How does a heart attack occur? Acute myocardial infarction – all about the pathology. Myocardial infarction: how to provide emergency care

Myocardial infarction is one of the forms, which is necrosis of the heart muscle caused by a sudden cessation of coronary blood flow due to damage to the coronary arteries.

Heart and vascular diseases continue to be the leading cause of death worldwide. Every year, millions of people experience one or another manifestation of coronary heart disease - the most common form of myocardial damage, which has many types, invariably leading to disruption of the usual way of life, loss of ability to work and claiming the lives of a large number of patients. One of the most common manifestations of IHD is myocardial infarction (MI), at the same time, it is the most common cause of death in such patients, and the developed countries- not an exception.

According to statistics, in the United States alone, about a million new cases of heart attack are registered per year, about a third of patients die, with about half of deaths occurring within the first hour after the development of necrosis in the myocardium. Increasingly, among the sick there are able-bodied people of young and mature age, with several times more men than women, although by the age of 70 this difference disappears. With age, the number of patients is steadily growing, and more and more women are appearing among them.

However, one cannot fail to note the positive trends associated with a gradual decrease in mortality due to the emergence of new diagnostic methods, modern methods treatment, as well as increased attention to those risk factors for developing the disease that we ourselves can prevent. Thus, the fight against smoking at the state level, promotion of the fundamentals healthy behavior and lifestyle, the development of sports, and the formation of responsibility among the population regarding their health significantly contribute to the prevention of acute forms of coronary artery disease, including myocardial infarction.

Causes and risk factors of myocardial infarction

Myocardial infarction is necrosis (death) of a section of the heart muscle due to the complete cessation of blood flow through the coronary arteries. The reasons for its development are well known and described. The result of various studies of the problem of coronary heart disease has been the identification of many risk factors, some of which do not depend on us, and others that everyone can eliminate from their lives.

As is known, hereditary predisposition plays an important role in the development of many diseases. Coronary heart disease is no exception. Thus, the presence among blood relatives of patients with coronary artery disease or other manifestations of atherosclerosis significantly increases the risk of myocardial infarction. , various metabolic disorders, for example, are also a very unfavorable background.

There are also so-called modifiable factors contributing to acute coronary heart disease. In other words, these are those conditions that can either be completely eliminated or their influence significantly reduced. Currently, thanks to a deep understanding of the mechanisms of disease development, the emergence modern methods early diagnosis, as well as the development of new medicines it has become possible to combat fat metabolism disorders, maintain normal values blood pressure and indicator.

Do not forget that avoiding smoking, alcohol abuse, stress, and also good physical form and maintaining adequate body weight significantly reduce the risk of cardiovascular pathology in general.

The causes of heart attack are conventionally divided into two groups:

1. Significant atherosclerotic changes in the coronary arteries;
2. Non-atherosclerotic changes in the coronary arteries of the heart.

Damage and inflammation of the endocardium is fraught with the occurrence of blood clots and thromboembolic syndrome, and pericarditis over time will lead to the growth of connective tissue in the cavity of the cardiac sac. In this case, the pericardial cavity overgrows and the so-called “armored heart” is formed, and this process underlies the subsequent formation due to the limitation of its normal mobility.

With timely and adequate medical care most of Patients who survive acute myocardial infarction are left to live, and a dense scar develops in their heart. However, no one is immune from repeated episodes of circulatory arrest in the arteries, even those patients in whom the patency of the heart vessels was surgically restored (). In cases where, with an already formed scar, a new focus of necrosis occurs, they speak of a recurrent myocardial infarction.

As a rule, the second heart attack becomes fatal, but the exact number of them that the patient can endure has not been determined. In rare cases, there are three episodes of necrosis in the heart.

Sometimes you can find the so-called recurrent infarction, which occurs during the period of time when scar tissue forms in the heart at the site of an acute injury. Since, as mentioned above, it takes an average of 6-8 weeks for a scar to “ripen,” it is during this period that a relapse can occur. This type of heart attack is very unfavorable and dangerous for the development of various fatal complications.

Sometimes an occurrence occurs, the causes of which will be thromboembolic syndrome with extensive transmural necrosis involving the endocardium in the process. That is, blood clots formed in the cavity of the left ventricle when the inner lining of the heart is damaged, enter the aorta and its branches that carry blood to the brain. When the lumen is blocked cerebral vessels and brain death (infarction) occurs. In such cases, these necrosis is not called a stroke, since they are a complication and consequence of myocardial infarction.

Types of myocardial infarction

To date, there is no single generally accepted classification of heart attack. In the clinic, based on the amount of assistance needed, the prognosis of the disease and the characteristics of the course, the following types are distinguished:

• Large-focal myocardial infarction – can be transmural or non-transmural;
• Finely focal– intramural (in the thickness of the myocardium), subendocardial (under the endocardium), subepicardial (in the area of ​​the heart muscle under the epicardium);
• Myocardial infarction of the left ventricle (anterior, apical, lateral, septal, etc.);
• Right ventricular infarction;
• Atrial myocardial infarction;
• Complicated and uncomplicated;
• Typical and atypical;
• Protracted, recurrent, repeated infarction.

In addition, they highlight flow periods myocardial infarction:

1. Acute;
2. Spicy;
3. Subacute;
4. Post-infarction.

Manifestations of heart attack

The symptoms of myocardial infarction are quite characteristic and, as a rule, allow one to suspect it with a high degree of probability even in pre-infarction period development of the disease. So, patients experience longer and more intense chest pain, which are less responsive to treatment with nitroglycerin, and sometimes do not go away at all. IN You may experience shortness of breath, sweating, and even nausea. At the same time, patients are increasingly suffering from even minor physical exercise.

At the same time, characteristic electrocardiographic signs disturbances in blood supply to the myocardium, and constant observation for a day or more is especially effective for their detection ().

The most characteristic signs of a heart attack appear in the most acute period when a zone of necrosis appears and expands in the heart. This period lasts from half an hour to two hours, and sometimes longer. There are factors that provoke the development of an acute period in predisposed individuals with atherosclerotic lesions of the coronary arteries:

• Excessive physical activity;
• Severe stress;
• Operations, injuries;
• Hypothermia or overheating.

The main clinical manifestation of necrosis in the heart is pain, which is very intense. Patients can characterize it as burning, squeezing, pressing, “dagger-like.” The pain has a retrosternal localization, can be felt to the right and left of the sternum, and sometimes covers the anterior part chest. Characteristic is the spread (irradiation) of pain to the left arm, shoulder blade, neck, lower jaw.

In most patients, the pain syndrome is very pronounced, which also causes certain emotional manifestations: a feeling of fear of dying, severe anxiety or apathy, and sometimes excitement is accompanied by hallucinations.

