Myocardial infarction is the result of coronary heart disease. The active cell death occurs as a result of insufficient blood supply to tissues in a limited area of the heart. Myocardial necrosis develops gradually due to thrombosis of the coronary arteries, or atherosclerosis. Therefore, it is important to as quickly as possible to diagnose the occurrence of the symptoms of the pathological process and prevent its progress. Otherwise there is a high risk of developing complications.
From which arises
Most people wonder what happens from myocardial infarction: causes in 97-98% of cases are in the atherosclerotic lesions of the vascular endothelium of coronary arteries. As a result of such causes of heart attack, atherosclerosis, vascular lumen narrowing. The pathological process is complicated by thrombosis of blood flow in the affected area, that provokes a full or partial stopping blood supply oxygen and nutrient substances corresponding portion infarction.
Sometimes, a heart attack occurs due to increased blood viscosity. plasma thickening is due to the increased amount of the formed elements therein and amplification of platelet aggregation. thrombus may occur because of clumping of blood platelets.
In some cases, the cause of acute myocardial infarction (AMI) can serve as alcohol abuse, smoking, prolonged exposure to stressful conditions on the background of coronary artery disease. The risk of developing pathological process increases with physical inactivity, unhealthy diet, physical exhaustion and psychological strain.
Provoke the progression of ischemia and the major causes of myocardial infarction may be the following factors:
- diabetes, insulin resistance;
- increase in blood cholesterol;
- hypertonic disease;
- disorders of the endocrine system;
- obesity;
- severe infectious diseases, particularly those caused by abnormal growth of Staphylococcus or Streptococcus;
- rheumatic heart disease;
- depression;
- enhanced physical activity.
Angina, incorrect work of the left ventricle, coronary vasospasm and other diseases of the heart blood vessels can also lead to heart attack - in this case the reason may lie in congenital diseases. To reflect the occurrence of heart failure should be the appearance of:
- snoring, shortness of breath, sleep apnea;
- bleeding gums;
- swelling of feet, face;
- arrhythmia;
- frequent headaches;
- pain in the left shoulder;
- urination at night.
The reason a heart attack may be hiding in these signs.
How to recognize
The approximation of necrosis indicates worsening of coronary heart disease (CHD). The disease appears mostly in people older than 50 years. Ischemia is characterized by obstruction of the coronary arteries by atherosclerotic plaques, which form the basis of low-density lipoprotein (LDL) cholesterol, and (Xc). Therefore, to prevent predinfarktnogo state care should be taken as an indication of LDL and total cholesterol.
As a result, the formation of cholesterol plaques narrows the lumen of the vessel, which increases the load on the myocardium. At strengthening the work of the heart muscle cells are depleted faster. Cardiomyocytes in load conditions require more oxygen and nutrients, but due to the narrowing of the lumen of the coronary vessels can not be a full trophic tissue. At the same time there is the risk of rupture of fatty plaques. Detached clot lipoproteins while advancing through the bloodstream capable clog narrower vessel, which would entail expression of thrombosis and necrosis.
The main signs of heart attack are pain in the sternum, keenly felt after exercise. These harbingers of a heart attack are well cropped vasodilators.
If you start to disturb predinfarkta symptoms should consult a cardiologist. The doctor will explain what happens during a heart attack and prescribe appropriate treatment if the diagnosis is confirmed.
The typical form
Characteristic symptoms of myocardial typical form in the majority of cases occur in men are:
- sharp stabbing pain in the left side of the chest;
- labored breathing;
- fatigue, appearance of sticky sweat;
- arrhythmia, extrasystoles, atrial fibrillation;
- feelings of anxiety, panic attacks, depression;
- dizziness.
To recognize a heart attack in women is more difficult, because in this case there are atypical symptoms. Pain in 87% of cases, is not limited or completely absent in the sternum, extending below the left shoulder, the left arm and its shoulder joint, the upper chest. In some cases, the first signs of a heart attack in a woman's body can be a pain in the throat or the lower dentition.
Signs predinfarkta typical form may manifest as:
- nausea and retching;
- hypotension;
- cyanosis - pale skin, especially on the face and hands;
- dry cough;
- speech disorder, blurred vision, loss of coordination of movements.
Man with myocardial necrosis feels stabbing, sharp pain or a painful contraction in the heart. When this syndrome is not relieved by analgesics and nitroglycerin. Intense pain is manifested for a long time - from 10 to 45 minutes. The symptom may be present constantly or periodically appear.
In rare cases, the pain may spread to the abdominal cavity, from which there is a false sense of the gastro-intestinal colic. Pain syndrome, with symptoms similar to stomach ulcers, lesions observed in the rear wall of the heart.
Acute myocardial in 70% of cases occur in the morning. The phenomenon is due to a reduced load on the heart during sleep. Upon awakening begins to produce serotonin, which activates the release of other hormones into the blood. This increases blood pressure, heart rate quickens. When myocardial trophic disorders appear arrhythmia, the risk of rupture of atherosclerotic plaques with subsequent occlusion of the vessel.
