Oim symptoms. Acute, subacute, scarring period of myocardial infarction. Acute MI without pathological Q wave

Myocardial infarction is an acute ischemic necrosis of the heart muscle due to a mismatch of the coronary circulation with the needs of the myocardium during prolonged spasm of the coronary arteries or their blockage (thrombosis).

There are macrofocal, transmural (with Q wave, Q-myocardial infarction) and small focal (without Q wave, non-Q-myocardial infarction) myocardial infarction.

Localization of myocardial infarction: anterior, lateral, posterior wall of the left ventricle, interventricular septum and, relatively rarely, the right ventricle.

Classification of clinical types of onset of myocardial infarction(Tetelbaum, 1960):

1. Retrosternal pain (classic status anginosus) type; fifty%

2. Peripheral type; 25%

3. Abdominal type; 5%

4. Cerebral type; ten%

5. Painless type; ten%

6. Arrhythmic type.

7. Asthmatic type.

8. Combined type

Forms of the peripheral type according to the localization of pain: left-scapular, left-handed, upper vertebral, mandibular, laryngeal-pharyngeal.

Abdominal type according to clinical signs similar: to an acute abdominal catastrophe of the type of perforated ulcer, gastric bleeding, intestinal obstruction; on the picture of the inflammatory process in the abdominal cavity (cholecystitis, pancreatitis, appendicitis); esophageal disease.

Cerebral type - the onset of myocardial infarction in the form of fainting, hypertensive crisis, hemiplegia (stroke), toxic infection.

Painless type - the onset of myocardial infarction of total heart failure, collapse.

Arrhythmic type - in the absence of pain, transient arrhythmias appear.

Asthmatic type - the onset of myocardial infarction with acute left ventricular failure (pulmonary edema).

Periods of myocardial infarction:

1) pre-infarction (from several days to 1-3 weeks),

2) sharpest,

3) sharp,

4) subacute.

1. The pre-infarction period is characterized by a clinical picture of progressive, unstable angina pectoris. Increases the intensity, duration, frequency of seizures, they occur with less physical exertion, are slower under the influence of rest or nitroglycerin. In the intervals between attacks of angina, there is a dull pain or a feeling of tightness in the chest (pressure). The appearance of rest angina in a patient with exertional angina is characteristic.

There is a negative dynamics of the ECG: an ischemic change in the ST segment and the T wave ("acute coronary" T - pointed, symmetrical). There are no changes in the general and biochemical blood tests.

2. The most acute period of myocardial infarction - the time from the appearance of the first clinical electrocardiographic signs acute ischemia myocardium before the formation of a focus of necrosis (about 2-3 hours). It is characterized by extremely intense, acute, "dagger" pain, radiating under the left shoulder blade, in left hand. The pain is undulating in nature, can last for several hours or even days, is not stopped by taking nitroglycerin, is accompanied by a feeling of fear, arousal.

Examination reveals pallor of the skin and mucous membranes, acrocyanosis.

Palpation of the region of the heart reveals the displacement of the apex beat outward and downward, it becomes low, non-resistant and spilled. The pulse of low tension and filling, frequent, may be arrhythmic. Blood pressure during the period of a painful attack may increase, then decrease.

Percussion reveals the displacement of the left border of relative dullness outward, the expansion of the diameter of the heart. On auscultation, there is a weakening of the first tone, deafness of tones, a gallop rhythm, systolic murmur at the apex of the heart and aorta, various types of rhythm disturbances (extrasystole, paroxysmal tachycardia, atrial fibrillation).

When examining the respiratory system, tachypnea is detected. With the development of acute left ventricular failure over the lungs - blunted tympanitis in the posterior lower sections, in the same place - weakening of vesicular respiration and successively - crepitus, small-, medium- and large-bubbling wet rales, spreading to the upper sections. With the development of pulmonary edema - bubbling breathing with the release of pinkish foamy sputum.

3. Acute period myocardial infarction is characterized by the disappearance of pain, lasts 7-10 days. Previously occurring symptoms of acute heart failure and arterial hypotension may persist and even increase. The data of objective research remain the same.

In the acute period of myocardial infarction, signs of resorption of necrotic masses and aseptic inflammation in the tissues adjacent to the necrosis zone are revealed - fever occurs.

4. Subacute period of myocardial infarction - the formation of a connective tissue scar at the site of necrosis, remodeling of the left ventricle. The duration of the subacute period is 4-6 weeks.

Features of manifestation different forms myocardial infarction.

A clear division of the periods of myocardial infarction and clinical signs are characteristic of Q wave myocardial infarction(transmural).

