Diagnosis The first signs and symptoms of acute myocardial infarction. Signs of a heart attack in a woman

What it is? A heart attack is a form of coronary heart disease, which is necrosis of the heart muscle caused by a sudden cessation of coronary blood flow due to damage to the coronary arteries. The disease is the leading cause of death among adults in developed countries. The frequency of myocardial infarction directly depends on the gender and age of a person: men get sick approximately 5 times more often than women, and 70% of all sick people are between 55 and 65 years old.

What is a heart attack?

Myocardial infarction is necrosis of a section of the heart muscle, the cause of which is a circulatory disorder - a critical decrease in blood flow through the coronary vessels.

The risk of death is especially high in the first 2 hours after its onset and decreases very quickly when the patient is admitted to the intensive care unit and undergoes clot dissolution, called thrombolysis or coronary angioplasty.

1. With an extensive area of ​​necrosis, most patients die, half before arriving at the hospital. 1/3 of surviving patients die from repeated heart attacks, which occur within a period of several days to a year, as well as from complications of the disease.
2. The average mortality rate is about 30-35%, of which 15% is sudden cardiac death.
3. Cardiologists note that in the male population, heart attacks occur much more often, because in the female body, estrogens control the level of cholesterol in the blood. If previously the average age for developing a heart attack was 55-60 years, now it is relatively younger. Cases of pathology are diagnosed even in young people.

Periods of development

There are five periods in the clinical course of myocardial infarction:

• 1st period – pre-infarction (prodromal): increased frequency and intensification, can last several hours, days, weeks;
• period 2 – the most acute: from the development of ischemia to the appearance of myocardial necrosis, lasts from 20 minutes to 2 hours;
• 3rd period – acute: from the formation of necrosis to myomalacia (enzymatic melting of necrotic muscle tissue), duration from 2 to 14 days;
• 4th period – subacute: initial processes of scar organization, development of granulation tissue in place of necrotic tissue, duration 4-8 weeks;
• Period 5 – post-infarction: scar maturation, adaptation of the myocardium to new operating conditions.

Important to remember: If heart pain bothers you for ten to twenty minutes, or even more so for about half an hour, and does not go away after taking nitrates, you should not endure the pain, you must definitely call an ambulance!

Classification

If we consider the stages of the disease, there are four of them, each of which is characterized by its own symptoms. The size of the affected area is also taken into account in the classification. Highlight:

• Large-focal infarction, when tissue necrosis covers the entire thickness of the myocardium.
• Finely focal, a small part is affected.

By location they are distinguished:

• Right ventricular infarction.
• Left ventricle.
• Interventricular septum.
• Side wall.
• Rear wall.
• Anterior wall of the ventricle.

A heart attack can occur with or without complications, so cardiologists distinguish:

• Complicated heart attack.
• Uncomplicated.

By frequency of development:

• primary;
• recurrent (occurring up to two months after the initial infarction);
• repeated (occurs two or more months after the primary).

According to the location of the pain syndrome:

• typical form (with retrosternal localization of pain);
• atypical forms of myocardial infarction (all other forms - abdominal, cerebral, asthmatic, painless, arrhythmic).

There are 3 main periods of heart attack

During myocardial infarction there are three main periods. The duration of each directly depends on the area of ​​the lesion, the functionality of the vessels supplying the heart muscle, associated complications, the correctness of treatment measures, and the patient’s compliance with the recommended regimens.

The first signs of a heart attack in adults

Some people are familiar with such a disease as a heart attack - its symptoms and first signs cannot be confused with other diseases. This disease affects the heart muscle, often caused by a disruption in its blood supply due to blockage of one of the heart arteries by atherosclerotic plaques. The affected muscle dies and necrosis develops. Cells begin to die 20 minutes after the blood flow stops.

You should learn and remember the first signs of myocardial infarction:

1. the sternum and heart begin to ache very much, perhaps the entire surface of the chest, the pain is pressing, it can radiate to the left arm, back, shoulder blade, jaw;
2. the pain lasts more than 20–30 minutes, is recurrent, that is, recurring in nature (it subsides, then recurs);
3. pain is not relieved by nitroglycerin;
4. the body (forehead, chest, back) is covered profusely with cold, sticky sweat;
5. there is a feeling of “lack of air” (the person begins to suffocate, and as a result, panic);
6. severe weakness is felt (difficulty raising your arm, too lazy to take a pill, a desire to lie down without getting up).

If at least one, and even more so several of these signs are present during illness, then there is a suspicion of myocardial infarction! You should urgently call zero-three, describe these symptoms and wait for a team of doctors!

Causes

The main and most common cause of myocardial infarction is a violation of blood flow in the coronary arteries, which supply the heart muscle with blood and, accordingly, oxygen.

Most often this disorder occurs against the background of atherosclerosis of the arteries, in which the formation of atherosclerotic plaques occurs on the walls of blood vessels.

If a heart attack develops, the causes may be different, but the main one is the cessation of blood flow to certain areas of the heart muscle. This most often occurs due to:

• Atherosclerosis of the coronary arteries, as a result of which the walls of blood vessels lose their elasticity, the lumen is narrowed by atherosclerotic plaques.
• Spasm of the coronary vessels, which can occur due to stress, for example, or exposure to other external factors.
• Arterial thrombosis, if a plaque breaks off and is carried through the bloodstream to the heart.

Most often, a heart attack affects people suffering from a lack of physical activity against the background of psycho-emotional overload. But it can also defeat people with good physical fitness, even young ones.

The main reasons contributing to the occurrence of myocardial infarction are:

• overeating, unhealthy diet, excess animal fats in food;
• insufficient physical activity,
• hypertonic disease,
• bad habits.

The likelihood of developing a heart attack in people leading a sedentary lifestyle is several times greater than in people who are physically active.

Symptoms of myocardial infarction in adults

The symptoms of myocardial infarction are quite characteristic and, as a rule, make it possible to suspect it with a high degree of probability even in the pre-infarction period of the disease. Thus, patients experience longer and more intense chest pain, which is less responsive to treatment with nitroglycerin, and sometimes does not go away at all.

Shortness of breath, sweating, various arrhythmias and even nausea may occur. At the same time, patients are finding it increasingly difficult to endure even minor physical activity.

Unlike an attack of angina, pain syndrome during myocardial infarction persists for more than 30 minutes and does not resolve with rest or repeated administration of nitroglycerin.

