of the coronary arteries.There are a number of factors that significantly increase the risk of developing this acute condition:
- Atherosclerosis. Violation of lipid metabolism, in which atherosclerotic plaques form on the walls of blood vessels, is the main risk factor in the development of myocardial infarction.
- Age. The risk of developing the disease increases after 45–50 years of age.
- Floor. According to statistics, this acute condition occurs 1.5–2 times more often in women than in men, and the risk of developing myocardial infarction in women during menopause is especially high.
- arterial hypertension. People suffering have an increased risk of cardiovascular accidents, because with high blood pressure, myocardial oxygen demand increases.
- Previous myocardial infarction, even small-focal.
- Smoking. This addiction leads to disruption in the work of many organs and systems of our body. In chronic nicotine intoxication, narrowing of the coronary arteries occurs, which leads to an insufficient supply of oxygen to the myocardium. And we are talking not only about active smoking, but also passive.
- and hypodynamia. In violation of fat metabolism, the development of atherosclerosis, arterial hypertension accelerates, and the risk of diabetes mellitus increases. Insufficient physical activity also negatively affects the metabolism in the body, being one of the reasons for the accumulation of excess body weight.
- Diabetes. Patients with diabetes mellitus are at high risk of developing myocardial infarction, since elevated blood glucose levels have a detrimental effect on the walls of blood vessels and hemoglobin, impairing its transport function (oxygen transport).
Symptoms of myocardial infarction
This acute condition has rather specific symptoms, and they are usually so pronounced that they cannot go unnoticed. Nevertheless, it should be remembered that there are also atypical forms of this disease.
In the vast majority of cases, patients experience a typical pain form of myocardial infarction, so that the doctor has the opportunity to correctly diagnose the disease and immediately begin its treatment.
The main symptom of the disease is severe pain. The pain that occurs during myocardial infarction is localized behind the sternum, it is burning, dagger, some patients characterize it as "tearing". The pain can be given to the left arm, lower jaw, interscapular region. The occurrence of this symptom is not always preceded by physical activity, often the pain syndrome occurs at rest or at night. The described characteristics of the pain syndrome are similar to those with, however, they have clear differences.
Unlike an attack of angina pectoris, pain in myocardial infarction persists for more than 30 minutes and is not stopped at rest or by repeated administration of nitroglycerin. It should be noted that even in cases where the pain attack lasts more than 15 minutes, and the measures taken are ineffective, it is necessary to immediately call an ambulance team.
Atypical forms of myocardial infarction
Myocardial infarction, which occurs in an atypical form, can cause difficulties for the doctor in making a diagnosis.
gastritis variant. The pain syndrome that occurs with this form of the disease resembles pain during exacerbation of gastritis and is localized in the epigastric region. On examination, tension in the muscles of the anterior abdominal wall can be observed. Typically, this form of myocardial infarction occurs when the lower parts of the left ventricle, which are adjacent to the diaphragm, are damaged.
asthmatic variant. Reminds me of a severe asthma attack. The patient develops suffocation, cough with frothy sputum (but may be dry), while the typical pain syndrome is absent or mild. In severe cases, pulmonary edema may develop. On examination, a violation of the heart rhythm, a decrease in blood pressure, and wheezing in the lungs can be detected. Most often, the asthmatic form of the disease occurs with repeated myocardial infarction, as well as against the background of severe cardiosclerosis.
arrhythmic option. This form of myocardial infarction manifests itself in the form of various arrhythmias (extrasystole, atrial fibrillation or paroxysmal tachycardia) or atrioventricular blockades of varying degrees. Due to a violation of the heart rhythm, the picture of myocardial infarction on the electrocardiogram may be masked.
cerebral variant. It is characterized by impaired blood circulation in the vessels of the brain. Patients may complain of dizziness, headache, nausea and vomiting, weakness in the limbs, consciousness may be confused.
Painless option (erased form). This form of myocardial infarction causes the greatest difficulties in diagnosis. Pain syndrome may be completely absent, patients complain of indefinite discomfort in the chest, increased sweating. Most often, such an erased form of the disease develops in patients and is very difficult.
Sometimes in the clinical picture of myocardial infarction there may be symptoms of different variants of the disease, the prognosis in such cases, unfortunately, is unfavorable.
Treatment of myocardial infarction
With the appearance of severe burning pain in the heart, the patient should take a semi-sitting position and dissolve a nitroglycerin tablet under the tongue. A patient may be suspected of having a myocardial infarction if:
- burning severe pain behind the sternum lasts more than 5-10 minutes;
- the intensity of the pain syndrome does not decrease at rest, over time and after taking nitroglycerin, even repeated;
- pain syndrome is accompanied by the appearance of severe weakness, nausea, vomiting, headache and dizziness.
If you suspect a myocardial infarction, you must immediately call an ambulance and begin to help the patient. The sooner the first aid is provided to the patient, the better the prognosis.