Main clinical manifestation myocardial infarction without Q wave(non-transmural) - pain syndrome in the form of prolonged attacks of rest angina (lasting more than 20-30 minutes), poorly stopped by nitroglycerin. The intensity of pain is less than in myocardial infarction with a Q wave (transmural). Retrosternal pain may be accompanied by general symptoms: increasing weakness, sweating, shortness of breath, transient rhythm and conduction disturbances, and a decrease in blood pressure.

Non-Q wave myocardial infarction may present with mild but frequent bouts of exertional angina.

An objective examination does not give specific signs confirming the diagnosis. During auscultation, a weakening of the first tone, additional tones (III or IV) may appear. Possible transient disorders heart rate and blood pressure changes.

Only a targeted laboratory and instrumental study can confirm or refute the presence of myocardial infarction without a Q wave.

The prognosis of the course of the disease and the likelihood of mortality in acute myocardial infarction is determined by the main clinical signs (degree of heart failure, arrhythmias), localization of the infarction (worse with anterior infarction).

Clinical Killip myocardial infarction severity classification(Killip) is based on an assessment of the severity of heart failure, is predictive:

Class I - without signs of circulatory failure; mortality up to 5%.

Class II - signs of circulatory insufficiency are moderately expressed, there are signs of right ventricular failure (a gallop rhythm is heard, moist rales in the lower parts of the lungs, signs of venous stasis - hepatomegaly, edema); mortality 10-20%.

Class III - acute left ventricular failure (pulmonary edema); mortality 30-40%.

Class IV - cardiogenic shock (blood pressure less than 90 mm Hg, constriction peripheral vessels, sweating, impaired consciousness, oliguria); mortality over 50%.

Laboratory and instrumental diagnostics.

Complete blood count: in the first days, neutrophilic leukocytosis appears (up to 10-12 10 9 /l), which normalizes by the tenth day. By the eighth to tenth day, the ESR increases and can persist for several weeks.

Biochemical analysis of blood: increased activity of the MB-fraction of creatine phosphokinase, the first fraction of lactate dehydrogenase, AST and ALT, an increase in myoglobin, troponin. Nonspecific changes: increased urea, CRP, fibrinogen, seromucoid, sialic acids, glucose.

Coagulogram: increase in APTT, prothrombin index.

ECG: changes depend on the stage of myocardial infarction (ischemic, damage, acute, subacute, cicatricial).

The focus of myocardial damage during a heart attack consists of a zone of necrosis, an adjacent zone of damage, which passes into the zone of ischemia.

The ischemic stage lasts only 15-30 minutes, is characterized by the formation of a "coronary" T wave. This stage cannot always be registered.

The stage of damage lasts from several hours to several days, is characterized by an arcuate rise or depression of the ST segment, which passes into the "coronary" T wave and merges with it. The R wave is reduced or an abnormal Q wave has appeared: ventricular QR or Qr complex in non-transmural infarction and QS in transmural infarction.

The acute stage lasts up to 2-3 weeks, is characterized by an increase in the depth of the Q wave. The ST segment approaches the isoline, a negative, symmetrical "coronary" T wave appears.

The subacute stage is characterized by the absence of a zone of damage (the ST segment returns to the isoline, the “coronary” T wave is negative, symmetrical is preserved or even increases, the “pathological” Q wave is preserved (more than 1/4 of the R wave). The end of the subacute stage is the absence of tooth dynamics T.

The cicatricial stage is characterized by the persistent preservation of the “pathological” Q wave. The ST segment is on the isoline, the T wave is positive, smoothed or negative, there is no dynamics of its changes.

Topical diagnosis of myocardial infarction:

For infarction of the anterior wall and apex, ECG changes in leads I, II, aVL and V 1–4,

For the anterolateral wall - in leads I, II, aVL, V 5–6,

For the anterior aspect of the interventricular septum in leads V3,

For the posterior diaphragmatic wall III, II, aVF,

For posterolateral -III, II, aVF, V 5-6,

For the back wall (common) - III, II, aVF, V 5-7.

Complications of myocardial infarction:

Rhythm disturbances (extrasystole, paroxysmal tachycardia, atrial fibrillation, blockade); acute circulatory failure (fainting, collapse, cardiogenic shock, pulmonary edema, cardiac asthma); pericarditis; thromboendocarditis; heart aneurysm; thromboembolism; cardiac tamponade; Dressler's post-infarction syndrome (pneumonitis, pleurisy, pericarditis); acute erosive and ulcerative lesions gastrointestinal tract; stomach bleeding; paralytic intestinal obstruction; paresis of the bladder; chronic circulatory failure.

