What causes myocardial infarction. Symptoms of acute myocardial infarction: timely treatment - the ability to return to active life Symptoms characteristic of the acute period of myocardial infarction

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

There are a number of factors that significantly increase the risk of developing this acute condition:

1. 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.
2. Age. The risk of developing the disease increases after 45–50 years of age.
3. 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.
4. arterial hypertension. People suffering have an increased risk of cardiovascular accidents, because with high blood pressure, myocardial oxygen demand increases.
5. Previous myocardial infarction, even small-focal.
6. 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.
7. 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.
8. 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 transfer).

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

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

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.

General information

- a focus of ischemic necrosis of the heart muscle, which develops as a result of an acute violation of the coronary circulation. It is clinically manifested by burning, pressing or squeezing pains behind the sternum, radiating to the left arm, collarbone, shoulder blade, jaw, shortness of breath, a feeling of fear, cold sweat. Developed myocardial infarction is an indication for emergency hospitalization in cardiological intensive care. If timely assistance is not provided, a fatal outcome is possible.

At the age of 40-60 years, myocardial infarction is 3-5 times more common in men due to the earlier (10 years earlier than in women) development of atherosclerosis. After 55-60 years, the incidence among both sexes is approximately the same. The mortality rate for myocardial infarction is 30-35%. Statistically, 15-20% of sudden deaths are due to myocardial infarction.

Violation of blood supply to the myocardium for 15-20 minutes or more leads to the development of irreversible changes in the heart muscle and a disorder of cardiac activity. Acute ischemia causes the death of part of the functional muscle cells (necrosis) and their subsequent replacement with connective tissue fibers, i.e., the formation of a post-infarction scar.

There are five periods in the clinical course of myocardial infarction:

• 1 period- pre-infarction (prodromal): increased frequency and intensification of angina attacks, can last several hours, days, weeks;
• 2 period- the most acute: from the development of ischemia to the appearance of myocardial necrosis, lasts from 20 minutes to 2 hours;
• 3 period- acute: from the formation of necrosis to myomalacia (enzymatic fusion of necrotic muscle tissue), duration from 2 to 14 days;
• 4 period- subacute: initial processes of scar organization, development of granulation tissue at the site of necrotic tissue, duration 4-8 weeks;
• 5 period- post-infarction: scar maturation, myocardial adaptation to new conditions of functioning.

Causes of myocardial infarction

Myocardial infarction is an acute form of CAD. In 97-98% of cases, the basis for the development of myocardial infarction is atherosclerotic lesions of the coronary arteries, causing narrowing of their lumen. Often, acute thrombosis of the affected area of ​​the vessel joins atherosclerosis of the arteries, causing a complete or partial cessation of blood supply to the corresponding area of ​​the heart muscle. Thrombus formation is facilitated by increased blood viscosity observed in patients with coronary artery disease. In some cases, myocardial infarction occurs against the background of spasm of the branches of the coronary arteries.

The development of myocardial infarction is promoted by diabetes mellitus, hypertension, obesity, neuropsychic stress, alcohol addiction, smoking. Sharp physical or emotional stress on the background of coronary artery disease and angina pectoris can provoke the development of myocardial infarction. More often myocardial infarction of the left ventricle develops.

Classification of myocardial infarction

according to dimensions focal lesions of the heart muscle secrete myocardial infarction:

• macrofocal
• small focal

Small-focal myocardial infarctions account for about 20% of clinical cases, however, often small foci of necrosis in the heart muscle can transform into large-focal myocardial infarction (in 30% of patients). Unlike large-focal infarcts, aneurysm and rupture of the heart do not occur in small-focal infarctions, the course of the latter is less often complicated by heart failure, ventricular fibrillation, and thromboembolism.

Depending on the depth of the necrotic lesion myocardial infarction is isolated from the heart muscle:

• transmural - with necrosis of the entire thickness of the muscular wall of the heart (usually macrofocal)
• intramural - with necrosis in the thickness of the myocardium
• subendocardial - with myocardial necrosis in the area adjacent to the endocardium
• subepicardial - with myocardial necrosis in the area adjacent to the epicardium

According to the changes recorded on the ECG, distinguish:

• "Q-infarction" - with the formation of a pathological Q wave, sometimes a ventricular QS complex (more often large-focal transmural myocardial infarction)
• “not Q-infarction” - not accompanied by the appearance of a Q wave, manifested by negative T-teeth (more often small-focal myocardial infarction)

By topography and depending on the damage to certain branches of the coronary arteries, myocardial infarction is divided into:

• right ventricular
• left ventricular: anterior, lateral and posterior walls, interventricular septum

By frequency of occurrence distinguish myocardial infarction:

• primary
• recurrent (develops within 8 weeks after the primary)
• repeated (develops 8 weeks after the previous one)

According to the development of complications myocardial infarction is divided into:

• complicated
• uncomplicated

According to the presence and localization of the pain syndrome distinguish forms of myocardial infarction:

1. typical - with localization of pain behind the sternum or in the precordial region
2. atypical - with atypical pain manifestations:

• peripheral: left-scapular, left-handed, laryngeal-pharyngeal, mandibular, maxillary, gastralgic (abdominal)
• painless: collaptoid, asthmatic, edematous, arrhythmic, cerebral
• asymptomatic (erased)
• combined

According to the period and dynamics development of myocardial infarction allocate:

• stage of ischemia (acute period)
• stage of necrosis (acute period)
• organization stage (subacute period)
• scarring stage (postinfarction period)

Symptoms of myocardial infarction

Pre-infarction (prodromal) period

About 43% of patients note the sudden development of myocardial infarction, while the majority of patients have a period of unstable progressive angina of varying duration.

