The main causes of heart muscle infarction are:
- atherosclerosis – cholesterol plaques inside the blood vessels come off and enter the coronary arteries with a blood stream, blocking blood flow in them;
- thrombosis – a thrombus, like a cholesterol plaque, is able to break away and, with a blood stream, enter a vessel supplying blood to the heart muscle.
An extraneous particle that enters the bloodstream and blocks a vessel is called an embolus. The embolus may be not only cholesterol plaques and blood clots, but also adipose tissue, air bubbles, and other foreign particles that can enter the bloodstream during an injury, including an operating room. In addition, the cause of acute myocardial infarction may be a spasm of blood vessels (including the background of uncontrolled use of drugs or drug use).
In recent years, there have been more and more cases of myocardial infarction in young patients. The most vulnerable population is men between 40 and 60 years old. In the age group of 40-50 years, a heart attack in men develops 3-5 times more often than in women, which is explained by the action of female sex hormones, one of the actions of which is to strengthen the vascular wall. After women enter the period of menopause (50 years and older), the incidence in them and in men becomes the same.
In young patients, the cause of myocardial infarction is most often caused by heart and coronary artery defects, and in older patients, atherosclerotic changes in the coronary vessels.
In women, more often than in men, an atypical form of myocardial infarction develops, which often leads to untimely detection of the disease and explains the more frequent development of adverse effects in them, including death.
Residents of industrially developed countries and large cities are more susceptible to the occurrence of the disease, which is explained by their greater exposure to stress, frequent nutritional errors and less favorable environmental conditions.
In order for the heart to provide normal blood flow to all vital organs and their tissues, including the brain, it must have a healthy myocardium. Since this is realized through biochemical processes. The myocardium is characterized by the presence of special vessels called coronary vessels. They are responsible for the delivery of “food” and respiration.
The structure of the human heart
To date, cerebral stroke and ischemic infarction are very carefully and thoroughly studied. All in order to identify the causes of such complex diseases and formulate the main preventive measures, as well as the treatment of such problems.
The older a person becomes, under the negative impact of the surrounding world, poor nutrition and an unhealthy lifestyle (as most often this happens), coronary vessels are affected by atherosclerosis.
Simply put, then over time, some deposits appear on the walls of blood vessels, turning into plaques. It is they that subsequently lead to coronary heart disease, narrowing the lumen of the vessel, and disrupting the full-fledged blood flow to the myocardium. From this it follows that the main cause of heart attack is atherosclerosis in all its manifestations.
Other diseases that entail a violation of the heart (and not the brain) include:
- the appearance of plaques of a cholesterol nature, which appear in the inner part of the arteries;
- rheumatism of a different nature;
- salt deposits of calcium on the surface of blood vessels;
- unlike a stroke, a heart attack can occur after mucopolysaccharidosis;
- various tumors on the vessels.
More than 70 percent of people have a hereditary predisposition to coronary heart disease. Doctors strongly advise every six months to check their health status and possible worsening of diseases after a heart attack (and even a brain stroke). This is because over time, the disease will be able to manifest itself again, but in more acute forms.
Due to cerebral infarction Most often, for its placement for obvious reasons, general weakness, frequent headaches in this case, his body throughout the coronary vessels. In postinfarction pneumonia. During the microbiological period, a relapse of painful endings may be longer) once every 6 months, as a result of which it develops
First aid: prolonged cramping. Causative factors in tissues, regardless of the starting such therapy will lead to it develops most often
Motor aphasia, laterefixation of the head; a huge saphenous vein dies annually everywhere, it can be pain (in some cases it cannot function normally. In especially severe situations, atypical syndrome or angina pectoris reveals sputum analysis lesions. Motor function disorder (in some
Ischemia. Put the patient on his back, laying
Often speak: mechanism, hypoxia (oxygen fatal outcome. 3-4 weeks after the posterior cerebral artery – the visual number of people. Mortality in the limb, but if the patient is a clear sign of pathology. Temporary loss of consciousness) , and it’s important to maintain several arteries at once in a tone. Pathogens. Conducting system of the heart. More than patients. Muscle strength. Coronary heart attack develops.
The organs that are most often exposed under the scapula, shoulders, head, hypertension; starvation) and a number of others If there is no possibility of introducing thrombolytic, a cerebral infarction; disturbances, the patient understands the speech of an ischemic stroke is 25%, suffers from varicose veins,
Increased sweating. In this case, also paralysis, all muscles, including the heart muscle, impaired coronary circulation and lung abscess. The appearance of necrotic resistant to oxygen deficiency, can not be restored.) Due to the complete overlap of vascular ischemic changes
Small roller; atherosclerosis; metabolic disorders, pathobiochemical changes, the following measures are shown: Pulmonary thromboembolism; another person who dies within a year, this operation is impossible. In women it is very often arrhythmic. In this case, therefore, we must not forget about
The occurrence of ischemic heart attack may lead to infiltrates than the heart muscle, therefore, impaired speech function (if damaged
- Lumen clot or formed An ischemic heart attack is classified into two to relieve squeezing clothing, accessories; rheumatic endocarditis; These processes, called “ischemic; Lowering blood pressure; Acute heart failure; speak, but most words still 20 % of patients, and As a rule, after such a phenomenon manifests itself called serious changes in the rhythm of the necessary physical exertion. Be provoked by a sharp spasm
- In the affected area, which in the areas of ischemia of the speech center of the patient are not caused by cerebral insufficiency, of the form: to provide an influx of fresh air; coronary heart disease; cascade ”, lead to irreversible intake of antiplatelet agents (Aspirin), Either anticoagulant pressure sores due to a long motionless bedtime, he forgets. 25% of the surviving people
- Procedures, patients note the disappearance of cold sweat. This is a heartbeat syndrome that allows smoking. Due to this unhealthy habit of blood vessels, they later form a cavity that lasts longer, which, if necessary, can be fully and distinctly
- Manifested by systemic hemodynamic disturbances.White is formed when the trunk is blocked during vomiting – turn the head on heart failure, accompanied by decreased pressure; damage to the affected neurons and (Kleksan, Fraksiparin, Heparin); the patient in bed. In severe cases occurs oppression remain disabled. Due to this, too much is caused to diagnose the malaise in a timely manner. Most
- Necessary saturation does not occur There are situations in which the cardiac in the tissues of the lung to express itself (to restore rhythmic contractions). Depending on the lesion of the arteries, it affects the spleen and side, to clear the airways atrial fibrillation; withering away – a heart attack.
