A heart that has ever suffered from severe ischemia will never be the same. If you have a history of at least one coronary attack, you need to carefully monitor your condition. By following simple recommendations, you can significantly reduce the risk of severe complications.

Myocardial infarction: acute period and development of pathological changes

The International Classification of Diseases identifies various forms of ischemia; the names of the disease may differ depending on the severity of the lesion, ranging from stable angina to an attack of necrosis of the heart muscle. Determination of pathology by ECG depends on the stage of development of ischemia. The necrotic process of the posterior wall of the heart muscle can be much more difficult to determine than damage to the anterior wall, since it is not always visualized on the electrocardiogram.

Acute myocardial infarction is manifested by cardiac dysfunction and other characteristic symptoms, is accompanied by numerous complications and poses a threat to life

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

• Damage to muscle fibers. Due to the disruption of normal blood flow through the coronary arteries, persistent ischemia occurs. The lack of oxygen negatively affects the condition of cardiomyocytes; in the affected area they begin to collapse. Still living fibers react to ischemia and pain occurs. The stage lasts from several hours to 2-3 days.
• The period of acute manifestation of clinical signs. Depending on the severity of ischemia, necrosis or mild tissue damage may occur in various areas.

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

Within two weeks, the focus of inflammation continues to form. Interpretation of the ECG helps to detect the pathological Q wave. An ischemic zone forms at the periphery of the necrotic area.

Acute myocardial infarction is the undisputed leader in the structure of mortality worldwide

• AMI in the subacute stage. The final stabilization of muscle tissue occurs. The area of ​​necrosis becomes clearer, and damaged areas are restored. It is difficult to say with accuracy how long this stage lasts. Usually its duration is up to 3 months, in severe cases – up to 1 year.
• Scar stage. The signs of the most acute period completely disappear, the person practically ceases to be bothered by pressing pain in the chest, dizziness and weakness. Adaptive mechanisms involve the formation of fibrous tissue at the site of the affected lesion. Healthy areas hypertrophy, trying to compensate for the decrease in the functioning area of ​​the heart.

If a report was provided that described an ischemic attack, you should be on guard.

Important! Mild manifestations of coronary artery disease, in the absence of appropriate treatment, can develop into more severe forms over time.

A dangerous complication is left ventricular failure, followed by cardiogenic shock.

Myocardial infarction: causes and diagnosis

Spontaneous occurrence of a heart attack is quite common. A person can engage in normal activities until a burning chest pain takes him by surprise. Doctors classify this disease as a polyetiological disease and claim that AMI occurs only if there are predisposing factors.

The most common cause of acute myocardial infarction is atherosclerosis

The cause of ischemia is blockage of the coronary vessels:

• blood clot due to coronary thrombosis;
• atherosclerotic plaque.

The etiology of IHD may be associated with the following conditions:

• high level of cholesterol in the blood (a connection has been established with atherosclerosis);
• endocrine pathologies;
• blood pathologies (hypercoagulation, thrombosis);
• arterial hypertension;
• bad habits;
• old age and the presence of concomitant diseases of the circulatory system.

Diagnosis of AMI necessarily includes an electrocardiogram, which will help identify pathological abnormalities. A blood test is done to detect neutrophilic leukocytosis. Additional diagnosis of myocardial infarction, its acute form, is made by identifying biochemical markers of necrosis (CPK-MB, tropinin, myoglobin) in the blood.

How does necrosis of the heart muscle manifest on an ECG?

Manifestations of the disease on the electrocardiogram can vary depending on the location of the lesion, its size and the severity of the necrotic process. In turn, there are common symptoms for most forms of the disease.

“Q-infarction” - with the formation of a pathological Q wave, sometimes a ventricular QS complex (usually large-focal transmural myocardial infarction)

An ECG with necrotic heart disease has a number of features:

• in the damage stage: the S-T segment rises above the isoline, the R wave has a reduced amplitude, the presence of a pathological Q wave depends on the formation of necrosis, at this stage it may be absent;
• the most acute stage is characterized by: a slight decrease in the S-T segment, the appearance of a pathological Q wave, a negative T wave;
• the third stage of the disease is divided into two parts: first, the ECG shows a negative T wave with a large amplitude; as recovery progresses, it decreases and rises to the baseline;
• During the scarring stage, the normal appearance of the electrocardiogram is restored, the Q wave may disappear, the S-T segment returns to the isoline, and the T wave becomes positive.

Restoring normal heart function after an AMI is individual. In some people, the signs of the disease disappear very quickly and its presence in the anamnesis is almost impossible to determine by ECG; in others, the pathological Q wave can persist for a long time.

What features does non-Q-infarction have?

Small-focal lesions are tolerated more easily than large-focal forms of the disease. Clinical signs characteristic of the non-Q form of the disease are less pronounced. There may be slight chest pain that resembles an angina attack.

“non-Q-infarction” – not accompanied by the appearance of a Q wave, manifested by negative T-waves (usually small-focal myocardial infarction)

Important! With this type of disease, an electrocardiogram without a pathological Q wave is observed.

Some people who have experienced a small-focal form of myocardial necrosis learn about the presence of pathological changes only during a routine examination, for example, a medical examination. It is necessary to pay attention to the T wave, which in this form of the disease changes greatly; it becomes double-humped or jagged.

Acute coronary infarction

Since the symptoms of ischemia can vary significantly, there are cases where necrosis of the heart muscle was mistaken for angina pectoris.

Before starting treatment for coronary syndrome, it is recommended to do an electrocardiogram, which helps to establish the type of disease:

• Acute myocardial infarction with S-T segment elevation. A blockage of a blood vessel occurs with a thrombus or atherosclerotic plaque, which causes ischemia and transmural damage to the heart muscle.
• AMI without S-T segment elevation. An ECG of this type is observed in the initial stages of the necrotic process. When small focal changes are recorded, the S-T segment is at the usual level, and the pathological Q wave is most often absent. The difference from angina is the presence of necrosis markers.

Typical cases of myocardial infarction are characterized by extremely intense pain with pain localized in the chest and radiating to the left shoulder, neck, teeth, ear, collarbone, lower jaw

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

After examination by a cardiologist and collection of complaints, an additional examination is carried out to help differentiate unstable angina and necrosis of the heart muscle.