Unlike other types of coronary artery disease, a painful attack during a heart attack lasts at least 20-30 minutes, and the analgesic effect of nitroglycerin is absent.

Under favorable circumstances, at the site of the necrosis focus, so-called granulation tissue begins to form, rich in blood vessels and fibroblast cells that form collagen fibers. This period of the infarction is called subacute, and it lasts up to 8 weeks. As a rule, it proceeds well, the condition begins to stabilize, the pain weakens and disappears, and the patient gradually gets used to the fact that he has suffered such a dangerous phenomenon.

Subsequently, a dense connective tissue scar forms in the heart muscle at the site of necrosis, the heart adapts to new working conditions, and post-infarction marks the offensive next period course of the disease, which continues for the rest of life after a heart attack. Those who have had a heart attack feel well, but there is a resumption of pain in the heart and attacks.

As long as the heart is able to compensate for its activity by hypertrophy (enlargement) of the remaining healthy cardiomyocytes, there are no signs of heart failure. Over time, the adaptive capabilities of the myocardium are depleted and heart failure develops.

projections of pain during myocardial infarction

It happens that the diagnosis of myocardial infarction is significantly complicated by its unusual course. This characterizes its atypical forms:

1. Abdominal (gastralgic) – characterized by pain in the epigastrium and even throughout the entire abdomen, nausea, vomiting. Sometimes it may be accompanied by gastrointestinal bleeding associated with the development of acute erosions and ulcers. This form of heart attack must be distinguished from peptic ulcer stomach and duodenum, cholecystitis, pancreatitis;
2. Asthmatic form - occurs with attacks of suffocation, cold sweat;
3. The edematous form is characteristic of massive necrosis with total heart failure, accompanied by edematous syndrome and shortness of breath;
4. Arrhythmic form, in which rhythm disturbances become the main clinical manifestation of MI;
5. Cerebral form - accompanied by symptoms of cerebral ischemia and is typical for patients with severe atherosclerosis of the vessels supplying blood to the brain;
6. Erased and asymptomatic forms;
7. Peripheral form with atypical localization of pain (mandibular, left-handed, etc.).

Video: non-standard signs of a heart attack

Diagnosis of myocardial infarction

Usually the diagnosis of a heart attack does not cause significant difficulties. First of all, it is necessary to carefully clarify the patient’s complaints, ask him about the nature of the pain, clarify the circumstances of the attack and the presence of the effect of nitroglycerin.

Upon examination the patient is noticeably pallor skin, signs of sweating, possible cyanosis (cyanosis).

A lot of information will be provided by such objective research methods as palpation(palpation) and auscultation(listening). So, at can be identified:

• Pulsation in the area of ​​the cardiac apex, precordial zone;
• Increased heart rate to 90 - 100 beats per minute;

On auscultation hearts will be characteristic:

1. Muting the first tone;
2. Low systolic murmur at the apex of the heart;
3. A gallop rhythm is possible (the appearance of a third tone due to left ventricular dysfunction);
4. Sometimes a fourth sound is heard, which is associated with stretching of the muscle of the affected ventricle or with a disturbance in the conduction of impulses from the atria;
5. Systolic “cat purring” is possible due to the return of blood from the left ventricle to the atrium due to pathology of the papillary muscles or stretching of the ventricular cavity.

The overwhelming majority of people suffering from a large-focal form of myocardial infarction have a tendency to lower blood pressure, which, under favorable conditions, can normalize in the next 2-3 weeks.

A characteristic symptom of necrosis in the heart is also an increase in body temperature. As a rule, its values ​​​​do not exceed 38 ºС, and the fever lasts about a week. It is noteworthy that in younger patients and in patients with extensive myocardial infarction, the increase in body temperature is longer and more significant than in small foci of infarction and in elderly patients.

In addition to physical ones, of no small importance are laboratory methods diagnosis of MI. So, the following changes are possible in the blood test:

• An increase in the level of leukocytes () is associated with the appearance of reactive inflammation in the focus of myocardial necrosis, persists for about a week;
• – associated with an increase in the concentration in the blood of proteins such as fibrinogen, immunoglobulins, etc.; the maximum occurs 8-12 days from the onset of the disease, and ESR numbers return to normal after 3-4 weeks;
• The appearance of so-called “biochemical signs of inflammation” - an increase in the concentration of fibrinogen, seromucoid, etc.;
• The appearance of biochemical markers of necrosis (death) of cardiomyocytes - cellular components that enter the bloodstream when they are destroyed (troponins, etc.).

It is difficult to overestimate the importance of (ECG) in the diagnosis of myocardial infarction. Perhaps this method remains one of the most important. An ECG is accessible, easy to perform, can be recorded even at home, and at the same time provides a large amount of information: indicates the location, depth, extent of the infarction, and the presence of complications (for example, arrhythmia). With the development of ischemia, it is advisable to record an ECG repeatedly with comparison and dynamic monitoring.

table: particular forms of heart attack on ECG

ECG signs acute phase necrosis in the heart:

1. the presence of a pathological Q wave, which is the main sign of muscle tissue necrosis;
2. decrease in the size of the R wave due to a fall contractile function ventricles and conduction of impulses along nerve fibers;
3. dome-shaped shift of the ST interval upward from the isoline due to the spread of the infarction from the subendocardial zone to the subepicardial zone (transmural lesion);
4. formation of the T wave.

Based on typical changes in the cardiogram, one can determine the stage of development of necrosis in the heart and accurately determine its location. Of course, you can independently decipher the cardiogram data without having medical education, it is unlikely to succeed, but ambulance doctors, cardiologists and therapists can easily establish not only the presence of a heart attack, but also other disorders of the heart muscle and.

In addition to the listed methods, for the diagnosis of myocardial infarction are used (allows you to determine the local contractility of the heart muscle), , magnetic resonance and (helps to assess the size of the heart, its cavities, and identify intracardiac blood clots).

Video: lecture on the diagnosis and classification of heart attacks

Complications of myocardial infarction

Myocardial infarction both in itself poses a threat to life and through its complications. The majority of those who have undergone it remain with certain disturbances in the activity of the heart, associated primarily with changes in conduction and rhythm. Thus, in the first day after the onset of the disease, up to 95% of patients experience arrhythmias. Severe arrhythmias during massive infarctions can quickly lead to heart failure. The possibility of thromboembolic syndrome also causes many problems for both doctors and their patients. Timely assistance in these situations will help the patient prevent them.

