home Endocrinology The first signs and symptoms of acute myocardial infarction. What is myocardial infarction? Why does it develop and why is it dangerous? Acute myocardial infarction associated with pain

The first signs and symptoms of acute myocardial infarction. What is myocardial infarction? Why does it develop and why is it dangerous? Acute myocardial infarction associated with pain

What is myocardial infarction

Myocardial infarction is a clinical form in which an acute disruption of the blood supply occurs and, as a result, necrosis (infarction, necrosis) of a section of the heart muscle, accompanied by impaired circulation.

Myocardial infarction in 90% of cases occurs due to long-term progression. Men aged 42-67 years are most often affected. The heart is supplied with blood through the right and left coronary arteries, which arise from the base of the aorta. As a result, the vessels form plaques that block the lumen of the coronary arteries.

Normally, the coronary arteries, due to their expansion, are capable of increasing coronary blood flow 5-6 times to compensate for physical activity and stress. When the arteries narrow, this compensatory mechanism does not work: any load leads to oxygen “starvation” (ischemia) of the myocardium.

Myocardial infarction can develop without load, with a sharp blocking of coronary blood flow, for example, with rupture and thrombosis of an atherosclerotic plaque, as well as with a sharp spasm of the coronary artery.

Clinical signs of a heart attack appear if the lumen of the artery decreases by more than 80%. Necrosis of the bloodless myocardium occurs 30-90 minutes after the cessation of blood supply. Therefore, doctors have only 1-2 hours to prevent the death of the heart muscle using drugs and/or intervention aimed at opening the blocked artery. Without this, irreversible damage develops - myocardial necrosis, which forms within 15-60 days.

Myocardial infarction is an extremely dangerous condition, the mortality rate reaches 35%.

Causes of myocardial infarction

In 95% of cases, the disease manifests itself against the background of atherosclerotic lesions of the coronary arteries. In the remaining cases, necrosis develops due to a sharp spasm of the coronary arteries. There are factors that contribute to the progression and increase the risk of developing myocardial infarction:

smoking;
past infections;
low levels of high-density lipoproteins in the blood;
sedentary lifestyle;
elderly age;
poor environmental conditions in the place of residence;
excess body weight;
, ;
history of myocardial infarction;
congenital underdevelopment of the coronary arteries;
long-term use;
oncological diseases.

Symptoms of myocardial infarction

Here are the classic signs of a heart attack:

acute strong pressing, bursting pain behind the sternum, radiating to the neck, left shoulder, between the shoulder blades;
shortness of breath, cough;
feeling of fear;
pale skin;
increased sweating.

Symptoms for atypical forms of myocardial infarction

Abdominal form - characterized by pain in the upper abdomen (episgastric region), hiccups, bloating, nausea and vomiting.

Asthmatic form - occurs after 50 years and is manifested by intense shortness of breath, suffocation, dry and wet, medium and coarse wheezing in the lungs.

Painless form - occurs in 1% of cases, usually in patients with. It manifests itself as weakness, lethargy, and lack of subjective sensations. A previous heart attack is detected by routine electrocardiography (ECG).

The cerebral form is characterized by impaired blood supply to the brain. In 40% of cases it occurs with infarction of the anterior wall of the left ventricle. Clinic: dizziness, impaired consciousness (muscle paresis), disorientation in time and space, loss of consciousness.

The collaptoid form is a manifestation of cardiogenic shock, which is the most dangerous complication of myocardial infarction. Clinic: a sharp drop in blood pressure, dizziness, darkening of the eyes, profuse sweating, loss of consciousness.

The edematous form is manifested by shortness of breath, weakness, edema, accumulation of fluid in the chest and abdomen (ascites), enlargement of the liver and spleen (hepatomegaly) due to increasing right ventricular failure.

The combined form is characterized by various combinations of atypical forms of infarction.

Classification of myocardial infarction by stages

The most acute stage lasts up to 120 minutes from the cessation of blood supply.

The acute stage lasts up to 10 days; at this stage, the heart muscle has already collapsed, but the formation of necrosis has not begun.

The subacute stage lasts up to 2 months. Characterized by the formation of scar tissue (necrosis).

The post-infarction stage lasts up to six months. During this period, the cardiac scar is finally formed, the heart adapts to new operating conditions.

Based on the prevalence of the pathological process, large and small focal infarctions are distinguished.

Large-focal (transmural, or extensive) infarction - damage to a large area of the myocardium. The process is developing very quickly. In 70% of cases, changes in the heart are irreversible. The patient can avoid severe complications of a large-focal infarction, in particular, if medical assistance is provided no later than 3-4 hours.

Small focal infarction - damage to small areas of the heart muscle. It is characterized by a milder course and less pronounced pain syndrome than large-focal. In 27% of cases, a small-focal infarction develops into a large-focal one. Occurs in every fourth patient. The prognosis is favorable, complications occur in 5% of cases, usually with delayed treatment.

Diagnosis of myocardial infarction

The disease is diagnosed using an ECG. Additionally, ultrasound of the heart, coronary angiography, myocardial scintigraphy and laboratory tests are prescribed: complete blood count, cardiotropic proteins in the blood (CF-CK, AST, LDH, troponin).

Treatment of myocardial infarction

At the slightest suspicion of myocardial infarction (retrosternal pain), you need to call an ambulance.

The disease is treated only in a hospital and even in an intensive care unit. Strict bed rest is required for 3-7 days. Then motor activity is expanded on an individual basis. Medicines prescribed include painkillers (Morphine, Fentanyl), antiplatelet drugs (Acetylsalicylic acid, Clopidogrel), anticoagulants (Heparin, Enoxaparin), thrombolytic drugs (Streptokinase, Alteplase), beta-blockers (Propranolol).

The most effective and promising method of treatment is emergency (up to 6 hours) opening of a blocked coronary artery using balloon angioplasty with the installation of a coronary stent. In some cases, urgent coronary artery bypass grafting is performed.

