Myocardial infarction - symptoms, causes, signs, treatment, prevention of the disease. Myocardial infarction: causes, varieties, symptoms, diagnosis and modern treatment. Specialist consultations Treatment of patients with acute heart attack includes

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

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

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

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

The heart pumps oxygenated blood and transports it to other organs. However, it itself needs a lot of oxygen. And with its lack of heart muscle cells cease to function. As in the case of oxygen starvation of the brain, in this situation a few minutes are enough for irreversible changes and tissue death to begin.

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

Types of heart attack

Under one name, several variants of the course of the disease are hidden. Depending on the localization, the swiftness of the course and a number of other factors, the patient's condition and the ability to save him depend.

There are several classifications of myocardial infarction:

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

Depending on the set of symptoms, it happens:

• Cerebral form, which is accompanied by neurological disorders, dizziness, confusion;
• Abdominal - has symptoms of acute inflammation of the digestive system - abdominal pain, nausea, vomiting. Out of ignorance, it is easy to confuse it with acute pancreatitis;
• Asymptomatic - when the patient does not feel particularly pronounced manifestations of the disease. Often this form occurs in diabetics. This course complicates the diagnosis of acute myocardial infarction;
• Asthmatic, when the clinical picture of a heart attack resembles asthmatic, which is accompanied by suffocation and pulmonary edema.

Who is at risk?

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

In addition, those who:

• Little moves;
• Is overweight;
• Is a chronic hypertensive patient;
• Constantly stressed;
• Smokes or uses drugs - this increases the risk of a sharp vasospasm several times;
• Has a hereditary predisposition to atherosclerosis and heart attack.

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

What causes a heart attack?

Surely everyone has heard the phrase "bring to a heart attack." It has a rational grain - with a strong nervous shock, a sharp spasm of blood vessels can develop, which will lead to a cessation of blood supply to the heart muscle. There are 3 causes of acute myocardial infarction:

1. Blockage of a coronary artery by a thrombus that could form in any organ.
2. Spasm of the coronary vessels (more often occurs due to stress).
3. Atherosclerosis is a disease of blood vessels, which is characterized by a decrease in the elasticity of the walls, a narrowing of their lumen.

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

How to recognize a heart attack?

It is easy to confuse it with the usual attack of angina or asthma, stroke, and even pancreatitis. But still it can be distinguished by some significant, characteristic features only to him.

In acute myocardial infarction, the symptoms are as follows:

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

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

Stages of a heart attack

The statistics of mortality from a heart attack indicates that each attack proceeds differently: someone dies in the first minutes, someone can hold out for an hour or more before the arrival of the medical team. In addition, long before the attack, you can notice changes in the ECG and some blood parameters. Therefore, with regular thorough examination of patients from the risk zone, it is possible to minimize the likelihood of an attack by prescribing prophylactic drugs.

The main stages of the development of an attack:

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

Examination and diagnostics

A single glance at a patient is not enough for a doctor to make a final diagnosis. To confirm it and prescribe adequate treatment, you need to carry out:

• Thorough external examination;
• Collection of a detailed anamnesis, including finding out whether there were cases of heart attack in relatives;
• A blood test that will reveal markers that indicate this diagnosis. Usually, patients have an increase in the level of leukocytes and ESR, a lack of iron. In parallel with the general, a biochemical analysis is performed, which will identify complications;
• Analysis of urine;
• ECG and EchoCG - they will help to assess the extent of damage to the heart muscle. An ECG is performed in acute myocardial infarction, and then changes are monitored. For the most complete picture, all results should be in the patient's chart;
• Coronary angiography - examination of the state of the coronary vessels;
• Chest x-ray to track changes in the lungs.

Other tests may also be ordered as needed.

Consequences of a heart attack

Complications as a result of an attack do not always appear immediately. Violations in the work of the heart itself and other organs may appear after a while. The most dangerous for the patient is the first year - during this period, about 30% of patients die from complications.

The most common consequences of myocardial infarction:

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

What to do with a heart attack

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

First aid during an attack

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

Be sure to measure the pulse rate and pressure, if necessary, give a drug to increase or decrease pressure.

If the patient is unconscious, the pulse is not palpable - it is necessary to carry out an indirect heart massage and artificial respiration before the arrival of doctors.

