All about heart attack. Atypical variants of the course. Brief description of the problem

Acute myocardial infarction- a pathology characterized by necrosis of an area of ​​the heart muscle, caused by problems with blood flow in the coronary vessels.

Such disturbances are the result of a discrepancy between the amount of oxygen required to maintain normal functioning of the heart and what is “delivered” in a real situation. In this article, I propose to carefully consider this formidable disease, which is considered a complication of coronary heart disease.

We will find out in more detail the causes of the disease, types of diagnosis, and forms of treatment in order to reduce the risks of ending up in cardiac intensive care.

I would like to note that the information below should under no circumstances create illusions or be perceived as a self-medication guide. Such actions are categorically unacceptable. I consider the opinion of those who, having read articles on the topic of their disease, to be naive, assume that they are able to discuss and communicate on equal terms with a cardiologist.

Making a diagnosis, developing a treatment strategy, and prescribing medications is the exclusive prerogative of the specialized attending physician.

However, one should not be discounted psychological aspect. To prevent disease, let’s arm ourselves with at least a minimum amount of information. It would not be superfluous to learn about all the possible factors that provoke the occurrence of the disease.

In relation to myocardial infarction, such a statement is relevant, since the percentage of deaths after the first heart attack is significant. Of three patients diagnosed with acute myocardial infarction, only two survive. I am sure this is a convincing argument to think about how serious the danger is for hearts represents this pathological condition.

Causes of heart attack

Atherosclerosis is a fundamental risk factor that creates the preconditions for the formation of cholesterol accumulations on the walls of the arteries. Such lipid formations are called atherosclerotic plaques, which can appear in various forms: convex, flat, thick, thin, durable.

The listed criteria have a high degree of significance, since the likelihood of plaque rupture is based on them.

Vessels that have fallen under the pressure of atherosclerosis lose their key property - elasticity, becoming dense. With cholesterol plaque, the capacity of the artery is reduced. The “request of the heart” to increase blood flow through it turns out to be impossible.

However, the insidiousness of the problem is that “” has been silent, for many years, monotonously performing menial duties.

For a long time, vascular damage does not manifest itself in any way. There comes a moment when a person is overtaken by oppressive painful sensations in the middle of the chest. This heart “signals” you for help.

Such manifestations of coronary artery disease are called angina pectoris.

The heart is unable to cope with increased loads, since the coronary arteries are, so far, only partially blocked by atherosclerotic accumulations.

If you care about your heart health, consult a cardiologist in a timely manner.

By adhering to medical prescriptions, you will be able to stop attacks, pain will occur less frequently, and problems will temporarily subside.

If you do not take any steps, neglect the recommendations of doctors, ignore the basics healthy image life, then there will come a time when the situation can worsen dramatically.

The next time I took nitroglycerin, there was no relief. Only by taking one or more tablets will the long-awaited relief come.

This is a serious signal, literally a heart alarm, saying that the integrity of the plaque has been compromised. There are plenty of reasons:

• stressful situation
• hypertensive crisis
• physical overexertion
• plaque inflammation

The body will try to “patch” the resulting crack with a blood clot. Blood clotting at the site of injury increases, and the natural result is the formation of a blood clot.

Since there are no reasons preventing proliferation, the arterial lumen will be closed thrombus extremely fast. The passage of blood through the artery stops. Cells and tissues, experiencing a colossal lack of oxygen, die. Thus, acute myocardial infarction develops.

The degree of myocardial damage is directly dependent on the size of the artery that was blocked by the thrombus. The larger it is, the more cells fall under the influence of necrosis (die). Accordingly they are divided:

• large focal, when the entire thickness of the heart muscle is affected
• finely focal

A heart scar (scar) remains for life. It will not be able to dissolve, leaving its imprint forever.

Key symptoms

In typical situations, the symptoms characteristic of acute are as follows.

The primary symptom is the presence of chest pain. The intensity of the burning sensation is high, with the pain likely localized in different places: shoulder, neck, jaw, arm, back. The flow pattern is wavy. At the time of the attack, the patient’s face becomes greatly distorted and the skin turns pale. Extremities are wet, cold, rapid breathing.

If, with angina pectoris, such signs manifest themselves during exercise, then pre-infarction state, characterized by the presence of pain when a person is at rest. Nitroglycerin taken does not help.

You should immediately call an ambulance.

However, the list of symptoms is not limited to pain. The patient has strong fluctuations in blood pressure. Immediately at the moment of pain, pressure readings can increase sharply, and then a steep “peak” occurs, to unusually low values ​​for the patient.

As for the pulse, it is not distinguished by its constancy. Mostly they identify common ones, although sometimes there are exceptions (rare ones).

In addition to tachycardia, a whole bunch of other various violations from the autonomic nervous system:

• muscle weakness
• cold sweat
• dyspnea
• frequent urination
• increased anxiety
• anxiety
• mental disorders are likely

The last three signs arise due to a sharp increase in stimulating hormones (adrenaline) entering the blood.

At the end of the first day, after a painful attack, a noticeable pain is noted, which is caused by the entry of “dead” cells of the affected myocardium into the blood.

Having penetrated the blood, they quickly spread throughout the body, causing poisoning.

An increase in temperature after the chest pain has subsided a little - alarm bell about an impending heart attack. Usually, it is in the range of 38-39 degrees.

I note that an attack of angina pectoris does not cause an increase in temperature.

The clinical picture of a heart attack is striking in its diversity. Some people carry it on their legs, while others have a typical course of the disease. In still others, against the background of a heart attack, a number of serious complications. In addition, there are situations where death occurs as a result of complications.

Secondary signs

1. Pain that occurs in digestive tract, cannot be characterized as acute. The area where they are felt is not sensitive to touch. It causes problems for the patient, accompanied by a burning sensation. Reduce slightly unpleasant feeling, taking antacid medications will help.
2. My arm and shoulder hurt, usually the left one. However, a feeling of heaviness can also cover right side. The nature of the pain is monotonous, aching, spreading down to the fingers.
3. Shortness of breath is one of the “popular” symptoms of a possible approaching heart attack. You should be alarmed when a normal load makes you suddenly puff and choke. Any movement becomes difficult. Similar problems with breathing are called “air fasting,” which disappears with rest. However, do not delude yourself, because if you continue walking, shortness of breath returns again.
4. Often, a symptom accompanying shortness of breath is chronic fatigue, which completely covers the entire body.

Diagnosis of heart attack

The statistics are inexorable; the percentage of people hospitalized with this diagnosis is small. Not everyone is able to identify the problem in a timely manner or address it in a timely manner.

Half an hour, maximum forty minutes - this is the optimal time period for successful treatment of a heart attack.

