Acute myocardial infarction characteristic symptoms. Acute myocardial infarction: symptoms, classification, definition, mechanism of occurrence. Video: educational film about pathology

A few words about how the course of myocardial infarction passes. At the moment, in the clinical picture of both uncomplicated and complicated course of myocardial infarction, five periods are distinguished: prodromal (pre-infarction), acute, acute, subacute, post-infarction immediate and remote.

What are the periods of mycoardial infarction

1. Preinfarction period (prodromal)- this period of myocardial infarction is considered as a period of increasing severity of coronary insufficiency. It lasts from several minutes to 1.5 months. Most often during this period there is an increase in seizures unstable angina, their intensity increases. The zone of prevalence of pain expands, begins to disturb and to the right of the sternum. The irradiation zone also increases significantly, occupying the interscapular and epigastric region, some patients note it in the cervical-occipital region. The decrease in tolerance to the usual physical activity is progressing. The effectiveness of nitroglycerin taken sublingually is significantly reduced, and sometimes the pain syndrome is not removed. Patients are restless, anxious, sometimes they have a feeling of fear of death. They have signs of cardiovascular insufficiency: cold extremities, clammy sweat, etc. various disorders heart rate, falling blood pressure. Patients may note the addition to the above complaints of a feeling of shortness of breath, dizziness. The signs listed above are most characteristic of the first period - pain, or ischemic. If treatment is started on time, a heart attack can be avoided. You can name the objective symptoms of this period: a slight cyanosis of the lips and subungual spaces, an increase in blood pressure (then decrease); increase in heart rate; a slight increase in the left border of the heart; during auscultation, muffled heart sounds are sometimes heard; practically unchanged biochemical parameters blood, characteristics on the ECG. Especially helps in the diagnosis of Holter ECG monitoring for a day or more. At the same time, a decrease in the 8T interval of the ischemic type, the appearance of a negative "coronary" T wave, an increase in the P wave in some leads, the absence of a pathological O wave, and the appearance of rhythm disturbances are revealed.

2. course of myocardial infarction. Acute period (feverish, inflammatory) The course of myocardial infarction is characterized by the occurrence of necrosis at the site of ischemia of the heart muscle. All signs of aseptic inflammation appear, products of hydrolysis of necrotic masses begin to be absorbed. The pain usually goes away. The duration varies, according to some sources, from 30 minutes to 2-4 hours. Provoking factors contribute to the development of this period of myocardial infarction: intense physical activity, psycho-emotional stressful situation, trauma, possibly overeating, surgical intervention, severe cooling or overheating, in patients diabetes- insulin hyperglycemia, sexual intercourse. These factors significantly increase myocardial oxygen demand and at the same time increase arterial pressure and cause spasm coronary arteries. In most patients with myocardial infarction, pain in the region of the heart becomes excessively intense. The pains are characterized as strong pressing, squeezing, many note intense burning or "dagger" pains. Clinical Research revealed a direct relationship between the intensity of pain in the region of the heart, the extent of infarction and the age of the patient. As a rule, the pain radiates to the left hand, there may be a feeling of severe squeezing pain in the wrist area. Can give to left shoulder, left shoulder blade, neck, lower jaw, ear. Characterized by undulations of pain. It gradually increases, becomes intense, and then decreases somewhat, but soon resumes with greater strength. This undulating course of myocardial infarction can last up to several hours. The use of nitroglycerin in any form, under the tongue or in the form of a spray, does not relieve pain. During an attack of pain, people experience a feeling of fear of death, longing, doom, sometimes excited and restless, patients with myocardial infarction may feel a feeling of lack of air. When examining a patient with myocardial infarction during this period of the disease, pallor is detected, often high humidity skin, cyanosis of the lips, nose, ears, subungual spaces. Palpation of the heart area in patients with extensive transmural myocardial infarction can detect presystolic pulsation, synchronous with the IV tone. Systolic pulsation can also be detected in the III, IV, V intercostal spaces to the left of the sternum. The pulse rate in the uncomplicated course of the disease is normal, but the pulse is sometimes arrhythmic due to extrasystoles. Blood pressure may rise slightly, but then quickly returns to normal. But with extensive myocardial infarction, its decrease is observed, mainly systolic. Arterial hypotension often occurs with repeated myocardial infarctions. The borders of the heart only sometimes slightly increase due to the left border. An increase in size may be associated with extensive myocardial infarction. In patients with uncomplicated, but extensive myocardial infarction, a muffled 1 tone and a quiet tone are determined. systolic murmur at the top. With extensive transmural myocardial infarction, a gallop rhythm may be heard. In some cases, a systolic "cat's purr" is heard. Physical examination of other organs and systems does not reveal any significant changes in patients with uncomplicated myocardial infarction. The ECG clearly shows signs of myocardial damage:

1) with penetrating myocardial infarction, when the zone of necrosis extends from the pericardium to the endocardium on the ECG, the displacement of the 8T segment above the isoline, the shape is convex upward, this is the first sign of a penetrating myocardial infarction. The fusion of the T wave with the 8T segment occurs on days 1–3; a deep and wide tooth (5 is one of the main signs; a decrease in the size of the K wave is also characteristic. Dis-coordinate changes occur - opposite displacements of ST and T (for example, in standard leads 1 and 2 compared to standard lead 3); on average, with On the 3rd day, the reverse dynamics of characteristic ECG changes is observed: the 8T segment approaches the isoline, a uniform deep T appears.

2) with an intramural infarction, a large increase in the tooth (does not occur; the displacement of the 8T segment can be not only up, but also down. For a more reliable assessment, a second ECG is necessary.

Of course, ECG signs have great importance when making a diagnosis, but all signs of diagnosing myocardial infarction should be taken into account:

1) clinical signs;

2) electrocardiographic signs;

3) biochemical signs indicating damage to heart muscle cells.

