Pre-infarction condition: causes, first signs and treatment. The main signs of a pre-infarction state Pre-infarction state briefly what it is

A pre-infarction condition is a disease associated with a sudden restriction of the blood supply to the heart muscle, which does not lead to the death of heart cells.

This term is often used by doctors to explain the seriousness and danger of the condition to the patient and his relatives, emphasizing the possibility of developing a myocardial infarction (MI for short). The diagnosis behind it is unstable angina.

A patient with a pre-infarction condition is at high enough risk of a life-threatening myocardial infarction, so he needs emergency medical care. With proper treatment, the danger to the health and life of a person with unstable angina is significantly reduced.

With the help of modern methods of drug therapy and minimally invasive surgical interventions, in many patients it is possible to almost completely get rid of the symptoms of a pre-infarction state and reduce the risk of developing myocardial infarction.

The problem of the pre-infarction state is dealt with by cardiologists, internists and cardiac surgeons.

Causes of pre-infarction condition

Three factors involved in the development of a preinfarction state:

Mismatch between the needs of the heart muscle and the delivery of blood through the coronary arteries.
Rupture of atherosclerotic plaque and thrombosis.
Spasm of the coronary arteries.

1. Mismatch between demand and oxygen delivery

Unstable angina occurs due to an increase in myocardial oxygen demand or due to a decrease in its delivery through the coronary arteries.

The increased need of the heart muscle for these substances can be caused by:

An increase in body temperature.
An increase in heart rate.
A very strong increase in blood pressure (BP).
Thyrotoxicosis (thyroid disease, in which a lot of thyroid hormones are produced).
Pheochromocytoma (a tumor of the adrenal gland that produces norepinephrine).
Use of cocaine or amphetamines.
aortic stenosis.
Congestive heart failure.

Reduced oxygen delivery can be caused by:

anemia
hypoxia (decrease in blood oxygen saturation);
decrease in blood pressure.

Doctors believe that the mismatch between the request and delivery of oxygen to the heart muscle is responsible for about a third of cases of pre-infarction.

2. Rupture of atherosclerotic plaque and thrombosis

Most cases of unstable angina are caused by a sudden narrowing of the lumen of the coronary artery, due to which there is a decrease in the blood supply to part of the heart muscle. This narrowing most often develops as a result of atherosclerosis, a disease in which fats and cholesterol are deposited in the inner layer of the arteries, forming plaques (atheromas). As the atherosclerotic plaque grows, it gradually causes narrowing of the lumen of the artery, causing the development of symptoms of stable angina.

Most cases of preinfarction are caused by atheroma rupture. At the site of damage to the vascular wall, a thrombus is formed, which sharply worsens the blood flow through the affected artery and causes symptoms of a pre-infarction state. This place is unstable, at any moment a blood clot that has arisen in it can completely block the coronary artery and cause MI.

3. Spasm of the coronary arteries

Rarely, a pre-infarction state can be caused by a spasm of the arteries, which temporarily cuts off blood flow and causes an angina attack. In most of these cases, atherosclerotic plaque is also involved in the occurrence of vasospasm. Other causes include cocaine use, cold weather, and emotional stress.

Characteristic symptoms

Signs of a pre-infarction state practically do not differ from the symptoms of a myocardial infarction, therefore, if they occur, it is urgent to consult a doctor. They belong to:

Pain, discomfort or tightness in the chest.
Increased sweating.
Dyspnea.
Nausea and vomiting.
Pain or discomfort in the back, neck, lower jaw, upper abdomen, arms or shoulders.
Dizziness or sudden weakness.
Accelerated heartbeat.

The clinical picture of unstable angina has the following characteristics:

symptoms started within the previous month and gradually become more severe;
angina attacks limit physical activity and daily activities;
symptoms suddenly become more frequent, severe and prolonged, they occur with less exercise;
an attack occurs at rest, without any exertion or stress. Some patients develop angina during sleep;
symptoms do not improve with rest or after taking nitroglycerin.

Compared with men, women with a pre-infarction condition are more likely to experience shortness of breath, nausea, pain in the back or lower jaw. Although the main first signs of unstable angina in both sexes are pain or discomfort in the heart area.

Diagnostics

Sometimes, based on the clinical picture, even an experienced cardiologist cannot distinguish a pre-infarction state from a real MI. To establish the correct diagnosis and determine the tactics of treatment, a patient with pain in the heart area is carried out:

Electrocardiography (ECG) is a test that records the electrical activity in the heart using electrodes attached to the patient's skin. Abnormal impulses may indicate oxygen deficiency in the myocardium. In many patients with a pre-infarction state, the ECG may be normal, especially if it is not recorded during an attack. In some patients, it is impossible to distinguish unstable angina pectoris from small-focal myocardial infarction using ECG.
Blood tests that detect certain substances that enter the bloodstream when heart cells die. With the help of these tests, a differential diagnosis is made between a pre-infarction state and myocardial infarction.
Echocardiography is an examination of the heart using ultrasound, which can be used to evaluate the contractile function of the heart, as well as to identify its structural disorders.

Treatment methods

Treatment of a preinfarction condition consists of two stages:

Pain relief.
Prevention of disease progression and development of MI.

To choose the right treatment tactics, doctors assess each patient's risk of developing cardiovascular complications in the near future. This assessment is carried out on a special scale, which includes the following indicators:

patient's age;
the presence of other risk factors for cardiovascular disease (such as smoking, high blood cholesterol, arterial hypertension, diabetes mellitus);
laboratory test results;
the nature of the ECG changes.

Based on an assessment of the risk of developing MI, doctors choose a conservative or invasive strategy for treating patients.

Conservative treatment strategy

A conservative strategy for the treatment of a pre-infarction state is used when the patient is at low risk of developing a heart attack in the near future. It involves the conduct of drug therapy, including the following groups of drugs:

Antiplatelet agents - prevent the formation of blood clots at the site of a damaged atherosclerotic plaque, worsening the aggregation (gluing) of platelets. It has been scientifically proven that the use of antiplatelet agents in patients with a pre-infarction state reduces the risk of MI and stroke. The most commonly prescribed drugs in this group are aspirin, clopidogrel (Plavix) and ticagrelor (Brilint). The main side effect of antiplatelet agents is an increased risk of bleeding.
Anticoagulants are drugs that affect blood clotting factors and prevent the formation of blood clots. These drugs are prescribed only in the acute period of the pre-infarction state. These include heparin, enoxaparin, fondaparinux.
Statins are drugs that lower blood cholesterol levels. These include atorvastatin, simvastatin, rosuvastatin.
Beta-blockers are antiarrhythmic drugs that lower blood pressure and pulse rate. Due to these effects, beta-blockers reduce the workload on the heart and reduce the risk of MI. This group includes metoprolol, nebivolol, bisoprolol, carvedilol.
Angiotensin-converting enzyme inhibitors are drugs that help relax blood vessels, lower blood pressure and reduce the workload on the heart. These include ramipril, perindopril, lisinopril.
Nitrates are drugs that dilate blood vessels. Thanks to this action, they improve the blood supply to the myocardium and alleviate an attack of angina pectoris. Despite being effective in relieving cardiac pain, nitrates do not reduce mortality or the risk of MI. The most commonly used drugs include nitroglycerin and nitrosorbitol.

If medical therapy fails to relieve pre-infarction symptoms, doctors recommend an invasive treatment strategy.

Invasive treatment strategy

An invasive treatment strategy is used in patients with unstable angina who are at high risk of developing MI or when conservative medical therapy has failed.

The goal of the invasive strategy is to locate the narrowing of the coronary artery that is responsible for the onset of the preinfarction condition and to eliminate it.

Click on photo to enlarge

To detect the pathology of the coronary arteries, coronary angiography is performed - a minimally invasive examination, during which a contrast agent is injected into the lumen of these vessels using a thin catheter and x-rays are taken. After conducting coronary angiography and identifying places of narrowing of the arteries of the heart, doctors can restore their patency using:

Angioplasty and stenting is a minimally invasive operation that consists in expanding the lumen of the artery using a special balloon and a stent (intravascular prosthesis) brought to the site of narrowing of the vessel using a thin catheter.
Bypass surgery is an open heart surgery in which cardiac surgeons create a bypass for blood flow (bypass) bypassing the site of a narrowed coronary artery.

