Symptoms of acute myocardial infarction: timely treatment – ​​the opportunity to return to an active life. Classification of ischemic myocardial injury

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 former functions and is gradually being replaced by a 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 made up of various cells blood 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.

The most people rush to the place of the breakdown different cells blood. 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, which occurs during thrombosis, is manifested by 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.

At hypertrophic cardiomyopathy There is no vascular spasm as such. 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;
	finely focal
Depth	transmural;
	intramural;
	subendocardial;
	subepicardial.
According to ECG changes	With Q wave;
	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 a person is not young– 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 upper layers 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 during death muscle tissue. 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 they are starting to appear late violations rhythm: 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 a pronounced 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 left hand or left shoulder, 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.

Skin pale, with a grayish tint. They always have it cold sweat. 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 occurs in patients with diabetes. Absolutely asymptomatic, detected as an incidental finding on an ECG or at autopsy.

Gap 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 possible heart attack myocardium. First, the person is seated; a lying position is undesirable. They free up the neck and chest so that the person can breathe easier.

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 one nearby vascular center, then the patient is brought 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 humans, suffered a heart attack myocardium:

All medications 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 has been made coronary disease heart disease, 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:

Acute myocardial infarction

Myocardial infarction is one of the most common diseases. With acute myocardial infarction, approximately 35% of patients die, and slightly more than half before reaching the hospital. Another 15-20% of patients who have suffered the acute stage of myocardial infarction die within the first year.

Clinical picture.

Most often, patients with myocardial infarction complain of pain. For some, the pain is so severe that the patient describes it as one of the worst they have ever felt. Heavy, squeezing, tearing the pain usually occurs deep in the chest and is similar in nature to regular angina attacks, but it is more pronounced and longer lasting. In typical cases, pain is observed in the central part of the chest and/or in the epigastric region. In approximately 30% of patients, it radiates to the upper extremities, less often to the abdomen, back, involving the lower jaw and neck.

The pain is often accompanied by weakness, sweating, nausea, vomiting, dizziness, and agitation. Unpleasant sensations begin at rest, often in the morning. If the pain begins during physical activity, then, unlike an attack of angina, it, as a rule, does not disappear after it stops.

However, pain is not always present. In approximately 15-20% of patients, acute myocardial infarction is painless; such patients may not seek medical help at all. More often, silent myocardial infarction is recorded in patients with diabetes mellitus, as well as in the elderly. In elderly patients, myocardial infarction is manifested by sudden shortness of breath, which can develop into pulmonary edema. In other cases, myocardial infarction, both painful and non-painful, is characterized by a sudden loss of consciousness, a feeling of severe weakness, the occurrence of arrhythmias, or simply an unexplained sharp decrease in pressure.

Physical examination. In many cases, patients have a dominant reaction to pain in chest. They are restless and agitated, trying to relieve pain by moving in bed, writhing and stretching, trying to induce shortness of breath or even vomiting. Patients behave differently during an attack of angina. They tend to take a stationary position for fear of pain.

Paleness, sweating and coldness of the extremities are often observed. Chest pain lasting more than 30 minutes and sweating observed at the same time indicate a high probability acute heart attack myocardium. Despite the fact that many patients have pulse and blood pressure within normal limits, approximately 25% of patients with anterior myocardial infarction exhibit hyperreactivity of the sympathetic nervous system (tachycardia and/or hypertension).

The pericardial region is usually unchanged. Apical palpation is difficult. There is muffled heart sounds and, rarely, paradoxical splitting of the 2nd tone. During auscultation, many patients with transmural myocardial infarction occasionally hear a pericardial friction rub. In patients with right ventricular infarction, pulsation of the distended jugular veins often occurs. In the first week of a heart attack, body temperature may rise to 38 o C, but if the body temperature exceeds this, another reason for its increase should be looked for. Blood pressure varies widely. In most patients with transmural infarction, systolic pressure decreases by 10-15 mmHg. Art. from the initial level.

Laboratory research.

To confirm the diagnosis of myocardial infarction, the following laboratory indicators are used: 1) nonspecific indicators of tissue necrosis and inflammatory reaction 2) ECG data 3) results of changes in the level of serum enzymes.

Manifestation nonspecific reactivity The body's response to myocardial damage is polymorphic cell leukocytosis, which occurs within a few hours after the onset of anginal pain and persists for 3-7 days. An increased ESR is observed.