Myocardial infarction: how to provide emergency care

If you suspect a heart attack, you should call an ambulance. Self-medication can lead to irreversible serious consequences.

Important! “If you have previously experienced sharp pain in the chest, this is fraught with an increase in the focus of necrosis. The further success of treating the disease depends on how correctly first aid is provided.”

While medical workers are traveling to the patient, the algorithm of actions is as follows:

• the patient should completely relax, for this it is advisable to take a horizontal position, loosen tight clothes, open the window, create a calm environment in the room;
• you can try to stop the attack with nitroglycerin, it can slightly reduce spasm of the coronary vessels;
• pre-medical care does not imply special medications (thrombolytics, anticoagulants), they should be taken in a hospital setting under the supervision of a doctor; giving such medications to a patient on their own is very risky;

To slow down the further development of atherosclerosis, it is important to prevent the formation of fatty plaques in the vessels. For this purpose, drugs from the statin group are prescribed.

• if you suspect cardiac arrest, you should immediately begin giving the patient an indirect massage, which is presented in the form of 30 chest compressions; sometimes artificial ventilation may be required.

An attack of AMI is completely controlled only by narcotic analgesics. To prevent relapses of the disease in a hospital setting, specific therapy can be prescribed, which involves a set of medications that can reduce the load on the heart and protect muscle tissue from the manifestations of ischemia.

Complications of acute myocardial infarction

Even if the electrocardiogram does not show any signs of necrosis and you feel satisfactory, you should be periodically examined to exclude dangerous complications.

AMI can cause the following serious consequences:

• heart failure;
• the immediate complication is cardiogenic shock;
• pulmonary edema (as a consequence of heart failure);
• Dressler's syndrome (autoimmune damage to the heart muscle);
• changes in rhythm and conductivity (arrhythmias, blockades).

Often complications arise already in the first hours and days of myocardial infarction, complicating its course.

Medicine of the twenty-first century does not stand still; it carefully studies the problems of each cardiac patient. To eliminate the severe consequences of the disease, there are a number of drugs that will help reduce the load on the heart, restore vascular tone and protect tissues from the development of ischemia. Proper first aid provided during the initial period of the disease and careful adherence to the recommendations of doctors will help reduce the risk of complications.

Signs of acute myocardial infarction

People who first suffered from necrosis of the heart muscle remember its manifestations for a long time. In some cases, symptoms may be somewhat blurred, depending on the presence of concomitant pathologies or in the case of a small-focal form of the disease.

Attention! If you suffer from diabetes, it can be difficult to understand what is really happening to your heart. The sensitivity of tissues decreases, and therefore some people calmly tolerate the disease “on their feet.”

You are actually overtaken by an attack of this serious illness if:

• A sign of the most acute stage is pain behind the sternum of a burning and pressing nature, which radiates to the left arm, shoulder blade, neck, jaw. May be accompanied by indigestion, abdominal cramps, and numbness of the limbs.

The patient's complaints during myocardial infarction depend on the form (typical or atypical) of the disease and the extent of damage to the heart muscle

• Characteristic signs of ischemia: dizziness, malaise, shortness of breath, rapid fatigue. Cold sweat appears, and during an attack the person is completely unable to engage in usual activities.
• Blood pressure surges (it can fall or rise to critical values), the pulse becomes faster, and there is strong anxiety about one’s condition and life. Sometimes the body temperature rises, and signs of intoxication of the body with particles of dead tissue appear.

The clinical variant of the disease (abdominal, asthmatic, collaptoid, arrhythmic, etc.) matters. Depending on the form of the disease, nausea or cough may occur, which bring additional difficulties in diagnosing the disease.

Attention! Cases have been recorded where a patient was admitted to the hospital with suspected gastrointestinal or pulmonary pathology, but only after a thorough examination were signs of cardiac muscle necrosis identified.

If the diagnosis is not made in time, severe syndromes may occur that pose a risk to the patient's life.

Treatment of acute myocardial infarction

The complex of symptoms characteristic of coronary artery disease does not refer to conditions that “will go away on their own.” The disappearance of pressing pain behind the sternum does not mean complete recovery. Even a small focus of necrosis can seriously affect the functioning of the heart.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, and cardiogenic shock

In the initial period of the disease, very severe pain occurs, which requires intensive care:

• nitroglycerin in a standard dose of 0.4 mg (to enhance the speed of action, it is recommended to place it under the tongue, you can use up to 3 tablets);
• beta-blockers, which fight ischemia and help protect areas of the heart from death (standard drugs are Metoprolol and Atenolol);
• in severe cases, when there is a significant necrotic process, narcotic analgesics, such as morphine, are administered intravenously.

Myocardial infarction is dangerous, first of all, because of its complications. In order to restore damaged tissue and reduce the load on a diseased heart, a cardiologist selects special therapy.

Drugs for severe myocardial infarction are taken continuously, and not only in the acute period; to prevent relapse, the following are prescribed:

• Thrombolytics (streptokinase, urokinase). The pathogenesis of the disease most often lies in the disruption of blood flow through the coronary vessels, which are blocked by a blood clot.
• Beta blockers. Reduce the need for oxygen, reduce the load on the heart muscle. They are often used in drug therapy for arterial hypertension. Drugs in this group can lower blood pressure.

Pain relief is carried out using a combination of narcotic analgesics

• Anticoagulants and antiplatelet agents. Standards of treatment include medications that can thin the blood. The most popular today is acetylsalicylic acid. It is contraindicated for gastritis and bronchial asthma.
• Nitrates. It is appropriate to use nitroglycerin in the first minutes of an attack; its beneficial effect on protecting cardiomyocytes from ischemia has been proven. Its use reduces the risk of complications, including cardiogenic shock.

If you follow all clinical recommendations, you can avoid many dangerous complications. A history of AMI makes a person more vulnerable. Even minor physical activity can lead to a recurrent attack. To make life easier, specialists in the field of cardiology provided an algorithm of actions to improve the patient’s condition.

