Symptoms of acute myocardial infarction: timely treatment – ​​the opportunity to return to an active life. Life after a heart attack: features of rehabilitation

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 pain occurs. The stage lasts from several hours to 2-3 days.
• Period acute manifestation clinical signs. Depending on the severity of ischemia on various areas necrosis or slight damage fabrics.

Attention! Experienced doctor able to make a diagnosis characteristic features, 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. Final stabilization occurs muscle tissue. The area of ​​necrosis becomes clearer, and 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. Signs 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 education 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.

Most common reason acute heart attack myocardium – 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 cholesterol in the blood (a connection has been established with atherosclerosis);
• endocrine pathologies;
• blood pathologies (hypercoagulation, thrombosis);
• arterial hypertension;
• bad habits;
• elderly 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 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 general signs 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 development 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 isoline;
• 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.

Restoring normal heart function 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 for coronary syndrome, it is recommended to do an electrocardiogram, which helps to establish the type of disease:

• 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 localization of pain in the chest and irradiation 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, a 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.”

While medical workers are traveling to the patient, the algorithm of actions is as follows:

• the patient must relax completely, for this it is advisable to take a horizontal position, relax 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;
• pre-medical care does not imply special medications (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 be required artificial ventilation lungs.

An attack of AMI is completely stopped only narcotic analgesics. To prevent relapse of the disease in a hospital setting, it may be prescribed specific therapy, 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 satisfactory, 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 conductivity (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 eliminate the severe consequences of the 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 accompanying pathologies or with 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:

• Sign 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. Speaking cold sweat, a person during an attack is completely unable to engage in usual activities.
• Jumps (it can fall or rise to critical values), the pulse becomes faster, and there is strong anxiety about your 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 when a patient was admitted to the hospital with suspected pathology of the gastrointestinal tract or lungs, but only with thorough examination signs of cardiac muscle necrosis were detected.

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

Complex of symptoms characteristic coronary disease, does not apply to conditions that “will go away on their own.” Disappearance pressing pain behind the sternum does not carry with it full 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, narcotic analgesics, such as morphine, are administered intravenously.

Myocardial infarction is dangerous, first of all, because of its complications. In order to restore damaged tissue and reduce the load on 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 reduce arterial 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; its beneficial effect on protecting cardiomyocytes from ischemia has been proven. Its use reduces the risk of complications, including cardiogenic shock.

If you do everything clinical guidelines, many dangerous complications can be avoided. 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 nutrition, heavy physical labor, chronic stress and the presence of concomitant diseases can negatively affect the body’s recovery rate. 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:

• products with low content cholesterol;
• 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 weight within normal limits;
• 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, they eat proper food 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.

Heart pathologies are one of the most common problems and often lead to human death. The greatest danger to life is acute myocardial infarction. What kind of disease is this?

What is an acute heart attack?

Myocardial infarction is a disease in which necrosis of heart muscle cells occurs. This pathology develops when the cells of an organ do not receive sufficient quantity oxygen. This occurs due to the blockage of the blood vessel that feeds the tissue.

As a result, myocardial cells are not able to fully function, and the process of their death begins. This phenomenon is called a heart attack. The danger of the disease lies in the fact that the attack occurs unexpectedly, and it is necessary to quickly take measures to eliminate it. Otherwise the person may die.

Causes of acute heart attack

The culprit in the development of acute ST-segment elevation myocardial infarction is the occlusion of a blood vessel. This can happen due to the following reasons:

1. Blockage of a vessel by a blood clot that could appear in any part of the body.
2. Spasm of the coronary arteries. This disorder often occurs during stressful situations. Therefore, the phrase “bring to a heart attack” fully justifies itself. When a person experiences nervous shock, the blood vessels constrict and cut off oxygen supply to the heart.
3. Atherosclerosis. This vascular pathology is accompanied by a deterioration in the elasticity of the walls and their stenosis.

Such pathological phenomena develop under the systematic influence of provoking factors. The first of these are coronary heart disease (CHD) ) and angina. The presence of these diseases significantly increases the risk of myocardial infarction.

Also factors contributing to the development of cardiac pathology are:

• sedentary lifestyle life;
• excess body weight;
• high blood pressure;
• frequent stressful situations;
• bad habits;
• hereditary predisposition;
• age of men over 45 years and women over 65 years.