The effectiveness of therapy against an attack of chest pain is directly dependent on the timeliness of seeking medical help. Successful fight against a blood clot that has barricaded a heart artery is possible in the first 3 hours after the onset of a heart attack.

An electrocardiogram (in typical situations) will be enough for emergency doctors to ascertain the seriousness of the situation (extensiveness, depth, through, lying in the thickness of the myocardium). An ultrasound of the heart will help determine how seriously affected the patient is, of course, provided that the patient is promptly taken to the hospital.

What to do before the doctors arrive

If you feel chest pain, you should:

1. Stop everything active actions, sit down.
2. Use nitroglycerin by placing it under your tongue.
3. If it doesn’t help, then take another tablet after at least five minutes. It is acceptable, in the absence of positive changes, to take 4-5 tablets within an hour. It is worth considering that taking nitroglycerin reduces arterial pressure, headaches are likely.

Treatment of heart attacks

The primary task is to stop an attack of pain by administering intramuscular, intravenous analgesics, different combination. WITH similar diagnosis, emergency transportation of the patient to a hospital is mandatory.

The ideal option for hospitalization would be a department intensive care, with the ability to continuously monitor heart function. If necessary, emergency assistance is provided immediately. List of measures, depending on indications:

• cardiac defibrillation
• ventilation (artificial)
• cardiac stimulation

If the moment is not missed, less than six hours have passed since the onset of the attack, in the absence of contraindications, the main task comes down to dissolving the blood clot that has caused a blockage in the coronary artery arteries. Drugs such as fibrinolysin and streptase are used. The administration of heparin can prevent the progression of thrombosis.

To slow down the death of myocardial cells and tissues, medications are administered intravenously to reduce the heart's need for oxygen.

Complications of a heart attack

1. Rupture of the ventricular wall, accompanied by cardiac tamponade, is the most critical complication, leading to death in just five minutes.
2. A cardiac aneurysm is a formation that has a convex shape and, during contractions, seems to be falling out. Blood clots form inside the cavity. They are carried around by the bloodstream, causing a disease called thromboembolism.
3. Cardiogenic shock is a dangerous complication characterized by a sudden decrease in blood pressure. The symptomatic picture is as follows:

• the skin turns pale
• veins become barely visible upon visual inspection
• cold limbs
• heart sounds are muffled
• pulse thready
• urination is weak
• possible loss of consciousness
• blockades - problems with the conduction of cardiac impulses
• Arrhythmias may sometimes occur

How complications are treated

In case of cardiogenic shock, dopamine is administered based on systolic pressure values.

Pulmonary edema - analgesics are administered intravenously. The procedure for removing foamy sputum from the bronchi is carried out using specialized suction (vacuum apparatus), and inhalation of oxygen enriched with vapor ethyl alcohol, helps remove mucus from the small bronchi.

A procedure called coronary angiography will help accurately determine the artery responsible for causing a heart attack. If necessary, balloon angioplasty and stenting of the affected artery are performed, which helps clear the “blockages” and restore normal blood flow.

An idealized option is the implementation of systemic thrombolysis by cardiologists who arrive on call (which is rare, usually therapists come), right at home. The essence of the method is to inject a drug that dissolves a blood clot that has blocked the lumen of a coronary vessel.

Coronary artery bypass grafting in acute infarction is rarely performed because the risk of death is high. Exceptions, rupture of the interventricular septum - the patient’s life is in danger.

It is necessary to provide daily careful care. Help with washing and eating will be indispensable. You will need to systematically turn in bed, wipe your skin, and watch your stool.

Salt-free laxatives (vaseline oil, buckthorn) will help eliminate constipation.

The regimen is adjusted by the doctor, much depends on how severely the myocardium was damaged.

In the case of a small focal infarction, bed rest is maintained throughout two to three days. Then, in case of positive dynamics, movement within the ward is allowed. After a week, movement is allowed within the department, with a gradual increase in physical activity.

Upon discharge, the distance that the patient is able to cover, with complete absence discomfort in the chest, should approach 700-900 meters. Climbing up one floor on your own should not cause any difficulties.

The recovery period after a heart attack is unthinkable without physical therapy. Its implementation begins during the hospital stay, and in the future, you should regularly visit the exercise therapy room.

Acute myocardial infarction does not go away without leaving a trace; the functionality of the heart muscle is partially impaired. Risk factor (atherosclerosis coronary vessels) is still present, it is unfortunately impossible to become completely healthy after a heart attack.

To prevent a heart disaster from happening again, you should take care of your own health. No one will lead you by the hand to the cardiologist’s office. Try to follow your doctor's recommendations. They are talked about a lot, but rarely implemented.

Your course psychological mood should be aimed only at a healthy lifestyle, although not everyone succeeds in this. Take it seriously preventive measures, because heart health is at stake.

Acute myocardial infarction is the death of a section of the heart muscle caused by a circulatory disorder. Heart attack is one of the main causes of disability and mortality among adults.

Causes and mechanisms of vascular incompetence of the heart

The peculiarities of the heart - constant contractions of the myocardium - determine a very high level of metabolic processes in its cells, high consumption of oxygen and nutrients. This mode of activity requires an uninterrupted flow of highly oxygenated ( rich in oxygen) blood, which is provided by an extensive network of cardiac vessels starting from the aorta in the form of coronary (coronary) arteries.

The downside to the effectiveness of the heart muscle is its high sensitivity to oxygen starvation. If there is a malnutrition in the myocardium, pathological phenomena develop that very quickly become irreversible.

If the lack of blood flow is not critical, reversible ischemia (anemia) of the heart muscle occurs, which is manifested by anginal pain in the chest. When the flow of blood to a certain area is completely stopped, a cascade of pathological processes develops - the accumulation of toxic metabolic products that are not excreted, the transition to an anaerobic (oxygen-free) mode of operation using the internal energy reserves of cells.

The body's own reserves of energy carriers (glucose and ATP) are very quickly (in about 20 minutes) depleted, and the bloodless section of the heart muscle dies. This is myocardial infarction - necrosis, the size of which depends on the level of vessel occlusion (large or small branch), the rate of onset of ischemia (with gradual cessation of blood supply, partial adaptation is possible), the patient’s age and many other factors. For example, acute transmural myocardial infarction (with necrosis of the entire thickness of the heart muscle), which has a very severe course, develops with occlusion (overlapping) of a large branch of a coronary vessel.