In cases of doubt, it is necessary to carry out echocardiography (identification of "fixed" areas of the myocardium) and radioisotope research heart (myocardial scintigraphy). Similarly, a retrospective diagnostic assumption of myocardial infarction complicating the course of other diseases or the postoperative period is substantiated.

3. acute period. During this period, the focus of myocardial necrosis is finally formed, and myomalacia occurs in it. The period lasts from 2 to 10-14 days. Pain in the acute period disappears, but in rare cases with the expansion of the zone of necrosis in progressive myocardial infarction, there may be preservation pain syndrome. An increase in heart rate, a tendency to lower blood pressure are determined, muffled tones and a soft systolic murmur at the apex of the heart will remain. In this period, on the 2nd, less often on the 3rd day, there is a rise in body temperature to 37.1-37.9°C, in rare cases it exceeds 38°C. The temperature rise lasts for about 3–7 days, possibly up to 10 days. The magnitude of the temperature reaction and its duration to a certain extent depend on the extent of necrosis and the age of the patient. In blood tests, the following changes are noted: the number of leukocytes increases already on days 2–4 and persists up to 3–7 days. Usually their number reaches 10-12 X 10 9 /l, with widespread transmural myocardial infarction - up to 15 X 10 9 /l. Leukocytosis is accompanied by a shift leukocyte formula to the left. There is also an increase in ESR from day 2–3 of illness, which peaks between day 8–12 and then slowly decreases, returning to normal after 3–4 weeks. Longer maintenance of increased ESR indicates the presence of complications. In the biochemical analysis of blood, the content of fibrinogen, seromucoid, sialic acids, y-globulin, C-reactive protein increases. Markers of death of cardiomyocytes are determined, such as aspartate aminotransferase, lactate dehydrogenase, creatine phosphokinase, myoglobin, myosin, cardiotropins T and I, glycogen phosphorylase. The ECG also shows changes characteristic of this period of the disease.

4. Subacute period lasts about 8 weeks. During this time, the scar is completely formed and compacted. The duration of this period is influenced by the vastness of the necrosis zone, the presence of complications, as well as the reactivity and age of the patient. In prognostic terms, this period is more favorable, since the most life-threatening complications for the patient most often develop in the first days from the onset of the disease. It has been found that in uncomplicated myocardial infarction subacute period proceeds most favorably. On examination, the patient's condition is satisfactory, there is no pain syndrome. The heart rate returned to normal, systolic murmur in the apex of the heart is not heard. Blood pressure is usually normal if, before the onset of myocardial infarction, arterial hypertension, then in this period, blood pressure begins to rise again. In the subacute period, body temperature returns to normal, changes in the blood disappear. An abnormal O wave is recorded on the ECG.

5. Postinfarction period of myocardial infarction- a period of complete adaptation of the cardiovascular system to new conditions of functioning, i.e. turning off the contractile function of the myocardial region. Given the presence of a connective tissue scar at the site of necrosis, this period is also called the period of postinfarction cardiosclerosis. The postinfarction period continues throughout the rest of the patient's life, this period, in turn, is divided into 2 periods: the nearest one - 2-6 months and the remote one - after 6 months. Pain most often does not bother the patient in this period, but sometimes there are cases of resumption of angina pectoris. In the postinfarction period, the patient's condition is satisfactory. Patients are fully adapted in social and psychological terms. When examining a patient, only signs of atherosclerosis of the chest and abdominal region aorta, sometimes they find a slight expansion of the left border of the heart to the left, muffled first heart sound above the apex of the heart. In patients with arterial hypertension diagnosed before myocardial infarction, an increase in blood pressure is recorded, which requires immediate antihypertensive therapy. The pathological wave O remains on the ECG. When examining other organs and systems, no pathological changes are detected.

Atypical forms of myocardial infarction

1) peripheral with atypical localization of pain. With this type of pain syndrome different intensity, localized not behind the sternum and not in the pericardial region, but in typical places for the classical form. This form difficult to diagnose, but when examining blood counts and ECG data, data can be obtained indicating myocardial infarction;

2) abdominal form (gastralgic). Proceeds according to the type of lesion of the gastrointestinal tract, with characteristic pains in the abdomen, nausea, vomiting and bloating. Most often, the gastralgic form (abdominal) of myocardial infarction occurs with infarction of the posterior wall of the left ventricle. Sometimes this variant of the course of a heart attack is mistaken for surgical or infection. In this case, sometimes put misdiagnosis food poisoning, wash the stomach, put cleansing enema thereby causing great harm to the patient;

3) asthmatic form: begins with shortness of breath, cardiac asthma and contributes to the development of complications such as pulmonary edema. Pain syndrome may be absent. The asthmatic form is most common in older people with cardiosclerosis, as well as in a second heart attack or with very extensive heart attacks;

4) cerebral form (cerebral): in the foreground, symptoms of cerebrovascular accident like a stroke with loss of consciousness, patients may complain of headaches, dizziness, visual disturbances. Paralysis and paresis of the limbs are possible. This form occurs more often in older people who have cerebral vascular sclerosis;

5) a silent or painless form sometimes becomes an accidental discovery during medical examination. From clinical manifestations: suddenly it became "bad", arose severe weakness, sticky cold sweat, then everything passes, weakness remains. This course is typical in old age and with repeated myocardial infarctions;

6) the arrhythmic form is the main sign of paroxysmal tachycardia, while the pain syndrome may be absent. Patients complain of increased heart rate or, conversely, the heart rate is sharply reduced and the patient loses consciousness. The latter is a manifestation of complete atrioventricular blockade;

7) the collaptoid form is characterized by the absence of pain in the region of the heart, the sudden development fainting, darkening in the eyes, drop in blood pressure, dizziness. Loss of consciousness is usually not observed. This form often occurs with repeated, extensive or transmural myocardial infarctions;

8) edematous form appears rapid emergence shortness of breath, weakness, palpitations, interruptions in the heart rhythm and edematous syndrome. This variant is observed in extensive, transmural, repeated myocardial infarctions leading to the development of total heart failure;

9) combined-atypical. This variant of the course of myocardial infarction combines the manifestations of several atypical forms. Myocardial infarction is very serious illness With large quantity deaths and the risk of complications, especially in the first and second period.