Further therapy

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

Pulmonary edema may require defoaming and mechanical ventilation. After the patient is removed from the acute state, constant monitoring of indicators and restorative treatment are carried out.

Also prescribed drugs that thin the blood and prevent the formation of blood clots.

Life after a heart attack: features of rehabilitation

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

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

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

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 “suffered”, 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.

Acute myocardial infarction - necrosis of cardiac tissues due to cessation of blood supply to the organ.

The symptoms of acute myocardial infarction are quite vague, but preliminary self-diagnosis is vital for timely seeking medical help.

stages

Myocardial infarction is divided into several progressive stages, which indicate the onset of an attack. You need to be able to distinguish between them in order to more accurately determine the degree of danger.

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So, there are five stages of development:

The main symptoms of acute myocardial infarction

The main signs of a heart attack include sternum pain, it is similar to, but more pronounced. Patients may have other symptoms of acute myocardial infarction.

They depend on the degree of violations of the pumping function of the heart, on the size and localization of the focus. It is believed that the overall picture of the symptoms of the disease is very unusual and often a heart attack is confused with other problems in the body.

During a typical myocardial infarction, there are such manifestations and symptoms of the disease:

Atypical manifestations

It is much more difficult to identify atypical signs of a heart attack.

Symptoms often indicate diseases of a different kind, seemingly not foreshadowing heart problems, and pain either completely stops or becomes less pronounced.

In such a situation, it is very difficult to identify a cardiological problem and predict the diagnosis. Atypical symptoms are observed in the elderly, over 60 years of age, and in patients with chronic diseases.

All symptoms of acute myocardial infarction are grouped into syndromes:

Thus, myocardial infarction disease has numerous symptoms and signs. In this regard, diagnosis is carried out only in a hospital, excluding a general examination and patient complaints.

You should pay attention to all the symptoms, because it is possible that an attack of a heart attack begins right now. If the condition does not improve, you should immediately consult a doctor for a diagnosis.

Myocardial infarction is the death of a section of the heart muscle due to an acute violation of blood circulation in this area. According to statistical studies, myocardial infarction often develops in men aged 40 to 60 years. In women, this disease occurs about one and a half to two times less often.

Myocardial infarction occurs in patients with coronary heart disease (CHD), atherosclerosis, arterial hypertension. Risk factors for myocardial infarction include smoking (because it causes constriction of the coronary vessels of the heart and reduces the supply of blood to the heart muscle), obesity, lack of physical activity.

At the same time, myocardial infarction can be the first manifestation of coronary artery disease.

Unfortunately, myocardial infarction is now one of the main causes of disability in adulthood, and mortality among all patients is 10-12%.

Causes of myocardial infarction

Oxygen and nutrients are delivered to the cells of the heart muscle by a special branched network of vessels called coronary vessels. With myocardial infarction, one of these vessels is blocked by a thrombus (in 95% of cases, a coronary artery thrombus forms in the area of ​​atherosclerotic plaque). The supply of oxygen to the cells of the heart muscle, which was fed by the blocked artery, is enough for 10 seconds. For about 30 minutes, the heart muscle remains viable. Then the process of irreversible changes in the cells begins, and by the third or sixth hour from the onset of occlusion, the heart muscle in this area dies. 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.

The clinical picture of myocardial infarction is diverse, which makes it difficult to make a correct diagnosis in the shortest possible time.
The diagnosis is established on the basis of three criteria:

• typical pain syndrome
• changes in the electrocardiogram
• changes in the parameters of a biochemical blood test, indicating damage to the cells of the heart muscle.

In doubtful cases, doctors use additional studies, such as radioisotope methods to detect a focus of myocardial necrosis.

Symptoms of myocardial infarction

Typically, myocardial infarction reveals the following symptoms:

• prolonged intense squeezing-pressing pain behind the sternum in the region of the heart, may radiate to the arm, neck, back or shoulder blades;
• pain does not go away after taking nitroglycerin;
• pale skin, cold sweat;
• fainting state.

Not always the disease manifests itself in such a classic picture. A person may feel only discomfort in the chest or interruptions in the work of the heart. In some cases, there is no pain at all. In addition, there are atypical cases of myocardial infarction, when the disease is manifested by difficulty in breathing with shortness of breath or abdominal pain. Such cases are especially difficult to diagnose.