Section of the heart wall during myocardial infarction

Among the causes of impaired blood supply to the myocardium, the most common is a block of the lumen of the vessel by an atherosclerotic plaque or thrombus (these phenomena can be combined). In addition, a sharp spasm of the coronary arteries is possible under the influence of physical (cold) or chemical (poisons, drugs) factors. Severe anemia, which occurs sharp decrease The content of hemoglobin in the blood, and therefore its ability to transport oxygen, can also cause myocardial ischemia. Inconsistency of blood supply with increased needs occurs with sudden hypertrophy of the heart muscle - cardiomyopathy.

Predisposing factors for the development of heart attack

Some diseases and pathological conditions are increased risk factors for the development of acute myocardial ischemia. These include:

• Diabetes.
• Hypertonic disease.
• Coronary heart disease (CHD), manifested by attacks of angina (especially its unstable forms).
• Increased levels of cholesterol and some fractions of lipoproteins in the blood.
• Excessive body weight.
• Smoking.
• Alcohol abuse.
• Errors in diet (high consumption of salt, animal fats).
• Cardiac arrhythmia.
• Prolonged stressful situations.
• Age over 60 years (although in last years"rejuvenation" of the infarction is observed).
• Male gender (after 70 years, the number of men and women suffering from a heart attack equalizes).

Classification of ischemic myocardial injury

There are different criteria for classifying a heart attack. Some of them:

• The size of the damage zone is large-focal and small-focal.
• According to the depth of damage to the heart muscle - transmural (throughout the entire thickness of the heart wall), intramural (necrosis in the thickness of the wall), subendocardial (damage to the inner layer), subepicardial (outer layer).
• According to topography - left ventricular (anterior wall, posterior and lateral walls, interventricular septum), right ventricular.

A painful attack lasting more than 20 minutes is one of diagnostic criteria heart attack

Symptoms of a heart attack

In the development of the pathological process, several periods are distinguished, each of which has its own duration and symptoms.

Pre-infarction period can last from a few minutes to months. It is characterized by an increase in the frequency of angina attacks and an increase in their intensity.

The most acute period, in which ischemia and necrosis of the heart muscle develops, lasts up to several hours. It may have a typical or atypical course.

The painful, or anginal, variant is typical (about 90% of all cases). It is characterized by high-intensity pain behind the sternum of a burning or pressing nature, which can radiate (give) to the left limbs, jaw, and neck. There may be fear of death, sweating, pale or reddened facial skin, and shortness of breath. The severity of pain depends on the size of the affected area - large-focal infarction causes more severe symptoms, than small-focal. The pain is not relieved by taking nitroglycerin.

Atypical variants can occur as an asthmatic type (have symptoms of an attack bronchial asthma), abdominal (with symptoms of an acute abdomen), arrhythmic (in the form of an attack of cardiac arrhythmia), cerebral (with impaired consciousness, dizziness, paralysis, visual impairment).

The acute period lasts about 10 days. The necrosis zone is finally formed and delimited, absorption of decay products and scar formation begins. The pain syndrome disappears or decreases. Possible increase in temperature, hypotension and heart failure.

Subacute period(about two months) – the stage of scar formation and compaction. There is no pain syndrome, the condition is gradually improving. Well-being in this period is largely determined by the nature and extent of changes that have occurred in the heart muscle.

Post-infarction period, or rehabilitation (up to six months), is characterized by the absence of clinical and laboratory signs heart attack (changes on the ECG remain - they will remain for life), however, in this phase, the development of heart failure, angina pectoris and recurrent heart attack is possible.

Complications of myocardial infarction

Acute myocardial ischemia, in itself being serious condition, may be further aggravated by the addition of complications.

The most common complications:

• Violations heart rate(paroxysmal tachycardia, extrasystole, atrial fibrillation). A situation such as the appearance of ventricular fibrillation with the transition to fibrillation can cause the death of the patient.
• Heart failure is associated with a disruption in the activity of the left ventricle in pumping blood through the vessels. It can lead to pulmonary edema and death due to a sharp drop in pressure and cessation of renal filtration.
• Thromboembolism pulmonary artery can lead to pneumonia, pulmonary infarction and death.
• Cardiac tamponade can occur when the heart muscle ruptures in the area of ​​infarction and blood leaks into the pericardial cavity. The condition is life-threatening and requires immediate attention.
• Acute – bulging of a section of scar tissue during extensive damage myocardium. In the future, it can cause the development of heart failure.
• Thromboendocarditis is the deposition of fibrin on the inner surface of the heart. Its separation can cause a stroke, mesenteric thrombosis (closure of a branch of the vessel feeding the intestine) with subsequent necrosis of a section of the intestine, and kidney damage.
• Post-infarction syndrome is the general name for long-term complications (pericarditis, pleurisy, arthralgia).

Some ECG signs acute heart attack myocardium

Diagnosis of heart attack

In the diagnosis of a heart attack, data from the anamnesis (circumstances of the course of the disease and previous life, ascertained by interviewing the patient and his relatives), laboratory and instrumental methods research.

Anamnesis

Past attacks of chest pain of varying frequency and intensity, risk factors (smoking, stress, chronic diseases). Upon examination, it is possible to identify overweight, indirect signs high pressure (capillary network on the face), etc. Substernal pain lasting more than 20 minutes is considered one of the diagnostic criteria for a heart attack.

Laboratory methods

Laboratory research methods for a heart attack reveal the following changes:

• Blood clinic. Leukocytosis (increased number of leukocytes), increased ESR.
• Biochemistry of blood. Increased activity of the enzymes AlT, AST, LDH, creatine kinase, myoglobin, which is an indicator of damage to the heart muscle. Changes in the level of electrolytes and iron are possible.

Instrumental research methods

• ECG – characteristic signs of a heart attack (negative T wave, pathological QRS complex, etc.). Taking a cardiogram in different leads helps determine the location of the necrotic focus (for example, the anterior or posterior wall of the left ventricle, etc.).
• EchoCG – local (limited) violation of contractility of the affected ventricle.
• Coronary angiography reveals narrowing or blockage of the vessel supplying the myocardium. It should be noted that when conducting this research method, it can also be used to provide assistance (after submitting contrast agent through the same catheter is introduced into the vessel medicinal product or an expander stent is installed).

Coronary angiography for infarction

Treatment of myocardial infarction

Emergency care (performed directly during a painful attack and then in a specialized clinic):

• Providing the patient with complete rest.
• Give sublingual (under the tongue) nitroglycerin and Corvalol orally.
• Immediate transportation for further treatment to the cardiac intensive care unit (preferably on specialized resuscitation transport).

Surgical treatment is one of the modern methods of helping with a heart attack.