It is necessary to reduce the load on the heart, for this the patient must be laid with a raised headboard. It is necessary to provide an influx of fresh air and try to calm the patient, you can give sedatives,
You should give the patient under the tongue (you can pre-grind) a tablet of nitroglycerin and chew one tablet of aspirin.
If at hand there are drugs from the group of beta-blockers (Atenolol, Metaprolol), then it is necessary to give the patient to chew 1 tablet. If the patient is constantly taking these drugs, then you need to take an extraordinary dose of the drug.
To reduce the intensity of the pain syndrome, it is necessary to give the patient an anesthetic drug (analgin, baralgin, pentalgin, etc.).
Additionally, the patient can take a tablet of Panangin or 60 drops of Corvalol.
If cardiac arrest is suspected (loss of consciousness, respiratory arrest, lack of pulse and response to external stimuli), resuscitation measures (indirect cardiac massage and artificial respiration) should be started immediately. If the patient does not regain consciousness, then they need to be continued until the doctors arrive.
Qualified care for myocardial infarction at the prehospital stage
The main task in the treatment of patients with myocardial infarction is to restore and maintain blood circulation in the affected area of the myocardium as quickly as possible. The health and life of patients largely depends on the provision of care at the prehospital stage.
One of the most important tasks facing emergency physicians is the relief of a pain attack, since as a result of the activation of the sympathoadrenal system, the load on the heart and myocardial oxygen demand increase, which further exacerbates ischemia of the affected area of the heart muscle. Often, doctors have to use narcotic analgesics to relieve retrosternal pain; morphine is most often used at the prehospital stage. If the analgesic effect of the use of narcotic analgesics is insufficient, intravenous administration of nitropreparations or beta-blockers is possible.
Restoration of coronary blood flow is an equally important task for physicians in the treatment of a patient with myocardial infarction. In the absence of contraindications, the doctor may begin to perform thrombolysis in an ambulance. This procedure is not indicated for all patients with myocardial infarction, the indications for it are determined by the doctor, based on the results of the electrocardiogram. The effectiveness of thrombolysis directly depends on the timing of its onset; with the introduction of thrombolytic drugs in the first hours after the onset of a cardiovascular catastrophe, the probability of restoring blood flow in the myocardium is quite high.
The decision to perform thrombolysis at the stage of transportation to the hospital depends on the time factor. The introduction of drugs begins the doctor of the ambulance team, if the time of transporting the patient to the hospital exceeds 30 minutes.
Treatment of myocardial infarction in a hospital
When symptoms of myocardial infarction appear, the patient should be hospitalized in a hospital in a short time. The best method of restoring blood flow and patency of the coronary arteries is an immediate angioplasty operation, during which a stent is placed in the artery. Stenting should also be carried out in the first hours after the onset of myocardial infarction. In some cases, the only way to save the heart muscle is urgent coronary artery bypass surgery.
A patient with myocardial infarction is hospitalized in the intensive care unit, and, if necessary, in the intensive care unit, where doctors can constantly monitor the patient's condition using special devices.
In the treatment of this disease, a large number of groups of drugs can be used, because in the treatment of myocardial infarction, several tasks must be performed at once:
- prevention of thrombus formation and blood thinning is achieved with the help of drugs from the groups of anticoagulants, antiplatelet agents and antiplatelet agents;
- limiting the area of myocardial damage is achieved by reducing the oxygen demand of the heart muscle, for which drugs from the groups of beta-blockers and ACE inhibitors (angiotensin-converting enzyme) are used;
- reduction of pain syndrome is achieved with the use of non-narcotic and narcotic analgesics, nitropreparations also have an antianginal effect, which also reduce myocardial oxygen demand and reduce the load on the heart;
- to normalize the level of blood pressure, the patient is prescribed antihypertensive drugs;
- in the event of heart rhythm disturbances, the patient is prescribed antiarrhythmic drugs.
Not all groups of drugs that can be used to treat myocardial infarction are listed. Therapeutic tactics depends on the general condition of the patient, the presence of concomitant diseases of the kidneys, liver and other organs, as well as on many other factors. Therefore, the treatment of this serious disease should be carried out only by a qualified doctor, self-medication is unacceptable and can lead to the death of the patient.
Consequences of myocardial infarction
The consequences of myocardial infarction always negatively affect the state of the whole organism. Of course, this depends on how extensive the myocardial damage is. Patients who have had a myocardial infarction often develop cardiac arrhythmias. Due to the necrosis of the myocardial area and the formation of a scar, the contractile function of the heart decreases, as a result of which it develops.
As a result of an extensive infarction and the formation of a large scar, a condition may occur that threatens the life of the patient and requires surgical treatment. An aneurysm not only worsens the functioning of the heart, but also increases the likelihood of blood clots in it, and the risk of its rupture is also high.