Treatment uncomplicated myocardial infarction.

Patients with myocardial infarction are delivered on a stretcher or wheelchair in the intensive care cardiology department.

The treatment program includes: stopping a pain attack, restoring the main coronary blood flow and preventing further thrombosis, limiting the size of myocardial infarction, and preventing the development of arrhythmias.

Pain syndrome it is stopped by narcotic analgesics (morphine), neuroleptanalgesia.

To restore coronary blood flow, thrombolytic, antithrombotic medicines(streptokinase once, anticoagulants 3-5 days 24 hours after administration of strepokinase, acetylsalicylic acid).

In order to limit the size of myocardial infarction, intravenous nitrates are used with the transition to prolonged nitrates, ß-blockers.

According to the indications: angiotensin-converting enzyme inhibitors, calcium antagonists.

Physical rehabilitation of patients is carried out under the supervision of a physician, taking into account the class of clinical severity of myocardial infarction.

Surgical and interventional treatment ischemic heart disease. The optimal treatment for stenosing atherosclerosis is the restoration of adequate blood supply in the ischemic zone. Currently, coronary artery bypass grafting and various interventional methods (percutaneous transluminal angioplasty, stenting, atherectomy, laser angioplasty) are used. The choice of the method of surgical treatment is determined by the data of the clinic and coronary angiography.

Coronary artery bypass grafting using vascular grafts allows you to get a long-term effect of eliminating the ischemic zone. However, the method is traumatic (thoracotomy), requires expensive special equipment (extracorporeal circulation).

Interventional methods of intravascular interventions make it possible to obtain a long-term preservation of the result, repeatedly perform endovascular procedures with low risk complications.

During stenting coronary arteries in areas of significant narrowing of their lumen, implantation of a metal stent, a drug-coated stent (drugs that disrupt cell division), a conductor with a source of radioactivity (antiproliferative effect of ionizing radiation), a laser conductor is used in the coronary artery. Stenting is combined with predilation (balloon expansion) of stenosis. Stenting is carried out, including urgently in case of acute myocardial infarction.

Atherectomy - removal of endothelial hyperplasia or atherosclerotic plaque that forms a stenosis, using blades, drills.

The disadvantage of all endovascular methods, including percutaneous transluminal angioplasty (to a greater extent) and stenting, atherectomy and laser angioplasty, is the process of restenosis.

The stages of myocardial infarction (successive periods of development) can be characterized clinical symptoms. The approach to choosing a method of treatment also depends on the stage of the disease. Therefore, it is extremely important to accurately determine what period of pathology is present in a particular patient. This article talks about all periods of the development of a heart attack and methods of therapy.

What stages exist?

Myocardial infarction is characterized by necrosis of heart muscle cells. In simple words, their death occurs, the process is irreversible. This condition occurs due to circulatory disorders in the coronary vessels. This is facilitated by thrombosis and other pathologies of the cardiovascular system.

The disease develops in stages. There are five such periods:

The pre-infarction course of the disease lasts up to several days.
The most acute course is characterized by an interval of 2 hours from the ischemic state to the development of necrosis.
Acute course lasts 2 weeks. During this period, dead cells are completely melted.
Subacute course- scarring of necrotic tissues is formed.
Post-infarction course - the heart begins to adapt to new conditions.

Features and signs of each stage

preinfarction stage. Maximum duration prodromal period is 60 days. It is characterized by increased attacks of pain, progression. If the patient has previously had such attacks, then their frequency increases significantly. pain threshold intense, long duration. If examined on an electrocardiogram, then myocardial instability becomes noticeable, that is, transient changes.

This is the period that is found in patients most often with myocardial infarction. Other symptoms include insomnia, fatigue, sharp deterioration general condition, constant anxiety and change of mood.

Feature - it is impossible to get rid of weakness even after good rest.

The most acute stage. The most acute period occurs unexpectedly and abruptly, lasts a maximum of a couple of hours. If the heart is examined using an ECG, then myocardial necrosis is detected. It appears like this:

80-90% of all cases occur in the painful type of period (anginous). The patient constantly has a burning pain syndrome. The pain is localized in the sternum, after which it moves to the shoulder blades, neck, lower jaw, collarbone and left arm. Accompanied by fears and an overexcited state. The pain cannot be stopped even with drugs.
Asthmatic type of myocardial infarction is manifested by signs bronchial asthma- breathing becomes difficult severe shortness of breath. This type acute period occurs mainly in people who have already suffered a heart attack.
With the abdominal type of the most acute period, necrosis develops in the lower part of the heart muscles. But the pain is localized in the abdomen, which causes nausea and even vomiting, most often diarrhea also joins. Diagnosing this type is quite difficult, since the symptoms resemble intoxication of the body and other diseases of the gastrointestinal tract.
The arrhythmic type of the disease is characterized by a violation of the heart rhythm and blockade. The patient may lose consciousness and be in a pre-fainting state.
In the cerebral acute period, there are pains in the head and severe dizziness. The patient has impaired speech and coordination of movement, seizures of epilepsy are noted.