Myocardial infarction is a disease in which there is a violation of the blood supply to the heart, leading to tissue necrosis. Its main symptoms are intense burning pains behind the sternum, cold sweat, a feeling of shackling causeless horror that appeared suddenly, and difficulty breathing.

This condition requires immediate medical attention. Typically, men over 40 and women over 50 suffer from myocardial infarction.

General classification

There are several options for classifying the disease in accordance with different parameters and factors.

• All information on the site is for informational purposes and is NOT a guide to action!
• Give you an ACCURATE DIAGNOSIS only DOCTOR!
• We kindly ask you DO NOT self-medicate, but book an appointment with a specialist!
• Health to you and your loved ones!

Depending on how deeply the necrosis has penetrated, such types of myocardial infarction are distinguished as:

ECG with myocardial infarction in stages will accurately determine which area is damaged and how large the affected area is. However, with the help of this study, it is sometimes difficult to diagnose the disease due to the lack of typical changes at the onset of a heart attack and for other reasons.

According to the second classification, the disease, depending on the size of the affected area, is divided into two types:

• macrofocal;

Moreover, the second form occurs much less frequently (in about 20% of cases), but can develop into the first form.

Small-focal infarction has a milder course and less risk of negative consequences. In this case, there is practically no thromboembolism, heart failure or rupture, ventricular fibrillation or.

Specialists also distinguish atypical varieties of myocardial infarction, which are characterized by their own symptoms and manifestations.

Taking into account the main indicator of multiplicity, cardiologists talk about the following types of diseases:

Do not confuse necrotic myocardial damage with infarct conditions such as:

Stages and periods of macrofocal myocardial infarction

Specialists depending on external and internal manifestations and features of the course, there are five periods of the disease, which has a macrofocal character:

Manifestations with small focal lesions

Small-focal myocardial infarction is characterized by the occurrence of several small foci of necrosis in the heart muscle. This form of the disease does not have clear periods of the course, as in a large-focal one. It does not cause such complications as arterial hypertension, insufficiency and rupture of the heart, aneurysm.

The pain experienced by the patient is also less pronounced. But the small-focal form of myocardial infarction can be transformed into a large-focal one.

This type of heart attack goes away in most cases without being accompanied by arrhythmias and problems with myocardial conduction. However, depending on the affected area, the consequences of a small-focal infarction can be very different: from fairly mild to malignant arrhythmia of the ventricles of the heart.

Timely diagnosis and initiation of treatment can reduce the risk of complications of both large-focal and small-focal myocardial infarction.

At the first symptoms of its occurrence, which include severe chest pain, especially in combination with dizziness and increased fatigue, as well as shortness of breath, excessive sweating, it is recommended to immediately seek medical help from a specialist.

Everything today more people complain of poor heart condition. If it is not provided on time urgent care the consequences can be very dire. The most formidable condition of our motor is acute myocardial infarction. What is this disease, how to deal with it and carry out high-quality treatment?

Description and causes of the disease

In Russia, tens of thousands of people die every year from myocardial infarction, more specifically 65,000. Many others become disabled. This disease does not spare anyone, neither the elderly nor the young. The whole thing is in the heart muscle, which is called the myocardium.

The cause of the disease is the death of heart cells

Blood flows through the coronary arteries to this muscle. A blood clot can clog some artery that feeds it. It turns out that this part of the heart remains without oxygen. In this state, myocardial cells can last about thirty minutes, after which they die. This is the immediate cause of a heart attack - stopping coronary circulation. However, it can be caused not only by a thrombus. In general, the reasons for this situation in the vessels can be described as follows:

1. Atherosclerosis. In this case, a thrombus is formed. If you do not interfere with its formation, it will grow very quickly, and eventually block the artery. The above process takes place, which causes such a terrible disease;
2. Embolism. As you know, this is a process in which blood or lymph contains particles that should not be in normal condition. This leads to disruption of the local blood supply. If the embolism is the cause of acute myocardial infarction, then most often it is a fat embolism, in which droplets of fat enter the bloodstream. This happens with numerous bone fractures;
3. Spasm of the heart vessels. This means that the lumen of the coronary arteries narrows sharply and suddenly. Although this process is temporary, the consequences can be the most unpleasant;
4. Surgical interventions, namely the complete dissection of the vessel across or its ligation;

In addition, the factors that influence the above causes, and, accordingly, the occurrence acute course The disease we are discussing can be described as follows:

1. A dangerous disease is diabetes mellitus, so you should not let its treatment take its course;
2. Smoking;
3. stress;
4. Hypertension;
5. Age (most often the occurrence of myocardial infarction occurs in women after 50 years and men after 40 years);
6. Obesity;
7. hereditary predisposition;
8. low physical activity;
9. Heart arythmy:
10. Already transferred myocardial infarction;
11. Cardiovascular diseases;
12. alcohol abuse;
13. Increased amount of triglycerides in the blood.

You can help your heart even before the disease worsens, you just need to change your life.

Signs of the disease

Symptoms that are quite pronounced will help determine the occurrence of a heart attack. The main thing is to recognize them in time and take action. necessary measures.