Complications of myocardial infarction

If left untreated, myocardial infarction can lead to acute heart failure, cardiogenic shock, heart rupture, heart rhythm disturbances, and other dangerous conditions.

Complications associated with myocardial infarction require emergency medical care.

What can you do

If you notice the symptoms described above in yourself or your loved ones, you should urgently call an ambulance. Before the doctor arrives, first aid should be given - give the person a comfortable sitting or lying position, give nitroglycerin (it is absorbed under the tongue) and Corvalol (30-40 drops inside).

What can a doctor do

In order to avoid mistakes, at the slightest suspicion of a heart attack, the patient is taken to the hospital as soon as possible. Treatment of myocardial infarction is necessarily carried out in the intensive care unit of the hospital.

Therapy includes painkillers, drugs that help dissolve the formed blood clot, drugs that lower blood pressure, reduce the volume of circulating blood, and reduce heart rate. The effectiveness of treatment depends on the time elapsed from the onset of the disease to getting to the hospital.

After the hospital, an unusually important period of rehabilitation begins, which lasts up to 6 months. The doctor will prescribe the necessary therapy for you. Some medications will have to be taken for the rest of your life. However, when following prescriptions, quitting smoking and dieting, people after myocardial infarction live a full healthy life for many years to come.

Heart attack prevention

Prevention of myocardial infarction is the annual medical examination and timely adequate treatment of chronic diseases such as coronary heart disease, hypertension, atherosclerosis, etc.

The diagnosis of coronary heart disease is the basis for assessing the condition of the coronary arteries using coronary angiography (coronary angiography). X-rays made in a special way allow you to determine the exact location of atherosclerotic plaques and the degree of narrowing of the coronary arteries. If there are indications, the found narrowing can be expanded from the inside of the vessel - this procedure is called coronary angioplasty. In addition, a stent can be implanted into the coronary artery - a metal frame that will maintain the open state of the vessel. In some cases, a complex operation is performed, coronary artery bypass grafting, when additional vessels are inserted between the aorta and the coronary arteries, bypassing the site of narrowing of the coronary vessel and creating an opportunity for blood to flow to the heart muscle.

ECG - The first and main diagnostic method at the emergency stage is an electrocardiogram, which determines changes characteristic only for a heart attack, it can be used to establish the localization of the lesion, the period of the heart attack. A cardiogram is recommended for all the symptoms described above.

Method of coronary angiography- X-ray method of research, in which the coronary vascular system is contrasted through the probe, and blood flow through the vessels is observed under X-ray radiation. The method allows you to determine the patency of blood vessels and more accurately indicate the localization of the focus.

Method of computer coronary angiography- more often used in coronary disease in order to determine the degree of vasoconstriction, which shows the likelihood of developing a heart attack. This method, unlike X-ray coronary angiography, is more expensive, but also more accurate. It is less common due to the lack of equipment and specialists who own the technique.

Laboratory diagnostics- With myocardial infarction, characteristic changes in the composition of the blood and biochemical parameters occur, which are controlled throughout the treatment.

First aid and treatment of myocardial infarction

First aid for myocardial infarction

A person with a suspected heart attack must be laid down, the airways must be freed from squeezing clothing (tie, scarf). A core with experience may have nitroglycerin preparations with him, you need to put 1 tablet under his tongue, or inject if it is a spray (isoket). Nitroglycerin preparations should be given every 15 minutes until the doctors arrive. It’s good if aspirin is at hand, aspecard is drugs containing acetylsalicylic acid, they have an analgesic effect and prevent the formation of blood clots. In case of cardiac arrest and breathing, the patient needs to carry out artificial respiration and chest compressions until the doctors arrive.

Attention:

• Nitroglycerin preparations not only dilate the coronary vessels, they have the same effect on the vessels of the brain, if a person is in an upright position, a sharp outflow of blood is possible and a sudden short-term (orthostatic collapse), falling, the patient may be injured. Nitroglycerin should be given to the patient in the supine or sitting position. Orthostatic collapse goes away on its own, if you put a person down and raise his legs, after 1-2 minutes.
• If the patient has heavy noisy gurgling breathing, he should not be laid down, as this will aggravate the condition. Such a patient must be comfortably and securely seated.