In order for your life to be the same after a heart attack, you need to radically change your lifestyle. Properly selected drug therapy for AMI is not everything. Unhealthy foods, heavy physical labor, chronic stress and the presence of concomitant diseases can negatively affect the body’s recovery rate. Doctors around the world have developed clinical recommendations aimed at improving the patient’s condition.

Necessary conditions for the prevention of myocardial infarction are maintaining a healthy and active lifestyle, giving up alcohol and smoking, and a balanced diet.

Acute myocardial infarction requires only proper nutrition:

• low cholesterol foods;
• fresh fruits, vegetables, berries, which, with the help of a large amount of vitamins, promote the regeneration of heart fibers;
• a special diet is required, which involves excluding fast food, chips, crackers, etc. from the diet;
• refusal to drink alcohol and coffee.

If a person often clutches his heart, he experiences shortness of breath after minor physical exertion, his limbs go numb, or his blood pressure fluctuates - this can become an alarm bell in the progression of the disease.

Prevention of acute myocardial infarction requires you to carefully monitor your own health, which includes:

• getting rid of bad habits (nicotine negatively affects blood vessels and the heart, coffee increases the need for oxygen);
• moderate physical activity (walking in the fresh air is an excellent choice);
• absence of stress, training in relaxation methods;
• maintaining normal weight;
• periodic measurement of blood pressure and pulse.

It is easier to avoid AMI than to spend the rest of your life treating it. Among people who are accustomed to regular physical activity, eat healthy foods and try to have a positive outlook on life, coronary heart disease is much less common.

Acute myocardial infarction, how is rehabilitation going?

The development of the disease and rehabilitation of patients in each individual case can occur differently. Some people suffer from ischemia, which is very dangerous, and at the same time calmly engage in normal activities. Other patients after illness are forced to avoid unnecessary stress, some of them even begin to register for disability. Proper exercise will help you recover faster.

Exercise therapy after acute myocardial infarction implies:

• moderate dynamic loads (running, skating or roller skating, cycling, swimming);
• breathing exercises (for example, a set of exercises by Strelnikova);
• Indian yoga.

But static exercises with a heavy load are strictly contraindicated for cores.

Attention! Lifting heavy weights can contribute to the occurrence of another attack. It should also be remembered that you need to start gymnastics no earlier than at the stage of scar formation.

Myocardial infarction is a focus of necrosis of the heart muscle that develops against the background of an acute circulatory disorder in the coronary arteries. If we talk about myocardial lesions in general, infarction is the most common pathology. This condition is a direct indication for hospitalization of the patient in a specialized department, since without the provision of qualified medical care it can lead to death.

Considering the danger of pathology, it is better to prevent it than to treat it. That is why, if you suspect heart disease (IHD) or other disorders of the heart, it is important to immediately seek help from a specialist in order to prevent the formation of a disease such as myocardial infarction.

Reasons

To understand what a heart attack is, it is extremely important to understand the reasons that cause it. One of the most important reasons against which this condition develops can be confidently called atherosclerosis. This is a disease whose pathogenetic basis is a violation of fat metabolism in the body.

Against the background of excess cholesterol and lipoproteins, they are deposited in the lumen of blood vessels with the formation of characteristic plaques. In case of blockage of the coronary arteries, a heart attack occurs. In more detail, there are three main components of atherosclerosis, which can cause circulatory disorders in the coronary arteries, namely:

• Narrowing of the lumen of blood vessels as a result of the deposition of plaques on their walls. This also leads to a decrease in the elasticity of the vascular wall.
• Vasospasm, which can occur due to severe stress. In the presence of plaques, this can lead to acute coronary circulatory disorders.
• Separation of plaque from the vascular walls can cause arterial thrombosis and, worse, myocardial infarction (damage).

Thus, atherosclerosis is the main cause of myocardial infarction, which is a rather dangerous condition and must be corrected.

The risk of developing a disease such as a heart attack is significantly increased by the following factors:

• Bad heredity. Pathologies of the cardiovascular system in close relatives play a role.
• Poor nutrition and sedentary lifestyle. These factors lead to the formation of a condition such as obesity in a person.
• Obesity. Excess fat leads to direct deposition of plaques on the walls of blood vessels.
• Bad habits. Drinking alcohol and smoking lead to vasospasm.
• Endocrine disorders. Patients with diabetes are more prone to changes in cardiac circulation. This is due to the negative effect of this disease on blood vessels.
• A history of heart attacks.

Blood pressure disorders, manifested by persistent hypertension, and constant stress can also cause a heart attack.

Symptoms

The symptoms of myocardial infarction directly depend on its stage. During the damage stage, patients may not have any complaints, but some have unstable angina.

In the acute stage, the following manifestations are observed:

• Severe pain in the heart area or behind the sternum. Irradiation is possible. The nature of the pain varies from person to person, but most often it is pressing. The severity of pain directly depends on the size of the lesion.
• Sometimes there is no pain at all. In this case, the person turns pale, blood pressure rises greatly, and the heart rhythm is disturbed. Also, with this form, the formation of cardiac asthma or pulmonary edema is often observed.
• At the end of the acute period, against the background of necrotic processes, there may be a significant increase in temperature, as well as an increase in hypertensive syndrome.

In the case of an erased course, manifestations are completely absent, and the presence of a problem can only be suspected when an ECG is performed. This is why it is so important to undergo preventive examinations from specialists.

It should be said about atypical forms of the acute period. In this case, the pain syndrome may be localized in the throat or fingers. Very often, such manifestations are typical for older people with concomitant cardiovascular pathologies. It is worth noting that an atypical course is possible only in the acute stage. Subsequently, the clinical picture of myocardial infarction in most patients is the same.

In the subacute period, with myocardial infarction, gradual improvement occurs, the manifestations of the disease gradually become easier, until they disappear completely. Subsequently, the condition normalizes. There are no symptoms.

First aid

Understanding what it is - the occurrence of myocardial infarction, it is important to realize that first aid plays an important role. So, if you suspect this condition, it is important to take the following steps:

1. Call an ambulance.
2. Try to calm the patient down.
3. Ensure free access of air (get rid of tight clothing, open the windows).
4. Place the patient in bed so that the upper half of the body is higher than the lower half.
5. Give a nitroglycerin tablet.
6. If you lose consciousness, begin cardiopulmonary resuscitation (CPR).