The main symptom is sharp pain in the chest

This disease has a bright sign that occurs very often - it is pain localized behind the sternum. However, for some, this feature may not be expressed strongly, and for those who have diabetes, it may not be at all. In addition, pain can be felt in the abdomen, arm, neck, shoulder blade, and so on. But in many cases the pain will be burning and squeezing. The person may feel as if a hot brick has been placed on their chest. This state lasts at least fifteen minutes. It can go on for several hours. If the entire left ventricle is affected during a heart attack, then pain usually spreads, which is called irradiation.

Another significant symptom, which is also distinctive in myocardial infarction, is shortness of breath. It appears because contractility heart is decreasing. If shortness of breath is accompanied by a cough, this indicates that the speed pulmonary circulation slows down. In this case, necrosis of a significant area of ​​the left ventricle occurs. Even pulmonary edema and shock may occur due to the fact that the volume of the affected myocardium is large enough.

Other features that are companions of a heart attack are weakness, profuse sweat, that is, too heavy sweating, and interruptions in the work of the heart. In some cases, unexpected cardiac arrest may occur. It is worth paying attention to weakness and autonomic reactions, which will also help to recognize this disease.

This does not mean that the above symptoms occur all together and in each person. Important to consider individual characteristics and the fact that some signs may not manifest themselves in any way. Recognizing symptoms is an important aid in dealing with them.

Disease classification

The development of acute myocardial infarction can be divided into four stages:

1. Sharpest phrase. In another way, it is called the phase of damage. It lasts from 2 to 24 hours. During this period, the process of myocardial dying in the affected area is formed. Unfortunately, most people die during this period, so emergency care at this moment is especially important.
2. acute phase. Its duration is up to 10 days, starting from the onset of the disease. This period is characterized by the fact that inflammation occurs in the infarction zone. This means that the body temperature will be raised. The zone of inflammation will become edematous and will put pressure on healthy areas of the myocardium, worsening its blood supply.
3. The subacute phase in which a scar forms. It lasts from ten days to 4-8 weeks.
4. The scarring phase, the duration of which is 6 months. This stage is also called chronic.

With myocardial infarction, necrosis, that is, the disease itself, is localized in the following places:

• left ventricle;
• right ventricle;
• apex of the heart;
• interventricular septum;
• other combined localizations.

The size of the infarction can be divided into large focal and small focal.

Diagnosis of the disease

Acute myocardial infarction can be diagnosed in several ways:

1. ECG. This is the main objective method. Thanks to him, you can determine in which place the myocardium was affected.
2. Heart markers. These are enzymes secreted from myocardial cells in case of damage, which is expressed in a heart attack. An increase in these markers is observed a day after the attack. However, emergency care is included in the treatment, which must be provided immediately. This is how it should be done, and in a day cardiac markers will help to establish an accurate diagnosis.
3. Angiography. This method is used when there are difficulties with diagnosis, as well as when it is possible to restore blood flow by endovascular surgery. The essence of angiography is that the catheter is brought to the coronary vessel. A special substance is introduced through it, which allows real-time fluoroscopy. Thus, the disease will become more understandable.

What to do?

The treatment of such a disease as acute myocardial infarction is a very important undertaking. It is not for nothing that we used the word “event”, since emergency care involves following several principles. Of course, it is important to know them, but, despite this, it is really qualified assistance can only be provided by medical staff. It turns out that the first thing to do is to call ambulance. On the phone, be sure to say what is happening with the patient and list the symptoms. The entire condition of the person should be described in detail to the medical staff when they arrive. Next, it's up to them.

In total, the principles that include treatment can be divided into several points:

1. Anesthesia. This process is necessary, since there is a strong production of catecholamines in response to a pain impulse. They constrict the arteries of the heart. For pain relief, two types of analgesics are used - narcotic and non-narcotic. Morphine is often commonly used. But from the very beginning, its application can be erroneous, as there may be respiratory disorders. Therefore, nitroglycerin is often given before this drug, which can relieve pain. Nitroglycerin is contraindicated only if the blood pressure is low, 90/60 or lower. There is an option to use analgin. If it does not help, morphine is used to relieve pain, which is administered intravenously fractionally. In acute infarction, treatment with analgesics is necessarily present, which are used on the first day. Qualitatively rendered assistance in this direction will weaken the disease.
2. Recovery. Emergency care also means restoring patency coronary vessels. To do this, use drugs that affect blood clotting. After 3-6 hours have passed since it all started, thrombolytic agents such as alteplase, streptokinase, and so on are included in the treatment. So that it doesn't happen in the future re-development thrombosis, anticoagulants must be used: fragmin, heparin, fraxiparin. The same goal is promoted by antiplatelet agents: clopidogrel, aspirin, plavix.

It is important to remember that until the ambulance arrives, the life of the patient is in the hands of the one who is nearby, so emergency care is more important than ever. The patient needs to be laid down, but if he does not want this, you should not force him, since such people often look for the most optimal body position for them. If there are no contraindications, sublingual nitroglycerin should be given. If the pain does not subside, it can be applied every five minutes. The main thing is to make anesthesia. Before using any such means, even analgin, you need to ask if the patient tolerates them. Sedatives will help enhance the effect of painkillers. In addition, you need to measure your blood pressure and pulse frequently, preferably every five minutes. As we have already said, in the case low pressure nitroglycerin should be skipped. If the pulse is 60 beats per minute, then you can give atenolol, 25 mg. This is done to prevent arrhythmia.

emergency surgical intervention can save a life

Treatment may include surgical methods, which help to some extent defeat the disease. If surgical intervention is performed urgently, then in most cases this is done in order to restore blood flow. stenting is used. This means that to the site that is affected by thrombosis, metal structure. It expands, due to which the vessel expands. Today, this method often includes emergency care. In the case of a planned intervention, the goal is to reduce the area of ​​necrosis. Elective surgeries include coronary artery bypass grafting. With this method, the risk of recurrence of acute infarction is further reduced.