The recovery (rehabilitation) period lasts up to six months. During this time, patients gradually increase physical activity, starting with 10 steps per day. Medicines are taken for life.

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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 forms of ischemia; the names of the disease may differ depending on the severity of the lesion, ranging from stable angina to 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 posterior wall 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

The following stages of the formation of cardiac muscle necrosis are distinguished:

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.
The period of acute manifestation of clinical signs. Depending on the severity of ischemia, necrosis or mild tissue damage may occur in various areas.

Attention! An experienced doctor is able to make a diagnosis based on characteristic signs, such as: burning and pressing pain behind the sternum, fear of death, dizziness.

Within two weeks, the focus of inflammation continues to form. Deciphering the ECG 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. The final stabilization of muscle tissue occurs. 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. The signs of the most acute period completely disappear, the person practically ceases to be bothered by pressing pain in the chest, dizziness and weakness. Adaptive mechanisms involve the formation of 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 of a heart attack is quite common. 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.

The most common cause of acute myocardial infarction is 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 of cholesterol in the blood (a connection has been established with atherosclerosis);
endocrine pathologies;
blood pathologies (hypercoagulation, thrombosis);
arterial hypertension;
bad habits;
old age and the presence of concomitant diseases of the 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 diagnosis of myocardial infarction, its acute form, is made 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 common symptoms 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 damage stage: the S-T segment rises 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:

Acute myocardial infarction with S-T segment elevation. 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 pain localized in the chest and radiating to the left shoulder, neck, teeth, ear, collarbone, lower jaw

Important! Upon admission to the hospital, the patient is usually given a general diagnosis of “coronary syndrome,” which may be with or without S-T segment elevation on the electrocardiogram.

After examination by a cardiologist and collection of complaints, an additional examination is carried out to help differentiate 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 should completely relax, for this it is advisable to take a horizontal position, loosen tight clothes, open the window, create a calm environment in the room;
you can try to stop the attack with nitroglycerin, it can slightly reduce 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 the further development of 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 you suspect cardiac arrest, you should immediately begin giving the patient an indirect massage, which is presented in the form of 30 chest compressions; sometimes artificial ventilation may be required.

An attack of AMI is completely controlled only by narcotic analgesics. To prevent relapses of the disease in a hospital setting, specific therapy can be prescribed, 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;
pulmonary edema (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 of concomitant pathologies or in the case of 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:

A sign of the most acute stage is pain behind the sternum of a burning and pressing nature, which radiates to the left arm, 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. Cold sweat appears, and during an attack the person is completely unable to engage in usual activities.
Blood pressure surges (it can fall or rise to critical values), the pulse becomes faster, and there is strong anxiety about one’s 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! There have been cases when a patient was admitted to the hospital with suspected gastrointestinal or pulmonary pathology, but only after a thorough examination were signs of cardiac muscle necrosis identified.

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

The complex of symptoms characteristic of coronary artery disease does not refer to conditions that “will go away on their own.” The disappearance of pressing pain behind the sternum does not mean complete 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 the initial period of the disease, very severe pain occurs, which requires intensive care:

nitroglycerin in a standard dose of 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 a 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 for arterial hypertension. Drugs in this group can lower blood 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 follow all clinical recommendations, you can avoid many dangerous complications. 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. Properly selected drug therapy for AMI is not everything. Unhealthy foods, 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:

low cholesterol foods;
fresh fruits, vegetables, berries, which, with the help of a large amount of vitamins, promote the regeneration of heart fibers;
a special diet is required, which involves excluding 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 fluctuates - this can become an alarm bell 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, eat healthy foods 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.

The death of a section of the heart muscle, leading to the formation of coronary artery thrombosis, is called myocardial infarction. This process leads to the disruption of blood circulation in this area. Myocardial infarction is predominantly fatal because the main heart artery is blocked. If, at the first sign, appropriate measures are not taken to hospitalize the patient, then death is 99.9% guaranteed.

The medical facility begins to immediately dissolve the blood clot in order to restore normal blood circulation in this area. Due to the fact that this disease occurs quite often and both older people and young people suffer from it, it is worth paying attention and considering all the nuances of the course of the disease. Let's start with an in-depth look at the question of what a heart attack is.

Description of the disease

Myocardial infarction is an acute manifestation. The disease often primarily affects women; in rare cases, it also affects men. If over a certain period of time there is no blood supply to the area of the heart muscle, then the process of death of this part of the heart begins. The area that actually begins to die as a result of lack of oxygen is called myocardial infarction. Disruption of blood flow to a part of the muscle occurs due to the destruction of an atherosclerotic plaque in the artery. This plaque is normally located in the lumen of one of the vessels, but when any load is applied to it, its destruction occurs. In its place, a blood clot begins to grow, which can either gradually clog the vessel, as a result of which a person tends to periodically feel acute pain in the heart area, or quickly. Rapid blockage causes acute myocardial infarction, which requires hospitalization of the patient.

The mortality statistics from myocardial infarction are quite high. Most patients die without waiting for an ambulance. Another half die on the road if urgent resuscitation measures are not taken. Even those people who have undergone therapeutic resuscitation measures also die due to the development of complications. As you can see, the disease is so serious that it is almost impossible to survive after its manifestation. Only in 1–2% of cases is it possible to save people from death, but after this a relapse cannot be ruled out.

The dynamics of rapid growth of the disease among young people is observed every year. Moreover, these are people aged 25–30 years and older. In women under the age of 40–50, this disease is less common, but with the onset of menopause, heart attacks are much more common. The reasons for this dynamics are estrogens. The bottom line is that the female reproductive organs produce a hormone called estrogen. It is estrogen in women that performs a protective function, preventing the atherosclerotic plaque from coming off. In men, the disease is less common than in women, but every year the number of people affected by myocardial infarction is growing.