The degree of occurrence of a cardiac infarct symptoms depends on the area of myocardial damage and associated diseases. With the development of the pathological process in a small area of the clinical picture may correspond to signs of colds. Body temperature rises to + 38 ° C, there is a weakness, headache, and chest tightness. The only feature is the lack of microinfarcts Q wave on the electrocardiogram (ECG).
atypical form
Symptoms of a heart attack is more difficult to identify atypical forms, because the clinical picture of disease coincides with the appearance of other diseases. To classify the varieties of pathology, symptoms are grouped according to affiliation in the respective system of the body.
| View necrosis | clinical picture |
| Abdominal | Symptoms of the disease are often confused with disorders of the gastrointestinal tract. Characterized predinfarkt abdominal symptoms:
|
| arrhythmic | Arrhythmic heart attack begins with the type of cardiac rhythm disorders. Quickens the rate of myocardial contractions, the person feels the blood flow in the temples, raised blood pressure. |
| Cerebral | The withering away of cardiomyocytes causes dizziness, headache. Man faints, he violated it. |
| Asthmatic | Prior myocardial arrhythmic form appears dyspnea. When enhanced physical activities the patient does not have enough air. |
| kollaptoidnye | This kind of myocardial necrosis can be recognized by a sharp fall in blood pressure, blackouts. Possible loss and confusion, dizziness. |
| Hydropic | Signs of impending heart attack in this case characterized by:
|
| painless | It observed in rare cases. High risk of painless myocardial observed in patients with diabetes, which is caused by the simultaneous defeat of the nerves and vessels of the heart disease. Therefore, the pain is not felt. |
Determine myocardial at home is possible by the development of characteristic symptoms - occurrence of the pain in the chest or on the left side of the body, the shortage of air, reduction in blood pressure. If you suspect a cardiac necrosis is necessary to call an ambulance and to reduce the burden on the body.
Diagnostics
Diagnosis of heart attack involves conducting laboratory and instrumental investigations. Among the changes are the most important procedures of teeth on the ECG, medical history, a blood serum level of activity of enzymes. complaints of the patient are taken into account indirectly, because in atypical forms of heart disease, symptomatic picture is blurred.
Manifestation of signs of myocardial necrosis depends on the area of the heart muscle injury and the type of pathology. Congestive heart failure can be suspected in case of prolonged pain behind the breastbone, conduction disorders, and heart rate.
Laboratory research
Diagnosis of myocardial infarction in the laboratory is carried out using the following methods:
- determining the acid-base balance and electrolyte levels in the blood;
- monitoring the sugar concentration, bilirubin, total cholesterol, urea, triglycerides, alpha-amylase and myoglobin;
- general and biochemical blood tests;
- coagulation.
During the first 4-6 hours of the onset of pain diagnose myocardial possible to increase the level of myoglobin - protein responsible for transporting oxygen molecules inside cells. After 8-10 hours, an increase of creatine phosphokinase activity (CPK) by 50-70%. If the positive dynamics of indicators of treatment CK return to normal within 48 hours. Suspicion of myocardial necrosis is necessary to determine the level of CK at intervals of 6-8 hours. Myocardial excluded only if 3 negative test results.
To reveal the pathological process at a later stage, medical professionals pay attention to indicators of lactate dehydrogenase (LDH). The activity of this enzyme is increased after 24-48 hours after the onset of necrosis. LDH indices return to normal after 1-2 weeks.
For heart attack characterized by increased levels of troponin, responsible for the contractility of cardiomyocytes. Troponin-T and troponin-1 are increased in unstable angina, so with an increase in their number pay attention to the level of myoglobin and CK. If necrosis of the heart is increased erythrocyte sedimentation rate, increased activity of alanine aminotransferase and aspartate, increased number of leukocytes.
instrumental methods
The presence of a heart attack can attest to the following studies:
- electrocardiogram;
- chest X-ray;
- echocardiography;
- coronary angiography;
- clock monitoring of the dynamics of heart rate.
The characteristic changes in the ECG may include the formation of negative tooth T or Q. In the latter case diagnosed macrofocal death of tissue. Perhaps the formation of abnormal QRS complex. Echocardiography can determine local disturbance ventricular contractility and thinning of the muscular wall.
Identify thrombosis, and decrease ventricular contractility allows coronary angiography. In this procedure helps to assess the possibility of aortic bypass surgery and angioplasty.
How to treat
In most cases, treatment of heart attack begin to confirm the preliminary diagnosis to minimize the effects and possible complications. It is necessary to assign patient oxygen therapy and oral medications for thinning the blood. Drugs reduce blood viscosity and reduce the risk of thrombotic events. The attending physician may prescribe the use of sublingual nitroglycerin. Vasodilator drug reduces the afterload on the heart and helps to improve the blood supply to the myocardium of coronary arteries.
Upon confirmation of the diagnosis treatment is focused on restoration of blood supply of the damaged portion. Key therapies include receiving thrombolytics to cleave a blood clot and restoring local blood flow, as well as coronary angioplasty. The procedure is a percutaneous surgery, allows you to clear the lumen of the coronary arteries from fatty plaque and thrombus.