If all necessary measures are taken, this does not mean that the treatment stops there. Throughout life, the patient must use hypolidemic drugs and antiplatelet agents, for example, atorvostatin, simvostatin, and so on. This is important so that the disease has as little chance as possible to return. The first day in acute myocardial infarction is the most important, so you need to be on your guard so that, if necessary, an emergency is provided. health care. Therefore, the medical staff at this time should conduct multiple examinations, measure pressure, pulse, heart rate, and so on. In addition, nutrition is very important. The first days in the diet of the patient should not be smoked meats, pickles, alcohol, fatty meat. It is best to consume fruits, vegetables and mashed potatoes from them.

Therapeutic exercise helps to ease the disease

In order for treatment and recovery to be most effective, sometimes prescribed physiotherapy exercises. It helps a lot in relieving the disease. For this, a special set of exercises is selected, which can only be performed under the supervision of an instructor. He will monitor how the heart reacts to such loads. Usually the complex includes walking, breathing exercises, hand exercises and exercises in the pool. After the patient is discharged from the hospital, he will most likely be advised to continue the same activities. If there is a desire to make any innovations, they must be discussed with the doctor. In the process of exercise, you need to carefully monitor your health so that help in case of exacerbation is provided on time.

All of the above is very important to know. This will help to be prepared for the fact that a nearby person will have an attack. Symptoms will help you understand what kind of disease is developing right before your eyes, and the right emergency care at such a moment will save a person's life. Properly selected treatment will prolong it and reduce the risk of complications. It is important to remember that to reduce the risk of cardiovascular diseases each person can, if he leads healthy lifestyle life.

The reasons

Myocardial infarction is always an acute condition, triggered by an abrupt cessation of coronary circulation. In this case, within a few minutes (if blood circulation stops 100%), irreversible death of muscle cells occurs. And, the larger the diameter of the vessel in which the movement of blood stops, the more cells die. Therefore, acute myocardial infarction, the causes of which are reduced to those that cause coronary circulation arrest, is always an acute condition.

The reasons for stopping blood flow in the heart vessels, as well as myocardial infarction itself, include (in importance):

• Atherosclerosis of the coronary vessels. More precisely, its complications such as thrombosis, embolism;
• Spasm of the arterial vessels of the heart;
• Embolism with a foreign body or pieces of tissue. The most common fat embolism multiple fractures bones;
• Surgical interventions on the heart: ligation of the coronary vessel or its complete transverse dissection.

Causes and mechanisms of vascular insufficiency of the heart

Features of the work of the heart - constant contractions of the myocardium - cause very high level metabolic processes in its cells, high oxygen consumption and nutrients. This mode of activity requires an uninterrupted supply of highly oxygenated ( rich in oxygen) blood, which is provided by an extensive network of cardiac vessels starting from the aorta in the form of coronary (coronary) arteries.

The flip side of the effectiveness of the heart muscle is its high sensitivity to oxygen starvation. In case of malnutrition, pathological phenomena develop in the myocardium, which very quickly become irreversible.

If the lack of blood flow is not critical, reversible ischemia (anemia) of the heart muscle area occurs, which is manifested by angina pectoris pain behind the sternum. With the complete cessation of blood flow to a certain area, a cascade of pathological processes develops - there is an accumulation of toxic metabolic products that are not excreted, a transition to an anaerobic (oxygen-free) mode of operation using internal energy reserves cells.

Own reserves of energy carriers (glucose and ATP) are very quickly (in about 20 minutes) depleted, and the bloodless section of the heart muscle dies. This is myocardial infarction - necrosis, the size of which depends on the level of occlusion of the vessel (large or small branch), the rate of onset of ischemia (with a gradual cessation of blood supply, partial adaptation is possible), the age of the patient and many other factors. For example, sharp transmural infarction myocardium (with necrosis of all thicknesses of the heart muscle), which has a very severe course, develops with occlusion (overlap) of a large branch of the coronary vessel.

Section of the heart wall in myocardial infarction

Among the causes of impaired blood supply to the myocardium, the most common block of the lumen of the vessel is an atherosclerotic plaque or thrombus (these phenomena can be combined). In addition, a sharp spasm of the coronary arteries is possible under the influence of physical (cold) or chemical (poisons, drugs) factors. Severe anemia, in which there is a sharp decrease in the content of hemoglobin in the blood, and, consequently, its ability to transport oxygen, can also cause myocardial ischemia. The inconsistency of blood supply with increased needs occurs with a sharp hypertrophy of the heart muscle - cardiomyopathy.

Predisposing factors for the development of a heart attack

Some diseases and pathological conditions are factors increased risk in terms of development acute ischemia myocardium. These include:

• Diabetes.
• Hypertonic disease.
• Ischemic heart disease (CHD), manifested by attacks of angina pectoris (especially its unstable forms).
• Increased blood levels of cholesterol and some fractions of lipoproteins.
• Excessive body weight.
• Smoking.
• Alcohol abuse.
• Errors in the diet (high intake of salt, animal fats).
• Cardiac arrhythmia.
• Prolonged stressful situations.
• Age over 60 (although last years“rejuvenation” of the infarction is observed).
• Male gender (after 70 years, the number of men and women suffering from a heart attack levels off).

Classification of ischemic myocardial injury

There are various criteria for classifying a heart attack. Some of them:

• By the size of the damage zone - large-focal and small-focal.
• According to the depth of damage to the heart muscle - transmural (throughout the entire thickness of the heart wall), intramural (necrosis in the thickness of the wall), subendocardial (damage to the inner layer), subepicardial (outer layer).
• According to topography - left ventricular (anterior wall, posterior and lateral walls, interventricular septum), right ventricular.