Classification of myocardial infarction

A dangerous and fatal disease is classified according to the size, depth and location of the outbreak. Let's look at the different classes of myocardial infarction:

Each form is dangerous and fatal, but it is worth highlighting transmural extensive myocardial infarction, which occurs abruptly and does not last long. The final outcome is fatal in most cases.

Stages of heart attack

What is a heart attack, and what types of it are known, now it is worth paying attention to the stages of development of a dangerous fatal disease. The stages are formed based on the duration of the disease and the danger to the patient. So, the stages of a heart attack have the following names:

The most acute stage. Its duration is approximately 5–6 hours. This stage is treatable, but often death from a heart attack occurs much earlier than the patient is taken to a medical facility. During the acute stage, arrhythmias and severe complications occur.
Acute. Oddly enough, this stage is the most dangerous. It occurs unexpectedly and may be accompanied by acute pain for 14 days. The stage is characterized by the formation of a scar.
Subacute stage. Formation takes about a month. During this period, a scar gradually forms and signs of necrotizing syndrome disappear. An ECG for myocardial infarction at the subacute stage shows signs of normalization of the metabolism of the disease.
Post-infarction stage. It mainly forms from the second month of the disease and depends on the lesion. The stage is characterized by the adaptation of the heart to new conditions.
Scarring stage. The final stage, which is characterized by scar formation.

What contributes to the formation of a dangerous disease or what are the reasons and prerequisites for this. Let's take a closer look at the causes of myocardial infarction.

Causes

The causes of myocardial infarction are varied, but first of all, it is worth highlighting that most often the disease is diagnosed in elderly or inactive people who are obese or inactive. If we add to this frequent psycho-emotional overload, mood swings, stress, etc., then the result is 100% myocardial infarction syndrome.

Sometimes myocardial infarction affects people with good physical fitness, both young and old. The cause of the disease in people with a developed system of muscle groups is mainly bad habits and frequent psycho-emotional disorders. Any disorder leads to cell death. Among the main reasons for the formation of myocardial infarction, it is also worth highlighting the following factors:

Frequent overeating. A person should eat 3-4 times a day, but more is allowed if food is consumed in small quantities. It is better to eat more often, but in small portions, than once or twice a day, but at the same time overeat.
Hypertensive diseases.
Low physical activity. A person must walk at least two kilometers every day so that the muscles have the opportunity to contract.
No animal fats in food.
Bad habits. These include not only smoking and excessive alcohol consumption, but also taking narcotic and toxic drugs.
High cholesterol. Cholesterol is the main component that leads to the formation of plaque on artery walls.
. An increased composition of blood sugar leads to a deterioration in the transport of oxygen through the bloodstream.

Based on research, it was found that the syndrome predominantly occurs in sedentary and inactive people. These are mainly women aged 40–50 years and men over 30. Relapses are especially common in men who consume an extremely large amount of alcoholic beverages. In physically active people, heart attack is extremely rare and is often caused by severe emotional stress.

Against the background of all the above reasons, a blockage of the heart vessels occurs with a thrombus, which is a plug in the artery. Accordingly, blood with a fresh supply of oxygen does not flow to the parts of the heart. The heart muscle can survive without oxygen for 10 seconds; if after this time the oxygen supply process is not restored, then the muscle gradually dies. About 30 minutes after complete blockage, the heart muscle is viable, and after that irreversible processes begin to develop.

Thus, in order to exclude such a disease, it is necessary to switch your body and consciousness to leading a healthy lifestyle and not succumb to stressful situations. How does a heart attack manifest in humans?

Symptoms

Symptoms of the disease mainly manifest themselves in the form of acute pain in the chest. But such symptoms are characteristic primarily of males. In women, symptoms also appear in other forms.

Symptoms of myocardial infarction depend on the degree of complexity of the disease, clinical manifestations, myocardial damage and other associated factors. It was found that the symptoms of the disease are somewhat different in women and men. Let's consider the main types of symptoms of the disease and atypical signs.

Main symptoms of a heart attack

Against the background of the above-mentioned reasons, a person experiences a pain symptom, which is an attack of pain in the chest area. Sometimes it is quite difficult to say that it is the heart that hurts, since the characteristic location of pain is the area below the heart. Pain occurs primarily during physical activity that may not have been previously performed, or during severe and prolonged emotional disturbances.

Symptoms of a heart attack also have the following characteristic features:

Sudden onset of acute pain in the chest area, predominantly on the left side of the body. The duration of pain lasts up to 15–30 minutes. The pain is sometimes so severe that a person wants to scream. If there are signs of acute discomfort in the heart area, emergency assistance must be called.
Even if a person resorts to taking nitroglycerin, the pain does not disappear, but may decrease slightly.
Acute pain is characterized by squeezing, squeezing and burning symptoms.
Signs of myocardial infarction often have an intense form of manifestation, but in rare cases it can be wavy.
Over time, the symptoms of pain increase and radiate to the neck, left arm and even jaw.

Based on the first signs, we can say that a person is having a heart attack, which is caused by activation of the nervous system. Also, symptoms of myocardial infarction manifest themselves in the form of increased sweating, general weakness and malaise of the body. A person often, being in this state, cannot continue to move further or perform any actions, the skin becomes pale, and the patient becomes white. Sweat is characterized by stickiness and coldness. With acute pain, the patient begins to feel dizzy and falls to the floor, holding his heart.

Nausea and vomiting are also signs of myocardial infarction. Vomiting occurs due to decreased blood pressure. In rare cases, symptoms of cardiogenic shock are observed, which are characteristic primarily of the acute stage of the disease. Cardiogenic shock is characterized by paleness of the human body, the appearance of cyanosis on the lips, the limbs become white with a blue tint, and the pulse cannot be palpated.

Important! First aid for myocardial infarction is mandatory, even if you find a person who is holding his chest and cannot speak, you must immediately call an ambulance and begin providing first aid.