With the help of these operations, in most patients, it is possible to significantly improve the blood supply to the heart muscle and avoid the development of myocardial infarction. It should be remembered that surgical treatment of unstable angina does not mean that drug therapy can be abandoned.

Lifestyle change

Regardless of the chosen treatment strategy, all patients with a diagnosis of "preinfarction" are recommended to adhere to the rules of a healthy lifestyle, which includes the following:

to give up smoking;
healthy eating;
physical activity;
blood pressure control;
maintaining normal weight;
refusal to abuse alcohol;
stress control.

Forecast

The prognosis for unstable angina depends on many factors that affect the risk of myocardial infarction. According to statistics, the pre-infarction condition leads to the death of 4.8% of patients within 6 months.

Pre-infarction state: what is it, manifestations, how to identify and prevent development

A pre-infarction state is nothing more than unstable angina. It can be classified as acute coronary syndrome - the most dangerous heart disease. But it's still not a heart attack. With timely first aid and further competent treatment, an attack may recede.

Not all patients respond correctly to the first signs of a formidable disease, and therefore an unreasonably large percentage of deaths from a heart attack. This is unfortunate, because today cardiologists have the richest modern arsenal of effective methods for treating the most complex cardiac pathologies.

Etiology

Myocardial infarction is the cessation of nutrition of the heart muscle due to impaired conduction of the coronary arteries. The pre-infarction state is characterized by narrowing of the arteries supplying the heart muscle. The lumen of the vessels narrows against the background of spasm, blockage by an atherosclerotic plaque or thrombus, and the blood supply to the myocardium worsens.

This state is called:

stress;
Nervous fatigue;
Hypertensive crises;
Flu and other respiratory infections;
An overdose of alcoholic beverages;
Unaccustomed physical overload;
Heatstroke;
Overdose of medications;
hypothermia;
Smoking.

How to recognize a pre-infarction condition?

A state bordering on a heart attack appears against the background of progressive advanced angina pectoris. If treatment is insufficient or not carried out at all, myocardial infarction may develop with the addition of provoking factors. Sometimes there is a spontaneous relief of the development of the disease, and the patient recovers. With the progression of the symptoms of a pre-infarction state, severe retrosternal pain is noted, resembling the pain syndrome of angina pectoris. The pain can only intensify, and attacks occur more and more often. The consequence of this may be the gradual necrosis of part of the heart muscle.

The target of pre-infarction pain can be the hands, sublingual and subclavian areas, the right side of the chest. The patient has a terrible fear of death. Sometimes people are even afraid to stand up. There is a strong tachycardia, the patient is agitated and restless. Sometimes the patient feels suffocation and nausea. Often there are sensations in the form of cutting or aching pain, which increases with an increase in the load on the body.

Basically, the pain decreases when the patient is at rest and takes a large number of cardiological drugs.

Unfortunately, there are signs of a pre-infarction condition, by which it is very difficult to recognize it. Atypical symptoms appear as:

typical irradiation of pain in a heart attack

drowsiness;
insomnia;
Weaknesses;
dizziness;
Irritability;
cyanosis;
Shortness of breath at rest (20 or more breaths per minute);
absence of pain;
Acute bursting pain in the lower jaw;
Burning in the epigastric region;
Pain in the epigastrium (more often in women), extending to the left sternum or upper abdomen.

A person cannot lie down; when sitting, he clings strongly to surrounding objects.

Sometimes patients complain of pain in the back (upper part), extending to the shoulder. Often even doctors mistake these symptoms for cervicothoracic osteochondrosis, prescribe an X-ray examination and miss the time.

In atypical forms of preinfarction, an electrocardiogram should be urgently done. Only an ECG will show paroxysmal tachycardia, extrasystole, or insufficient blood circulation (in the event of an impending cardiac catastrophe).

Atypical forms are often noted in elderly patients (men and women) and the elderly. Such symptoms require particularly close attention for the appointment of timely adequate treatment.

How long does the prodromal period last?

The duration of the pre-infarction state in different patients can be different: for some it is only 3 days, while for others it is 3 weeks or more. But it does not mean at all that the longer the harbinger of the disease lasts, the more favorable the outcome and vice versa. How this period ends - MI or recovery - depends on timely and accurate diagnosis.

If the patient has at least a few symptoms of the disease, an urgent examination and, according to indications, hospitalization are necessary.

Diagnostics

First, the doctor listens to the patient's complaints, analyzes the symptoms and takes an anamnesis. Further, in order to confirm his guesses, the doctor appoints a series of studies:

echocardiography

Echocardiography can detect:

Electrocardiogram

As a result of this study, it is possible to determine ischemic disorders (areas of the myocardium with poor blood supply), arrhythmias, the position of the heart, infarct scars. In addition, you can see the occurred heart attack.

magnetic resonance imaging

With the help of MRI, the blood supply to the myocardium is assessed, the presence of ischemia is determined and its development is predicted, tumors and myocardial infarction are detected. The quality of the study is significantly improved if contrast agents are introduced into the body. This method is called MR angiocardiography.

Coronary angiography

With the radiopaque method, the coronary vessels are examined. A contrast agent is injected into the blood, thanks to which the coronary vessels become clearly visible. You can see where the vessel is narrowed, how dangerous the situation is. This study helps to develop a plan for future treatment.

Holter monitoring

The work of the heart can be traced for 24 hours. Using a small device, a cardiogram is recorded. A special computer program processes the results. This method allows you to identify hidden cardiac arrhythmias and myocardial ischemia. Blood pressure is also monitored. Using this method, the development of a pre-infarction state is usually monitored. With a heart attack, it is not suitable, since time in this case goes by minutes.

In addition to hardware methods for examining the heart, the patient is shown to take biochemical blood tests. Elevated levels of troponin and creatine kinase enzymes may indicate the development of myocardial infarction or progressive unstable angina.

Emergency Methods

The main thing that needs to be done is to stop the pain syndrome and prevent a heart catastrophe. First of all, the patient should get rest and fresh air. Before the arrival of the ambulance, you should take nitroglycerin (1-2 tablets). If after taking the medicine you feel dizzy or have a headache, there is no need to panic - this is not dangerous and usually passes after a while.

You can not take a large dose of nitroglycerin - this can lead to a sharp drop in blood pressure.

Instead of glycerin, you can put a validol tablet or a few drops of a liquid agent on sugar under the tongue. If the patient was previously helped to eliminate the pain of valocordin or corvalol, then these drugs can also be used. They can also improve myocardial blood supply by dilating blood vessels.

You can reduce the likelihood of blood clots with an aspirin tablet. Aspirin thins the blood, which significantly improves the prognosis of the disease.

Video: myocardial infarction - how to recognize, first aid

Therapeutic measures

Treatment of a pre-infarction condition is aimed at preventing the actual heart attack. It is not much different from the treatment of advanced angina. To reduce the load on the heart muscle, bed rest is prescribed.

Medical therapy

Myocardial oxygen requirements are reduced when taking beta-blockers. When they act, the strength and frequency of heart contractions, which inhibit the conduction of the myocardium, decrease.

Reduce the need of the heart muscle for oxygen and also contribute to its better transportation through the vessels of prolonged preparations of the nitroglycerin series - sustak, sustonitis, trinitrolong, sustabukkal, as well as nitroglycerin itself.

To prevent coronary thrombosis, an old proven remedy, heparin, is used as an alternative to aspirin. This medicine exhibits not only anticoagulant properties, but also reduces the number of angina attacks. Also, when using this drug, lipid metabolism improves, which is important for the treatment of a pre-infarction condition.

If the cause of anginal attacks is a spastic component, then it is recommended to take drugs that represent a group of calcium antagonists. When the concentration of calcium cations in the cells of the myocardium and blood vessels decreases, the arteries of the heart expand. As a result, blood flow improves, oxygen supply to the heart muscle. Such antispastic agents include corinfar, nifedipine, isoptin and others.

During treatment, the state of the heart muscle and blood vessels is monitored using an ECG. Physical activity is prohibited during this time. Sometimes it is recommended to extend the rest mode to one month or more. Usually during this time, coronary insufficiency is compensated, and the patient is on the mend.

