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Myocardial infarction: initial symptoms, signs and consequences

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Myocardial infarction – what is it?

Myocardial infarction is ischemic hearth of necrosis of the heart muscle, which is formed due to acute disorders of coronary circulation. Such a condition poses a direct threat to life, therefore, requires emergency admission of the person into intensive care in cardiology Department. If timely assistance is not provided, then the pathological process most often results in death.

For the first time the term was coined in 1896, R. Marie, and the clinical picture of the disease was described in 1892 V. M. Kerned.

Statistics indicates that a heart attack aged 40 to 60 years occurs in men 3-5 times more often than women, and is caused by existing atherosclerosis. Ranging from 55 to 60 years old, he is registered in both sexes with approximately equal frequency. In women young and middle-aged acute myocardial develops less frequently in comparison with men, experts attribute this to the fact that female sex hormones delay the development of atherosclerosis. After menopause the level of estrogen in the female body dramatically decreases and the heart attack they happen even more often than in men. Moreover, the consequences for women suffering an acute heart attack is more global and often lead to death.

This cardiovascular pathology mainly affects people living in industrialized countries, in large cities.

If the circulation of the myocardium remains broken more than 20 minutes at a time, this leads to the formation of irreversible changes in the heart muscle, as well as to disorder the function of the heart. Part of the muscle cell undergoes necrosis, being replaced by connective tissue fibers. In the end the man who has had a heart attack, is formed post-infarction scar in the heart. Naturally, this will have a negative effect on the future work of the authority.

Statistics of mortality of myocardial infarction

Death from myocardial infarction is recorded in 30-35% of cases. And 15 to 20% of allsudden deaths are due to this pathology. Statistics indicates that only in the United States from a heart attack a day die 140.

There is also evidence that among all deaths of heart attack 52% are women and 48% men.

Prehospital death occurs in approximately 20% of cases, 15% of patients die in the hospital. The maximum mortality rate for patients registered in the first two days, so it is important to conduct a competent medical action in this short period of time. Experimentally, it was confirmed that if perfusion is restored within 4-6 hours from the onset of the pathological process, the size of the scar are not as high in the local and General contractility of the left ventricle improved significantly, the risk of postinfarction complications decreases. Particularly good impact on the patients recovery of perfusion during the first 60-120 minutes of an acute heart attack.

Causes of myocardial infarction

The etiology of this disease can be very diverse, but in 95% of cases the myocardial infarction is the consequence of thrombotic occlusion of arteries that have undergone atheromatous changes. In this case, the heart attack is an acute form of cardiac ischemia. The formation of blood clots contributes to high blood viscosity in patients with ischemia.

In all other cases a heart attack becomes a complication of various diseases and pathologies, including:

  • Malformations of coronary arteries;

  • Blockage of the arteries fragments of mural thrombus, the thrombus parietal valve, parts of the tumor, vegetariani;
  • Any inflammation of the blood vessels responsible for nutrition of the heart muscle, narrowing of the arteries, their breakup, Buerger's disease, aortic aneurysm, disturbances in the functioning of vascular endothelium;

  • DIC, accompanied by the formation of a blood clot in the coronary artery. Trigger DIC is capable of such factors as a decrease in circulating blood volume, infection, poisoning of the body, malignant tumors, thrombocytosis, chronic leukemia , etc.;

  • Tumor of the heart. A heart attack happens because of necrosis, either due to blockage of coronary artery by parts of growing tumors;
  • Extracardiac tumors lead to a heart attack during their germination and metastasis in the artery;
  • To provoke a heart attack can risk of electric shock, mechanical injury and damage to arteries and the heart when conductingcardiac surgical interventions;
  • A heart attack may develop on the background of the spasm of the coronary arteries due to the use of narcotic substances (amphetamine, cocaine);
  • Hypertension, diabetes mellitus, obesity, alcohol abuse, Smoking, nervous and physical strain – all of these factors in the presence of ischemia of the heart can cause a heart attack.

The first signs of heart attack in men and women

The initial symptoms of a heart attack in men and women are somewhat different. It is established that the symptoms in women more blurred. Only 43% of the patients noted sudden development of the pathology, in all other cases it is preceded by a different length of the period of unstable angina with pain at rest.

The first signs of heart attack in women can resemble the flu or pronounced fatigue. In this regard, the doctors often underestimate the severity of the condition of the patient and recommend her treatment following bed rest. With 95% of women who take the heart attack was indicated that health problems they have manifested long before the crisis.