First aid in an ambulance

Until arrival at the hospital, the patient continues to receive the necessary treatment in accordance with the leading symptoms:

• give oxygen;
• provide access to a vein;
• try to stop the pain syndrome with non-narcotic or narcotic analgesics (droperidol, morphine hydrochloride), depending on the degree of its severity, if there is no effect, they can apply inhalation anesthesia with nitrous oxide (resuscitation vehicles are equipped with portable anesthesia machines), or administer sodium hydroxybutyrate intravenously, this the drug, in addition to the hypnotic and analgesic effect, protects organs from oxygen starvation;
• to prevent the formation of blood clots and resorption of existing ones, heparin is used;
• normalize blood pressure, with high blood pressure, lasix is ​​administered, with low blood pressure, prednisone, hydrocortisone;
• for the prevention or relief of arrhythmias, intravenous lidocaine is administered in saline.

Hospital treatment

In the acute period, the treatment of a heart attack is based on the leading syndromes, the main task of the doctor is to stabilize the patient's vital functions and limit the spread of the lesion. The maximum possible resumption of coronary circulation. Prevention of complications.

• Pain relief is a simultaneous prevention of cardiogenic shock.

- If the pain syndrome persists, after 30-40 minutes, droperidol with fetanyl is re-introduced. These drugs have a side effect - respiratory depression.
- Therefore, you can replace them with a mixture of analgin with Relanium or 0.5% novocaine; a mixture of analgin, dimedrol and promedol in 20 ml of saline. These mixtures may have vomiting as a side effect; for prophylaxis, a 0.1% solution of atropine is injected subcutaneously.
- In the absence of effect - anesthesia with nitrous oxide.

• In asthmatic variant with pulmonary edema

The patient needs to raise the upper body as much as possible. Three times with an interval of 2-3 minutes nitroglycerin (isoket) under the tongue. Effective inhalation of oxygen with alcohol. While waiting for the doctor, in the absence of oxygen, near the patient's face (without closing the airways!) You can keep a cloth richly moistened with alcohol or vodka. At elevated or normal blood pressure, lasix (furosemide) is injected intravenously in large doses. With hypotension, prednisolone is administered intravenously, rheopolyglucin is dripped

• With arrhythmias

Tachycardia (frequent pulse) is stopped by isoptin solution. In case of onset of atrial fibrillation and flutter - novocainamide, unitiol. If there is no effect, electrodefibrillation is used. Bradycardia (rare pulse) - atropine, isadrin 1 tablet under the tongue is administered intravenously. If there is no effect - Alupent IV and prednisolone.

• One of the causes of violations of the coronary circulation is their blockage by blood clots.

They are treated with medication using fibrolytic therapy based on streptokinase and its analogues. All types of bleeding are contraindications to such therapy. Therefore, against the background of this treatment, the patient's condition is strictly monitored and the level of platelets and the time of blood clotting are monitored.

Surgery

After reaching a stable state, restoring a normal heart rhythm, and other vital signs, surgical treatment is performed according to indications in order to restore the patency of the coronary vessels. To date, the following interventions are being carried out:

• Stenting is the introduction of a metal frame (wall) into the narrowed areas of the coronary vessel. During this operation, the chest is not opened, the walls are inserted with a special probe into the required place through the femoral artery under the control of an X-ray machine.
• CABG - coronary artery bypass grafting. The operation is performed on an open heart, its essence lies in the fact that they create an additional possibility of blood supply to the affected focus by transplanting the patient's own veins, creating additional blood flow paths.

Indications for surgical treatment and the choice of the type of intervention depends on the results of coronary angiography:

• damage to two of the three arteries, or the degree of narrowing of more than 50%
• presence of post-infarction

Of great importance in the treatment of myocardial infarction is the patient's motor regimen. In the first period from 1 to 7 days, strict bed rest is recommended, in which, from the moment a stable state is reached, it is recommended to perform passive movements while lying in bed, and breathing exercises under the supervision of medical personnel. Further, as the condition improves, it is recommended to constantly expand motor activity by adding active movements daily (turns, sitting down in bed, independent eating, washing, etc.).