If the ambulance arrived on time and managed to save the patient, then the next day the second period of malaise begins, which is characterized, first of all, by an increase in temperature to 38 degrees. An increase in temperature is the body’s reaction to the cessation of myocardial activity and its further death. If cardiogenic shock occurs, then damage to internal organs is possible, that is, their death or decreased vital activity. Often the first organ to fail is the kidneys. In this case, urine accumulates in the kidneys, which is practically not excreted. The accumulation of unnecessary products in the body begins, which lead to intoxication.

The rehabilitation period also has its own characteristics, which are characterized by:

The appearance of swelling in the upper and lower extremities.
Frequent shortness of breath even with minor exertion.
There is an enlargement of the liver and its pain.

Often, at the rehabilitation stage, a phenomenon develops, caused by the cause of depletion of the heart muscle. Symptoms of myocardial infarction are the first signs that it is urgently necessary to call an ambulance to save a person. The disease is one of the most dangerous diseases known. The main or typical symptoms are clearly manifested in men, while women have atypical signs of the disease that are worth talking about.

Atypical symptoms

Atypical symptoms of myocardial infarction, which are typical for women, have several types of clinical forms.

Asthmatic form. Characterized by a feeling of lack of air and shortness of breath. Often, against the background of shortness of breath, panic begins, which aggravates the situation. Attempts to breathe deeply are unsuccessful. Excess fluid accumulates in the alveoli, which makes itself felt in the form of bubbling sounds during inhalation. Further development of the disease leads to the formation of swelling of the lungs and the development of pneumonia. Choking during myocardial infarction often occurs during sleep, with a sudden awakening reminiscent of an attack.
Gastralgic form. A rare phenomenon that is characterized by the appearance of abdominal pain, mainly in the upper sections. It is very difficult to determine the real diagnosis based on the first signs, since the symptoms are more similar to acute or poisoning. But in fact, under the symptoms of vomiting, hiccups and belching, a dangerous heart attack is hidden. Determined only through diagnosis at a medical center.
Cerebrovascular form. The first signs of the disease appear in the form of deep fainting. This form of the disease occurs more often in men and less often in women. As a result of the disease, paralysis and paresis occur, as well as brain failure and pathological abnormalities.
Arrhythmic form. Symptoms of arrhythmic myocardial infarction manifest themselves in the form of rhythm disturbances. The most dangerous thing in the arrhythmic form is the formation of atrioventricular blockades. Based on these blockades, the heart rate decreases. Such signs require immediate hospitalization of the patient for assistance.

The symptoms of myocardial infarction are quite varied, therefore, at the first ailments in people with ischemic abnormalities, you should urgently call an ambulance and begin providing first aid to the patient. We’ll look at how to do this a little later, but first, let’s look at how the disease is diagnosed in medical centers.

Diagnostics

Diagnosis of myocardial infarction is carried out according to three main factors:

Clinical picture.
Laboratory tests and troponin test.

The clinical picture of the disease is determined mainly by close people who observe the aggravation of the situation. Based on the following symptoms: sharp acute pain in the sternum, inability to breathe, nausea, vomiting, weakening of the body, cold sweat and difficulty speaking, it is necessary to call an ambulance and tell all the signs to the arriving doctor. Based on the clinical picture, an experienced doctor will determine an accurate diagnosis without tests. But a mandatory procedure is also to conduct an ECG in a hospital or in an ambulance. In cases of myocardial infarction, not a minute can be lost, so all diagnostic procedures are carried out very quickly.

The study of cardiac abnormalities using an electrocardiogram confirms the diagnosis previously made by an experienced doctor. On an ECG, myocardial infarction manifests itself as the formation of Q waves and ST segment elevation in the leads. Based on the data received, the doctor observes a picture of damage to certain parts of the heart, which is a sign of a heart attack.

Heart disease ranks among the leading causes of death. Myocardial infarction is the most dangerous in this group: it often occurs and develops suddenly, and in almost 20% of cases leads to rapid death. The first hour after an attack is especially critical - death occurs with almost one hundred percent probability if a person does not receive first aid.

But even if a person survives an attack, he is in danger for at least a week, when his risk of death is many times higher. Any minor stress - physical or emotional - can become a trigger. Therefore, it is important to recognize this disease in time and provide the patient with quality treatment and rehabilitation.

In fact, this process is a complication of coronary heart disease. It occurs against the background of existing cardiac pathologies and almost never occurs in people with a healthy heart.

Acute myocardial infarction develops when the lumen of an artery is blocked by a blood clot or cholesterol plaque. The heart muscle does not receive enough blood, resulting in tissue necrosis.

The heart pumps oxygenated blood and transports it to other organs. At the same time, it itself needs a large amount of oxygen. And with its deficiency, heart muscle cells stop functioning. As in the case of oxygen starvation of the brain, in this situation a few minutes are enough for irreversible changes and tissue death to begin.

The human body is a complex system that is configured to survive in any conditions. Therefore, the heart muscle has its own supply of substances necessary for normal functioning, primarily glucose and ATP. When blood access to it is limited, this resource is activated. But, alas, its supply is only enough for 20-30 minutes. If resuscitation measures are not taken during this period and the blood supply to the heart muscle is not restored, the cells will begin to die.

Types of heart attack

One name hides several variants of the course of the disease. Depending on the location, the speed of the flow and a number of other factors, the patient’s condition and the ability to save him depend.

There are several classifications of myocardial infarction:

By location - right ventricular and left ventricular. The latter is divided into several subtypes: infarction of the interventricular wall, anterior, posterior and lateral walls.
According to the depth of muscle damage - external, internal, damage to the entire wall or part of it.
Depending on the scale of the affected area - small-focal and large-focal.