In addition, the most acute form may be accompanied by numbness of all limbs, cold sweating, suffering distortion of the face, and wheezing. Then urgent medical attention is needed.

acute stage. Since the acute period lasts about 2 weeks, the examination reveals clear boundaries of cardio-muscular necrosis, as well as scarring. Feature - in the primary acute period, necrosis is delimited from healthy tissues for 2-4 days. If the infarction is secondary, then the stage lasts 10-14 days.

The acute stage is manifested by such symptoms:

body temperature rises;
the number of leukocytes and ESR increases;
heart enzymes are overactive;
pain may be present constantly or appear occasionally;
violated cerebral circulation;
the patient has a fever.

The acute period is considered life-threatening, since a rupture of the heart muscle is possible. In addition, there is a hypotensive state, myocardial insufficiency, thromboembolism, and.

Subacute stage. The subacute period can last up to 60 days, connective tissue scars are formed. That is, after an acute period, when dead cells are separated from healthy tissues, these necrotic areas begin to grow with connective tissues, forming a scar. That's why given period characterized by the smoothing of signs of impaired functioning of the heart. The patient's body temperature is restored, the pain syndrome subsides, the respiratory functions, but the main thing is that the level of leukocytes becomes normal. Consequently, the patient's condition is normalized and stabilized.

However, some complications and additional symptoms develop. Most often against the background acute stage pleurisy and pericarditis appear, joint pain and pneumonia. Be sure to join the urticaria.

Postinfarction stage. The longest period of myocardial infarction is the post-infarction stage, since its duration is a maximum of 6 months. This is the final stage in which the scar is fully formed.

Over such a long period of time in the development of pathology, the heart adapts to new conditions of functioning, so the symptoms disappear completely. The patient can fully withstand moderate physical activity. After the examination, it becomes clear that the heart is functioning in normal rhythm, and the blood counts correspond to those healthy person. However, such a heart already has fewer cells that contract, so angina pectoris, heart failure, and even secondary myocardial infarction can develop.

Symptoms are aggravated only if significant areas are affected by necrosis. In other cases, the patient feels healthy.

What should be done at each stage?

First of all, with any period of development of myocardial infarction, it is necessary. The patient must pass a general and biochemical blood test, undergo an examination: an electrocardiogram, ECHO, ultrasound and magnetic resonance imaging. Further, based on the obtained data, drug therapy.

Watch the video below to learn more about the features diagnostic measures and methods of treatment of myocardial infarction (MI).

preinfarction stage. If the preinfarction period has begun at home, it is urgent to provide emergency care. The patient needs to calm down and accept comfortable position lying or sitting. Be sure to open all the vents and windows, since a heart attack requires a large amount of oxygen ( fresh air). It is important to take "Nitroglycerin". No more than 2 tablets are allowed. If he was not at home, you can offer the patient "Validol", "Valocordin", "Corvalol". And, of course, you have to call ambulance.

Hospital treatment based on the intake of beta-blockers, anticoagulants, antiplatelet agents, ACE inhibitors, antispasmodics, nitrate groups and antiarrhythmic drugs. Be sure to prescribe a heparin group of drugs to prevent the development of thrombosis.

Since there is a high need for oxygen during a heart attack, the doctor will prescribe drugs that reduce this need. These are drugs such as Sustak, Sustonit, Sustabukkal, Trinitrolong. To improve blood circulation, Nifedipine, Isoptin, etc. are prescribed. Treatment is only in stationary conditions, bed mode.

The most acute stage. In the most acute period, it is necessary to call an ambulance of a specialized direction - cardiology, resuscitation.

The rules for first aid are the same as in the previous case. But the patient still needs to unbutton all buttons and remove accessories. In addition to "Nitroglycerin", it is important to give "", but it is not swallowed, but chewed. The drug thins the blood, accelerating the process of blood supply. If there is unbearable pain, you can give "Analgin" or "Paracetamol". Quite often when the most acute form vomiting opens, so you need to put the patient on one side so that he does not choke on vomit.

