Myocardial infarction the first signs of symptoms and emergency care

The development of a heart attack begins far enough before its manifestation. Not even so, atherosclerosis initially develops (the appearance of atherosclerotic plaques in the vessels), and only then, under adverse circumstances (lifestyle), myocardial infarction begins to develop.

More details about the appearance of atherosclerotic plaques in human blood vessels are described in the article on atherosclerosis, and if you are not interested in those subtleties, we summarize this information.

Atherosclerotic plaques are formed in blood vessels from “bad” cholesterol, which together with low density lipoproteins (LDL) precipitate, because they are poorly soluble in the blood. The sediment itself accumulates under the endothelium (the inner wall of the vessels). Over time, if you do not take any action and do not adjust the lifestyle, and this is, first of all, low-quality food and a sedentary lifestyle, the lumen of blood vessels decreases due to atherosclerotic plaques, thereby normal blood circulation is disturbed. This increases the load on the heart, because to “push” blood to all organs, you need more effort.

- Myocardial infarction the first signs of symptoms and emergency care

Thus, the fight against heart attack must be started from a young age, when the vessels are still clean, then you will minimize the risk of not only heart attack, but also a host of other equally dangerous diseases – atherosclerosis, hypertension, coronary heart disease, obesity, stroke, necrosis, fibrosis and etc.

Myocardial infarction develops depending on how long this ailment lasts in a person. In other words, in the vast majority, the first precursors appear a month before the attack. And if a person is not promptly provided with first aid for a heart attack, then the consequences can be disastrous.

Heart attack

Three main periods are distinguished during myocardial infarction. The duration of each of them directly depends on the area of ​​the lesion focus, the functionality of the vessels supplying the heart muscle, the accompanying complications, the correctness of the treatment measures, and the patient’s compliance with the recommended regimes.

The acute period, on average, with a heart attack with a large focus without complications, lasts about 10 days. This is the most difficult period of the disease, during which the focus of the lesion is limited, the replacement of necrotic tissue with granulation begins. At this time, the most formidable complications may occur, the highest mortality rate.

The subacute period lasts until about 30 days after the development of a heart attack. There is a replacement of the affected area with connective tissue, improving: the general condition of the patient, blood pressure figures, pulse rate, cardiogram data. The rheological properties of blood are normalized. The patient is expanded the regimen, therapeutic exercises are introduced into the therapy complex.

The scarring period at best lasts up to 8 weeks, but in some cases can be extended up to 4 months. As the name implies, the final healing of the affected area by scarring occurs during this period. The scar from a cured heart attack is determined on a cardiogram for the rest of his life.

Myocardial infarction: causes, symptoms, first aid.

HypodynamiaA sedentary life is the scourge of our time, a huge number of technical achievements make our life much easier, but this is what slowly kills. Today’s children have almost forgotten about outdoor games; they spend most of their time watching TV or using a computer.Psycho-emotional overstrainThis group includes persons whose lifestyle and professional activities are associated with prolonged stress. As well as people who, due to the characteristics of their personality, perceive the events of their lives too emotionally.ObesityThe higher the degree of obesity, the greater the risk of a heart attack. As the patient’s weight increases, the body experiences malfunctions in the general metabolism, in particular fat. Excess fat is deposited not only in the subcutaneous fat and abdominal glands, but also on the surface of the heart, which can provoke mechanical pressure on the coronary arteries.Alcohol abuseIncreases blood pressure, constant intoxication significantly disrupts metabolic processes, leads to depletion of the heart muscle (myocardial dystrophy).SmokingNicotine significantly reduces the level of oxygen in the blood, forming pathological compounds with hemoglobin, while the level of hemoglobin in smokers often exceeds the norm, but it does not cope with oxygen transport. The second adverse effect of nicotine is a violation of vascular tone and increased blood pressure. Each cigarette causes short-term tachycardia, increasing myocardial oxygen demand.HeredityScientists have come to the unequivocal conclusion that there is a hereditary predisposition to heart attack. E. Sh. Halden drew attention to the fact that there is an external sign – the diagonal fold of the earlobe, which is more common in people suffering from coronary heart disease complicated by heart attack than in healthy people.
Health status
Atherosclerotic coronary artery diseaseThis disease is associated with a violation of fat metabolism, it has many causes and a rather complex pathogenesis. But the main point is that atherosclerotic plaques are deposited on the inner walls of the vessels, which significantly narrow the lumen of the vessels up to complete blockage, reduce elasticity and tone make them fragile, disrupt normal blood flow, contributing to the formation of blood clots. Therefore, atherosclerosis is one of the important factors in the occurrence of a heart attack (see details on cerebral arteriosclerosis).Hypertonic diseaseAn increase in blood pressure increases the need for myocardium in oxygen. With inadequate treatment and malignant forms of hypertension, left ventricular heart failure can develop.Coronary heart diseaseCHD is a chronic violation of coronary circulation. Indication of previous heart attacks of varying severity.DiabetesA stable increase in blood glucose adversely affects the state of the vascular bed, changes the normal blood formula, and disrupts the hemoglobin transport function.