It is important to understand that the disease called myocardial infarction is a life-threatening condition. And the development of complications and even the life of the patient depends on the correctness of first aid, as well as the speed of initiation of medical measures.

Classification

Heart attacks are classified according to the following criteria:

• Size of the lesion.
• Depth of damage.
• Changes in the cardiogram (ECG).
• Localization.
• Presence of complications.
• Pain syndrome.

Also, the classification of myocardial infarction can be based on stages, of which four are distinguished: damage, acute, subacute, scarring.

Depending on the size of the affected area - small- and large-focal infarction. It is more favorable to involve a smaller area, since complications such as cardiac rupture or aneurysm are not observed. It is worth noting that, according to studies, more than 30% of people who have suffered a small-focal heart attack are characterized by transformation of the hearth into a large-focal one.

According to ECG abnormalities, two types of disease are also noted, depending on whether there is a pathological Q wave or not. In the first case, instead of a pathological wave, a QS complex may form. In the second case, the formation of a negative T wave is observed.

Considering how deep the lesion is located, the following types of disease are distinguished:

• Subepicardial. The affected area is adjacent to the epicardium.
• Subendocardial. The affected area is adjacent to the endocardium.
• Intramural. An area of ​​necrotic tissue is located inside the muscle.
• Transmural. In this case, the muscle wall is affected to its entire thickness.

Depending on the consequences, uncomplicated and complicated types are distinguished. Another important point on which the type of heart attack depends is the localization of pain. There is a typical pain syndrome localized in the heart or behind the sternum. In addition, atypical forms are noted. In this case, the pain can radiate (give) to the shoulder blade, lower jaw, cervical spine, and abdomen.

Stages

The progression of myocardial infarction is usually rapid and cannot be predicted. Nevertheless, experts identify a number of stages that the disease goes through:

1. Damage. During this period, there is a direct disruption of blood circulation in the heart muscle. The duration of the stage can range from one hour to several days.
2. Spicy. The duration of the second stage is 14-21 days. During this period, the beginning of necrosis of some of the damaged fibers is noted. The rest, on the contrary, are being restored.
3. Subacute. The duration of this period varies from several months to a year. During this period, the final completion of the processes that began in the acute stage occurs, with a subsequent decrease in the ischemic zone.
4. Scarring. This stage can continue throughout the patient’s life. Necrotic areas are replaced by connective tissue. Also during this period, in order to compensate for myocardial function, hypertrophy of normally functioning tissue occurs.

The stages of myocardial infarction play a very important role in its diagnosis, since changes in the electrocardiogram depend on them.

Variants of the disease

Depending on the characteristic manifestations, there are several options possible for myocardial infarction, namely:

1. Anginous. It is characteristic that for myocardial infarction, it is the most common option. It is characterized by the presence of severe pain, which is not relieved by taking nitroglycerin. The pain may radiate to the left shoulder blade, arm or lower jaw.
2. Cerebrovascular. In this case, the pathology is characterized by manifestations of cerebral ischemia. The patient may complain of severe dizziness, nausea, severe headaches, and fainting. Neurological symptoms make it quite difficult to make a correct diagnosis. The only symptoms of myocardial infarction are characteristic changes on the ECG.
3. Abdominal. In this case, the localization of pain is atypical. The patient has severe pain in the epigastric region. Characterized by vomiting and heartburn. The abdomen is very swollen.
4. Asthmatic. Symptoms of respiratory failure come to the fore. Severe shortness of breath is expressed, a cough with foamy sputum may appear, which is a sign of left ventricular failure. The pain syndrome is either completely absent or appears before shortness of breath. This option is typical for older people who already have a history of a heart attack.
5. Arrhythmic. The main symptom is irregular heart rhythm. The pain syndrome is mild or completely absent. In the future, shortness of breath and a decrease in blood pressure may occur.
6. Erased. With this option, manifestations are completely absent. The patient does not make any complaints. The disease can be detected only after an ECG.

Given the abundance of options possible for this disease, its diagnosis is an extremely difficult task and is most often based on an ECG examination.

Diagnostics

For this disease, specialists use a number of diagnostic techniques:

1. Collection of medical history and complaints.
2. Study of the activity of specific enzymes.
3. General blood test data.
4. Echocardiography (EchoCG).
5. Coronary angiography.

In the medical history and life history, the doctor pays attention to the presence of concomitant pathologies of the cardiovascular system and heredity. When collecting complaints, you need to pay attention to the nature and localization of pain, as well as other manifestations characteristic of the atypical course of the pathology.

ECG is one of the most informative methods for diagnosing this pathology. When conducting this survey, the following points can be assessed:

1. Duration of the disease and its stage.
2. Localization.
3. Extent of damage.
4. Depth of damage.

At the stage of damage, a change in the ST segment is observed, which can occur in the form of several options, namely:

• If the anterior wall of the left ventricle is damaged in the area of ​​the endocardium, the location of the segment below the isoline is observed, in which the arc is directed downward.
• If the anterior wall of the left ventricle is damaged in the area of ​​the epicardium, the segment, on the contrary, is located above the isoline, and the arc is directed upward.

In the acute stage, the appearance of a pathological Q wave is noted. If the transmural variant occurs, the QS segment is formed. With other options, the formation of a QR segment is observed.

The subacute stage is characterized by normalization of the location of the ST segment, but the pathological Q wave remains, as well as negative T wave. In the cicatricial stage, the presence of a Q wave and the formation of compensatory myocardial hypertrophy may be noted.

To determine the exact location of the pathological process, it is important to evaluate in which leads the changes are determined. In the case of localization of the lesion in the anterior sections, signs are noted in the first, second and third chest leads, as well as in the first and second standard leads. There may be changes in lead AVL.

Lesions of the lateral wall almost never occur independently and are usually a continuation of damage to the posterior or anterior walls. In this case, changes are recorded in the third, fourth and fifth chest leads. Also, signs of damage must be present in the first and second standard. In case of posterior wall infarction, changes are observed in lead AVF.

A small focal infarction is characterized only by changes in the T wave and ST segment. Pathological teeth are not detected. The large-focal variant affects all leads and reveals the Q and R waves.

