Abdominal Myocardial Infarction ⋆ Heart Treatment

In laboratory diagnostics, indicators such as an increase in the level of leukocytes and sialic acids, the detection of c-reactive protein are not distinctive features of a heart attack, therefore, they are not taken into account for differentiation in emergency diagnostics. An important analysis is the study of enzymes that distinguishes diseases with symptoms of an “acute abdomen” from a heart attack.

Other uninformative analyzes in this case will be blood tests for aspartate and alanine aminotransferase indicators. A blood test for creatine phosphokinase, lactate dehydrogenase takes time, and the results may indicate pancreatitis, so usually this analysis is not carried out if you need to urgently identify the cause of the disease. Indicative data can be obtained from the coagulogram. A cardiogram can reveal signs of necrosis of the heart, but they appear in a day.

As mentioned above, in a disease such as myocardial infarction, the abdominal form requires surgical differentiation from pathologies of other organs in the abdominal cavity. Symptoms such as pain in the upper abdomen and epigastric region against the background of nausea and vomiting can indicate pancreatitis, gastritis in the acute period, cholecystitis, exacerbation of gallstone disease, heart attack.

It is important to know under what circumstances the pains appeared. For example, hepatic colic occurs after fatty and spicy dishes. Pain amid nausea will bother on the right side under the ribs, immediately manifest themselves to the maximum. If the pain is caused by an abdominal infarction, they will appear not only on the right under the ribs, but also in the epigastric region.

Acute cholecystitis is manifested by an enlarged gall bladder, palpation reveals pain in the bladder and liver. With a heart attack, the muscles will not be so tense, and there is no jaundice, as with gallstone disease. As for the test results, with colic, the ALAT indicator exceeds the AcAt level, alkaline phosphatase increases.

In the treatment of this form of myocardial infarction, the same means are used as with typical manifestations. The pain is not stopped by nitroglycerin, so with its occurrence it is worth resorting to narcotic analgesics.

Due to the ambiguity of symptoms, the disease should be differentiated from:

  • acute pancreatitis;
  • acute cholecystitis;
  • poisoning;
  • inflammation of the appendix;
  • intestinal obstruction.

For the prevention of repeated attacks appoint:

  • beta blockers;
  • calcium antagonists;
  • sedatives;
  • anticoagulants;
  • angioprotectors.

It is necessary to exclude excessively fatty and fried foods, excessive physical activity, bad habits. If the recommendations of the doctors are not followed, relapses are characteristic of myocardial infarction. Maintaining a healthy lifestyle will help to avoid repeated attacks. Food rich in vitamins and antioxidants helps protect blood vessels from the negative effects of pathogenic factors.

Abdominal myocardial infarction masquerades as symptoms of other heart diseases, and many manifestations coincide with diseases that are not related to the cardiovascular system, which complicates the diagnosis. The first symptoms may be similar to an attack of cholecystitis, acute pancreatitis.

Those who have chronic gastrointestinal diseases attribute such manifestations to their illnesses, but if shortness of breath, severe weakness, blue face and lips, cold sweat appear, you should immediately call an ambulance. Be sure to go to the hospital to undergo a full examination.

The cardiogram is usually taken immediately after the arrival of an ambulance, even before hospitalization, which helps to make the correct diagnosis and provide first aid. The patient is given thrombolytic therapy, antiplatelet agents and heparin are administered.

It is very important that the abdominal form of myocardial infarction be recognized as quickly as possible.

The main confirmation of this diagnosis is given by the ECG. The ambulance team must have a portable electrocardiograph. The appearance and size of the pathological teeth of the cardiogram may indicate the location and size of the affected lesion. If the results of a mobile examination show a violation of the conduction of the heart muscle, then the patient urgently needs to be hospitalized.

The gastralgic variant of MI in the hospital is clarified and finally confirmed using laboratory rapid tests. The presence of cardiomarkers in the blood indicates damage to the heart muscle:

  • myoglobin and troponins, proteins of muscle cells, they enter the bloodstream when the integrity of the membranes is violated;
  • AST and ALT are enzymes whose increase indicates damage to internal tissues.

