Can there be pain after treatment for a heart attack? Relapse Prevention Measures

An acute heart attack is always accompanied by pain. On last stage myocardial infarction, the main symptoms become less noticeable. The patient usually feels much better during the scarring period. How sharp pain, and periodic heart pain during the rehabilitation period requires special attention. A burning sensation behind the sternum during an acute heart attack and a few minutes after the attack may indicate further development of necrosis. Correct therapy involves not only the administration of an analgesic, but also the establishment of a clear cause for the appearance of a focus of necrosis in the area of the heart muscle.

Pain during myocardial infarction

The severity of symptoms depends on clinical form diseases (cardiac, asthmatic, collapsed, etc.). Sometimes the formation of a necrotic focus occurs unnoticed. This form occurs in diabetes mellitus, when sensitivity is reduced. Most people complain of a “dagger feeling” behind the breastbone during an attack. Using a set of clinical symptoms of cardiac muscle necrosis, it is possible to differentiate it from various options angina pectoris and other diseases of the circulatory system.

Myocardial infarction is a lesion of the heart muscle caused by an acute disruption of its blood supply due to thrombosis

Characteristics of pain during myocardial infarction:

depends on the size of the affected area (the larger the dead area, the stronger the pain will be, pathological changes most pronounced with necrosis of the left ventricle);
reminds swipe with a dagger, gives it to left half body - jaw, shoulder blade, shoulder, arms may go numb;
Many people have heart pain after a heart attack, and the pain may come and go;
if the left ventricle is damaged, it is accompanied by difficulty breathing and severe dizziness, cold sweat;
often accompanied by an increase blood pressure and displacement of the boundaries of the heart;
the nature of the pain during myocardial infarction is acute (burning) and pressing;
practically cannot be removed with the help of nitrates ().

Unlike angina pectoris, during the first minutes of an attack a person is not able to engage in usual activities (walking, having a conversation), he clutches his heart and freezes in one position. Pain during a heart attack is wave-like, it can fade after the administration of potent analgesics and then resume.

Against the background of damage to the left ventricle, the patient can even lose consciousness. Those patients who have previously had angina pectoris report a higher severity of symptoms compared to previous attacks. There is a feeling of fear, the face is distorted.

Severe pain behind the sternum. It can spread to the left arm, shoulder, left half of the neck, to the interscapular space

Atypical pain during a heart attack

Despite public awareness of heart disease, unexpected situations may arise when diagnosing myocardial necrosis. The image of a person clutching his heart may never appear if an atypical form of the disease is present. Diagnosis is difficult against the background of diabetes mellitus and decreased sensitivity to pain.

Some people suffer an attack on their feet, others are admitted to other hospital departments with suspected diseases of other systems.

There are several atypical forms myocardial infarction:

Gastric. This form occurs in 5% of cases. Reminds me severe disorder stomach. Accompanied constant nausea, severe vomiting, bloating, and in some cases diarrhea. The feeling of severe pain in the stomach area leads to false diagnosis and only on electrocardiogram ECG You can see signs of heart damage.
Arrhythmic. In the patient, the disease manifests itself as a feeling of pronounced palpitations, and there may be interruptions in the functioning of the heart. The attack resembles tachycardia, extrasystole, and less commonly, bradycardia. Each next blow is different from the previous one. The appearance of pain during a heart attack in such cases is not necessary.
Asthmatic. Similar to left ventricular failure or bronchial asthma. The patient has difficulty breathing due to a dry cough. Severe shortness of breath and discomfort behind the sternum for several minutes make appearance the victim is exhausted, there is cyanosis of the skin.

The gastralgic version is similar to the picture " acute abdomen": abdominal pain, bloating, and with them weakness, drop in blood pressure, tachycardia

Collaptoid (cerebral). This form occurs against the background of a tendency to arterial hypotension. It is very dangerous, as it increases the risk of damage to brain vessels. There is severe weakness, which is accompanied by dizziness and darkening before the eyes. Blood pressure drops noticeably, leading to fainting and collapse.

Despite the severe manifestations of myocardial infarction, today cases of asymptomatic disease are increasingly being recorded, when a person is conscious during an attack and experiences only mild symptoms, such as: poor sleep, chest discomfort, cold sweat, heaviness in the head, anxiety.