People at risk should be more attentive to their heart health and be examined by a cardiologist every year.

Classification and stages of development

Myocardial infarction has its own classification. Doctors highlight the following types diseases depending on the area of ​​the lesion: large-focal and small-focal. Based on the depth of myocardial damage, they are distinguished:

1. , affecting the entire thickness of the fabric.
2. Subendocardial, affecting only the inner layer.
3. Subepicardial, covering the anterior outer layer of the muscle.

Myocardial infarction occurs in several stages, each of which has its own characteristics. The following stages of pathology development are distinguished:

• The sharpest. Lasts from 30 minutes to 2 hours. At this stage, ischemia of the organ cells begins, which then smoothly transitions into the process of tissue death.
• Spicy. Lasts from 2 or more days. It is characterized by the formation of a necrotic focus in the myocardium. Often at this stage of development, the heart muscle ruptures, the lungs swell, and swelling occurs in the hands.
• Subacute. Develops over month period. During this period, dead tissue is rejected, creating conditions for the formation of a scar on the muscle.
• Post-infarction. Rehabilitation of the patient can take about 5 months. At this stage, scarring occurs, the myocardium adapts to work in new conditions.

NOTE!!! The last stage of the development of a heart attack does not mean that the disease is over and no consequences will arise. The patient still requires doctor's supervision, as the risk of complications is high.

Symptoms

The main sign of a heart attack is pain in the chest area. It can have different intensity and character. Patients often describe it as burning, pressing, piercing. Pain occurs in the back of the sternum and radiates to the left side of the body: arm, neck, lower jaw.

The symptom lasts over 20 minutes. For many people, the pain is very pronounced. As a result, a person experiences negative emotions, presented in the form of fear of death, anxiety, and apathy.

In addition to pain, the following manifestations of a heart attack are observed:

• increased sweating;
• pale skin;
• dyspnea;
• weak pulse.

If chest pain occurs, immediate emergency care and calling a doctor are required.

Diagnostics

The patient is examined using visual inspection, blood tests and instrumental methods. Such comprehensive diagnostics allows us to diagnose accurate diagnosis.

REFERENCE!!! For early detection disease by the patient himself can be used. It can be purchased at a pharmacy. This method allows you to accurately determine whether there is a heart attack or not.

Anamnesis

When a patient comes to the hospital, the doctor talks with him. The patient's complaints are clarified and his medical history is studied. It is important for the doctor to know whether there have been chest pains before, how intense they were, and whether the person is at risk for developing myocardial infarction.

Next, the specialist examines the patient for excess body weight, high blood pressure, and pale skin. If the patient indicates a pain duration of more than 20 minutes, then the doctor will first suspect a heart attack.

Laboratory methods

After being examined by a doctor, the patient must undergo laboratory test. It includes the following types of blood tests:

• General clinical. In case of cardiac pathology, the interpretation of the result shows a high level of leukocytes and ESR.
• Biochemical. This study reveals an increase in the activity of the enzymes AlT, AsT, LDH, creatine kinase, and myoglobin. This indicator indicates that the myocardium is damaged.

Instrumental methods

To make an accurate diagnosis, the following activities are carried out:

• Electrocardiography. The infarction state is reflected on the ECG in the form of a negative T wave, pathological QRS complex and other aspects. The procedure is performed in different leads, which helps to detect the localization of the necrosis focus.
• In acute myocardial infarction, the ECG looks at the ST segment. Acute myocardial infarction with ST segment elevation indicates the development.
• Ultrasonography hearts. Allows you to accurately determine where failure occurs in the contractions of the ventricular muscles.
• Coronary angiography. Designed to detect narrowing or blockage of the vessel that supplies the heart muscle. This diagnostic method is used not only to identify pathology, but also for its therapy.

Based comprehensive survey The heart doctor makes a diagnosis and selects appropriate treatment tactics for each patient.

Complications

Adverse consequences from a heart attack do not occur immediately. Complications can develop gradually and affect not only the heart, but also other organs. The greatest danger to a person is the first year of life after a heart attack. It is during this period that most of the consequences that lead to death occur.

