Acute myocardial infarction often develops. Acute myocardial infarction - all about the pathology

Death of a section of the heart muscle, leading to the formation of thrombosis coronary artery, called myocardial infarction. This process leads to the disruption of blood circulation in this area. Myocardial infarction is predominantly fatal because the main heart artery is blocked. If, at the first sign, appropriate measures are not taken to hospitalize the patient, then death is 99.9% guaranteed.

The medical facility begins to immediately dissolve the blood clot in order to restore normal blood circulation in this area. Due to the fact that this disease occurs quite often and both older people and young people suffer from it, it is worth paying attention and considering all the nuances of the course of the disease. Let's start with an in-depth look at the question of what a heart attack is.

Description of the disease

Myocardial infarction is an acute manifestation. The disease often primarily affects women; in rare cases, it also affects men. If over a certain period of time there is no blood supply to the area of the heart muscle, then the process of death of this part of the heart begins. The area that actually begins to die as a result of lack of oxygen is called myocardial infarction. Disruption of blood flow to the muscle section occurs due to the destruction of atherosclerotic plaque in the artery. This plaque in in good condition is located in the lumen of one of the vessels, but when any load is applied to it, its destruction occurs. In its place, a blood clot begins to grow, which can either gradually clog the vessel, as a result of which a person tends to periodically feel acute pain in the area of the heart, or quickly. Rapid blockage causes acute myocardial infarction, which requires hospitalization of the patient.

The mortality statistics from myocardial infarction are quite high. Most patients die without waiting for an ambulance. Another half die on the road if there are no urgent resuscitation measures. Even those people who have undergone therapeutic resuscitation measures also die due to the development of complications. As you can see, the disease is so serious that it is almost impossible to survive after its manifestation. Only in 1–2% of cases is it possible to save people from death, but after this a relapse cannot be ruled out.

The dynamics of rapid growth of the disease among young people is observed every year. Moreover, these are people aged 25–30 years and older. In women under the age of 40–50, this disease is less common, but with the onset of menopause, heart attacks are much more common. The reasons for this dynamics are estrogens. The bottom line is that the female reproductive organs produce a hormone called estrogen. It is estrogen that performs the protective function, not allowing you to break away atherosclerotic plaque. In men, the disease is less common than in women, but every year the number of people affected by myocardial infarction is growing.

Classification of myocardial infarction

A dangerous and fatal disease is classified according to the size, depth and location of the outbreak. Let's consider what classes of myocardial infarction are distinguished:

Large-focal. Has characteristic signs of an acute disorder coronary blood flow. The cause of its formation is considered to be the artery, resulting from spasm or the development of necrosis. The name suggests that the resulting thrombus is predominantly large in size. Large focal also has the name massive heart attack myocardium, as there is a violation of blood flow as a whole. As a result, a scar develops based on cell death.
Finely focal. The reasons for its formation are small ischemic damage heart muscle. Characterized by small-sized thrombus formation and mild form course of the disease. In rare cases, a small focal heart attack can lead to cardiac rupture or an aneurysm.
Atypical forms of myocardial infarction. The main feature of this species is the asymptomatic course of the disease. Mostly, a sign of the disease is detected in the hospital on a cardiogram. An ECG for myocardial infarction of this form is the only way to diagnose and determine the disease. In 1–10% of cases this form of the disease occurs.
Anterior infarction. The anterior wall of the left ventricle is predominantly affected.
Posterior infarction. Caused by the formation of a blood clot in the coronary aorta. As a result, the posterior wall of the left ventricle is affected.
Lower or basal. Characterized by damage to the lower wall of the left ventricular artery.
Transmural myocardial infarction is predominantly an acute form of the disease. It is one of the most dangerous types, and is characterized by an effect on the entire wall of the ventricle. Damage occurs to the epicardium and endocardium. Predominantly transmural myocardial infarction always has a large-focal form of manifestation. Men over 30 years of age often fall under the influence. In women this type is extremely rare. The end of this form is scarring of the lesion and subsequent tissue death. Transmural myocardial infarction is practically untreatable and is fatal.
Abdominal. Formed as a result of the development of pathologies on back wall left ventricle.
Intramural. It is formed on the basis of damage to the muscle throughout its entire thickness.
Recurrent. Occurs due to the formation of blood clots in coronary sclerosis. Characterized by the presence of periodic repetitions.

Each form is dangerous and fatal, but it is worth highlighting transmural extensive myocardial infarction, which occurs abruptly and does not last long. The final outcome is fatal in most cases.

Stages of heart attack

What is a heart attack, and what types of it are known, now it is worth paying attention to the stages of development of a dangerous fatal disease. The stages are formed based on the duration of the disease and the danger to the patient. So, the stages of a heart attack have the following names:

The most acute stage. Its duration is approximately 5–6 hours. This stage is treatable, but often death from a heart attack occurs much earlier than the patient is taken to a medical facility. In the background the most acute stage arrhythmias and severe complications occur.
Acute. Oddly enough, this stage is the most dangerous. It occurs unexpectedly and may be accompanied by acute pain for 14 days. The stage is characterized by the formation of a scar.
Subacute stage. Formation takes about a month. During this period, a scar gradually forms and signs of necrotizing syndrome disappear. ECG for myocardial infarction subacute stage displays signs of normalization of disease metabolism.
Post-infarction stage. It mainly forms from the second month of the disease and depends on the lesion. The stage is characterized by the adaptation of the heart to new conditions.
Scarring stage. The final stage, which is characterized by scar formation.

What contributes to the formation of a dangerous disease or what are the reasons and prerequisites for this. Let's take a closer look at the causes of myocardial infarction.

Reasons

The causes of myocardial infarction are very different, but first of all, it is worth highlighting that most often the disease is diagnosed in the elderly or young. active people those who are obese or inactive. If we add to this frequent psycho-emotional overload, mood swings, stress, etc., then the result is 100% myocardial infarction syndrome.

Sometimes myocardial infarction also affects people with good physical training, both young and old. The cause of the disease in people with a developed system of muscle groups is mainly bad habits and frequent psychoemotional disorders. Any disorder leads to cell death. Among the main reasons for the formation of myocardial infarction, it is also worth highlighting the following factors:

Frequent overeating. A person should eat 3-4 times a day, but more is allowed if food is consumed in small quantities. It is better to eat more often, but in small portions, than once or twice a day, but at the same time overeat.
Hypertensive diseases.
Low physical activity. A person must walk at least two kilometers every day so that the muscles have the opportunity to contract.
No animal fats in food.
Bad habits. These include not only smoking and excessive alcohol consumption, but also taking narcotic and toxic drugs.
High cholesterol. Cholesterol is the main component that leads to the formation of plaque on artery walls.
. An increased composition of blood sugar leads to a deterioration in the transport of oxygen through the bloodstream.

Based on research, it was found that the syndrome predominantly occurs in sedentary and inactive people. These are mainly women aged 40–50 years and men over 30. Relapses are especially common in men who consume extremely high amounts of alcohol. alcoholic drinks. In physically active people cardiac infarction It is extremely rare and is often caused by severe emotional stress.