Electrocardiographic manifestations of acute myocardial infarction consist of three sequentially or simultaneously occurring pathophysiological processes - ischemia, damage and infarction. ECG signs of these processes include changes in the T wave (ischemia), ST segment (damage and complex), and QRS (infarction).

In the first hours of the development of the disease, a change occurs in the ST segment and the T wave. The descending limb of the R wave, without reaching the isoelectric line, passes into the ST segment, which, rising above it, forms an arc, convex to the top and merging directly with the T wave. It is formed like this called monophasic curve. These changes usually last 3-5 days. Then the ST segment gradually decreases to the isoelectric line, and the T wave becomes negative and deep. A deep Q wave appears, the R wave becomes low or disappears completely, and then the QS complex is formed. The appearance of the Q wave is characteristic of a transmural infarction.

Serum enzymes.

Necrotic heart muscle during acute myocardial infarction releases a large amount of enzymes into the blood. Levels of two enzymes, serum glutamate oxaloacetate transaminase (SGOT) and creatine phosphokinase (CPK), rise and fall very quickly, while lactate dehydrogenase (LDH) rises more slowly and remains elevated longer. Determining the content of the MB isoenzyme CPK has advantages over determining the concentration of SGOT, since this isoenzyme is practically undetectable in extracardiac tissue and is therefore more specific than CGOT. There is also a correlation between the concentration of enzymes in the blood and the size of the infarction.

Radionucliotide methods are also used to diagnose acute myocardial infarction and assess its severity. Scans usually give a positive result from the 20th to the 5th day after the onset of myocardial infarction, however, in terms of diagnosis, this method is less accurate than CPK analysis.

Also, the use of two-dimensional echocardiography may be useful in the diagnosis of acute myocardial infarction. In this case, contractility disorders due to the presence of scars or severe acute ischemia myocardium.

Treatment of a patient with uncomplicated infarction.

Analgesia. Since acute myocardial infarction is most often accompanied by severe pain, pain relief is one of the the most important techniques therapy. Morphine is used for this purpose. However, it may lower blood pressure by reducing arteriolar and venous constriction mediated through sympathetic system. The resulting deposition of blood in the veins leads to a decrease in output. Hypotension resulting from pooling of blood in the veins is usually relieved by elevation of the lower extremities, although some patients may require administration of saline. The patient may also feel sweating and nausea. It is important to distinguish these side effects of morphine from similar manifestations of shock, so as not to prescribe vasoconstrictor therapy unnecessarily. Morphine has vagotonic effects and can cause bradycardia and high-degree heart block. These side effects can be reversed by administering atropine.

To eliminate pain during acute myocardial infarction, beta-blockers can also be administered intravenously. These drugs reliably relieve pain in some patients, mainly as a result of a decrease in ischemia due to a decrease in myocardial oxygen demand.

Oxygen. Oxygen inhalation increases arteriolar Po 2 and thereby increases the concentration gradient necessary for the diffusion of oxygen into the area of ​​ischemic myocardium from adjacent, better perfused zones. Oxygen is prescribed during the first one to two days of an acute heart attack.

Physical activity. Factors that increase the work of the heart may contribute to an increase in the size of myocardial infarction.

Most patients with acute myocardial infarction should be placed in intensive care units and monitored (ECG) for 2-4 days. A catheter is inserted into a peripheral vein and an isotonic glucose solution is constantly slowly injected, or it is washed with heparin. In the absence of heart failure and other complications, the patient should remain in bed most of the day during the first 2-3 days. By day 3-4, patients with uncomplicated myocardial infarction should sit on a chair for 30-60 minutes 2 times a day.

Most patients are able to return to work after 12 weeks, and some patients even earlier. Before the patient returns to work (after 6-8 weeks), a maximum load test is often performed.

Diet. During the first 4-5 days, it is preferable for patients to be prescribed a low-calorie diet, taking food in small fractional doses, since after eating there is an increase in cardiac output. If you have heart failure, you should limit your sodium intake. In addition, patients receiving diuretics should be advised to eat foods high in potassium. Unusual position in bed in the first 3-5 days of illness and the effect of narcotic analgesics often leads to constipation, so consumption of dietary fiber should be recommended.

Complications. Complications most often occur in the first days after the onset of the disease. Rhythm and conduction disturbances are observed in almost all patients with large focal myocardial infarction. Rhythm disturbances can be different. Particularly dangerous is the appearance of ventricular tachycardia, which can develop into ventricular fibrillation and cause the death of the patient. With the development of heart failure, cardiac asthma and pulmonary edema occur. With extensive transmural myocardial infarction in the first 10 days of illness, rupture of the wall of the ventricle of the heart is possible, which leads to rapid, within a few minutes, death of the patient. During the course of the disease, an aneurysm may form.