First aid
With the possible development of AMI is required to immediately call an ambulance. Before coming teams must be first aid, which may increase the chances of a favorable prognosis. The algorithm is:
- It is necessary to reduce the load on the heart. If the patient is conscious, you need to calm him down and moved into a horizontal position with the raised headboard. The patient can not move. Allowed administering sedatives or reception. The room must come fresh air.
- It is necessary to put the victim under the tongue nitroglycerin tablets crushed. In addition, the patient should chew an aspirin.
- If there are medicines in the medicine cabinet of the beta-blockers (atenolol, metoprolol), you need to give the patient 1 chewable tablet. At constant reception of these drugs need to take extraordinary dose.
- To reduce the level of pain, you can give the victim analgesic drugs. But it is important to remember that in myocardial painkillers ineffective means.
- Allowed to use Pananginum or 60 Corvalolum droplets.
When syncope is necessary to try to bring the patient in mind. It is necessary to check for a pulse, respiration, response to stimuli. In the absence of signs of life requires immediate resuscitation before the arrival of the ambulance: CPR, chest compressions.
At home,
To treat myocardial infarction in the home can not be and is strictly prohibited due to the high risk of death. When the acute pain and other associated symptoms of necrosis of heart tissue requires immediate medical treatment. During pathological process divided into three periods:
- Acute. Duration - 2 weeks. Due to the high probability of complications and death the patient is in the intensive care unit. During this period, the dead areas are replaced by granulation tissue.
- Subacute. It lasts about a month. Affected cardiomyocytes are replaced by connective tissue. At recovery time the patient is transferred to the cardiology department.
- Scarring. It lasts about 6 months. After subacute closure period of the patient discharged. Treatment after myocardial infarction continues at home. Regeneration occurs inflammatory focus, so the extra therapy folk remedies. It is important to remember that the drugs prescribed by the doctor are required for use.
Auxiliary methods of alternative medicine therapy is carried out with the authorization of the cardiologist. To improve myocardial blood supply is recommended to use the following tools:
- garlic;
- dried fruit, particularly a mixture of dried apricots, buckwheat honey and walnuts;
- motherwort decoction;
- centaury;
- parsnip;
- wheat germ.
After discharge should exclude bad habits. Please observe proper diet, do light exercise and avoid stressful situations.
professional treatment
After determining the clinical diagnosis of reduced patency of the coronary arteries and the blood supply to the myocardium by means of immediate stenting - vascular angioplasty. An operation is required to spend the first hours after the onset of symptoms of tissue necrosis. In the later stages of myocardial angioplasty is not carried out and the only way out is to coronary artery bypass grafting.
A patient with a heart attack are hospitalized in the intensive care unit. If unconscious or high risk patient's heart stops placed in the intensive care unit, where you can monitor the status of the victim. For the treatment of acute myocardial patient is prescribed a large number of drugs:
- anticoagulant and antiplatelet agents are needed for the prevention of thrombosis and blood thinners;
- ACE inhibitors and beta-blockers help reduce necrotic area and decrease myocardial oxygen demand;
- narcotic analgesics allow stopping pain;
- antihypertensives needed for stabilization of arterial pressure;
- antiarrhythmic medications normalize heart rhythm.
Self-treat heart attack and to make changes in the therapeutic course is strictly prohibited. Medication cardiologist sets depending on the patient's state of health, presence of concomitant disorders, liver and kidney status. Improper treatment after a heart attack increases the likelihood of complications.
How to prevent the disease
In more than 50% cases of heart infarction is the result of the progressive ischemia. Therefore, to reduce the likelihood of developing necrosis help correct treatment of CHD. In carrying out preventive measures for the prevention of heart attacks and other serious cardiovascular pathologies pay special attention to nutrition.
Myocardial diet should contain large amounts of fiber and vitamin complexes. It is necessary to completely eliminate or limit the intake of protein foods, fatty and fried foods. It is recommended to include in the diet of boiled or steamed fillet of fish rich in omega-3.
Prevention of myocardial necrosis is performed using the following methods:
- reduction of overweight;
- moderate exercise to combat physical inactivity;
- control of plasma glucose and cholesterol;
- monitoring blood pressure indicators.
Consequences and complications
The most dangerous consequences of necrosis of muscle tissue of the heart is to stop the heart rate and clinical death and then death. Acute myocardial can cause the following complications:
- pulmonary edema;
- ulcerative erosive lesions of the stomach and duodenum;
- cardiac aneurysm;
- brain stroke;
- chronic heart failure;
- psychological disorders;
- cardiogenic shock;
- arrhythmia;
- brain damage due to hypoxia.
Lethal outcome can have from 1 to 10, with no provision of appropriate medical care. 80% of people who have had a heart attack, return to normal life. In this case, patients need to take drugs to prevent recurrence and to keep a healthy lifestyle. To reduce the risk of complications is important to recognize the symptoms of disease.