It is also advisable to do coronary angiography.

Due to the atypical symptoms of abdominal myocardial infarction, it is necessary to conduct differential diagnosis with the following diseases:

  • pancreatitis;
  • cholecystitis;
  • like ulcer;
  • food toxicoinfection;
  • intestinal obstruction
  • appendicitis;

A preliminary diagnosis is made on the basis of a family history and complaints, as well as a physical examination, which reveals soreness and tension of the abdominal wall during palpation. The exact diagnosis is made after laboratory tests: ECG, echocardiography, coronary angiography and MSCT. Sometimes in clinics blood tests are also performed for the abdominal form of a heart attack.

Therapies

After the contradictions are clarified, and the diagnosis is established, proceed to treatment. Moreover, it is advisable to start events as early as possible. Doctors share therapy in the acute period and in the long. Pain is removed from the very beginning to exclude pain shock and subsequent heart failure.

For this, morphine and other narcotic analgesics are used. Every half hour gives 2-5 mg of morphine, which reduces pain and dilates the blood vessels that nourish the heart. It is worth considering that nitroglycerin and other nitrates that remove angina do not help with cardiac necrosis. If the pain is not eliminated with nitroglycerin, this in itself indicates the possibility of a heart attack.

With cardiac muscle necrosis, anticoagulants are also prescribed. Clexane and heparin used to be used, now it is alteplase and urokinase. These drugs have helped reduce mortality by 12%. Among the first resuscitation actions, the elimination of a lack of oxygen occupies an important place.

For the treatment of this form of the disease, hospitalization and hospitalization are required.

The patient must strictly observe bed rest, any motor activity is forbidden. In the process of recovery, it is important to avoid stressful situations.

!  First aid for myocardial infarction at home for a person

For a speedy recovery, a complex of medications is prescribed, among which there are:

  • Painkillers – analgesics;
  • Sedatives;
  • Beta-blockers – dilate the vessels that feed the myocardium;
  • Anticoagulants – promote blood thinning and prevent blood clots;
  • Thrombolytics – fight with existing blood clots;
  • ACE inhibitors.

Usually a person knows that he develops ischemic heart disease and is ready for its acute manifestation.

In this situation, you need to follow a clear algorithm of actions:

  1. Call an ambulance.
  2. Lie on a bed or sofa so that your head is raised.
  3. Put one or two Nitroglycerin tablets under the tongue and dissolve them, but do not swallow.
  4. After 5 minutes, again take two tablets of the same “Nitroglycerin”.
  5. If after 20 minutes the pain persists, drink aspirin, also two tablets.

It is advisable to provide access to fresh air.

In a hospital, usually in the intensive care unit, after confirming the diagnosis, intensive treatment begins.

  • analgesia by strong analgesics;
  • protection of the heart muscle from hypoxia – oxygen starvation;
  • attempts to dissolve a blood clot with the help of special drugs, that is, to carry out thrombolysis;
  • surgery if necessary.

After the removal of the acute condition, there is a long stage of complex rehabilitation therapy. From my practice I can recall many examples of successful cure and return to an active life in patients who followed all my recommendations.

Treatment of abdominal infarction is carried out in a hospital to ensure constant monitoring of the patient’s well-being. Therapeutic measures include a combination of therapeutic methods with medication.

The therapeutic technique is based on the complete restriction of any motor activity. The patient should remain calm, including avoiding stress.

Compliance with the diet and rest of the hospital is recommended.

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Medicated

Drug treatment is aimed at eliminating pain symptoms, preventing the development of the disease and complications. Drug therapy includes:

  • analgesic drugs to eliminate pain;
  • sedatives to reassure the patient;
  • beta-blockers for the expansion of the nas;
  • calcium antagonists designed to change heart rate;
  • nitrates to relieve pain;
  • anticoagulants that prevent blood clots;
  • blood thinners;
  • thrombolytics that destroy existing blood clots;
  • beta-blockers;
  • ACE inhibitors;

Depending on the complications, other drugs may be prescribed to the patient.

