Whether there can be pains after treatment of a heart attack. Measures to prevent relapse

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

Pain in myocardial infarction

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

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

Characteristics of pain in myocardial infarction:

depends on the size of the affected area (the larger the dead area, the stronger the pain will be, pathological changes most pronounced with necrosis of the left ventricle);
recalls swipe dagger, gives in left half bodies - jaw, shoulder blade, shoulder, hands may go numb;
many people have a heart ache after a heart attack, while the pain can either appear or fade away;
with damage to the left ventricle, it is accompanied by labored breathing and severe dizziness, cold sweat;
often accompanied by an increase blood pressure and displacement of the borders of the heart;
the nature of pain in myocardial infarction is acute (burning) and pressing;
practically not removed with the help of nitrates ().

Unlike angina pectoris, a person during the first minutes of an attack is not able to engage in the usual activities (walking, talking), he grabs his heart and freezes in one position. Pain during a heart attack is undulating, it can fade after the introduction of potent analgesics and then resume.

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

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

Atypical pain in a heart attack

Despite public awareness of heart disease, the diagnosis of myocardial necrosis can be unexpected. The image of a person clutching his heart may never appear if an atypical form of the disease is present. Diagnosis is difficult due to diabetes and reduced sensitivity to pain.

Some people endure an attack on their legs, others are admitted to other departments of hospitals with suspected diseases of other systems.

There are several atypical forms myocardial infarction:

Gastritis. This form occurs in 5% of cases. Reminds severe disorder stomach. Accompanied constant nausea, severe vomiting, bloating, in some cases diarrhea is present. Feeling of severe pain in the stomach area misdiagnosis and only on electrocardiogram ECG you can see signs of damage to the heart.
Arrhythmic. In a patient, the disease is manifested by a feeling of pronounced palpitations, while there may be interruptions in the work of the heart. The attack resembles tachycardia, extrasystole, less often - bradycardia. Each next hit is different from the previous one. The appearance of pain during a heart attack in such cases is not necessary.
Asthmatic. Similar to left ventricular failure or bronchial asthma. The patient has difficulty breathing due to dry cough. Severe shortness of breath and discomfort behind the sternum for several minutes make appearance the victim is exhausted, there is cyanosis of the skin.

The gastralgic variant is similar to the painting " acute abdomen»: abdominal pain, bloating, and with them - weakness, drop in blood pressure, tachycardia

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

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

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

Who is at risk

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

Probability heart attack increase:

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

Excessive physical activity also negatively affects the metabolism in the body.

Availability bad habits(, alcohol, passion for tonic drinks);
disease endocrine system(diabetes mellitus of the first and second types, thyrotoxicosis, excess weight accompanied by obesity of the heart);
excessive physical activity, running long distances in old age, carrying weights;
high blood pressure (with hypertension, blood vessels narrow, and blood circulates with difficulty in the body).

The negative influence of provoking factors increases significantly during severe stress. Nervous system is inextricably linked to the functioning of the heart. Against the backdrop of exhaustion severe fatigue And constant discomfort myocardial necrosis may occur unexpectedly. Older people and pregnant women are especially sensitive to environmental factors, which should be remembered if they have chronic diseases.

What to do if there is chest pain

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

Before the doctors arrive:

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

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

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

Approximately 30% of patients soon after hospitalization, chest pain resumes. This is an unfavorable prognostic sign, such patients are indicated for emergency coronary angiography followed by bypass surgery or angioplasty. If coronary angiography is not possible, nitrates, b-blockers and heparin IV are prescribed and the patient is transferred to a specialized medical institution.

myocardial infarction in pregnancy

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

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

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

Causes of myocardial infarction in pregnant women and women in labor due to pregnancy or inherent in pregnancy

Spontaneous dissection of a coronary artery
Hypercoagulable state: Coronary thrombosis; hereditary thrombophilia; Coronary embolism (from artificial mitral or aortic valves; from the left atrium mitral stenosis; from the left atrium or ventricle with generic or other cardiomyopathy; paradoxical, with an atrial wall defect or with an open foramen ovale with cyanotic birth defects hearts; from the placenta with hydatidiform mole or chorionepithelioma)
Drugs that stimulate tribal activity: Ergot alkaloids; Bromocriptine
Preeclampsia

Random causes of myocardial infarction in pregnant women

coronary atherosclerosis
Coronary arteritis: Nodular periarteritis; Antiphospholioid syndrome; Still's disease; Arteritis Takayasu; History of Kawasaki disease; Behçet's disease
coronary embolism: Infective endocarditis; Myxoma of the left atrium
cocaine use
Pheochromocytoma

Diagnosis of myocardial infarction

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

Diagnosis must be confirmed by ECG, echocardiography, coronary angiography, and cardiac troponin. Since the concentration of CK MB increases after delivery due to its intake from the myometrium, only evaluation of a series of troponin determinations can be reliable, but it will only be retrospective, since urgent measures must be taken.

Majority cardiovascular disorders that occur during pregnancy can be recognized with an ECG, which should be done immediately, as confirmation of the diagnosis will allow you to take necessary actions to save the life of the patient.

Generic cardiomyopathy

This disease can be very similar to a myocardial infarction, when it starts suddenly and presents with chest pain, pulmonary edema, or arrhythmia with ECG changes that are suspicious of a heart attack, as well as an increase in cardiac troponin levels. In ancestral cardiomyopathy, even echocardiography may reveal focal rather than complete left ventricular dysfunction, although there is left ventricular hypokinesia as well as right ventricular hypokinesia. Final Diagnosis allow coronary angiography to be established.

Birth cardiomyopathy ± coronary embolism
Embolism pulmonary artery: Venous thrombus; amniotic fluid
Aortic root dissection
Pericarditis
Fluid overload: After surgical delivery; Infusion of ritodrine

Acute pericarditis

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

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

Management of patients with myocardial infarction

Due to the high mortality, treatment should be urgent, as with a heart attack outside of pregnancy. With a dissection of the coronary artery, which is probable cause heart attack, usually suffers from a large area of \u200b\u200bthe myocardium, which it supplies with blood, and sometimes more extensive. The condition is complicated by the absence of collateral circulation, which is absent in patients with previously healthy coronary arteries.

Due to the fact that there are many possible mechanisms infarction, and Because of the need for revascularization, coronary angiography and echocardiography should be performed immediately to assess left ventricular function and exclude ancestral cardiomyopathy, pulmonary embolism, and intracardiac thrombosis. Angiography of the left ventricle can be omitted.

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