It is important to remember that the development of intoxication after an attack is manifested by an unexpected deterioration in the patient’s condition. Often, signs of a heart attack in such patients first appear on an ECG during a random examination.

Who is at risk

Blockage of a coronary artery by a blood clot formed due to atherosclerotic plaque, can occur against the background of increased blood clotting, hypertension, hypercholesterolemia. In old age, myocardial infarction occurs much more often due to wear and tear of the heart muscle. It is important for women in the post-reproductive period, as well as people with a family history of heart attacks, to be attentive to the treatment and prevention of vascular pathologies.

Probability heart attack increase:

various variants of arrhythmia (against the background of uneven contraction of the myocardium, the rhythm of the beats is distorted, creating additional stress on the heart);

Excessive physical activity also negatively affects the body's metabolism.

availability bad habits(, alcohol, passion for tonic drinks);
illnesses endocrine system(diabetes mellitus of the first and second types, thyrotoxicosis, overweight accompanied by obesity of the heart);
excessive physical activity, running long distances in old age, carrying heavy objects;
high blood pressure (with hypertension, blood vessels narrow and blood has difficulty circulating in the body).

The negative impact of provoking factors increases significantly during severe stress. Nervous system is inextricably linked with the functioning of the heart. Against the backdrop of overwork, severe fatigue And constant discomfort Myocardial necrosis may unexpectedly occur. Elderly people and pregnant women are especially sensitive to environmental factors, which should be kept in mind if they have chronic diseases.

What to do if you have chest pain

If an attack of angina can be easily stopped with a Nitroglycerin tablet, then myocardial infarction can only be dealt with narcotic analgesics. For differential diagnosis of common spasm coronary vessels and their blockage with a blood clot, you should try to relieve pain with the help of organic nitrates. If nitroglycerin is ineffective, this is a reason to call an ambulance. A team of specialists must correctly determine the boundaries of the heart and stop the attack with a strong pain reliever.

Before the doctors arrive you need to:

provide the patient with complete peace of mind (turn off loud music, exclude unnecessary conversations, do not mention terrible diagnoses);
position the victim correctly (pick up a hard surface, tilt the head back, if vomiting occurs, in addition to the head, turn the whole body to one side);
open admission window fresh air, unfasten the buttons, free your hands from the watch and remove tight underwear to improve the flow of oxygen to the brain;
if necessary, artificial respiration is performed (the patient's nose is pinched and air is blown through the mouth; a napkin is applied to ensure sterility).

If resuscitation efforts do not bring results, you need to check the patient for a pulse. In its absence, it is done indirect massage hearts. The hands of the person resuscitating are placed one on top of the other so that the lower palm is 2 cm above the xiphoid process, then pressing movements are carried out. Heart massage should be alternated with artificial respiration. Improving the patient's condition implies constriction of the pupils,

Huge impact on the immediate and long term forecast in case of myocardial infarction it has timely diagnosis and treatment of complications. For almost all complications, consultation with a cardiologist is advisable.

In approximately 30% of patients, chest pain returns soon after hospitalization. This is an unfavorable prognostic sign; such patients are indicated for emergency coronary angiography followed by bypass surgery or angioplasty. If coronary angiography cannot be performed, nitrates, b-blockers and intravenous heparin are prescribed and the patient is transferred to a specialized medical facility.

Myocardial infarction in pregnancy

Myocardial infarction in pregnant women is rare; its incidence is estimated to be 1 in 10,000 pregnancies.

It usually occurs without previous angina, since despite the fact that the frequency coronary disease increased among pregnant women, atherosclerosis is not its main cause. According to the review by Hankins et al. atherosclerosis was the cause of myocardial infarction in 9 of 70 cases, although data on early atherosclerosis and coronary disease are probably underrepresented in the publications.

Crack cocaine use has increased, which may be a cause of myocardial infarction occurring in young women with no apparent risk factors. The cause may be intense spasm coronary arteries, sometimes with subsequent dissection and thrombosis.