The most acute period

Typical cases of myocardial infarction are characterized by an extremely intense pain syndrome with localization of pain in the chest and irradiation to the left shoulder, neck, teeth, ear, collarbone, lower jaw, interscapular zone. The nature of the pain can be compressive, arching, burning, pressing, sharp ("dagger"). The larger the zone of myocardial damage, the more pronounced the pain.

The pain attack proceeds in waves (sometimes intensifying, then weakening), lasts from 30 minutes to several hours, and sometimes days, is not stopped by repeated administration of nitroglycerin. The pain is associated with severe weakness, agitation, fear, shortness of breath.

Perhaps an atypical course of the most acute period of myocardial infarction.

Patients have a sharp pallor of the skin, sticky cold sweat, acrocyanosis, anxiety. Blood pressure during an attack is increased, then moderately or sharply decreases compared to the initial (systolic< 80 рт. ст., пульсовое < 30 мм мм рт. ст.), отмечается тахикардия , аритмия .

During this period, acute left ventricular failure (cardiac asthma, pulmonary edema) may develop.

Acute period

In the acute period of myocardial infarction, the pain syndrome, as a rule, disappears. Preservation of pain is caused by a pronounced degree of ischemia of the near-infarction zone or the addition of pericarditis.

As a result of the processes of necrosis, myomalacia and perifocal inflammation, fever develops (from 3-5 to 10 or more days). The duration and height of the rise in temperature during fever depend on the area of ​​necrosis. Arterial hypotension and signs of heart failure persist and increase.

Subacute period

There are no pain sensations, the patient's condition improves, body temperature normalizes. Symptoms of acute heart failure become less pronounced. Disappears tachycardia, systolic murmur.

Postinfarction period

In the postinfarction period, there are no clinical manifestations, laboratory and physical data are practically without deviations.

Atypical forms of myocardial infarction

Sometimes there is an atypical course of myocardial infarction with localization of pain in atypical places (in the throat, fingers of the left hand, in the area of ​​the left shoulder blade or cervicothoracic spine, in the epigastrium, in the lower jaw) or painless forms, the leading symptoms of which may be cough and severe suffocation, collapse, edema, arrhythmias, dizziness and confusion.

Atypical forms of myocardial infarction are more common in elderly patients with severe signs of cardiosclerosis, circulatory failure, against the background of recurrent myocardial infarction.

However, only the most acute period usually proceeds atypically, the further development of myocardial infarction becomes typical.

The erased course of myocardial infarction is painless and accidentally detected on the ECG.

Complications of myocardial infarction

Quite often, complications arise already in the first hours and days of myocardial infarction, aggravating its course. In most patients, various types of arrhythmias are observed in the first three days: extrasystole, sinus or paroxysmal tachycardia, atrial fibrillation, complete intraventricular blockade. The most dangerous is ventricular fibrillation, which can turn into fibrillation and lead to the death of the patient.

Left ventricular heart failure is characterized by congestive wheezing, cardiac asthma, pulmonary edema, and often develops during the most acute period of myocardial infarction. An extremely severe degree of left ventricular failure is cardiogenic shock, which develops with an extensive heart attack and is usually fatal. Signs of cardiogenic shock are a drop in systolic blood pressure below 80 mm Hg. Art., impaired consciousness, tachycardia, cyanosis, decreased diuresis.

Rupture of muscle fibers in the area of ​​necrosis can cause cardiac tamponade - hemorrhage into the pericardial cavity. In 2-3% of patients, myocardial infarction is complicated by thromboembolism of the pulmonary artery system (can cause pulmonary infarction or sudden death) or systemic circulation.

Patients with extensive transmural myocardial infarction in the first 10 days may die from ventricular rupture due to acute cessation of blood circulation. With extensive myocardial infarction, failure of the scar tissue may occur, its bulging with the development of an acute aneurysm of the heart. An acute aneurysm can transform into a chronic one, leading to heart failure.

The deposition of fibrin on the walls of the endocardium leads to the development of parietal thromboendocarditis, which is dangerous for the possibility of embolism of the vessels of the lungs, brain, and kidneys by detached thrombotic masses. In a later period, postinfarction syndrome may develop, manifested by pericarditis, pleurisy, arthralgia, eosinophilia.