Specialized treatment

• Relief of pain syndrome (narcotic analgesics and antipsychotics are used).
• Dissolution of a blood clot located in a coronary vessel by introducing special thrombolytic agents (streptase, cabinase). The method is very effective, but has a time limit - assistance must be provided within the first hour after the attack; subsequently, the percentage of saved myocardial mass rapidly decreases.
• Antiarrhythmic drugs.
• Improving metabolic processes in the heart muscle.
• Reducing the volume of circulating blood to reduce the load on the heart.
• Surgical methods of treatment - balloon angioplasty of the coronary vessels, insertion of a stent (tubular spacer), coronary artery bypass grafting (providing bypass blood flow by placing a shunt on the damaged vessel).
• Anticoagulants (heparin, aspirin) to reduce blood clotting and prevent thrombosis.

The prognosis for a heart attack is always serious and depends on the volume of the affected myocardium, the localization of the necrotic focus (for example, if the conduction system of the heart is involved in the area of ​​damage, the prognosis worsens), the patient’s age, concomitant diseases, timeliness of treatment, the presence of complications, etc. The percentage of residual effects and occurrence is high. disability.

After passing the acute period, patients are shown rehabilitation with a gradual increase in the level of stress. In the future it is necessary medical supervision, prophylactic appointment antianginal drugs.

Prevention of a heart attack is to avoid bad habits, fight with overweight, rational mode nutrition, work and rest, timely treatment when angina pain occurs.

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

Myocardial infarction

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

Reasons for the development of ischemia

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

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

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

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

According to the course of MI there are stages

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

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

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

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

By area of ​​the lesion:

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

According to the frequency of the disease:

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

By place of origin (topography):

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

According to the depth of the lesion:

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

According to the presence of complications:

• uncomplicated;
• complicated.

Very often, complications of myocardial infarction are observed already in the first hours of the disease. These can be various types of arrhythmias, pulmonary edema, and cardiogenic shock, leading to death.

Diagnostics

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

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

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

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

Rehabilitation

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

Such actions may include:

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

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

Myocardial infarction develops as a consequence of coronary heart disease. Signs of a heart attack are chest pain, shortness of breath, tachycardia. Symptoms of myocardial infarction are often erased, so a patient with a heart attack should immediately call an ambulance.

Here we will discuss one of the most dangerous diseases for humans - myocardial infarction, which can be fatal. That's all, because the affected area is the heart. Let's discuss the diagnosis and symptoms of the disease. We will also tell you what measures need to be taken if this disease develops.

Myocardial infarction

From medical reference book It follows that the disease “myocardial infarction” is a focus of necrosis of the heart muscles of an ischemic nature, which unfolds against the background of circulatory disorders in the coronary veins. Typical picture myocardial infarction - pressing, burning or squeezing pain behind the chest, which radiates to the left arm (numbness of the limb), shoulder blade, collarbone, jaw. Manifested by shortness of breath, anxiety and shock. The person develops a cold sweat. Further development of the disease requires emergency assistance, hospitalization in the intensive care unit. If the patient is not given necessary help, then death is guaranteed.

Myocardial infarction: statistics

According to world statistics, myocardial infarction most often (3-5 times) occurs in men. Their ages range from forty to sixty years. This is also due to the fact that men are more susceptible early development(ten years earlier than women) vascular atherosclerosis. However, after fifty years, both sexes are equally susceptible to the disease. Death occurs in approximately 30-35 percent of cases. About 10-15% of sudden deaths occur due to myocardial infarction.

In addition, disruption of the blood supply to the myocardium for fifteen minutes leads to pathological, irreversible changes in the heart muscles; cause cardiac dysfunction. Acute ischemia leads to the death of part of the muscle fibers and further formation of a post-infarction scar.

Heart attack: how it develops

The following five periods of myocardial infarction are distinguished:

• Pre-infarction (prodromal). Angina attacks occur more often, and their severity increases over and over again. Sometimes attacks can recur and increase in symptoms over several days or even weeks;
• The sharpest. Starting from the development of ischemia up to the death of myocardial muscle fiber cells. Last from twenty minutes to two hours;
• Spicy. It begins with the death of heart muscle cells until the necrotic tissue is “melted” by enzymes. Last from two to fourteen days;
• Subacute. Development of scar formation, granulation tissue in place of dead and “recycled” cardiac fibers. Duration – 4-8 weeks;
• Post-infarction. Complete scar formation; irreversible changes in the myocardium, which disrupts the normal functioning of the heart.

Causes of myocardial infarction

According to medical statistics, myocardial infarction is a “consequence” of a person’s lack of movement against the background of mental, nervous and emotional overload. The main reasons that become a “beacon” for heart attack are: too a large number of animal fats in the diet, unhealthy diet or overeating, bad habits.

But a heart attack can happen even in people in good physical shape who have not yet reached the “target” age. However, people who lead a sedentary lifestyle are much more susceptible to heart attacks than active ones.

If you didn’t know, the heart is a “bag” of muscles that pumps blood through its ventricles. But the heart itself receives the necessary “fuel” - oxygen, not through the distilled blood, but with the help of vessels that approach it from the outside. If these vessels are partially affected by atherosclerosis, the heart does not receive enough oxygen-enriched blood. This is the main reason for the development of cardiac ischemia. A heart attack affects just a part circulatory system, which is responsible for the blood supply to the heart: the affected vessels simply do not transfer blood to the heart. Typically, this leads to the development of blood clots on the plaque of a blocked coronary artery, and less commonly, it causes spasms. The part of the heart that does not receive oxygen gradually dies. Hence the name “infarction” - from Latin it means “dead tissue”.

Myocardial infarction is an acute form of ischemia. In almost 100% of cases, the “foundation” for the development of this disease is atherosclerosis of the coronary vessels and arteries, which leads to their narrowing and reduced permeability of blood flow. It is also common that the narrowing of the arteries is accompanied by acute thrombosis of the vessel sector, which leads to a partial or complete cessation of blood flow into the heart through this artery. Thrombosis occurs most often due to excess “viscosity” of the blood, which is present in patients with ischemia. Often, a heart attack occurs along with spasm of the coronary arteries.

What contributes to the development of acute ischemic heart disease? Patients with diabetes mellitus, obesity, hypertension, psychological damage and neuroses are most at risk of myocardial infarction; people who are addicted to smoking, alcohol and other harmful habits for the body. Most often, a heart attack occurs in the left ventricle.

The main factors that are a “signal” to the development of myocardial infarction:

• Patient's age. Oddly enough, but what older man, the greater the risk of developing heart disease;
• Diabetes. Increased blood sugar levels, impaired metabolism, etc. – all this increases pressure on the blood vessels of the heart, reduces the amount of hemoglobin, which reduces the oxygen content in the blood;
• Second myocardial infarction. People who have had a small focal heart attack are at risk of getting a second one;
• Hypertension. High blood pressure from 139/89 – ideal “soil” for the development of the disease;
• Bad habits. Smoking (both passive and active) increases a person's chances of having a myocardial infarction by almost three times. Moreover, this “picture” persists even three years after the patient stopped smoking.
• Obesity. And as a result, an increase in cholesterol in the blood, which leads to the formation of blood clots and the development of atherosclerosis in the arteries of the heart.