Cardiovascular diseases are almost in the first place among the causes of death of the population in many countries. One of the most common pathologies is a heart attack, what kind of disease is it, for what reason does it develop, is it possible to prevent the disease and how to help the patient? We will try to answer all these questions in detail.
Heart attack - what is it?
Almost everyone knows that this is a dangerous condition, but the mechanism and causes of development are not always of interest, although this must be known in order to prevent such a pathology. A heart attack develops as a result of impaired blood supply to areas of the heart muscle.
This pathology is also called one of the forms of the heart. If the blood supply is interrupted for more than 15-20 minutes, then necrosis of living tissues occurs, which is accompanied by severe pain and can be fatal.
Cardiologists note that in the male population, a heart attack will happen much more often, because in the female body estrogens control the level of cholesterol in the blood. If earlier the development of a heart attack was 55-60 years, now he is relatively younger. Cases of pathology are diagnosed even in young people.
A heart attack does not always end fatally for a person, but you need to know that after what happened, a scar always remains on the heart, so many patients become disabled after suffering such a disease.
How does a heart attack develop?
The formation of a heart attack begins long before its manifestation. It all starts with the formation of atherosclerotic plaques, which begin to form in the vessels from bad cholesterol. The culprits of its appearance in the blood are dietary errors and a sedentary lifestyle. These plaques gradually narrow the lumen of the vessels, disrupting normal blood circulation.
The process is gradually aggravated, the plaques become of such a size that any pathological effect on them leads to rupture. At this point, the blood coagulates, forming a blood clot, which clogs the vessel, preventing blood from passing further. This is exactly what happens in the region of the heart during a heart attack.
Reasons for the development of pathology
If a heart attack develops, the causes may be different, but the main one is the cessation of blood flow to some parts of the heart muscle. This is most often due to:
- Atherosclerosis, as a result of which the walls of blood vessels lose their elasticity, the lumen is narrowed by atherosclerotic plaques.
- which can occur against the background of stress, for example, or the impact of other external factors.
- Thrombosis of the arteries, if the plaque breaks off and is brought to the heart with blood flow.
Factors that can provoke such conditions include:
- Hereditary predisposition to heart disease.
- High levels of "bad" cholesterol in the blood.
- The presence of such a bad habit as smoking.
- Too much body weight.
- Arterial hypertension.
- Diabetes.
- A large amount of fatty foods in the diet.
- chronic stress.
- Some doctors also note the influence of psychosomatics, when excessive aggression and intolerance become the cause of a heart attack.
- Belonging to the stronger sex.
- Low physical activity.
- Age after 40 years.
It must be taken into account that if there is a combination of several factors, the risk of developing a heart attack increases.
Varieties of the disease
If we analyze such a pathology as a heart attack (what it is, we have already found out), then cardiologists distinguish several forms of pathology depending on several criteria.
If we consider the stages of the disease, then they are distinguished by four, each of which is characterized by its own characteristics. The size of the affected area is also taken into account in the classification. Allocate:
- Large-focal infarction, when tissue necrosis captures the entire thickness of the myocardium.
- Small-focal, a small part is affected.
By location, they distinguish:
- Right ventricular infarction.
- left ventricle.
- Interventricular septum.
- Side wall.
- back wall.
- Anterior wall of the stomach.
A heart attack can occur with or without complications, so cardiologists distinguish:
- Complicated heart attack.
- Uncomplicated.
Localization of pain can also be different, so the following types of heart attacks are distinguished:
- A typical form with pain behind the sternum.
- The atypical form may present with abdominal pain, shortness of breath, cardiac arrhythmias, dizziness, and headache. Sometimes a heart attack develops in the absence of pain.
Types of heart attacks are also distinguished depending on the multiplicity of development:
- primary pathology.
- recurrent
- Repeated.
Life after a heart attack will depend on the severity of the pathology, its form and timely assistance.
Stages of development of a heart attack
Necrotic changes in the heart muscle develop in a certain sequence, therefore, the following stages of a heart attack are distinguished:
- preinfarction state. The duration of this period is from several hours to several weeks, at which time small foci of necrosis are already formed in the heart muscle, and then a heart attack develops in their place.
- The acute period can last from several minutes to 2 hours. Increasing myocardial ischemia.
- The acute stage of a heart attack lasts for several days. During this period, a focus of necrosis is formed in the heart and partial resorption of damaged muscle tissue is observed.
- The postinfarction stage can last up to six months, the scar from the connective tissue is finally formed.
Diagnosis of myocardial infarction
Diagnosis begins with a conversation with the patient. The doctor finds out when the pains appeared, what character they have, how long they last, how the patient relieves heart attacks and whether there is a result from taking medications.
Then, risk factors are necessarily identified, for this the doctor clarifies the features of the lifestyle, culinary preferences, and the presence of bad habits. A family history is analyzed - the doctor finds out if someone in the family has heart disease, whether there have been cases of a heart attack.