This period is dangerous because cardiac arrest can occur, so you have to do artificial respiration and heart massage. But first, try to deliver a jerky blow to the sternum. This should trigger the start of the heart.

Every 3-5 minutes, check the patient's pulse, listen to the heart and measure arterial pressure to control its status.

Treatment of the most acute period of myocardial infarction is carried out in intensive care unit where narcotic analgesics, neuroleptics and tranquilizers are administered. The latter are used only in the most acute stage of MI. Further, antiplatelet agents, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors are prescribed.

acute stage. In the acute stage of myocardial infarction, blockage of the veins is noted, and therefore blood circulation is disturbed. Therefore, during an attack, it is urgent to give "Aspirin" and "Nitroglycerin". If that doesn't help, give Plavix or clopidrogel. The emergency doctor will definitely give you an injection of morphine.

Further therapy involves the use of such groups of drugs:

beta-blockers: "Atenolol" or "Metoprolol";
thrombolytic agents: Urokinase, Streptokinase;
antiplatelet and anticoagulant drugs;
nitroglycerin agents.

Subacute stage. In the subacute period of myocardial infarction, medical assistance and a call to doctors are also necessary. The ambulance representative should perform thrombolysis to neutralize or prevent clots.

The hospital provides standard therapy for myocardial infarction. Additionally, it is necessary to normalize alkaline and acid balance.

Postinfarction stage. In the postinfarction period, drug therapy is also prescribed. These can be drugs that eliminate arrhythmia and angina pectoris, nitrates, beta-blockers, statins and fibrates. Also - potassium antagonists, angiotensin-converting enzyme inhibitors, sequesters bile acids. These drugs are prescribed only by a doctor. Other means: "Aspirin", "Plavix", "Actovegin", "Tiklid", "Piracetam", "Riboxin", "Mildronat", vitamin premixes (especially vitamin E).

The patient must adhere to long time, engage and lead healthy lifestyle life. The attending specialist will definitely refer the patient to a sanatorium or other health-improving institution.

Learn about general symptoms myocardial infarction and first aid with this disease. This video tells you what to do and what not to do.

If you know about all stages of myocardial infarction, then you will be able to provide first aid to the patient. And also timely seek help from specialists. Remember that on initial stages the development of heart disease, therapy is much easier, and the risk of complications and lethal outcome minimal.

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 quality treatment and rehabilitation.

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

Acute myocardial infarction occurs when an artery is blocked by a thrombus 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 also needs in large numbers 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 necessary for normal functioning substances, especially 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.

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:

The cerebral form which is accompanied neurological disorders, dizziness, confusion;
Abdominal - has symptoms acute inflammation digestive organs - abdominal pain, nausea, vomiting. Out of ignorance, it is easy to confuse it with acute pancreatitis;
Asymptomatic - when the patient does not feel much pronounced manifestations illness. Often this form occurs in diabetics. Such a course complicates;
asthmatic when clinical picture an attack of a heart attack resembles an asthmatic one, 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 plays a decisive role blood vessels- in almost 90% of cases, it leads to this 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.

Also at risk are men over 45 and women over 65 - they may have a heart attack 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. At acute infarction myocardial causes 3:

Blockage of a coronary artery by a thrombus that could form in any organ.
Spasm coronary vessels(often occurs due to stress).
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, among which are − wrong image life, obesity, insufficient physical activity, presence of other diseases, disorders hormonal background 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 the 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. it disturbing 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 acute period - rupture of the heart muscle, pulmonary edema, thrombosis of the veins of the extremities, which entails tissue death, and others. It is better to treat the patient during this period in a hospital in order to 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 its formation can be well traced: under the positive electrode, an enlarged Q wave is observed, under the negative electrode, it is symmetrical to the first T wave. A decrease in the T wave over time indicates a decrease in the area of ischemia. Subacute 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 and appoint adequate treatment, you need to do:

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 echocardiography - 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;
x-ray chest 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.

Most frequent consequences myocardial infarction:

Heart failure;
Heart rhythm disturbances;
Aneurysm (bulging of a wall or area of scar tissue);
Thromboembolism pulmonary artery, 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 a drink soothing drops and a nitroglycerin tablet under the tongue. If there are no serious contraindications, you need to take an aspirin tablet, after chewing it. To reduce pain, you can give non-steroidal painkillers - analgin.

Be sure to measure 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 - you need to carry out indirect massage heart 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 artificial ventilation. After removing the patient from acute condition held constant control indicators and restorative treatment.

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 ordinary life. But most patients are still forced to limit themselves to physical activity, take medication regularly and adhere to proper nutrition to prolong life, and minimize the risk of a relapse.