Diagnosis of myocardial infarction

Among the diagnostic criteria for myocardial infarction, the most important are the history of the disease, characteristic changes in the ECG, and indicators of the activity of blood serum enzymes. Complaints of the patient with myocardial infarction depend on the form (typical or atypical) of the disease and the extent of damage to the heart muscle. Myocardial infarction should be suspected in severe and prolonged (longer than 30-60 minutes) attack of retrosternal pain, impaired conduction and heart rhythm, acute heart failure.

Characteristic ECG changes include the formation of a negative T wave (with small-focal subendocardial or intramural myocardial infarction), a pathological QRS complex, or a Q wave (with large-focal transmural myocardial infarction). Echocardiography reveals a violation of local contractility of the ventricle, thinning of its wall.

In the first 4-6 hours after a painful attack in the blood, an increase in myoglobin, a protein that transports oxygen into cells, is determined. An increase in the activity of creatine phosphokinase (CPK) in the blood by more than 50% is observed after 8-10 hours from the development of myocardial infarction and decreases to normal after two days. Determination of the level of CPK is carried out every 6-8 hours. Myocardial infarction is ruled out with three negative results.

To diagnose myocardial infarction at a later date, they resort to determining the enzyme lactate dehydrogenase (LDH), the activity of which increases later than CPK - 1-2 days after the formation of necrosis and comes to normal values ​​after 7-14 days. Highly specific for myocardial infarction is an increase in the isoforms of myocardial contractile troponin protein - troponin-T and troponin-1, which also increase with unstable angina. In the blood, an increase in ESR, leukocytes, activity of aspartate aminotransferase (AcAt) and alanine aminotransferase (AlAt) is determined.

Coronary angiography (coronary angiography) allows you to establish thrombotic occlusion of the coronary artery and a decrease in ventricular contractility, as well as evaluate the possibility of coronary artery bypass grafting or angioplasty - operations that help restore blood flow in the heart.

Treatment of myocardial infarction

With myocardial infarction, emergency hospitalization in cardiological intensive care is indicated. In the acute period, the patient is prescribed bed rest and mental rest, fractional, limited in volume and calorie nutrition. In the subacute period, the patient is transferred from the intensive care unit to the cardiology department, where the treatment of myocardial infarction continues and the regimen is gradually expanded.

Relief of the pain syndrome is carried out by a combination of narcotic analgesics (fentanyl) with neuroleptics (droperidol), intravenous administration of nitroglycerin.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, cardiogenic shock. Antiarrhythmic drugs (lidocaine), ß-blockers (atenolol), thrombolytics (heparin, acetylsalicylic acid), Ca antagonists (verapamil), magnesia, nitrates, antispasmodics, etc. are prescribed.

In the first 24 hours after the onset of myocardial infarction, perfusion can be restored by thrombolysis or emergency balloon coronary angioplasty.

Prognosis for myocardial infarction

Myocardial infarction is a severe disease associated with dangerous complications. Most of the deaths occur on the first day after myocardial infarction. The pumping capacity of the heart is related to the location and volume of the infarction zone. If more than 50% of the myocardium is damaged, as a rule, the heart cannot function, which causes cardiogenic shock and death of the patient. Even with less extensive damage, the heart does not always cope with the load, resulting in heart failure.

After the acute period, the prognosis for recovery is good. Unfavorable prospects in patients with complicated myocardial infarction.

Prevention of myocardial infarction

The necessary conditions for the prevention of myocardial infarction are maintaining a healthy and active lifestyle, avoiding alcohol and smoking, balanced nutrition, exclusion of physical and nervous strain, control of blood pressure and blood cholesterol levels.

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 and decreases very quickly when the patient is admitted to the intensive care unit and they undergo dissolution of the clot, called thrombolysis or coronary angioplasty. Allocate myocardial infarction with a pathological Q wave and without it. As a rule, the area and depth of the lesion is greater in the first case, and the risk of re-development of a heart attack in the second. Therefore, the long-term prognosis is about the same.

Causes of myocardial infarction

Most often, a heart attack affects people suffering from a lack of physical activity against the background of psycho-emotional overload. But he can also defeat people with good physical fitness, even young ones. The main causes contributing to the occurrence of myocardial infarction are: overeating, malnutrition, excess animal fats in food, insufficient physical activity, hypertension, bad habits. The likelihood of developing a heart attack in people leading a sedentary lifestyle is several times greater than in physically active people.

The heart is a muscular sac that pumps blood through itself like a pump. But the heart muscle itself is supplied with oxygen through the blood vessels that come to it from the outside. And now, as a result of various reasons, some part of these vessels is affected by atherosclerosis and can no longer pass enough blood. Ischemic heart disease occurs. In myocardial infarction, the blood supply to part of the heart muscle stops suddenly and completely due to a complete blockage of the coronary artery. Usually this leads to the development of a thrombus on an atherosclerotic plaque, less often - a spasm of the coronary artery. The section of the heart muscle deprived of nutrition dies. In Latin, dead tissue is a heart attack.