Depending on the set of symptoms, it happens:

Cerebral form, which is accompanied by neurological disorders, dizziness, confusion;
Abdominal – has symptoms of acute inflammation of the digestive organs – abdominal pain, nausea, vomiting. Out of ignorance, it can easily be confused with acute pancreatitis;
Asymptomatic – when the patient does not feel particularly pronounced manifestations of the disease. This form is often found in diabetics. This course complicates the diagnosis of acute myocardial infarction;
Asthmatic, when the clinical picture of a heart attack resembles asthmatic, which is accompanied by suffocation and pulmonary edema.

Who is at risk?

A history of coronary heart disease and angina significantly increases the risk of a heart attack. Atherosclerosis of blood vessels plays a decisive role - in almost 90% of cases it leads to this outcome.

In addition, those who:

Moves little;
Is overweight;
Is a chronic hypertensive patient;
Constantly exposed to stress;
Smoking or using drugs - this increases the risk of severe vasospasm several times;
Has a hereditary predisposition to atherosclerosis and heart attack.

Also at risk are men over 45 years of age and women over 65 - they may have a heart attack as a result of age-related changes. To prevent this, you need to regularly do an electrocardiogram and, when the first signs appear, monitor changes in the ECG over time.

What causes a heart attack?

Surely everyone has heard the phrase “give a heart attack.” There is a rational grain in it - with a strong nervous shock, a sharp spasm of blood vessels can develop, which will lead to the cessation of blood supply to the heart muscle. Acute myocardial infarction has 3 causes:

Blockage of a coronary artery by a blood clot that could form in any organ.
Spasm of coronary vessels (most often occurs due to stress).
Atherosclerosis is a vascular disease characterized by a decrease in the elasticity of the walls and a narrowing of their lumen.

These causes arise as a result of constant and cumulative exposure to risk factors, including poor lifestyle, obesity, lack of physical activity, the presence of other diseases, hormonal imbalances, etc.

How to recognize a heart attack?

It can easily be confused with a regular attack of angina or asthma, stroke, or even pancreatitis. But it can still be distinguished by some essential characteristics characteristic only of it.

The symptoms of acute myocardial infarction are as follows:

Severe chest pain, which can be felt in the neck, arm, stomach, back. The intensity is much stronger than during an attack of angina, and does not go away when a person stops physical activity.
Heavy sweating;
The limbs are cold to the touch, the patient may not feel them;
Severe shortness of breath, respiratory arrest.

Heart pain does not decrease after taking nitroglycerin. This is an alarming fact and a reason to urgently call an ambulance. For a person to survive, first aid for acute myocardial infarction must be provided within the first 20 minutes from the onset of the attack.

Stages of heart attack

Statistics on mortality from a heart attack indicate that each attack proceeds differently: someone dies in the first minutes, someone can hold out for an hour or more until the medical team arrives. In addition, long before an attack, you can notice changes in the ECG and some blood parameters. Therefore, with regular thorough examination of patients at risk, the likelihood of an attack can be minimized by prescribing prophylactic medications.

The main stages of the development of an attack:

The most acute period of a heart attack lasts from half an hour to two hours. This is the period when tissue ischemia begins, gradually turning into necrosis.
The acute period lasts from two days or more. It is characterized by the formation of a dead section of muscle. Frequent complications of the acute period are rupture of the heart muscle, pulmonary edema, thrombosis of the veins of the extremities, which entails tissue death, and others. It is better to treat the patient during this period in a hospital in order to monitor the slightest changes in the condition.
The subacute period of myocardial infarction lasts about a month - until a scar begins to form on the heart muscle. On the ECG, signs of its formation can be clearly seen: under the positive electrode there is an enlarged Q wave, under the negative electrode there is a T wave symmetrical to the first. A decrease in the T wave over time indicates a decrease in the area of ischemia. The subacute stage of myocardial infarction can last up to 2 months
The post-infarction period lasts up to 5 months after the attack. At this time, the scar is finally formed, the heart gets used to functioning in new conditions. This phase is not yet safe: constant medical supervision and taking all prescribed medications are necessary.

Examination and diagnosis

For a doctor, one glance at a patient is not enough to make a final diagnosis. To confirm it and prescribe adequate treatment, you need to:

Thorough external examination;
Collecting a detailed medical history, including finding out whether there have been cases of heart attack in relatives;
A blood test that will identify markers that indicate this diagnosis. Typically, patients experience an increase in the level of leukocytes and ESR, and a lack of iron. In parallel with the general one, a biochemical analysis is performed, which will help identify complications;
Analysis of urine;
ECG and EchoCG - they will help assess the extent of damage to the heart muscle. An ECG is performed in case of acute myocardial infarction, and then changes are monitored. For the most complete picture, all results should be in the patient’s chart;
Coronary angiography – study of the condition of the coronary vessels;
Chest X-ray to monitor changes in the lungs.

Other tests may also be prescribed if necessary.

Consequences of a heart attack

Complications resulting from an attack do not always appear immediately. Disturbances in the functioning of the heart itself and other organs may appear after a while. The most dangerous year for the patient is the first year - during this period approximately 30% of patients die from complications.

The most common consequences of myocardial infarction:

Heart failure;
Heart rhythm disturbances;
Aneurysm (bulging wall or area of scar tissue);
Pulmonary embolism, which in turn can lead to respiratory failure and pulmonary infarction;
Thromboendocarditis is the formation of a blood clot inside the heart. Its interruption can cut off the blood supply to the kidneys and intestines and lead to their necrosis;
Pleurisy, pericarditis and others.

What to do if you have a heart attack

The sooner first aid is provided and treatment for acute myocardial infarction is started, the greater the patient’s chances of survival and the lower the risk of complications.

First aid during an attack

During this period, it is important not to panic and do everything to gain time before the ambulance arrives. The patient should be provided with rest and access to fresh air, given sedative drops and a nitroglycerin tablet under the tongue. If there are no serious contraindications, you need to take an aspirin tablet, after chewing it. To reduce pain, you can give non-steroidal painkillers - analgin.

Be sure to measure your pulse rate and blood pressure and, if necessary, give medication to increase or decrease your blood pressure.