In more severe cases, when drug therapy does not give the desired result, surgical treatment is performed - usually coronary artery bypass grafting. It should be said that the operation does not guarantee a complete cure.

In the case of an attack, the patient needs to understand that under unfavorable conditions for the body, atherosclerotic plaques in the coronary vessels will reappear and the lumen of the arteries will inevitably decrease.

How to avoid illness

For the prevention of ischemic attacks it is necessary:

Regularly take prescribed medications;
Control blood counts, especially cholesterol;
Quit smoking;
Move more;
Control blood pressure;
Lose weight;
Avoid stress.

The first signs of a pre-infarction condition - symptoms, first aid and hospital treatment

Mortality from heart disease is constantly at the top of the ranking of causes of death in modern Russia. The main problem is that many patients are not even aware of the possible danger and write off the symptoms of an impending myocardial infarction as a general malaise. Unstable angina (pre-infarction condition) is successfully treated if timely attention is paid to specific pain and secondary side effects.

What is a pre-infarction condition

Actually, myocardial infarction itself is the death of a section of the heart muscle due to the cessation of its supply by the coronary artery. The pre-infarction state is the development of the disease, which is characterized by an increase in the frequency of attacks. The pain symptom at this moment is not stopped by nitroglycerin or similar drugs, the arteries that feed the heart muscle are narrowed to a minimum. Also, the cause may be blockage of blood vessels by a thrombus or atherosclerotic plaque. The preinfarction state is provoked by the following factors:

constant stressful situations;
emotional stress;
severe respiratory diseases (flu);
alcohol intoxication;
heat stroke;
smoking;
drug overdose;
hypothermia;
hypertensive crisis.

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Symptoms

The cause of the preinfarction state is progressive angina pectoris. If atypical symptoms are ignored, the degree of development of myocardial infarction is high, therefore, patients with an established diagnosis should be attentive to any deterioration in well-being, increased pain, and an increase in the number of attacks. The main symptoms of a pre-infarction state:

there are pains behind the sternum, under the right shoulder blade, in the region of the collarbone, hands, sometimes migrating to the lower jaw and parts of the face;
high frequency of attacks, more than with angina pectoris;
the patient experiences anxiety, panic attacks;
increased emotionality and arousal;
there is a strong tachycardia;
resistance to the usual cardio drugs;
drowsiness or insomnia;
cyanosis;
dizziness;
dyspnea;
weakness.

Among women

The peculiarity of this problem is that the symptoms of a pre-infarction state in women can differ significantly from those in men. For the representatives of the weaker sex, it can be characteristic: there is a slight pain behind the sternum or its complete absence, localization of the pain syndrome in the abdomen, shortness of breath, irritation and aggressiveness, nausea, back pain. Due to such uncharacteristic manifestations, the moment of correct diagnosis is often missed.

In men

The symptoms of a pre-infarction condition in men are more pronounced and clearer, so it is easier to diagnose it. The main evidential argument is the general disruption of normal life after the first manifestations of acute coronary syndrome. During this period, urgent hospitalization is important. If the onset of unstable angina has been missed, there is less and less time left to prevent a heart attack.

First signs

When the patient is aware of the presence of angina pectoris, it is easier to determine the impending problem. However, for those people who first encountered such manifestations, it will be useful to know with what primary symptoms a threat can be recognized. It is important to remember that many of these signs alone are often the result of overwork. Possible symptoms before a heart attack:

the problems described above continue for a month with increasing severity of manifestation;
angina pectoris does not allow you to fully work and lead a familiar life;
symptoms occur even with minimal stress on the body or at rest;
nitroglycerin does not eliminate the manifestations of the disease, and they do not go away at rest.

How to distinguish a pre-infarction condition from a heart attack

Only a specialist cardiologist can determine the diagnosis in the case of a heart attack or acute coronary syndrome. For this, the medical history is used as an archive of observations of the patient's condition, a complex of pronounced symptoms, blood tests for biochemistry, myoglobin, MB fractions, ECG, ECHO-KG, coronary angiography. The patient himself can, based on his feelings, assume a worsening of his illness. Attention should be paid to the following symptoms of a pre-infarction condition:

change in the usual localization of pain, duration and intensity;
the appearance of new pain manifestations;
different from the usual conditions for the onset of symptoms;
increased seizures;
decrease in the effectiveness of nitroglycerin.

How long does the prodromal period last?

The clinical state of the pre-infarction state does not have a clear time frame. Depending on the general condition of the patient, his rhythm of life, age, this period lasts from 2-3 days to 3 weeks or longer. At the same time, there is no relationship between the duration of the prodromal state and the prospect of a positive recovery (in some cases, the pre-infarction period, which lasts a long time, is much more catastrophic for the patient's heart than a sharp deterioration, which was identified and stopped in time).

Diagnostics

Modern medicine has a whole range of diagnostics of work and the heart and the identification of conditions that threaten a heart attack. The history of the patient and his specific symptoms only sets the direction for a comprehensive investigation. It is important to remember that even the combination of the above manifestations does not necessarily indicate a heart attack or a prodromal condition. To make an accurate diagnosis, use:

echocardiography: reveals the pathology of the departments and tissues of the heart, the presence of scars from heart attacks, defects, blood clots, tumors, aneurysms;
electrocardiogram: helps to determine ischemic disorders, the position of the heart, arrhythmia, fixes a heart attack that has occurred (this tool is the first to diagnose the problem that has occurred);
MRI (magnetic resonance imaging using a contrast agent): this method will help assess the quality of the blood supply to the heart, the presence of tumors, ischemia (in fact, even predict its development);
Holter monitoring - is considered one of the most reliable ways to determine the dynamics of the heart, since it analyzes data for 24 hours, highlights recurring exacerbations and draws up a rhythmic picture (a small device is put on the patient and continuously records readings);
coronary angiography: an invasive form of examination of the coronary artery, which helps to determine the patency of the vessel, the thickness and condition of the walls;
additional studies in the unclear etiology of heart problems.

Treatment

The prodromal condition is not treated only by relieving symptoms, which patients often stop at. Even without the presence of pain, insufficient vascular patency remains. A heart attack in this case will be a tragic surprise, which often ends in death. Hospitalization in case of suspicion is mandatory. In the hospital, based on the patient's analyzes and the studies performed (ECG, ECHO-KG), a specific drug treatment of the pre-infarction condition is prescribed.

Urgent care

Timely first aid for a pre-infarction condition will help save the patient's life until the ambulance arrives. The first thing to do is to stop the pain manifestations (1-2 tablets of nitroglycerin or analogues). It is important to remember that the drug may not help if the attack is severe. The second is to provide peace and fresh air to the patient. You can also take Validol, Valocordin or Corvalol, if they have previously helped to relieve pain. To reduce blood clots, you should take aspirin.

Medical therapy

A complex of drugs is selected by a cardiologist depending on the severity of the pre-infarction state, the age of the patient and individual tolerance. The main direction of influence is the relief of pain manifestations, the rehabilitation of blood vessels and the heart muscle. Heparin or its analogues are used to prevent thrombosis. Nitroglycerin is administered intravenously to regulate the supply of oxygen to the muscle and can be replaced by Sustak, Trinitrolong, Sustonit, Sustabukkal.

Nutrition in a pre-infarction state

Experts constantly say that the main cause of heart problems is an unhealthy lifestyle. Problems arise due to unbalanced nutrition, which leads to obesity, deterioration of vascular patency, and poor functioning of internal organs. A diet in a pre-infarction condition is not much different from the usual recommendations of nutritionists:

complete rejection of salty, sweet, fatty, smoked;
replace corn and sunflower oil with olive oil;
increase the amount of dairy products (calcium) in the diet;
give preference to fresh vegetables and fruits;
exclude alcohol, strong coffee, tea.

Effects

The habit of many patients to stoically endure difficulties and problems without going to the doctors leads to the fact that the prodromal state provokes a full-fledged heart attack, which often ends in death. Even after successful treatment, the patient should regularly visit a cardiologist and control his heart, because against the background of a crisis, tachycardia, shortness of breath, heart aneurysm, heart failure and a whole range of diseases develop.