Symptoms of myocardial infarction

The most typical manifestation of myocardial infarction is chest pain. The pain “radiates” along the inner surface of the left hand, producing tingling sensations in the left hand, wrist, fingers. Other possible areas of irradiation are the shoulder girdle, neck, jaw, interscapular space, also predominantly on the left. Thus, both localization and irradiation of pain does not differ from an angina attack.

Pain in myocardial infarction is very strong, perceived as a dagger, tearing, burning, "a stake in the chest." Sometimes this feeling is so unbearable that it makes you scream. As with angina pectoris, it may not be pain, but discomfort in the chest: a feeling of strong compression, pressure, a feeling of heaviness “pulled with a hoop, squeezed in a vise, crushed with a heavy plate.” Some people experience only a dull ache, numbness in the wrists, combined with severe and prolonged chest pain or discomfort in the chest.

The onset of anginal pain in myocardial infarction is sudden, often at night or early morning. Pain sensations develop in waves, periodically decrease, but do not stop completely. With each new wave, pain or discomfort in the chest intensifies, quickly reaches a maximum, and then weakens.

Pain or discomfort in the chest lasts more than 30 minutes, sometimes for hours. It is important to remember that for the formation of a myocardial infarction, the duration of anginal pain for more than 15 minutes is sufficient. Another important hallmark of myocardial infarction is the lack of reduction or cessation of pain at rest or when taking nitroglycerin (even repeatedly).

Angina pectoris or myocardial infarction

The place of origin of pain in angina pectoris and myocardial infarction is the same. The main differences in pain in myocardial infarction are:

• severe intensity of pain;
• longer than 15 minutes;
• pain does not stop after taking nitroglycerin.

Atypical forms of a heart attack

In addition to the typical, sharp tearing pain behind the sternum, characteristic of a heart attack, there are several more forms of a heart attack, which can be disguised as other diseases of the internal organs or not manifest themselves in any way. Such forms are called atypical. Let's get into them.

Gastritis variant of myocardial infarction. It manifests itself as severe pain in the epigastric region and resembles an exacerbation of gastritis. Often on palpation, i.e. palpation of the abdomen, there is pain and tension in the muscles of the anterior abdominal wall. As a rule, with this form, the lower parts of the myocardium of the left ventricle, adjacent to the diaphragm, are affected.

Asthmatic variant of myocardial infarction. This atypical type of heart attack is very similar to an attack of bronchial asthma. It is manifested by a hacking dry cough, a feeling of congestion in the chest.

A painless version of a heart attack. It is manifested by a deterioration in sleep or mood, a feeling of indefinite discomfort in the chest (“heart anguish”), combined with severe sweating. Usually this option is typical in the elderly and senile age, especially in diabetes mellitus. This option for the onset of myocardial infarction is unfavorable, since the disease is more severe.

Factors in the development of myocardial infarction

Risk factors for myocardial infarction are:

1. age, the older a person becomes, the risk of a heart attack increases.
2. previously transferred myocardial infarction, especially small-focal, i.e. non-Q generator.
3. diabetes mellitus is a risk factor for the development of myocardial infarction, tk. an elevated level has an additional detrimental effect on the heart vessels and hemoglobin, worsening its oxygen transport function.
4. smoking, the risk of myocardial infarction when smoking, both active and passive, just inhaling tobacco smoke from a smoker, increases by 3 and 1.5 times, respectively. Moreover, this factor is so "corrosive" that it persists for the next 3 years after the patient quit smoking.
5. arterial hypertension, increased blood pressure above 139 and 89.
6. high cholesterol levels, contributes to the development of atherosclerotic plaques on the walls of arteries, including coronary ones.
7. Obesity or overweight contributes to an increase in blood cholesterol and, as a result, the blood supply to the heart worsens.

Prevention of myocardial infarction

Methods for the prevention of myocardial infarction are similar to the prevention of coronary heart disease.

The likelihood of developing complications of myocardial infarction

Myocardial infarction is dangerous in many ways, due to its unpredictability and complications. The development of complications of myocardial infarction depends on several important factors:

1. the magnitude of damage to the heart muscle, the larger the area affected by the myocardium, the more pronounced the complications;
2. localization of the zone of myocardial damage (anterior, posterior, lateral wall of the left ventricle, etc.), in most cases, myocardial infarction occurs in the anterior septal region of the left ventricle with the capture of the apex. Less often in the region of the lower and posterior wall
3. the time of restoration of blood flow in the affected heart muscle is very important, the sooner medical care is provided, the smaller the damage zone will be.

Complications of myocardial infarction

Complications of myocardial infarction mainly occur with extensive and deep (transmural) damage to the heart muscle. It is known that a heart attack is a necrosis (necrosis) of a certain area of ​​the myocardium. At the same time, muscle tissue, with all its inherent properties (contractility, excitability, conductivity, etc.), is transformed into connective tissue, which can only play the role of a "frame". As a result, the thickness of the heart wall decreases, and the dimensions of the cavity of the left ventricle of the heart grow, which is accompanied by a decrease in its contractility.