Acute aneurysm.

It develops in the first days of transmural myocardial infarction, when, under the influence of intraventricular pressure, swelling of the remaining layers of the heart wall occurs in the area of ​​myomalacia. An aneurysm usually forms in the wall of the left ventricle of the heart.

The clinical picture of an acute cardiac aneurysm is characterized by the appearance of pericardial pulsation in the third - fourth intercostal space on the left at the sternum. When listening to the heart, you can determine the gallop rhythm, as well as the pericardial friction noise due to the development of reactive pericarditis.

Chronic aneurysm

It is formed from an acute one, when a necrotic area of ​​the heart muscle is replaced by a connective tissue scar in a later period. Its signs are pericardial pulsation, displacement of the left border of the heart to the left, systolic murmur in the area of ​​the aneurysm, “frozen”, i.e. retaining changes characteristic of the acute period of the disease, ECG. X-ray examination reveals a bulging contour of the heart with paradoxical pulsation. Chronic aneurysm leads to the development of heart failure, which is difficult to treat.

In 2-3% of patients it is possible embolism. The source of thromboembolism may be intracardiac thrombosis. With prolonged restriction of movement, especially in older people, thrombosis of the veins of the lower extremities sometimes develop, which can cause thromboembolism in the pulmonary artery system with subsequent development of pulmonary infarction.

Which is accompanied by a significant deficiency coronary blood flow and death (necrosis) of one or another part of the heart muscle. This pathology It is much more common in men over 60 years of age, but after reaching 55-60 years of age, it can develop in women with equal probability. Such changes in the myocardium lead not only to significant disturbances in the functioning of the heart, but also in 10-12% of cases threaten the patient’s life. In our article we will introduce you to the main causes and signs of this serious cardiac pathology, and such knowledge will allow you to “recognize the enemy by sight” in time.

Statistics. General information

According to statistics, over the past 20 years, the mortality rate from this disease has increased by more than 60%, and it has become significantly younger. If earlier this acute condition was found among people 60-70 years of age, now few people are surprised by the detection of myocardial infarction in 20-30 year olds. It should also be noted that this pathology often leads to disability of the patient, which makes significant negative adjustments to his lifestyle.

In the event of a myocardial infarction, it is extremely important to immediately seek medical help, since any delay significantly aggravates the consequences of a heart attack and can cause irreparable damage to one’s health.

Causes and predisposing factors

In 90% of cases, myocardial infarction is caused by thrombosis coronary artery, which is provoked by atherosclerosis. Blockage of this artery by a fragment of an atherosclerotic plaque causes a cessation of blood supply to a section of the heart muscle, against the background of which oxygen starvation of the tissues develops, insufficient supply nutrients to the muscle and, as a result, necrosis of the myocardium. Such changes in the structure of the muscle tissue of the heart occur 3-7 hours after the cessation of blood flow to the muscle area. After 7-14 days, the area of ​​necrosis is overgrown with connective tissue, and after 1-2 months a scar forms on it.

In other cases, the following pathologies become the cause of myocardial infarction:

• spasm of coronary vessels;
• thrombosis of coronary vessels;
• heart injuries;

Predisposing factors (conditions and diseases that contribute to the disorder) also play an important role in the occurrence of myocardial infarction. coronary circulation). Significantly increase the risk of developing such acute condition such factors:

• a history of myocardial infarction;
• smoking;
• adynamia;
• obesity;
• increased levels of “bad” cholesterol (LDL) in the blood;
• postmenopausal age in women;
• diabetes mellitus;
• frequent stress;
• excessive physical and emotional stress;
• blood clotting disorders;
• alcoholism.

Classification

During myocardial infarction, areas of muscle tissue of various sizes may undergo necrosis, and, depending on the size of the lesion, cardiologists distinguish following forms of this pathology:

• finely focal;
• macrofocal.

Also, myocardial infarction can be classified depending on the depth of damage to the heart wall:

• transmural – the entire thickness of the muscle layer is exposed to necrosis;
• intramural – necrosis is located deep in the heart muscle;
• subepicardial – necrosis is located in areas where the heart muscle adheres to the epicardium;
• subendocardial – necrosis is located in the area of ​​contact between the myocardium and the endocardium.