It should be noted that even in cases where a painful attack lasts more than 15 minutes, and the measures taken are ineffective, it is necessary to immediately call an ambulance team.

What are the symptoms of myocardial infarction in the acute period? The typical course of the pathology includes the following symptom complex:

• Severe pain in the chest - piercing, cutting, stabbing, bursting, burning
• Radiation of pain to the neck, left shoulder, arm, collarbone, ear, jaw, between the shoulder blades
• Fear of death, panic state
• Shortness of breath, chest tightness
• Weakness, sometimes loss of consciousness
• Paleness, cold sweat
• Blue discoloration of the nasolabial triangle
• Increase in pressure, then its drop
• Arrhythmia, tachycardia

Atypical forms of myocardial infarction:

• Abdominal. The symptoms mimic a surgical disease of the abdominal cavity - abdominal pain, bloating, nausea, and drooling appear.
• Asthmatic. Characterized by shortness of breath, impaired exhalation, acrocyanosis (blue discoloration of the lips, edges of the ears, nails).
• Cerebral. Brain disorders come first - dizziness, confusion, headache.
• Arrhythmic. Attacks of increased heart rate and extraordinary contractions (extrasystoles) occur.
• Edema form. Peripheral soft tissue edema develops.

In atypical forms of myocardial infarction, pain can be much less severe than in typical forms; there is a painless variant of the course of the disease.

If you have symptoms, you should urgently call an ambulance, before her arrival, you can take nitroglycerin tablets (0.5 mg) at intervals of 15 minutes, but no more than three times, so that a sharp drop in pressure does not occur. The risk zone is predominantly for older people and active smokers.

Diagnostics

If you have symptoms resembling myocardial infarction, you should call an ambulance. A patient with a heart attack is treated by a cardiologist, who also provides rehabilitation and follow-up care after the illness. If stenting or bypass surgery is necessary, it is performed by a cardiac surgeon.

When examining the patient, pallor of the skin, signs of sweating are noticeable, and cyanosis (cyanosis) is possible.

A lot of information will be provided by such methods of objective research as palpation (feeling) and auscultation (listening). So, with palpation you can identify:

• Pulsation in the area of ​​the cardiac apex, precordial zone;
• Increased heart rate to 90 - 100 beats per minute.

After the ambulance arrives, the patient, as a rule, undergoes an urgent electrocardiogram, according to the readings of which the development of a heart attack can be determined. At the same time, doctors collect anamnesis, analyzing the time of onset of the attack, its duration, pain intensity, its localization, irradiation, etc.

In addition, acutely occurring bundle branch block may be indirect signs of the development of a heart attack. Also, the diagnosis of myocardial infarction is based on the detection of markers of damage to the muscle tissue of the heart.

Today the most convincing (obvious) marker This type can be considered an indicator of troponin in the blood, which will be significantly increased when the described pathology occurs.

Troponin levels may rise sharply in the first five hours after a heart attack and may remain elevated for up to twelve days. In addition, to detect the pathology in question, doctors can prescribe echocardiography.

The most important diagnostic signs of myocardial infarction are the following:

• prolonged pain syndrome (more than 30 minutes), which is not relieved by nitroglycerin;
• characteristic changes in the electrocardiogram;
• changes in the general blood test: increased ESR, leukocytosis;
• deviation from the norm of biochemical parameters (appearance of C-reactive protein, increased levels of fibrinogen, sialic acids);
• the presence in the blood of markers of myocardial cell death (CPK, LDH, troponin).

Differential diagnosis of the typical form of the disease does not present any difficulties.

First aid for heart attack

Emergency medical care for myocardial infarction includes:

1. Sit or lay the person in a comfortable position, free his torso from tight clothing. Provide free air access.

2. Give the victim the following to drink:

• Nitroglycerin tablet, for severe attacks, 2 pieces;
• Corvalol drops - 30-40 drops;
• Acetylsalicylic acid tablet (Aspirin).

These medications help relieve the pain of a heart attack, as well as minimize a number of possible complications. In addition, Aspirin prevents the formation of new blood clots in blood vessels.

Treatment

In case of myocardial infarction, emergency hospitalization in a cardiac intensive care unit is indicated. In the acute period, the patient is prescribed bed rest and mental rest, fractional meals limited in volume and calorie content. In the subacute period, the patient is transferred from intensive care to the cardiology department, where treatment of myocardial infarction continues and the regimen is gradually expanded.

Medications

In case of an acute attack, the patient must be admitted to a hospital. In order to restore blood supply to the lesion during myocardial infarction, thrombolytic therapy is prescribed. Thanks to thrombolytics, plaques in the myocardial arteries dissolve and blood flow is restored. It is advisable to start taking them in the first 6 hours after MI. This minimizes the risk of an unfavorable outcome of the disease.

Treatment tactics and first aid during an attack:

• Heparin;
• Aspirin;
• Plavix;
• Prasugrel;
• Fraxiparine;
• Alteplase;
• Streptokinase.

For pain relief the following are prescribed:

• Promedol;
• Morphine;
• Fentanyl with droperidol.

After completion of hospital treatment, the patient should continue medication therapy. It is necessary for:

• maintaining low blood cholesterol levels;
• restoration of blood pressure indicators;
• prevention of blood clots;
• fight against swelling;
• restoring normal blood sugar levels.

The list of medications is individual for each person, depending on the extent of the myocardial infarction suffered and the initial level of health. In this case, the patient should be informed about the dosage of all prescribed medications and their side effects.

Nutrition

The diet for myocardial infarction is aimed at reducing body weight and is therefore low-calorie. Products with a high content of purines are excluded, as they have a stimulating effect on the nervous and cardiovascular systems, which leads to impaired blood circulation and kidney function and aggravates the patient’s condition.

List of prohibited foods after a heart attack:

• bread and flour products: fresh bread, baked goods, baked goods from various types of dough, pasta;
• fatty meats and fish, rich broths and soups made from them, all types of poultry, except chicken, fried and grilled meat;
• lard, cooking fats, offal, cold appetizers (salted and smoked foods, caviar), stewed meat;
• canned food, sausages, salted and pickled vegetables and mushrooms;
• egg yolks;
• confectionery products with rich cream, limited sugar;
• legumes, spinach, cabbage, radish, radish, onion, garlic, sorrel;
• fatty dairy products (whole milk, butter, cream, high-fat cottage cheese, sharp, salty and fatty cheeses);
• coffee, cocoa, strong tea;
• chocolate, jam;
• seasonings: mustard, horseradish, pepper;
• grape juice, tomato juice, carbonated drinks.