What is myocardial infarction?

There are several types of heart attack. Myocardial infarction is classified according to the size of the lesions in the heart muscles:

• Large-focal.
• Finely focal.

According to statistics maintained by medical experts, the diagnosis of “small-focal myocardial infarction” is made in almost one fifth of cases. As a rule, small foci in dying heart muscle tissue “merge”, creating large-focal necrosis (in 30% of cases). At small focal infarctions There is no aneurysm or heart rupture. Whereas with large-focal ones, heart failure, thromboembolism and fibrillation of the ventricles of the heart are less likely to occur.

Among other things, myocardial infarction is divided according to the depth of death of muscle tissue in the heart:

• Transmural. Tissue death occurs throughout the entire thickness of the muscle wall.
• Intramural. This is when a heart attack occurs deep within the myocardium.
• Subendocardial. Damage to the heart muscles occurs in the endocardial zone.
• Subepicardial. Here necrosis manifests itself in the area adjacent to the epicardium.

An electrocardiogram divides a heart attack into the following “categories”:

• Not a Q-heart attack. The Q wave is not formed, but is manifested by pathological T waves (with a small focal infarction).
• Q-infarction. In this case, a pathological tooth still forms. It happens that it unfolds in the ventricular QS complex (most often, this occurs with a large-focal, transmural infarction).

The following classification of infarction: depending on the detrimental effect on the branches of the coronary arteries and the topography of the pathology:

• Left ventricular. There are the following localizations: lateral, anterior, posterior walls, septum between the ventricles.
• Right ventricular.

According to the “frequency” of heart attack:

• Primary;
• Recurrent (manifests within eight weeks after the primary);
• Repeated (occurs eight weeks after the previous heart attack).

For pathological changes and complications:

• Complicated;
• Uncomplicated.

Another classification is based on pain syndrome. Namely, its presence and location:

• Typical. Localization of pain behind the chest, in the precordial region;
• Atypical. If the pain syndrome is located in a different place and has a different character - peripheral (left-handed, gorton-mammary, left-scapular, mandibular, gastralgic, upper vertebral localization of pain); painless (astamatic, edematous, cerebral, arrhythmic, collaptoid); with erased symptoms; combined nature of the pain syndrome.

According to the dynamics and period of development, they also distinguish:

• Stage of ischemia;
• Stage of scarring;
• Stage of necrosis;
• Organization stage.

Symptoms of myocardial infarction

As a rule, one of the most common, generalized symptoms indicating the development of myocardial infarction is pain behind the chest. Painful sensations “transition” to the left hand (inner surface), which can be confused with numbness and unpleasant tingling in the fingers of the left hand and wrist. Others possible areas irradiation of the neck, jaw, belt, and space between the shoulder blades are signs of acute ischemia. From this we can conclude that the irradiation of pain and localization do not differ from an attack of angina.

The pain that the patient feels is incredibly strong: it is similar to a blow from a dagger, it tears into the chest, and has a burning effect. Often, this sensation is so strong that it causes the person in agony to scream. Just like during attacks of angina pectoris, a different sensation may arise: unpleasant, in the chest - strong compression, squeezing, heaviness, as if “pulled in a vice, pressed down with an iron plate.” Some patients experience a dull ache and numbness in the arms, which occurs along with prolonged, severe chest pain and discomfort.

The agonizing pain of a heart attack occurs suddenly, often at night. The pain “spreads” throughout the body in waves, decreasing, stopping and increasing. With each new “wave” the sensations only intensify over time: they reach a maximum and suddenly stop.

Attacks of pain and severe discomfort in the chest last from thirty minutes, sometimes not stopping for hours. Remember that myocardial infarction occurs after incessant, agonizing pain that lasts from fifteen minutes. Another important noteworthy sign is this fact: heart pain is felt even after the patient has taken nitroglycerin.

Stages of heart attack development:

1. Pre-infarction.

Less than half of patients notice a sudden development of a heart attack. But in the majority of patients, progressive angina develops unstably.

2. Acute.

Typically, a heart attack is characterized by intense pain that is located in the chest and radiates to the left shoulder, teeth, ear, neck, as well as the interscapular area, clavicle area and lower jaw. It is worth emphasizing that the pain during this period can be squeezing, pressing, burning, bursting, “dagger-like.” The larger the area of ​​necrosis on the muscle tissue of the heart, the stronger the pain.

Pain comes over a person in “waves” - intensifying and gradually weakening. Last from thirty minutes to several hours (in some cases, days). And these sensations are not relieved by nitroglycerin. The patient experiences a state of shock: fear, chills, horror, etc.

But there is an atypical course of the acute period: the patient’s skin turns pale, cold sweat appears, and he feels restless. Blood pressure is elevated at these moments. Soon it decreases to moderate, but differs sharply from the original. The patient has severe arrhythmia and tachycardia.

At this stage of development it appears acute failure in the left ventricle (asthma in the heart, pulmonary edema).

3. Acute period.

During the development of the next stage, painful sensations disappear. Their persistence occurs due to severe ischemia of the peri-infarction zone against the background of pericarditis.

The development of death of the heart muscle and inflammation causes a febrile state for a period of three to ten days (this condition can persist longer). The duration of the fever and its degree depend on the area of ​​tissue death. Heart failure and arterial hypertension develop and increase.

4. Subacute period.

The patient does not experience pain, the condition improves, the body temperature becomes normal, the fever goes away. Symptoms of heart failure are vague. There is a systolic murmur in the left ventricle and tachycardia.

5. Post-infarction period.

At this stage, there are no clinical manifestations at all, heart studies do not show obvious deviations from the norm.

There are atypical forms of heart attack development. In this case, pain sensations are located in other places that are not typical for the normal course of the disease - this is the throat, left shoulder blade, cervicothoracic region spine, lower jaw, epigastrium, fingers of the left hand. It happens that there will be no pain at all, and the main symptoms of a heart attack are coughing, suffocation, swelling, arrhythmia, collapse, and clouded consciousness.

Such forms of acute coronary heart disease appear in older people who have cardiosclerosis, circulatory problems, or have already had one heart attack. However, unusually only the most acute period. Further, everything is according to the typical “program”. And the erased course of a heart disease can be determined on an electrocardiogram, as it passes in some cases without pain.