- A general blood test is done, it allows you to detect an increased level of leukocytes, a high erythrocyte sedimentation rate, signs of anemia - all this begins to manifest itself when the heart muscle cells are destroyed.
- Urinalysis will help detect comorbidities that can provoke heart attacks.
- A biochemical blood test is performed to determine:
- cholesterol content;
- the ratio of "bad" and "good" cholesterol;
- the presence of triglycerides;
- blood sugar to assess the risk due to atherosclerosis of the vessels.
If there is a suspicion of a heart attack, then a study of specific blood enzymes is carried out.
A coagulogram is made, it gives indicators of blood clotting, which help to choose the right dosage of drugs for treatment.
Diagnosis of myocardial infarction is impossible without electrocardiography. Based on the results, a specialist can determine the localization of the pathology, the duration of development and the degree of damage.
An ultrasound examination of the heart is performed to study the structure and size of the heart muscle, to assess the degree of vascular damage by atherosclerotic plaques.
X-ray helps to identify changes in the thoracic aorta, lungs and detect complications.
Coronary angiography is used to clarify the diagnosis, it allows you to accurately determine the location and degree of vasoconstriction.
With contrasting, it allows you to get an accurate image of the heart, identify defects in its walls, valves, deviations in functioning and vasoconstriction.
After all the studies, you may need to consult a therapist.
Only after the diagnosis is clarified, the patient is prescribed an effective therapy that will help bring life after a heart attack back to normal.
Symptoms of pathology
As a rule, a heart attack does not develop from scratch, usually the patient has already been diagnosed with angina pectoris or other cardiac pathologies. If a heart attack develops, the symptoms, the first signs in women and men may be as follows:
- Pain behind the sternum becomes more intense and prolonged. The pain has a burning character, compression and squeezing is felt, it can give to the shoulder, arm or neck.
- There is irradiation and expansion of the pain zone.
- The patient cannot tolerate physical activity.
- Reception of "Nitroglycerin" does not already give such an effect.
- Even at rest, shortness of breath, weakness and dizziness appear.
- There may be discomfort in the abdomen.
- The heart rhythm is disturbed.
- Breathing becomes difficult.
- Cold sweat appears, the skin turns pale.
If at least some of the listed symptoms appear, then it is necessary to urgently call a doctor.
First aid to the sick
If there is a suspicion of a heart attack, the symptoms, the first signs in women, will only progress if you do not provide emergency care. It is as follows:
- The person must be seated or put in a comfortable position.
- Loosen tight clothing.
- Provide air access.
- Give a tablet of "Nitroglycerin" under the tongue, if the attack is strong, then two can be.
- If there is no Nitroglycerin, then you can use Corvalol or Aspirin.
Emergency care for a heart attack will help relieve pain during an attack and reduce the risk of complications.
Complications after a heart attack
It is very rare that a heart attack passes without complications, the consequences are almost always. It is they who reduce life expectancy after suffering a pathology. The following complications are most often diagnosed:
- Heart failure.
- Rupture of the heart muscle.
- Aneurysm.
- Cardiogenic shock.
- Violation of the rhythm of the heart.
- Postinfarction angina.
- Pericarditis.
A heart attack can also have later consequences, for example:
- After a few weeks, a post-infarction syndrome may develop.
- Thromboembolic complications are often noted.
- Neurotrophic disorders of the nervous system.
Many patients are interested in the question of how long can you live after a heart attack? The answer will depend on several factors: the degree of damage to the heart muscle, the timeliness of first aid, the effectiveness and correctness of therapy, the development of complications.
According to statistics, about 35% of patients die, most of them before they even reach the medical facility. Those patients who have suffered a heart attack are most often forced to change the scope of their activities or leave work altogether, many receive disability.
How to prevent a second heart attack or prevent its occurrence altogether
Everyone now understands about a heart attack, that this is a very serious disease that can be fatal or make you disabled. But everything is in the hands of the person himself - if you follow some recommendations, you can significantly reduce the risk of developing this pathology:
- Constantly keep under control the level of blood pressure, especially if there is a periodic increase.
- Monitor blood sugar levels.
- In summer, avoid being in direct sunlight for a long time.
- It is necessary to review your diet, reduce the consumption of fatty foods, processed foods and add fresh vegetables and fruits.
- Increase physical activity, it is not necessary to go to the gym, it is enough to take walks every day, walk a lot, ride a bike.
- If health is more expensive, then you will have to give up smoking and alcohol abuse, and also not get carried away with coffee.
- To keep your weight normal, if you yourself cannot reduce it, then you can visit a nutritionist who will help you create an individual nutrition program.
- In the presence of chronic diseases, it is necessary to treat them periodically, especially for cardiac pathologies, vascular diseases.
- If relatives have been diagnosed with myocardial infarction, then you should take your health more seriously, avoid hard physical labor.