In the acute period of the disease, the following nutrition is indicated:

• porridge on the water,
• vegetable and fruit puree,
• pureed soups,
• drinks (juices, tea, compotes),
• lean beef, etc.

Limit salt and liquid intake. From the 4th week after a heart attack, a diet enriched with potassium is prescribed. Such a microelement can significantly improve the outflow of all excess fluid from the body, enhancing the contractile ability of the myocardium. Potassium-rich foods: prunes, dried apricots, dates.

Surgery

In addition to drug therapy, surgical methods are sometimes used to treat a heart attack and its complications. Such measures are resorted to for special indications.

Rehabilitation after a heart attack

After a myocardial infarction, cardiologists recommend the following:

• Avoid work that involves moving heavy objects.
• You definitely need to pay attention to physical therapy. Walking and cycling will be useful. Swimming and dancing are allowed.
• Bad habits must be forgotten forever. Coffee consumption should be reduced to a minimum.
• A prerequisite is diet. Your diet should include fiber and vegetables, fruits and dairy products, as well as fish.
• It is important to constantly measure your blood pressure and at the same time monitor your sugar levels.
• You can't stay in the sun for a long time.
• If you have extra pounds, you need to try to bring your weight back to normal.

Forecast for life

Regarding prognosis, they directly depend on the extent of damage to the heart muscle, as well as on the timeliness and quality of emergency care. Even if there are no serious complications after an acute heart attack, absolute recovery cannot be guaranteed. If the area of ​​myocardial damage is large, it will not be able to fully recover.

In the future, a person will suffer from cardiovascular problems. This requires constant monitoring by a cardiologist. According to statistics, within a year after an attack, relapse occurs in 20-40% of cases. To avoid this, you must carefully follow all established recommendations of a specialist.

Prevention

Preventive measures aimed at preventing myocardial infarction include eliminating risk factors, adjusting nutrition and physical activity.

Typically, prevention includes the following steps:

• Exclusion from the diet of foods high in salt, semi-finished products, canned food, sausages. Avoid fatty foods and fried foods.
• Increase physical activity. Helps improve oxygen transport throughout the body, preventing oxygen starvation and tissue necrosis.
• Quitting bad habits: completely stopping smoking and drinking alcohol.
• Adding fresh fruits and vegetables, cereals, and high-fiber foods to your diet. You should give preference to steamed or baked products.

Consequences of a heart attack for humans

The consequences of myocardial infarction always negatively affect the condition of the entire organism. Of course, this depends on how extensive the myocardial damage is.

It is extremely rare that such a terrible disease passes without a trace; in most cases, the consequences of a heart attack, in the form of complications, significantly reduce life expectancy.

The most common complications that develop are:

• cardiogenic shock;
• acute cardiovascular failure;
• heartbreak;
• cardiac aneurysm;
• heart rhythm disturbances;
• early post-infarction angina;

The mortality rate for a heart attack is 10-12%, while other statisticians note that only half of the victims reach a medical facility, but even if a person survives, a scar remains at the site of death of the heart tissue for the rest of his life. Therefore, it is not surprising that many people who have had a heart attack become disabled.

Be healthy and monitor your well-being constantly. In case of deviation and the appearance of unpleasant symptoms, be sure to contact a cardiologist for a diagnosis!

This is all about myocardial infarction: what is the history of the disease, its first signs and main symptoms in women and men, features of treatment.

Cardiovascular diseases are practically the first cause of death in many countries. One of the most common pathologies is a heart attack. What kind of disease is this, for what reason does it develop, is it possible to prevent the disease and how to help the patient? We will try to answer all these questions in detail.

Heart attack - what is it?

Almost everyone knows that this is a dangerous condition, but the mechanism and causes of development are not always of interest, although this must be known in order to prevent such a pathology. A heart attack develops as a result of a disruption in the blood supply to areas of the heart muscle.

This pathology is also called one of the forms of the heart. If the blood supply is disrupted for more than 15-20 minutes, then necrosis of living tissue occurs, which is accompanied by severe pain and can be fatal.

Cardiologists note that in the male population, heart attacks occur much more often, because in the female body, estrogens control the level of cholesterol in the blood. If before the development of a heart attack was 55-60 years, now it is relatively younger. Cases of pathology are diagnosed even in young people.

A heart attack does not always end in death for a person, but you need to know that after an incident there is always a scar left on the heart, so many patients become disabled after suffering such a disease.

How does a heart attack develop?

The formation of a heart attack begins long before its manifestation. It all starts with the formation of atherosclerotic plaques, which begin to form in blood vessels from bad cholesterol. The culprits of its appearance in the blood are dietary errors and a sedentary lifestyle. These plaques gradually narrow the lumen of the blood vessels, disrupting normal blood circulation.

The process gradually worsens, the plaques become so large that any pathological impact on them leads to rupture. At this point, the blood coagulates, forming a blood clot, which clogs the vessel, preventing blood from passing further. This is exactly the process that occurs in the heart area during a heart attack.

Reasons for the development of pathology

If a heart attack develops, the causes may be different, but the main one is the cessation of blood flow to certain areas of the heart muscle. This most often occurs due to:

• Atherosclerosis, as a result of which the walls of blood vessels lose their elasticity, the lumen is narrowed by atherosclerotic plaques.
• which can occur due to stress, for example, or exposure to other external factors.
• Arterial thrombosis, if a plaque breaks off and is carried through the bloodstream to the heart.

Factors that can provoke such conditions include:

• Hereditary predisposition to heart pathologies.
• High levels of “bad” cholesterol in the blood.
• Having a bad habit such as smoking.
• Too much body weight.
• Arterial hypertension.

• Diabetes.
• A large amount of fatty foods in the diet.
• Chronic stress.
• Some doctors also note the influence of psychosomatics, when the cause of a heart attack is excessive aggression and intolerance.
• Belonging to the stronger sex.
• Low physical activity.
• Age after 40 years.

It is necessary to take into account that if there is a combination of several factors, the risk of developing a heart attack increases.

Types of disease

If we look at a pathology such as a heart attack (we have already found out what it is), then cardiologists distinguish several forms of pathology depending on several criteria.