Operation

Often, doctors fail to diagnose the condition on time, and the patient is in a difficult situation, which requires surgical intervention:

  • Coronary Angioplasty In place of the abnormal narrowing of the vessel, a metal tube is installed, which supports the vessel expanded and contributes to normal blood flow.
  • Coronary artery bypass grafting. During the surgical procedure, a detour from the patient’s vein is created in a necrotic place, which allows blood flow to be restored.

If indicated, other procedures may be performed, including a heart transplant.

Therapy

In practice, the treatment of abdominal myocardial infarction does not differ from therapeutic measures in typical forms of this pathology.

The patient needs to be laid and raised legs above the level of the heart. In the presence of bubbling breathing, it is impossible to lay the patient, it is necessary to seat him comfortably and not to allow sharp movements, it is important to provide access to fresh air. If nitroglycerin is ineffective, give the patient a chew tablet of aspirin. When cardiac arrest is performed, cardiac massage and artificial respiration

Upon arrival, the ambulance team provides emergency resuscitation, which consists in relieving pain (narcotic and non-narcotic analgesics) and providing oxygen to the human body. Treatment of myocardial infarction is carried out in stationary conditions, strict bed rest is prescribed with limited movement.

The patient is prescribed drug therapy, which includes:

  • Antihypertensive drugs.
  • Antiarrhythmic drugs in accordance with the pulse.
  • Anticoagulants (with an abdominal form, these drugs are prescribed under special control, since their massive use can lead to gastrointestinal bleeding). The use of these drugs is carried out under the constant monitoring of blood coagulation parameters (coagulogram).

Modern medicine offers surgical methods of treatment. After stabilization of the patient’s condition on the basis of coronary angiography, the following types of interventions are performed:

  • Stenting – a metal frame is introduced into the narrowed sections of the coronary vessel. The operation is performed using a special probe, which allows you to enter the stent through the femoral artery under the supervision of an x-ray machine.
  • Bypass surgery (CABG) is an open operation, the essence of which is to create an additional possibility of blood flow to the necrotic site by transplanting the patient’s own veins.

First aid for abdominal myocardial infarction

The cause of a diagnostic error may be the identification of a cardiac attack against a background of chronic diseases in the abdominal organs. With severe symptoms of an undiagnosed nature, hospitalization in cardiology is necessary to make a final diagnosis.

If a person has the symptoms listed above and an abdominal variant of myocardial infarction is suspected, you must be able to provide first aid. Initially, you need to call an ambulance, and put the patient in a half-sitting position. In the room you need to open the window, unfasten your clothes so that nothing would impede the access of fresh air. It is advisable to measure the pressure, if it is elevated and the person has medications from the doctor, they need to be taken.

In order to exclude erroneous hospitalization of a patient with a heart attack in the infectious ward, and with gastritis – in cardiology, it is necessary to remove an electrocardiogram before traveling to the hospital. In approximately 80% of cases, changes in the cardiogram will show a lower back infarction.

!  Moderate disturbance of left ventricular repolarization processes

For any pain that persists for a long time and does not stop after taking medication, especially if there is a suspicion of a heart attack, you should immediately seek medical help.

Upon admission to the medical facility, the patient is given an ECG and, upon confirmation of the diagnosis, they are urgently placed in a hospital. All experienced doctors adhere to such tactics.

In this case, the patient’s condition only worsens, and after a few days the pain reaches the heart. Gradually, the pain subsides and completely disappears, but necrotic changes caused by a heart attack will be visible on the ECG.

Based on the foregoing, we can conclude: for any pain in the abdomen, regardless of the assumptions, it is necessary to undergo an ECG.

First aid methods are the same as with any myocardial infarction. The main problem is that people around cannot detect the abdominal form, while the symptoms of a typical coronary myocardial infarction are known to many.

To help you need:

  1. Remove excess clothing from the patient that can slow blood circulation and breathing.
  2. To plant a person so that he has something to lean on.
  3. If nitroglycerin is present, put one tablet under the tongue.
  4. If the pain attacks do not stop for more than three minutes, you need to call an ambulance or deliver the patient to a medical care center on your own (only in cases where calling a doctor is not practical).
  5. If possible, give the sufferer an aspirin to drink, the dosage should be 300 mg, for the fastest effect, it is recommended to crush or chew it, this will help prevent necrosis.