The most common and dangerous complications of myocardial infarction:

• Heart rhythm disturbances (tachycardia, etc.);
• Acute heart failure (with massive heart attacks, atrioventricular blockades) – the development of acute left ventricular failure with symptoms of alveolar pulmonary edema, which threatens the patient’s life, is possible;
• – extreme degree of heart failure with a sharp drop in blood pressure and impaired blood supply to all organs and tissues, including vital ones;
• Heart ruptures are a severe and fatal complication, accompanied by the release of blood into the pericardial cavity and an abrupt cessation of cardiac activity and hemodynamics;
• (protrusion of a section of the myocardium in the focus of necrosis);
• Pericarditis is inflammation of the outer layer of the heart wall during transmural, subepicardial infarctions, accompanied by constant pain in the region of the heart;
• Thromboembolic syndrome - in the presence of a blood clot in the infarction zone, in the left ventricular aneurysm, with prolonged bed rest, .

Most life-threatening complications occur in the early post-infarction period, so careful and constant monitoring of the patient in a hospital setting is very important. The consequences of an extensive cardiac infarction include large-focal post-infarction cardiosclerosis (a massive scar that has replaced an area of ​​dead myocardium) and various arrhythmias.

Over time, when the heart's ability to maintain adequate blood flow to organs and tissues is depleted, congestive (chronic) heart failure. Such patients will suffer from edema, complain of weakness, shortness of breath, pain and interruptions in the functioning of the heart. Increasing chronic failure blood circulation is accompanied by irreversible dysfunction internal organs, accumulation of fluid in the abdominal, pleural and pericardial cavities. Such decompensation of cardiac activity will ultimately lead to the death of patients.

Principles of treatment of myocardial infarction

Emergency care for patients with myocardial infarction should be provided as soon as possible from the moment of its development, since delay can lead to the development of irreversible hemodynamic changes and sudden death. It is important to have someone nearby who can, at least, call an ambulance. If you are lucky and there is a doctor nearby, his qualified participation can help avoid serious complications.

The principles of helping patients with a heart attack come down to the step-by-step provision of therapeutic measures:

1. Pre-hospital stage – involves transporting the patient and providing necessary measures ambulance team;
2. At the hospital stage, the maintenance of basic body functions, prevention and control of blood clots, cardiac arrhythmias and other complications in hospital intensive care units continue;
3. Stage rehabilitation activities– in specialized sanatoriums for cardiac patients;
4. Stage dispensary observation and outpatient treatment - carried out in clinics and cardiac centers.

First aid can be provided under time pressure and outside the hospital. It’s good if it is possible to call a specialized cardiac ambulance team, which is equipped with what is necessary for such patients - medications, a pacemaker, and equipment for resuscitation. Otherwise, it is necessary to call a line ambulance team. Now almost all of them have portable devices ECG, which allows you to quickly place a fairly accurate diagnosis and start treatment.

The basic principles of care before arriving at the hospital are adequate pain relief and prevention of thrombosis. In this case the following is used:

• under the tongue;
• Administration of analgesics (promedol, morphine);
• Aspirin or heparin;
• Antiarrhythmic drugs if necessary.

Video: first aid for myocardial infarction

At the stage inpatient treatment measures to maintain the function of the cardiovascular system continue. Elimination of pain is the most important of them. As analgesics narcotic analgesics (morphine, promedol, omnopon) are used; if necessary (severe agitation, fear), tranquilizers (relanium) are also prescribed.

For questions this section V this moment answers: Sazykina Oksana Yurievna, cardiologist, therapist

You can thank a specialist for their help or support the VesselInfo project at any time.

a brief description of Problems

Every person has heard the word “myocardium” at least once in his life, but only a few know what it is. The myocardium is the heart muscle that constantly receives blood. This muscle ensures the spread of impulses between different parts of the heart and, as a result, it is vital for maintaining the normal functioning of the organ. If for some reason there is a blockage of the artery supplying blood to the myocardium, such an important part of the heart remains without oxygen. In “autonomous mode” the muscle lives no more than 20-30 minutes, after which myocardial infarction occurs - irreversible death of muscle tissue and its subsequent scarring. In the absence of help, this process leads to the death of a person, since the “road” along which cardiac impulses spread from section to section is destroyed.

In recent years, myocardial infarction is rapidly becoming younger. If previously the disease mainly affected older people, today the destruction of the cardiovascular system is increasingly observed in young people under 30 years of age. This means that when diagnosed with myocardial infarction, treatment may be required for any of us, regardless of age and place of residence. Of course, there are also provoking factors that can speed up the process of a heart attack. We will talk about them in the next section of our article.

Why does myocardial infarction occur?

The main cause of the disease is vascular atherosclerosis, which is present to one degree or another in every person. At first, the narrowing of blood vessels does not cause any particular inconvenience to the patient, but over time this process becomes pathological. In addition to atherosclerosis, tissue death can be caused by other reasons:

• age – acute myocardial infarction is most often observed in people over 50 years of age;
• gender of the person – men get sick more often than women;
• hereditary factors - the risk of having a heart attack is higher if one of your family members has had it;
• high cholesterol, unhealthy diet;
• smoking is one of the main reasons why myocardial infarction occurs (symptoms of tissue death are observed in 9 out of 10 smokers);
• sedentary lifestyle;
• diabetes.

Each of the above reasons significantly increases the risk of “acquaintance” with a fatal dangerous disease, and together they make this “meeting” inevitable. Remember this when you light another cigarette or eat an absolutely useless hamburger while sitting in front of your favorite TV.

What happens during myocardial infarction?

Throughout life, fatty deposits accumulate on the walls of our blood vessels. For some people this process happens slowly, for others it happens much faster. Upon reaching a critical mass, fats form a so-called atherosclerotic plaque. The walls of this formation can burst at any time, which is the first sign of an approaching heart attack. A blood clot immediately appears at the site of the crack. It quickly grows in size and eventually forms a blood clot, which can completely block the internal space of the vessel. As a result, blood flow through the artery stops, and the person develops myocardial infarction (first aid during an attack involves administering to the patient vasodilators to restore normal blood supply). We also note that the larger the blocked vessel, the faster the process of cell death occurs, because a large artery supplies oxygen to large areas of the myocardium.

Myocardial infarction - symptoms and clinical picture of the disease

The main sign to suspect life-threatening conditions is pain in the chest area. It does not go away even at rest and often spreads to neighboring parts of the body - shoulder, back, neck, arm or jaw. Painful sensations, unlike angina pectoris, can occur for no reason. Moreover, they are very strong and do not disappear after taking nitroglycerin. If you feel similar symptoms, then call an ambulance immediately. The sooner help is provided after a myocardial infarction, the higher the chance of avoiding serious complications and continuing a normal, fulfilling life.

Let's note other symptoms of the disease:

• labored breathing;
• nausea, vomiting;
• discomfort in the stomach;
• interruptions in the heart;
• loss of consciousness

It should be noted that a person can suffer a myocardial infarction and not even understand what happened to him. This situation is typical for the painless form of the disease, which is most often observed in patients suffering from diabetes mellitus.