When conducting an ECG, the doctor may encounter certain difficulties. Most often this is due to the following characteristics of the patient:

• The presence of scar changes causes difficulties in diagnosing new areas of damage.
• Conduction disorders.
• Aneurysm.

In addition to the ECG, a number of additional studies are required to complete the determination. A heart attack is characterized by an increase in myoglobin in the first few hours of the disease. Also in the first 10 hours there is an increase in an enzyme such as creatine phosphokinase. Its contents return to full normal only after 48 hours. Afterwards, to make a correct diagnosis, it is necessary to evaluate the amount of lactate dehydrogenase.

It is also worth noting that during myocardial infarction there is an increase in troponin-1 and troponin-T. A general blood test reveals the following changes:

• Increase in ESR.
• Leukocytosis.
• Increase in AsAt and AlAt.

EchoCG may reveal impaired contractility of cardiac structures, as well as thinning of the walls of the ventricles. Carrying out coronary angiography is advisable only if occlusive lesions of the coronary arteries are suspected.

Complications

Complications of this disease can be divided into three main groups, which can be seen in the table.

According to the time of occurrence, late and early complications are distinguished. The later ones include the following:

• Dressler's syndrome.
• Endocarditis.
• Chronic heart failure.
• Innervation disorders.

In addition to classic complications, gastric ulcers and other acute gastrointestinal pathologies, mental disorders, and others may occur.

Treatment

The first thing to understand is that to achieve maximum effect, treatment must be started as quickly as possible. Initially, reperfusion therapy (thrombolysis, angioplasty) is necessary. The goals of treatment are:

1. Relief of pain syndrome. Initially, nitroglycerin is used sublingually for this purpose. If there is no effect, intravenous administration of this drug is possible. If this does not help, morphine is used to relieve pain. In order to enhance its effect, it is possible to use droperidol.
2. Restoring normal blood flow. The effect of the use of thrombolytics directly depends on how early therapeutic measures were started. The drug of choice is streptokinase. In addition to it, it is possible to use urokinase, as well as tissue plasminogen activator.
3. Additional treatment. Also used for heart attacks are aspirin, heparin, ACE inhibitors, antiarrhythmic drugs and magnesium sulfate.

In any case, therapy for myocardial infarction should be comprehensive and begin as quickly as possible. In the absence of adequate drug therapy, not only the early development of complications, but also death is possible.

If coronary artery disease is diagnosed, surgery may be necessary. Methods such as balloon angioplasty, stenting and bypass surgery are used.

Prevention

Considering the causes of myocardial infarction, one can easily understand that by following preventive measures, the risk of developing the disease is greatly reduced. For the purpose of prevention, the following rules must be observed:

1. Control your body weight. The main goal is to prevent obesity, since this factor is decisive in the formation of atherosclerosis - one of the main causes of myocardial infarction.
2. Dieting. Reducing salt intake, as well as reducing the intake of fats from food, can not only reduce the risk of obesity, but also normalize blood pressure.
3. Maintaining an active lifestyle. Adequate physical activity helps normalize metabolic processes, reduce body weight, and generally strengthen the body. If you have a history of a heart attack or other cardiovascular pathologies, you should consult your doctor about the amount of exercise.
4. Quitting bad habits.
5. Cholesterol control.
6. Pressure control.
7. Measuring sugar levels.
8. Carrying out preventive examinations with a specialist.

Thus, given the etiology of myocardial infarction, we can say with confidence that prevention plays an important role. If you follow the above recommendations, the risk of developing the disease is reduced significantly.

Myocardial infarction is an emergency condition most often caused by coronary artery thrombosis. 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. Myocardial infarction is distinguished with and without a pathological Q wave. As a rule, the area and depth of the lesion are greater in the first case, and the risk of recurrent infarction is greater in the second. Therefore, the long-term prognosis is approximately the same.

Causes of myocardial infarction

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, hypertension, 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.

The heart is a muscular sac that pumps blood through itself like a pump. But the heart muscle itself is supplied with oxygen through blood vessels that approach it from the outside. And so, as a result of various reasons, some part of these vessels is affected by atherosclerosis and can no longer pass enough blood. Coronary heart disease occurs. In myocardial infarction, the blood supply to part of the heart muscle is suddenly and completely stopped due to complete blockage of the coronary artery. Usually this is caused by the development of a blood clot on an atherosclerotic plaque, or less often by a spasm of the coronary artery. A section of the heart muscle that is deprived of nutrition dies. In Latin, dead tissue is an infarction.

Symptoms of myocardial infarction

The most typical manifestation of myocardial infarction is chest pain. The pain “radiates” along the inner surface of the left arm, producing a tingling sensation in the left hand, wrist, and fingers. Other possible areas of irradiation are the shoulder girdle, neck, jaw, interscapular space, also predominantly on the left. Thus, both the localization and irradiation of pain do not differ from an attack of angina.

The pain during myocardial infarction is very strong, perceived as dagger-like, tearing, burning, “a stake in the chest.” Sometimes this feeling is so unbearable that it makes you scream. Just like with angina pectoris, there may be not pain, but discomfort in the chest: a feeling of strong compression, squeezing, a feeling of heaviness “pulled with a hoop, squeezed in a vice, pressed down with a heavy slab.” Some people experience only a dull ache or numbness in the wrists combined with severe and prolonged chest pain or chest discomfort.

The onset of anginal pain during myocardial infarction is sudden, often at night or in the early morning hours. Painful sensations develop in waves, periodically decrease, but do not stop completely. With each new wave, pain or discomfort in the chest intensifies, quickly reaches a maximum, and then weakens.

An attack of pain or discomfort in the chest lasts more than 30 minutes, sometimes for hours. It is important to remember that for the formation of myocardial infarction, a duration of anginal pain of more than 15 minutes is sufficient. Another important hallmark of myocardial infarction is the lack of reduction or cessation of pain at rest or when taking nitroglycerin (even repeatedly).

Angina or myocardial infarction

The location of pain in angina and myocardial infarction is the same. The main differences between pain during myocardial infarction are:

• severe intensity of pain;
• duration more than 15 minutes;
• the pain does not stop after taking nitroglycerin.