The main complications of myocardial infarction are:

• arrhythmia is the most common complication of myocardial infarction. The greatest danger is ventricular tachycardia (a type of arrhythmia in which the ventricles of the heart take on the role of the pacemaker) and ventricular fibrillation (chaotic contraction of the walls of the ventricles). However, it must be remembered that any hemodynamically significant arrhythmia requires treatment.
• heart failure (decreased contractility of the heart) occurs with myocardial infarction quite often. The decrease in contractile function occurs in proportion to the size of the infarction.
• arterial hypertension due to an increase in the need for oxygen by the heart and tension in the wall of the left ventricle leads to an increase in the infarction zone, and to its stretching.
• mechanical complications (heart aneurysm, rupture of the interventricular septum) usually develop in the first week of myocardial infarction and are clinically manifested by a sudden deterioration in hemodynamics. Mortality in such patients is high, and often only urgent surgery can save their lives.
• recurrent (constantly recurring) pain syndrome occurs in about 1/3 of patients with myocardial infarction, the dissolution of the thrombus does not affect its prevalence.
• Dressler's syndrome is a post-infarction symptom complex, manifested by inflammation of the heart bag, lung bag and inflammatory changes in the lungs themselves. The occurrence of this syndrome is associated with the formation of antibodies.
• Any of these complications can be fatal.

Diagnosis of acute myocardial infarction

Acute myocardial infarction is diagnosed based on 3 main criteria:

1. a characteristic clinical picture - with myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the sternum, extending to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin, it does not completely disappear and only briefly decreases. There is a feeling of lack of air, cold sweat, severe weakness, lowering blood pressure, nausea, vomiting, a feeling of fear may appear. Prolonged pain in the region of the heart, which lasts more than 20-30 minutes and does not go away after taking nitroglycerin, may be a sign of myocardial infarction. Contact an ambulance.
2. characteristic changes on the electrocardiogram (signs of damage to certain areas of the heart muscle). Usually this is the formation of Q waves and ST segment elevation in the leads of interest.
3. characteristic changes in laboratory parameters (an increase in the blood level of cardiospecific markers of damage to heart muscle cells - cardiomyocytes).

Emergency care for myocardial infarction

An ambulance should be called if this is the first attack of angina pectoris in life, as well as if:

• pain behind the sternum or its equivalents increase or last more than 5 minutes, especially if all this is accompanied by worsening of breathing, weakness, vomiting;
• pain behind the sternum did not stop or worsened within 5 minutes after resorption of 1 tablet of nitroglycerin.

Help before the arrival of the ambulance for myocardial infarction

What should you do if you suspect a heart attack? There are simple rules that will help you save the life of another person:

• lay the patient down, raise the head, re-give a nitroglycerin tablet under the tongue, and crushed (chew) 1 aspirin tablet;
• additionally take 1 tablet of analgin or baralgin, 60 drops of corvalol or valocardine, 2 tablets of panangin or potassium orotate, put a mustard plaster on the heart area;
• urgently call an ambulance team ("03").

Everyone should be able to revive

The patient's chances of surviving are the higher, the earlier resuscitation measures are started (they must be started no later than one minute from the onset of a cardiac catastrophe). Rules for conducting basic resuscitation measures:

If the patient has no reactions to external stimuli, immediately proceed to paragraph 1 of these Rules.

Ask someone, such as neighbors, to call an ambulance.

Properly lay down the resuscitated person, ensuring the patency of the airway. For this:

• the patient must be laid on a flat hard surface and his head thrown back as much as possible.
• to improve airway patency, removable dentures or other foreign bodies should be removed from the oral cavity. In case of vomiting, turn the patient's head to one side, and remove the contents from the oral cavity and pharynx with a swab (or improvised means).

1. Check for spontaneous breathing.
2. If there is no spontaneous breathing, begin artificial respiration. The patient should lie in the position described earlier on his back with his head thrown back sharply. The pose can be provided by placing a roller under the shoulders. You can hold your head with your hands. The lower jaw should be pushed forward. The caregiver takes a deep breath, opens his mouth, quickly brings it closer to the patient's mouth and, pressing his lips tightly to his mouth, takes a deep breath, i.e. as if blows air into his lungs and inflates them. To prevent air from escaping through the resuscitator's nose, pinch his nose with your fingers. The caregiver then leans back and takes a deep breath again. During this time, the patient's chest collapses - there is a passive exhalation. The caregiver then blows air into the patient's mouth again. For hygienic reasons, the patient's face can be covered with a handkerchief before blowing air.
3. If there is no pulse on the carotid artery, artificial ventilation of the lungs must be combined with an indirect heart massage. To conduct an indirect massage, place your hands one on top of the other so that the base of the palm lying on the sternum is strictly on the midline and 2 fingers above the xiphoid process. Without bending your arms and using your own body weight, smoothly shift the sternum towards the spine by 4-5 cm. With this displacement, compression (compression) of the chest occurs. Perform the massage so that the duration of the compressions is equal to the interval between them. The frequency of compressions should be about 80 per minute. In pauses, leave your hands on the sternum of the patient. If you are resuscitating alone, after doing 15 chest compressions, take two breaths in a row. Then repeat the indirect massage in combination with artificial ventilation of the lungs.
4. Remember to constantly monitor the effectiveness of your resuscitation efforts. Resuscitation is effective if the patient's skin and mucous membranes turn pink, the pupils narrowed and a reaction to light appeared, spontaneous breathing resumed or improved, and a pulse appeared on the carotid artery.
5. Continue CPR until the ambulance arrives.