If we consider the stages of the disease, there are four of them, each of which is characterized by its own symptoms. The size of the affected area is also taken into account in the classification. Highlight:

• Large-focal infarction, when tissue necrosis covers the entire thickness of the myocardium.
• Finely focal, a small part is affected.

By location they are distinguished:

• Right ventricular infarction.
• Left ventricle.
• Interventricular septum.
• Side wall.
• Rear wall.
• Anterior wall of the ventricle.

A heart attack can occur with or without complications, so cardiologists distinguish:

• Complicated heart attack.
• Uncomplicated.

The localization of pain can also be different, so the following types of heart attacks are distinguished:

• Typical form with chest pain.
• The atypical form can be manifested by abdominal pain, shortness of breath, heart rhythm disturbances, dizziness and headache. Sometimes a heart attack develops in the absence of pain.

Types of heart attacks are also distinguished depending on the frequency of development:

• Primary pathology.
• Recurrent
• Repeated.

Life after a heart attack will depend on the severity of the pathology, its form and timely assistance provided.

Stages of heart attack development

Necrotic changes in the heart muscle develop in some sequence, therefore the following stages of infarction are distinguished:

1. Pre-infarction condition. The duration of this period ranges from several hours to several weeks, at which time small foci of necrosis are already forming in the heart muscle, and in their place a heart attack then develops.
2. The most acute period can last from several minutes to 2 hours. Myocardial ischemia increases.
3. The acute stage of a heart attack lasts several days. During this period, a focus of necrosis forms in the heart and partial resorption of damaged muscle tissue is observed.
4. The post-infarction stage can last up to six months; the connective tissue scar is completely formed.

Diagnosis of myocardial infarction

Making a diagnosis begins with a conversation with the patient. The doctor finds out when the pain began, what nature it has, how long it lasts, how the patient relieves heart attacks, and whether there is any result from taking medications.

Then risk factors are necessarily identified; for this, the doctor clarifies the features of lifestyle, culinary preferences, and the presence of bad habits. A family history is analyzed - the doctor finds out if anyone in the family has heart disease, or whether there have been cases of heart attack.

1. A general blood test is done, it allows you to detect an increased level of leukocytes, a high erythrocyte sedimentation rate, signs of anemia - all this begins to appear when the cells of the heart muscle are destroyed.
2. A urine test will help detect concomitant pathologies that can provoke heart attacks.
3. A biochemical blood test is performed to determine:

• cholesterol content;
• the ratio of “bad” and “good” cholesterol;
• presence of triglycerides;
• blood sugar levels to assess the risk due to vascular atherosclerosis.

If there is a suspicion of a heart attack, then a study of specific blood enzymes is carried out.

A coagulogram is done; it gives indicators of blood clotting, which help to choose the correct dosage of drugs for treatment.

Diagnosis of myocardial infarction is impossible without electrocardiography. Based on the results, a specialist can determine the localization of the pathology, how long ago it developed and the degree of damage.

An ultrasound examination of the heart is performed to study the structure and size of the heart muscle, to assess the degree of damage to blood vessels by atherosclerotic plaques.

X-rays help identify changes in the thoracic aorta, lungs and detect complications.

Coronary angiography is used to clarify the diagnosis; it allows you to accurately determine the location and degree of vasoconstriction.

With contrast, it allows you to obtain an accurate image of the heart, identify defects in its walls, valves, abnormalities in functioning and narrowing of blood vessels.

After all the research, you may need to consult a therapist.

Only after the diagnosis has been clarified, the patient is prescribed effective therapy, which will help bring life back to normal after a heart attack.

Symptoms of pathology

As a rule, a heart attack does not develop out of nowhere; usually the patient has already been diagnosed with angina or other cardiac pathologies. If a heart attack develops, the symptoms and first signs in women and men may be as follows:

• Chest pain becomes more intense and prolonged. The pain has a burning character, squeezing and squeezing is felt, and can radiate to the shoulder, arm or neck.

• Irradiation and expansion of the pain zone appears.
• The patient cannot tolerate physical activity.
• Taking Nitroglycerin no longer gives such an effect.
• Even at rest, shortness of breath, weakness and dizziness appear.
• There may be discomfort in the stomach.
• The heart rhythm is disturbed.
• Breathing becomes difficult.
• Cold sweat appears, the skin turns pale.

If at least some of the listed symptoms appear, you should urgently call a doctor.

First aid to a patient

If there is a suspicion of a heart attack, the symptoms and first signs in women will only progress if emergency assistance is not provided. It is as follows:

• The person must be seated or placed in a comfortable position.

• Unfasten tight clothing.
• Provide air access.
• Give a Nitroglycerin tablet under the tongue, if the attack is severe, then two are possible.
• If there is no Nitroglycerin, then you can use Corvalol or Aspirin.

Emergency care for a heart attack will help relieve pain during an attack and reduce the risk of complications.

Complications after a heart attack

It very rarely happens that a heart attack goes away without complications; there are almost always consequences. They reduce life expectancy after suffering from pathology. The most commonly diagnosed complications are:

• Heart failure.
• Rupture of the heart muscle.
• Aneurysm.
• Cardiogenic shock.
• Heart rhythm disturbances.

• Post-infarction angina.
• Pericarditis.

A heart attack can also have late consequences, for example:

• After a few weeks, post-infarction syndrome may develop.
• Thromboembolic complications are common.
• Neurotrophic disorders of the nervous system.

Many patients are interested in the question of how long can one live after a heart attack? The answer will depend on several factors: the degree of damage to the heart muscle, the timeliness of first aid, the effectiveness and correctness of therapy, and the development of complications.

According to statistics, about 35% of patients die, most of them, without even reaching a medical facility. Those patients who have suffered a heart attack are most often forced to change their field of activity or leave work altogether; many receive disability.