Pain attack lasting more than 20 minutes is one of the diagnostic criteria for a heart attack

Symptoms of a heart attack

In development pathological process There are several periods, each of which has its own duration and symptoms.

The pre-infarction period can last from a few minutes to months. It is characterized by an increase in angina attacks and an increase in their intensity.

Sharpest period. in which the development of ischemia and necrosis of the heart muscle occurs, lasts up to several hours. May have a typical and atypical variant of the course.

Pain, or anginal variant, is typical (about 90% of all cases). It is characterized by pain behind the sternum of high intensity, burning or pressing, which can radiate (give) to the left limbs, jaw, neck. There may be a fear of death, sweating, blanching or redness of the skin of the face, shortness of breath. The severity of pain depends on the size of the affected area - large-focal infarction causes more severe symptoms than small-focal. The pain is not relieved by nitroglycerin.

Atypical variants can proceed according to the asthmatic type (have symptoms of an attack bronchial asthma), abdominal (with symptoms acute abdomen), arrhythmic (in the form of an attack of cardiac arrhythmia), cerebral (with impaired consciousness, dizziness, paralysis, visual impairment).

The acute period lasts about 10 days. The zone of necrosis is finally formed and demarcated, the absorption of decay products and the formation of a scar begin. The pain syndrome disappears or decreases. Possible fever, hypotension and heart failure.

The subacute period (about two months) is the stage of scar formation and compaction. There is no pain syndrome, the condition is gradually improving. Well-being in given period is largely determined by the nature and extent of changes that have occurred in the heart muscle.

Postinfarction period. or rehabilitation (up to six months), characterized by the absence of clinical and laboratory signs heart attack (changes on the ECG remain - they will remain for life), however, in this phase, the development of heart failure, angina pectoris and re-infarction is possible.

Complications of myocardial infarction

Acute myocardial ischemia, itself being serious condition, may be even more aggravated by the addition of complications.

The most frequent complications:

• Cardiac arrhythmias ( paroxysmal tachycardia, extrasystole, atrial fibrillation). Such a situation as the appearance of ventricular fibrillation with the transition to their fibrillation can cause the death of the patient.
• Heart failure is associated with a violation of the activity of the left ventricle in pumping blood through the vessels. It can lead to pulmonary edema, cardiogenic shock and death due to a sharp drop in pressure and cessation of renal filtration.
• Thromboembolism pulmonary artery can lead to pneumonia lung infarction and death.
• Cardiac tamponade can occur when the heart muscle ruptures in the infarction zone and blood ruptures into the pericardial cavity. The condition is life-threatening and requires emergency care.
• Acute aneurysm of the heart - bulging of the area of ​​scar tissue with extensive damage to the myocardium. In the future, it can lead to the development of heart failure.
• Thromboendocarditis is the deposition of fibrin on the inner surface of the heart. Its detachment can cause a stroke, mesenteric thrombosis (closing of the branch of the vessel that feeds the intestines), followed by necrosis of the intestine, and kidney damage.
• Post-infarction syndrome - a common name long-term complications(pericarditis, pleurisy, arthralgia).

Some ECG signs of acute myocardial infarction

Diagnosis of a heart attack

In the diagnosis of a heart attack, anamnesis data (the circumstances of the course of the disease and previous life, ascertained by questioning the patient and his relatives), laboratory and instrumental methods research.

Anamnesis

Existing attacks of chest pain of varying frequency and intensity, risk factors (smoking, stress, chronic diseases). Examination may reveal excess weight, indirect signs increased pressure (capillary network on the face), etc. Retrosternal pain lasting more than 20 minutes is considered one of the diagnostic criteria for a heart attack.

Laboratory methods

• Blood clinic. Leukocytosis (an increase in the number of leukocytes), an increase in ESR.
• Biochemistry of blood. An increase in the activity of ALT, AST, LDH, creatine kinase, myoglobin enzymes, which is an indicator of damage to the heart muscle. Possible change in the level of electrolytes, iron.

Instrumental research methods

• ECG - characteristic signs of a heart attack (negative T wave, pathological QRS complex, etc.). Removal of a cardiogram in different leads helps to determine the localization of a necrotic focus (for example, the anterior or posterior wall of the left ventricle, etc.).
• EchoCG is a local (limited) violation of the contractility of the affected ventricle.
• Coronary angiography - revealed narrowing or overlap of the vessel that feeds the myocardium. It should be noted that when carrying out this method research, it can also be used to provide assistance (after filing contrast agent through the same catheter, a drug is injected into the vessel or a stent expander is installed).

Coronary angiography for myocardial infarction

Treatment of myocardial infarction

Emergency care (performed directly during pain attack and further in a specialized clinic):

• Providing the patient with complete rest.
• Giving sublingually (under the tongue) nitroglycerin and corvalol inside.
• Immediate transport for further treatment to the department of cardiological resuscitation (preferably on specialized resuscitation transport).

Surgical treatment is one of modern methods help with a heart attack

Specialized Treatment

• Relief of pain syndrome (used narcotic analgesics and neuroleptics).
• Dissolution of a thrombus located in a coronary vessel by introducing special thrombolytic agents (streptase, cabikinase). The method is very effective, but has a limited time - assistance should be provided within the first hour after an attack, in the future, the percentage of myocardial mass saved is rapidly falling.
• Antiarrhythmic drugs.
• Improvement of metabolic processes in the heart muscle.
• Decreased blood volume to reduce the workload on the heart.
• Surgical methods of treatment - balloon angioplasty of coronary vessels, the introduction of a stent (tubular strut), coronary artery bypass grafting (providing bypass blood flow by applying a shunt to the damaged vessel).
• Anticoagulants (heparin, aspirin) to reduce blood clotting and prevent thrombosis.