Acute myocardial infarction

This form of heart disease is designated when three main criteria coincide:

Symptoms of acute heart attack

During a heart attack, the development of “tearing” pain in the heart or behind the sternum is common; it almost always radiates to the left arm, in some cases to the lower jaw and scapula. The pain lasts for thirty minutes and is not relieved by using nitroglycerin. The patient feels suffocation, lack of air, which manifests itself through pale skin, cold sweat, severe weakness, decreased blood pressure, nausea, fear, and vomiting. Prolonged pain for more than 20-30 minutes, which does not disappear after the patient has taken nitroglycerin.

Heart attack on ECG

Pathological changes on the ECG are signs of damage to areas of the heart muscle. Typically, this is the detection of Q waves and ST segment elevation.

Changes in tests during acute heart attack

Deterioration laboratory tests and other indicators. For example, an increase in the blood of cardiac-specific markers - cardiomyocytes, which indicate destructive processes in the heart muscle.

Signs of myocardial infarction

People with coronary disease the heart is concerned with the question: how to detect myocardial infarction? Among the measures taken to diagnose heart disease, the most important are anamnesis, pathological changes in the electrocardiogram, and indicators of blood enzyme activity.

The patient's complaints of pain, which can tell the doctor about the development of coronary heart disease, can be completely different - depending on the course of the heart attack. This is also affected by the area of ​​tissue death. A heart attack can be suspected if there is prolonged, severe pain (from thirty minutes to an hour) in the chest. A doctor can diagnose a heart attack if the clinical picture coincides with acute heart failure or cardiac arrhythmia.

On the electrocardiogram, the “signal” for the development of a heart attack can be attributed to the formation of a T-wave (typical of a small-focal intramural or subendocardinal infarction), a pathological QRS complex, or a Q-wave (typical of a large-focal infarction).

During the first 4-6 hours after the onset of severe “wavy” pain, an increase in the content of the protein that transports oxygen into cellular structures – myoglobin – can be detected in the blood.

In addition, an increase in creatine phosphokinase activity in the blood by half can be detected after the next eight to ten hours of the development of a heart attack. After two days, this process decreases to normal. This level should be determined every six to eight hours. If the study shows three “negative” cases in a row, then a heart attack is excluded.

To diagnose myocardial infarction late stage, doctors use a test for the enzyme lactate dehydrogenase. It has been noticed that the increased activity of this enzyme occurs after one or two days, when the death of a section of the muscle tissue of the heart has already formed. And after a week or two weeks this value also normalizes.

One of the most characteristic clinical signs of myocardial infarction is an increase in the number of isoforms of the myocardial protein - troponin (T-form and 1-form), which also increases during unstable attacks of progressive angina. In the patient's blood, the ESR gradually increases, an increase in the number of leukocytes is observed, and the activity of aspartate aminotransferase and alanine aminotransferase increases.

With an echocardiogram, the doctor can detect a local violation of the contractility of the left ventricle and thinning of its walls.

Coronary angiography gives the doctor the opportunity to determine the presence of thrombotic occlusion in the coronary arteries and the presence of decreased ventricular contractility. In addition, this makes it possible to determine whether it is possible to perform coronary artery bypass surgery or angioplasty, which helps restore cardiac activity.

How to treat myocardial infarction

How is myocardial infarction treated? Important: if a heart attack is detected, the patient is immediately admitted to the cardiac intensive care unit at the hospital. In the acute period of the development of the disease, the patient must remain at rest, bed rest, he must not be disturbed, and the person must take a limited diet in volume and calories. In the subacute period, the patient is transferred from intensive care to the cardiology department, where doctors continue therapy with a subsequent expansion of the regimen.

The main goal in treatment for myocardial infarction is to restore blood flow to the affected area of ​​the heart as quickly as possible and maintain it normal. To achieve this, medicine uses the following means:

• Aspirin – does not allow blood clots to develop and prevents them.
• Plavix (together with Ticlopidine, Prasugrel) - also carried positive effect, prevent blood clots from forming, and are much stronger than aspirin.
• Thrombolytics (Alteplase, Streptokinase, Reteplase, TNK) – powerful drugs, which are able to dissolve a blood clot without separating it and moving it through the blood vessels.
• Heparin (Lovenox, Fraxiparin and other low molecular weight heparins), Bivalirudin are anticoagulants that affect blood clotting and help thin blood clots.

All drugs and similar ones from this group are used in combination for quality treatment myocardial infarction.

After much research, modern medicine considers the most the best method restoration of the lumen of the coronary arteries, restoration of blood circulation to the dying part of the heart - immediate surgery on the artery with the possible installation of a stent (angioplasty). Most researchers argue that in the first hour of a heart attack, and if angioplasty is not possible, it is best to use thrombolytic drugs.

If the above measures do not bring the desired result, they are impossible - urgent surgical intervention in the form of bypass surgery will be required. This may be the only right decision to save the myocardium and prevent death.

In addition to the main task, treatment of a person with myocardial infarction must fulfill the following goals:

• Preventing the merging of small foci of necrosis and merging into a large foci in the area of ​​the heart muscle. This is achieved by reducing oxygen to the myocardium using beta blockers (Metoprolol, Bisoprolol, Atenolol, etc.); reducing the “load” on this area (Rampril, Enalapril, Lisiopril, etc.).
• Treatment of arrhythmia with Amiodarone, Lidocaine (for arrhythmias with an increased rhythm), Atropine, temporary cardiac stimulation (for a slow rhythm).
• Control of pain syndrome (painful sensations disappear after restoration of normal blood flow to the affected area of ​​the heart) with the help of Nitroglycerin, narcotic analgesics.
• Maintaining the patient’s vital activity, monitoring blood pressure, pulse, proper kidney function, and breathing.

It is worth emphasizing: the first days of the disease are critical for the patient. Subsequent forecasting depends on the quality of the measures taken and their results. Of course, the degree of “damage” to the heart is taken into account, as well as the presence and size of risk factors for subsequent diseases of the heart muscle.

In addition, if the course is favorable, high efficiency treatment of a patient with a heart attack, there is no need for strict bed rest on the first day. It is worth emphasizing that excessive amounts of this regimen may have a negative impact on the patient's recovery after therapy.

The reduction and complete “destruction” of pain is carried out in a complex - narcotic analgesics (fentanyl), neuroleptics (droperidol), and nitroglycerin.

Therapeutic measures for a heart attack should include preventing the development of arrhythmias and their elimination, relieving heart failure, and preventing cardiogenic shock. For this purpose, antiarrhythmic drugs (lidocaine), beta-blockers (atenolol), calcium antagonists (verapamil), thrombolytics (heparin, aspirin), nitrates, magnesia, etc. are used.