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

Physiotherapy exercises, first with minimum load, which gradually increases. Its purpose is to normalize blood circulation, improve lung ventilation, 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.
Taking medications prescribed by a cardiologist.
Maximum stress reduction.
Also, to improve health, the patient may need to reduce weight and complete failure from bad habits.

Subject to all medical indicators you can save your health and win a few years of a full life.

dangerous clinical form ischemic heart disease. Due to lack of blood supply to the heart muscle in one of its sections (left or right ventricle, apex of the heart, interventricular septum etc.) necrosis develops. A heart attack threatens a person with cardiac arrest, and in order to protect yourself and your loved ones, you need to learn to recognize its signs in time.

The beginning of a heart attack

In 90% of cases, the onset of myocardial infarction is accompanied by the appearance of angina pectoris:

A person complains of a pressing, burning, stabbing, squeezing feeling of pain right behind the sternum or in its left half.
The pain grows for a short time, can weaken and intensify in waves, gives to the arm and shoulder blade, right side chest, neck.
At rest, the pain does not go away, taking nitroglycerin or other cardiac drugs most often does not bring relief.
characteristic symptoms weakness, severe shortness of breath, lack of air, dizziness, increased sweating, feeling strong anxiety, fear of death.
The pulse in myocardial infarction can be either too rare (less than 50 beats per minute), or accelerated (more than 90 beats per minute), or irregular.

4 stages of a heart attack

According to the stages of development, the infarction is divided into the most acute, acute, subacute and scarring period. Each of them has its own flow characteristics.

Acute myocardial infarction lasts up to 2 hours from the onset of the attack. Strong and prolonged attacks of pain indicate the growth of a necrotic lesion.

Acute period of infarction lasts several days (on average, up to 10). The zone of ischemic necrosis is delimited from healthy myocardial tissues. This process is accompanied by shortness of breath, weakness, fever up to 38-39 degrees. It is at this time that the risk or its recurrence is especially great.

In the subacute stage of myocardial infarction dead myocardial tissue is replaced by a scar. It lasts up to 2 months after the attack. All this time, the patient complains of symptoms of heart failure and increased blood pressure. The absence of angina attacks is a favorable indicator, but if they persist, this increases the risk of a second heart attack.

Scarring after a heart attack myocardium lasts about six months. The healthy part of the myocardium resumes its efficient work, blood pressure and pulse return to normal, the symptoms of heart failure disappear.

What to do before the ambulance arrives

From the moment of infarction to the onset of irreversible phenomena in the heart muscle, about 2 hours pass. Cardiologists call this time the “therapeutic window”, therefore, suspecting heart attack need to call an ambulance immediately. Before the doctors arrive:

Take a semi-sitting position, put a pillow under your back and bend your knees.
Measure blood pressure. If it turns out to be too high, you need to take a pill for pressure.
Take a tablet of nitroglycerin and aspirin. This combination will expand the coronary vessels and make the blood more fluid, so that the infarction zone will decrease.

With a heart attack, you do not need to move, show any physical activity: this will increase the load on the heart.

Complications of a heart attack

Myocardial infarction is dangerous both by itself and by the complications that arise on different stages illness.

Early complications of a heart attack include cardiac arrhythmias and conduction disturbances, cardiogenic shock, acute heart failure, thromboembolism, myocardial rupture, arterial hypotension, respiratory failure and pulmonary edema.

On the late stages heart attack there is a risk of developing chronic heart failure, post-infarction Dressler syndrome, thromboembolism and other complications.

The stages of myocardial infarction, despite the rapid development of the process, it is important to determine for first aid, treatment and prevention of delayed complications. Myocardial infarction is an acute violation of the blood circulation of the heart muscle, which leads to its damage. When a vessel that feeds a certain part of the heart is clogged, destroyed or narrowed as a result of spasm, the heart muscle experiences an acute lack of oxygen (and the heart is the most energy-consuming human organ), as a result of which the tissues of this area die - necrosis is formed.

Stages of myocardial infarction

Damage develops sequentially, in several stages. Because the immune system acts on tissues indirectly through biological transmitters, physicians have some time to assist in order to avoid myocardial cell death, or, according to at least to minimize damage.

The most important method for diagnosing a heart attack is an electrocardiogram, which is readily available and can be carried out already in an ambulance.