Against the background of all the above reasons, a blockage of the heart vessels occurs with a thrombus, which is a plug in the artery. Accordingly, blood with a fresh supply of oxygen does not flow to the parts of the heart. The heart muscle can survive without oxygen for 10 seconds; if after this time the oxygen supply process is not restored, then the muscle gradually dies. About 30 minutes after complete blockage, the heart muscle is viable, and after that irreversible processes begin to develop.

Thus, in order to exclude such a disease, it is necessary to switch your body and consciousness to management healthy image life and not give in to stressful situations. How does a heart attack manifest in humans?

Symptoms

Symptoms of the disease mainly manifest themselves in the form of acute pain in the chest. But such symptoms are characteristic primarily of males. In women, symptoms also appear in other forms.

Symptoms of myocardial infarction depend on the severity of the disease, clinical manifestations, myocardial damage and others associated factors. It was found that the symptoms of the disease are somewhat different in women and men. Let's consider the main types of symptoms of the disease and atypical signs.

Main symptoms of a heart attack

Against the background of the above reasons, a person develops pain symptom, which is an attack of pain in the chest area. Sometimes it is quite difficult to say that it is the heart that hurts, since the characteristic location of pain is the area below the heart. Pain occurs mainly during exercise physical activity, which previously may not have been performed, in case of strong and prolonged emotional disorders.

Symptoms of a heart attack also have the following characteristic features:

Sudden onset of acute pain in the chest area, predominantly on the left side of the body. The duration of pain lasts up to 15–30 minutes. The pain is sometimes so severe that a person wants to scream. If there are signs of acute discomfort in the heart area, emergency assistance must be called.
Even if a person resorts to taking nitroglycerin, the pain does not disappear, but may decrease slightly.
Acute pain is characterized by squeezing, squeezing and burning symptoms.
Signs of myocardial infarction often have an intense form of manifestation, but in rare cases it can be wavy.
Over time, the symptoms of pain increase and radiate to the neck, left arm and even jaw.

Based on the first signs, we can say that a person is having a heart attack, which is caused by activation nervous system. Symptoms of myocardial infarction also appear as increased sweating, general weakness and malaise of the body. A person often, being in this state, cannot continue to move further or perform any actions, the skin becomes pale, and the patient becomes white. Sweat is characterized by stickiness and coldness. With acute pain, the patient begins to feel dizzy and falls to the floor, holding his heart.

Nausea and vomiting are also signs of myocardial infarction. Vomiting occurs due to decreased blood pressure. In rare cases, symptoms of cardiogenic shock are observed, which are characteristic primarily of the acute stage of the disease. Cardiogenic shock is characterized by paleness of the human body, the appearance of cyanosis on the lips, the limbs become white with a blue tint, and the pulse cannot be felt.

Important! First aid for myocardial infarction is mandatory, even if you find a person who is holding his chest and cannot speak, you must immediately call an ambulance and begin providing first aid.

If the ambulance arrived on time and managed to save the patient, then the next day the second period of malaise begins, which is characterized, first of all, by an increase in temperature to 38 degrees. An increase in temperature is the body’s reaction to the cessation of myocardial activity and its further death. If cardiogenic shock occurs, damage is possible internal organs, that is, their death or decline in vital activity. Often the first organ to fail is the kidneys. In this case, urine accumulates in the kidneys, which is practically not excreted. The accumulation of unnecessary products in the body begins, which lead to intoxication.

The rehabilitation period also has its own characteristics, which are characterized by:

The appearance of swelling in the upper and lower extremities.
Frequent shortness of breath even with minor exertion.
There is an enlargement of the liver and its pain.

Often, at the rehabilitation stage, a phenomenon develops, caused by the cause of depletion of the heart muscle. Symptoms of myocardial infarction are the first signs that it is urgently necessary to call an ambulance to save a person. The disease is one of the most dangerous diseases known. The main or typical symptoms are clearly manifested in men, while women have atypical signs of the disease that are worth talking about.

Atypical symptoms

Atypical symptoms of myocardial infarction, which are typical for women, have several types of clinical forms.

Asthmatic form. Characterized by a feeling of lack of air and shortness of breath. Often, against the background of shortness of breath, panic begins, which aggravates the situation. Attempts to breathe deeply are unsuccessful. Accumulates in the alveoli excess fluid, which makes itself felt in the form of bubbling during inhalation. Further development of the disease leads to the formation of swelling of the lungs and the development of pneumonia. Choking during myocardial infarction often occurs during sleep, with a sudden awakening reminiscent of an attack.
Gastralgic form. A rare phenomenon that is characterized by the appearance of abdominal pain, mainly in the upper sections. It is very difficult to determine the real diagnosis based on the first signs, since the symptoms are more similar to acute or poisoning. But in fact, under the symptoms of vomiting, hiccups and belching, a dangerous heart attack is hidden. Determined only through diagnosis at a medical center.
Cerebrovascular form. The first signs of the disease appear in the form of deep fainting. This form of the disease occurs more often in men and less often in women. Against the background of the disease, paralysis and paresis occur, and brain failure And pathological abnormalities.
Arrhythmic form. Symptoms of arrhythmic myocardial infarction manifest themselves in the form of rhythm disturbances. The most dangerous in arrhythmic form is the formation of atrioventricular blockades. Based on these blockades, the heart rate decreases. Such signs require immediate hospitalization of the patient for assistance.

The symptoms of myocardial infarction are quite varied, therefore, at the first ailments in people with ischemic abnormalities, you should urgently call an ambulance and begin providing first aid to the patient. We’ll look at how to do this a little later, but first, let’s look at how the disease is diagnosed in medical centers.

Diagnostics

Diagnosis of myocardial infarction is carried out according to three main factors:

Clinical picture.
Laboratory tests and troponin test.

The clinical picture of the disease is determined mainly by close people who observe the aggravation of the situation. Based on the following symptoms: sharp acute pain in the sternum, inability to inhale, nausea, vomiting, weakening of the body, cold sweat and difficulty speaking, it is necessary to call an ambulance and tell all the signs to the arriving doctor. Based on the clinical picture, an experienced doctor will determine accurate diagnosis. But a mandatory procedure is also to conduct an ECG in a hospital or in an ambulance. In cases of myocardial infarction, not a minute can be lost, so everything diagnostic procedures are carried out very quickly.

The study of cardiac abnormalities using an electrocardiogram confirms the diagnosis previously made by an experienced doctor. On ECG heart attack myocardium manifests itself in the form of the formation of Q waves and ST segment elevation in the leads. Based on the data received, the doctor observes the picture of the damage certain parts parts of the heart, which is a sign of a heart attack.

A heart that has ever suffered from severe ischemia will never be the same. If you have a history of at least one coronary attack, you need to carefully monitor your condition. By following simple recommendations, you can significantly reduce the risk of severe complications.

Myocardial infarction: acute period and development of pathological changes

The International Classification of Diseases identifies various shapes ischemia, the names of the disease may differ depending on the severity of the lesion, starting stable angina and ending with an attack of necrosis of the heart muscle. Determination of pathology by ECG depends on the stage of development of ischemia. The necrotic process of the heart muscle can be much more difficult to determine than damage to the anterior wall, since it is not always visualized on the electrocardiogram.