After the first day of infarction development, perfusion should be restored using thrombolysis or angioplasty.

Forecast of an infraction

This disease is very serious with accompanying dangerous complications. According to statistics, the vast majority deaths In case of a heart attack, it occurs in the first 24 hours. The ability of the heart to function depends on the degree of necrosis and its location. If more than fifty percent of the myocardium is damaged, the heart cannot function, leading to cardiogenic shock and death of the patient. Even with a smaller area of ​​necrosis, doctors are not always able to save a patient whose heart cannot cope with the load. However, after the acute period the prognosis for recovery is very good.

Myocardial infarction: rehabilitation and prevention

Important conditions for preventive measures for myocardial infarction are maintaining a healthy lifestyle, giving up unhealthy habits, a balanced diet, avoiding overexertion, and controlling blood pressure and cholesterol in the blood.

The patient must follow all the doctor’s recommendations and also follow a special diet. Because people with coronary artery disease are at high risk of thrombosis, avoiding certain foods, along with taking medications, is necessary to avoid this. A patient after a heart attack is not recommended to eat:

• cow butter (it must be replaced with low-fat margarine for sandwiches);
• egg yolks (they contain a lot of cholesterol, which negatively affects the walls of blood vessels and large arteries);
• pork, beef, veal, lamb;
• sour cream, cream and milk with high content fat;
• lard and products containing palm oil.

• low-fat margarine;
• olive oil (can be fried and salad dressing);
• skim milk and kefir;
• chicken, turkey;
• low-fat varieties of fish, as well as fish with healthy fatty acids(salmon);
• vegetables and fruits in large quantities.

Together with proper diet, it is necessary to adjust physical activity. They should be, but they should be moderate. People who have had a heart attack need to walk fresh air without making heavy loads. Of course, sports and heavy lifting are contraindicated for people with ischemia and a previous heart attack. However moderate loads contribute to the proper functioning of the heart and the easy flow of oxygen into the blood.

Heart attack: complications

As a rule, complications of the disease occur with extensive, deep necrosis of the heart muscles. It is reliably known that a heart attack is the death of a certain area of ​​the heart. Necrotic muscle tissue, as well as all its functions and features, are transformed into connective tissue, losing the ability to contract, excite, losing the necessary degree of conductivity, etc. As a result, the walls of the heart become thinner, while the cavities of the left ventricle of the heart increase. Often, complications during myocardial infarction arise even before the end of all stages of the disease, significantly complicating the course of the disease.

In this case, the patient experiences several types of arrhythmias at once: sinus, extrasystology, paroxysmal tachycardia, complete intraventricular block, atrial fibrillation. All this can happen in the first 3 days. The most dangerous is considered to be ventricular fibrillation, which can “develop” into fibrillation and lead to death.

Congestive wheezing, pulmonary edema, cardiac asthma - all these are signs of left ventricular heart failure, which occurs during the acute period of a heart attack. Left ventricular failure, which is accompanied by cardiogenic shock, which occurs with a large infarction, is very difficult to tolerate. Leads to the death of the patient. Signs of cardiogenic shock are blood pressure below eighty, impaired consciousness, cyanosis, tachycardia.

If muscle fibers rupture due to tissue necrosis, this leads to cardiac tamponade. In other words, this means that the patient will have a pericardial hemorrhage.

Only 2-3 percent of total number In patients with myocardial infarction, thromboembolism of the pulmonary artery system and systemic circulation is observed. This can lead to death due to sudden pulmonary infarction.

In the first ten days, patients with extensive transmural infarction may die due to ventricular rupture, because acute disruption of blood flow occurs. Extensive heart attack myocardium can also lead to “inconsistency” of scars, their bulging with the development of a cardiac aneurysm. The acute form of an aneurysm can change into a chronic form, which causes heart failure.

Fibrin, deposited on the walls of the endocardium, causes the progression of parietal thromboendocarditis. This disease is dangerous because it causes embolism in the vessels of the brain, lungs, and kidneys, because separated thrombotic masses wander through the blood. In more late period post-infarction syndrome develops, which is accompanied by pleurisy, arthalgia, and pericarditis.

Common complications are:

• Arrhythmia. The most common complication myocardial infarction. As a rule, the greatest danger to the patient is ventricular fibrillation and ventricular tachycardia, which is fatal. We must not forget that any type of cardiac arrhythmia requires immediate treatment.
• Arterial hypertension. The complication arises due to the fact that during illness the heart requires many times more oxygen, and also due to increased load on the walls of the left ventricle. These factors lead to an increase in the affected area and its stretching.
• Mechanical complications. These include ventricular septal rupture and cardiac aneurysm. As a rule, this complication develops in the first week of the disease and is clinically manifested by a deterioration in hemodynamics, which causes death. Urgent surgery required.
• Dressler's syndrome. Post-infarction condition, which is manifested by inflammation of the heart sac, inflammatory changes in the lungs and in the lung sac. The occurrence of this disease is associated with a high level of antibodies.
• Intense painful sensations, periodically repeated with equal force. This complication occurs in approximately one third of patients with ischemia and infarction.
• Heart failure. This implies a decrease in heart contractions. A fairly common complication of a heart attack. Decline contractile function directly proportional to the area of ​​damage to the heart muscles.

Acute cardiac ischemia is dangerous because the development of complications is often very difficult to predict. Their appearance and progression depends on the following factors:

• Amount of heart damage. How larger area necrosis, the stronger the complication will be.
• Location of myocardial damage: anterior, posterior, lateral wall of the left ventricle, etc. As a rule, myocardial infarction develops in the anterior region of the left ventricle. Less often – lower and back wall myocardium.
• Time to restore blood circulation in the affected area. The sooner medical care and effective treatment are provided, the smaller the area of ​​heart damage will be.

Help with a heart attack

If you find the above symptoms of a heart attack in a person (burning, tearing pain, radiating to left side, state of shock, etc.). If angina appears in a patient for the first time, you should immediately call an ambulance. You will also need emergency help if:

• Pain in the chest that intensifies for more than five minutes. Weakness, vomiting, difficulty breathing.
• The chest pain did not stop after five minutes and the first nitroglycerin tablet was dissolved.

First aid for a heart attack and suspected heart attack before the ambulance arrives

• The patient should be put down as soon as possible, the head should be left elevated, and then nitroglycerin should be given under the tongue again. You can also give aspirin (the patient must chew the tablet; if this is not possible, then it must first be crushed).
• Give one tablet of analgin or baralgin, sixty drops of Corvalol. An alternative is Valocardin, or two tablets of Panangin. Place the mustard plaster on the chest (in the area of ​​the heart).
• Wait for paramedics from the ambulance.