- Every year you need to arrange a good rest for yourself away from the bustle of the city, you can go to the mountains or to the sea coast.
- Expose yourself to psycho-emotional stress as little as possible, learn relaxation techniques.
- Regularly undergo examinations and take all the necessary tests in order to detect elevated levels of sugar or cholesterol in the blood in a timely manner.
If a heart attack could not be avoided, then every effort must be made to prevent a second attack. To do this, you must follow all the recommendations of the doctor, take prescribed medicines and change your lifestyle.
For decades, aspirin (acetylsalicylic acid) has been used to prevent thrombosis and coronary disease, but long-term use of it can lead to problems in the gastrointestinal tract, such as heartburn, gastritis, nausea, stomach pain, etc.
To reduce the risk of such undesirable consequences, it is necessary to take funds in a special enteric coating. For example, you can use the drug "Trombo ACC®" *, each tablet of which is coated with an enteric film coating that is resistant to the effects of gastric hydrochloric acid and dissolves only in the intestine. This avoids direct contact with the gastric mucosa and reduces the risk of heartburn, ulcers, gastritis, bleeding, etc.
* There are contraindications, before use it is necessary to consult a specialist.
ECG - The first and main diagnostic method at the emergency stage is an electrocardiogram, which determines changes characteristic only for a heart attack, it can be used to establish the localization of the lesion, the period of the heart attack. A cardiogram is recommended for all the symptoms described above.
Method of coronary angiography- X-ray method of research, in which the coronary vascular system is contrasted through the probe, and blood flow through the vessels is observed under X-ray radiation. The method allows you to determine the patency of blood vessels and more accurately indicate the localization of the focus.
Method of computer coronary angiography- more often used in coronary disease in order to determine the degree of vasoconstriction, which shows the likelihood of developing a heart attack. This method, unlike X-ray coronary angiography, is more expensive, but also more accurate. It is less common due to the lack of equipment and specialists who own the technique.
Laboratory diagnostics- With myocardial infarction, characteristic changes in the composition of the blood and biochemical parameters occur, which are controlled throughout the treatment.
First aid and treatment of myocardial infarction
First aid for myocardial infarction
A person with a suspected heart attack must be laid down, the airways must be freed from squeezing clothing (tie, scarf). A core with experience may have nitroglycerin preparations with him, you need to put 1 tablet under his tongue, or inject if it is a spray (isoket). Nitroglycerin preparations should be given every 15 minutes until the doctors arrive. It’s good if aspirin is at hand, aspecard is drugs containing acetylsalicylic acid, they have an analgesic effect and prevent the formation of blood clots. In case of cardiac arrest and breathing, the patient needs to carry out artificial respiration and chest compressions until the doctors arrive.
Attention:
- Nitroglycerin preparations not only dilate the coronary vessels, they have the same effect on the vessels of the brain, if a person is in an upright position, a sharp outflow of blood is possible and a sudden short-term (orthostatic collapse), falling, the patient may be injured. Nitroglycerin should be given to the patient in the supine or sitting position. Orthostatic collapse goes away on its own, if you put a person down and raise his legs, after 1-2 minutes.
- If the patient has heavy noisy gurgling breathing, he should not be laid down, as this will aggravate the condition. Such a patient must be comfortably and securely seated.
First aid in an ambulance
Until arrival at the hospital, the patient continues to receive the necessary treatment in accordance with the leading symptoms:
- give oxygen;
- provide access to a vein;
- try to stop the pain syndrome with non-narcotic or narcotic analgesics (droperidol, morphine hydrochloride), depending on the degree of its severity, if there is no effect, they can use inhalation anesthesia with nitrous oxide (resuscitation vehicles are equipped with portable anesthesia machines), or administer sodium oxybutyrate intravenously, this the drug, in addition to the hypnotic and analgesic effect, protects organs from oxygen starvation;
- to prevent the formation of blood clots and resorption of existing ones, heparin is used;
- normalize blood pressure, with high blood pressure, lasix is administered, with low blood pressure, prednisone, hydrocortisone;
- for the prevention or relief of arrhythmias, intravenous lidocaine is administered in saline.
Hospital treatment
In the acute period, the treatment of a heart attack is based on the leading syndromes, the main task of the doctor is to stabilize the vital functions of the patient and limit the spread of the lesion. The maximum possible resumption of coronary circulation. Prevention of complications.
- Pain relief is a simultaneous prevention of cardiogenic shock.
- If the pain syndrome persists, after 30-40 minutes, droperidol with fetanyl is re-introduced. These drugs have a side effect - respiratory depression.
- Therefore, you can replace them with a mixture of analgin with Relanium or 0.5% novocaine; a mixture of analgin, dimedrol and promedol in 20 ml of saline. These mixtures may have vomiting as a side effect; for prophylaxis, a 0.1% solution of atropine is injected subcutaneously.