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In 30% of cases, a heart attack develops against the background of the so-called pre-infarction period, to which the following conditions can be attributed:

  • destabilization of coronary heart disease, that is, an increase in seizures, a decrease in the effect of taking nitroglycerin preparations, a decrease in resistance to stress;
  • the first attack of angina pectoris;
  • heart rhythm disturbances first detected;
  • the appearance of symptoms of heart failure, in the form of congestive pneumonia.

In other cases, the symptoms of acute myocardial infarction develop suddenly. The course of a heart attack is very diverse. The most common variant is anginal (vascular), 90-95% of all heart attacks.

The sore throat variant proceeds with severe pain behind the sternum in the region of the heart, which sometimes gives to the left hand, under the scapula, to the neck area on the left. Patients characterize pain as pressing, stitching, compressing, tearing. The patient is restless, pale, breathing quickened, he rushes about. It is noted that with heart and respiratory problems, people experience a strong fear of death.

These first symptoms of myocardial infarction are so common and typical that other types of pain are considered atypical.

The asthmatic variant is observed more often in the elderly, for a long time suffering from hypertensive and ischemic diseases. The classic symptoms of a heart attack are accompanied by pulmonary edema. Sometimes asphyxiation may be the first symptom of a repeated heart attack. Pulmonary edema with a heart attack is determined by noisy, bubbling breathing at a distance, pronounced shortness of breath, up to suffocation.

Myocardial infarction with cardiogenic shock syndrome. Type of heart attack with a pronounced pain syndrome, cold sweat, cold extremities, a sharp drop in blood pressure. This form of the disease is often mistaken for internal bleeding or food poisoning.

Arrhythmic variant. A heart attack begins with an attack of arrhythmia, where it also acts as a leading symptom. Confirmation of the diagnosis is found on the cardiogram.

Cerebral variant. Leading symptoms: headache, sensory and motor disorders, nausea, vomiting, visual impairment. Cardiac symptoms may be erased. The complexity of the diagnosis lies in the fact that a stroke is inherently a cerebral infarction, that is, these two pathologies can be combined in one patient.

Abdominal (gastralgic) type. It begins with a sharp pain in the stomach, nausea, vomiting, bloating. On palpation, the abdomen is painful, muscles are tense. Often take the abdominal form of a heart attack as a perforated ulcer or acute pancreatitis.

Heart attack diagnosis

ECG – The first and main diagnostic method at the emergency stage is an electrocardiogram, on which changes characteristic only for a heart attack are determined, it can be used to determine the location of the lesion, the period of the heart attack. A cardiogram is recommended for all the symptoms described above.

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

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

Laboratory diagnosis – With myocardial infarction, characteristic changes in blood composition and biochemical parameters occur, which are monitored throughout the treatment.

First aid and treatment of myocardial infarction

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First aid for myocardial infarction

A person with a suspicion of a heart attack should be laid down, the respiratory tract free from squeezing clothes (tie, scarf). Nitroglycerin preparations may turn out to be at the core with experience, you need to put 1 tablet under the tongue, or inject it if it is a spray (isoket). Nitroglycerin preparations should be given every 15 minutes until the arrival of doctors. It’s good if aspirin is at hand, aspecard – preparations containing acetylsalicylic acid, they have an analgesic effect and prevent the formation of blood clots. When cardiac arrest and breathing stop, the patient needs artificial respiration and indirect heart massage before doctors arrive.

  • Nitroglycerin preparations not only dilate the coronary vessels, they have the same effect on the blood vessels of the brain, if a person is in an upright position, a sharp outflow of blood and sudden short-term loss of consciousness (orthostatic collapse) are possible, if a patient falls, he may be injured. Nitroglycerin should be given to the patient in a lying or sitting position. Orthostatic collapse takes place independently, if you lay a person and raise his legs, after 1-2 minutes.
  • If the patient has heavy noisy bubbling breathing, he can not be laid, as this will aggravate the condition. Such a patient must be comfortably and securely seated.

First Aid Ambulance

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

  • give oxygen;
  • provide access to Vienna;
  • they try to stop the pain syndrome with non-narcotic or narcotic analgesics (droperidol, morphine hydrochloride), depending on its severity, in the absence of effect, they can use inhaled anesthesia with nitrous oxide (reanimobiles are equipped with portable anesthesia devices), or inject sodium oxybutyrate iv the drug, in addition to sleeping pills and painkillers, protects organs from oxygen starvation;
  • for the prevention of blood clots and resorption of existing ones, heparin is used;
  • normalize blood pressure, with a high value Blood pressure is injected with lasix, with low prednisone, hydrocortisone;
  • for the prevention or relief of arrhythmias, iv lidocaine is administered in physiological saline.

Hospital treatment

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

  • Relieving pain, this is the simultaneous prevention of cardiogenic shock.

– When pain remains after 30 to 40 minutes, droperidol with fetanil is reintroduced. These drugs have a side effect – respiratory depression.
– Therefore, you can replace them with a mixture of dipyrone with relanium or 0,5% novocaine; a mixture of analgin, diphenhydramine and promedol in 20 ml of physiological saline. In these mixtures, vomiting can be a side effect; for prevention, 0,1% atropine is administered subcutaneously.
– In the absence of effect – anesthesia with nitrous oxide.