Prevention

The main set of measures to prevent a pre-infarction condition is the banal observance of the rules of a healthy lifestyle: controlling one's own weight, being in an emotionally positive environment, minimizing or completely quitting the use of alcohol and cigarettes, proper nutrition, and physical activity. Separately, it is worth reminding patients with diagnosed heart problems about the control of blood pressure, the state of the vessels, the quality of the blood composition and the need to be regularly observed by a specialist.

Video

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

A pre-infarction state is a complex of specific signs that a person can feel before a critical lack of blood circulation through the coronary vessels. Correct interpretation of the symptoms allows timely provision of first, pre-medical and specialized assistance to the patient and prevent death.

Thirdly, to stabilize the effect, maintenance therapy is prescribed and recommendations are given for lifestyle correction.

Medical therapy

The main groups of drugs that are used to treat pre-infarction condition:

Antianginal agents: beta-blockers (metoprolol, atenolol, propranolol), nitrates (nitroglycerin, nitrosorbide), calcium antagonists (nifedipine, diltiazem, verapamil).
: , clopidogrel, cardiomagnyl.
Anticoagulants: heparin, fraxiparin.

Depending on the cause of the pre-infarction condition, other medications may also be needed: antihypertensive drugs, membrane protectors (also called statins: atorvastatin, rosuvastatin) and other cholesterol-lowering drugs.

Lifestyle change

After a case of manifestation of a pre-infarction state, along with drug therapy, the patient needs to radically reconsider his lifestyle:

Get rid of excess body weight, if present.
Normalize the diet: a strict diet is recommended with the addition of plant foods to the menu and the maximum reduction in fat (fried foods, canned food, fast food are excluded).
Physical therapy classes (the most favorable are such types of physical activity as yoga, stretch gymnastics, Pilates).
Getting rid of bad habits: quitting smoking, alcohol, drugs.

When is surgery required?

Surgical intervention is necessary for persistent organic changes that lead to manifestations of a pre-infarction state:

Anatomical narrowing of the coronary arteries.
Atherosclerotic lesions of the coronary arteries, making conservative treatment ineffective.
thrombus formation.

Forecast of later life

With the right approach to the treatment of a patient with a pre-infarction condition, a favorable prognosis for recovery is given in 85% of cases, only 10% of patients, despite all the measures, still have a heart attack, and the remaining 5% have sudden cardiac death. So we can safely say that the survival rate for this pathology is quite high.

Drug therapy is effective in 75% of patients, the rest require surgical intervention for a favorable prognosis.

The quality of life of patients deteriorates significantly. To prevent relapse, patients need to take drugs for life. The risk of developing myocardial infarction in the future in such people increases.

A pre-infarction state is a cessation of nutrition of any part of the heart muscle for various reasons, but always due to local vasospasm or blockage. Causes and risk factors in this case: hypertensive crises, nervous fatigue, stress, alcohol overdose, physical activity unusual for this person, hypothermia, heat stroke, smoking, overeating. This condition in healthy people can very rarely occur theoretically, but in practice there should always be ground for the development of a heart attack - this, of course, is coronary artery disease, atherosclerosis, hypertension. The pre-infarction state is otherwise called a precursor or prodromal period of MI (myocardial infarction). It can last from several days to several weeks. In this state, we are always talking about a deterioration in cardiac circulation, and it is then that the next stage of the disease, the heart attack itself, can be prevented.

Classification of pathology

WHO usually classifies pre-infarction as unstable angina, which has several forms:

1. Angina pectoris, first registered in a person within the last month.
2. Progressive angina pectoris (a person already has, but recently her attacks have become more frequent and worse).
3. Early postinfarction angina pectoris: the onset of pain within a month after myocardial infarction.
4. Angina pectoris after heart surgery (coronary bypass grafting).
5. Prinzmetal's angina: pain occurs in the early morning hours.

In any case, the pre-infarction state develops with neglected and untreated angina pectoris, it is also called acute coronary syndrome. But still, this is not the heart attack itself, with the right measures, the attack can stop and not go into MI.

Inherent symptoms

Signs of a pre-infarction state are varied, but the main symptom is pain. It can be localized behind the sternum, in the epigastric region (abdominal syndrome), in the right iliac region, and even in the lower jaw. The pain radiates (gives) to the left shoulder, arm, shoulder blade, under the tongue. The patient becomes excited, he rushes about, there is a fear of death, so strong that the person is afraid to even get up. The pain may not be in the classical sense, but in the form of a burning sensation behind the sternum, severe pressure, heaviness in the region of the heart. It increases with exercise, decreases at rest and when taking cardio drugs.

The pain attack lasts an average of 1 to 20 minutes, with progression, the attacks will become more frequent and stronger. Another symptom is a rapid heartbeat (tachycardia), a feeling of lack of air, suffocation, causeless shortness of breath with a respiratory rate of more than 20 per minute, numbness of the fingers of the left hand, the patient is in a forced position - sitting, resting on his hands, holding on to some objects. There is a cold sweat, blanching of the face, pressure may increase. Signs of preinfarction in men fit into the description of the above picture.

Elderly patients may not have pain, then they talk about an atypical course of the process. In this case, symptoms can manifest as drowsiness, especially daytime, weakness, dizziness, shortness of breath, irritability, cyanosis of the lips, nose, nails, heartburn, even nausea and vomiting. The duration of the pre-infarction state of the outcome of the disease does not determine, everything depends on the correct diagnosis and assistance. Patients may experience pain in the upper back, and if the doctor regards this as cervical osteochondrosis and prescribes physiotherapy, time may be lost. If even a few of these symptoms are present, the patient must be hospitalized.

Signs of preinfarction in women may differ in the lack of symptoms, because. women have a higher pain threshold. Their pain may be in the form of tingling or discomfort in the epigastrium, abdomen, dizziness, difficulty breathing may occur, a woman is able to take this for fatigue and not take action. Or vice versa, women may have severe pain, frequent attacks up to 20-30 times a day, especially at night or in the early morning hours, they last about 30 minutes and are not relieved by taking nitroglycerin. Non-stopping seizures indicate a developing threat of MI. The pre-infarction state eventually leads to necrosis (necrosis) of some part of the heart muscle.

Diagnostic measures

If you suspect a heart attack or a pre-infarction condition, you should not hesitate, you need to call an ambulance, better a specialized team, which should first do an ECG. What to do before the ambulance arrives will be discussed below. Of course, almost any doctor knows how to determine a pre-infarction condition, the clinic plays an important role in making a diagnosis, but changes in ECG waves are decisive. In patients who have had an angina attack for the first time, the electrocardiogram will show changes in the form of segment displacement, T wave changes, conduction and heart rhythm disturbances. The cardiogram is especially important in the case of an atypical form of a pre-infarction state, extrasystoles, paroxysmal tachycardia and circulatory failure will be recorded on it.

If the attack has receded, it cannot be considered that the person has recovered, an examination by a cardiologist is mandatory for everyone without exception. In addition to the ECG, the doctor will prescribe coronary angiography (the introduction of a contrast agent into the vessels will show the vasoconstriction and their localization on the x-ray, tell you how dangerous the situation is, i.e. help determine the plan for further treatment), ultrasound of the heart, Doppler study and MRI. As laboratory tests, it is necessary to donate blood for the content of 3 indicators in it: troponin (normally does not occur in the blood), creatine phosphokinase (an increase in indicators above 5.8 ng / l) and CRP. On an echocardiogram, you can determine the presence of scars from past heart attacks, heart defects, symptoms of poor circulation, aneurysm (expansion) of the heart.

An ECG will show ischemic areas, arrhythmias, infarct scars. MRI evaluates the blood supply to the myocardium, determines the presence of ischemia and predicts its development. Recently, Holter monitoring has been used, i.e. monitor the work of the heart with attached sensors for 24 hours. Then the results are processed, they can reveal hidden rhythm disturbances, control pressure and determine myocardial ischemia. The method is applicable after the removal of the attack. All of these studies are prescribed to confirm or exclude the suspicion of myocardial ischemia, i.e. to an advanced cardiac event. What to do during an attack?

Help and treatment of the disease

First of all, the called ambulance should urgently hospitalize patients who have a history of unstable angina. To relieve pain before the arrival of the ambulance, you need to take an Aspirin tablet (chew) to thin the blood and to avoid the appearance of blood clots. You also need to take a Nitroglycerin tablet under the tongue with an interval of 5-10 minutes until the spasm is relieved. Nitroglycerin should not be taken more than 3 tablets, because. it will cause the pressure to drop. Dizziness or headache when taking nitroglycerin will go away on its own, this is a temporary phenomenon.