Acute myocardial infarction is manifested by cardiac dysfunction and other characteristic symptoms, is accompanied by numerous complications and poses a threat to life

Highlight next stages formation of cardiac muscle necrosis:

Damage to muscle fibers. Due to the disruption of normal blood flow through the coronary arteries, persistent ischemia occurs. The lack of oxygen negatively affects the condition of cardiomyocytes; in the affected area they begin to collapse. Still living fibers react to ischemia and arise painful sensations. The stage lasts from several hours to 2-3 days.
Period acute manifestation clinical signs. Depending on the severity of ischemia, necrosis or slight damage fabrics.

Attention! Experienced doctor is able to make a diagnosis based on characteristic signs, such as: burning and pressing pain behind the sternum, fear of death, dizziness.

Within two weeks, the focus of inflammation continues to form. ECG interpretation helps to detect a pathological Q wave. An ischemic zone forms at the periphery of the necrotic area.

Acute myocardial infarction is the undisputed leader in the structure of mortality worldwide

AMI in the subacute stage. The final stabilization of muscle tissue occurs. The area of necrosis becomes clearer, and the damaged areas are restored. It is difficult to say with accuracy how long this stage lasts. Usually its duration is up to 3 months, in severe cases – up to 1 year.
Scar stage. The signs of the most acute period finally disappear, the person practically ceases to be bothered by pressing pain in the chest, dizziness and weakness. Adaptive mechanisms involve the formation of fibrous tissue at the site of the affected lesion. Healthy areas hypertrophy, trying to compensate for the decrease in the functioning area of the heart.

If a report was provided that described an ischemic attack, you should be on guard.

Important! Mild manifestations of coronary artery disease, in the absence of appropriate treatment, can develop into more severe forms over time.

A dangerous complication is left ventricular failure, followed by cardiogenic shock.

Myocardial infarction: causes and diagnosis

Spontaneous occurrence heart attack- enough common occurrence. A person can engage in normal activities until a burning chest pain takes him by surprise. Doctors classify this disease as a polyetiological disease and claim that AMI occurs only if there are predisposing factors.

The most common cause of acute myocardial infarction is atherosclerosis

The cause of ischemia is blockage of the coronary vessels:

blood clot due to coronary thrombosis;
atherosclerotic plaque.

The etiology of IHD may be associated with the following conditions:

high level of cholesterol in the blood (a connection has been established with atherosclerosis);
endocrine pathologies;
blood pathologies (hypercoagulation, thrombosis);
arterial hypertension;
bad habits;
old age and availability concomitant diseases circulatory system.

Diagnosis of AMI necessarily includes an electrocardiogram, which will help identify pathological abnormalities. A blood test is done to detect neutrophilic leukocytosis. Additional diagnostics of myocardial infarction, its acute form, is produced by identifying biochemical markers of necrosis (CPK-MB, tropinin, myoglobin) in the blood.

How does necrosis of the heart muscle manifest on an ECG?

Manifestations of the disease on the electrocardiogram can vary depending on the location of the lesion, its size and the severity of the necrotic process. In turn, there are common symptoms for most forms of the disease.

“Q-infarction” - with the formation of a pathological Q wave, sometimes a ventricular QS complex (usually large-focal transmural myocardial infarction)

An ECG with necrotic heart disease has a number of features:

in the stage of damage: rise S-T segment above the isoline, the R wave has a reduced amplitude, the presence of a pathological Q wave depends on the formation of necrosis, at this stage it may be absent;
the most acute stage is characterized by: a slight decrease in the S-T segment, the appearance of a pathological Q wave, a negative T wave;
the third stage of the disease is divided into two parts: first, the ECG shows a negative T wave with a large amplitude; as recovery progresses, it decreases and rises to the baseline;
During the scarring stage, the normal appearance of the electrocardiogram is restored, the Q wave may disappear, the S-T segment returns to the isoline, and the T wave becomes positive.

Recovery normal operation heart after an AMI is individual. In some people, the signs of the disease disappear very quickly and its presence in the anamnesis is almost impossible to establish by ECG; in others, the pathological Q wave can persist for a long time.

What features does non-Q-infarction have?

Small-focal lesions are tolerated more easily than large-focal forms of the disease. Clinical signs characteristic of the non-Q form of the disease are less pronounced. There may be slight chest pain that resembles an angina attack.

“non-Q-infarction” – not accompanied by the appearance of a Q wave, manifested by negative T-waves (usually small-focal myocardial infarction)

Important! With this type of disease, an electrocardiogram without a pathological Q wave is observed.

Some people who have experienced a small-focal form of myocardial necrosis learn about the presence of pathological changes only during a routine examination, for example, a medical examination. It is necessary to pay attention to the T wave, which in this form of the disease changes greatly; it becomes double-humped or jagged.

Acute coronary infarction

Since the symptoms of ischemia can vary significantly, there are cases where necrosis of the heart muscle was mistaken for angina pectoris.

Before starting treatment coronary syndrome, it is recommended to do an electrocardiogram, which helps to establish the type of illness:

Spicy . A blockage of a blood vessel occurs with a thrombus or atherosclerotic plaque, which causes ischemia and transmural damage to the heart muscle.
AMI without S-T segment elevation. An ECG of this type is observed in the initial stages of the necrotic process. When small focal changes are recorded, the S-T segment is at the usual level, and the pathological Q wave is most often absent. The difference from angina is the presence of necrosis markers.

Typical cases of myocardial infarction are characterized by extremely intense pain with pain localized in the chest and radiating to the left shoulder, neck, teeth, ear, collarbone, lower jaw

Important! Upon admission to the hospital, the patient is usually given general diagnosis“coronary syndrome”, which may be with or without S-T segment elevation on the electrocardiogram.

After examination by a cardiologist and collection of complaints, additional examination promoting differentiation unstable angina and necrosis of the heart muscle.

Myocardial infarction: how to provide emergency care

If you suspect a heart attack, you should call an ambulance. Self-medication can lead to irreversible serious consequences.

Important! “If you have previously experienced sharp pain in the chest, this is fraught with an increase in the focus of necrosis. The further success of treating the disease depends on how correctly first aid is provided.”

Bye medical workers go to the patient, the algorithm of actions is as follows:

the patient must relax completely, for this it is advisable to take horizontal position, loosen up tight clothes, open the window, create a calm environment in the room;
you can try to stop the attack, it can slightly reduce the spasm of the coronary vessels;
first aid does not include special drugs(thrombolytics, anticoagulants), they should be taken in a hospital setting under the supervision of a doctor; giving such medications to a patient on their own is very risky;

To slow down further development atherosclerosis, it is important to prevent the formation of fatty plaques in the vessels. For this purpose, drugs from the statin group are prescribed.

if cardiac arrest is suspected, the patient should immediately begin indirect massage, which is presented as 30 chest compressions, may sometimes require mechanical ventilation.

An attack of AMI is completely controlled only by narcotic analgesics. To prevent relapses of the disease in a hospital setting, specific therapy can be prescribed, which involves a set of medications that can reduce the load on the heart and protect muscle tissue from the manifestations of ischemia.