  • With an asthmatic variant with pulmonary edema

The patient needs to maximize the upper body. Three times with an interval of 2-3 minutes nitroglycerin (isoket) under the tongue. Inhalation of oxygen with alcohol is effective. In anticipation of a doctor, in the absence of oxygen, near the patient’s face (without blocking the airways!), You can hold a tissue that is richly moistened with alcohol or vodka. At high or normal blood pressure, lasix (furosemide) is injected intravenously in large doses. With hypotension, iv prednisolone is administered, reopoliglukin is dripped

Tachycardia (frequent pulse) is stopped by a solution of isoptin. In case of atrial fibrillation and atrial flutter – novokainamid, panangin, unitiol. In the absence of effect, electrodefibrillation is used. Bradycardia (rare pulse) – iv atropine, isadrine 1 tablet under the tongue. If there is no effect – iv alupent and prednisone.

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

They are struggling with medication using fibrolytic therapy based on streptokinase and its analogues. Contraindications to the conduct of such therapy are all types of bleeding. Therefore, against the background of this treatment, the patient’s condition is strictly monitored and the platelet count and blood coagulation time are monitored.

Surgery

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

  • Stenting – the introduction of a metal frame (wall) into the narrowed sections of the coronary vessel. During this operation, the chest is not opened, the walls are inserted with a special probe into the desired location through the femoral artery under the control of the x-ray machine.
  • CABG – coronary artery bypass grafting. The operation is performed on an open heart, its essence is that they create an additional opportunity for blood supply to the affected area by transplanting the patient’s own veins, creating additional ways for blood flow.

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

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

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

In the second period, when transferring to ward mode, the patient is allowed to get up, first walk near the bed, then gradually increase the load along the corridor. In the corridors of the cardiology departments there is a special marking for therapeutic walking, which indicates the day of the disease, the patient must walk this distance daily. The patient switches to full self-care.

In the third period, the patient is given a free regime, gradually switching to a rehabilitation and training regime in a sanatorium.

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The patient’s nutritional recommendations are individually adapted, depending on the patient’s condition, laboratory parameters (cholesterol level), and body weight. Patients are recommended 4-5 meals a day. If the cholesterol level exceeds the norm, a restriction on the use of egg yolk, brain, liver, and caviar is introduced.

One third of the fats consumed should be vegetable fats. Cholesterol levels are reduced if pectin-rich foods (apples, bananas) are included in the menu, a high amount of dietary fiber is important, which inhibits cholesterol absorption in the intestine, maintains its stable level in bile. Criteria for discharge of a patient with hospital myocardial infarction:

  • relief of the main symptoms of the disease
  • self-service option
  • sufficient resistance to physical exertion (a patient, without deterioration, can overcome one flight of stairs and take walks from 0,5 to 3 km in several steps during the day)

Psychological rehabilitation

In patients after myocardial infarction up to 4 months, a personal reaction to the disease, fears about the outcome of the disease, and further prospects for personal and public life may persist. If the patient is not provided with timely psychological assistance, the following may occur:

  • Neurosis, which is characterized by increased irritability, sudden mood swings, sleep disorders, obsessive fears.
  • Or by the hypochondriacal development of the personality – “going into a disease”, the patient requires special attention, as he considers himself on the verge of death, and objectively his condition is satisfactory.

Psychological rehabilitation aims to return the patient to work and restore his status in the family.

Unconventional method of therapy

For the treatment and prevention of coronary heart disease and myocardial infarction, hirudotherapy is used with great success – treatment with leeches. Assign from 4 to 8 pieces of leeches on the heart region from 2 to 4 times with an interval of 2-3 days.

Leech saliva contains a special enzyme that slows down blood clotting and prevents blood clots. Infection and suppuration of bite sites is not observed, since hiruds have bactericidal properties. Hirudotherapy is contraindicated in diseases accompanied by increased bleeding.

Diagnosis of myocardial infarction

ECG – The first and main diagnostic method at the emergency stage is an electrocardiogram, on which changes characteristic only for a heart attack are determined, it can be used to determine the location of the lesion, the period of the heart attack. A cardiogram is recommended for all the symptoms described above.

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

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

Laboratory diagnosis – With myocardial infarction, characteristic changes in blood composition and biochemical parameters occur, which are monitored throughout the treatment.

What determines the success of first aid for a patient with myocardial infarction?

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.

  • intense pain behind the sternum;
  • irradiation of pain in the left arm, shoulder blade, teeth or neck area;
  • severe weakness;
  • fear of death and intense anxiety;
  • cold, sticky sweat;
  • nausea.

With atypical forms of heart attack, the patient may have other symptoms:

  • stomach ache;
  • digestive disorders;
  • vomiting;
  • dyspnea;
  • choking, etc.