Myocardial infarction - treatment and rehabilitation

To provide qualified medical care, the patient is hospitalized in the intensive care unit of the clinic. This is quite normal practice. If a patient is diagnosed with myocardial infarction, first aid should be provided in the first hours after the attack. The main task of doctors is to dissolve the “fresh” blood clot, dilate the blood vessels and restore natural blood supply. To prevent the formation of new blood clots, the patient is given medications that slow down blood clotting. As a rule, regular aspirin is used for such purposes. By using it immediately after a myocardial infarction, doctors can reduce the number of complications and serious consequences.

Very often, myocardial infarction is treated with beta blockers - drugs that reduce the tissue need for oxygen. Economical functioning of the heart is very important during an attack, and therefore researchers are constantly working to find new technologies that would solve the problem of oxygen supply without threatening the patient’s life. Some of these developments, such as the invasive method or balloon angioplasty, are indeed very promising.

What needs to be done if a person has experienced a myocardial infarction. Rehabilitation in this case is no less important than the treatment itself, because even the smallest loads are dangerous for a damaged heart. Previously, a patient who suffered an acute myocardial infarction did not get out of bed for at least several weeks. Modern technologies Treatments can significantly reduce this period, but in any case, a person needs to adapt to a new life. The ideal option is to go on vacation to some well-known sanatorium, and upon return, consult a doctor who will prescribe therapeutic exercises, will pick up necessary medications and will give other recommendations relevant during the rehabilitation period.

What is a heart attack?

Heart attack. Definition, causes, development.

A heart attack means the death of tissue in a living organism. This means that during a heart attack in a living organism, a section of living tissue dies, and the body itself loses a certain area of ​​tissue that performs a specific function. Thus, during a heart attack, the body loses not only a section of tissue (organ), but also the function performed by them. The term heart attack includes many diseases in which there is death of living tissue in the body. In this article we will describe different kinds heart attacks, but let us dwell in more detail on the problem of myocardial infarction - necrosis (necrosis) of a section of the heart muscle.

What does the survival of our body tissues depend on?

The tissues of our body maintain a constant metabolism that ensures their vital functions. To live and work, body tissues need nutrients and oxygen. Stopping the supply of nutrients and oxygen to tissues, even during a short time, leads to a gross disruption of the metabolic process, cell destruction and tissue necrosis (formation of a heart attack). The sensitivity of organs (tissues) to a lack of oxygen and nutrients is higher, the higher the functional activity of the tissues, that is, the harder the organ works, the more painfully it reacts to the lack of oxygen and nutrients. These “hard working” and “sensitive” organs include the brain, heart muscle, kidneys, and liver.

In our body, oxygen and nutrients are carried through the bloodstream, which means that stopping the blood flow can lead to an acute lack of oxygen and nutrients. In case of heart attack various localizations there is a local disturbance of blood circulation, that is, a certain blood vessel fails. This happens when a vessel is blocked by a thrombus or a migrated embolus (broken thrombus), when a vessel ruptures, or when the vessel is suddenly compressed. The most common cause of heart attack is thrombosis and embolism of arterial vessels.

What is a heart attack?

As has already become clear, a heart attack is characterized by the necrosis of living tissues of the body, which occurs due to abrupt end blood flow and, therefore, supplying organs with oxygen and nutrients.

For most people, the word "heart attack" means "infarction of the heart muscle." myocardium”, that is, a heart disease in which there is necrosis of a section of the heart muscle. However, a heart attack can occur in any organ:

• Cerebral infarction(stroke) death of a section of brain tissue due to thrombosis or rupture of one of the brain vessels.
• Pulmonary infarction– necrosis of lung tissue due to blockage of one of the branches of the pulmonary artery.
• Occurs less frequently renal infarction. splenic infarction. intestinal infarction .

Causes of heart attack

The root cause of a heart attack is always a violation of blood flow through a vessel supplying a certain area of ​​an organ. Such a violation of blood flow, as we said above, can occur due to thrombosis or embolism (blockage) of a vessel, when the vessel ruptures and when it is sharply compressed. An important role in the development of infarction of various organs is played by diseases of the blood vessels themselves: atherosclerosis (disease of the artery walls) and thrombosis of large veins (formation of migrating blood clots).

What happens during a heart attack?

During a heart attack, a section of tissue of a certain organ becomes dead, the dead tissue loses all the properties characteristic of its life activity: metabolism, performance of a certain function. Loss of function of an area of ​​tissue can negatively affect the functioning of the entire organ. The severity of organ dysfunction depends on the extent of the infarction zone (extensive infarction, microinfarction) and on the functional significance of the organ (organ section). An extensive heart attack can cause acute heart failure, while a cerebral infarction can cause irreversible loss of a certain function (speech, movement, sensitivity). Small heart attack

What happens after a heart attack?

A heart attack (of the brain, heart, lungs) is extremely severe and dangerous condition With high risk lethal outcome. If a person manages to survive after a heart attack, then restoration processes occur in the area of ​​the heart attack, during which the resulting tissue defect is replaced connective tissue. Such replacement corrects only the anatomical defect, but not the functional one. Connective tissue in our body plays the role of a certain filler, but it is not able to work, since the heart muscle, brain or other complex organs work.

Myocardial infarction

Myocardial infarction is the death (necrosis) of a section of the heart muscle. A heart attack occurs mainly due to disruption of blood flow through one of the branches of the coronary arteries (coronary arteries of the heart). The main reason leading to blockage (thrombosis) of the coronary arteries is atherosclerosis, a disease that affects the large arterial vessels of our body.

Myocardial infarction can be localized in various parts of the heart muscle, but most often the heart attack affects the left side of the heart, which experiences the greatest load. Distinguish

• Anterior infarction – damage to the anterior wall of the left ventricle of the heart;
• Posterior infarction – damage to the posterior wall of the left ventricle of the heart;
• Basal (lower) infarction - damage to the lower wall of the left ventricle of the heart;
• Septal infarction – damage to the interventricular septum;

• Subepicardial infarction - infarction of the outer surface of the heart (epicardium - the membrane covering the outside of the heart);
• Subendocardial infarction - infarction of the inner surface of the heart (endocardium - the membrane covering the heart from the inside);
• Intramural infarction - localized in the thickness of the walls of the heart muscle;
• Transmural infarction - involves the entire thickness of the heart muscle.

Myocardial infarction - what causes it, how to treat it, how to prevent it

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From a heart attack or heart rupture, as they said in the old days, 12% of people die from total number There are more deaths than from infectious diseases, cancer and car accidents. Every year the terrible figure is growing. What causes the epidemic of heart attacks in modern society?