The prognosis for a heart attack is always serious and depends on the volume of the affected myocardium, the localization of the necrotic focus (for example, if the heart conduction system is involved in the damage zone, the prognosis worsens), the age of the patient, concomitant diseases, timeliness of treatment, the presence of complications, etc. A high percentage residual effects and the occurrence of disability.

After the passage of the acute period, patients are shown rehabilitation with a gradual increase in the level of stress. In the future, medical supervision, prophylactic administration of antianginal drugs is necessary.

Prevention of a heart attack is the rejection of bad habits, the fight against overweight, rational mode food, work and rest, timely treatment with the onset of angina pain.

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. The intensity, duration, frequency of attacks increases, they occur at a lower physical activity, pass more slowly 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). Changes from the general and biochemical analyzes there is no blood.

2. The most acute period of myocardial infarction - the time from the appearance of the first clinical electrocardiographic signs of acute myocardial ischemia to the onset of 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. During auscultation, there is a weakening of the first tone, deafness of tones, 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. The acute period of 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, in the lower parts of the lungs - wet rales, 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, peripheral vascular constriction, 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 are characteristic,

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 of the 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.

The pain syndrome is stopped by narcotic analgesics (morphine), neuroleptanalgesia.

To restore coronary blood flow, thrombolytic, antithrombotic drugs are used (streptokinase once, anticoagulants 3-5 days 24 hours after the 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.

When performing stenting of 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.

Acute myocardial infarction - necrosis of a section of the heart muscle caused by a circulatory disorder. Heart attack is one of the main causes of disability and death among the adult population.

Causes and mechanisms of vascular insufficiency of the heart

Features of the work of the heart - constant contractions of the myocardium - cause a very high level of metabolic processes in its cells, a large consumption of oxygen and nutrients. This mode of activity requires an uninterrupted flow of highly oxygenated (oxygen-rich) blood, which is provided by an extensive network of cardiac vessels starting from the aorta in the form of coronary (coronary) arteries.

The reverse side of the effectiveness of the heart muscle is its high sensitivity to oxygen starvation. In case of malnutrition, pathological phenomena develop in the myocardium, which very quickly become irreversible.

If the lack of blood flow is not critical, reversible ischemia (anemia) of the heart muscle area occurs, which is manifested by angina pectoris pain behind the sternum. With the complete cessation of blood flow to a certain area, a cascade of pathological processes develops - there is an accumulation of toxic metabolic products that are not excreted, a transition to an anaerobic (oxygen-free) mode of operation using internal energy reserves of cells.

Own reserves of energy carriers (glucose and ATP) are very quickly (in about 20 minutes) depleted, and the bloodless section of the heart muscle dies. This is myocardial infarction - necrosis, the size of which depends on the level of occlusion of the vessel (large or small branch), the rate of onset of ischemia (with a gradual cessation of blood supply, partial adaptation is possible), the age of the patient and many other factors. For example, acute transmural myocardial infarction (with necrosis of all thicknesses of the heart muscle), which has a very severe course, develops with occlusion (overlap) of a large branch of the coronary vessel.

Section of the heart wall in myocardial infarction

Among the causes of impaired blood supply to the myocardium, the most common block of the lumen of the vessel is an atherosclerotic plaque or thrombus (these phenomena can be combined). In addition, a sharp spasm of the coronary arteries is possible under the influence of physical (cold) or chemical (poisons, drugs) factors. Severe anemia, in which there is a sharp decrease in the content of hemoglobin in the blood, and, consequently, its ability to transport oxygen, can also cause myocardial ischemia. The inconsistency of blood supply with increased needs occurs with a sharp hypertrophy of the heart muscle - cardiomyopathy.

Predisposing factors for the development of a heart attack

Certain diseases and pathological conditions are risk factors for the development of acute myocardial ischemia. These include:

• Diabetes.
• Hypertonic disease.
• Ischemic heart disease (CHD), manifested by attacks of angina pectoris (especially its unstable forms).
• Increased blood levels of cholesterol and some fractions of lipoproteins.
• Excessive body weight.
• Smoking.
• Alcohol abuse.
• Errors in the diet (high intake of salt, animal fats).
• Cardiac arrhythmia.
• Prolonged stressful situations.
• Age over 60 years (although in recent years there has been a "rejuvenation" of a heart attack).
• Male gender (after 70 years, the number of men and women suffering from a heart attack levels off).

Classification of ischemic myocardial injury

There are various criteria for classifying a heart attack. Some of them:

• By the size of the damage zone - large-focal and small-focal.
• According to the depth of damage to the heart muscle - transmural (throughout the entire thickness of the heart wall), intramural (necrosis in the thickness of the wall), subendocardial (damage to the inner layer), subepicardial (outer layer).
• According to topography - left ventricular (anterior wall, posterior and lateral walls, interventricular septum), right ventricular.

Pain attack lasting more than 20 minutes is one of the diagnostic criteria for a heart attack

Symptoms of a heart attack

In the development of the pathological process, several periods are distinguished, each of which has its own duration and symptoms.

Preinfarction period can last from a few minutes to months. It is characterized by an increase in angina attacks and an increase in their intensity.

The most acute period, in which the development of ischemia and necrosis of the heart muscle occurs, lasts up to several hours. May have a typical and atypical variant of the course.

Pain, or anginal variant, is typical (about 90% of all cases). It is characterized by pain behind the sternum of high intensity, burning or pressing, which can radiate (give) to the left limbs, jaw, neck. There may be a fear of death, sweating, blanching or redness of the skin of the face, shortness of breath. The severity of pain depends on the size of the affected area - a large-focal infarction causes more severe symptoms than a small-focal one. The pain is not relieved by nitroglycerin.