Depending on the location of the affected areas of the coronary vessels, the following types of infarction are distinguished:

• right ventricular;
• left ventricular.

Depending on the frequency of occurrence, this heart pathology can be:

• primary – observed for the first time;
• recurrent - a new area of ​​necrosis appears within 8 weeks after the primary one;
• repeated - a new area of ​​necrosis appears 8 weeks after the previous infarction.

By clinical manifestations Cardiologists distinguish the following types of myocardial infarction:

• typical;
• atypical.

Signs of myocardial infarction

Characteristic signs of myocardial infarction are the following manifestations of this heart pathology:

1. Long-term intense pain, which lasts more than half an hour and does not disappear even after repeated administration of nitroglycerin or other vasodilators.
2. Most patients characterize painful sensations like burning, dagger, tearing, etc. Unlike an attack of angina, they do not subside at rest.
3. Sensations of burning and squeezing in the heart area.
4. Pain often appears after physical or severe emotional load, but can also begin during sleep or at rest.
5. The pain radiates (gives) to the left arm (to in rare cases– to the right), scapula, interscapular area, lower jaw or neck.
6. The pain is accompanied by intense anxiety and feeling unreasonable fear. Many patients characterize such worries as “fear of death.”
7. The pain may be accompanied by dizziness, fainting, pallor, acrocyanosis, increased sweating(cold and sticky sweat), nausea or vomiting.
8. In most cases, the heart rhythm is disrupted, which can be seen by the patient’s rapid and arrhythmic pulse.
9. Many patients report shortness of breath and difficulty breathing.

Remember! In 20% of patients, myocardial infarction occurs in an atypical form (for example, pain is localized in the abdomen) or is not accompanied by pain.

If there is any suspicion of myocardial infarction, you should immediately call ambulance and start taking first aid measures!

Symptoms of a typical myocardial infarction

The severity of symptoms during myocardial infarction depends on the stage of the disease. During its course the following periods are observed:

• pre-infarction - not observed in all patients, occurs in the form of exacerbation and increased frequency of angina attacks and can last from several hours or days to several weeks;
• acute – accompanied by the development of myocardial ischemia and the formation of an area of ​​necrosis, lasting from 20 minutes to 3 hours;
• acute – begins from the moment of formation of a focus of necrosis on the myocardium and ends after the enzymatic melting of dead muscle, lasts about 2-14 days;
• subacute – accompanied by the formation of scar tissue, lasts about 4-8 weeks;
• post-infarction - accompanied by scar formation and adaptation of the myocardium to the consequences of changes in the structure of the heart muscle.

The most acute period in a typical course of myocardial infarction, it manifests itself as pronounced and characteristic symptoms that cannot go unnoticed. The main symptom of this acute condition is severe pain of a burning or stabbing nature, which, in most cases, appears after physical exertion or significant emotional stress. It is accompanied by severe anxiety, fear of death, severe weakness and even fainting states. Patients note that the pain radiates to the left arm (sometimes to the right), neck, shoulder blades, or lower jaw.

Unlike pain with angina pectoris, this cardialgia is characterized by its duration (more than 30 minutes) and is not eliminated even by repeated administration of nitroglycerin or other vasodilators. That is why most doctors recommend immediately calling an ambulance if heart pain lasts more than 15 minutes and is not eliminated by taking the usual medications.

Relatives of the patient may notice:

• increased heart rate;
• (pulse becomes arrhythmic);
• severe pallor;
• acrocyanosis;
• the appearance of cold sticky sweat;
• temperature rise up to 38 degrees (in some cases);
• promotion blood pressure followed by a sharp decline.

IN acute period the patient's cardialgia disappears (pain is present only in the case of inflammation of the pericardium or in the presence of severe insufficiency of blood supply to the peri-infarction zone of the myocardium). Due to the formation of an area of ​​necrosis and inflammation of the heart tissue, the body temperature rises, and the fever can last about 3-10 days (sometimes more). The patient's symptoms persist and increase cardiovascular failure. Blood pressure remains elevated

Subacute period A heart attack occurs in the absence of heart pain and fever. The patient's condition is normalized, blood pressure and heart rate are gradually approaching normal, and manifestations of cardiovascular failure are significantly weakened.

IN post-infarction period all symptoms completely disappear, and laboratory parameters gradually stabilize and return to normal.

Symptoms for atypical forms of heart attack

In some patients, myocardial infarction begins with acute pain in the stomach.