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First aid in such situations should begin with an ambulance call. In a conversation with the dispatcher of this service, you must:

  • report symptoms that are observed in the patient;
  • make an assumption about the possibility of myocardial infarction;
  • ask for a team of cardiologists or resuscitators.

After that, you can begin to carry out those activities that can be performed outside the hospital.

First aid

  1. The patient must be neatly laid on his back and give him the most comfortable position (half-sitting or a roller under the back of his head).
  2. Provide fresh air and the most comfortable temperature. Remove clothing that impedes breathing (tie, belt, etc.).
  3. Persuade the patient to remain calm (especially if the patient has signs of motor agitation). Talk to the victim in a calm and even tone, do not panic and do not make sudden movements.
  4. Give the patient a tablet of Nitroglycerin under the tongue and sedative (Corvalol, tincture of motherwort or valerian).
  5. Measure blood pressure. If the pressure is not more than 130 mm. Hg. Art., then repeated administration of Nitroglycerin is advisable to be carried out every five minutes. Before the arrival of doctors, you can give 2-3 tablets of this drug. If the first dose of Nitroglycerin caused a severe pulsating headache, then the dosage should be reduced to ½ tablet. When using such a drug in the form of a spray, its single dose should be 0,4 mg. If the patient’s first intake of Nitroglycerin caused a sharp decrease in blood pressure, then this drug should not be used further.

Give the patient a ground tablet of Aspirin (to thin the blood).

  1. Count the pulse of the patient. If the heart rate is not more than 70 beats per minute and the patient does not suffer from bronchial asthma, then he can be given one of the beta-blockers (for example, Atenolol 25-50 mg).
  2. Mustard must be placed on the area of ​​pain localization (do not forget to follow it so that there is no burn).

During the provision of first aid, the patient’s condition may be complicated by such conditions:

When fainting occurs, it is necessary to remain calm and ensure the normal functioning of the respiratory system. The patient must be given a horizontal position, put a roller under the shoulders and remove dentures from the oral cavity (if any). The patient’s head should be in a tilted position, and with signs of vomiting it should be turned to its side.

If cardiac arrest occurs before the medical team arrives, artificial respiration and indirect heart massage should be performed. The frequency of pressure on the midline of the chest (heart region) should be 75-80 per minute, and the frequency of blowing air into the respiratory tract (mouth or nose) should be about 2 breaths every 30 strokes of the chest.

Emergency medical care for myocardial infarction begins with the relief of acute pain. For this, various analgesics (Analgin) and drugs (Promedol, Morphine, Omnopon) can be used in combination with Atropine and antihistamines (Diphenhydramine, Pipolfen, etc.). For the onset of a faster effect, painkillers are administered intravenously. Also, Seduxen or Relanium is used to eliminate the patient’s excitement.

Then, to assess the severity of a heart attack, an electrocardiogram is performed on the patient. If hospitalization is possible within half an hour, then the patient is immediately transported to a medical institution. If it is impossible to deliver the patient to the hospital for 30 minutes, thrombolytics (Alteplaza, Purolaza, Tenecteplase) are administered to restore coronary blood flow.

A stretcher is used to transfer the patient to the ambulance, and during transportation to the intensive care unit, humidified oxygen is inhaled. All these measures are aimed at reducing the load on the heart muscle and preventing complications.

After arriving at the intensive care unit to eliminate a pain attack and excitement, the patient is administered neuroleptanalgesia with Talamonal or a mixture of Fentanyl and Droperidol. In case of a prolonged religious attack, the patient may be inhaled anesthetized with a gaseous mixture of nitrous oxide and oxygen.

Nitroglycerin, Isosorbide dinitrate, Isoket – in the acute period of myocardial infarction, these drugs are used to reduce myocardial oxygen demand, first they are administered intravenously, and after stabilization of the patient’s condition, they are administered orally and sublingually.

  1. Beta-blockers (Anaprilin, Inderal, Obzidan, Propranolol) – help to reduce heart rate and reduce the load on the heart.
  2. Antiplatelet agents (Aspirin) – thin the blood and prevent the development of a new heart attack.
  3. Anticoagulants (Heparin) – used to prevent re-infarction and reduce blood coagulation.
  4. ACE inhibitors (Ramipril, Captopril, Enalapril, etc.) – are used to reduce blood pressure and reduce the load on the heart.
  5. Sedative and sleeping pills (Diazepam, Oxazepam, Triazolam, Temazepam, etc.) – are used if necessary to limit the patient’s activity and sleep disorders.
  6. Antiarrhythmic drugs (Novocainamide, Rhythmylene, Lidocaine, Difenin, Amiodarone, etc.) – are used for heart rhythm disturbances to stabilize cardiac activity and reduce the load on the myocardium.

Other pharmacological preparations can also be used to treat myocardial infarction, because the tactics of drug treatment of a patient depend on the general condition of the patient and the presence of other pathologies (diseases of the kidneys, blood vessels, liver, etc.).

Also, for the treatment of myocardial infarction, modern medicine uses various instrumental highly effective methods for restoring coronary blood flow:

  • balloon angioplasty;
  • coronary artery bypass grafting.