Complications of acute myocardial infarction

Even if the electrocardiogram does not show any signs of necrosis and you feel well, you should be periodically examined to exclude dangerous complications.

AMI can cause the following serious consequences:

heart failure;
the immediate complication is cardiogenic shock;
(as a consequence of heart failure);
Dressler's syndrome (autoimmune damage to the heart muscle);
changes in rhythm and conduction (arrhythmias, blockades).

Often complications arise already in the first hours and days of myocardial infarction, complicating its course.

Medicine of the twenty-first century does not stand still; it carefully studies the problems of each cardiac patient. To exclude severe consequences disease, there are a number of drugs that will help reduce the load on the heart, restore vascular tone and protect tissues from the development of ischemia. Proper first aid provided during the initial period of the disease and careful adherence to the recommendations of doctors will help reduce the risk of complications.

Signs of acute myocardial infarction

People who first suffered from necrosis of the heart muscle remember its manifestations for a long time. In some cases, symptoms may be somewhat blurred, depending on the presence of concomitant pathologies or in the case of a small-focal form of the disease.

Attention! If you suffer from diabetes, it can be difficult to understand what is really happening to your heart. The sensitivity of tissues decreases, and therefore some people calmly tolerate the disease “on their feet.”

You are actually overtaken by an attack of this serious illness if:

A sign of the most acute stage is pain behind the sternum of a burning and pressing nature, which radiates to left hand, shoulder blade, neck, jaw. May be accompanied by indigestion, abdominal cramps, and numbness of the limbs.

The patient's complaints during myocardial infarction depend on the form (typical or atypical) of the disease and the extent of damage to the heart muscle

Characteristic signs of ischemia: dizziness, malaise, shortness of breath, rapid fatigue. Cold sweat appears, the person is completely unable to exercise during an attack familiar types activities.
Jumps (it can fall or rise to critical values), the pulse becomes faster, and there is strong anxiety about one’s condition and life. Sometimes the body temperature rises, and signs of intoxication of the body with particles of dead tissue appear.

The clinical variant of the disease (abdominal, asthmatic, collaptoid, arrhythmic, etc.) matters. Depending on the form of the disease, nausea or cough may occur, which bring additional difficulties in diagnosing the disease.

Attention! Cases have been recorded where a patient was admitted to the hospital with suspected gastrointestinal or pulmonary pathology, but only after a thorough examination were signs of cardiac muscle necrosis identified.

If the diagnosis is not made in time, severe syndromes may occur that pose a risk to the patient's life.

Treatment of acute myocardial infarction

The complex of symptoms characteristic of coronary artery disease does not refer to conditions that “will go away on their own.” The disappearance of pressing pain behind the sternum does not mean complete recovery. Even a small focus of necrosis can seriously affect the functioning of the heart.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, and cardiogenic shock

IN initial period The disease causes very severe pain that requires intensive care:

nitroglycerin in standard dose 0.4 mg (to enhance the speed of action, it is recommended to place it under the tongue, you can use up to 3 tablets);
beta-blockers, which fight ischemia and help protect areas of the heart from death (standard drugs are Metoprolol and Atenolol);
in severe cases, when there is a significant necrotic process, intravenous narcotic analgesics, for example, morphine.

Myocardial infarction is dangerous, first of all, because of its complications. In order to restore damaged tissue and reduce the load on the diseased heart, a cardiologist selects special therapy.

Drugs for severe myocardial infarction are taken continuously, and not only in the acute period; to prevent relapse, the following are prescribed:

Thrombolytics (streptokinase, urokinase). The pathogenesis of the disease most often lies in the disruption of blood flow through the coronary vessels, which are blocked by a blood clot.
Beta blockers. Reduce the need for oxygen, reduce the load on the heart muscle. They are often used in drug therapy arterial hypertension. Drugs in this group can lower blood pressure.

Pain relief is carried out using a combination of narcotic analgesics

Anticoagulants and antiplatelet agents. Standards of treatment include medications that can thin the blood. The most popular today is acetylsalicylic acid. It is contraindicated for gastritis and bronchial asthma.
Nitrates. It is appropriate to use nitroglycerin in the first minutes of an attack; it has been proven beneficial influence to protect cardiomyocytes from ischemia. Its use reduces the risk of complications, including cardiogenic shock.

If you follow all clinical recommendations, you can avoid many dangerous complications. A history of AMI makes a person more vulnerable. Even minor physical activity can lead to a recurrent attack. To make life easier, specialists in the field of cardiology provided an algorithm of actions to improve the patient’s condition.

In order for your life to be the same after a heart attack, you need to radically change your lifestyle. Correctly selected drug therapy with AMI – that’s not all. Harmful products food, heavy physical labor, chronic stress and the presence of concomitant diseases can negatively affect the speed of recovery of the body. Doctors around the world have developed clinical recommendations aimed at improving the patient’s condition.

Necessary conditions for the prevention of myocardial infarction are maintaining a healthy and active lifestyle, giving up alcohol and smoking, and a balanced diet.

Acute myocardial infarction requires only proper nutrition:

low cholesterol foods;
fresh fruits, vegetables, berries, which, with the help of a large amount of vitamins, promote the regeneration of heart fibers;
required special diet, which implies the exclusion of fast food, chips, crackers, etc. from the diet;
refusal to drink alcohol and coffee.

If a person often clutches his heart, he experiences shortness of breath after minor physical exertion, his limbs go numb, or his blood pressure increases, this may become a wake-up call in the progression of the disease.

Prevention of acute myocardial infarction requires you to carefully monitor your own health, which includes:

getting rid of bad habits (nicotine negatively affects blood vessels and the heart, coffee increases the need for oxygen);
moderate physical activity (walking in the fresh air is an excellent choice);
absence of stress, training in relaxation methods;
maintaining normal weight;
periodic measurement of blood pressure and pulse.

It is easier to avoid AMI than to spend the rest of your life treating it. Among people who are accustomed to regular physical activity, eat healthy foods and try to have a positive outlook on life, coronary heart disease is much less common.

Acute myocardial infarction, how is rehabilitation going?

The development of the disease and rehabilitation of patients in each individual case can occur differently. Some people suffer from ischemia, which is very dangerous, and at the same time calmly engage in normal activities. Other patients after illness are forced to avoid unnecessary stress, some of them even begin to register for disability. Proper exercise will help you recover faster.

Exercise therapy after acute myocardial infarction implies:

moderate dynamic loads (running, skating or roller skating, cycling, swimming);
breathing exercises (for example, a set of exercises by Strelnikova);
Indian yoga.

But static exercises with a heavy load are strictly contraindicated for cores.

Attention! Lifting heavy weights can contribute to the occurrence of another attack. It should also be remembered that you need to start gymnastics no earlier than at the stage of scar formation.

Acute myocardial infarction is a severe, dangerous pathological condition that occurs as a result of ischemia (long-term disturbance of the blood circulation of the heart muscle). Characterized by the appearance of necrosis (death) of tissue. Damage to the myocardium of the left ventricle of the heart is more often diagnosed.

This disease is included in the list of the main causes of disability and death among the adult population of the country. The most dangerous is large-focal (extensive) myocardial infarction. In this form, death occurs within an hour after the attack. With a small-focal form of the disease, the chances of a complete recovery are much higher.