If the patient is unconscious and the pulse cannot be felt, chest compressions and artificial respiration must be performed until the doctors arrive.

Further therapy

Treatment of acute myocardial infarction is carried out in a hospital, where the patient is prescribed drugs that improve vascular patency and accelerate the recovery of the heart muscle.

Pulmonary edema may require defoaming and artificial ventilation. After removing the patient from an acute condition, constant monitoring of indicators and restorative treatment is carried out.

Medicines that thin the blood and prevent the formation of blood clots are also prescribed.

Life after a heart attack: features of rehabilitation

Some manage to fully recover from a heart attack and return to normal life. But most patients are still forced to limit themselves in physical activity, regularly take medications and adhere to proper nutrition in order to prolong life and minimize the risk of a recurrent attack.

Rehabilitation lasts from six months to a year. It includes:

Physical therapy, initially with a minimal load, which gradually increases. Its goal is to normalize blood circulation, improve lung ventilation, and prevent congestion. Simple exercises are also used as a method of assessing the dynamics of recovery: if, a few weeks after an attack, the patient can climb the 3-4th floor of the stairs without shortness of breath, it means that he is on the mend.
Physiotherapeutic procedures.
Diet therapy. After a heart attack, it is worth significantly reducing the consumption of fatty, fried, smoked foods - foods that increase blood viscosity and cholesterol levels. It is worth increasing the amount of fiber and foods rich in vitamins and minerals. Especially needed at this time are iron (found in the liver), potassium and magnesium, which improve the condition of the heart muscle - they can be “gleaned” from fresh and dried fruits and nuts.

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Myocardial infarction and cerebral stroke are firmly ranked first in the world in mortality. We are used to hearing that one of our neighbors, colleagues, or relatives suffered a heart attack. For us, this disease is present somewhere nearby.

What it is? Myocardial infarction is a form of coronary heart disease (CHD), which can be considered a complication, since it is a condition in which the heart muscle experiences a severe lack of oxygen and nutrients.

Thus, in 2011, 13 million people died from heart attacks worldwide. This is more than the populations of Denmark and Israel combined. If we take our country, then in Russia the mortality rate from acute myocardial infarction has broken all possible and impossible records and, according to 2012 data, amounted to 587 cases per 100 thousand population, including old people and infants. This means that within a year, every one of the 165 people you know or pass by will die from a heart attack.

In Russia, 43% of men who die from this disease die in the prime of life, or, as dry statistics say, “at economically active age.” If we take developed countries, then this figure is four times lower.

A third of patients with a heart attack die in the first 24 hours from the onset of the disease. This is partly caused by delaying emergency hospitalization until they “get it,” since 50% of them die before meeting doctors.

But even if the patient managed to be taken to the hospital and treated, then after discharge, which was done according to all the rules and with normalization of tests, 5-15% of those discharged will die within a year, and each subsequent year will claim the life of every 20th person (5 % in year). Therefore, coronary heart disease, and its most dangerous manifestation – myocardial infarction – is a very serious disease.

More men fall ill and die than women. Thus, myocardial infarction in women and men (incidence) correlates, according to various sources, from 1:2 to 1:6, depending on age. What kind of disease is this, how does it manifest itself, and how to treat it?

Acute myocardial infarction - what is it?

Acute myocardial infarction is the rapid death or necrosis of a part of the heart muscle due to a severe lack of blood supply to this area.

To avoid confusion, it should be said that a heart attack is a standard pathological process caused by blockage of a vessel bringing arterial blood to an organ. Thus, an infarction of the kidney and spleen occurs. Cerebral infarction has received its own name - stroke.

And myocardial infarction is so significant in terms of the number of victims that it is simply called a heart attack. Why does this pathology develop?

Causes of myocardial infarction, risk factors

If the coronary vessels that carry blood to the heart are healthy, then a heart attack will not develop. After all, its cause is three successive events, and a prerequisite is the presence of atherosclerosis and plaque inside the vessel:

External release of adrenaline and acceleration of coronary blood flow. This is an ordinary situation, for example, anxiety at work, stress, high blood pressure, or physical activity, which may be very small;
An increase in blood velocity in the lumen of the coronary vessel damages and ruptures the atherosclerotic plaque;
After this, at the site of the rupture, the blood forms a durable clot, which falls out when the blood interacts with the plaque substance. As a result, blood flow below the accident site either stops or sharply decreases.

Most often, newly formed, “young” and unstable plaques disintegrate. The problem is that old plaques “sit” firmly, even if they block 70% of the lumen of the vessel, and young plaques that block 40% may be the cause. What causes plaques to form?

Risk factors

It is unlikely that new studies can add another risk factor to the existing ones. All of them are well studied:

age of men over 40 years, women over 50 years;
the presence of heart attacks or sudden cardiac death in relatives;
smoking;
overweight or obesity. The easiest way to determine it is by waist circumference: the norm for men is no more than 102, and for women – no more than 88 cm;
physical inactivity and decreased physical activity;
hypercholesterolemia – increased content of cholesterol, its atherogenic fraction;
presence of a diagnosis of arterial hypertension, or essential hypertension;
diabetes;
constant stress.

As you can see, only the first two factors cannot be changed in any way - they are unmodifiable. But the rest can be handled quite well!

In the same case, when a heart attack develops, how does it proceed? What are its symptoms?

The first signs and symptoms of myocardial infarction

Signs of myocardial infarction can be very diverse. But when making a diagnosis, looking ahead, we will say that in addition to the external picture of the disease, ECG data are taken into account, as well as the results of laboratory tests of some enzymes contained in the muscles that enter the blood during a heart attack

Characteristic first signs of a heart attack

The main symptom is acute chest pain (70-90% of all cases). It lasts more than 20 minutes, “rolling” in attacks. Each subsequent attack is stronger than the previous one.