Such surgical techniques allow patients with severe forms of myocardial infarction to avoid serious complications and prevent a high risk of mortality from this cardiac pathology.

All patients with myocardial infarction are shown to have limited motor activity, since this regimen contributes to a more rapid replacement of the infarcted area with scar tissue.

In the early days, the patient must observe a strict bed rest, and from 2-3 days, in the absence of complications and signs of heart failure, his motor regime begins to gradually expand.

Initially, he is allowed to sit on a bedside chair 1-2 times a day and sit on it for about 15-30 minutes (the frequency and duration of these actions is determined by the doctor).

These days, the patient can eat on their own. It must also be washed and washed, and for bowel movements he must use a vessel (the use of a bedside chair is permissible only with the permission of a doctor and only for patients with a stable heart rhythm).

Starting from 3-4 days, the patient is allowed to sit on a stool for about 30-60 minutes twice a day. With uncomplicated heart attack, the patient is allowed to start walking between 3-5 days (this time is determined by the doctor). The time of such a walk and the distance over which the patient moves, increase gradually.

In the uncomplicated form of myocardial infarction, the patient is discharged from the hospital on days 7-12, and in complicated cases it can take place only after 3 weeks or more.

During this period, the intensity and duration of physical activity gradually increases depending on indicators of health status.

In the first week after myocardial infarction, the patient is recommended a low-calorie diet with a restriction of salt, animal fats, fluids, products with nitrogenous substances, excessively coarse fiber and cholesterol. The diet should include foods that are rich in lipotropic substances, vitamin C and potassium salts.

In the first 7-8 days, all dishes should be mashed. Food is taken in small portions 6-7 times a day.

The diet may include such foods and dishes:

  • wheat bread crackers;
  • semolina, oatmeal, buckwheat and rice groats;
  • low-fat veal;
  • low-fat fish;
  • chicken meat;
  • protein steam omelet;
  • low-fat cheese;
  • sour-milk drinks;
  • butter;
  • salad of freshly grated carrots and apples;
  • vegetable soups;
  • boiled beets and cauliflower;
  • mashed fruits;
  • fruit drinks and fruit drinks;
  • broth of dogrose;
  • weak tea;
  • honey.

During this period, the use of such foods and dishes is prohibited:

  • dough products (pancakes, donuts, pastries, pies);
  • smoked and pickled dishes;
  • pickles;
  • fried foods;
  • sausage;
  • fatty dairy products;
  • salted and hot cheeses;
  • caviar;
  • fat meat;
  • boiled and fried eggs;
  • broths of fish and mushrooms;
  • pasta;
  • cooking oil;
  • mushrooms;
  • beans;
  • sorrel;
  • turnip;
  • grapes;
  • tomato juice;
  • spice;
  • chocolate;
  • natural coffe.

2-3 weeks after a heart attack, the patient is recommended the same set of products and a list of restrictions, but the food may already not be mashed, prepared without adding salt and taken about 5 times a day. Subsequently, the patient’s diet expands.

Remember! Myocardial infarction is a serious and dangerous pathology that can cause many serious complications and even death of the patient. Be sure to adhere to all the rules of first aid at the onset of this acute condition, call an ambulance in a timely manner and follow all the doctor’s recommendations during treatment in a hospital.

  • knowledge of the person assisting, the algorithm of action for a heart attack, the ability to perform resuscitation;
  • time elapsed from the seizure to the onset of action;
  • medical support and instrumental support (tonometer, “Nitroglycerin”, “Aspirin”);
  • staffing of ambulance crews with necessary equipment, preparations, staff qualifications;
  • remoteness from specialized cardiology departments.
  • Relieving pain, this is the simultaneous prevention of cardiogenic shock.
  • Stenting – the introduction of a metal frame (wall) into the narrowed sections of the coronary vessel. During this operation, the chest is not opened, the walls are inserted with a special probe into the desired location through the femoral artery under the control of the x-ray machine.
  • CABG – coronary artery bypass grafting. The operation is performed on an open heart, its essence is that they create an additional opportunity for blood supply to the affected area by transplanting the patient’s own veins, creating additional ways for blood flow.

Myocardial infarction – symptoms, causes, emergency care, treatment and rehabilitation

Platelets are blood cells that promote coagulation (coagulation).

Myocardial infarction is the death (necrosis) of a portion of the heart muscle due to blockage of the coronary artery by a thrombus against an atherosclerotic plaque. As a result of necrosis, the muscle section stops working and the pumping function of the heart is disrupted. After a myocardial infarction, a site of dead heart tissue is scarred, and this condition is called post-infarction cardiosclerosis.

Myocardial infarction is characterized by pain more intense than with an attack of angina pectoris, lasting more than 20-30 minutes and not passing after repeated administration of nitroglycerin (nitrospray)

It is important to know that 10 -15% of MI occurs without classic chest pain. This happens, as a rule, in patients with diabetes mellitus, chronic alcoholism and the elderly. In this category of patients, heart receptors are insensitive to pain.