The duration of human life in the XX_XXI centuries is increasing at a fantastic speed. In 1900 in the USA, an American could count on an average of 47 years of life, in 2010 - 75. The planet's population is rapidly aging, advances in medicine and hygiene are reducing morbidity and mortality from dangerous infections- as a result, a person is burdened with diseases that he simply did not live to see before. However, we should not discount other facts - the obesity epidemic, recognized by WHO in 2011, pollution environment, sedentary lifestyle of inhabitants of megacities and endless stress. The human heart is simply not designed for such loads - so it can’t stand it.

Heart disease

Myocardial infarction is a consequence of coronary heart disease. The arteries that deliver oxygen to the heart become narrowed, covered from the inside with sclerotic plaques, or compressed due to a sharp spasm. The blood coagulates, one of the vessels becomes clogged with a thrombus. The heart muscle stops getting enough oxygen, one or more areas are “cut off” from the blood supply. The heartbeat changes dramatically, hormones are released into the blood, and the body tries to correct the situation on its own. Sometimes this is successful - a person does not even notice that he has had a heart attack, puts a nitroglycerin tablet under his tongue and goes about his business, and cicatricial changes in the muscle are discovered by chance when medical examination. But, as a rule, the situation deteriorates very quickly. There is severe pain behind the sternum, radiating to the left arm, breathing problems, a feeling of panic, the patient may die from painful shock. The area of ​​the muscle affected by the infarction quickly dies. Cardiologists know about the “golden hour” rule - if a blood clot is eliminated within 90 minutes after a heart attack and blood supply to the heart is restored, then complete healing is possible and the muscle will return to life. If the blood clot is not removed, tissue necrosis, heart failure occurs, and serious complications appear - pulmonary edema, heart rhythm disturbances, inflammation of the pericardium (heart sac), repeated heart attacks and even heart rupture. 70% of deaths occur in the first few days after a heart attack.

If the body manages to cope with the disease, the dead areas of muscle are gradually replaced by scar tissue over several months, and after six months the patient can be considered conditionally recovered. But his heart becomes less elastic, less adapted to stress, and the risk of repeated heart attacks, angina attacks, arrhythmias and other cardiovascular diseases increases.

Warning signs

The risk group for heart attack is quite wide. The main “heart attack” age is from 40 to 60 years, but with severe stress and concomitant diseases, heart attacks occur in younger people and even children. Before menopause, women suffer a heart attack half as often as men - estrogen hormones protect blood vessels, after menopause the statistics level out. Diabetes, hypertension, atherosclerosis, lupus erythematosus, preeclampsia in pregnant women, cardiac muscle hypertrophy, inflammatory diseases heart and blood vessels increase the likelihood of disease. Bad habits also contribute to heart attacks - alcohol abuse, smoking (including passive smoking), severe obesity, a sedentary lifestyle, short temper and aggressiveness (a boss who yells at his subordinates has every chance of going to the hospital right from his office). If relatives in the ascending line have suffered heart attacks or strokes, this also increases the risk.

Symptoms of the disease, unfortunately, are not always obvious. In half of the cases, this is severe pressing pain in the chest, radiating to the neck, back, shoulder blade and arm. The person turns pale, becomes covered in sticky sweat, and becomes very scared. Interruptions in the functioning of the heart occur; nitroglycerin and other ordinary remedies do not make it easier. But an insidious heart attack can masquerade as other diseases.

The abdominal form is “pretending” acute pancreatitis, appendicitis or stomach ulcer. Severe pain occurs in the abdomen (strictly above the navel), vomiting, hiccups, and gas appears. Attention - no-spa and analogues do not help, vomiting does not bring relief!

The asthmatic form looks like an attack of bronchial asthma - the leading symptom is increasing respiratory distress and lack of oxygen. Attention - inhalers do not help!

The cerebral form shows increasing signs of impairment cerebral circulation and an impending stroke. Attention - tomography shows that everything is fine with the brain!

The atypical form redirects the pain syndrome to a completely atypical place, masking the heart attack as cervical osteochondrosis, pinched nerves and even... toothache. Attention - non-narcotic painkillers do not help!

A silent heart attack occurs in patients with diabetes or against the background of severe stress with the strain of all forces - a person can finish playing on stage, land a plane, complete an operation, etc. go out and die.

The diagnosis of a heart attack is made using an electrocardiogram and a blood test, which reveals changes in the level of certain enzymes and the appearance of cardiomyocytes - cells that signal damage to the heart muscle.

If you suspect a heart attack, you should call urgently. Ambulance" - how rather a patient goes to the hospital, the higher the chance of recovery. Before the doctor arrives, the person needs to be seated or laid down comfortably, his collar, belt, bra, etc. should be unbuttoned. provide access to fresh air, give a nitroglycerin tablet under the tongue and 40 drops of Corvalol or analogues to relieve panic and reduce pain. If signs of cardiac arrest appear, cardiopulmonary resuscitation should be started and carried out until the doctor arrives.

Tube in the heart

Heart attack requires complex treatment, restoring the function of the heart muscle and preventing secondary complications and disability of the patient.

All patients are prescribed “fast” aspirin in a loading dose to combat blood clots. In the initial period (up to 6 hours after a heart attack), emergency thrombolytic therapy is possible, dissolving blood clots and restoring blood supply to the heart muscle, but in some concomitant diseases it is contraindicated.

To eliminate the cause of the disease and restore blood circulation, special procedures are used - angioplasty and stenting of coronary vessels. Through femoral artery A special catheter with a balloon or a rolled mesh at the end is inserted into the vessel, it is brought to the affected area of ​​the cardiac artery and the balloon or mesh is straightened. The balloon destroys the sclerotic plaque and clears the lumen of the vessel, the mesh strengthens its walls, eliminating the problem.

If this is not enough or catheterization is difficult, coronary artery bypass surgery is performed - using a piece of a vessel taken from the patient’s arm or leg, the surgeon constructs a bypass path for blood flow, bypassing the narrowed and damaged section of the vessel.

The latest word in medicine is stem cell therapy for heart attack. The patient's own stem cells, either donor or taken from cord blood. Within 6-12 months, according to researchers, this allows you to restore the heart muscle and avoid complications associated with impaired heart function. But the method has not yet been introduced into widespread practice and its use is a risk for the patient.

If the treatment went well and the patient was discharged home, this does not mean that he has recovered. The process of muscle scarring takes about 6 months, during which time late complications may develop. During the rehabilitation period, heavy physical activity is prohibited, emotional stress, intense sex and sports, alcohol, nicotine and overeating. It is important to consult a doctor to develop an individual complex gymnastic exercises, walk often, get positive impressions. It makes sense to do yoga, study psychological techniques relaxation, meditative or prayer practices - for people who have had a heart attack, it is very important to be able to calm down and not worry about trifles. And there will be no trace of heartache.