The main reason for the development of a heart attack is considered to be blockage of a large blood clot. coronary vessel. In addition, common causes include a sharp spasm, contraction of the coronary arteries due to severe hypothermia or exposure to chemicals and toxic substances.

How does acute myocardial infarction manifest, what is emergency care, what consequences can this disease have? What folk remedies are recommended to be used after treatment? Let's talk about it:

Acute heart attack - symptoms

The pathological process develops gradually and has several main periods, each of which is characterized by certain symptoms. Let us briefly consider each of the periods:

Pre-infarction. Different to varying degrees duration - from several minutes to several months. During this period it is celebrated frequent occurrence attacks of angina pectoris with pronounced intensity.

Spicy. During this period, ischemia occurs and necrosis of the heart muscle develops. May be typical or atypical. In particular, the painful variant of the acute period is typical and is observed in the vast majority of cases (90%).

[u]The acute period is accompanied by certain symptoms: [u]

Pain appears in the area of the heart, which is pressing, burning, or bursting or squeezing in nature. As the attack continues, the pain intensifies, radiating to the left shoulder, collarbone and scapula. May be felt in the left side of the lower jaw.

The attack can be short-lived or can last up to several days. Most often its duration is several hours. Characteristic feature pain is the lack of connection between it and stress or physical activity (as, for example, with coronary artery disease).

However, it is not blocked by the usual heart medications Validol and Nitroglycerin. On the contrary, after taking the medicine, the pain continues to increase. This distinguishes a heart attack from another heart attack, such as angina.

Besides the strong painful sensations, an acute heart attack is accompanied by a decrease in blood pressure, dizziness, and sometimes loss of consciousness. There are breathing problems, nausea and vomiting may occur. Skin pale and covered in cold sweat.

The severity of pain depends on the volume and area
defeats. For example, a large-focal (extensive) heart attack is characterized by more severe symptoms than a small-focal one.

If we talk about atypical variants of the course, then in these cases the signs of a heart attack can be disguised as attacks of bronchial asthma. The abdominal version causes symptoms of an acute abdomen, and the arrhythmic one is similar to an attack of cardiac arrhythmia, etc.

In any case, if the above symptoms are observed, you should immediately call an ambulance.

What are the risks of acute myocardial infarction, and what are the consequences?

Consequences varying degrees severity can develop at any stage of this disease. They can be early or late. Early ones usually appear immediately after an attack. These include:

Cardiogenic shock, symptoms of the condition such as acute heart failure and blood clots;
- conduction disorders, as well as heart rhythm disturbances;
- very often ventricular fibrillation develops, pericarditis occurs;
- Cardiac tamponade is less common. This pathology develops due to a possible rupture of the wall of the heart muscle.

After a heart attack, dangerous complications can also appear. They usually occur when subacute course or in the post-infarction period - several weeks after the attack. Late complications include:

Post-infarction syndrome (Dressler's syndrome);
- chronic heart failure.
- cardiac aneurysm and possible thromboembolic complications;

Acute myocardial infarction - emergency care

If a heart attack is suspected, emergency medical care is required. So call immediately! Before the doctor arrives, open the windows and vents to allow fresh air into the room.

Place the patient in a semi-sitting position. Place a large pillow under your back. His head should be slightly raised.

Unbutton your collar and remove the tie that is restricting movement. Give the patient an Aspirin tablet (acetylsalicylic acid). For severe pain, give an anesthetic drug, for example, Analgin or Baralgin. You can put a mustard plaster on the chest area.

If cardiac arrest occurs, perform chest compressions as quickly as possible and give the patient artificial respiration.

To do this, place the patient on a flat, hard surface. Tilt his head back. Using the palms of your hands, apply four sharp pressures on the sternum and one inhalation. Again four presses and one breath, etc. You can find out more about the use of these resuscitation techniques on the website.

Home acute myocardial infarction - helping yourself:

If an attack occurs at home and no one is nearby, call an ambulance immediately. After which you need to open the windows, take painkillers and lie down on the bed in a semi-sitting position. The front door should be left unlocked. This will help doctors enter the apartment in case of loss of consciousness.

Further treatment is carried out in a hospital. The patient is placed in the cardiac intensive care unit.

Folk remedies after a heart attack

Mix an equal amount of crushed valerian roots, motherwort herb, marsh cudweed and also use the medicinal plant astragalus. Add the same amount of finely broken wild rosemary shoots, calendula and clover flowers. Add the same amount of white willow bark, ground to a powder. Mix everything.

Pour boiling water (300 ml) into half a tablespoon of the mixture. It's better to cook in a thermos. The infusion will be ready in about 6 hours. It must be filtered, after which you can take a quarter glass, several times a day. Before taking the product, warm it up a little.

Combine an equal amount of dried flowers horse chestnut, motherwort herbs, corn silk. Add the same amount of arnica inflorescences, lavender herb, leaves of the coltsfoot plant and sedum. Add the fennel fruits, crushed to a powder. Pour 1 tsp of the mixture into 200 ml of boiling water. If you cook in a thermos, healing agent will be ready in 4 hours. Be sure to strain it and drink a quarter glass an hour before meals.

Heart attack is one of the leading causes of death, especially among older people. But in recent years the age of development is significantly younger dangerous pathology. Myocardial infarction in a 40-year-old man is no longer uncommon.

At its core, infarction or necrosis refers to dead tissue. It can no longer perform its previous functions and is gradually replaced by universal connective tissue.

Mechanism of infarction formation

The cause of death of the heart muscle is cessation of blood flow. It is stopped due to blockage of the vessel by a blood clot.

If the vessel is large, then the area of necrosis will be large, if it is small, then it will be insignificant.

The severity of symptoms depends in part on the area of the lesion. A thrombus is a clot that is made up of various blood cells and proteins.

Most often, a blood clot does not form in an empty place, but on a damaged vessel. The arteries that supply blood to the heart are called coronary arteries. They may undergo the process of atherosclerosis.

This is what they call a disease when there is excess unhealthy fat deposited on the wall of the vessel, forming a bulge - a plaque. This plaque makes the lumen of the vessel narrower, and less blood flows to the heart muscle.

With atherosclerosis, the heart experiences oxygen starvation, especially under stress or physical exercise when the heart is forced to beat faster.

For some reasons, the surface of the blood clot may rupture:

Pressure surge;
Infection;
Inflammation;
Frequent heartbeat;
Spontaneously.

A variety of blood cells rush to the site of the tear. They all stick to the plaque, to each other, and form a blood clot. Blood coagulation systems are activated - proteins that make the blood clot even larger and denser. Thick blood clot closes the lumen of the vessel. Blood can no longer flow through the artery and feed the muscle. The heart muscle dies.

Oxygen starvation that occurs during thrombosis manifests itself severe pain. At this time, the cell forms large number acidic metabolic products that destroy the cell from the inside - necrosis of the heart muscle or myocardial infarction develops.

Cell death causes severe, burning pain. If the clot is not dissolved in the next few hours, the death of the muscle will be irreversible.