Resuscitation of a patient with a heart attack

What to do if the patient does not show signs of life? The patient's chance of survival increases if immediate resuscitation measures are taken (they should begin no later than one minute after cardiac collapse).

So what should you do?

1. Call an ambulance immediately.

2. Correctly position the patient who has stopped responding to external stimuli. Provide passability respiratory tract for free access of air. You will need to place the person on a flat, hard surface, tilt their head back; remove from the mouth any objects that interfere with artificial respiration: dentures and any other foreign bodies. If the patient has vomited and is now unconscious, turn the patient's head to one side and remove the contents from the mouth and throat mechanically.

3. Check for breathing.

If there is no spontaneous breathing, then perform resuscitation - artificial ventilation. Place the patient on a flat and preferably hard surface; he should lie on his back with his head thrown back. It is necessary to move the patient's lower jaw forward. Inhale deeply and exhale air into the open mouth of the patient, whose nose is pinched, lips pressed tightly. Repeat this procedure several times.

Place your hand on the carotid artery: if there is no pulse there, then ventilation must be accompanied with indirect massage on the heart. To do this, you need to fold your hands one on top of the other, the base of the palm lying on the chest should be strictly along the midline. Important: the patient’s arms must be straight at all times and should not be bent. Using your own weight, you need to bend the patient's chest 4-5 centimeters towards the spine. The duration of pressing should not exceed more than eighty shocks per minute. Accompany compression with artificial respiration in the proportion of 1-2 inhalations per 10-15 shocks.

Do not forget to monitor the effectiveness of resuscitation efforts. The degree of effectiveness increases with the change in the patient's condition - the skin turns pink, the pupils narrow - this means that there is a reaction to light, the pulse in the area of ​​the carotid artery began to be felt, and an improvement in spontaneous breathing is observed. Resuscitation measures must be continued until the ambulance arrives.

Typical signs of a heart attack

As a rule, a heart attack is preceded by frequent attacks of angina in a patient with coronary heart disease. However, disruption of blood flow can also occur against the background of complete well-being. In addition, a person is not always able to appreciate that his illness is associated with the development of a pathological process in the heart.

Pain syndrome during myocardial infarction

its duration is at least 15 minutes;

taking nitroglycerin helps reduce pain, but does not relieve it completely;

the source of pain is in the left half of the chest or behind the sternum;

the pain is burning, pressing or squeezing in nature;

the pain can be intense or wave-like (either decreasing or increasing again);

the patient may complain of pain spreading to the lower jaw, neck, left arm (and even leg) and the space between the shoulder blades.

Associated symptoms

In addition to pain during a heart attack, the following accompanying symptoms are noted:

sticky and cold sweat,

general pallor of the skin,

• • marble skin color,
  • cyanosis of lips and limbs,
  • Difficulty determining blood pressure and pulse.

  Hesitating to call an ambulance at the first signs of myocardial infarction is extremely dangerous. The fact is that the pathological process can develop within a few hours, or vice versa very quickly. This is evidenced by sad statistics - 40% of patients with a heart attack die before doctors arrive. This usually occurs due to arrhythmia, incompatible with life, in which the heart is no longer able to pump blood.

  Even after providing timely medical assistance, the patient may begin to experience next period heart attack with a rise in body temperature to 38 degrees (reaction immune system to the death of a section of the myocardium). In this case, internal organs can also be affected if the patient goes into cardiogenic shock. For example, due to bad work kidneys, the amount of synthesized urine significantly decreases, which leads to the accumulation of metabolic products in the patient’s body and general intoxication.

  In a later rehabilitation period, the patient may experience signs of heart failure:

  • edema lower limbs,
  • shortness of breath when lying down or with little exertion.

  When the affected area of ​​the heart becomes thinner, an aneurysm may develop, in the cavity of which blood clots will begin to form, which, once in the systemic circulation, can cause embolism of the intracerebral and pulmonary arteries.

  Possible localization of pain during a heart attack:

  

  Atypical heart attack symptoms

  Among less typical signs It is customary to distinguish several clinical forms of myocardial infarction.

  Asthmatic form

  This form of manifestation is typical for 7% of cases of heart attack in women. It is characterized by the following symptoms:

  Gastralgic form

  With this form, the patient may experience:

  nausea or vomiting.

  With these symptoms, your doctor may suspect acute poisoning, appendicitis or stomach ulcer, mistakenly hospitalize the patient in another department. As a result, precious time may be lost, which is fraught with the development of complications in the patient’s condition with a heart attack.

  Cerebrovascular form

  This form occurs in 1% of patients and occurs in the form of deep fainting or stroke. Such atypical clinical manifestations are more typical for men than for women (three times more often). Subsequently, paresis and paralysis may develop against the background of general cerebral symptoms.

  Arrhythmic form

  This form is characterized by various heart rhythm disturbances (extrasystole, atrial fibrillation). To the most dangerous violations refers to atrioventricular block, when the heart rate is reduced to a critical level and below, and ventricular fibrillation is manifested by chaotic contraction of muscle fibers. In such a situation, emergency health care to prevent cessation of blood circulation through the vessels.

  Atypical clinical manifestations also include localization of pain in the back, spine or right half of the chest. If the pain syndrome manifests itself over a shorter period of time (up to 10 minutes), then this may be a sign of a microinfarction, which is no less dangerous in its consequences than a regular one.

  Due to the fact that the symptoms of a heart attack are extremely varied, any unusual signs observed in a patient with coronary artery disease should be regarded as a pre-infarction condition, which requires immediate contact with medical specialists.

  

  Symptoms of heart attack in women

  According to research, the first warning signs of a heart attack in most women who have had a heart attack can appear long before the attack. These include:

  feeling chronic fatigue experienced even after a normal period of rest,

  dizziness,

  increased sweating,

  lack of normal sleep, insomnia,

  sharp drop blood pressure,

  slow and slurred speech(speech impairment),

  difficulty breathing (characteristic of heart failure), shortness of breath with changes in body position,

  digestive disorders, nausea and vomiting that appear for no apparent reason,

  the appearance of profuse cold sweat,

  cyanosis and pallor of the skin, lips,

  unbearable sharp pain in the chest, lasting at least 10 minutes,

  Taking heart medications gives a weak result or does not help at all.

  

  What to do before the ambulance arrives

  Until the medical team arrives and the diagnosis is confirmed using ECG (electrocardiography), it is necessary:

  placing the patient in bed or on a flat surface with his head elevated, provide him with maximum flow of fresh air,

  prepare everything for doctors medical documents patient, reporting what medications he took the day before.

  Attention: during a heart attack, taking medications that lower blood pressure is strictly prohibited.