The atypicality of the symptoms of myocardial infarction is insidious in that it can cause significant difficulties in making a diagnosis, and in its painless version the patient can literally endure it on his feet. Characteristic atypical symptoms in such cases are observed only in the acute period, after which the infarction proceeds typically.

Among atypical forms The following symptoms may occur:

1. Peripheral with an atypical location of pain: with this option, the pain makes itself felt not behind the sternum or in the precordial region, but in the left upper limb or in the tip of the left little finger, in the area of ​​the lower jaw or neck, in the shoulder blade or in the area cervicothoracic region spinal column. Other symptoms remain the same as with typical clinical picture this heart pathology: arrhythmias, weakness, sweating, etc.
2. Gastric - with this form of heart attack, the pain is localized in the stomach and may resemble an attack acute gastritis. During the examination of the patient, the doctor can detect muscle tension abdominal wall, and for staging final diagnosis he might need additional methods research.
3. Arrhythmic - with this type of infarction, the patient exhibits atrioventricular blockades varying intensity or arrhythmias (, paroxysmal tachycardia, ). Similar violations heart rate can significantly complicate diagnosis even after an ECG.
4. Asthmatic - this form of this acute cardiac pathology in its onset resembles an asthma attack and is more often observed in the presence of cardiosclerosis or repeated heart attacks. Pain in the heart is mild or completely absent. The patient develops a dry cough, suffocation increases and develops. Sometimes, the cough may be accompanied by foamy sputum. In severe cases it develops. When examining the patient, the doctor determines signs of arrhythmia, decreased blood pressure, wheezing in the bronchi and lungs.
5. Collaptoid - with this form of infarction, the patient develops cardiogenic shock, in which complete absence pain, sharp drop blood pressure, dizziness, cold sweat and darkening of the eyes.
6. Edema - with this form of infarction the patient complains of shortness of breath, severe weakness, rapid appearance of edema (up to ascites). When examining the patient, an enlarged liver is revealed.
7. Cerebral - this form of infarction is accompanied by a violation cerebral circulation, which is manifested by confusion, speech impairment, dizziness, nausea and vomiting, paresis of the limbs, etc.
8. Painless - this form of heart attack occurs against a background of discomfort in the chest, increased sweating and weaknesses. In most cases, the patient does not pay attention to such signs, and this significantly aggravates the course of this acute condition.

In some cases, myocardial infarction occurs with a combination of several atypical forms. This condition aggravates the pathology and significantly aggravates the further prognosis for recovery.

The danger of myocardial infarction also lies in the fact that already in the first days after necrosis of a section of the heart muscle, the patient may develop various severe complications:

• atrial fibrillation;
• sinus or paroxysmal tachycardia;
• extrasystole;
• ventricular fibrillation;
• cardiac tamponade;
• pulmonary thromboemolius;
• acute cardiac aneurysm;
• thromboendocarditis, etc.

Most deaths after myocardial infarction occur in the first hours and days after the development of this acute form coronary heart disease. The risk of death largely depends on the extent of damage to myocardial tissue, the presence of complications, the age of the patient, timeliness and concomitant diseases.

How the human heart works. Myocardial infarction.

Myocardial infarction

Acute myocardial infarction – severe, dangerous pathological condition, resulting from ischemia (long-term disruption 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 full recovery 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 to this, to common reasons 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? urgent Care what are the consequences of this disease? 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 option 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, in ischemic 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 is what makes a heart attack different from another heart attack, for example, angina pectoris.

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. The skin turns pale and becomes 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 bronchial asthma. The abdominal variant causes symptoms acute abdomen, and arrhythmic 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 possible rupture walls of the heart muscle.

After suffered a heart attack may also appear dangerous complications. They usually occur when subacute course or in the post-infarction period - several weeks after the attack. TO 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, an ambulance is required medical care. 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, treat as soon as possible indirect massage hearts, give it to 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. Entrance 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 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.

• Causes of myocardial infarction
• Symptoms, diagnosis
• Acute myocardial infarction and its treatment
• Why is myocardial infarction dangerous?
• Prevention of heart attack

An abrupt stop of coronary circulation in medicine is defined as acute myocardial infarction. Moreover, the prefix “acute” emphasizes that such a human condition can arise unexpectedly, develops in attacks and leaves indelible marks on a part of the heart, its myocardium.