- In the absence of effect - anesthesia with nitrous oxide.
- In asthmatic variant with pulmonary edema
The patient needs to raise the upper body as much as possible. Three times with an interval of 2-3 minutes nitroglycerin (isoket) under the tongue. Effective inhalation of oxygen with alcohol. While waiting for the doctor, in the absence of oxygen, near the patient's face (without closing the airways!) You can keep a cloth richly moistened with alcohol or vodka. At elevated or normal blood pressure, lasix (furosemide) is injected intravenously in large doses. With hypotension, prednisolone is administered intravenously, rheopolyglucin is dripped
- With arrhythmias
Tachycardia (frequent pulse) is stopped by isoptin solution. In case of onset of atrial fibrillation and flutter - novocainamide, unitiol. If there is no effect, electrodefibrillation is used. Bradycardia (rare pulse) - atropine, isadrin 1 tablet under the tongue is administered intravenously. If there is no effect - Alupent IV and prednisolone.
- One of the causes of violations of the coronary circulation is their blockage by blood clots.
They are treated with medication using fibrolytic therapy based on streptokinase and its analogues. All types of bleeding are contraindications to such therapy. Therefore, against the background of this treatment, the patient's condition is strictly monitored and platelet levels and blood clotting time are monitored.
Surgery
After reaching a stable state, restoring a normal heart rhythm, and other vital signs, surgical treatment is performed according to indications in order to restore the patency of the coronary vessels. To date, the following interventions are being carried out:
- Stenting is the introduction of a metal frame (wall) into the narrowed areas of the coronary vessel. During this operation, the chest is not opened, the walls are inserted with a special probe into the required place through the femoral artery under the control of an X-ray machine.
- CABG - coronary artery bypass grafting. The operation is performed on an open heart, its essence lies in the fact that they create an additional possibility of blood supply to the affected focus by transplanting the patient's own veins, creating additional blood flow paths.
Indications for surgical treatment and the choice of the type of intervention depends on the results of coronary angiography:
- damage to two of the three arteries, or the degree of narrowing of more than 50%
- presence of post-infarction
Of great importance in the treatment of myocardial infarction is the patient's motor regimen. In the first period from 1 to 7 days, strict bed rest is recommended, in which, from the moment a stable state is reached, it is recommended to perform passive movements while lying in bed, and breathing exercises under the supervision of medical personnel. Further, as the condition improves, it is recommended to constantly expand motor activity by adding active movements daily (turns, sitting down in bed, independent eating, washing, etc.).
myocardial infarction- acute form of ischemic heart disease. Myocardial infarction occurs when blood stops flowing to one or another part of the heart muscle.
Already 15-20 minutes after the cessation of blood flow in the heart muscle, irreversible changes begin to develop. This is called myocardial infarction.
Why does blood stop flowing to one or another part of the myocardium? This happens when a blood clot (a blood clot formed as a result of blood eddies due to an atherosclerotic plaque) blocks the lumen of a coronary vessel.
That is why it is very important to treat atherosclerosis of the coronary arteries in a timely manner, since it is plaques and blood clots formed due to them that are the fundamental cause of myocardial infarction.
This is vital! If you are worried about any discomfort in the area of the heart, not to mention the pain, immediately make an appointment with our cardiologist. A timely visit and professional diagnostics can literally save your life.
Make an appointment
Myocardial infarction in women
Myocardial infarction in women occurs most often after 50 years, after menopause. Why? The thing is that during this period in the body of a woman, the production of specific female sex hormones - estrogens, which protect blood vessels from various harmful factors and prevent the formation of atherosclerotic plaques, is significantly reduced.
Myocardial infarction: symptoms
Symptoms of myocardial infarction depend on the rate of blockage, the diameter of the affected vessel, the degree of myocardial damage, and a number of other factors.
The main symptom of a myocardial infarction is acute chest pain, which usually occurs during intense physical exertion or emotional distress. The danger is that so many people do not associate this pain specifically with the heart, because it is felt a little lower, and, as a result, they think that this is a temporary harmless phenomenon that will pass by itself.
Pain in myocardial infarction has characteristic features that are important to know about:
- Pain is sharp, squeezing, squeezing, burning, suddenly occurs in the chest area on the left side of the body
- Lasts over 5 minutes
- Doesn't go away with nitroglycerin
- Growing, gives to the neck, left arm and jaw
In addition to the characteristic pain, myocardial infarction is manifested by other symptoms:
- Increased sweating, sweat is clammy and cold
- General weakness - you can hardly move
- The skin turns pale
- Dizziness
- Nausea and even vomiting (due to decreased pressure)
- Rarely, at the acute stage of a heart attack, symptoms of cardiogenic shock appear: the lips turn blue, the limbs turn white, the pulse is not palpable
Myocardial infarction: the depth of the lesion
According to the depth of damage to the heart muscle, there are:
- Large-focal, or extensive myocardial infarction
Acute disturbance of blood flow in large branches of the coronary arteries, which occurs as a result of thrombosis. - Small focal myocardial infarction
It develops as a result of thrombosis of small branches of the coronary arteries with a limited area of ischemic damage to the heart muscle.