Causes of acute myocardial infarction

The main reasons that can lead to the death of the heart muscle are vascular spasm or blockage of their lumen by a blood clot. There is also a combination of these two factors. Vasospasm can be caused hormonal changes, taking certain medications, or physical factors such as cold.

Severe anemia can also cause myocardial ischemia. The less hemoglobin in the blood, the less oxygen it carries to the cells. The myocardial muscle experiences oxygen starvation and quickly dies.

With hypertrophic cardiomyopathy as such, there is no vasospasm. But the heart muscle grows so much that the existing vessels cannot meet the heart’s oxygen needs. This discrepancy becomes especially noticeable during physical activity.

Predisposing factors

There are a number of conditions that in themselves do not cause a heart attack. But they worsen the condition of blood vessels, blood, and heart muscle. Therefore they are considered predisposing.

If they are, then the likelihood of developing a heart attack is much higher than in a person without predisposing factors:

How more factors a person has, the higher the risk of developing a heart attack. Moreover, we cannot correct some of these issues, such as heredity and age. But low physical activity, smoking can be easily changed. Correcting such factors reduces the likelihood of a heart attack.

Classification

Criterion	Options
Dimensions	large-focal;
Dimensions	finely focal
Depth	transmural;
	intramural;
	subendocardial;
	subepicardial.
According to ECG changes	With Q wave;
According to ECG changes	without Q wave.
By localization	partitions;
	tops;
	front part;
	common;
	lower

Diagnostics

The development of a heart attack is easy to suspect based on symptoms. Burning pain behind the sternum in an elderly person is always an indication for recording an ECG.

Changes characteristic of a heart attack are recorded on film. This is a pathological, deep Q wave or even a QS complex when the R wave completely disappears.

ST segment elevation is also detected, which indicates ischemia of the upper layers of the myocardium. The T wave becomes negative or high, coronal. Those leads in which changes are detected will show the localization of the infarction. If all chest leads are affected, then they speak of a widespread heart attack.

When performing ECHO cardioscopy, it is discovered that the area of the heart that has died is contracting poorly. The myocardial wall in this place is relaxed and thinned. If the heart attack was small, then there will be no changes on ECHO.

Be sure to take blood to analyze the content of proteins that are markers of infarction - CPK, troponins. These are the substances that are formed when muscle tissue dies. They are not a 100% criterion for a heart attack, but they indicate serious damage muscles.

They take it general analysis blood, which reveals an increase in leukocytes, acceleration of ESR. These indicators indicate the development of inflammation around the dead myocardial tissue. A few days later, the general blood test comes back normal.

Coronary angiography carried out in large diagnostic centers. It allows you to identify places where something is blocking the blood flow - a narrowing or a blood clot. This the only way reliably and accurately tell about myocardial infarction and confirm it morphologically.

If planned surgical treatment heart attack, then coronary angiography is mandatory.

Narrowing of the vessel

Stages

During the development of a heart attack, several stages are distinguished, which differ in time and changes in electrocardiography films. The very first stage is preceded by a prodromal period. In some people it cannot be detected. Others note a gradual deterioration of the condition until pain develops.

The most acute stage

In a typical case, it manifests itself sharply, burning pain behind the sternum. Shortness of breath and a feeling of fear immediately appear. A person cannot find a place for himself, since none of the positions alleviate the condition. The most acute period lasts up to 2 hours.

Acute stage

The pain syndrome decreases, and the muscle begins to die. The pressure, which may have been high in the first stage, decreases. Body temperature may rise, and there are signs of inflammation in the blood. This is due to the formation of an inflammatory zone around the dead tissue.

Subacute stage

The condition is returning to normal. There is no pain syndrome, but late rhythm disturbances begin to appear: tachycardia, extrasystole. The period lasts up to 28 days.

Post-infarction cardiosclerosis

Starting from day 29, a heart attack is not diagnosed. The condition is believed to have become stable at this time. The area of necrosis is replaced by connective tissue. Rhythm disturbances that did not disappear at the previous stage will remain for life.

Symptoms

The classic form of myocardial infarction is called typical. It includes severe pain syndrome. Moreover, the pain is located clearly in the middle of the chest, behind the sternum.

It is diffuse, burning and strong. Most often, the pain radiates to the left arm or left shoulder, it can radiate under the shoulder blade, to the back area. Less commonly, the pain spreads to the neck and lower jaw. It is not eliminated by taking nitroglycerin.

The circumstances under which the pain occurred are also very important. It is always physical activity or stressful situation. She's calling rapid heartbeat, increased blood pressure. This leads to plaque rupture.

It is also common for a heart attack to occur in the morning, around 4-5 o’clock. It's work related hormonal system: the release of adrenaline and corticosteroids occurs precisely at this time. These hormones increase blood pressure and make the heart beat faster.

In addition to pain, a person is worried about:

Nausea;
Vomit;
Dyspnea;
Feeling of fear of death;
Dizziness;
Weakness.

The skin is pale, with a grayish tint. There is always cold sweat on them. During a heart attack, rhythm disturbances often develop, so people feel interruptions in the functioning of the heart and describe the feeling of “turning over the heart.”

Besides typical shape, there are also atypical options:

Asthmatic: predominantly shortness of breath, attacks of suffocation. The pain is not as pronounced.
Abdominal: pain in the stomach, nausea, repeated vomiting. It occurs with an inferior diaphragmatic infarction, when parts of the heart located close to the abdomen are affected.
Cerebral: headache, dizziness, loss of consciousness, convulsions.
Arrhythmic: pain in the heart area is not expressed, but there are rhythm disturbances.
Peripheral: pain syndrome only in the area of the arm, shoulder, neck. Difficult to diagnose option.
Dumb: often happens in patients diabetes mellitus. Absolutely asymptomatic, detected as an incidental finding on an ECG or at autopsy.

Rupture of atherosclerotic plaque

Emergency care for acute heart attack

The first aid algorithm for a heart attack is simple and understandable. If you experience chest pain of a typical nature, especially in an elderly man, you should always think about a possible myocardial infarction. First, the person is seated; a lying position is undesirable. Release the neck and chest to make it easier for a person to breathe.

Then:

One tablet of nitroglycerin or one dose of nitrospray under the tongue is given;
After 5 minutes, if there is no effect, a second dose is given;
If after 5 minutes there is no improvement again, then a third dose of nitrates is given. At the same time, the person should chew an aspirin tablet. An ambulance must be called at this moment.
The dispatcher is always told that the person is having chest pain and possibly having a heart attack. In this case, a specialized cardiology or resuscitation team will definitely arrive.

Treatment in hospital

Further assistance will be provided by emergency and specialized department doctors. At the ambulance, they record an ECG film on which they record characteristic changes. If there are no contraindications, then emergency doctors perform thrombolysis - they administer special drugs that dissolve the blood clot.

If there is a vascular center nearby, the patient is taken here.

In some forms of heart attack, coronary angiography, a study of the heart vessels, is possible. If an area narrowed by a plaque and with a blood clot is identified, then surgery: The clot is removed and the vessel dilates.

A stent is installed in it - a metal frame that will prevent the vessel from narrowing.

What does a metal stent look like?