The nature of the pain is excruciating, pressing, gnawing, squeezing. It is immediately clear that the pain is “serious because it has never happened before”;
Localization of pain is usually behind the sternum, or in the projection of the heart (50%). In 25% of cases, pain occurs in the periphery: the left jaw, the left shoulder blade, the left arm and hand, the left shoulder, the spine, and even the pharynx;
The severity of pain, or intensity, varies. In severe cases, patients cannot endure and groan, but sometimes the pain is weak or absent altogether. Most often, this happens with diabetes mellitus, against the background of sensitivity disorders due to. There is “exorbitant” pain, which is not relieved even by morphine and promedol, or is relieved incompletely;
The pain lasts no less than 20 minutes (minimum), but can last for several days, it is not relieved by nitroglycerin, or disappears for a short time with resumption;
An attack is caused by physical activity, from defecation and making the bed to heavy work and sexual intercourse, stress, leaving the house in the cold, swimming in an ice hole, periods of sleep apnea, eating a large meal, and even moving the body from sitting to lying down.

To top it all off, we can say that a heart attack can occur at all, without any provocation, in the midst of complete rest.

What symptoms accompany a heart attack?

Most often, such characteristic accompaniments of acute coronary syndrome occur as:

restlessness, general weakness, or agitation;
fear of death, sweating, sallow complexion, severe pallor;
gastrointestinal symptoms: nausea, diarrhea, vomiting and bloating;
cardiac symptoms: pulse lability, thready pulse, decreased blood pressure;
Cold sweat may appear.

Atypical course options

In addition to the classic, “anginal” myocardial infarction with severe chest pain, you need to be able to diagnose the main “masks”, or atypical variants. These include:

Abdominal option. There is complete confidence that the problem is in the “stomach”. Pain occurs in the abdomen, in the projection of the stomach, in the right hypochondrium, accompanied by nausea and vomiting, bloating;
Asthmatic, which can be a manifestation of acute cardiac asthma: suffocation, shortness of breath, as well as a cough with pink, foamy sputum. More often it indicates acute stagnation in the pulmonary circulation. This happens often during repeated processes;
Arrhythmic option. Almost all symptoms are reduced to heart rhythm disturbances, the pain is mild;
Cerebral, “stroke-like” variant. It causes “floaters” before the eyes, intense dizziness, stupor, fainting, nausea and vomiting.

These variants can be expected in diabetes, in patients with a history of heart attacks, and in old age.

Stages of myocardial infarction

In order to know the “enemy in person”, let’s get acquainted with the periodicity of the disease. What happens in the heart muscle? There are several stages of the disease:

Development, or acute period, up to 6 hours after onset. It is characterized by the most striking symptoms, including on the ECG. By the 6th hour, the formation of the zone of myocardial necrosis ends. This is a critical time. Later, it is no longer possible to restore dead cells.
Acute period – up to 7 days. It is at this time that the greatest number of complications occur, and in the myocardium there are processes of remodeling, or the destruction of dead tissue by macrophages and the formation of pink, young connective tissue at the site of necrosis. She is good to everyone, but, alas, she cannot contract like a muscle;
The period of healing, or scarring. The scar thickens and “matures”; this period ends a month after the attack;
From a month onwards after a heart attack, PICS, or post-infarction cardiosclerosis, is determined. All those problems that have persisted by this period (arrhythmia, heart failure) will most likely remain.

Knowledge about the first symptoms of myocardial infarction is simply necessary for everyone. Here are the amazing numbers:

If you do not consult a doctor, 28% of patients die in the first hour of a heart attack. During the first 4 hours, 40% of patients die; after 24 hours, half of all patients will be dead;
Even if we take Moscow, then within the first 6 hours from the beginning about 8% of all patients end up in a specialized department, and in the USA this is 80%.

Why don’t people call an ambulance immediately, or at least half an hour after the onset of severe, unusual pain? Because Russian people are not accustomed to the fuss around them, and the patience of the Russian people is limitless. However, if you suspect a heart attack, you should immediately do the following:

Pull yourself together;
Put the patient in bed or on the sofa, prohibit him from getting up;
Place nitroglycerin under the tongue, then after 3 minutes again (if the pain does not go away), and then another one;
While the nitroglycerin is working, an ambulance is called;
If possible, open the window and ventilate the room;
If you have equipment, you need to measure your blood pressure, count your pulse, and check it for arrhythmia;
Let the person know that they are not going to abandon him, reassure him. This is very important because with a heart attack there may be a fear of death;
The patient can be given aspirin powder at a dose of 325 mg;
In case of low pressure, you can elevate your legs by placing something under them.

This completes your participation in first aid for acute myocardial infarction, and all that remains is to wait for the cardiac team. Doctors immediately give oxygen, record an ECG, administer narcotic analgesics in case of severe pain, and if the diagnosis is 100% certain, they perform thrombolysis at home to dissolve the blood clot and allow blood to “break through” to the affected area of the heart muscle.

Remember: necrosis (necrosis) is completed after 6 hours, so only within this time it is necessary to restore blood flow (recanalize) the thrombus. Therefore, the ideal option would be for doctors to arrive no later than the first hour after the onset of the illness.

But how to diagnose a heart attack? What helps doctors make the correct diagnosis?

Diagnosis of heart attack - ECG, tests and ultrasound

First of all, a diagnosis of heart attack is assumed, based on the patient’s complaints, examination and medical history (presence of risk factors, angina). Instrumental diagnosis of classic acute coronary thrombosis is quite simple.

In the diagnosis of acute myocardial infarction, determining the level of enzymes is of great help: CPK-MB, creatine phosphokinase, which increases 3 hours after the onset of necrosis, reaches a maximum by the end of the first day, and after another day returns to normal. Troponins are examined and a troponin test is performed. In the general blood test, ESR and leukocytosis increase.

Cardiac ultrasound and other research methods are also used in diagnosis.