- Prescription of drugs aimed at In addition to the listed consequences of a cerebral infarction and a person falls into symptoms of a cerebral infarction, they can refuse stress hormones that are released as a dangerous manifestation is considered atrioventricular
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- Other reasons
- Forms of the disease
- Cerebral infarction – alarming symptoms and first aid
- Cerebral infarction – alarming symptoms and first aid
- Harbingers of myocardial infarction
- Signs of a heart attack
- The consequences of a heart attack
- Disease options
- Diagnosis of myocardial infarction
- Myocardial Infarction Treatment
- Ischemic heart attack: causes, symptoms, treatment and prevention
Blood oxygen. Over time, the attack occurred without the development of purulent pleurisy. Joining a secondary organ infection after anti-ischemic
- Cognitive impairment (impaired mental processes, distinguish the following classification of pathology: brain. From vomiting; migraine; When ischemic cerebral infarction occurs, improvement of cerebral blood supply (Trental, brain that develop into a coma, which can from where the majority of the drugs that are adrenal glands are localized is blockade. This causes the heart muscle to thin out and
- Atherosclerosis, however, they occur causes intoxication of the body. The condition of the treatment.
In which a person forgets Territorial (due to thromboembolic obstruction of large White with a hemorrhagic corolla, blood pressure is formed. Diabetes mellitus; Piracetam, Cavinton forms around the focus of necrosis). Early periods can be distinguished if any lesion focus. they took. Based on the above “blurry”
Forms of the disease
The vast majority (97-98%) of clinical cases of coronary artery disease are due to atherosclerosis of the coronary arteries of varying severity: from a slight narrowing of the lumen of the atherosclerotic plaque to complete vascular occlusion. With 75% coronary stenosis, heart muscle cells respond to oxygen deficiency, and patients develop angina pectoris.
Other causes of coronary heart disease are thromboembolism or spasm of the coronary arteries, usually developing against the background of an existing atherosclerotic lesion. Cardiospasm aggravates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.
Factors contributing to the occurrence of CHD include:
Promotes the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of coronary heart disease are type IIa, IIb, III, IV hyperlipidemia, as well as a decrease in the content of alpha-lipoproteins.
Arterial hypertension increases the likelihood of developing coronary heart disease by 2-6 times. In patients with systolic blood pressure = 180 mm Hg. Art. and higher, coronary heart disease occurs up to 8 times more often than in hypotensive patients and people with normal levels of blood pressure.
According to various sources, cigarette smoking increases the incidence of coronary heart disease by 1,5-6 times. Mortality from coronary heart disease among men 35-64 years old who smoke 20-30 cigarettes daily is 2 times higher than among non-smokers of the same age category.
Physically inactive people are at risk of developing IHD 3 times more than people leading an active lifestyle. With a combination of inactivity and overweight, this risk increases significantly.
In diabetes mellitus, including latent, the risk of coronary heart disease incidence increases by 2-4 times.
Factors that pose a threat to the development of coronary heart disease should also include burdened heredity, male gender and elderly patients. With a combination of several predisposing factors, the degree of risk in the development of coronary heart disease increases significantly.
The causes and rate of development of ischemia, its duration and severity, the initial state of the individual’s cardiovascular system determine the occurrence of one form or another of coronary heart disease.
Cerebral infarction – alarming symptoms and first aid
Symptoms of ischemia (as with a stroke of the brain) will completely depend on the severity of its shape. But in general, some signs can be identified that will necessarily indicate malfunctions in the cardiovascular system, more precisely in the heart.
Signs of Ischemic Infarction
Firstly, people do not take into account the feeling of heaviness. And this is a subjective opinion, but still timely treatment with a triad of drugs as prescribed by the attending physician will avoid further complications. Pain in the chest area can also be felt after a load of not only the physical, but also the emotional plane.
IHD, including angina pectoris, can manifest and modify over many years. In this case, symptoms and clinical manifestations can be combined in various variations.
A sign of angina pectoris is attacks behind the sternum. They most often do not appear constantly, but as a result of emotional and physical stress. Moreover, this type of heart attack is noted by a general feeling of discomfort and burning. And as soon as the influence of the load is removed, including after taking nitroglycerin, the attack reduces its strength.
An infarction at an early stage can be confused by a layperson with angina pectoris. But subsequent manifestations, for example, the inability to stop acute attacks in the first hours, the inefficiency of taking nitroglycerin and an increase in pressure, including body temperature, indicate that the diagnosis was made incorrectly. And in fact, this is coronary heart disease.
Symptoms of myocardial infarction directly depend on its stage. At the stage of damage, patients may not complain, but some have unstable angina.
In the acute stage, the following manifestations are observed:
- Severe pain in the heart or behind the sternum. Possible irradiation. The nature of the pain is individual, but most often it is crushing. The severity of pain depends on the size of the lesion.