How to prevent another heart attack or even prevent its occurrence

Everyone now understands about a heart attack that it is a very serious disease that can result in death or leave you disabled. But everything is in the hands of the person himself - if you follow some recommendations, you can significantly reduce the risk of developing this pathology:

1. Keep your blood pressure level under control at all times, especially if it increases periodically.
2. Monitor your blood sugar levels.
3. In summer, avoid being in direct sunlight for long periods of time.
4. It is necessary to reconsider your diet, reduce the consumption of fatty foods, processed foods and add fresh vegetables and fruits.
5. Increase physical activity, you don’t have to go to the gym, it’s enough to take walks every day, walk a lot, ride a bike.
6. If health is more important, then you will have to give up smoking and alcohol abuse, and also not get carried away with coffee.
7. Keep your weight normal; if you can’t reduce it on your own, you can visit a nutritionist who will help you create an individual nutrition program.
8. If you have chronic diseases, they need to be treated periodically, especially for heart pathologies and vascular diseases.
9. If your relatives have been diagnosed with myocardial infarction, then you should take your health more seriously and avoid heavy physical labor.
10. Every year you need to arrange a good rest for yourself away from the bustle of the city; you can go to the mountains or to the sea coast.
11. Expose yourself to psycho-emotional stress as little as possible, learn relaxation techniques.
12. Be regularly examined and take all necessary tests to promptly detect elevated blood sugar or cholesterol levels.

If a heart attack could not be avoided, then every effort must be made to prevent another attack. To do this, you must follow all the doctor’s recommendations, take prescribed medications and change your lifestyle.

Aspirin (acetylsalicylic acid) has been used for decades to prevent thrombosis and coronary artery disease, but long-term use of it can lead to problems with the gastrointestinal tract, such as heartburn, gastritis, nausea, stomach pain, etc.

To reduce the risk of such undesirable consequences, it is necessary to take drugs in a special enteric coating. For example, you can use the drug "Trombo ACC®"*, each tablet of which is coated with an enteric film coating that is resistant to the effects of stomach hydrochloric acid and dissolves only in the intestines. This avoids direct contact with the gastric mucosa and reduces the risk of developing heartburn, ulcers, gastritis, bleeding, etc.

* There are contraindications; before use, you must consult a specialist.

Myocardial infarction is the death of a section of the heart muscle caused by an acute circulatory disorder in this section. As statistical studies show, myocardial infarction most often develops in men aged 40 to 60 years. In women, this disease occurs approximately one and a half to two times less often.

Myocardial infarction occurs in patients with coronary heart disease (CHD), atherosclerosis, and arterial hypertension. Risk factors for the development of myocardial infarction include smoking (as it causes a narrowing of the coronary vessels of the heart and reduces the blood supply to the heart muscle), obesity, and lack of physical activity.

At the same time, myocardial infarction may be the first manifestation of IHD.

Unfortunately, myocardial infarction is now one of the main causes of disability in adulthood, and the mortality rate among all patients is 10-12%.

Causes of myocardial infarction

Oxygen and nutrients are delivered to the cells of the heart muscle by a special branched network of vessels called coronary vessels. During myocardial infarction, one of these vessels is blocked by a thrombus (in 95% of cases, a coronary artery thrombus forms in the area of ​​an atherosclerotic plaque). The supply of oxygen to the heart muscle cells fed by the blocked artery will last for 10 seconds. The heart muscle remains viable for about 30 minutes. Then the process of irreversible changes in the cells begins and by the third to sixth hour from the onset of occlusion, the heart muscle in this area dies. Depending on the size of the dead area, large and small focal infarctions are distinguished. If necrosis involves the entire thickness of the myocardium, it is called transmural.

The clinical picture of myocardial infarction is varied, which makes it difficult to make the correct diagnosis as quickly as possible.
The diagnosis is made based on three criteria:

• typical pain syndrome
• changes on the electrocardiogram
• changes in biochemical blood test indicators, indicating damage to heart muscle cells.

In doubtful cases, doctors use additional studies, for example, radioisotope methods to identify the focus of myocardial necrosis.

Symptoms of myocardial infarction

Typically, myocardial infarction shows the following signs:

• prolonged intense squeezing-pressing pain behind the sternum in the heart area, which can radiate to the arm, neck, back or shoulder blade area;
• pain does not go away after taking nitroglycerin;
• pale skin, cold sweat;
• fainting state.

The disease does not always manifest itself in such a classic picture. A person may only feel discomfort in the chest or interruptions in the functioning of the heart. In some cases there is no pain at all. In addition, there are atypical cases of myocardial infarction, when the disease manifests itself as difficulty breathing with shortness of breath or abdominal pain. Such cases are especially difficult to diagnose.

Complications of myocardial infarction

If not treated promptly, myocardial infarction can lead to acute heart failure, cardiogenic shock, cardiac rupture, cardiac arrhythmias, and other dangerous conditions.

Complications associated with myocardial infarction require emergency medical attention.

What can you do

If you notice the symptoms described above in yourself or your loved ones, you should urgently call an ambulance. Before the doctor arrives, first aid should be provided - give the person a comfortable sitting or lying position, give nitroglycerin (dissolved under the tongue) and Corvalol (30-40 drops orally).

What can a doctor do?

To avoid mistakes, at the slightest suspicion of a heart attack, the patient is taken to the hospital as soon as possible. Treatment of myocardial infarction must be carried out in the intensive care unit of the hospital.

Therapy includes painkillers, drugs that help dissolve the formed blood clot, drugs that lower blood pressure, reduce the volume of circulating blood, and reduce the heart rate. The effectiveness of treatment depends on the time elapsed from the onset of the disease to hospital admission.

After hospitalization, an unusually important period of rehabilitation begins, which lasts up to 6 months. The doctor will prescribe the necessary therapy for you. Some medications you will have to take for the rest of your life. However, if you follow the instructions, quit smoking and follow a diet, people after myocardial infarction live a full, healthy life for many years.

Prevention of heart attack

Prevention of myocardial infarction is annual medical examination and timely adequate treatment of chronic diseases such as coronary heart disease, hypertension, atherosclerosis, etc.

The diagnosis of coronary heart disease is the basis for assessing the condition of the coronary arteries using coronary angiography (coronary angiography). Specially taken X-rays allow you to determine the exact location of atherosclerotic plaques and the degree of narrowing of the coronary arteries. If indicated, the found narrowings can be expanded from inside the vessel - this procedure is called coronary angioplasty. In addition, a stent can be implanted into the coronary artery - a metal frame that will maintain the open state of the vessel. In some cases, a complex coronary artery bypass surgery is performed, when additional vessels are inserted between the aorta and the coronary arteries, going around the narrowing of the coronary vessel and creating the opportunity for blood to flow to the heart muscle.