Treatment of myocardial infarction

The main goal in the treatment of a patient with acute myocardial infarction is to restore and maintain blood circulation to the affected area of ​​the heart muscle as quickly as possible. For this, modern medicine offers the following means:

Aspirin (Acetylsalicylic acid) - inhibits platelets and prevents the formation of a blood clot.

Plavix (Clopidogrel), also Ticlopidin and Prasugrel - also inhibit the formation of platelet thrombus, but they work perfectly and more powerfully than aspirin.

Heparin, low molecular weight heparins (Lovenox, Fraxiparin), Bivalirudin - anticoagulants that affect blood clotting and factors leading to the formation and spread of blood clots.

Thrombolytics (Streptokinase, Alteplase, Reteplase and TNK-ase) are powerful drugs that can dissolve an already formed blood clot.

All of the above groups of drugs are used in combination and are necessary in the modern treatment of a patient with myocardial infarction.

The best method of restoring the patency of the coronary artery and restoring blood flow to the affected area of ​​the myocardium is an immediate coronary artery angioplasty procedure with the possible installation of a coronary stent. Studies suggest that in the first hour of infarction, and if agioplasty cannot be performed immediately, thrombolytic drugs should be considered and are preferred.

If all the above measures do not help or are impossible, urgent coronary artery bypass surgery may be the only way to save the myocardium - restore blood circulation.

In addition to the main task (restoration of blood circulation in the affected coronary artery), the treatment of a patient with myocardial infarction has the following goals:

Limiting the size of a heart attack is achieved by reducing myocardial oxygen demand, using beta-blockers (Metoprolol, Atenolol, Bisoprolol, Labetalol, etc.); reducing the load on the myocardium (enalapril, ramipril, lisinopril, etc.).

Pain control (pain usually disappears with the restoration of blood circulation) - Nitroglycerin, narcotic analgesics.

Fight against arrhythmias: Lidocaine, Amiodarone - for arrhythmias with an accelerated rhythm; Atropine or temporary pacing - when the rhythm slows down.

Maintaining normal vital parameters: blood pressure, respiration, pulse, kidney function.

The first 24 hours of illness are critical. Further prognosis depends on the success of the measures taken and, accordingly, how much the heart muscle has “damaged”, as well as the presence and degree of “risk factors” for cardiovascular diseases.

It is important to note that with a favorable course and effective rapid treatment of a patient with myocardial infarction, there is no need for strict bed rest for more than 24 hours. Moreover, excessively long bed rest can have an additional negative effect on post-infarction recovery.

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, for which first aid 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, insufficient 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:

1. 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.
2. Fear of death . This unpleasant sensation is actually not such a bad sign, as it indicates the normal tone of the central nervous system.
3. 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.
4. 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 0.5 mg nitroglycerin tablets at a 15-minute interval, but not more than three times, 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

1. You should stop smoking. Smokers are twice as likely to die from heart attacks.
2. 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.
3. High blood pressure also contributes to the development of a heart attack. By controlling hypertension, you can prevent a heart attack.
4. 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.

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Brief description of the problem

Every person has heard the word “myocardium” at least once in their life, but only a few know what it is. The myocardium is the heart muscle that receives a constant supply of blood. This muscle ensures the distribution of the impulse between the various 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 that delivers blood to the myocardium, such an important part of the heart remains without oxygen. In "offline mode" the muscle lives no more than 20-30 minutes, after which the same myocardial infarction occurs - the irreversible death of muscle tissue and their subsequent scarring. Without help, this process leads to the death of a person, because the “road” along which cardiac impulses propagate from department to department is destroyed.

In recent years, myocardial infarction is rapidly getting younger. If earlier the disease mainly affected the elderly, then today the destruction of the cardiovascular system is increasingly observed in young people under 30 years old. This means that with a diagnosis of 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 accelerate 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 atherosclerosis of the vessels, which is present to one degree or another in every person. At first, vasoconstriction does not cause the patient any particular inconvenience, but over time this process becomes pathological. In addition to atherosclerosis, tissue death can be caused by other reasons:

• age - most often acute myocardial infarction occurs in people over 50 years old;
• gender of the person - men get sick more often than women;
• hereditary factors - the risk of suffering a heart attack is higher if one of your family members was sick;
• high cholesterol, malnutrition;
• smoking is one of the main causes of myocardial infarction (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 deadly disease, and together they make this "meeting" inevitable. Keep this in mind when you light another cigarette or eat a completely useless hamburger while sitting in front of your favorite TV.