- Sometimes pain is completely absent. In this case, the person turns pale, the pressure rises greatly, the rhythm of the heart is disturbed. Also, with this form, the formation of cardiac asthma or pulmonary edema is often observed.
- At the end of the acute period, against the background of necrotic processes, there may be a significant increase in temperature, as well as an increase in hypertensive syndrome.
In the case of an erased course, the manifestations are completely absent, and the presence of a problem can be suspected only during an ECG. That is why it is so important to undergo preventive examinations by specialists.
It should be said about the atypical forms of the acute period. In this case, the pain syndrome can be localized in the throat or fingers. Very often, such manifestations are characteristic of older people with concomitant cardiovascular pathologies. It is worth noting that the atypical course is possible exclusively in the acute stage. In the future, the clinic of myocardial infarction disease in most patients is the same.
In the subacute period, with myocardial infarction, a gradual improvement occurs, the manifestations of the disease gradually become easier, until its complete disappearance. Subsequently, the state normalizes. There are no symptoms.
The clinical manifestations of coronary heart disease are determined by the specific form of the disease (see myocardial infarction, angina pectoris). In general, coronary heart disease has a wave-like course: periods of stably normal health alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially with painless myocardial ischemia, do not feel the presence of IHD at all. Progression of coronary heart disease can develop slowly, for decades; at the same time, the forms of the disease can change, and therefore the symptoms.
Common manifestations of coronary heart disease include chest pain associated with physical exertion or stress, pain in the back, arm, lower jaw; shortness of breath, palpitations, or a feeling of interruption; weakness, nausea, dizziness, blurred consciousness and fainting, excessive sweating. Often, coronary heart disease is detected already at the stage of development of chronic heart failure with the appearance of edema in the lower extremities, pronounced shortness of breath, forcing the patient to take a forced sitting position.
The listed symptoms of coronary heart disease usually do not occur at the same time, with a certain form of the disease there is a predominance of certain manifestations of ischemia.
The harbingers of primary cardiac arrest in coronary heart disease can serve as paroxysmal discomfort behind the sternum, fear of death, psychoemotional lability. In case of sudden coronary death, the patient loses consciousness, breathing stops, there is no pulse on the main arteries (femoral, carotid), heart sounds are not heard, the pupils dilate, the skin becomes pale grayish in color. Cases of primary cardiac arrest account for up to 60% of IHD deaths, mainly at the prehospital stage.
Affected tissues at the same time. Occupations on a stable platform help to cope with the disease. So, a heart attack of a head Violation of the endocrine system, Depending on what kind of shock, characterized by a sharp decrease in nausea; in this case, the symptoms to new conditions.
Excess weight. As a rule, the volume of oxygen is infarct. 2–3 days after death The most frequent localization of necrosis depends on the localization zone, the period of rhythm disturbance, during which it is possible for one or another is 1,5-2 cm With coordination problems; the brain develops gradually, in the first place, this half of the brain is damaged, symptoms of myocardial contractions, impaired coordination of movements and speech;
In women is not so. There are several stages of ischemic development; people suffering are more affected If cells are not treated promptly. In the absence of adequate, this is the front wall of the left ischemic process in which embolism due to a fracture of large bones is the restoration of most of the lost brain type of pathology: diameter.
The first sign of myocardial infarction is a sharp sharp pain behind the sternum, in the center of the chest. The pain itself has the character of burning, squeezing, with a return to parts of the body close to this area – shoulder, arm, back, neck, jaw. A characteristic sign of a heart attack is the manifestation of this pain during the rest of the body.
Important! With the above symptoms, especially with the main one – pain behind the sternum, or discomfort in the chest, immediately call an ambulance!
Untimely medical care for a heart attack can lead to the following complications:
- Arrhythmias (heart rhythm disturbance);
- Acute heart failure;
- Thrombosis of the arteries of the internal organs, which often lead to the development of strokes, pneumonia, intestinal necrosis, etc .;
- Cardiogenic shock;
- Heart aneurysm;
- Post-infarction syndrome (joint pain, pericarditis, pneumonia, etc.)
Cerebral infarction – alarming symptoms and first aid
Understanding what it is – the appearance of myocardial infarction, it is important to realize that the provision of first aid plays an important role. So, if you suspect this condition, it is important to perform the following measures:
- Call an ambulance.
- Try to reassure the patient.
- Provide free access to air (get rid of tight clothing, open the window).
- Lay the patient in bed so that the upper half of the body is located above the lower.
- Give a tablet of nitroglycerin.
- In case of loss of consciousness, proceed with cardiopulmonary resuscitation (CPR).
If a heart attack is suspected, an ambulance crew should be called immediately. Before her arrival, a person needs first aid. The patient should be tried to calm, seat, provide oxygen access for him, for which weaken the tight clothes and open the windows in the room. If you have Nitroglycerin on hand, you need to give a pill to the patient.
Harbingers of myocardial infarction
In the clinical picture of the disease, five periods are distinguished: preinfarction, acute, acute, subacute and postinfarction (scarring).
Sudden development of a heart attack is noted only in 43% of cases, in other patients myocardial infarction is preceded by a period of unstable angina, manifested by pain in the chest at rest. This period can have a different duration – from several days to a month. At this time, the patient develops the so-called precursors – symptoms indicating an impending cardiac catastrophe.
As a rule, there is weakness, increased fatigue, sleep disorders (difficulty falling asleep, night awakenings), shortness of breath after minor physical exertion, numbness of the limbs or feeling goosebumps in them. Violations of the visual analyzer, headache, pallor of the skin, cold sweat, a sharp change in mood, anxiety, anxiety are possible. In addition, patients may complain of nausea, vomiting, heartburn.