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:

1. Large-focal. Has characteristic signs of acute disturbance of coronary blood flow. The cause of its formation is considered to be an artery that occurs as a result of spasm or the development of necrosis. The name suggests that the resulting thrombus is predominantly large in size. Large-focal also has the name extensive myocardial infarction, since there is a disturbance in blood flow as a whole. As a result, a scar develops based on cell death.
2. Finely focal. The causes of its formation are minor ischemic damage to the heart muscle. It is characterized by a small-sized formation of a blood clot and a mild form of the disease. In rare cases, a small focal heart attack can lead to cardiac rupture or an aneurysm.
3. Atypical forms of myocardial infarction. The main feature of this species is the asymptomatic course of the disease. Mostly, a sign of the disease is detected in the hospital on a cardiogram. An ECG for myocardial infarction of this form is the only way to diagnose and determine the disease. In 1–10% of cases this form of the disease occurs.
4. Anterior infarction. The anterior wall of the left ventricle is predominantly affected.
5. Posterior infarction. Caused by the formation of a blood clot in the coronary aorta. As a result, the posterior wall of the left ventricle is affected.
6. Lower or basal. Characterized by damage to the lower wall of the left ventricular artery.
7. Transmural myocardial infarction is predominantly an acute form of the disease. It is one of the most dangerous types, and is characterized by an effect on the entire wall of the ventricle. Damage occurs to the epicardium and endocardium. Predominantly transmural myocardial infarction always has a large-focal form of manifestation. Men over 30 years of age often fall under the influence. This type is extremely rare in women. The end of this form is scarring of the lesion and subsequent tissue death. Transmural myocardial infarction is practically untreatable and is fatal.
8. Abdominal. It is formed as a result of the development of pathologies on the posterior wall of the left ventricle.
9. Intramural. It is formed on the basis of damage to the muscle throughout its entire thickness.
10. Recurrent. Occurs due to the formation of blood clots in coronary sclerosis. Characterized by the presence of periodic repetitions.

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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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:

1. 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.
2. Even if a person resorts to taking nitroglycerin, the pain does not disappear, but may decrease slightly.
3. Acute pain is characterized by squeezing, squeezing and burning symptoms.
4. Signs of myocardial infarction often have an intense form of manifestation, but in rare cases it can be wavy.
5. 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:

1. The appearance of swelling in the upper and lower extremities.
2. Frequent shortness of breath even with minor exertion.
3. 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.

1. 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.
2. 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.
3. 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.
4. 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:

1. Clinical picture.
2. 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.

Myocardial infarction is one of the forms, which is necrosis of the heart muscle caused by a sudden cessation of coronary blood flow due to damage to the coronary arteries.

Heart and vascular diseases continue to be the leading cause of death worldwide. Every year, millions of people experience one or another manifestation of coronary heart disease - the most common form of myocardial damage, which has many types, invariably leading to disruption of the usual way of life, loss of ability to work and claiming the lives of a large number of patients. One of the most common manifestations of coronary artery disease is myocardial infarction (MI); at the same time, it is the most common cause of death in such patients, and developed countries are no exception.

According to statistics, in the United States alone, about a million new cases of heart attack are registered per year, about a third of patients die, with about half of deaths occurring within the first hour after the development of necrosis in the myocardium. Increasingly, among the sick there are able-bodied people of young and mature age, with several times more men than women, although by the age of 70 this difference disappears. With age, the number of patients is steadily growing, and more and more women are appearing among them.

However, one cannot fail to note the positive trends associated with a gradual decrease in mortality due to the emergence of new diagnostic methods, modern treatment methods, as well as increased attention to those risk factors for the development of the disease that we ourselves can prevent. Thus, the fight against smoking at the state level, the promotion of the basics of healthy behavior and lifestyle, the development of sports, and the formation of responsibility among the population regarding their health significantly contribute to the prevention of acute forms of coronary artery disease, including myocardial infarction.

Causes and risk factors of myocardial infarction

Myocardial infarction is necrosis (death) of a section of the heart muscle due to the complete cessation of blood flow through the coronary arteries. The reasons for its development are well known and described. The result of various studies of the problem of coronary heart disease has been the identification of many risk factors, some of which do not depend on us, and others that everyone can eliminate from their lives.

As is known, hereditary predisposition plays an important role in the development of many diseases. Coronary heart disease is no exception. Thus, the presence among blood relatives of patients with coronary artery disease or other manifestations of atherosclerosis significantly increases the risk of myocardial infarction. , various metabolic disorders, for example, are also a very unfavorable background.

There are also so-called modifiable factors contributing to acute coronary heart disease. In other words, these are those conditions that can either be completely eliminated or their influence significantly reduced. Currently, thanks to a deep understanding of the mechanisms of development of the disease, the emergence of modern methods of early diagnosis, as well as the development of new drugs, it has become possible to combat lipid metabolism disorders, maintain normal blood pressure and blood pressure levels.

Do not forget that avoiding smoking, alcohol abuse, stress, as well as good physical fitness and maintaining adequate body weight significantly reduce the risk of cardiovascular pathology in general.

The causes of heart attack are conventionally divided into two groups:

1. Significant atherosclerotic changes in the coronary arteries;
2. Non-atherosclerotic changes in the coronary arteries of the heart.

Damage and inflammation of the endocardium is fraught with the occurrence of blood clots and thromboembolic syndrome, and pericarditis over time will lead to the growth of connective tissue in the cavity of the cardiac sac. In this case, the pericardial cavity overgrows and the so-called “armored heart” is formed, and this process underlies the subsequent formation due to the limitation of its normal mobility.

With timely and adequate medical care, most patients who survive acute myocardial infarction remain alive, and a dense scar develops in their heart. However, no one is immune from repeated episodes of circulatory arrest in the arteries, even those patients in whom the patency of the heart vessels was surgically restored (). In cases where, with an already formed scar, a new focus of necrosis occurs, they speak of a recurrent myocardial infarction.

As a rule, the second heart attack becomes fatal, but the exact number of them that the patient can endure has not been determined. In rare cases, there are three episodes of necrosis in the heart.

Sometimes you can find the so-called recurrent infarction, which occurs during the period of time when scar tissue forms in the heart at the site of an acute injury. Since, as mentioned above, it takes an average of 6-8 weeks for a scar to “ripen,” it is during this period that a relapse can occur. This type of heart attack is very unfavorable and dangerous for the development of various fatal complications.