You can put a tablet of Validol under the tongue or drop it on sugar, you can also give drops of Corvalol or Valocordin, if they are in the patient's first aid kit. All these drugs dilate the coronary vessels and relieve pain. The patient needs to be provided with access to fresh air, but not cold, the person should lie down to reduce the load on the heart. Modern cardiologists say that if there are the first signs of a pre-infarction, the delay in death is similar. A person has the so-called first golden hour, during which he must get to the doctors, in this case, surgeons will be able to expand the narrowed vessel surgically by inserting a frame into it, and restore blood circulation in the heart muscle, avoiding an impending heart attack.

Treatment for a pre-infarction state differs little from the prevention of a heart attack itself, because. aimed at relieving an attack of angina pectoris.

Intramuscularly, you can enter the patient Papaverine, No-shpu, Platifillin, which also have a vasodilating effect and will help in reducing pain. If the patient is hypertensive and pain in the heart is combined with an increase in pressure, intravenous administration of Eufillin diluted with saline is necessary.

After intensive care in a hospital after a receding attack, treatment must be continued, it must be long enough. Among the prescribed drugs should be called:

1. Antiplatelet agents for blood thinning and prevention of agglutination of blood clots: Heparin, Cardiomagnyl, Thrombo ACC.
2. Beta-blockers improve myocardial conduction.
3. Statins lower cholesterol, the main culprit in blood clots.
4. Calcium antagonists (reduce the content of calcium ions in the blood, the consequence of this is the expansion of the vessels of the heart, the removal of spasm): Corinfar, Nifedipine, Isoptin, etc.
5. Nitrates (reduce myocardial oxygen demand and facilitate its work): Sustak, Nitrong, Trinitrolong, etc.

Regularly in the course of treatment, an ECG is performed to monitor the state of the heart muscle and select treatment and behavior tactics, moderate physical activity, sanatorium treatment, and rehabilitation measures are prescribed.

In severe cases, in the absence of the effect of therapeutic prescriptions, the patient may undergo surgical treatment (in a planned manner to improve the condition). This may be coronary artery bypass grafting, aortic balloon counterpulsation. The effect of the operation may be longer if the patient reconsiders his lifestyle in general, follows a diet with salt restriction, high content of fiber, fruits, vegetables, fish instead of meat, with the exception of animal fats. Moderate physical activity is good for the heart: therapeutic walking, cycling.

A pre-infarction condition is a disease associated with a sudden restriction of the blood supply to the heart muscle, which does not lead to the death of heart cells.

The problem of the pre-infarction state is dealt with by cardiologists, internists and cardiac surgeons.

Causes of pre-infarction condition

Three factors involved in the development of a preinfarction state:

Mismatch between the needs of the heart muscle and the delivery of blood through the coronary arteries.
Rupture of atherosclerotic plaque and thrombosis.
Spasm of the coronary arteries.

1. Mismatch between demand and oxygen delivery

Unstable angina occurs due to an increase in myocardial oxygen demand or due to a decrease in its delivery through the coronary arteries.

The increased need of the heart muscle for these substances can be caused by:

An increase in body temperature.
An increase in heart rate.
A very strong increase in blood pressure (BP).
Thyrotoxicosis (thyroid disease, in which a lot of thyroid hormones are produced).
Pheochromocytoma (a tumor of the adrenal gland that produces norepinephrine).
Use of cocaine or amphetamines.
aortic stenosis.
Congestive heart failure.

Reduced oxygen delivery can be caused by:

anemia
hypoxia (decrease in blood oxygen saturation);
decrease in blood pressure.

Doctors believe that the mismatch between the request and delivery of oxygen to the heart muscle is responsible for about a third of cases of pre-infarction.

2. Rupture of atherosclerotic plaque and thrombosis

Most cases of preinfarction are caused by atheroma rupture. At the site of damage to the vascular wall, a thrombus forms, which sharply worsens the blood flow through the affected artery and causes. This place is unstable, at any moment a blood clot that has arisen in it can completely block the coronary artery and cause MI.

3. Spasm of the coronary arteries

Characteristic symptoms

Signs of a pre-infarction state practically do not differ from the symptoms of a myocardial infarction, therefore, if they occur, it is urgent to consult a doctor. They belong to:

Pain, discomfort or tightness in the chest.
Increased sweating.
Dyspnea.
Nausea and vomiting.
Pain or discomfort in the back, neck, lower jaw, upper abdomen, arms or shoulders.
Dizziness or sudden weakness.
Accelerated heartbeat.

The clinical picture of unstable angina has the following characteristics:

symptoms started within the previous month and gradually become more severe;
angina attacks limit physical activity and daily activities;
symptoms suddenly become more frequent, severe and prolonged, they occur with less exercise;
an attack occurs at rest, without any exertion or stress. Some patients develop angina during sleep;
symptoms do not improve with rest or after taking nitroglycerin.

Diagnostics

Electrocardiography (ECG) is a test that records the electrical activity in the heart using electrodes attached to the patient's skin. Abnormal impulses may indicate oxygen deficiency in the myocardium. In many patients with a pre-infarction state, the ECG may be normal, especially if it is not recorded during an attack. In some patients, it is impossible to distinguish unstable angina pectoris from small-focal myocardial infarction using ECG.
Blood tests that detect certain substances that enter the bloodstream when heart cells die. With the help of these tests, a differential diagnosis is made between a pre-infarction state and myocardial infarction.
Echocardiography is an examination of the heart using ultrasound, which can be used to evaluate the contractile function of the heart, as well as to identify its structural disorders.

Treatment methods

Treatment of a preinfarction condition consists of two stages:

Pain relief.
Prevention of disease progression and development of MI.

patient's age;
the presence of other risk factors for cardiovascular disease (such as smoking, high blood cholesterol, arterial hypertension, diabetes mellitus);
laboratory test results;
the nature of the ECG changes.

Based on an assessment of the risk of developing MI, doctors choose a conservative or invasive strategy for treating patients.

Conservative treatment strategy

Antiplatelet agents - prevent the formation of blood clots at the site of a damaged atherosclerotic plaque, worsening the aggregation (gluing) of platelets. It has been scientifically proven that the use of antiplatelet agents in patients with a pre-infarction state reduces the risk of MI and stroke. The most commonly prescribed drugs in this group are aspirin, clopidogrel (Plavix) and ticagrelor (Brilint). The main side effect of antiplatelet agents is an increased risk of bleeding.
Anticoagulants are drugs that affect blood clotting factors and prevent the formation of blood clots. These drugs are prescribed only in the acute period of the pre-infarction state. These include heparin, enoxaparin, fondaparinux.
Statins are drugs that lower blood cholesterol levels. These include atorvastatin, simvastatin, rosuvastatin.
Beta-blockers are antiarrhythmic drugs that lower blood pressure and pulse rate. Due to these effects, beta-blockers reduce the workload on the heart and reduce the risk of MI. This group includes metoprolol, nebivolol, bisoprolol, carvedilol.
Angiotensin-converting enzyme inhibitors are drugs that help relax blood vessels, lower blood pressure and reduce the workload on the heart. These include ramipril, perindopril, lisinopril.
Nitrates are drugs that dilate blood vessels. Thanks to this action, they improve the blood supply to the myocardium and alleviate an attack of angina pectoris. Despite being effective in relieving cardiac pain, nitrates do not reduce mortality or the risk of MI. The most commonly used drugs include nitroglycerin and nitrosorbitol.

If medical therapy fails to relieve pre-infarction symptoms, doctors recommend an invasive treatment strategy.

Invasive treatment strategy

An invasive treatment strategy is used in patients with unstable angina who are at high risk of developing MI or when conservative medical therapy has failed.

The goal of the invasive strategy is to locate the narrowing of the coronary artery that is responsible for the onset of the preinfarction condition and to eliminate it.

Click on photo to enlarge

Angioplasty and stenting is a minimally invasive operation that consists in expanding the lumen of the artery using a special balloon and a stent (intravascular prosthesis) brought to the site of narrowing of the vessel using a thin catheter.
Bypass surgery is an open heart surgery in which cardiac surgeons create a bypass for blood flow (bypass) bypassing the site of a narrowed coronary artery.