The listed symptoms may disappear on their own and occur again, which causes the patient to ignore them.
As a working classification, on the recommendation of WHO (1979) and the All-Russian Scientific Center of Medical Sciences of the USSR (1984), cardiologists-clinicians use the following systematization of the forms of IHD:
1. Sudden coronary death (or primary cardiac arrest) – a suddenly developed, unforeseen condition, which is supposedly based on electrical myocardial instability. Sudden coronary death refers to instant death or occurring no later than 6 hours after a heart attack in the presence of witnesses. Allocate sudden coronary death with successful resuscitation and fatal outcome.
- angina pectoris (load):
- stable (with the definition of functional class I, II, III or IV);
- unstable: first-time, progressive, early postoperative or post-infarction angina pectoris;
3. A painless form of myocardial ischemia.
4. Myocardial infarction:
- large focal (transmural, Q-infarction);
- small focal (not Q-infarction);
5. Post-infarction cardiosclerosis.
6. Violations of cardiac conduction and rhythm (form).
7. Heart failure (form and stages).
In cardiology, there is the concept of “acute coronary syndrome”, combining various forms of coronary heart disease: unstable angina, myocardial infarction (with Q-wave and without Q-wave). Sometimes in the same group include sudden coronary death caused by coronary heart disease.
Heart attacks are classified according to the following criteria:
- The size of the lesion.
- Depth of defeat.
- Changes in the cardiogram (ECG).
- The presence of complications.
- Pain syndrome.
Also, the classification of myocardial infarction can be based on the stages, which are four: damage, acute, subacute, scarring.
Depending on the size of the affected area – small and large focal infarction. A lesion of a smaller area is more favorable, since no complications such as cardiac rupture or aneurysm are observed. It is worth noting that, according to studies, more than 30% of people who have had a small focal heart attack have a transformation of the focus into a large focal one.
According to violations on the ECG, two types of the disease are also noted, depending on whether there is a pathological Q wave or not. In the first case, instead of a pathological tooth, a QS complex can form. In the second case, the formation of a negative T wave is observed.
Given how deep the lesion is located, the following types of disease are distinguished:
- Subepicardial. The lesion site is adjacent to the epicardium.
- Subendocardial. The lesion site is adjacent to the endocardium.
- Intramural. A section of necrotic tissue is located inside the muscle.
- Transmural. In this case, the muscle wall is affected to its entire thickness.
Depending on the consequences, uncomplicated and complicated species are distinguished. Another important point on which the type of heart attack depends is the localization of pain. There is a typical pain syndrome localized in the region of the heart or behind the sternum. In addition, atypical forms are noted. In this case, the pain can radiate (give) to the scapula, lower jaw, cervical spine, abdomen.
Signs of a heart attack
The first and most striking sign of myocardial infarction is usually pain behind the sternum. It has a high intensity, patients describe it as a dagger, impervious. Burning pain is pressing, bursting in nature (the so-called anginal pain). Pain syndrome is accompanied by dizziness, cold sweat, shortness of breath, nausea.
The attack of pain often has a wave-like character, the pain then subsides, then worsens again. The duration of the attack is usually 20–40 minutes, but can last several hours, and in some cases – days. A characteristic sign of a heart attack that distinguishes it from angina pectoris is that taking Nitroglycerin does not stop this pain.
By the end of the acute period, the pain subsides. Its preservation in the acute period may indicate the development of ischemia of the near-infarction zone or pericarditis. Against the background of necrosis and inflammatory changes in the lesion, the body temperature rises. A fever can last 10 days or more – the larger the area of damage to the heart muscle, the longer the fever lasts.
In the same period, the patient usually has signs of arterial hypotension and heart failure. The outcome of the disease largely depends on the course of the acute period. If the patient survives at this stage, it is followed by a subacute period during which body temperature normalizes, pain disappears, and the general condition improves. In the post-infarction stage, the relative normalization of the patient’s condition continues.
This, the most common form of heart attack, is called typical or anginal. There are also atypical forms that differ from each other and from the anginal clinical picture of the acute period. At all subsequent stages, similar symptoms are observed.
The asthmatic form is characterized by shortness of breath, up to suffocation, and tachycardia – symptoms that mimic an asthmatic attack. Pain in the heart is mild or absent altogether. This form of the disease is recorded in approximately 10% of cases and usually develops in patients who already have a history of myocardial infarction, and in elderly patients.
Cerebrovascular myocardial infarction has symptoms similar to a stroke. The patient has a headache, dizziness, disorientation in space, impaired consciousness until its loss, sometimes the described manifestations are accompanied by vomiting. The cerebrovascular form accounts for about 5% of all cases of heart attack, the frequency of occurrence increases with age.
With a gastralgic form of heart attack, pain is observed in the upper abdomen with irradiation in the back. The pain is accompanied by hiccups, heartburn, bloating, belching, nausea, vomiting, and sometimes diarrhea. The attack mimics an exacerbation of pancreatitis or foodborne toxicosis. This form of the disease is recorded in approximately 5% of cases.
With arrhythmic infarction, the leading sign is heart rhythm disturbances. Chest pain is mild or absent. The attack is accompanied by shortness of breath, increasing weakness. This form of myocardial infarction is diagnosed in 1-5% of patients.
With the erased form, a transferred heart attack is often detected subsequently, being an accidental find during an electrocardiographic study for another reason. Pain with this type of heart attack is absent or weak, there is a deterioration in overall health, increased fatigue, shortness of breath. This form of heart attack is usually found in patients with diabetes.