Sometimes an occurrence occurs, the causes of which will be thromboembolic syndrome with extensive transmural necrosis involving the endocardium in the process. That is, blood clots formed in the cavity of the left ventricle when the inner lining of the heart is damaged, enter the aorta and its branches that carry blood to the brain. When the lumen of the cerebral vessels is blocked, brain death (infarction) occurs. In such cases, these necrosis is not called a stroke, since they are a complication and consequence of myocardial infarction.

Types of myocardial infarction

To date, there is no single generally accepted classification of heart attack. In the clinic, based on the amount of assistance needed, the prognosis of the disease and the characteristics of the course, the following types are distinguished:

• Large-focal myocardial infarction – can be transmural or non-transmural;
• Finely focal– intramural (in the thickness of the myocardium), subendocardial (under the endocardium), subepicardial (in the area of ​​the heart muscle under the epicardium);
• Myocardial infarction of the left ventricle (anterior, apical, lateral, septal, etc.);
• Right ventricular infarction;
• Atrial myocardial infarction;
• Complicated and uncomplicated;
• Typical and atypical;
• Protracted, recurrent, repeated infarction.

In addition, they highlight flow periods myocardial infarction:

1. Acute;
2. Spicy;
3. Subacute;
4. Post-infarction.

Manifestations of heart attack

The symptoms of myocardial infarction are quite characteristic and, as a rule, allow one to suspect it with a high degree of probability even in pre-infarction period development of the disease. So, patients experience longer and more intense chest pain, which are less responsive to treatment with nitroglycerin, and sometimes do not go away at all. IN You may experience shortness of breath, sweating, and even nausea. At the same time, patients are finding it increasingly difficult to endure even minor physical activity.

At the same time, characteristic electrocardiographic signs disturbances in blood supply to the myocardium, and constant observation for a day or more is especially effective for their detection ().

The most characteristic signs of a heart attack appear in the most acute period when a zone of necrosis appears and expands in the heart. This period lasts from half an hour to two hours, and sometimes longer. There are factors that provoke the development of an acute period in predisposed individuals with atherosclerotic lesions of the coronary arteries:

• Excessive physical activity;
• Severe stress;
• Operations, injuries;
• Hypothermia or overheating.

The main clinical manifestation of necrosis in the heart is pain, which is very intense. Patients can characterize it as burning, squeezing, pressing, “dagger-like.” The pain has a retrosternal localization, can be felt to the right and left of the sternum, and sometimes covers the front of the chest. Characteristic is the spread (irradiation) of pain to the left arm, shoulder blade, neck, and lower jaw.

In most patients, the pain syndrome is very pronounced, which also causes certain emotional manifestations: a feeling of fear of dying, severe anxiety or apathy, and sometimes excitement is accompanied by hallucinations.

Unlike other types of coronary artery disease, a painful attack during a heart attack lasts at least 20-30 minutes, and the analgesic effect of nitroglycerin is absent.

Under favorable circumstances, at the site of the necrosis focus, so-called granulation tissue begins to form, rich in blood vessels and fibroblast cells that form collagen fibers. This period of the infarction is called subacute, and it lasts up to 8 weeks. As a rule, it proceeds well, the condition begins to stabilize, the pain weakens and disappears, and the patient gradually gets used to the fact that he has suffered such a dangerous phenomenon.

Subsequently, a dense connective tissue scar forms in the heart muscle at the site of necrosis, the heart adapts to new working conditions, and post-infarction marks the onset of the next period of the disease, which continues for the rest of life after a heart attack. Those who have had a heart attack feel well, but there is a resumption of pain in the heart and attacks.

As long as the heart is able to compensate for its activity by hypertrophy (enlargement) of the remaining healthy cardiomyocytes, there are no signs of heart failure. Over time, the adaptive capabilities of the myocardium are depleted and heart failure develops.

projections of pain during myocardial infarction

It happens that the diagnosis of myocardial infarction is significantly complicated by its unusual course. This characterizes its atypical forms:

1. Abdominal (gastralgic) – characterized by pain in the epigastrium and even throughout the entire abdomen, nausea, vomiting. Sometimes it may be accompanied by gastrointestinal bleeding associated with the development of acute erosions and ulcers. This form of heart attack must be distinguished from peptic ulcer of the stomach and duodenum, cholecystitis, pancreatitis;
2. Asthmatic form - occurs with attacks of suffocation, cold sweat;
3. The edematous form is characteristic of massive necrosis with total heart failure, accompanied by edematous syndrome and shortness of breath;
4. Arrhythmic form, in which rhythm disturbances become the main clinical manifestation of MI;
5. Cerebral form - accompanied by symptoms of cerebral ischemia and is typical for patients with severe atherosclerosis of the vessels supplying blood to the brain;
6. Erased and asymptomatic forms;
7. Peripheral form with atypical localization of pain (mandibular, left-handed, etc.).

Video: non-standard signs of a heart attack

Diagnosis of myocardial infarction

Usually the diagnosis of a heart attack does not cause significant difficulties. First of all, it is necessary to carefully clarify the patient’s complaints, ask him about the nature of the pain, clarify the circumstances of the attack and the presence of the effect of nitroglycerin.

Upon examination The patient shows pallor of the skin, signs of sweating, and possible cyanosis (cyanosis).

A lot of information will be provided by such objective research methods as palpation(palpation) and auscultation(listening). So, at can be identified:

• Pulsation in the area of ​​the cardiac apex, precordial zone;
• Increased heart rate to 90 - 100 beats per minute;

On auscultation hearts will be characteristic:

1. Muting the first tone;
2. Low systolic murmur at the apex of the heart;
3. A gallop rhythm is possible (the appearance of a third tone due to left ventricular dysfunction);
4. Sometimes a fourth sound is heard, which is associated with stretching of the muscle of the affected ventricle or with a disturbance in the conduction of impulses from the atria;
5. Systolic “cat purring” is possible due to the return of blood from the left ventricle to the atrium due to pathology of the papillary muscles or stretching of the ventricular cavity.

The overwhelming majority of people suffering from a large-focal form of myocardial infarction have a tendency to lower blood pressure, which, under favorable conditions, can normalize in the next 2-3 weeks.

A characteristic symptom of necrosis in the heart is also an increase in body temperature. As a rule, its values ​​​​do not exceed 38 ºС, and the fever lasts about a week. It is noteworthy that in younger patients and in patients with extensive myocardial infarction, the increase in body temperature is longer and more significant than in small foci of infarction and in elderly patients.