Heart disease ranks among the leading causes of death. Myocardial infarction is the most dangerous in this group: it often occurs and develops suddenly, and in almost 20% of cases leads to rapid death. The first hour after an attack is especially critical - death occurs with almost one hundred percent probability if a person does not receive first aid.

But even if a person survives an attack, he is in danger for at least a week, when his risk of death is many times higher. Any minor stress - physical or emotional - can become a trigger. Therefore, it is important to recognize this disease in time and provide the patient with quality treatment and rehabilitation.

In fact, this process is a complication of coronary heart disease. It occurs against the background of existing cardiac pathologies and almost never occurs in people with a healthy heart.

Acute myocardial infarction develops when the lumen of an artery is blocked by a blood clot or cholesterol plaque. The heart muscle does not receive enough blood, resulting in tissue necrosis.

The heart pumps oxygenated blood and transports it to other organs. At the same time, it itself needs a large amount of oxygen. And with its deficiency, heart muscle cells stop functioning. As in the case of oxygen starvation of the brain, in this situation a few minutes are enough for irreversible changes and tissue death to begin.

Human organism - a complex system, which is configured to survive in any conditions. Therefore, in the heart muscle there is own stock substances necessary for normal functioning, primarily glucose and ATP. When blood access to it is limited, this resource is activated. But, alas, its supply is only enough for 20-30 minutes. If resuscitation measures are not taken during this period and the blood supply to the heart muscle is not restored, the cells will begin to die.

Types of heart attack

One name hides several variants of the course of the disease. Depending on the location, the speed of the flow and a number of other factors, the patient’s condition and the ability to save him depend.

There are several classifications of myocardial infarction:

• By location - right ventricular and left ventricular. The latter is divided into several subtypes: infarction of the interventricular wall, anterior, posterior and lateral walls.
• According to the depth of muscle damage - external, internal, damage to the entire wall or part of it.
• Depending on the scale of the affected area - small-focal and large-focal.

Depending on the set of symptoms, it happens:

• Cerebral form, which is accompanied by neurological disorders, dizziness, confusion;
• Abdominal – has symptoms of acute inflammation of the digestive organs – abdominal pain, nausea, vomiting. Out of ignorance, it can easily be confused with acute pancreatitis;
• Asymptomatic – when the patient does not feel particularly pronounced manifestations of the disease. This form is often found in diabetics. This course complicates the diagnosis of acute myocardial infarction;
• Asthmatic, when the clinical picture of a heart attack resembles asthmatic, which is accompanied by suffocation and pulmonary edema.

Who is at risk?

A history of coronary heart disease and angina significantly increases the risk of a heart attack. Atherosclerosis of blood vessels plays a decisive role - in almost 90% of cases it leads to this outcome.

In addition, those who:

• Moves little;
• Is overweight;
• Is a chronic hypertensive patient;
• Constantly exposed to stress;
• Smoking or using drugs - this increases the risk of severe vasospasm several times;
• Has a hereditary predisposition to atherosclerosis and heart attack.

Also at risk are men over 45 years of age and women over 65 - they may have a heart attack as a result of age-related changes. To prevent this, you need to regularly do an electrocardiogram and, when the first signs appear, monitor changes in the ECG over time.

What causes a heart attack?

Surely everyone has heard the phrase “give a heart attack.” There is a rational grain in it - with a strong nervous shock, a sharp spasm of blood vessels can develop, which will lead to the cessation of blood supply to the heart muscle. Acute myocardial infarction has 3 causes:

1. Blockage of a coronary artery by a blood clot that could form in any organ.
2. Spasm of coronary vessels (most often occurs due to stress).
3. Atherosclerosis is a vascular disease characterized by decreased elasticity of the walls and narrowing of their lumen.

These causes arise as a result of constant and cumulative exposure to risk factors, including poor lifestyle, obesity, lack of physical activity, the presence of other diseases, hormonal imbalances, etc.

How to recognize a heart attack?

It can easily be confused with a regular attack of angina or asthma, stroke, or even pancreatitis. But it can still be distinguished by some essential characteristics characteristic only of it.

The symptoms of acute myocardial infarction are as follows:

• Severe chest pain, which can be felt in the neck, arm, stomach, back. The intensity is much stronger than during an attack of angina, and does not go away when a person stops physical activity.
• Heavy sweating;
• The limbs are cold to the touch, the patient may not feel them;
• Severe shortness of breath, respiratory arrest.

Heart pain does not decrease after taking nitroglycerin. This is an alarming fact and a reason to urgently call an ambulance. For a person to survive, first aid for acute myocardial infarction must be provided within the first 20 minutes from the onset of the attack.

Stages of heart attack

Statistics on mortality from a heart attack indicate that each attack proceeds differently: someone dies in the first minutes, someone can hold out for an hour or more until the medical team arrives. In addition, long before an attack, you can notice changes in the ECG and some blood parameters. Therefore, with regular thorough examination For patients at risk, the likelihood of an attack can be minimized by prescribing prophylactic medications.

The main stages of the development of an attack:

• The most acute period of a heart attack lasts from half an hour to two hours. This is the period when tissue ischemia begins, gradually turning into necrosis.
• The acute period lasts from two days or more. It is characterized by the formation of a dead section of muscle. Frequent complications acute period– rupture of the heart muscle, pulmonary edema, thrombosis of the veins of the extremities, which entails tissue death, and others. It is better to treat the patient during this period in a hospital in order to monitor the slightest changes in the condition.
• The subacute period of myocardial infarction lasts about a month - until a scar begins to form on the heart muscle. On the ECG, signs of its formation can be clearly seen: under the positive electrode there is an enlarged Q wave, under the negative electrode there is a T wave symmetrical to the first. A decrease in the T wave over time indicates a decrease in the area of ​​ischemia. The subacute stage of myocardial infarction can last up to 2 months
• The post-infarction period lasts up to 5 months after the attack. At this time, the scar is finally formed, the heart gets used to functioning in new conditions. This phase is not yet safe: constant medical supervision and taking all prescribed medications are necessary.

Examination and diagnosis

For a doctor, one glance at a patient is not enough to make a final diagnosis. To confirm and assign it adequate treatment, you need to do:

• Thorough external examination;
• Collecting a detailed medical history, including finding out whether there have been cases of heart attack in relatives;
• A blood test that will identify markers that indicate this diagnosis. Typically, patients experience an increase in the level of leukocytes and ESR, and a lack of iron. In parallel with the general one, a biochemical analysis is performed, which will help identify complications;
• Analysis of urine;
• ECG and EchoCG - they will help assess the extent of damage to the heart muscle. An ECG is performed in case of acute myocardial infarction, and then changes are monitored. For the most complete picture, all results should be in the patient’s chart;
• Coronary angiography – study of the condition of the coronary vessels;
• Chest X-ray to monitor changes in the lungs.