What happens in myocardial infarction?

Throughout life, fatty deposits accumulate on the walls of our blood vessels. For some people this process is slow, for others it is much faster. Upon reaching a critical mass, fats form the 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 grows rapidly in size and, in the end, forms a thrombus, which can completely block the interior of the vessel. As a result, blood flow through the artery stops, and a person develops a myocardial infarction (first aid during an attack involves the introduction of vasodilators to the patient in order to restore normal blood supply). We also note that the larger the clogged vessel, the faster the process of cell death, because a large artery supplies oxygen to large areas of the myocardium.

Myocardial infarction - symptoms and clinical picture of the disease

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

Note other symptoms of the disease:

• labored breathing;
• nausea, bouts of vomiting;
• discomfort in the abdomen;
• 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 with 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 the patient is diagnosed with myocardial infarction, first aid should be provided in the first hours after the attack. The main task of doctors in this case is to dissolve the “fresh” blood clot, expand the blood vessels and restore the natural blood supply. To prevent the formation of new blood clots, the patient is given drugs that slow down blood clotting. As a rule, ordinary aspirin is used for such purposes. By applying 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 tissue oxygen demand. The economical work of the heart is very important during an attack, and therefore researchers are constantly working on finding new technologies that would solve the problem of oxygen supply without endangering the patient's life. Some of these developments, such as the invasive method or balloon angioplasty, are indeed very promising.

What should 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 most insignificant loads are dangerous for a damaged heart. Previously, a patient who had an acute myocardial infarction did not get out of bed for at least several weeks. Modern treatment technologies 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 returning, consult a doctor who will prescribe therapeutic exercises, select the necessary drugs and give other recommendations that are relevant during the rehabilitation period.

What is a heart attack?

Heart attack. Definition, causes, development.

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

What determines the survival of our body tissues?

The tissues of our body maintain a constant metabolism that ensures their vital activity. Organisms need nutrients and oxygen to live and work. The cessation of the supply of nutrients and oxygen to the tissues, even for 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 the higher, the higher the functional activity of tissues, that is, the harder an organ works, the more painfully it reacts to a lack of oxygen and nutrients. Such "hard-working" and "sensitive" organs include the brain, heart muscle, kidneys, and liver.

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

What is a heart attack?

As it has already become clear, a heart attack is characterized by the necrosis of living tissues of the body, which occurs due to a sharp cessation of blood flow and, consequently, the supply of oxygen and nutrients to organs.

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

• cerebral infarction(stroke) necrosis of a section of brain tissue due to thrombosis or rupture of one of the vessels of the brain.
• Lung infarction- necrosis of lung tissue due to blockage of one of the branches of the pulmonary artery.
• Occurs less often kidney infarction. splenic infarction. bowel infarction .

Causes of a heart attack

The root cause of a heart attack is always a violation of blood flow through a vessel that feeds a certain area of ​​​​an organ. Such a violation of the blood flow, as we said above, can occur due to thrombosis or embolism (blockage) of the vessel, with a rupture of the vessel and with its sharp compression. An important role in the development of a heart attack of various organs is played by diseases of the blood vessels themselves: atherosclerosis (disease of the walls of the arteries) and thrombosis of large veins (formation of migrating blood clots).

What happens during a heart attack?

With a heart attack, a tissue site of a certain organ dies, the dead tissue loses all the properties characteristic of its life activity: metabolism, performance of a certain function. The loss of function of a tissue site can adversely affect the functioning of the entire organ. The severity of organ malfunctions depends on the prevalence of the infarct zone (extensive infarction, microinfarction) and on the functional significance of the organ (section of the organ). Extensive heart attack can cause acute heart failure, cerebral infarction - the irreversible loss of a certain function (speech, movement, sensitivity). Small heart attack

What happens after a heart attack?

A heart attack (brain, heart, lung) is an extremely serious and dangerous condition with a high risk of death. If a person manages to survive after a heart attack, then recovery processes occur in the infarct zone, during which the resulting tissue defect is replaced by connective tissue. Such a replacement fills only the anatomical defect, but not the functional one. The connective tissue in our body plays the role of a certain filler, but it is not able to work, as the heart muscle, brain or other complex organs work.

myocardial infarction

Myocardial infarction is the death (necrosis) of a portion of the heart muscle. A heart attack occurs mainly due to a violation of blood flow through one of the branches of the coronary arteries (coronary arteries of the heart). The main cause 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 different parts of the heart muscle, but most often a 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) heart attack - 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 - a membrane covering the heart from the outside);
• Subendocardial infarction - infarction of a portion of the inner surface of the heart (endocardium - a membrane that covers the heart from the inside);
• Intramural infarction - localized in the thickness of the walls of the heart muscle;
• Transmural infarction - captures the entire thickness of the heart muscle.