In addition to physical ones, of no small importance are laboratory methods diagnosis of MI. So, the following changes are possible in the blood test:

• An increase in the level of leukocytes () is associated with the appearance of reactive inflammation in the focus of myocardial necrosis, persists for about a week;
• – associated with an increase in the concentration in the blood of proteins such as fibrinogen, immunoglobulins, etc.; the maximum occurs 8-12 days from the onset of the disease, and ESR numbers return to normal after 3-4 weeks;
• The appearance of so-called “biochemical signs of inflammation” - an increase in the concentration of fibrinogen, seromucoid, etc.;
• The appearance of biochemical markers of necrosis (death) of cardiomyocytes - cellular components that enter the bloodstream when they are destroyed (troponins, etc.).

It is difficult to overestimate the importance of (ECG) in the diagnosis of myocardial infarction. Perhaps this method remains one of the most important. An ECG is accessible, easy to perform, can be recorded even at home, and at the same time provides a large amount of information: indicates the location, depth, extent of the infarction, and the presence of complications (for example, arrhythmia). With the development of ischemia, it is advisable to record an ECG repeatedly with comparison and dynamic monitoring.

table: particular forms of heart attack on ECG

ECG signs of the acute phase of necrosis in the heart:

1. the presence of a pathological Q wave, which is the main sign of muscle tissue necrosis;
2. decrease in the size of the R wave due to a decrease in the contractile function of the ventricles and the conduction of impulses along nerve fibers;
3. dome-shaped shift of the ST interval upward from the isoline due to the spread of the infarction from the subendocardial zone to the subepicardial zone (transmural lesion);
4. formation of the T wave.

Based on typical changes in the cardiogram, one can determine the stage of development of necrosis in the heart and accurately determine its location. Of course, it is unlikely that you will be able to independently decipher the cardiogram data without a medical education, but ambulance doctors, cardiologists and therapists can easily establish not only the presence of a heart attack, but also other disorders of the heart muscle, etc.

In addition to the listed methods, for the diagnosis of myocardial infarction are used (allows you to determine the local contractility of the heart muscle), , magnetic resonance and (helps to assess the size of the heart, its cavities, and identify intracardiac blood clots).

Video: lecture on the diagnosis and classification of heart attacks

Complications of myocardial infarction

Myocardial infarction both in itself poses a threat to life and through its complications. The majority of those who have undergone it remain with certain disturbances in the activity of the heart, associated primarily with changes in conduction and rhythm. Thus, in the first day after the onset of the disease, up to 95% of patients experience arrhythmias. Severe arrhythmias during massive infarctions can quickly lead to heart failure. The possibility of thromboembolic syndrome also causes many problems for both doctors and their patients. Timely assistance in these situations will help the patient prevent them.

The most common and dangerous complications of myocardial infarction:

• Heart rhythm disturbances (tachycardia, etc.);
• Acute heart failure (with massive heart attacks, atrioventricular blockades) – the development of acute left ventricular failure with symptoms of alveolar pulmonary edema, which threatens the patient’s life, is possible;
• – extreme degree of heart failure with a sharp drop in blood pressure and impaired blood supply to all organs and tissues, including vital ones;
• Heart ruptures are a severe and fatal complication, accompanied by the release of blood into the pericardial cavity and an abrupt cessation of cardiac activity and hemodynamics;
• (protrusion of a section of the myocardium in the focus of necrosis);
• Pericarditis is inflammation of the outer layer of the heart wall during transmural, subepicardial infarctions, accompanied by constant pain in the heart area;
• Thromboembolic syndrome - in the presence of a blood clot in the area of ​​the infarction, in the aneurysm of the left ventricle, with prolonged bed rest, .

Most life-threatening complications occur in the early post-infarction period, so careful and constant monitoring of the patient in a hospital setting is very important. The consequences of an extensive cardiac infarction include large-focal post-infarction cardiosclerosis (a massive scar that has replaced an area of ​​dead myocardium) and various arrhythmias.

Over time, when the heart's ability to maintain adequate blood flow to organs and tissues is depleted, congestive (chronic) heart failure. Such patients will suffer from edema, complain of weakness, shortness of breath, pain and interruptions in the functioning of the heart. Increasing chronic circulatory failure is accompanied by irreversible dysfunction of internal organs, accumulation of fluid in the abdominal, pleural and pericardial cavities. Such decompensation of cardiac activity will ultimately lead to the death of patients.

Principles of treatment of myocardial infarction

Emergency care for patients with myocardial infarction should be provided as soon as possible from the moment of its development, since delay can lead to the development of irreversible hemodynamic changes and sudden death. It is important that there is someone nearby who can at least call an ambulance. If you are lucky and there is a doctor nearby, his qualified participation can help avoid serious complications.

The principles of helping patients with a heart attack come down to the step-by-step provision of therapeutic measures:

1. Pre-hospital stage – involves transporting the patient and providing the necessary measures by an ambulance team;
2. At the hospital stage, the maintenance of basic body functions, prevention and control of blood clots, cardiac arrhythmias and other complications in hospital intensive care units continue;
3. The stage of rehabilitation measures - in specialized sanatoriums for cardiac patients;
4. The stage of dispensary observation and outpatient treatment is carried out in clinics and cardiac centers.

First aid can be provided under time pressure and outside the hospital. It’s good if it is possible to call a specialized cardiac ambulance team, which is equipped with what is necessary for such patients - medications, a pacemaker, and equipment for resuscitation. Otherwise, it is necessary to call a line ambulance team. Now almost all of them have portable ECG machines, which make it possible to quickly make a fairly accurate diagnosis and begin treatment.

The basic principles of care before arriving at the hospital are adequate pain relief and prevention of thrombosis. In this case the following is used:

• under the tongue;
• Administration of analgesics (promedol, morphine);
• Aspirin or heparin;
• Antiarrhythmic drugs if necessary.

Video: first aid for myocardial infarction

At the stage of inpatient treatment measures to maintain the function of the cardiovascular system continue. Elimination of pain is the most important of them. Narcotic analgesics (morphine, promedol, omnopon) are used as analgesics; if necessary (severe agitation, fear), tranquilizers (Relanium) are also prescribed.

The questions in this section are currently answered by: Sazykina Oksana Yurievna, cardiologist, therapist

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