1. Stop physical activity. Stop, if possible, sit down. Provide fresh air.

2. Help with myocardial infarction begins with measuring arterial pressure. When lifting, blood pressure up to 160-180/100 mm RT. Art. chew 1 tablet of corinfarum or clonidine.

3. Calm down and relax. Take sedatives (valerian, 30-40 drops of corvalol, valocardine).

4. If such an attack occurs for the first time, emergency care for myocardial infarction will be an urgent call “ambulance”.

5. If this is not the first attack and there are doctor’s recommendations, take 1 tablet of nitroglycerin under the tongue or nitrospray. If the pain does not go away after 3 – 5 minutes, then repeat taking 1 table. nitroglycerin under the tongue or nitrospray. If the chest pain cannot be relieved within 20 minutes, then 1 tablet (0,5 g) of aspirin (myocardial infarction cannot be ruled out) must be chewed immediately and an ambulance urgently needed.

After the first attack of angina pectoris, it is necessary to consult a doctor to undergo an examination and receive treatment recommendations.

When providing first aid for myocardial infarction, the doctor should know all the details of the attack, because changes in the electrocardiogram outside the attack may be absent.

If, in the treatment of myocardial infarction in the acute phase, thrombolytic therapy is carried out in time, which helps dissolve blood clots in the coronary vessels, then the size of the MI can be significantly limited and even interrupted.

In patients who have had myocardial infarction, a scar is formed at the site of cardiac muscle necrosis, which is not able to contract and perform a pumping function. If a small artery was clogged, then the size of the scar is small. If blood flow through the large artery has stopped, then the scar formed after myocardial infarction is large.

If therapeutic treatment is ineffective in specialized cardiological institutions, myocardium is revascularized (restoration of vessels that were destroyed by the necrotic process): coronary angioplasty, coronary artery bypass grafting.

Myocardial infarction (MI) is a very dangerous disease, often leading to death. The most dangerous period is considered to be the first day of MI (especially the first 2 hours). At this time, there are disturbances in the rhythm and conduction of the heart, which can lead to its arrest. After 1 month after MI, complications occur less frequently.

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Most people who have had MI return to normal. Despite the fact that some of the myocardial cells die, the rest of the heart continues to work. Over time, the heart will adapt to the load, and you can return to a normal lifestyle. During rehabilitation after myocardial infarction, it is necessary to follow all the recommendations of the attending physician to increase physical activity. At the same time, you must remember that to prevent complications, you need to reconsider your attitude to health.

Rehabilitation after myocardial infarction excludes smoking.

Limit or completely stop drinking alcohol.

After myocardial infarction, the amount of permissible physical activity is determined using stress tests. 50-70% of the level of tolerated loads (safe heart rate zone), determined using a stress test, is recommended as training.

Life after myocardial infarction does not end, but it is important to follow all the recommendations of doctors and the rules of healthy eating. Food should be steamed, boiled or baked. Use vegetable fats. It is necessary to increase the consumption of fruits and vegetables and sharply limit the amount of animal fats and sugary foods.

If the attacks of angina persist, there is a real risk of a recurrence of a heart attack.

The post-infarction period of myocardial infarction

The post-infarction period follows the subacute infarction period and lasts approximately 6 months. During this time, a scar from the connective tissue is completely formed at the site of the heart attack, and the remaining part of the heart muscle begins to work more efficiently. During this period, the symptoms of heart failure subside, and the pulse and blood pressure return to normal.

Symptoms of small focal and large focal myocardial infarction

Symptoms of small focal myocardial infarction are generally weaker and more erased than the symptoms of large focal myocardial infarction. With small focal infarction, the pain syndrome is less pronounced, as well as less severe heart failure and a decrease in blood pressure after a heart attack. In general, small-focal heart attack is tolerated by patients much easier than a massive heart attack and is associated with a lower risk of complications.

Emergency care for myocardial infarction

It is necessary to stop chest pain, not only because any pain requires analgesia, but also because in some cases it can cause shock. All patients with chest pain should have peace.

Before the doctor arrives, so-called home remedies can be used – sedatives (valerian), distractions (mustard plasters in the area of ​​pain localization), etc. With myocardial infarction, a severe anginal attack is often observed, which requires immediate relief.

For this, it is necessary to fully use modern painkillers, preferably intravenously. A terrible complication of myocardial infarction is the development of acute heart failure – pulmonary edema.

In order not to take risks, at the slightest suspicion of a heart attack, doctors send a person to the intensive care unit of the hospital. And the faster, the better.

Indeed, only during the first few hours, introducing special preparations, it is possible to dissolve a “fresh” blood clot and restore blood flow in the coronary artery. Then, the formation of new blood clots should be prevented. To do this, use drugs that slow down blood coagulation.

One of the most reliable means is acetylsalicylic acid, that is, ordinary aspirin. It reduces the number of complications and prolongs the life of people who have had a heart attack. Beta blockers are often used in treatment.

These drugs reduce myocardial oxygen demand, which means they save the cells of the heart muscle from death, reduce the size of necrosis. At the same time, they make the work of the heart more economical, which is very important for a heart attack.