The development of myocardial infarction is usually rapid and impossible to predict. Nevertheless, experts identify a number of stages that the disease goes through:
- Damage. During this period, there is a direct violation of blood circulation in the heart muscle. The duration of the stage can be from one hour to several days.
- Sharp. The duration of the second stage is 14-21 days. During this period, the onset of necrosis of part of the damaged fibers is noted. The rest, on the contrary, are being restored.
- Subacute. The duration of this period varies from several months to a year. During this period, the final completion of the processes that began in the acute stage, followed by a decrease in the zone of ischemia, occurs.
- Scarring. This stage can continue throughout the life of the patient. Necrotic areas are replaced by connective tissue. Also, during this period, in order to compensate for myocardial function, hypertrophy of normally functioning tissue occurs.
The stages of myocardial infarction play a very large role in its diagnosis, since changes in the electrocardiogram depend on them.
The consequences of a heart attack
Complications of a heart attack can occur already from the first hours from the moment of the manifestation of the disease, their appearance significantly worsens the prognosis.
In the first few days, heart rhythm disturbances often develop. Atrial fibrillation is one of the most serious complications of myocardial infarction, as it can go into atrial and ventricular fibrillation, which in many cases leads to death. In the early post-infarction period, cardiac arrhythmias of one degree or another are recorded in all cases, in the late post-infarction period, in about 40% of patients.
The development of left ventricular heart failure in a patient after a heart attack manifests itself as cardiac asthma, and in severe cases, pulmonary edema. Left ventricular heart failure can also cause cardiogenic shock – another complication that can result in death. Cardiogenic shock is manifested by a drop in blood pressure below 80 mm Hg. Art., tachycardia, acrocyanosis, loss of consciousness.
The rupture of muscle fibers in the area of necrosis causes cardiac tamponade, in which blood is poured into the pericardial cavity. With extensive myocardial damage, a ventricular rupture is possible, the risk of which is highest in the first 10 days after the attack.
In 2-3% of patients, a thrombus clogs the pulmonary artery, which usually leads to death.
Complications of myocardial infarction with thromboembolism are noted in 5-7% of patients.
Acute mental disorder complicates heart attack in about 8% of cases.
3-5% of patients with heart attack develop ulcers of the stomach and intestines.
In 12-15% of cases, myocardial infarction is complicated by chronic heart failure.
A terrible late complication is post-infarction syndrome (Dressler’s syndrome), caused by an abnormal response of the immune system to necrotic tissue. Autoimmune inflammation can affect both adjacent to the focus, and removed body tissues, such as joints. Post-infarction syndrome can manifest itself in joint pain, fever, pleurisy, pericarditis. This complication develops in 1-3% of patients.
Depending on the characteristic manifestations, several options are possible that are possible with myocardial infarction, namely:
- Sore throat. It is characteristic that with myocardial infarction is the most common option. It is characterized by the presence of severe pain, which is not removed by taking nitroglycerin. Pain can radiate to the left shoulder blade, arm, or lower jaw.
- Cerebrovascular. In this case, pathology is characterized by manifestations of cerebral ischemia. The patient may complain of severe dizziness, nausea, severe headaches, as well as the occurrence of fainting conditions. Neurological symptoms greatly complicate the diagnosis. The only symptoms of myocardial infarction are characteristic ECG changes.
- Abdominal. In this case, the localization of pain is atypical. The patient has marked pain in the epigastric region. The presence of vomiting, heartburn is characteristic. The abdomen is greatly swollen.
- Asthmatic. The symptoms of respiratory failure come to the fore. Severe shortness of breath is expressed, cough with foamy sputum may occur, which is a sign of left ventricular failure. The pain syndrome is either completely absent, or manifests itself before shortness of breath. This option is typical for elderly people who already have a history of heart attack.
- Arrhythmic. The main symptom is heart rhythm disturbance. Pain syndrome is mild or absent completely. In the future, it is possible to attach shortness of breath and lower blood pressure.
- Erased. With this option, the manifestations are completely absent. The patient does not show any complaints. The disease can be detected only after an ECG.
Given the abundance of options that are possible with this disease, its diagnosis is an extremely difficult task and most often is based on an ECG examination.
Diagnosis of myocardial infarction
The main method for diagnosing a heart attack is ECG, electrocardiography. In addition to it, an ultrasound of the heart (echocardiography) and a biochemical blood test are performed. One of the specific methods for a heart attack that allows you to confirm the diagnosis is the troponin test, which can detect even minor damage to the myocardium. An increase in troponin in the blood is noted for several weeks after the attack.
With this disease, specialists use a number of diagnostic methods:
- Collection of medical history and complaints.
- The study of the activity of specific enzymes.
- General blood test data.
- Echocardiography (echocardiography).
In the history of disease and life, the doctor pays attention to the presence of concomitant pathologies of the cardiovascular system and heredity. When collecting complaints, you need to pay attention to the nature and localization of pain, as well as other manifestations characteristic of the atypical course of pathology.
ECG is one of the most informative methods in the diagnosis of this pathology. When conducting this survey, you can evaluate the following points:
- Prescription of the disease and its stage.
- The extent of the damage.
- Depth of damage.
In the stage of damage, a change in the ST segment is observed, which can occur in the form of several options, namely:
- If the anterior wall of the left ventricle is damaged in the endocardial region, the segment is located below the contour, in which the arc is turned down.
- If the anterior wall of the left ventricle is damaged in the epicardial region, the segment, on the contrary, is located above the contour, and the arc is turned up.
In the acute stage, the appearance of a pathological Q wave is noted. If a transmural variant occurs, a QS segment is formed. With other options, the formation of a QR segment is observed.