Lifestyle change

Regardless of the chosen treatment strategy, all patients with a diagnosis of "preinfarction" are recommended to adhere to the rules of a healthy lifestyle, which includes the following:

to give up smoking;
healthy eating;
physical activity;
blood pressure control;
maintaining normal weight;
refusal to abuse alcohol;
stress control.

Forecast

Symptoms of a pre-infarction condition

Almost every person has heard of such a life-threatening pathology as myocardial infarction (hereinafter referred to as MI).

Under this condition, it is necessary to understand one of the clinical forms of coronary heart disease (hereinafter IHD), which is an absolute or partial coronary insufficiency of the myocardium, due to blockage of its arteries, followed by the development of necrosis (cessation of blood flow).

In this article, we will provide comprehensive information about the first signs and characteristic symptoms of myocardial infarction.

Cardiac ischemia

When does a heart attack occur?

Only in individual, isolated cases, MI can occur against the background of imaginary health. The sudden development of MI may be the result of blood clots entering the coronary vessels, very strong stresses, or it may be the result of a sharp vasospasm against the background of a sharp release of a large amount of adrenaline. Such events are rare in clinical practice. Basically, the development of MI has a certain ground - IHD, when the patient has arterial hypertension, atherosclerotic processes, as a result of which the vessels narrow.

With an established diagnosis of coronary artery disease, even in the early stages, when there are still no clinical symptoms and signs, a heart attack can occur against a background of a jump in blood pressure, severe stress or excessive physical exertion.

When does a heart attack occur?

In most cases, the development of MI against the background of ischemia is preceded by a prodromal period (harbingers), it can last for a long time - several weeks, and faster - only a couple of days.

Prodromal phenomena are associated with deterioration of the coronary circulation and are called the pre-infarction state. This is very important to remember, because it is at this time that you can recognize the symptoms in time and prevent myocardial infarction.

The clinical symptoms of a pre-infarction state directly depend on which part of the myocardium has undergone necrotic changes, its size and the individual characteristics of the organism of each particular patient.

The pre-infarction state is a consequence of local spasm of the coronary arteries against the background of narrowing of the vessel lumen by atherosclerotic plaques. As a result, the supply of a section of the heart muscle with blood and oxygen is difficult or even stops.

Spasms of the coronary arteries contribute to damage to the inner lining of the artery - the intima of the artery, it is in this place that a thrombus forms, which often completely blocks the access of oxygen - the result is a heart attack.

Etiology of pre-infarction condition

In clinical cardiology, a pre-infarction state is called unstable angina. Provoking factors include:

SARS;
arterial hypertension;
Physical and emotional overstrain;
sudden increase in physical activity

Main symptoms

Clinically, angina pectoris manifests itself through paroxysmal compressive or pressing pains behind the sternum, which often radiate to the lower jaw, left shoulder or arm, under the left shoulder blade, or even to the neck. Somewhat less often, the pain syndrome is felt in the right half of the body (between the shoulder blades and the stomach).

Seizures occur in the following cases:

Increased emotional arousal;

Stay in the cold.

Quite often, angina pectoris can be observed immediately after eating.

The duration of the pain attack is 1–15 minutes, it is stopped by taking nitroglycerin, and disappears on its own after the cessation of physical activity.

The prodromal period is characterized primarily by the fact that attacks occur after less pronounced physical activity than usual, or may occur at rest. As the prodrome progresses, the seizures become longer and more intense. To stop the attack, an increasing number of nitroglycerin tablets is needed.

How else does the pre-infarction state proceed?

Quite often, the clinical symptoms of a heart attack in women and men manifest themselves differently, they are called an atypical course. Atypical signs include:

Absence of pain syndrome;
Weakness;
Irritability;
Sleep disorders (drowsiness or insomnia);
Dizziness;
Shortness of breath from the rest stage;
Cyanosis.

An atypical form of a pre-infarction state can only be diagnosed using an ECG (presence of extrasystole, paroxysmal tachycardia, circulatory failure).

As a rule, this picture is observed in persons of elderly and senile age (75-90 years).

How else does the pre-infarction state proceed?

In some cases, on the eve of MI, an abdominal syndrome may be observed, in which pain radiates to the left side of the sternum and upper abdomen. The patient has the following symptoms:

Burning in the epigastric region;
Burning, cutting, aching or stabbing pain that increases with physical exertion, walking, stress.

The pain syndrome decreases at rest, as well as after taking high doses of cardiac drugs.

Patients may complain of pain in the upper back and in the left shoulder joint. Unfortunately, these symptoms of a microinfarction are sometimes mistakenly regarded as signs of cervicothoracic osteochondrosis or arthrosis. In such cases, patients mistakenly undergo x-rays and prescribe physiotherapeutic procedures that do not have a therapeutic effect, but, on the contrary, bring the development of a cardiac catastrophe closer.

Burning, cutting, aching or stabbing pain

Such symptoms should be given special attention, it is necessary for the timely diagnosis and appointment of necessary treatment even before the onset of MI.

What is the duration of this state?

As for the duration of the prodromal syndrome, it lasts no more than three days, and sometimes it can reach three weeks. The number of deaths during this period could have been much lower if it had been diagnosed in a timely and accurate manner. If the patient has the above symptoms of a heart attack, urgent hospitalization and complete rest are indicated.

An important place in the diagnosis of "pre-infarction condition" is occupied by clinical signs. To confirm the patient, the following diagnostic tests are mandatory:

Coronary angiography;
Ultrasound of the heart;
ECHO Doppler study;
Magnetic resonance imaging.

As a laboratory test, a biochemical blood test for enzymes can be prescribed, reflecting changes in the myocardium.

Basic principles of treatment

Absolutely all patients with a history of unstable angina must be urgently hospitalized in the cardiology department.

As therapeutic measures, the following can be prescribed:

anticoagulants and/or antiplatelet agents;
beta-blockers;
beds;
calcium antagonists;
nitrates.

Most of the drugs listed above are intended for parenteral administration.

In cases where conservative methods of therapy do not bring the desired result, surgical treatment is prescribed, for example:

coronary artery bypass grafting;
percutaneous angioplasty;
aortic balloon counterpulsation.

Preventive measures in the prodromal period of MI

As a preventive therapy for patients with ischemia, complex maintenance treatment of angina pectoris is prescribed:

It is necessary to monitor blood pressure indicators, laboratory control of cholesterol levels. An important place is occupied by dietary nutrition and a healthy lifestyle, including the rejection of addictions (alcohol, smoking).

Patients with a history of coronary artery disease are shown a good rest, therapeutic walking for training the heart muscle.

The first signs of a pre-infarction condition - symptoms, first aid and hospital treatment

What is a pre-infarction condition

constant stressful situations;
emotional stress;
severe respiratory diseases (flu);
alcohol intoxication;
heat stroke;
smoking;
drug overdose;
hypothermia;
hypertensive crisis.

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Symptoms

there are pains behind the sternum, under the right shoulder blade, in the region of the collarbone, hands, sometimes migrating to the lower jaw and parts of the face;
high frequency of attacks, more than with angina pectoris;
the patient experiences anxiety, panic attacks;
increased emotionality and arousal;
there is a strong tachycardia;
resistance to the usual cardio drugs;
drowsiness or insomnia;
cyanosis;
dizziness;
dyspnea;
weakness.

Among women

In men

First signs

the problems described above continue for a month with increasing severity of manifestation;
angina pectoris does not allow you to fully work and lead a familiar life;
symptoms occur even with minimal stress on the body or at rest;
nitroglycerin does not eliminate the manifestations of the disease, and they do not go away at rest.

How to distinguish a pre-infarction condition from a heart attack

change in the usual localization of pain, duration and intensity;
the appearance of new pain manifestations;
different from the usual conditions for the onset of symptoms;
increased seizures;
decrease in the effectiveness of nitroglycerin.

How long does the prodromal period last?

The clinical state of the pre-infarction state does not have a clear time frame. Depending on the general condition of the patient, his rhythm of life, age, this period lasts from 2-3 days to 3 weeks or longer. At the same time, there is no relationship between the duration of the prodromal state and the prospect of a positive recovery (in some cases, the pre-infarction period, which lasts a long time, is much more catastrophic for the patient's heart than a sharp deterioration, which was identified and stopped in time).