Complications often occur in the form of such diseases:

• Heart failure.
• Extrasystole.
• Aneurysm.
• Thromboembolism of the pulmonary artery.
• Thromboendocarditis.
• Pericarditis.

Fighting heart disease

Treatment for a heart attack begins with eliminating the attack before the ambulance arrives. The person next to the patient should take measures that will help gain time until doctors arrive.

To do this, it is necessary to ensure complete rest for the patient, open the windows and free his throat from constricting clothing so that as much oxygen as possible can flow. Then give the patient nitroglycerin.

If the patient has lost consciousness, his pulse is too weak, it is necessary to perform an indirect cardiac massage and artificial respiration. Everyone should know how to do this correctly. Anyone can be close to someone who has an unexpected heart attack.

Specialized treatment

After first aid is provided, the patient is taken to the hospital, where intensive observation and treatment of acute myocardial infarction is carried out. First of all, drug therapy is prescribed. The patient is recommended to take the following medications:

• Narcotic analgesics and antipsychotics to relieve pain behind the sternum.
• Thrombolytic drugs that help dissolve a blood clot that has blocked a blood vessel. The administration of these drugs is effective within the first hour after the onset of a heart attack.
• Antiarrhythmic drugs to restore normal heartbeat.
• Medicines aimed at normalizing metabolism in the myocardium.
• Anticoagulants that help thin the blood, reduce its clotting and prevent the development of.

Surgery is used in extreme cases. The following are used surgical methods treatment:

1. Balloon angioplasty of coronary vessels.
2. Installation of a stent in a vessel.
3. Arterial bypass.

The prognosis for acute myocardial infarction depends on how damaged the heart muscle is, where the focus of necrosis is located, how old the patient is, whether he has concomitant diseases, and from many other factors. The patient's risk of developing disability is very high.

Prevention

Preventive measures for myocardial infarction are actions that are aimed at preventing the development of this disease. Such measures will minimize the risk of developing heart disease.

1. To live an active lifestyle. Physical activity helps prevent the development of most diseases, including heart disease. Sport strengthens the muscle tissue of the organ, improves blood circulation, and normalizes metabolic processes.
2. To refuse from bad habits. Smoking and drinking alcohol significantly increase the risk of developing a heart attack, as they negatively affect the condition of blood vessels.
3. Eat properly. It is important that the diet is balanced and provides the body with everything it needs. useful substances. The menu should not include fast food or fatty foods.
4. Avoid stress. Negative feelings negatively affect the health of the heart. Therefore, it is worth getting as many positive emotions as possible.

Myocardial infarction - serious pathology heart disease, often leading to death. To always keep the health of the main organ under control, you should regularly visit a cardiologist for a preventive examination.

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. All the same pathological process 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 The permeability of the vascular walls increases, fluid leaks 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 is maintained coronary blood flow, characteristic of a state of rest, 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) decrease 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 disorder 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, but often patients misjudge the symptoms that arise and try to cope with them on their own, which leads to late consultation with a doctor. Therefore, when acute pain in the chest or others 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 of early myocardial infarctions has increased 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 seeking medical help and the age of the patient. 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 weak, 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 growth occurs 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 in atherosclerotic plaque so-called aseptic inflammation may develop, 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 back wall left ventricle and 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 allows us to suspect complete blockage of the coronary artery and extensive myocardial damage with more high risk development of 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 circulatory system.

Necrosis in the tissues of the heart muscle causes acute pain. Extensive myocardial damage can lead to impaired contractile function of the 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 of age and women over 65 years of age,
• suffering from obesity, dyslipidemia, arterial hypertension, diabetes mellitus,
• people whose relatives suffer from cardiovascular diseases and/or have suffered a myocardial infarction,
• smokers,
• leading a sedentary lifestyle,
• 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. We've heard almost everything wise saying that a disease is easier to prevent than to treat. This expression could not be more appropriate when talking 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, others suffer heart attacks in relatively at a young age. Why is this happening?

Some might say: genes. Indeed, heredity plays a role in early development cardiovascular diseases, but not only and not so much. Big 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 levels.

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. Trigger is fracture, cracking or pitting 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 ( excess weight, bad habits, high pressure, wrong diet, Availability apnea syndrome sleep) we are still able to eliminate, thereby reducing the likelihood of developing a heart attack.