Causes of myocardial infarction in pregnant women and women in labor, caused by pregnancy or inherent in pregnancy

Spontaneous coronary artery dissection
Hypercoagulable state: Coronary thrombosis; Hereditary thrombophilias; Coronary embolism (from artificial mitral or aortic valves; from the left atrium with mitral stenosis; from the left atrium or ventricle during labor or other cardiomyopathy; paradoxical, with a defect in the atrial wall or with an open foramen ovale with cyanotic congenital defects hearts; from the placenta with hydatidiform mole or chorionepithelioma)
Stimulant drugs labor: Ergot alkaloids; Bromocriptine
Preeclampsia

Random causes of myocardial infarction in pregnant women

Coronary atherosclerosis
Coronary arteritis: Periarteritis nodosa; Antiphospholyid syndrome; Still's disease; Takayasu arteritis; History of Kawasaki disease; Behçet's disease
Coronary embolism: Infective endocarditis; Left atrial myxoma
Cocaine use
Pheochromocytoma

Diagnosis of myocardial infarction

Except that the disease occurs suddenly and general situation unfavorable, myocardial infarction during pregnancy manifests itself in exactly the same way as in its absence. The mortality rate is high. If cardiac arrest occurs outside of a hospital, the outcome is almost always fatal. Other manifestations may be cardiogenic shock, severe chest pain or pulmonary edema. Diagnosis and treatment for severe chest pain may be delayed because a heart attack is considered unlikely and decisions regarding patient management and coronary angiography are delayed or not made at all.

The diagnosis should be confirmed by ECG, echocardiography, coronary angiography and cardiac troponin determination. Since the concentration of creatine kinase CK MB increases after birth due to its release from the myometrium, only the assessment of serial troponin determinations can be reliable, but this will only be retrospective, since urgent measures must be taken.

Majority cardiovascular disorders occurring during pregnancy can be recognized using an ECG, which must be performed immediately, since confirmation of the diagnosis will allow action to be taken necessary actions to save the patient's life.

Generic cardiomyopathy

This disease can be very similar to myocardial infarction, with onset suddenly and manifesting as chest pain, pulmonary edema, or arrhythmia with ECG changes suggestive of infarction, as well as increased cardiac troponin levels. In generic cardiomyopathy, even echocardiography can reveal focal rather than complete dysfunction of the left ventricle, although its hypokinesia occurs, as well as hypokinesia of the right ventricle. Final diagnosis allows you to establish coronary angiography.

Generic cardiomyopathy ± coronary embolism
Embolism pulmonary artery: Venous thrombus; Amniotic fluid
Aortic root dissection
Pericarditis
Fluid overload: After surgical delivery; Ritodrine infusion

Acute pericarditis

It tends to cause severe pain with a pleural component, which is relieved by bending forward. The ECG changes are consistent with widespread anterior infarction, but the patient has no evidence of circulatory abnormalities, and echocardiography demonstrates a normally contracting left ventricle. Cardiac markers increase only slightly, and their dynamics are benign.

Fluid overload after cesarean section or administration of ritodrine to delay preterm labor, especially when saline rather than 5% glucose is administered, can lead to sudden pulmonary edema, but echocardiography demonstrates normal ventricular contraction and high cardiac output.

Management of a patient with myocardial infarction

Due to the high mortality rate, treatment should be urgent, as with a heart attack outside of pregnancy. In case of coronary artery dissection, which is probable cause heart attack, usually a large area of the myocardium, which it supplies with blood, suffers, and sometimes a larger one. The condition is complicated by the lack of collateral circulation, which is absent in patients with previously healthy coronary arteries.

Due to the fact that there are many possible mechanisms development of infarction, and Because of the need for revascularization, coronary angiography and echocardiography should be immediately performed to assess left ventricular function and exclude generic cardiomyopathy, pulmonary embolism, and intracardiac thrombosis. Angiography of the left ventricle may not be performed.

Pregnant women whose myocardial infarction is accompanied by ST elevation need aggressive treatment without any discounts, with the exception of belly protection. There is no time for delivery and in any case the risk is very high. If possible, primary angioplasty and stenting should be performed, but if this is not possible, there should be no hesitation in using thrombolysis. Stenting can provide sealing of the dissected artery and healing, but if it fails or if the anterior dissection is extensive descending artery may require urgent coronary bypass surgery. Needed: pain relief, antiplatelet agents, )