Diagnostics

echocardiography: reveals the pathology of the departments and tissues of the heart, the presence of scars from heart attacks, defects, blood clots, tumors, aneurysms;
electrocardiogram: helps to determine ischemic disorders, the position of the heart, arrhythmia, fixes a heart attack that has occurred (this tool is the first to diagnose the problem that has occurred);
MRI (magnetic resonance imaging using a contrast agent): this method will help assess the quality of the blood supply to the heart, the presence of tumors, ischemia (in fact, even predict its development);
Holter monitoring - is considered one of the most reliable ways to determine the dynamics of the heart, since it analyzes data for 24 hours, highlights recurring exacerbations and draws up a rhythmic picture (a small device is put on the patient and continuously records readings);
coronary angiography: an invasive form of examination of the coronary artery, which helps to determine the patency of the vessel, the thickness and condition of the walls;
additional studies in the unclear etiology of heart problems.

Treatment

Urgent care

Medical therapy

Nutrition in a pre-infarction state

complete rejection of salty, sweet, fatty, smoked;
replace corn and sunflower oil with olive oil;
increase the amount of dairy products (calcium) in the diet;
give preference to fresh vegetables and fruits;
exclude alcohol, strong coffee, tea.

Effects

Prevention

Pre-infarction state: what is it, manifestations, how to identify and prevent development

Etiology

This state is called:

stress;
Nervous fatigue;
Hypertensive crises;
Flu and other respiratory infections;
An overdose of alcoholic beverages;
Unaccustomed physical overload;
Heatstroke;
Overdose of medications;
hypothermia;
Smoking.

How to recognize a pre-infarction condition?

Basically, the pain decreases when the patient is at rest and takes a large number of cardiological drugs.

Unfortunately, there are signs of a pre-infarction condition, by which it is very difficult to recognize it. Atypical symptoms appear as:

typical irradiation of pain in a heart attack

drowsiness;
insomnia;
Weaknesses;
dizziness;
Irritability;
cyanosis;
Shortness of breath at rest (20 or more breaths per minute);
absence of pain;
Acute bursting pain in the lower jaw;
Burning in the epigastric region;
Pain in the epigastrium (more often in women), extending to the left sternum or upper abdomen.

A person cannot lie down; when sitting, he clings strongly to surrounding objects.

Atypical forms are often noted in elderly patients (men and women) and the elderly. Such symptoms require particularly close attention for the appointment of timely adequate treatment.

How long does the prodromal period last?

If the patient has at least a few symptoms of the disease, an urgent examination and, according to indications, hospitalization are necessary.

Diagnostics

First, the doctor listens to the patient's complaints, analyzes the symptoms and takes an anamnesis. Further, in order to confirm his guesses, the doctor appoints a series of studies:

echocardiography

Echocardiography can detect:

Electrocardiogram

magnetic resonance imaging

Coronary angiography

Holter monitoring

Emergency Methods

You can not take a large dose of nitroglycerin - this can lead to a sharp drop in blood pressure.

You can reduce the likelihood of blood clots with an aspirin tablet. Aspirin thins the blood, which significantly improves the prognosis of the disease.

Video: myocardial infarction - how to recognize, first aid

Therapeutic measures

Medical therapy

Myocardial oxygen requirements are reduced when taking beta-blockers. When they act, the strength and frequency of heart contractions, which inhibit the conduction of the myocardium, decrease.

How to avoid illness

For the prevention of ischemic attacks it is necessary:

Regularly take prescribed medications;
Control blood counts, especially cholesterol;
Quit smoking;
Move more;
Control blood pressure;
Lose weight;
Avoid stress.

Pre-infarction condition: symptoms, causes, emergency care

Coronary heart disease has been the leading cause of death from myocardial infarction for many years. According to the WHO, the mortality from pathologies of the heart and blood vessels will steadily increase in the next 20 years, and the number of deaths will increase by 5 million people annually. It is the prevention of myocardial infarction that can prevent such disappointing prognosis. It consists in the early detection and timely treatment of the condition that precedes the necrosis of the heart muscle, i.e., the pre-infarction condition.

Such a term expressively emphasizes the danger of possible complications. A pre-infarction state is a progressive unstable angina at an advanced stage, which, without timely assistance, can lead to the development of myocardial infarction. It is not accompanied by infarct changes on the ECG and lasts for days or weeks, accompanied by a progressive narrowing of the coronary vessels and a constantly aggravated violation of the blood supply to the heart muscle. That is why it is isolated in a separate clinical condition. In this article, we will acquaint you with the main forms of manifestation, symptoms, diagnostic methods and emergency care for a pre-infarction condition.

The main forms of manifestation

The concept of "preinfarction state" combines all varieties of unstable angina pectoris and manifests itself in such types of this pathology:

Developing for the first time angina pectoris.
Progressive angina pectoris.
The appearance of rest angina pectoris after an earlier exertional angina pectoris.
Early postinfarction angina pectoris.
Prinzmetal's angina.
Angina pectoris after coronary bypass surgery.

Symptoms

The development of a pre-infarction state is preceded by:

stress;
nervous tension;
physical fatigue;
hypertensive crises;
drinking excessive amounts of alcohol or frequent smoking;
heatstroke;
hypothermia;
intensive sports training;
drug overdose, etc.

The main manifestation of the pre-infarction state is a pronounced pain syndrome, which is often accompanied by an increase in blood pressure.

Unlike normal episodes of angina, it either does not stop with nitroglycerin or requires higher doses of it. During the day, the patient may experience up to 30 such attacks.

The pain syndrome is of a long-term nature, and the pains become more intense. With typical symptoms of a pre-infarction condition, pain is localized behind the sternum and radiates to the right half of the body (sternum, arm, neck, collarbone, lower jaw). With the reappearance of angina pectoris, it can change its intensity and localization.

The patient has the following additional symptoms:

severe weakness;
dizziness;
shallow breathing;
dyspnea;
sensations of interruptions in the work of the heart;
cold sweat;
paleness or ashy complexion;
restlessness and agitation;
fear of death.

In some cases, these symptoms are accompanied by suffocation and nausea.

With an atypical course of a pre-infarction condition, pain can be localized only under the left shoulder blade, in the neck, shoulder (in any), in the upper abdomen. Its intensity may be insignificant.

In some cases, an atypical attack of a pre-infarction state proceeds without the appearance of a pain syndrome. It can manifest itself with such symptoms:

asthmatic: cough, shortness of breath, shortness of breath;
cerebral: severe weakness, dizziness, fainting;
abdominal: abdominal pain, nausea, hiccups, vomiting, flatulence;
arrhythmic: palpitations and interruptions in the work of the heart.

An atypical clinic of a pre-infarction state is more typical for older people: years.

The pre-infarction state is accompanied by a spasm of the coronary artery, which is caused at the site of atherosclerotic plaque localization. Spasm of the vessel leads to a sharp deterioration in blood flow, causing oxygen starvation of the myocardium and disruption of its nutrition. In addition, spasm of the artery is accompanied by damage to its inner lining and the formation of a thrombus, which further reduces the lumen of the vessel and may increase in size.

The formation of a large thrombus leads to a complete cessation of blood flow in the coronary artery. Such a course of the pre-infarction state after 15 minutes leads to the onset of myocardial infarction, and after 6-8 hours the affected area of the heart muscle is completely amenable to necrosis.

How to distinguish a pre-infarction state from a heart attack?

For the first time, pain behind the sternum of an angina pectoris is always the first harbinger of a heart attack, since narrowing of the vessel by more than 50% can cause myocardial necrosis. Cardialgia that occurs at rest is especially dangerous.

Most patients with a pre-infarction state have previously suffered angina attacks and note the following changes:

the localization, prevalence, intensity or duration of pain has changed;
there were complaints that were not there before;
the circumstances under which the pain appears have changed;
attacks of pain began to appear more often;
taking Nitroglycerin does not have the same effect.

Based on these changes, one can suspect the development of a pre-infarction state. They should be a mandatory reason for an immediate visit to the doctor!