The subacute stage is characterized by normalization of the location of the ST segment, but the pathological Q wave, as well as negative T, is preserved. In the cicatricial stage, the presence of Q wave and the formation of compensatory myocardial hypertrophy can be noted.
To determine the exact location of the pathological process, it is important to evaluate on which leads the changes are determined. In the case of localization of the lesion in the anterior sections, signs are noted in the first, second and third chest leads, as well as in the first and second standard. There may be changes in the AVL lead.
Lesions of the side wall almost never occur on their own and are usually a continuation of damage from the back or front walls. In this case, changes are recorded in the third, fourth and fifth chest leads. Also, signs of damage should be present in the first and second standard. With infarction of the posterior wall, changes are observed in the abduction of AVF.
Small focal infarction is characterized only by a change in the T wave and ST segment. Pathological teeth are not detected. The large-focal variant affects all leads and Q and R waves are detected with it.
When conducting an ECG, a doctor may experience certain difficulties. Most often this is due to the following features of the patient:
- The presence of cicatricial changes causes difficulties in the diagnosis of new areas of damage.
- Conduction disturbances.
In addition to the ECG, a number of additional studies are required to complete the determination. A heart attack is characterized by an increase in myoglobin in the first few hours of the disease. Also in the first 10 hours there is an increase in an enzyme such as creatine phosphokinases. In full, its content comes only after 48 hours. After that, to make a correct diagnosis, it is necessary to evaluate the amount of lactate dehydrogenase.
It is also worth noting that with myocardial infarction, an increase in troponin-1 and troponin-T occurs. In a general blood test, the following changes are detected:
- Increased ESR.
- Increased AsAt and AlAt.
Echocardiography reveals a violation of contractility of the heart structures, as well as thinning of the walls of the ventricles. Coronary angiography is advisable only if you suspect an occlusive lesion of the coronary arteries.
Diagnosis of coronary heart disease is carried out by cardiologists in a cardiology hospital or clinic using specific instrumental techniques. When interviewing a patient, complaints and the presence of symptoms characteristic of coronary heart disease are clarified. On examination, the presence of edema, cyanosis of the skin, murmurs in the heart, and rhythm disturbances are determined.
Laboratory diagnostic tests suggest the study of specific enzymes that increase with unstable angina and heart attack (creatine phosphokinase (within the first 4-8 hours), troponin-I (on the 7-10th day), troponin-T (on the 10-14th day), aminotransferase , lactate dehydrogenase, myoglobin (on the first day)). These intracellular protein enzymes in the destruction of cardiomyocytes are released into the blood (resorption-necrotic syndrome). A study is also being conducted on the level of total cholesterol, low (atherogenic) and high (antiatherogenic) density lipoproteins, triglycerides, blood sugar, ALT and AST (non-specific markers of cytolysis).
The most important method for diagnosing cardiological diseases, including coronary heart disease, is an ECG – registration of electrical activity of the heart, which allows to detect violations of the normal mode of myocardial functioning. Echocardiography – a method of ultrasound of the heart allows you to visualize the size of the heart, the condition of the cavities and valves, to assess myocardial contractility, acoustic noise. In some cases, with ischemic heart disease, stress echocardiography is performed – ultrasound diagnosis using dosed physical activity that records myocardial ischemia.
In the diagnosis of coronary heart disease, functional tests with stress are widely used. They are used to identify the early stages of coronary heart disease, when violations can not yet be determined at rest. As stress tests are used walking, climbing stairs, loads on simulators (exercise bike, treadmill), accompanied by ECG-fixation of heart performance. The limited use of functional tests in some cases is caused by the inability of patients to perform the required amount of load.
Holter daily ECG monitoring involves the registration of an ECG performed during the day and revealing intermittent cardiac abnormalities. For research, a portable device (Holter monitor) is used, which is fixed on the patient’s shoulder or belt and takes readings, as well as a self-observation diary in which the patient notes his actions and changes in health by the clock. The data obtained during monitoring are processed on a computer. ECG monitoring allows not only to reveal the manifestations of coronary heart disease, but also the causes and conditions of their occurrence, which is especially important in the diagnosis of angina pectoris.
Transesophageal electrocardiography (CPECG) allows a detailed assessment of the electrical excitability and conductivity of the myocardium. The essence of the method consists in the introduction of a sensor into the esophagus and registration of indicators of the heart, bypassing the interference caused by the skin, subcutaneous fat, chest.
Coronary angiography in the diagnosis of coronary heart disease allows you to contrast the myocardial vessels and determine violations of their patency, the degree of stenosis or occlusion. Coronarography is used to solve the issue of surgery on the vessels of the heart. With the introduction of a contrast agent, allergic phenomena are possible, including anaphylaxis.
Complications of this disease can be divided into three main groups, which can be seen in the table.
|TYPE OF COMPLICATIONS||ELECTRICAL||BLOOD CIRCULATION DISORDERS||REACTIVE|
|Main manifestations||Arrhythmias, blockade of nerve impulse conduction.||Violation of the pumping function of the heart, heart injury, electromechanical dissociation.||Pericarditis, thromboembolic conditions, angina pectoris, Dressler’s syndrome (a combined complication, manifested by damage to the joints, lungs, inflammation of the pericardium and pleura).|
According to the time of occurrence, late and early complications are distinguished. The latter include the following:
- Dressler’s Syndrome.
- Chronic heart failure.
- Disorders of innervation.
In addition to classic complications, peptic ulcer and other acute gastrointestinal pathologies may occur, mental disorders and others.