Other tests may also be prescribed if necessary.

Consequences of a heart attack

Complications resulting from an attack do not always appear immediately. Disturbances in the functioning of the heart itself and other organs may appear after a while. The most dangerous year for the patient is the first year - during this period approximately 30% of patients die from complications.

Most frequent consequences myocardial infarction:

• Heart failure;
• Heart rhythm disturbances;
• Aneurysm (bulging wall or area of ​​scar tissue);
• Pulmonary embolism, which in turn can lead to respiratory failure and pulmonary infarction;
• Thromboendocarditis is the formation of a blood clot inside the heart. Its interruption can cut off the blood supply to the kidneys and intestines and lead to their necrosis;
• Pleurisy, pericarditis and others.

What to do if you have a heart attack

The sooner first aid is provided and treatment for acute myocardial infarction is started, the greater the patient’s chances of survival and the lower the risk of complications.

First aid during an attack

During this period, it is important not to panic and do everything to gain time before the ambulance arrives. The patient should be provided with rest and access to fresh air, given sedative drops and a nitroglycerin tablet under the tongue. If there are no serious contraindications, you need to take an aspirin tablet, after chewing it. To reduce pain, you can give non-steroidal painkillers - analgin.

Be sure to measure your pulse rate and blood pressure and, if necessary, give medication to increase or decrease your blood pressure.

If the patient is unconscious and the pulse cannot be felt, it is necessary to carry out indirect massage hearts and artificial respiration before the doctors arrive.

Further therapy

Treatment of acute myocardial infarction is carried out in a hospital, where the patient is prescribed drugs that improve vascular patency and accelerate the recovery of the heart muscle.

In case of pulmonary edema, defoaming may be necessary and artificial ventilation. After removing the patient from acute condition Constant monitoring of indicators and restorative treatment are carried out.

Medicines that thin the blood and prevent the formation of blood clots are also prescribed.

Life after a heart attack: features of rehabilitation

Some manage to fully recover from a heart attack and return to normal life. But most patients are still forced to limit themselves in physical activity, regularly take medications and adhere to proper nutrition in order to prolong life and minimize the risk of a recurrent attack.

Rehabilitation lasts from six months to a year. It includes:

• Physical therapy, initially with a minimal load, which gradually increases. Its goal is to normalize blood circulation, improve lung ventilation, and prevent congestion. Simple exercises are also used as a method of assessing the dynamics of recovery: if, a few weeks after an attack, the patient can climb the 3-4th floor of the stairs without shortness of breath, it means that he is on the mend.
• Physiotherapeutic procedures.
• Diet therapy. After a heart attack, it is worth significantly reducing the consumption of fatty, fried, smoked foods - foods that increase blood viscosity and cholesterol levels. It is worth increasing the amount of fiber and foods rich in vitamins and minerals. Especially needed at this time are iron (found in the liver), potassium and magnesium, which improve the condition of the heart muscle - they can be “gleaned” from fresh and dried fruits and nuts.
Symptoms of the gastralgic form of myocardial infarction (GIM)

Heart pathologies are one of the most common problems and often lead to human death. The greatest danger to life is acute myocardial infarction. What kind of disease is this?

What is an acute heart attack?

Myocardial infarction is a disease in which necrosis of heart muscle cells occurs. This pathology develops when the cells of an organ do not receive sufficient quantity oxygen. This occurs due to the blocking of the blood vessel that feeds the tissue.

As a result, myocardial cells are not able to fully function, and the process of their death begins. This phenomenon is called a heart attack. The danger of the disease lies in the fact that the attack occurs unexpectedly, and it is necessary to quickly take measures to eliminate it. Otherwise the person may die.

Causes of acute heart attack

The culprit in the development of acute ST-segment elevation myocardial infarction is the occlusion of a blood vessel. This can happen due to the following reasons:

1. Blockage of a vessel by a blood clot that could appear in any part of the body.
2. Spasm of the coronary arteries. This disorder often occurs when stressful situations. Therefore, the phrase “bring to a heart attack” fully justifies itself. When a person is exposed nervous shock, the blood vessels constrict and block the supply of oxygen to the heart.
3. Atherosclerosis. This vascular pathology is accompanied by a deterioration in the elasticity of the walls and their stenosis.

Such pathological phenomena develop under the systematic influence of provoking factors. The first of these are ischemic disease heart (CHD ) and angina. The presence of these diseases significantly increases the risk of myocardial infarction.

Also factors contributing to the development of cardiac pathology are:

• sedentary lifestyle;
• excess body weight;
• high blood pressure;
• frequent stressful situations;
• bad habits;
• hereditary predisposition;
• age of men over 45 years and women over 65 years.

People at risk should be more attentive to their heart health and be examined by a cardiologist every year.

Classification and stages of development

Myocardial infarction has its own classification. Doctors distinguish the following types of disease depending on the area of ​​the lesion: large-focal and small-focal. Based on the depth of myocardial damage, they are distinguished:

1. , affecting the entire thickness of the fabric.
2. Subendocardial, affecting only the inner layer.
3. Subepicardial, covering the anterior outer layer of the muscle.

Myocardial infarction occurs in several stages, each of which has its own characteristics. The following stages of pathology development are distinguished:

• The sharpest. Lasts from 30 minutes to 2 hours. At this stage, ischemia of the organ cells begins, which then smoothly transitions into the process of tissue death.
• Spicy. Lasts from 2 or more days. It is characterized by the formation of a necrotic focus in the myocardium. Often at this stage of development, the heart muscle ruptures, the lungs swell, and swelling occurs in the hands.
• Subacute. Develops over month period. During this period, dead tissue is rejected, creating conditions for the formation of a scar on the muscle.
• Post-infarction. Rehabilitation of the patient can take about 5 months. At this stage, scarring occurs, the myocardium adapts to work in new conditions.

NOTE!!! Final stage the development of a heart attack does not mean that the disease is over and no consequences will arise. The patient still requires doctor's supervision, as the risk of complications is high.

Symptoms

The main sign of a heart attack is pain in the chest area. It can have different intensity and character. Patients often describe it as burning, pressing, piercing. Pain occurs in the back of the sternum and radiates to the left side of the body: arm, neck, lower jaw.

The symptom lasts over 20 minutes. For many people, the pain is very pronounced. As a result, a person develops negative emotions, presented in the form of fear of death, anxiety, apathy.

In addition to pain, the following manifestations of a heart attack are observed:

• increased sweating;
• pale skin;
• dyspnea;
• weak pulse.

If chest pain occurs, immediate emergency care and calling a doctor are required.