How does myocardial infarction proceed?
The course of myocardial infarction includes 5 periods:
- prodromal period. Its duration varies from several hours to 30 days. The main feature is that there is a recurring pain syndrome and electrical instability of the myocardium, which is manifested by tachycardia.
- The most acute period ranges from 30 minutes to 2 hours, that is, from the appearance of a sharp myocardial ischemia to the formation of signs of the death of a section of the heart muscle. Most often - in 70-80% of cases - it manifests itself in the form of an anginal attack - a characteristic pain in the chest. The pain syndrome often provokes a feeling of fear, agitation, anxiety, as well as various autonomic disorders, among which increased sweating is usually found.
- acute period. A focus of necrosis is formed (a dying section of the heart muscle). There is a so-called resorption-necrotic syndrome, which is due to the general reaction of the body to the absorption of necrotic cells into the blood. This syndrome is accompanied by disorders in the work of the cardiovascular system. If myocardial infarction proceeds without complications, the acute period usually lasts about 7-10 days.
- Subacute period. In the subacute period of myocardial infarction, a scar is gradually formed at the site of necrosis. The duration of the subacute period varies widely and mainly depends on the volume of the focus of necrosis, the state of the surrounding myocardium, untouched by the necrotic process, the presence or absence of concomitant diseases and complications of myocardial infarction. Usually the duration of the subacute period ranges from 4 to 6 weeks.
- Postinfarction period. In the postinfarction period, the scar, thickening, is finally formed. In parallel, a number of compensatory mechanisms are launched that help the body adapt to a new state.
Myocardial infarction: atypical forms
The most acute period of myocardial infarction can acquire atypical forms, which it is important to know about in order not to be confused with other diseases and take the necessary measures in time:
- Asthmatic form
There is a lack of air and shortness of breath, often provoking panic, which in turn aggravates the situation as a whole. It is impossible to take a deep breath. During inhalation, gurgling occurs as excess fluid accumulates in the alveoli. - gastralgic form
Occurs rarely. It is manifested by pain in the abdomen, sometimes hiccups, belching, vomiting, and this is the main danger: it is difficult to diagnose a heart attack quickly with such pain even in the clinic, since the symptoms are similar to signs of acute appendicitis or poisoning. - Cerebrovascular form
They manifest as a stroke or in the form of a deep syncope, against which paresis, paralysis occur, brain failure and other pathological changes develop. - Arrhythmic form
The arrhythmic form is manifested by heart rhythm disturbances, but the main danger is that atrioventricular blockades are formed, as a result of which the heart rate decreases.
Note! Chest pain is the main symptom of myocardial infarction. But there are many that you may mistake for signs of other illnesses or simply ailments.
Be especially vigilant if you have already been diagnosed with coronary artery disease: at the first serious symptoms, immediately call an ambulance.
If you have even a slight discomfort in the region of the heart, do not engage in useless self-medication and do not turn a blind eye to this in the hope that it will pass. If there really are problems, they will not go away by themselves and will only get worse.
Trying to solve the problem yourself, you waste precious time and risk provoking a number of life-threatening complications. Only specialists can accurately diagnose the cause of discomfort or pain and provide professional treatment that will really help you.
Make an appointment with our cardiologist now.
Make an appointment
Causes of myocardial infarction
Myocardial infarction is still most common among the elderly, as well as those who lead an inactive lifestyle and are obese. Although this dangerous disease has been rapidly “getting younger” in our country in recent years: myocardial infarction occurs even in young men and women who are not yet 30.
It is important to note: a healthy lifestyle and sports are not a guarantee of 100% protection against myocardial infarction.
Here are the main risk factors that can lead to the development of myocardial infarction:
- high cholesterol
Cholesterol is the main reason for the formation of plaques on the walls of the arteries, due to which blood clots form, blocking the lumen of the vessels. - Hypertonic disease
Myocardial infarction is one of the main consequences of this pathology. - Diabetes
An elevated blood sugar level leads to a deterioration in blood circulation in small vessels, followed by the development of metabolic disorders in tissues, including the myocardium. - Bad habits
Please note that this is not only alcohol and smoking, but also drugs, as well as toxic drugs. - Low physical activity
Your muscles should contract. It is very important. If you don't like sports, try to walk at least 2 kilometers a day. - Frequent overeating
It is better to eat 3-4 times a day, but little by little, than 1-2 times, but tightly. - Serious emotional stress
Stress and anxiety have a detrimental effect on the tissues of the heart muscle.