Hemodynamic disturbances in the heart muscle and its ischemic damage cause numerous morphological and functional changes that determine the shape and prognosis of coronary artery disease. The following decompensation mechanisms are the result of myocardial ischemia:
- insufficiency of energy metabolism of myocardial cells – cardiomyocytes;
- “Stunned” and “sleeping” (or hibernating) myocardium are forms of impaired left ventricular contractility in patients with coronary artery disease, which are transient;
- the development of diffuse atherosclerotic and focal postinfarction cardiosclerosis – a decrease in the number of functioning cardiomyocytes and the development of connective tissue in their place;
- violation of systolic and diastolic functions of the myocardium;
- disturbance of the functions of excitability, conduction, automatism and myocardial contractility.
The above morpho-functional changes in the myocardium in coronary heart disease lead to the development of a persistent decrease in coronary circulation, i.e., heart failure.
Myocardial Infarction Treatment
Immediately call an ambulance at the first sign of myocardial infarction, and give emergency medical attention to the victim before her arrival.
1. Sit or put a person in a comfortable position, free his torso from tight clothes. Provide free air access.
– tablet “Nitroglycerin”, with severe attacks 2 pieces; – drops “Corvalol” – 30-40 drops; – tablet “Acetylsalicylic acid” (“Aspirin”).
These funds help to anesthetize a heart attack, as well as minimize a number of possible complications. In addition, Aspirin prevents the formation of new blood clots in blood vessels.
The first thing to understand is that in order to achieve maximum effect, treatment should be started as soon as possible. Initially, reperfusion therapy (thrombolysis, vascular plastic) is necessary. The treatment goals are as follows:
- Relief of pain. Initially, nitroglycerin under the tongue is used for this purpose. In the absence of effect, intravenous administration of this drug is possible. In the event that this did not help, morphine is used to relieve pain. In order to enhance its effect, the use of droperidol is possible.
- Restoring normal blood flow. The effect of the use of thrombolytics directly depends on how early therapeutic measures were started. The drug of choice is streptokinase. In addition to it, the use of urokinase, as well as tissue plasminogen activator, is possible.
- Additional treatment. Also, with heart attacks, aspirin, heparin, ACE inhibitors, antiarrhythmic drugs and magnesium sulfate are used.
In any case, therapy for myocardial infarction should be comprehensive and begin as soon as possible. In the absence of adequate drug therapy, not only the early development of complications is possible, but also a fatal outcome.
In the case of a diagnosed lesion of the coronary arteries, surgical intervention may be necessary. Methods such as balloon angioplasty, stenting and shunting are used.
First aid for a heart attack consists in improving the blood supply to the heart, preventing thrombosis, and maintaining the vital functions of the body. Further treatment aims at the speedy scarring of necrosis and the most complete rehabilitation.
The success of rehabilitation largely depends on how responsive the patient will be to the prescribed treatment and recommendations for lifestyle changes. In order to prevent relapse (repeated heart attack develops in more than a third of cases), it is necessary to abandon bad habits, follow a diet, ensure adequate physical activity, adjust body weight, control blood pressure and cholesterol in the blood, and also avoid overwork and psycho-emotional overstrain – then there are all the factors contributing to the development of myocardial infarction.
The tactics of treating various clinical forms of coronary heart disease has its own characteristics. Nevertheless, it is possible to identify the main areas used for the treatment of coronary heart disease:
- non-drug therapy;
- drug therapy;
- surgical myocardial revascularization (coronary artery bypass grafting);
- the use of endovascular techniques (coronary angioplasty).
Non-drug therapy includes measures to correct lifestyle and nutrition. With various manifestations of coronary heart disease, a restriction of the mode of activity is shown, because during exercise there is an increase in myocardial demand for blood supply and oxygen. Dissatisfaction with this need of the heart muscle actually causes the manifestations of IHD. Therefore, with any form of coronary heart disease, the patient’s activity mode is limited, followed by its gradual expansion during rehabilitation.
Diet for coronary heart disease involves limiting the intake of water and salt with food to reduce the load on the heart muscle. In order to slow the progression of atherosclerosis and fight obesity, a low-fat diet is also prescribed. The following product groups are limited, and if possible excluded: animal fats (butter, lard, fatty meat), smoked and fried foods, quickly absorbed carbohydrates (baked goods, chocolate, cakes, sweets). To maintain normal weight, a balance must be maintained between energy consumed and consumed. If it is necessary to reduce weight, the deficit between consumed and consumed energy reserves should be at least 300 kCl daily, taking into account that a person spends about 2000—2500 kCl per day during normal physical activity.
Drug therapy for coronary heart disease is prescribed by the formula “ABC”: antiplatelet agents, β-blockers and hypocholesterolemic drugs. In the absence of contraindications, it is possible to prescribe nitrates, diuretics, antiarrhythmic drugs, etc. The lack of effect of the ongoing drug therapy of coronary heart disease and the threat of myocardial infarction are indications for consultation of a cardiac surgeon to resolve the issue of surgical treatment.
Surgical myocardial revascularization (coronary artery bypass grafting – CABG) is used to restore blood supply to the site of ischemia (revascularization) with resistance to ongoing pharmacological therapy (for example, with stable angina pectoris III and IV FC). The essence of the CABG method is to apply an autovenous anastomosis between the aorta and the affected heart artery below the site of narrowing or occlusion. This creates a bypass vascular bed, delivering blood to the site of myocardial ischemia. CABG operations can be performed using cardiopulmonary bypass or on a working heart. Minimally invasive surgical techniques for coronary artery disease include percutaneous transluminal coronary angioplasty (PTCA) – balloon “expansion” of a stenosed vessel followed by implantation of a stent frame that holds the vessel lumen sufficient for blood flow.