Diagnostics

The patient is examined using visual examination, blood tests and instrumental methods. Such a comprehensive diagnosis allows you to make an accurate diagnosis.

REFERENCE!!! For early detection disease by the patient himself can be used. It can be purchased at a pharmacy. This method allows you to accurately determine whether there is a heart attack or not.

Anamnesis

When a patient comes to the hospital, the doctor talks with him. The patient's complaints are clarified and his medical history is studied. It is important for the doctor to know whether there have been chest pains before, how intense they were, and whether the person is at risk for developing myocardial infarction.

Next, the specialist examines the patient for excess body weight, high blood pressure, and pale skin. If the patient indicates a pain duration of more than 20 minutes, then the doctor will first suspect a heart attack.

Laboratory methods

After being examined by a doctor, the patient must undergo laboratory testing. It includes the following types of blood tests:

• General clinical. In case of cardiac pathology, the interpretation of the result shows high level leukocytes and ESR.
• Biochemical. This study reveals an increase in the activity of the enzymes AlT, AsT, LDH, creatine kinase, and myoglobin. This indicator indicates that the myocardium is damaged.

Instrumental methods

To make an accurate diagnosis, the following activities are carried out:

• Electrocardiography. The infarction state is reflected on the ECG in the form of a negative T wave, pathological QRS complex and other aspects. The procedure is performed in different leads, which helps to detect the localization of the necrosis focus.
• In acute myocardial infarction, the ECG looks at the ST segment. Acute myocardial infarction with ST segment elevation indicates the development.
• Ultrasonography hearts. Allows you to accurately determine where failure occurs in the contractions of the ventricular muscles.
• Coronary angiography. Designed to detect narrowing or blockage of the vessel that supplies the heart muscle. This diagnostic method is used not only to identify pathology, but also for its therapy.

Based on a comprehensive examination of the heart, the doctor makes a diagnosis and selects appropriate treatment tactics for each patient.

Complications

Adverse consequences from a heart attack do not occur immediately. Complications can develop gradually and affect not only the heart, but also other organs. The greatest danger to a person is the first year of life after a heart attack. It is during this period that most of the consequences that lead to death occur.

Complications often occur in the form of such diseases:

• Heart failure.
• Extrasystole.
• Aneurysm.
• Thromboembolism of the pulmonary artery.
• Thromboendocarditis.
• Pericarditis.

Fighting heart disease

Treatment for a heart attack begins with eliminating the attack before the ambulance arrives. The person next to the patient should take measures that will help gain time until doctors arrive.

To do this, it is necessary to ensure complete rest for the patient, open the windows and free his throat from constricting clothing so that as much oxygen as possible can flow. Then give the patient nitroglycerin.

If the patient has lost consciousness, his pulse is too weak, chest compressions and artificial respiration must be performed. Everyone should know how to do this correctly. Anyone can be close to someone who has an unexpected heart attack.

Specialized treatment

After first aid is provided, the patient is taken to the hospital, where intensive observation and treatment of acute myocardial infarction is carried out. First of all, it is assigned medicinal method therapy. The patient is recommended to take the following medications:

• Narcotic analgesics and antipsychotics to relieve pain behind the sternum.
• Thrombolytic drugs that help dissolve a blood clot that has blocked a blood vessel. The administration of these drugs is effective within the first hour after the onset of a heart attack.
• Antiarrhythmic drugs to restore normal heartbeat.
• Medicines aimed at normalizing metabolism in the myocardium.
• Anticoagulants that help thin the blood, reduce its clotting and prevent the development of.

Surgical intervention is used in extreme cases. The following are used surgical methods treatment:

1. Balloon angioplasty of coronary vessels.
2. Installation of a stent in a vessel.
3. Arterial bypass.

The prognosis for acute myocardial infarction depends on how damaged the heart muscle is, where the focus of necrosis is located, how old the patient is, whether he has concomitant diseases, and from many other factors. The patient's risk of developing disability is very high.

Prevention

Preventive measures for myocardial infarction are actions that are aimed at preventing the development of this disease. Such measures will minimize the risk of developing heart disease.

1. To live an active lifestyle. Physical activity helps prevent the development of most diseases, including heart disease. Sport strengthens muscle tissue organ, improves blood circulation, normalizes metabolic processes.
2. To refuse from bad habits. Smoking and drinking alcohol significantly increase the risk of developing a heart attack, as they negatively affect the condition of blood vessels.
3. Eat properly. It is important that the diet is balanced and provides the body with all the necessary nutrients. The menu should not include fast food or fatty foods.
4. Avoid stress. Negative feelings negatively affect the health of the heart. Therefore, it is worth getting as many positive emotions as possible.

Myocardial infarction - serious pathology heart disease, often leading to death. To always keep the health of the main organ under control, you should regularly visit a cardiologist for a preventive examination.

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

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

Causes

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

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

• Narrowing of the lumen of blood vessels as a result of the deposition of plaques on their walls. This also leads to a decrease in the elasticity of the vascular wall.
• Vasospasm, which can occur due to severe stress. If plaques are present, this can lead to acute disorder coronary circulation.
• Separation of plaque from the vascular walls can cause arterial thrombosis and, worse, myocardial infarction (damage).

Thus, atherosclerosis is the main cause of myocardial infarction, which is a rather dangerous condition and must be corrected.

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

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

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

Symptoms

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

In the acute stage, the following manifestations are observed:

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

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

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

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

First aid

Understanding what it is - the occurrence of myocardial infarction, it is important to realize that first aid plays an important role. So, if you suspect this state It is important to carry out the following activities:

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

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

Classification

Heart attacks are classified according to the following criteria:

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

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

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

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

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

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

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

Stages

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

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

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

Variants of the disease

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

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

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

Diagnostics

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

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

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

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

1. Duration of the disease and its stage.
2. Localization.
3. Extent of damage.
4. Depth of damage.

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

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

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

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

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

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

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

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

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

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

It is also worth noting that during myocardial infarction there is an increase in troponin-1 and troponin-T. IN general analysis blood, the following changes are detected:

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

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

Complications

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

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

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

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

Treatment

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

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

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

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

Prevention

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

1. Control your body weight. the main objective– prevent obesity, since this factor is decisive in the formation of atherosclerosis – one of the main causes of myocardial infarction.
2. Dieting. Reducing salt intake, as well as reducing the intake of fats from food, can not only reduce the risk of obesity, but also normalize blood pressure.
3. Maintaining an active lifestyle. Adequate physical activity helps normalize metabolic processes, reduce body weight, and generally strengthen the body. If you have a history of a heart attack or other cardiovascular pathologies, you should consult your doctor about the amount of exercise.
4. Rejection of bad habits.
5. Cholesterol control.
6. Pressure control.
7. Measuring sugar levels.
8. Carrying out preventive examinations with a specialist.

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