Atypical forms of heart attack

In addition to the typical sharp tearing pain behind the sternum characteristic of a heart attack, there are several other forms of heart attack, which can disguise themselves as other diseases of the internal organs or not manifest themselves at all. Such forms are called atypical. Let's dig into them.

Gastric variant of myocardial infarction. It manifests itself as severe pain in the epigastric region and resembles an exacerbation of gastritis. Often upon palpation, i.e. When palpating the abdomen, pain and tension in the muscles of the anterior abdominal wall are noted. As a rule, with this type, the lower parts of the myocardium of the left ventricle, adjacent to the diaphragm, are affected.

Asthmatic variant of myocardial infarction. This is an atypical type of heart attack and is very similar to an asthma attack. It manifests itself as an annoying dry cough, a feeling of congestion in the chest.

Painless version of a heart attack. It manifests itself as a deterioration in sleep or mood, a feeling of vague discomfort in the chest (“heartbreak”) in combination with severe sweating. Typically, this option is typical in old and senile age, especially with diabetes mellitus. This option for the onset of myocardial infarction is unfavorable, since the disease is more severe.

Factors in the development of myocardial infarction

Risk factors for developing myocardial infarction are:

1. age, the older a person gets, the greater the risk of a heart attack.
2. previous myocardial infarction, especially small focal ones, i.e. non-Q generator.
3. Diabetes mellitus is a risk factor for the development of myocardial infarction, because an increased level has an additional detrimental effect on the blood vessels of the heart and hemoglobin, worsening its oxygen transport function.
4. Smoking, the risk of myocardial infarction when smoking, both active and passive, simply inhaling tobacco smoke from a smoking person, increases by 3 and 1.5 times, respectively. Moreover, this factor is so “corrosive” that it persists for the next 3 years after the patient quit smoking.
5. arterial hypertension, increased blood pressure above 139 and 89.
6. high cholesterol levels contribute to the development of atherosclerotic plaques on the walls of arteries, including coronary ones.
7. Obesity or excess body weight increases blood cholesterol and, as a result, worsens the blood supply to the heart.

Prevention of myocardial infarction

Methods for preventing myocardial infarction are similar to preventing coronary heart disease.

The likelihood of developing complications of myocardial infarction

Myocardial infarction is dangerous in many ways due to its unpredictability and complications. The development of complications of myocardial infarction depends on several important factors:

1. the magnitude of damage to the heart muscle, the larger the area of ​​the myocardium affected, the more pronounced the complications;
2. localization of the zone of myocardial damage (anterior, posterior, lateral wall of the left ventricle, etc.), in most cases myocardial infarction occurs in the anterior septal region of the left ventricle with involvement of the apex. Less often in the area of ​​the lower and posterior wall
3. the time of restoration of blood flow in the affected heart muscle is very important; the sooner medical assistance is provided, the smaller the damage area will be.

Complications of myocardial infarction

Complications of myocardial infarction mainly occur with extensive and deep (transmural) damage to the heart muscle. It is known that a heart attack is necrosis (death) of a certain area of ​​the myocardium. In this case, muscle tissue, with all its inherent properties (contractility, excitability, conductivity, etc.), is transformed into connective tissue, which can only serve as a “frame”. As a result, the thickness of the heart wall decreases, and the size of the cavity of the left ventricle of the heart increases, which is accompanied by a decrease in its contractility.

The main complications of myocardial infarction are:

• arrhythmia is the most common complication of myocardial infarction. The greatest danger is ventricular tachycardia (a type of arrhythmia in which the ventricles of the heart take on the role of pacemaker) and ventricular fibrillation (chaotic contraction of the walls of the ventricles). However, it must be remembered that any hemodynamically significant arrhythmia requires treatment.
• Heart failure (decreased contractility of the heart) occurs quite often with myocardial infarction. The decrease in contractile function occurs in proportion to the size of the infarction.
• Arterial hypertension, due to an increase in oxygen demand by the heart and tension in the wall of the left ventricle, leads to an increase in the infarction zone and to its stretching.
• mechanical complications (cardiac aneurysm, rupture of the interventricular septum) usually develop in the first week of myocardial infarction and are clinically manifested by a sudden deterioration in hemodynamics. The mortality rate in such patients is high, and often only urgent surgery can save their lives.
• recurrent (constantly recurring) pain syndrome occurs in approximately 1/3 of patients with myocardial infarction, the dissolution of the thrombus is not affected by its prevalence.
• Dressler's syndrome is a post-infarction symptom complex manifested by inflammation of the heart sac, lung sac and inflammatory changes in the lungs themselves. The occurrence of this syndrome is associated with the formation of antibodies.
• Any of these complications can be fatal.

Diagnosis of acute myocardial infarction

Acute myocardial infarction is diagnosed based on 3 main criteria:

1. A characteristic clinical picture is that during myocardial infarction, severe, often tearing, pain occurs in the region of the heart or behind the sternum, radiating to the left shoulder blade, arm, and lower jaw. The pain lasts more than 30 minutes; when taking nitroglycerin, it does not go away completely and only decreases for a short time. There is a feeling of lack of air, cold sweat, severe weakness, decreased blood pressure, nausea, vomiting, and a feeling of fear. Prolonged pain in the heart area, which lasts for more than 20-30 minutes and does not go away after taking nitroglycerin, may be a sign of the development of myocardial infarction. Call an ambulance.
2. characteristic changes in the electrocardiogram (signs of damage to certain areas of the heart muscle). Typically this is the formation of Q waves and ST segment elevation in the leads involved.
3. characteristic changes in laboratory parameters (an increase in the blood level of cardiac-specific markers of damage to cardiac muscle cells - cardiomyocytes).

Emergency care for myocardial infarction

An ambulance should be called if this is the first attack of angina pectoris in your life, as well as if:

• chest pain or its equivalent intensifies or lasts more than 5 minutes, especially if all this is accompanied by deterioration in breathing, weakness, vomiting;
• the chest pain did not stop or intensified within 5 minutes after dissolving 1 tablet of nitroglycerin.