Complications of a heart attack, features

It is known that, in principle, a person does not die from an uncomplicated heart attack. Death occurs from complications. What are the complications of coronary thrombosis? Isn't a dead section of the heart enough? It turns out not enough. A heart attack can be complicated by:

Pulmonary edema (shortness of breath, cyanosis, cold sweat, cough with foamy sputum, wheezing, foam at the mouth);
Cardiogenic shock, which develops against the background of an extensive heart attack and is associated with a decrease in cardiac function, includes pain and arrhythmic shock;
Ventricular fibrillation, which is the most dangerous rhythm disorder. Without defibrillation, death is inevitable. Develops already in the first hours after the onset of a heart attack;
Ventricular extrasystoles, idioventricular rhythm and other arrhythmias;
Impulse conduction disorders and severe blockades;
Asystole (complete electrical “silence” of the heart);
Rupture of the heart (wall of the left ventricle). Occurs with an extensive transmural zone of necrosis;
Intracavitary thrombosis;
Rupture of the interventricular septum and separation of papillary muscles and heart valves.

In addition to these very severe complications, some of which are certainly fatal, myocardial necrosis in the right ventricle may occur as a complication of necrosis on the left.

To top it all off, after a large number of muscle structures enter the bloodstream, Dressler's syndrome develops, associated with autoimmune inflammation, and is manifested by fever, polyarthritis and pericarditis. It occurs 2 weeks after a heart attack.

In order to avoid complications, including fatal ones, hospitalization for myocardial infarction is needed as early as possible.

Treatment of myocardial infarction, drugs

Competent treatment of acute myocardial infarction has its own goals. We will not talk here about pain relief, oxygen supply, or actions in case of sudden cardiac arrest. We will talk about the principles of treatment of ordinary and uncomplicated myocardial infarction in the most general and accessible form.

Thrombolysis

If you try to dissolve a fresh thrombus, then the chances of restoring 55% of the necrosis zone are available in the first 1.5 hours from the onset of a heart attack; by the end of the 6th hour this percentage drops to 15%. If you consult a doctor later, thrombolysis is pointless.

Think about it: a delay in thrombolysis of half an hour shortens the patient's life by a year, and an hour's delay leads to an increase in the risk of death by 20% per year even 5 years after a heart attack.

Heparin and anticoagulants

It is known that a week of heparin use reduces mortality by 60%. At the same time, blood fluidity increases and thrombotic complications, for example, inside the chambers of the heart, are prevented. Low molecular weight heparins are currently used.

Antiplatelet therapy

Prevents the formation of new blood clots. For this, “cardiac” aspirin is used in a dose of 75 to 325 mg. Clopidogrel, which is prescribed after illness for a year, is highly effective.

Nitrates

These drugs facilitate the work of the heart, reduce vascular spasm and reduce the load on the heart, improving the outflow from it, since blood is deposited in the vessels of the skin and muscles. The drugs are taken both in the form of an inhalation spray and in the form of tablets and infusions.

BAB (beta-blockers)

They protect the heart from increased work in case of adrenaline release into the blood. As a result, the need for raw oxygen does not increase, ischemia does not occur, and there is no heartbeat. This mode of heart operation can be called “energy saving”.

ACE inhibitors

In addition to the fact that angiotensin-converting enzyme inhibitors prevent an increase in blood pressure, they reduce the myocardial oxygen demand, and also prevent the appearance of atherosclerotic plaques and slow down their growth. As a result, they reduce the risk of recurrent heart attack and mortality.

In addition to these drugs, which are prescribed in various combinations to almost all patients, statins are prescribed that correct fat metabolism (after discharge), calcium blockers, and aldosterone receptor blockers in patients with a pronounced decrease in systolic output.

Surgical treatment of heart attack

In case of acute myocardial infarction, the following can be performed:

PCBA, or percutaneous balloon coronary angioplasty. It allows you to restore blood flow and implant a stent, and is an alternative to thrombolysis. The disadvantage is the impossibility of performing PCI after 12 or more hours from the onset of a heart attack, as well as the high cost. The purpose of the operation is to mechanically expand the vessel in the area of thrombosis, “press” the thrombus into the wall of the vessel and install a rigid tube - a stent.
CABG, or coronary artery bypass grafting. As a rule, it is performed no earlier than a week after the development of thrombosis, due to the high risk of early complications. The purpose of the operation is to build new vascular “bridges” and improve myocardial vascularization.
Intra-aortic balloon counterpulsation. This is a method of unloading the heart in both systole and diastole by installing a balloon in the aorta. It is performed in case of cardiogenic shock, septal rupture and is regarded as a temporary effect before surgery.

We have talked enough about what it is - myocardial infarction, and what the consequences and prognosis may be if you do not seek urgent help in a timely manner. Rehabilitation after myocardial infarction aims to reduce the social, physical and even psychological consequences of the disease, and prevent the possibility of relapse and other fatal complications.

It is known that, unlike a stroke, after a heart attack, about 80% return to normal (everyday) life after six months, and in the case of a mild course, after 2-3 months. As for professional rehabilitation, patients who have suffered a heart attack can no longer work as pilots, machinists, dispatchers, or in other responsible jobs.

An important component of rehabilitation is the treatment of post-infarction depression, which occurs in every 20th patient.

Physical rehabilitation involves increasing physical activity, which, with a competent approach (physical therapy), can reduce mortality by a quarter.

The main thing in rehabilitation is the identification of four functional classes and the correspondence of programs to their capabilities.

Patients should have different levels of physical activity, depending on the severity of the condition, the presence of post-infarction angina, and arrhythmias. Thus, class 1 has no restrictions at home, and in patients of class 4, any physical activity provokes angina attacks.

Also important is nutrition, prevention of weight gain, taking antiplatelet agents, statins under the control of biochemical blood tests, maintaining normal blood pressure levels and treating concomitant diseases - for example, diabetes or arterial hypertension.

This is the only way to reduce the risk of recurrent myocardial infarction and its long-term complications.