Ambulance and hospital doctors administer nitroglycerin intravenously, very slowly. Nitrates lower blood pressure, so as soon as it reaches 90/60 mmHg, nitrates are stopped administered. For tachycardia, beta blockers must be given: metoprolol, esmolol.

In the future, instead of intravenous medications, the person will receive tablets.

Mandatory medications for a person who has had a myocardial infarction:

All medicines must be prescribed by a doctor. They should be taken exactly in the concentration that is prescribed, since changing it can cause a second heart attack.

Prevention

Preventing a heart attack is easier than treating it.

You should get rid of those risk factors that can be eliminated:

Do physical exercise;
Stop smoking and overuse alcohol;
Control blood sugar levels;
Keep blood pressure low;
Eat right - avoid fatty and fried foods.
Be sure to eat 3-4 servings of fresh fruits and vegetables daily.

If a heart attack has already occurred or a diagnosis of coronary heart disease has been made, then you should take prescribed medications for life. Usually these are statins and aspirin. These medications will prevent blood clots from forming in the vessels and clogging them.

Video:

Immediately after acute coronary occlusion blood flow in vessels. located below the site of occlusion, ceases, with the exception of a small collateral blood flow from the border vessels. The area of the myocardium where blood flow is absent or so small that it cannot support cell viability becomes the infarction area. The entire pathological process is called myocardial infarction.

Soon after onset of myocardial infarction a certain amount of blood begins to penetrate into the affected area through collateral vessels. This, combined with the increasing expansion and overflow of local vessels, leads to stagnation of blood in the infarction zone. At the same time, muscle fibers use the last portions of oxygen, and blood hemoglobin in the infarction zone is completely restored. In this regard, the infarction zone acquires a characteristic blue-brown color with blood-filled vessels in which the blood flow has stopped. For more late stages permeability increases vascular walls, fluid comes out and the tissues become swollen. Muscle fibers also begin to swell, which is associated with disruption of cellular metabolism. A few hours after the blood supply is cut off, cardiomyocytes die.

Heart muscle approximately 1.3 ml of oxygen per 100 g of tissue per minute is required just to maintain viability. Compare this value with the normal supply to the left ventricle at rest, which is 8 ml of oxygen per 100 g of muscle tissue per minute. Therefore, if 15-30% of the normal level of coronary blood flow characteristic of the resting state is maintained, cell necrosis does not occur.

Subendocardial infarction. In the inner, subendocardial layers of the myocardium, infarction develops much more often than in the outer, epicardial layers. This can be explained by the fact that subendocardial muscle fibers have unfavorable blood supply conditions, because the blood vessels of the inner layers of the myocardium are exposed to intracardiac pressure. Squeezing (or compression) of these vessels occurs, especially during ventricular systole. In this regard, in case of violations coronary circulation The subendocardial areas of the heart muscle are the first to be damaged, and then the pathological process spreads to the outer, epicardial areas.

Causes of death in acute coronary occlusion

Main causes of death for acute myocardial infarction are: (1) decreased cardiac output; (2) stagnation of blood in the vessels of the pulmonary circulation and death as a result of pulmonary edema, (3) cardiac fibrillation; (4) heart rupture (much less common).

Decreased cardiac output. Systolic distension and cardiogenic shock. If some of the myocardial fibers do not contract, and the other contracts, but too weakly, the pumping function of the pathologically altered ventricles is sharply impaired. The strength of heart contractions during a heart attack is often reduced even more than might be expected. The reason for this is the so-called systolic stretch phenomenon. The figure shows that while healthy areas of the heart muscle contract, ischemic areas in which the muscle fibers have undergone necrosis and do not function, instead of contracting, bulge outward under the influence of high intraventricular pressure. Because of this, ventricular contraction becomes ineffective.

When contractile heart ability decreases, and it is unable to pump a sufficient amount of blood to the peripheral arterial system, heart failure and necrosis of peripheral tissues develop as a result of so-called peripheral ischemia. This condition is called coronary shock, cardiogenic shock, cardiac shock, or cardiac output failure. It is described in detail in the next chapter. Cardiogenic shock usually develops when more than 40% of the left ventricular mass is infarcted, and in 85% of patients this leads to death.

Stagnation of blood in venous system . When the pumping function of the heart decreases, blood stagnation occurs in the atria, as well as in the vessels of the small or great circle blood circulation This leads to an increase in capillary pressure, especially in the capillaries of the lungs.

In the first few hours after myocardial infarction stagnation of blood in the veins does not create additional difficulties for hemodynamics. Symptoms of venous stasis appear after a few days for several reasons. A sharp decrease in cardiac output leads to a decrease in renal blood flow. Then renal diuresis decreases. There is an increase in the total volume of circulating blood, and symptoms of venous stagnation appear. In this regard, many patients, whose condition in the first few days seems to be in no danger, suddenly develop pulmonary edema. Within hours of the first pulmonary symptoms appearing, many patients die.

Knowledge base: Acute myocardial infarction

Acute myocardial infarction

Myocardial infarction is a disease accompanied by necrosis of one or more areas of the heart muscle as a result of acute disruption of blood flow in the coronary arteries supplying the myocardium. Acute non-ST segment elevation myocardial infarction and ST-segment elevation myocardial infarction are types of acute coronary syndrome, which also includes unstable angina.

Myocardial infarction is the leading cause of death in most countries, including Russia. Timely hospitalization in many cases helps prevent irreversible damage to the heart muscle, however, patients often incorrectly assess the symptoms that arise and try to cope with them on their own, which leads to a late visit to the doctor. Therefore, if you have acute chest pain or other alarming symptoms It is necessary to consult with a specialist as soon as possible.

The risk of myocardial infarction increases with age; people over 60 years of age are more likely to get sick. However, in lately the number has increased early heart attacks myocardium – in people under 40 years of age. Among patients under 70 years of age, men predominate, but after 70 years, the number of men and women with myocardial infarction becomes the same. This may be due to the protective effect of estrogens (female sex hormones), which reduce the likelihood of atherosclerosis, the main risk factor for heart attack.

The prognosis of myocardial infarction depends on the extent of damage to the heart muscle, the presence of concomitant diseases, the time of treatment medical care and the patient's age. The mortality rate for acute myocardial infarction reaches 30%.

Synonyms Russian

Heart attack, MI.

Heart attack, acute myocardial infarction, MI, myocardial infarction.

The main symptom of acute myocardial infarction is sharp pain in the chest, which most often feels like a sharp squeeze. It usually lasts longer than 15 minutes and is not relieved by taking nitroglycerin. The pain may spread to the left shoulder, shoulder blade, neck, lower jaw, and may be accompanied by cold sweat, nausea and vomiting, and loss of consciousness. In some cases, the pain has an atypical localization - in the abdomen, spine, left or even right arm.

Sometimes a heart attack is preceded by nonspecific symptoms: For several days before a heart attack, a person may feel weakness, malaise, and discomfort in the chest area.

A heart attack may not be accompanied by a characteristic pain syndrome and may manifest itself only by such symptoms as shortness of breath, rapid heartbeat, weakness, and nausea. Subtle symptoms of myocardial infarction are especially common in women.