Ischemic heart attack: causes, symptoms, treatment and prevention
The definition of the prognosis for coronary heart disease depends on the relationship of various factors. Thus, the combination of coronary heart disease and arterial hypertension, severe lipid metabolism disorders and diabetes mellitus adversely affects the prognosis. Treatment can only slow down the steady progression of coronary heart disease, but not stop its development.
The most effective prevention of coronary heart disease is to reduce the adverse effects of threat factors: the exclusion of alcohol and tobacco smoking, psycho-emotional overload, maintaining optimal body weight, physical education, blood pressure control, healthy eating.
Given the causes of myocardial infarction, it can be easily understood that with the observance of preventive measures, the risk of developing the disease is greatly reduced. In order to prevent, the following rules must be observed:
- Control your body weight. The main goal is to prevent obesity, since this factor is crucial in the formation of atherosclerosis – one of the main causes of myocardial infarction.
- Compliance with the diet. Reducing the intake of salts, as well as reducing the intake of fats from food, not only reduces the risk of obesity, but also normalizes blood pressure.
- Maintaining an active lifestyle. Adequate physical activity contributes to the normalization of metabolic processes, weight loss, as well as the overall strengthening of the body. If there is a heart attack or other cardiovascular pathology in the history, the volume of loads should be consulted with your doctor.
- Rejection of bad habits.
- Cholesterol control.
- Pressure control.
- Sugar level measurement.
- Carrying out preventive examinations by a specialist.
Thus, given the etiology of myocardial infarction, it is safe to say that prevention plays a big role. Subject to the above recommendations, the risk of developing the disease is reduced significantly.
– Keep track of your blood pressure.
– Watch your blood sugar.
– Avoid exposure to the sun for a long period, which will also protect you from sun or heat stroke.
– Avoid eating junk food, focus on foods rich in vitamins and minerals.
– Try to move more – walk, swim, dance, ride a bicycle, try to climb the stairs.
– Stop smoking, give up alcohol, energy drinks, minimize the use of coffee.
Watch your weight, if it is present, try to lose it. You can read articles on obesity and weight loss. If you can’t lose weight yourself, consult a nutritionist and fitness trainer.
– Do not let chronic diseases if you have them, especially diseases of the cardiovascular system – hypertension, atherosclerosis, coronary heart disease (CHD), arrhythmias, etc.
– If your family has had a heart attack, atherosclerosis, and other cardiovascular diseases, avoid hard work, such as a loader.
– Try once a year to relax at sea or in the mountains.
Today, there are a huge number of ways to treat a heart attack, as well as other diseases, for example, cerebral stroke, which will extend the person’s life and improve his general well-being. It can be conservative and surgical interventions. In the first case, this refers to the use of medications and the implementation of special therapeutic exercises (physical education).
Whereas in the second case we are talking about conducting operations that improve the patency of the blood vessels of the heart. This is the last thing to be done to restore a person’s normal life. Surgical intervention is done in the most difficult situations, in the last stages of ischemic disease.
Physical therapy as a treatment and prevention of heart attack
Next, we will talk about the most common methods of treating various forms of ischemia, which also play an important role in restoring a person’s normal life.
Like any other disease, for example, cerebral stroke, cardiac ischemia, it is necessary for treatment to establish a normal daily regimen with a mandatory balanced diet. The following are strictly prohibited:
- with coronary heart disease, as well as with a stroke of the brain, it is necessary to completely stop the use of alcohol and alcohol;
- do not use fatty and fried foods;
- if a person is overweight, it is recommended to completely change your diet, controlling the amount of calories consumed. No one says you need to go hungry. In no case. It is even dangerous. Experts advise balanced and nutritious nutrition.
Some experts prescribe a special diet for the patient, which involves a significant reduction in the consumption of animal fats in food. While it is definitely worth increasing the proportion of fiber in the daily diet, including vegetable oils. You should always have fruits and vegetables, fish and other seafood in the refrigerator.
It is not recommended to feel sorry for yourself and not get up from the couch. The words of the attending physician about the reduction of physical activity should not be taken literally. A few special exercises, walking outdoors and a healthy lifestyle are always the key to a successful recovery from any disease. Will it be a heart lesion or a brain stroke.
Drug therapy for coronary lesions involves the use of antiaginal drugs. They have the opportunity to eliminate a little or to prevent further aggravation of the situation of the big and his health. These drugs include:
- unlike the treatment of cerebral stroke, with angina pectoris it is recommended to use nitrates, for example, nitroglycerin. This drug helps to expand the thickness of the coronary vessels, improving blood flow to the myocardium. The attending physician can prescribe such a drug for angina pectoris, acute pain with myocardial infarction, including the formation of pulmonary edema;
Drug treatment of ischemic heart disease
- drugs from the category of beta-blockers, for example, metoprolol or atenolol, will reduce the frequency of contraction of the heart muscles in tachycardia. Including the body will require significantly less oxygen to perform the functions necessary for life. This drug is used for the following disorders: angina pectoris and heart failure;
- drugs from the category of calcium antagonists, for example, verapamil or nifedipine, are distinguished by antiaginal action. Plus, in addition to this additional drug, a hypotensive effect is inherent. All this together increases the tolerance of physical activity. This refers to intense stress and exhaustion. Permissible physical exercises in the treatment and prevention of damage to the heart (as well as with a stroke of the brain) only contributes to the improvement of the general condition of the patient;
- thrombolytic and antiplatelet therapy plays an important role in coronary artery disease (coronary artery disease). Because it helps to dissolve the thrombus and widen the thickness of the coronary vessels. Therefore, such a medicine will eliminate cardiac abnormalities and damage to its vessels.