Myocardial infarction - what happens, what is treated, how to prevent

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

The duration of human life in the XX-XXI centuries is increasing at a fantastic rate. In 1900, in the United States, an American could count on an average of 47 years of life, in 2010 - 75. The world's population is rapidly aging, advances in medicine and hygiene reduce the incidence and mortality from dangerous infections - as a result, those diseases that he used to fall upon a person just didn't make it. However, other facts should not be discounted - the obesity epidemic, recognized by WHO in 2011, environmental pollution, the sedentary lifestyle of the inhabitants of megacities and endless stress. The human heart is simply not designed for such loads - that's why it can't stand it.

heart disease

Myocardial infarction is a consequence of coronary heart disease. The arteries that deliver oxygen to the heart narrow, become covered from the inside with sclerotic plaques, or contract from a sharp spasm. The blood coagulates, one of the vessels is clogged with a thrombus. The heart muscle ceases to have enough oxygen, one or more sections are "cut off" from the blood supply. The heartbeat changes dramatically, hormones are released into the blood, the body tries to correct the situation on its own. Sometimes this succeeds - 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 during a medical examination. But, as a rule, the situation deteriorates very quickly. There is severe pain behind the sternum, radiating to the left arm, respiratory failure, a feeling of panic, the patient may die from pain shock. The part of the muscle affected by a heart attack quickly dies off. Cardiologists know about the rule of the "golden hour" - if within 90 minutes after a heart attack a blood clot is eliminated and the blood supply to the heart is restored, then complete healing is possible, the muscle will return to life. If the thrombus is not removed, tissue necrosis, heart failure occurs, formidable complications appear - pulmonary edema, cardiac arrhythmias, inflammation of the pericardium (heart bag), repeated heart attacks and even heart failure. 70% of deaths occur in the first few days after a heart attack.

If the body manages to cope with the disease, the dead parts of the 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, the risk of repeated heart attacks, angina attacks, arrhythmias and other cardiovascular diseases increases.

Warning signs

The risk group for a 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 in children. Before menopause, women suffer a heart attack half as often as men - estrogen hormones protect blood vessels, after menopause the statistics even out. Diabetes, hypertension, atherosclerosis, lupus erythematosus, preeclampsia of pregnancy, hypertrophy of the heart muscle, inflammatory diseases of the heart and blood vessels increase the likelihood of the disease. Contribute to heart attacks and bad habits - alcohol abuse, smoking (including passive), severe obesity, sedentary lifestyle, irascibility and aggressiveness (the boss, yelling at his subordinates, has every chance to go to the hospital directly from his office). If relatives in the ascending line have had heart attacks or strokes, this also increases the risk.

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

The abdominal form "pretends" to be acute pancreatitis, appendicitis, or stomach ulcers. There is severe pain in the abdomen (strictly above the navel), vomiting, hiccups, gases appear. Attention - but-shpa and analogues do not help, vomiting does not bring relief!

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

The cerebral form shows increasing signs of cerebrovascular accident and impending stroke. Attention - tomography shows that everything is in order with the brain!

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

A painless heart attack occurs in diabetic patients or against the background of severe stress with all the effort - a person can stop playing on stage, land a plane, complete an operation, etc. come out and die.

The diagnosis of "heart attack" is established using an electrocardiogram and a blood test that reveals a change 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 need to urgently call an ambulance - the sooner the patient gets to the hospital, the higher the chance of recovery. Before the arrival of a doctor, a person should be comfortably seated or laid down, unfastened the collar, belt, bra, etc. 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 there are signs of cardiac arrest, you need to start cardiopulmonary resuscitation and carry it out until the doctor arrives.

Tube in the heart

A heart attack requires complex treatment that restores the function of the heart muscle and prevents secondary complications and disability of the patient.

All patients are prescribed "fast" aspirin in a loading dose to fight 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 with 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 the coronary vessels. Through the femoral artery, a special catheter with a balloon or a folded 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 frees the lumen of the vessel, the mesh strengthens its walls, eliminating the problem.

If this is not enough or catheterization is difficult, an aortocoronary bypass operation is performed - using a piece of a vessel taken from the patient's arm or leg, the surgeon constructs a bypass for blood flow, bypassing the narrowed and damaged section of the vessel.

The last word in medicine is stem cell therapy for heart attack. The patient's own stem cells, either donated or taken from umbilical cord blood, are injected into the patient's blood. Within 6-12 months, according to the researchers, this allows you to restore the heart muscle, avoid complications associated with impaired heart function. But the method has not yet been introduced into wide 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 recovered. The process of muscle scarring takes about 6 months, during which time the development of late complications is possible. During the rehabilitation period, heavy physical exertion, emotional stress, intense sex and sports, alcohol, nicotine and overeating are prohibited. It is important to consult a doctor to develop an individual set of gymnastic exercises, take frequent walks, and get positive impressions. It makes sense to do yoga, study psychological relaxation techniques, 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.