The first, most acute stage, or stage of ischemia

It is very short, but most favorable period for first aid. Its duration is on average 5 hours from the onset of an attack, but it is quite difficult to clearly determine the moment when angina pectoris turns into a heart attack, and the compensation time is individual, so fluctuations are possible in a fairly wide range. pathological anatomy the first stage is the formation of a primary zone of necrosis due to acute disorder blood circulation, and this focus will continue to expand subsequently. Already at this stage, the first clinical manifestations- acute retrosternal pain, weakness, trembling, tachycardia. Unfortunately, very often patients cannot define this condition as a heart attack, do not attach importance to it, try to ignore it and suffer from dangerous complications.

The second, acute stage of myocardial infarction

This stage is characterized by the expansion of the necrosis zone so much that the loss of this area of the heart muscle leads to heart failure, systemic disorder circulation. This can take up to 14 days in time. In case of providing adequate medical care this stage can also be compensated, to stop tissue destruction. The number of cells that die during the acute stage will influence the occurrence of delayed complications and their nature. It is during this period that cardiogenic shock and reperfusion syndrome can develop - two dangerous early complications. Cardiogenic shock occurs when power cardiac output decreases, and the resistance of peripheral vessels does not allow efficient pumping of blood. Reperfusion syndrome develops with excessive use of fibrinolytics - then, after a long ischemia, the cells abruptly return to work and are damaged by oxidized radicals.

Staging is essential for treatment, first aid, and prevention of delayed complications.

Third, subacute stage of myocardial infarction

it crucial moment during the course of the illness. It lasts from two weeks to a month, at which time the cells in necrobiosis (a state between life and death) still have a chance to return to work if conditions are favorable for recovery. This period is characterized by an immune response to aseptic inflammation. It is from this moment that Dressler's syndrome can develop - autoimmune disease, which is characterized by damage to the myocardium by immune cells. At positive outcome the necrotic area is resorbed by macrophages, the decay products are metabolized. The resulting defect begins to fill the connective tissue, forming a scar.

Stage 4 - cicatricial

The duration of the final infarction stage is more than two months. In this phase, the connective tissue completely replaces the destroyed area. However, since this tissue is just the "cement" of the body, it is not able to take over the functions of the heart muscle. As a result, the ejection force weakens, rhythm and conduction disturbances are observed. At high pressure scar tissue stretches, dilatation of the heart is formed, the heart wall becomes thinner and may burst. However, adequate maintenance therapy prevents this, and the absence of damaging agents provides patients at this stage with hope for a favorable outcome.

Sometimes phases fall out or pass one into another so that it is impossible to single out any stage of a heart attack separately. To find out which stage is taking place, and then adjust the treatment, instrumental diagnostics will allow.

Cardiogenic shock occurs when the force of cardiac output decreases and peripheral vascular resistance prevents efficient pumping of blood.

The mechanism of development of a heart attack

Myocardial infarction is one of the most common and at the same time the most dangerous diseases of cardio-vascular system. It is characterized by high mortality, most of which falls on the first hours of the attack oxygen starvation(ischemia) of the heart muscle. Necrotic changes are irreversible, but occur within a few hours.

Many factors affect cardiovascular system increasing the risk of a heart attack. This is smoking, an unbalanced diet with large quantity trans fats and carbohydrates, physical inactivity, diabetes, unhealthy lifestyle, night work, exposure to stress and many others. There are only a few reasons that directly lead to ischemia - this is a spasm of the coronary vessels that feed the heart (acute vascular insufficiency), their blockage by an atherosclerotic plaque or thrombus, critical increase nutritional needs of the myocardium (for example, during severe physical activity, stress), damage to the vessel wall with its subsequent rupture.

The heart is able to compensate for ischemia for some time due to the accumulated inside cardiomyocytes (cardiac muscle cells) nutrients, however, the reserves are exhausted after a few minutes, after which the cells die. The necrosis zone cannot take a functional part in the work of the muscular organ, aseptic inflammation occurs around it, and a systemic immune response to damage joins. If help is not provided at the right time, the infarct zone will continue to expand.

Symptoms

The symptoms of the disease vary, but there are several signs that indicate a heart attack with high probability. First of all, it is a cardiac pain that radiates to the arm, fingers, jaw, between the shoulder blades.

Reperfusion syndrome develops with excessive use of fibrinolytics - then, after a long ischemia, the cells abruptly return to work and are damaged by oxidized radicals.

The diagnostic criterion is a violation of the contractile, conductive, rhythm-forming work of the heart due to damage to the conduction system - the patient feels strong tremors of the heart, it stops (interruptions in work), uneven beats at different intervals. Systemic effects are also observed - sweating, dizziness, weakness, tremor. If the disease progresses rapidly, shortness of breath due to heart failure joins. May be observed mental manifestations heart attack - fear of death, anxiety, sleep disturbances, suspiciousness and others.