In recent years, not only medicines have been used to treat a heart attack. In particular, the so-called invasive methods include coronary balloon angioplasty. Angioplasty is indicated for drug therapy failure. In another case, the cardiac surgeon may suggest coronary artery bypass surgery. In the early days, strict bed rest is required.

At this time, a damaged heart may not withstand even minimal loads. Previously, a person who had a heart attack did not get out of bed for several weeks. Today, bed rest is significantly reduced. But still, at least three days after a heart attack, you must lie in bed under the supervision of doctors. Then it is allowed to sit, get up later, walk .

Recovery begins, adaptation to a new, “post-infarction” life.

Prognosis for myocardial infarction

About 15-20% of patients with myocardial infarction die at the prehospital stage, another 15% – in the hospital. The overall mortality rate for myocardial infarction is 30–35% (in the USA – 140 people per day).

Controlled trials showed that restoration of perfusion during the first 4-6 hours of myocardial infarction helps to limit its size, improve local and general contractility of the left ventricle, reduce the frequency of hospital complications (heart failure, pulmonary embolism, arrhythmias) and mortality.

The restoration of perfusion during the first 1-2 hours of myocardial infarction is particularly favorable. Late restoration of perfusion is also accompanied by an increase in survival, which is associated with an improvement in myocardial healing and a decrease in the frequency of arrhythmias (but not a limitation of the size of the heart attack).

Rehabilitation after myocardial infarction

Regardless of the extent of the ischemic lesion during myocardial infarction, the patient needs a long rehabilitation period. During the recovery period, the human vascular system is strengthened and disturbances in the functioning of its systems and organs are compensated. Rehabilitation of patients after a heart attack should be under the supervision of medical personnel.

Rehabilitation after a heart attack occurs in three stages. The first phase is recovery immediately after the disease is transferred, when the critical period ends and the patient’s general condition improves. For a myocardial infarction, rehabilitation in the acute phase of the disease is most responsible.

Usually it takes several days in a hospital bed – the patient in this case requires the strictest bed rest.

Rehabilitation after myocardial infarction in the second stage begins at the moment when the patient begins to move independently, and can not only walk independently, but also overcome such simple obstacles as, for example, a flight of stairs.

Myocardial Infarction Prevention

– 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.

Unconventional method of therapy

For the treatment and prevention of coronary heart disease and myocardial infarction, hirudotherapy is used with great success – treatment with leeches. Assign from 4 to 8 pieces of leeches on the heart region from 2 to 4 times with an interval of 2-3 days.

Leech saliva contains a special enzyme that slows down blood clotting and prevents blood clots. Infection and suppuration of bite sites is not observed, since hiruds have bactericidal properties. Hirudotherapy is contraindicated in diseases accompanied by increased bleeding.

Myocardial infarction – emergency

Blood circulation stops completely, and not just stops, which leads to the fact that the muscle cells of the heart die.

The number of dead cells depends on the diameter of the vessel in which the movement of blood stopped.

Manifestations of a heart attack depend on several factors. In particular, the area of ​​cell death, the depth of necrosis, and the area that was affected by it affect the symptoms. However, the main symptoms that characterize acute heart attack are highlighted:

  • sharp pain in the chest area, which is pressing, compressing and burning in nature. Duration of pain – more than 20 minutes, this is a heart attack and differs from angina pectoris. Often pain gives to the left arm and scapula, the left side of the neck and lower jaw;
  • shortness of breath appears due to a decrease in the ability of the heart to contract. The strong severity of this symptom indicates a large area of ​​necrosis of muscle tissue. Coughing may accompany shortness of breath. This is a sign that there is a slowdown in blood circulation in the lungs. This phenomenon is observed with left ventricular infarction;
  • autonomic reactions of the body, such as sweating and pallor of the skin.

These symptoms are strictly individual and appear in different ways, depending on the characteristics of the body.

The main cause of myocardial infarction, which is observed in 90% of cases, is vascular atherosclerosis (a disease in which atherosclerotic plaques appear in the vessels as a result of deposits of cholesterol and other fats). Therefore, the factors that provoke this disease increase the risk of developing myocardial infarction. These are:

  • gender: men are more prone to myocardial necrosis than women;
  • age: the risk of a heart attack increases at the age of 50 years;
  • genetic predisposition: if at least one of the relatives had coronary heart disease, heart attack, cerebral stroke, the risk of developing myocardial necrosis increases, especially if these diseases were diagnosed before age 55;
  • elevated blood cholesterol (blood test values ​​above 5 mmol/l);
  • smoking (this factor is the most frequent and significant);
  • obesity and lack of exercise (due to increased body weight, the heart has to pass more blood through itself, which leads to its overload);
  • arterial hypertension;
  • diabetes.

The presence in human life of at least one of these factors increases the risk of myocardial infarction. With the addition of each new factor, the risk increases several times.

Among the reasons that can provoke acute myocardial infarction, there are also:

  • spasm of the heart arteries;
  • embolism (blockage) of blood vessels by a foreign body or pieces of tissue;
  • surgical operations on the heart muscle, during which the coronary vessel was ligated or its transverse section.