In modern medicine, there is a very high mortality rate as a result of an attack of AMI. It is noted that death most often occurs in the first 3-4 hours of an attack. The disease has its own age group, which begins at age 35, is much less common in young people. The disease develops at lightning speed and is considered by doctors as special case coronary heart disease.

Causes of myocardial infarction

In many cases, the appearance of acute is explained by atherosclerosis. This disease is caused by the formation of plaques on the walls of blood vessels. Their prolonged growth may not bother a person at all for many years. But at one not at all wonderful moment, one of the plaques may come off and be carried by the bloodstream through the vessels until it gets stuck in a disproportionately narrow place. Then there may be several options for the development of events: the plaque, having damaged the wall of the vessel, will travel further or clog the blood flow through the vessel for some time.

Among all the vessels there may be those that lead to the heart, providing coronary circulation.

Experts note that the blockage process for the vessel is irreversible in any case; after this process, it dies. But the amount of oxygen that is needed for the heart to work remains the same, this makes everything human organs work more intensively, which will inevitably provoke a repeated attack of acute. And the likelihood of its occurrence will depend, first of all, on which particular vessel was damaged - the larger the diameter, the more severe the consequences.

The reasons for the appearance of plaques are known almost reliably:

• large amounts of fatty foods;
• alcoholic drinks;
• smoking.

But call acute myocarditis can:

• physical activity;
• stressful situations.

They will cause vascular atony, which can lead to blockage of blood flow to the heart. Diabetes mellitus, hereditary predisposition may cause acute myocardial ischemia.

Return to contents

Symptoms, diagnosis

Although myocarditis occurs as a rapid and fleeting attack, modern medicine has some diagnostic methods that can prevent its onset or at least facilitate the provision of timely assistance.

The level of creatine kinase, troponin I and lactate dehydrogenase isomer in the blood can determine the infarction state. These substances can be called markers that reflect damage to the myocardium of the heart. But it still cannot be said unequivocally that it is a blood test that predicts AMI, since the presence of markers is revealed by analysis approximately a day after the person felt the first symptoms, for example, severe pain or even a burning sensation behind the sternum.

On the electrocardiogram, acute myocarditis will be noticeable in the form of some changes that should be recognized by a specialist.

To even more modern methods The study includes angiography, and this method allows you to determine areas prone to atony, points of blockage, and also provide direct assistance to the patient.

And yet no diagnosis is possible if the patient does not see a doctor. In many cases, it has very specific, their appearance requires immediate appeal to the clinic:

• severe pain in the chest;
• cardiac arrhythmia;
• atrial fibrillation or even complete, sudden.

But most often these signs appear quite unexpectedly and very clearly, rarely not accompanied by pain, in addition, everything happens very quickly, so it is advisable urgent hospitalization sick.

Return to contents

Acute myocardial infarction and its treatment

Since the disease manifests itself in attacks and a person’s life depends on its course, first medical aid provided by someone around them is extremely important.

First of all, the patient must be seated, oxygen access must be made possible - fresh air, if the patient is taking antianginal drugs like nitroglycerin and has a couple of tablets on hand, you need to help him take one or two of them.

If you are not sure that such a drug is allowed for the patient, do not give anything and wait for the ambulance to arrive. This is a very sensitive point, which is disputed in the courts and other authorities. But in any case, the pill can help, as well as harm.

In the hospital degree necessary assistance determined by doctors. But first of all comes pain relief, since it is pain that deprives the heart of oxygen. Next, a whole bunch of drugs are prescribed, including:

• Beta blockers;
• diuretics;
• antianginal agents;
• acetylsalicylic acid or clopidogrel.

The dose and regimen are determined by the doctor. You can't rely on a list medicines, take and start taking any drug from the specified group. For example, doctors are selective in prescribing acetylsalicylic acid, since in its presence there is an increase in the concentration of nitroglycerin in the blood plasma, which can lead to severe headaches. Although for many patients it is aspirin that saves their lives after an attack.

In addition, there are a number of therapeutic measures aimed at dissolving the blood clot. For this purpose it is used special drug. Treatment can also be surgical, when a special catheter is inserted into the coronary artery in order to remove plaque from the vessel wall. These methods include angiography and endovascular surgery. Subject to several other principles coronary artery bypass surgery, in which a path is laid to bypass the blocked area of ​​the vessel.

It’s impossible not to touch on this topic preventive treatment, referring to cases where a person has repeatedly experienced attacks of tachycardia, panic situations, as well as nervous stress. All this is a direct prerequisite for AMI.