By using low calorie diet and moderate physical activity such as swimming, morning exercises and physical therapy, you can lose 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 with high content cholesterol (animal fats, egg yolk) 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 the normalization of breathing function at night and the elimination of all health risks caused by this disease.

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The heart is the most main body person. That is why it is extremely important that it is absolutely healthy. Unfortunately, with age, most people begin to develop various problems precisely in this area. Heart and vascular diseases are very common, and not only in our country. A system has been developed to fully coordinate the diagnosis and treatment of any disease. international classification according to ICD code.

Acute heart attack occurs as a consequence of coronary heart disease.

Myocardial infarction

Myocardial infarction is the death of heart tissue as a result of the cessation of blood flow to the organ. In the developed World Organization system, this diagnosis can be found under MBC code 10. These problems, unless we are talking about congenital pathologies, are the result of a disease vascular system body. Acute myocardial infarction is a direct consequence of coronary heart disease.

Reasons for the development of ischemia

Coronary heart disease is characterized by the occurrence of a difference between the blood flow necessary for normal heart function and the actual flow of blood to the organ. Some of the causes of this disease do not depend on the patient, but many of the provoking factors can and should be eliminated from the life of a person suffering from coronary artery disease as quickly as possible. Acute myocardial infarction (AMI) against the background of ischemic heart disease can develop in following cases:

• – sclerotic plaques that affect the vessels of the coronary circulation begin to collapse over time, and as a result, blockage of the arteries supplying the heart occurs.
• Thrombosis of the affected arteries.
• The coronary arteries may undergo complete or partial spasm - most often a sign of cocaine use.

In this case, in medicine it is customary to use the term acute coronary syndrome (ACS). Doctors often diagnose a combination of several factors that cause AMI. The reasons why these problems arise are quite well studied. These most often include:

• the presence of hereditary factors;
• violation of nutritional standards and, as a result, obesity;
• bad habits;
• low physical activity;
• blood diseases;
• arterial hypertension and a number of other reasons.

According to the course of MI there are stages

1. Pre-infarction - its duration can be from several hours to several days. During this period, there is a decrease in the intervals between angina attacks. These attacks can constantly intensify, the pain is not expressed, and there is a gradual general deterioration in health.
2. The most acute - and turns into myocardial necrosis. The duration of this stage ranges from twenty minutes to two hours. Characteristic symptoms the most acute period is unbearable pain in the chest area, which radiates to the left hand or left shoulder blade, patients sometimes talk about pain in the upper abdomen and pain in lower jaw. At this stage remove pain syndrome with the help of Nitroglycerin it is impossible. In addition to acute pain, other symptoms also appear at this time, such as changes in the color of the skin, increased sweating, and severe agitation associated with the fear of death.

Sometimes you can observe unusual this disease signs: nausea, vomiting, difficulty breathing, blue lips, severe swelling. Patients with diabetes may experience no pain at all. If these symptoms are present, doctors say atypical forms myocardial infarction.

1. Acute period - during this time the pain practically disappears. This happens because the nerve endings in the affected area are completely destroyed. The patient may experience increased body temperature and increased hypotension. This period lasts from two days to two weeks.
2. Subacute – takes from 4 to 8 weeks. It is characterized by the beginning of scar formation at the site of the necrotic lesion. The patient's temperature returns to normal, and the symptoms of heart failure become less pronounced.
3. Post-infarction period - the scar is fully formed, and the heart begins to adapt to new conditions.

Myocardial infarction does not have any one general classification. The most commonly used division of this disease is taking into account various parameters.

By area of ​​the lesion:

• small focal – death of cardiac tissue;
• large-focal - the area affected by necrosis is quite large.

According to the frequency of the disease:

• primary;
• recurrent - a second heart attack occurs within eight weeks after the first;
• repeated - if a heart attack occurs more than two months later.