The presence of these symptoms does not guarantee the presence of a heart attack. That is why it is necessary to conduct special laboratory tests to detect acute myocardial infarction:

  • non-specific indicators of tissue necrosis, as well as indicating the presence of an inflammatory process (occurs during the first hours after pain in the sternum and can last up to a week);
  • electrocardiogram;
  • changes in the level of enzymes that are in the blood serum (with a myocardial infarction, a large number of enzymes are released into the blood, however, the release rate may be different, which is why the change in the level of enzymes in the blood over time is of diagnostic value).

Treatment of acute myocardial infarction should be in accordance with the main princes:

  1. Anesthesia is necessary due to the fact that there is a large release of catecholamines, which provoke narrowing of blood vessels. Narcotic drugs are used as analgesics, most often morphine. The amount of the drug and the duration of use depend on the severity of the pain syndrome. Analgesics are used during the first day.
  2. Restoration of patency of coronary vessels. For this, medical preparations are used, the main action of which is aimed at changing blood coagulation. These drugs are thrombolytic drugs (Streptokinase, Alteplase), anticoagulants (Heparin, Fragmin), antiplatelet agents (Aspirin, Plavix). They are used both in the pre-hospital stage of treatment, and while in intensive care, and then in the hospital. In addition, nitrates are necessarily used, which can expand blood vessels. Such drugs include Nitroglycerin, Perlinganitis and others.

In urgent cases, the attending physician may decide to have surgery. Scheduled operations are also possible.

Emergency operations are designed to restore blood flow to the heart. To this end, stenting is done – the installation of a special metal structure, which subsequently expands itself and expands the affected vessel in this way.

Planned operations are carried out in order to reduce the area of ​​necrosis of the heart muscle. To do this, aortocorranic bypass surgery is performed. Such an operation will improve the quality of life, reduce the risk of recurring heart attacks.

Patient management

After a myocardial infarction, patients need strict constant monitoring and care, which depend on the degree of organ failure. There is a classification of patients, thanks to which you can choose the best care:

  • patients without signs of pulmonary or venous stasis (grade 1);
  • patients with moderate signs of heart failure (grade 2). In this case, the doctor listens to wheezing in the lungs, a gallop rhythm in the heart. The patient has shortness of breath. There are signs of insufficiency of the right parts of the heart, among which there is venous congestion;
  • Grade 3 unites patients with severe heart failure, which is accompanied by pulmonary edema;
  • in grade 4 patients in a state of shock are combined. The pressure is below 90 mm RT. Art. There are signs of peripheral vasospasm, sweating increased, confusion, lack of urine.

The recovery period after a heart attack can last several months. Depending on the living conditions and work, it is not always possible to return to the previous way of life, but this does not mean that life will be inferior. During the rehabilitation period, the patient takes the prescribed medications and gradually returns to exercise.

Prevention

Not all provocative factors can be excluded from your life. We are not able to change gender or age. However, changing the lifestyle and nutrition is quite real.

Preventive measures are:

  • regular measurement of blood pressure and maintaining it at a normal level;
  • normalization of blood sugar;
  • the refusal of a sedentary lifestyle, however, there should not be excessive loads;
  • giving up bad habits, primarily smoking;
  • normalization of body weight, which contributes to the correction of the diet: the use of a minimum amount of animal fats and bad cholesterol, the inclusion of vegetables and fruits.

With proper behavior during the rehabilitation period, a second attack can be avoided.

Pain (status anqinosus) is the most common and characteristic variant. The pain is localized in the sternum, heart, to the right of the sternum, across the entire surface of the chest.

Usually the pain is oppressive, constricting, tearing, burning, cutting, or vague. The pain lasts over 20-30 minutes, often several hours and often 1-2 days. May relapse.

It is not stopped by sublingual administration of nitroglycerin, analgesics.

Asthmatic. The clinic is dominated by a feeling of lack of air, asphyxiation. This variant of the course of myocardial infarction occurs with papillary muscle infarction, when the relative mitral valve insufficiency is manifested, as well as against the background of long-existing mitral valve insufficiency of various origins and congestive heart failure.

Abdominal (gastralgic). It manifests itself as pain under the xiphoid process or in the upper parts of the epigastrium with dyspeptic disorders (nausea, burping air, hiccups, vomiting).

Arrhythmic. It begins with an attack of ventricular, supraventricular tachycardia, degree AV block or acute blockade of the bundle of the bundle. In the vast majority of cases, rhythm disturbance is complicated by arterial hypotension. Arrhythmogenic shock, acute heart failure.

Cerebral infarction. It is rare. The clinical picture is dominated by symptoms of cerebrovascular accident: fainting, dizziness, nausea, vomiting, focal neurological symptoms.

Chest pain is mild or even absent. More often this variant of myocardial infarction is observed in people with severe discirculatory encephalopathy, including the elderly and senile.

Malosymptomatic (asymptomatic). It manifests itself as bouts of non-intense pain.

Short-term attacks of shortness of breath and other short-term changes in well-being, which do not serve as a reason for seeking medical attention.

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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