In a hospital, to exclude the onset of myocardial infarction, the following studies are mandatory:

Emergency care at the prehospital stage

First aid for a patient with a pre-infarction condition is the same as with an attack of unstable angina pectoris:

Provide the patient with bed rest in a position convenient for him (usually, pain is easier to bear in a half-sitting position).
Call the ambulance team.
Avoid any load.
Reassure the patient by giving him a tincture of motherwort, valerian, Corvalol or Valocardin.
Ensure the flow of fresh air and optimal temperature conditions.
Remove clothing that restricts breathing.
Give the patient a tablet of Aspirin 300 mg or Clopidogrel 300 mg.
Give the patient a Nitroglycerin tablet under the tongue or drugs such as Nitrolingval, Isoket, Nitrominate. If there is no effect, repeat the reception after 2-3 minutes. During an attack, you can not give more than three doses of nitrate drugs.
Count the patient's pulse and measure blood pressure. With severe tachycardia, give the patient Anaprilin (1-2 tablets), with arterial hypertension - Clonidine (1 tablet sublingually).
In some cases, with severe pain, it is allowed to take an anesthetic: Baralgin, Smazmalgon, Sedalgin.

In the pre-infarction state, it is not enough to stop the usual attack of angina pectoris, and the patient must be hospitalized in the intensive care unit.

Emergency care and hospital treatment

After hospitalization in the intensive care unit, the patient is immediately carried out all diagnostic measures to distinguish the pre-infarction state from a heart attack. To stop an attack of unstable angina, an intravenous administration of a solution of Nitroglycerin is performed, which allows you to relieve spasm from the coronary arteries.

In the future, the tactics of eliminating the pre-infarction state is not much different from the treatment of myocardial infarction. It is aimed at preventing the development of necrosis of the heart muscle.

Drug therapy includes drugs of the following groups:

During the time after hospitalization, the patient must comply with strict bed rest and a special diet, which is prescribed for myocardial infarction. Motor activity expands gradually, according to the doctor's indications.

With a pronounced narrowing of the coronary arteries, the patient is prescribed surgical treatment, since only an operation performed no later than 3-6 hours after the onset of intense pain can prevent necrosis of the heart muscle. To prevent myocardial infarction, the following surgical interventions can be performed:

After discharge from the hospital, the doctor gives the patient the following recommendations:

constant monitoring of blood pressure;
constant use of medications;
observation by a cardiologist with monitoring of lipoproteins and cholesterol;
dieting;
rejection of bad habits;
complete rest;
healthy lifestyle.

Remember that a pre-infarction condition is always urgent, it requires timely provision of first aid and immediate hospitalization of the patient in intensive care! Only such a tactic avoids the development of myocardial infarction and can prevent the possible death of the patient.

Our article will help you identify the signs of this life-threatening condition in time, and you will be able to provide timely assistance to yourself or your loved one.

Myocardial infarction, as you probably know, is a medical emergency requiring prompt medical attention. It is for this reason that it is important to recognize this condition in a timely manner, based in this on taking into account its main symptoms. A pre-infarction condition, the symptoms of which are important to recognize in time, is justified to be singled out as a separate clinical condition, because due to timely measures taken, the main threat, which is myocardial infarction, can be prevented.

general description

The morphological basis of the pre-infarction syndrome is based on the increase that the wall of occlusion acquires in the corresponding coronary artery, which can, for example, develop due to an increase in thrombosis.

Returning directly to the heart attack itself, we note that it is not only an acute condition, but also leads to the necrosis of a certain area of tissue in the heart muscle. Moreover, it can provoke a stop, or even a rupture of the heart, and its effect can also be expressed in ventricular fibrillation and the formation of an acute type.

Naturally, any condition that provokes a myocardial infarction can carry more than a serious risk to a person's life. Therefore, it will not be an exaggeration to highlight the fact that the timely recognition of the symptoms of a pre-infarction condition will allow you to save the life of a person in whom these symptoms actually arose. The pre-infarction state in its symptoms directly depends on the features that the body as a whole has, as well as on the location of the necrosis of a part of the heart muscle and on its size.

Pre-infarction state: the main forms of manifestation

The pre-infarction state is also commonly defined as unstable. It includes the following types of situations:

Angina pectoris, which arose for the first time.
Angina pectoris progressive. In this case, the condition provides for the presence in the past of angina attacks with their frequent manifestation in recent times. Here, situations are also noted with the occurrence of prolonged and more pronounced pains, with a change in their localization and the appearance of irradiation (that is, the spread of pain in areas outside the location of the heart muscle). Elimination of pain involves the use of more nitroglycerin than before.
Angina pectoris at rest (if angina pectoris occurred earlier). Pain in this case occurs after physical exertion in one form or another.
Angina pectoris postinfarction early. Attacks of pain occur in the period from the first day to a month after the transfer of myocardial infarction.
Angina that occurs after bypass surgery. An operation of this kind is performed if, due to atherosclerotic plaques, the lumen in the large arteries of the heart is narrowed.
Prinzmetal angina due to spasm in the coronary arteries. It is characterized by severe pain attacks, manifested mainly in the morning.

Pre-infarction condition: symptoms

When considering the pre-infarction state, it should be noted that it is characterized by the development of angina pectoris on a progressive scale, which, moreover, is in its own neglected stage. After some time, with inadequate or incomplete treatment, as well as under the influence of stress and under the influence of a different type of complications, angina pectoris can go directly to myocardial infarction. Often it also stops on its own, which, accordingly, allows the patient to recover.

A progressive pre-infarction condition is characterized by an increase in pain behind the sternum, an additional symptom is an increase in pressure.

The condition is characterized, as we have already noted, by an extremely pronounced pain syndrome, which in particular consists in pain in the area behind the sternum, in addition, this pain is similar to the pain that occurs during exertional angina. Meanwhile, if the manifestation of pain in angina pectoris can be eliminated by taking nitroglycerin, then in the pre-infarction state, nitroglycerin does not eliminate pain, but the number of attacks that occur throughout the day only increases. In some cases, their number can reach three dozen, which, in turn, leads to gradual necrosis in a specific area of \u200b\u200bthe heart muscle.

The pain that accompanies the pre-infarction condition radiates under the collarbone and in the sublingual region, in the right side of the sternum and in the arms. Cold sweat is formed, the patient experiences the strongest anxiety, agitation, the heartbeat increases, in addition, he also experiences the fear of death. Often these conditions are accompanied by nausea, suffocation.

The course of a pre-infarction state is also possible on an atypical scale. So, the patient complains of dizziness and severe weakness, there are sleep disturbances, insomnia. There is no pain syndrome in the atypical course. The course of this pathology in this form provokes the occurrence of shortness of breath and cyanosis, which occur without any reasons for them and while at rest. Diagnosis is possible only with the help of an electrocardiogram, which will indicate the formation of blockades in the patient, as well as decompensation in the blood circulation, paroxysmal tachycardia and extrasystole. A predominantly atypical picture of pre-infarction conditions in this course is observed among elderly people aged 79-90 years.

In certain cases, an abdominal syndrome occurs, in which the localization of pain is concentrated in the left hypochondrium, as well as in the upper abdomen. The patient experiences a characteristic burning sensation of the epigastric region, as for pain, it can be cutting, stabbing or aching in nature. Strengthening is noted during physical exertion of one type or another, as well as during stressful situations, experiences and when walking. Being at rest can eliminate painful manifestations, which is also possible when taking nitrates for this purpose.

This condition may be accompanied by nausea and vomiting, abdominal pain, hiccups, flatulence. In some cases, there is pain in the neck, throat or in the lower jaw. There are also cases in which only shortness of breath or disturbances noted in the rhythms of the heart are noted. With a cerebrovascular form of a pre-infarction state, fainting, dizziness and nausea are possible.

Pre-infarction condition: treatment

In this condition, treatment is focused on preventing the possible development of myocardial infarction after it. In other words, treatment is aimed at eliminating severe angina. This involves prescribing bed rest to the patient, which should reduce the load on the work of the heart, respectively, reducing its energy needs. Additionally, drug therapy is also prescribed. It is important to note that with the severity of manifestations indicating a pre-infarction condition, the best solution is to call a doctor.

If you have any concerns related to the work of the heart, as well as in the presence of varying degrees of these symptoms, you should consult a cardiologist.