Thus, the main symptoms of acute myocardial infarction are:

chest pain,
dyspnea,
cold sweat,
feeling of fear,
loss of consciousness,
nausea, vomiting.

General information about the disease

Myocardial infarction develops as a result of impaired blood supply to the heart muscle, which leads to a lack of oxygen and nutrients and necrosis (death) of the myocardium. The main cause of impaired blood flow in the vessels supplying the myocardium is atherosclerosis of the coronary arteries - the deposition of atherosclerotic plaques, consisting mainly of cholesterol, on inner surface vessels. Then there is a proliferation of connective tissue (sclerosis) of the vessel wall and the formation of calcium deposits (calcification) with further deformation and narrowing of the lumen of the vessel until complete blockage. Subsequently, the so-called aseptic inflammation can develop in the atherosclerotic plaque, which, when exposed to provoking factors (physical activity, increased blood pressure, etc.) can lead to plaque rupture. Platelets accumulate in the area of damage and are released biologically active substances, which further enhance adhesion (sticking together) shaped elements blood, and as a result a blood clot forms, clogging the lumen of the coronary artery. The formation of a blood clot also contributes to increased coagulability blood. If blood flow in the vessels is not restored in the next six hours, irreversible changes occur in the myocardial tissue.

Rarely, myocardial infarction occurs with a sharp spasm or thromboembolism of pathologically unchanged coronary arteries, but this is observed only in 5% of cases.

Most often, myocardial infarction is localized in the anterior wall of the left ventricle, less often in the posterior wall of the left ventricle and the interventricular septum. Right ventricular infarction is rare. Transmural and subendocardial myocardial infarction are distinguished. With transmural pathological changes affect the entire wall of the heart, with subendocardial - from. up to ½ wall thickness. There is also a division into myocardial infarction without ST segment elevation and myocardial infarction with ST segment elevation. The presence of changes in the S-T segment on the electrocardiogram suggests complete blockage of the coronary artery and extensive myocardial damage with a higher risk of developing irreversible tissue necrosis. S-T segment elevation is not observed when the artery is partially blocked - this may indicate myocardial infarction without S-T segment elevation or unstable angina. However, only during myocardial infarction does the activity of cardiac enzymes change.

When the blood supply to the myocardium is disrupted, cell death begins, first of all, in the endocardium, and then the damage zone spreads towards the pericardium. The extent of the lesion depends on the degree of blockage of the artery, its duration, and the collateral circulation system.

Necrosis in the tissues of the heart muscle causes acute pain. Extensive myocardial damage can lead to impairment contractile function heart, which is manifested by acute left ventricular failure with the development of pulmonary edema and cardiogenic shock. Cardiogenic shock, in turn, aggravates the course of myocardial infarction due to deterioration of coronary circulation. As a result, there are severe violations heart rhythm, including atrial fibrillation.

Transmural infarction in some cases can lead to rupture of the heart wall or to an aneurysm - local thinning and protrusion of a section of the myocardium.

Who is at risk?

The main cause of myocardial infarction (up to 90% of all cases) is atherosclerosis. Therefore, risk factors for the development of atherosclerosis increase the likelihood of developing a heart attack. The risk group includes:

men over 45 years old and women over 65 years old,
suffering from obesity, dyslipidemia, arterial hypertension, diabetes mellitus,
people whose relatives suffer from cardiovascular diseases and/or have suffered a myocardial infarction,
smokers,
presenters sedentary lifestyle life,
drug users (cocaine, amphetamines can provoke spasm of the coronary arteries),
experiencing severe stress.

Acute myocardial infarction in many cases is asymptomatic or atypical, which makes its diagnosis difficult. There are a number of diseases, the manifestations of which can often be similar to those of a heart attack: aneurysm

Causes of myocardial infarction

Despite great strides made in the treatment of myocardial infarction, this disease continues to be one of the leading causes of death throughout the world. Almost all of us have heard the wise saying that it is easier to prevent a disease than to treat it. This expression could not be more appropriate when we're talking about about a heart attack.

We have the power to reduce the risk of disaster significantly! This can be done even by people who are already at risk (hypertensive patients, patients with sleep apnea syndrome, people suffering from coronary heart disease). To do this, it is necessary to eliminate the causes of the disease.

Causes of myocardial infarction

Doctors have found that atherosclerosis is to blame for 95-98% of all heart attacks.

It is well known that the deposition of cholesterol on the walls blood vessels starts back in childhood. But even despite this, some people maintain their health until old age, while others suffer heart attacks at a relatively young age. Why is this happening?

Some might say: genes. Indeed, heredity plays a role in the early development of cardiovascular diseases, but not only and not so much. Great influence A sedentary lifestyle has an impact on heart and vascular diseases. Other causes of myocardial infarction are sleep apnea (sleep disorder characterized by snoring and sleep apnea), obesity, high blood pressure, smoking, and high cholesterol and sugar.

Each of these factors increases the risk of developing acute myocardial infarction by two or more times. But these are the reasons that you and I can directly influence!

Why does acute myocardial infarction develop?

There is a direct connection between the severity of atherosclerosis and the incidence of heart attacks. And yet, in order for a heart attack to develop, vasoconstriction due to atherosclerosis is not enough. The triggering mechanism is the destruction, cracking or ulceration of the cholesterol plaque. When it is damaged, platelets are sent to it, which form a blood clot and “clog” the vessel.

At the same time, the body releases substances into the blood that cause a strong spasm of the coronary artery, in which plaque destruction occurred. All this leads to a partial or complete cessation of blood supply to the myocardial area by this artery. In the absence of nutrition and oxygen, heart cells die and a heart attack develops.

Prevention of heart attack

There are causes of myocardial infarction that a person cannot respond to. yat. For example, risk factors for this disease may be male gender, old age, and genetics. But many potential causes ( overweight, bad habits, high blood pressure, wrong diet, presence of the syndrome sleep apnea) we are still able to eliminate, thereby reducing the likelihood of a heart attack.

By using low calorie diet and moderate physical activity, such as swimming, morning exercises and physical therapy, can reduce weight quite quickly. By eliminating salt from your diet and taking medications for hypertension, you will be able to normalize your blood pressure. In addition, every person has the power to quit smoking.

Any patient with coronary heart disease and hypertension can lower their blood lipids. To do this, it is enough to remove foods high in cholesterol from your diet (animal fats, egg yolks) and take special medications from the group of statins. Many patients with diabetes can achieve the desired sugar level without eating sweets and using medications selected by an endocrinologist. All this will reduce the risk of developing coronary disease and its complications, including myocardial infarction, by 2-4 times.

Sleep apnea syndrome, which also greatly increases the risk of heart attack, is well treated with CPAP therapy. Only with its help, even in patients with severe forms of apnea, can the likelihood of cardiac complications be reduced by 3-5 times!

It is never too late and never too early to take care of your health and prevent heart and vascular diseases. If you have heart problems, see a cardiologist. If you snore, you can deal with this problem today and prevent the development of sleep apnea syndrome. Well, if you have already experienced sleep apnea, treatment by specialists in the sleep medicine department of the Barvikha sanatorium will lead to normalization of breathing function at night and the elimination of all health risks caused by this disease.

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