Atypical variants can proceed according to the asthmatic type (have symptoms of an attack of bronchial asthma), abdominal (with symptoms of an acute abdomen), arrhythmic (in the form of an attack of cardiac arrhythmia), cerebral (with impaired consciousness, dizziness, paralysis, visual impairment).

The acute period lasts about 10 days. The zone of necrosis is finally formed and demarcated, the absorption of decay products and the formation of a scar begin. The pain syndrome disappears or decreases. Possible fever, hypotension and heart failure.

Subacute period(about two months) - the stage of formation and compaction of the scar. There is no pain syndrome, the condition is gradually improving. The state of health in this period is largely determined by the nature and extent of the changes that have occurred in the heart muscle.

Postinfarction period, or rehabilitation (up to six months), is characterized by the absence of clinical and laboratory signs of a heart attack (ECG changes persist - they will remain for life), however, in this phase, the development of heart failure, angina pectoris and re-infarction is possible.

Complications of myocardial infarction

Acute myocardial ischemia, being a serious condition in itself, can be even more aggravated by the addition of complications.

The most frequent complications:

• Heart rhythm disturbances (paroxysmal tachycardia, extrasystole, atrial fibrillation). Such a situation as the appearance of ventricular fibrillation with the transition to their fibrillation can cause the death of the patient.
• Heart failure is associated with a violation of the activity of the left ventricle in pumping blood through the vessels. It can lead to pulmonary edema, and death due to a sharp drop in pressure and the cessation of renal filtration.
• Pulmonary embolism can lead to pneumonia, pulmonary infarction, and death.
• Cardiac tamponade can occur when the heart muscle ruptures in the infarction zone and blood ruptures into the pericardial cavity. The condition is life-threatening and requires emergency care.
• Acute - bulging of the area of ​​scar tissue with extensive damage to the myocardium. In the future, it can lead to the development of heart failure.
• Thromboendocarditis is the deposition of fibrin on the inner surface of the heart. Its detachment can cause a stroke, mesenteric thrombosis (closing of the branch of the vessel that feeds the intestines), followed by necrosis of the intestine, and kidney damage.
• Postinfarction syndrome is the common name for long-term complications (pericarditis, pleurisy, arthralgia).

Some ECG signs of acute myocardial infarction

Diagnosis of a heart attack

In the diagnosis of a heart attack, anamnesis data (the circumstances of the course of the disease and previous life, ascertained by interviewing the patient and his relatives), laboratory and instrumental methods of research are important.

Anamnesis

Existing attacks of pain behind the sternum of varying frequency and intensity, risk factors (smoking, stress, chronic diseases) are being clarified. On examination, it is possible to identify excess weight, indirect signs of increased pressure (capillary network on the face), etc. Retrosternal pain lasting more than 20 minutes is considered one of the diagnostic criteria for a heart attack.

Laboratory methods

Laboratory research methods for a heart attack reveal the following changes:

• Blood clinic. Leukocytosis (an increase in the number of leukocytes), an increase in ESR.
• Biochemistry of blood. An increase in the activity of ALT, AST, LDH, creatine kinase, myoglobin enzymes, which is an indicator of damage to the heart muscle. Possible change in the level of electrolytes, iron.

Instrumental research methods

• ECG - characteristic signs of a heart attack (negative T wave, pathological QRS complex, etc.). Removal of a cardiogram in different leads helps to determine the localization of a necrotic focus (for example, the anterior or posterior wall of the left ventricle, etc.).
• EchoCG is a local (limited) violation of the contractility of the affected ventricle.
• Coronary angiography - revealed narrowing or overlap of the vessel that feeds the myocardium. It should be noted that when carrying out this research method, it can also be used to provide assistance (after applying a contrast agent through the same catheter, a drug is injected into the vessel or a stent expander is installed).

Coronary angiography for myocardial infarction

Treatment of myocardial infarction

Emergency care (performed directly during a pain attack and then in a specialized clinic):

• Providing the patient with complete rest.
• Giving sublingually (under the tongue) nitroglycerin and corvalol inside.
• Immediate transportation for further treatment to the cardiac intensive care unit (preferably on a specialized intensive care vehicle).

Surgical treatment is one of the modern methods of helping with a heart attack.

Specialized Treatment

• Relief of pain syndrome (narcotic analgesics and neuroleptics are used).
• Dissolution of a thrombus located in a coronary vessel by introducing special thrombolytic agents (streptase, cabikinase). The method is very effective, but has a limited time - assistance should be provided within the first hour after an attack, in the future, the percentage of myocardial mass saved is rapidly falling.
• Antiarrhythmic drugs.
• Improvement of metabolic processes in the heart muscle.
• Decreased blood volume to reduce the workload on the heart.
• Surgical methods of treatment - balloon angioplasty of coronary vessels, the introduction of a stent (tubular strut), coronary artery bypass grafting (providing bypass blood flow by applying a shunt to the damaged vessel).
• Anticoagulants (heparin, aspirin) to reduce blood clotting and prevent thrombosis.

The prognosis for a heart attack is always serious and depends on the volume of the affected myocardium, the localization of the necrotic focus (for example, if the heart conduction system is involved in the area of ​​damage, the prognosis worsens), the patient's age, concomitant diseases, timeliness of treatment, the presence of complications, etc. The percentage of residual effects and the occurrence of disability.

After the passage of the acute period, patients are shown rehabilitation with a gradual increase in the level of stress. In the future, medical supervision, prophylactic administration of antianginal drugs is necessary.

The prevention of a heart attack is the rejection of bad habits, the fight against excess weight, a rational diet, work and rest, timely treatment for the appearance of angina pain.