Sometimes classic symptoms are not expressed, and sometimes atypical signs appear. Then they talk about atypical forms of myocardial infarction:

abdominal - in its manifestations resembles peritonitis with acute abdomen syndrome (intense pain in epigastric region, burning, nausea);
cerebral - occurs in the form of dizziness, clouding of consciousness, the development of neurological signs;
peripheral - the pain is distant from the source and is localized in the fingertips, neck, pelvis, legs;
painless, or asymptomatic form - usually occurs in patients with diabetes mellitus.

Anatomically, there are several types of infarction, each of which damages different shells hearts. Transmural infarction affects all layers - a large zone of damage is formed, cardiac function suffers to a large extent. Unfortunately, this type also accounts for the majority of all cases of myocardial infarction.

Intramural infarction has limited localization and more favorable course. The damage zone is located in the thickness of the heart wall, but does not reach the epicardium from the outside and the endocardium inside. With subendocardial infarction, the focus of damage is localized immediately under the inner shell of the heart, and with subepicardial infarction - under the outer one.

The heart is able to compensate for ischemia for some time due to the nutrients accumulated inside the cardiomyocytes, but the reserves are exhausted after a few minutes.

Depending on the volume of the lesion and the characteristics of the necrotic process, large-focal and small-focal infarcts are also distinguished. Large focal has characteristic features on the electrocardiogram, namely, a pathological Q wave, therefore, a large-focal one is called a Q-infarction, and a small-focal one is called a non-Q-infarction. The size of the area of damage depends on the caliber of the artery that has fallen out of circulation. If the blood flow in a large coronary artery is blocked, a large-focal infarction occurs, and if the final branch is small-focal. A small-focal infarction may almost not manifest itself clinically, in this case, patients carry it on their feet, and the scar after alteration is discovered quite by accident. However, cardiac function suffers significantly in this case as well.

Diagnosis of a heart attack

The most important method for diagnosing a heart attack is an ECG (electrocardiogram), which is easily accessible and can be carried out already in an ambulance in order to identify the type and localization of damage. By changes electrical activity heart, you can judge all the parameters of a heart attack - from the size of the focus to the duration.

The first stage is characterized by elevation (elevation) of the ST segment, which indicates severe ischemia. The segment rises so much that it merges with the T wave, the increase of which indicates damage to the myocardium.

In the second, acute stage of a heart attack, a pathological deep Q wave appears, which can turn into a barely noticeable R (it decreased due to a deterioration in conduction in the ventricles of the heart), or it can skip it and go immediately to ST. It is by the depth of pathological Q that Q-infarction and non-Q-infarction are distinguished.

With subendocardial infarction, the focus of damage is localized immediately under the inner shell of the heart, and with subepicardial infarction - under the outer one.

In the next two stages, deep T appears and then disappears - its normalization, as well as the return of high ST to the isoline, indicates fibrosis, replacement of the lesion connective tissue. All changes in the ECG are gradually leveled, only R will gain the necessary potential for a long time, but in most cases it never returns to its pre-infarction indicator - contractility cardiac muscle is difficult to return after acute ischemia.

An important diagnostic indicator is a blood test, general and biochemical. General (clinical) analysis allows you to see changes characteristic of a systemic inflammatory response - an increase in the number of leukocytes, increase in ESR. Biochemical analysis allows you to measure the level of enzymes specific to cardiac tissue. Indicators characteristic of a heart attack include an increase in the level of CPK (creatine phosphokinase) of the MB fraction, LDH (lactate dehydrogenase) 1 and 5, a change in the level of transaminases.

Echocardiography is the decisive examination to clarify changes in hemodynamics in the heart after injury. It allows you to visualize the blood flow, the focus of necrosis or fibrosis.

Treatment at different stages of a heart attack

In the initial stages, treatment is aimed at reducing the damage that the heart muscle receives. To do this, drugs are introduced that dissolve the thrombus and prevent aggregation, that is, sticking together, of platelets. Drugs are also used that increase myocardial endurance in hypoxic conditions, and vasodilators to increase the lumen of the coronary arteries. The pain syndrome is relieved by narcotic analgesics.

The first stage is characterized by ST segment elevation, which indicates severe ischemia. The segment rises so much that it merges with the T wave, the increase of which indicates damage to the myocardium.

In the later stages, control of the patient's diuresis is necessary, in addition, vasoprotectors and different kind membrane stabilizers. Heart failure is to some extent compensated by cardiotonic drugs.

In the future, cardiorehabilitation and supportive therapy are carried out.

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