By place of origin (topography):

• right ventricular infarction;
• left ventricular infarction. Here, infarction of the anterior wall of the left ventricle of the heart, infarction of the posterior or lateral wall and interventricular septum are distinguished. Left ventricular infarction is much more common. This happens due to the fact that this part of the heart bears the heaviest load of pumping blood.
• atrial infarction

According to the depth of the lesion:

• intramural (located deep in the myocardium);
• subendocardial (myocardial necrosis adjacent to the outer lining of the heart);
• subepicardial (myocardial necrosis adjacent to the epicardium, the inner lining of the heart);
• transmural (the entire depth of the muscular wall of the heart is affected; this type of heart attack occurs only with).

According to the presence of complications:

• uncomplicated;
• complicated.

Very often, complications of myocardial infarction are observed already in the first hours of the disease. It could be different kinds arrhythmias, pulmonary edema, and cardiogenic shock, leading to death.

Diagnostics

Modern medicine today has every opportunity to quickly and accurately diagnose this disease.

1. The doctor receives the first data from the patient himself, who reports severe pain that he could not relieve with Nitroglycerin.
2. The next stage of the examination may be palpation (the presence of pulsation in the area of ​​the cardiac apex) and auscultation (the presence characteristic changes tones and rhythm of the heart).
3. Accurate data on the presence of a heart attack can be obtained by taking an electrocardiogram. This procedure is now carried out by an emergency doctor.
4. A blood test (the presence of cell destruction enzymes) can also show a typical picture of such heart damage.
5. X-ray examination of the coronary vessels using injection contrast agent allows you to accurately determine the degree of blockage.
6. Computed tomography helps detect the presence of blood clots in the heart.

If the first signs of acute myocardial infarction appear, the patient must be provided with complete rest and urgently call ambulance. With this disease, the chance of saving a person’s life will depend on the speed of providing first emergency aid. During the first twenty minutes, the heart works using its internal reserves, and only then tissue necrosis begins. Upon arrival of the ambulance, the team will carry out emergency first aid. It most often involves relieving pain. In acute myocardial infarction, pain can only be relieved with narcotic analgesics. Further, to prevent thrombosis, Aspirin or Heparin is used.

Treatment in a hospital. The patient is urgently admitted to intensive care cardiology department, where the already started treatment to maintain cardiac activity is continued. Essential on early stages Thrombolytic therapy, which is aimed at dissolving blood clots and restoring the activity of the coronary arteries, plays a role in the development of a heart attack. Anticoagulants are also used for the same purposes. Treatment will also include a number of medications to eliminate problems with arrhythmia. There are also minimally invasive surgical methods to restore sufficient blood supply to the heart. This may be the introduction of a wall or a catheter, which are inserted into the vessel and normalize its lumen. Typically, this surgical procedure is performed within the first 24 hours after the patient is admitted to the intensive care unit.

Rehabilitation

Myocardial infarction is a serious disease that can lead to disability or even death. A negative prognosis is usually more common in people who have a second heart attack. Considering this circumstance, a person who has suffered an acute heart attack must pay close attention to subsequent rehabilitation, which begins almost immediately after passing through the most acute stage of the heart attack. After a heart attack, it is much more difficult for the heart to perform its functions, so the patient will have to undergo a whole.

Such actions may include:

1. Constant reception medicines to reduce blood clotting and dilate blood vessels.
2. Normalizing cholesterol levels in the blood.
3. Monitor blood pressure readings.
4. Restoring, as far as possible, the contractile functions of the heart.
5. Improving motor activity.
6. Return to work capacity.

All measures intended to restore the patient require the joint efforts of the doctor and the patient. Exactly A complex approach will provide an opportunity to as soon as possible come back to active life. A patient who has suffered a heart attack must completely abandon any bad habits. Review your diet and avoid any stressful situations. Cardiologists recommend that everyone who has suffered from this disease constantly engage in physical therapy. After inpatient treatment It is advisable for patients to continue their recovery in specialized sanatoriums or rehabilitation centers. It is here that qualified specialists there is every opportunity to provide effective physical and psychological assistance.

• 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 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 acute myocarditis can be caused by:

• physical exercise;
• stressful situations.

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

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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.

By the content of creatine kinase, troponin I and lactate dehydrogenase isomer in the blood, the infarction state can be determined. 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;
• Heart arythmy;
• atrial fibrillation or even complete, sudden.

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

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Acute myocardial infarction and its treatment

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

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 selectively prescribe 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. A special preparation is used for this. 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.