Note: if you want to reduce the risk of developing myocardial infarction to a minimum, eliminate all harmful factors, go in for sports and do not be nervous over trifles.
Myocardial infarction: consequences
The consequences of myocardial infarction are early and late.
Early complications (within 10 days after a heart attack):
- Arrhythmias are the most common complication. The most dangerous are ventricular tachycardia (when the ventricles of the heart begin to respond to the rhythm) and ventricular fibrillation (when the walls of the ventricles randomly contract)
- Arterial hypertension, which occurs due to the greater need of the heart for oxygen and tension in the wall of the left ventricle, as a result of which the infarct zone increases and stretches
- Mechanical pathologies (for example, a ruptured interventricular septum or an aneurysm of the heart) - as a rule, form in the first week after a myocardial infarction and very often lead to death if surgery is not done in time
- Cardiac tamponade - when, getting into the pericardial cavity, the blood squeezes the heart
- Cardiogenic shock
- Cardiac conduction disorder
- Thrombosis of the arteries of the brain and limbs
- Aseptic pericarditis
Late complications (after 10 days from the date of myocardial infarction):
- The weakening of the contractility of the heart, proportional to the size of the heart attack (chronic heart failure) - occurs in a third of patients.
- Constantly recurring pain - even after the clot is dissolved or removed
- Dressler's syndrome - due to the formation of antibodies, a complex of symptoms occurs, including inflammation of the heart bag, pleura, as well as inflammatory processes in the lungs themselves
- Postinfarction angina
- Chronic protrusion (aneurysm) of the myocardium of the left ventricle
- Various cardiac arrhythmias that are usually progressive
As a rule, extensive and transmural infarcts lead to complications. And any of them can be fatal.
Diagnosis of myocardial infarction
Diagnosis of myocardial infarction includes:
- Clinical picture
- Laboratory research
- Instrumental diagnostics
Clinical picture
Often, an experienced doctor needs a general clinical picture to diagnose myocardial infarction. Acute chest pain, in which a person instinctively grabs his heart, inability to breathe, nausea, vomiting, cyanosis of the lips and fingertips, protruding sweat, inability to speak - these signs are enough to suspect a myocardial infarction and immediately begin to provide the necessary assistance.
Laboratory research
A blood test helps to identify damage to heart muscle cells and thereby confirm the diagnosis.
A particularly characteristic indicator of necrosis of the heart muscle is an elevated level of troponin. If a heart attack occurs, a troponin test will show this even earlier than an ECG.
Instrumental Methods
- Electrocardiography
In various periods of the disease, the ECG shows specific pathological changes characteristic of myocardial infarction, as well as various rhythm and conduction disturbances. - echocardiography
Ultrasound of the heart shows the affected areas of the myocardium, allows you to identify the expansion of the ventricles, see the aneurysm, assess the degree of impaired contractility and other indicators of the work of the heart. - Chest radiography
Helps diagnose pulmonary edema, pneumonia and other complications of myocardial infarction. - Coronary angiography
Helps to detect affected arteries. Appointed when it is necessary to understand whether an operation is needed.
Treatment of myocardial infarction
The main goal of treating myocardial infarction is to restore blood circulation in the affected area of the heart muscle as quickly as possible.
Note! Mortality from myocardial infarction is high. Studies have shown that mortality from myocardial infarction directly depends on its severity, the time of hospitalization and the start of treatment. However, if the necessary measures are taken in time, 70-80% of people can be saved.
Not without reason in cardiology there is the concept of "golden hour", which means the period of the beginning of treatment, in which the patient has the highest chance of staying alive.
Why is the time factor important?
The process of tissue death develops catastrophically fast. Irreversible changes in the heart muscle appear after 30-40 minutes, and after 3-6 hours all myocardial cells in the ischemic zone die.
Thus, the urgent diagnosis of a heart attack and the correct timely treatment is the main condition for maintaining the viability of the myocardium and saving the life of the patient.
Medical treatment
It is important not only to restore blood circulation in the affected coronary artery. There are a number of other tasks that are vital to solve in the medical treatment of myocardial infarction: limit the size of the infarction, reduce myocardial oxygen demand, relieve pain, restore normal heart rhythm, and generally maintain normal vital parameters throughout the entire treatment: blood pressure, respiration, pulse, kidney function.
Preparations for the treatment and rehabilitation of a person who has had a myocardial infarction are selected strictly individually and are used in various combinations depending on the complexity of each specific case.
Surgery
The most effective way to restore the patency of the coronary artery and blood flow to the affected area of the myocardium are surgical interventions - angioplasty of the coronary artery and coronary artery bypass grafting.
Angioplasty of the coronary artery
The doctor inserts a catheter with a small balloon at the end through the skin into an artery, monitoring its movement and position with an X-ray machine. When the narrowed section of the coronary artery is reached, the doctor inflates the balloon, expanding the vessel.
Loading...