Help before the ambulance arrives in case of myocardial infarction

What should you do if you suspect a heart attack? There are simple rules that will help you save the life of another person:

• Lay the patient down, raise the head of the bed, re-give a nitroglycerin tablet under the tongue, and crushed (chew) 1 aspirin tablet;
• additionally take 1 tablet of analgin or baralgin, 60 drops of Corvalol or Valocardin, 2 tablets of panangin or potassium orotate, put mustard plaster on the heart area;
• urgently call an ambulance team (“03”).

Everyone should be able to resuscitate

The patient’s chances of surviving are higher the earlier resuscitation measures are started (they must begin no later than one minute from the onset of the cardiac catastrophe). Rules for carrying out basic resuscitation measures:

If the patient has no reactions to external stimuli, immediately proceed to paragraph 1 of these Rules.

Ask someone, such as neighbors, to call an ambulance.

Properly position the person being resuscitated, ensuring airway patency. To do this:

• The patient should be placed on a flat, hard surface and his head should be tilted back as much as possible.
• To improve airway patency, removable dentures or other foreign bodies must be removed from the oral cavity. In case of vomiting, turn the patient's head to the side, and remove the contents from the mouth and pharynx using a tampon (or improvised means).

1. Check for spontaneous breathing.
2. If there is no spontaneous breathing, begin artificial ventilation. The patient should lie in the previously described position on his back with his head tilted sharply back. The pose can be achieved by placing a cushion under the shoulders. You can hold your head with your hands. The lower jaw should be pushed forward. The person providing assistance takes a deep breath, opens his mouth, quickly brings it closer to the patient’s mouth and, pressing his lips tightly to his mouth, exhales deeply, i.e. as if blowing air into his lungs and inflating them. To prevent air from escaping through the nose of the person being resuscitated, pinch his nose with your fingers. Then the person providing assistance leans back and takes a deep breath again. During this time, the patient's chest collapses - passive exhalation occurs. Then the person providing assistance blows air into the patient’s mouth again. For hygienic reasons, the patient's face can be covered with a scarf before blowing air.
3. If there is no pulse in the carotid artery, artificial ventilation must be combined with chest compressions. To carry out indirect massage, place your hands one on top of the other so that the base of the palm lying on the sternum is strictly in the midline and 2 fingers above the xiphoid process. Without bending your arms and using your own body weight, smoothly move your sternum towards your spine by 4-5 cm. With this displacement, compression of the chest occurs. Carry out the massage so that the duration of the compressions is equal to the interval between them. The compression rate should be about 80 per minute. During pauses, leave your hands on the patient's sternum. If you are performing resuscitation alone, after performing 15 chest compressions, give two air blows in a row. Then repeat the indirect massage in combination with artificial ventilation.
4. Do not forget to constantly monitor the effectiveness of your resuscitation measures. Resuscitation is effective if the patient’s skin and mucous membranes turn pink, the pupils constrict and a reaction to light appears, spontaneous breathing resumes or improves, and a pulse appears in the carotid artery.
5. Continue resuscitation measures until the ambulance arrives.

Treatment of myocardial infarction

The main goal in treating a patient with acute myocardial infarction is to restore and maintain blood circulation to the affected area of ​​the heart muscle as quickly as possible. For this, modern medicine offers the following means:

Aspirin (Acetylsalicylic acid) - inhibits platelets and prevents blood clot formation.

Plavix (Clopidogrel), also Ticlopidine and Prasugrel - also inhibit the formation of platelet thrombus, but act perfectly and more powerfully than aspirin.

Heparin, low molecular weight heparins (Lovenox, Fraxiparin), Bivalirudin are anticoagulants that affect blood clotting and factors leading to the formation and spread of blood clots.

Thrombolytics (Streptokinase, Alteplase, Reteplase and TNKase) are powerful drugs that can dissolve an already formed blood clot.

All of the above groups of drugs are used in combination and are necessary in the modern treatment of a patient with myocardial infarction.

The best method to restore patency of the coronary artery and restore blood flow to the affected area of ​​the myocardium is an immediate procedure of coronary artery angioplasty with the possible placement of a coronary stent. Studies suggest that in the first hour of a heart attack, and if agioplasty cannot be performed immediately, the use of thrombolytic drugs should be performed and is preferred.

If all of the above measures do not help or are impossible, an urgent operation of coronary artery bypass grafting may be the only means to save the myocardium - restore blood circulation.

In addition to the main task (restoration of blood circulation in the affected coronary artery), treatment of a patient with myocardial infarction has the following goals:

Limiting the size of the infarction is achieved by reducing the myocardial oxygen demand using beta blockers (Metoprolol, Atenolol, Bisoprolol, Labetalol, etc.); reducing the load on the myocardium (Enalapril, Ramipril, Lisinopril, etc.).

Pain control (pain usually disappears with restoration of blood circulation) - Nitroglycerin, narcotic analgesics.

Fighting arrhythmias: Lidocaine, Amiodarone - for arrhythmias with an accelerated rhythm; Atropine or temporary cardiac pacing - if the rhythm slows down.

Maintaining normal vital parameters: blood pressure, respiration, pulse, kidney function.

The first 24 hours of the disease are critical. The further prognosis depends on the success of the measures taken and, accordingly, how much the heart muscle has been “damaged”, as well as the presence and degree of “risk factors” for cardiovascular diseases.

It is important to note that with a favorable course and effective rapid treatment of a patient with myocardial infarction, there is no need for strict bed rest for more than 24 hours. Moreover, excessive bed rest may have an additional negative effect on post-infarction recovery.

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

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

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

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

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

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

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

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What is it?

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

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

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

Causes of myocardial infarction and risk factors

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

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

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

Risk factors

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

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

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

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

The first signs and symptoms of myocardial infarction

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

Characteristic first signs of a heart attack

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

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

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

What symptoms accompany a heart attack?

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

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

Atypical course options

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

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

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

Stages of development

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

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

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

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

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

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

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

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

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

Diagnostics - ECG, tests and ultrasound

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

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

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

Danger of complications

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

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

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

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

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

Treatment of myocardial infarction, drugs

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

Thrombolysis

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

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

Heparin and anticoagulants

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

Antiplatelet therapy

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

Nitrates

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

BAB (beta-blockers)

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

ACE inhibitors

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

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

Surgical treatment

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

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

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

ECG - The first and main diagnostic method at the emergency stage is an electrocardiogram, which detects changes characteristic only of a heart attack; it can be used to determine the localization of the lesion and the period of the infarction. It is recommended to do a cardiogram for all the symptoms described above.