Complications

An abdominal infarction with the wrong diagnosis or treatment can be complicated:

  • arrhythmias;
  • pericarditis;
  • aneurysms;
  • acute heart failure;
  • rupture of the heart wall;
  • post-infarction syndrome;
  • thrombosis
  • neurotrophic disorders;

If it is too late to start treatment and not give first aid on time, the patient may develop sudden coronary death. It is also important to go through all stages of rehabilitation after emergency treatment. Read about the forecasts in the clinical example of the abdominal form of acute and other forms of myocardial infarction.

Prevention

Abdominal infarction is not a new disease, but a well-studied pathology, therefore prevention measures are similar to the recommendations that are given for any type of heart attack. The main recommendation is to annually undergo a routine examination by a cardiologist, conduct an ECG. It is especially important to do this for men who have crossed the 50-year period, and women during menopause.

If atherosclerosis, IHD, hypertension are detected in a person, then in 60-70% of cases this can become a prerequisite for the development of a heart attack. Such patients are advised to perform coronary angiography. In the study, it is possible to identify problem areas of the vessels, if serious lesions are detected, stent implantation, coronary artery bypass grafting is recommended. Such operations are expensive, require a long stay in the clinic, do not always end well.

To avoid the manifestation of this disease, you need to follow simple rules:

  1. Regularly undergo a medical examination;
  2. Observe blood cholesterol, periodically measure blood pressure;
  3. Reduce fatty foods and foods high in “fast” carbohydrates;
  4. Exercise and walk in the fresh air;

Adhering to these rules, you can avoid any form of heart attack, including abdominal, reduce the risk of other diseases of the cardiovascular system.

Damage to the blood vessels of the heart is much easier to prevent than to treat.

To do this, you must follow a number of simple rules:

  • get rid of harmful addictions such as smoking and alcohol abuse;
  • change eating habits by opting for fiber and protein to the detriment of excess fat and carbohydrates;
  • increase aerobic exercise to at least 8000 steps per day;
  • daily monitor blood pressure, annually visit the clinic for medical examination and do an ECG;
  • take 75 mg of Aspirin every day – but this is suitable for people with relatively healthy liver and kidneys.

Recognizing abdominal MI is a difficult task even for an experienced therapist. But the ability to quickly receive a cardiogram and rapid tests confirming necrosis in the heart muscle greatly simplifies this problem. Where hospitals and mobile teams are provided with good equipment, mortality from atypical forms of ischemia is reduced by 20-30%.

Increases survival after acute cardiac circulatory disorders by 50-60% by knowledge of the patients themselves with typical and atypical signs, as well as the rules of emergency self-help.

Preventive measures are aimed at preventing the development of a typical myocardial infarction. To do this, you need:

  • Monitor the state of the heart muscle. To do this, it is enough to undergo an examination with a cardiologist.
  • Monitor cholesterol and blood pressure, with an increase they must be reduced.
  • Monitor the diet, that is, reduce fat intake, replacing them with protein products, for example, lean meat, as well as beans, cereals, nuts, vegetables and fish.
  • Monitor physical fitness, i.e. get rid of obesity.
  • Regularly devote time to physical activity, especially cardio training: running, swimming, etc.

It is also important to completely quit smoking and reduce the amount of alcohol consumed as much as possible, since these products have a greater effect on the development of a heart attack.

Forecast

Abdominal myocardial infarction is one of the dangerous complications of coronary heart disease (40% mortality). An erroneous diagnosis and lack of qualified emergency care can lead to the death of the patient. But with the correct definition of the disease, the prognosis is quite favorable, the patient stays in the hospital for about 25 days.

The prognosis of abdominal infarction is complicated by the fact that the disease at the diagnostic stage is often confused with others, which can delay treatment and lead to complications.

Mortality in the hospital is extremely low: approximately 20%. Slightly less than 8% of patients recovered from a heart attack die within 1 year.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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