Coronary angiography method– an x-ray research method in which the coronary vascular system is contrasted through a probe, and blood flow through the vessels is observed under x-ray radiation. The method allows you to determine the patency of blood vessels and more accurately indicate the location of the lesion.

Computed coronary angiography method– often used for coronary artery disease to determine the degree of vasoconstriction, which indicates the likelihood of developing a heart attack. This method, unlike X-ray coronary angiography, is more expensive, but also more accurate. It is less common due to the lack of equipment and specialists who know the technique.

Laboratory diagnostics— During myocardial infarction, characteristic changes in blood composition and biochemical parameters occur, which are monitored throughout the treatment.

First aid and treatment of myocardial infarction

First aid for myocardial infarction

A person suspected of having a heart attack must be laid down and the airways freed from constricting clothing (tie, scarf). An experienced heart patient may have nitroglycerin preparations with him; you need to put 1 tablet under his tongue, or inject him if it is a spray (isoket). Nitroglycerin preparations should be given every 15 minutes until doctors arrive. It’s good if you have aspirin on hand, aspecard - drugs containing acetylsalicylic acid, they have an analgesic effect and prevent the formation of blood clots. If the heart and breathing stop, the patient needs to undergo artificial respiration and chest compressions until doctors arrive.

Attention:

• Nitroglycerin preparations not only dilate the coronary vessels, they have the same effect on the vessels of the brain; if a person is in an upright position, a sudden outflow of blood and a sudden short-term (orthostatic collapse) are possible; the patient may be injured when falling. Nitroglycerin should be given to the patient in a lying or sitting position. Orthostatic collapse goes away on its own if you lay the person down and raise his legs in 1-2 minutes.
• If the patient has heavy noisy bubbling breathing, he should not be put down, as this will aggravate the condition. Such a patient must be seated comfortably and securely.

First aid in an emergency room

Before arriving at the hospital, the patient continues to receive the necessary treatment in accordance with the leading symptoms:

• give oxygen;
• provide access to the vein;
• they try to relieve the pain syndrome with non-narcotic or narcotic analgesics (droperidol, morphine hydrochloride), depending on the degree of its severity; if there is no effect, they can use inhalation anesthesia with nitrous oxide (resuscitation vehicles are equipped with portable anesthesia machines), or administer sodium hydroxybutyrate intravenously, this The drug, in addition to its hypnotic and analgesic effect, protects organs from oxygen starvation;
• Heparin is used to prevent the formation of blood clots and resorption of existing ones;
• normalize blood pressure; if blood pressure is high, Lasix is ​​administered; if blood pressure is low, prednisolone and hydrocortisone are administered;
• To prevent or relieve arrhythmias, lidocaine is administered intravenously in saline solution.

Inpatient treatment

In the acute period, treatment of a heart attack is based on the leading syndromes; the main task of the doctor is to stabilize the patient’s vital functions and limit the spread of the lesion. Maximum possible resumption of coronary circulation. Prevention of complications.

• Relief of pain syndrome is a simultaneous prevention of cardiogenic shock.

— If the pain persists, droperidol with fetanyl is re-administered after 30–40 minutes. These drugs have a side effect - respiratory depression.
- Therefore, you can replace them with a mixture of analgin with Relanium or 0.5% novocaine; a mixture of analgin, diphenhydramine and promedol in 20 ml of physiological solution. These mixtures may have vomiting as a side effect; for prevention, a 0.1% atropine solution is administered subcutaneously.
— If there is no effect, anesthesia with nitrous oxide.

• In case of asthmatic variant with pulmonary edema

The patient needs to elevate his upper body as much as possible. Three times with an interval of 2-3 minutes, nitroglycerin (isoket) under the tongue. Inhalation of oxygen with alcohol is effective. While waiting for the doctor, in the absence of oxygen, you can hold a cloth generously moistened with alcohol or vodka near the patient’s face (without closing the airways!). For high or normal blood pressure, Lasix (furosemide) is injected intravenously in large doses. For hypotension, prednisolone is administered intravenously and rheopolyglucin is infused drip-wise.

• For arrhythmias

Tachycardia (fast pulse) is stopped with isoptin solution. In the event of atrial fibrillation and flutter - novocainamide, unithiol. If there is no effect, electrodefibrillation is used. Bradycardia (rare pulse) - atropine is administered intravenously, izadrin 1 tablet under the tongue. If there is no effect, IV alupent and prednisolone.

• One of the reasons for coronary circulation disorders is their blockage with blood clots.

They are combated with medication using fibrolytic therapy based on streptokinase and its analogues. Contraindications to such therapy are all types of bleeding. Therefore, during this treatment, the patient’s condition is strictly monitored and platelet levels and blood clotting time are monitored.

Surgical treatment

After achieving a stable condition, restoration of normal heart rhythm, and other vital signs, surgical treatment is performed according to indications in order to restore the patency of the coronary vessels. The following interventions are currently being carried out:

• Stenting is the introduction of a metal frame (wall) into the narrowed areas of the coronary vessel. During this operation, the chest is not opened; a special probe is inserted into the desired location through the femoral artery under the control of an X-ray machine.
• CABG – coronary artery bypass grafting. The operation is performed on an open heart, its essence is that it creates an additional possibility of blood supply to the affected area by transplanting the patient’s own veins, creating additional paths for blood flow.

Indications for surgical treatment and the choice of type of intervention depend on the results of coronary angiography:

• damage to two arteries out of three, or the degree of narrowing is more than 50%
• presence of post-infarction

The patient’s physical activity is of great importance in the treatment of myocardial infarction. In the first period from 1 to 7 days, strict bed rest is recommended, in which, from the moment a stable condition is achieved, it is recommended to perform passive movements while lying in bed, and breathing exercises under the supervision of medical personnel. Further, as the condition improves, it is recommended to constantly expand physical activity daily by adding active movements (turning, sitting up in bed, eating independently, washing, etc.).