On average, preinfarction period is a month, it's time you experience the following symptoms:

  • Fatigue was noticed to 70.7% of women. Characteristically, fatigue does not pass after a night's rest. Patients feel overwhelmed and exhausted, lacking the strength to do everyday tasks. Over time, the condition does not improve and becomes a permanent weakness;
  • Sleep problems (to 47.8%). Women with difficulty falling asleep, awake often at night;
  • Shortness of breath. Even under light load, the patient develops shortness of breath. After resting breathing has normalized;
  • Pain and discomfort in the chest (29,7%), which resemble the pain that occurs in muscles of the sternum. Possible irradiation of pain in the shoulder, in the upper jaw, in the arm, in the neck. Sometimes limbs growing cold, in them there is tingling;
  • Likely to develop headache, disorders of organs of vision;

  • Characteristic mood swings, causeless anxiety;
  • Digestion is broken, there heartburn, nausea, sometimesvomiting;

  • Skin paler than usual, often a cold sweat.

These statistics are the first signs of heart attack in women given by the authors of an article published in the journal Circulation in 2003. The survey polled 515 women who have already suffered a heart attack. They indicate that the first signs are passing: there are, then again disappear. Women notice them, but to go to the doctor not in a hurry because of feelings of embarrassment and fear. They compare their condition with the cold or flu, which is also observed increased fatigability, fatigue, weakness.

As for men, they have the first sign of a heart attack is chest pain. They indicate that early signs they were absent. Of course, in fact it is not. The body always takes certain signals that something is not right, but men simply ignore them. During the heart attack and 43% of women have not experienced pain at all, at the time, this pathology is painless only 10% of men. Problems breathing indicated 57% of women.

The main symptoms of myocardial infarction

The main symptoms of myocardial infarction depend on typical or atypical it is.

For a typical case characterized by the following clinical picture:

  • The first period of a heart attack is called "acute". Characterized by an extremely intense pain that is localized mainly in the chest. They may be given in the neck, teeth, left shoulder or collarbone, in the area between the shoulder blades, in the ear;
  • Pain are of a different character. Can be pressing, arching, acute. The large area of myocardium is affected, the stronger the pain;
  • The attacks of pain have a wavy character, becoming stronger then weaker. The duration of the attack may range from an hour to several hours or even days. Secondary taking Nitroglycerin relieves pain;
  • The patient experiences severe feelings of fear, may be overly excited. Sometimes the attacks of pain, on the contrary, are accompanied by apathy, weakness and shortness of breath;
  • The skin is pale, acts cold clammy sweat;
  • Blood pressure during an attack increases, and then either moderately or sharply. In parallel, the patient has a tachycardia andarrhythmias;

  • The gradual fading away of pain characterizes the end of the acute period of myocardial infarction and the beginning of the acute period. At this time, the pain can persist only under the condition that a patient develops pericarditis or okolinata area is subjected to severe ischemia;

  • The patient body temperature rises, which is due to start processes of necrosis and perifocal inflammation. To the fever may last up to 10 days or more. The larger the area of damage, the higher the body temperature, the longer it will stay. In parallel, it will increase the symptoms of heart failure and arterial hypotension;

  • If the patient survives the acute phase of infarction, followed by a subacute period with normalization of body temperature, eliminate pain and improve overall health. The symptoms of heart failure go.
  • In the postinfarction period, all indicators of the health of the patient come to a relative norm.

It is worth considering the fact that the symptoms of heart attack in men often clear. For the male is characterized by the classic development of heart attack. The predominant symptom is chest pain. In women of a heart attack in the majority of cases is blurry. The symptoms are similar to symptoms of flu, either for exhaustion.

Over in the acute phase of a heart attack women experience chest pain, but usually these are not as high intensity as men. The pain spreads across the chest, not localizes in the heart. Characterized by dizziness, cold sweat, nausea, shortness of breath.

As already mentioned, a heart attack can occur atypical. The preceding analnogo symptoms of a heart attack, which are typical and occur in 70-90% of cases.

However, it is not excluded other variants in the pathogenesis, among which are:

  • Asthmatic variant of development of attack. During its beginning, in the foreground, shortness of breath and dyspnea, heart palpitation. Pain is either absent or weakly expressed. The frequency of occurrence of asthmatic version of myocardial infarction, 10%. This is typical for either for the elderly or for those patients who suffer a recurrent episode;
  • Gastrolychnis scenario attack. Localized pain at the top of the abdomen, accompanied by hiccups, belching, nausea, repeated vomiting. Characterized by bloating, can sometimes develop diarrhea. Give pain in the back, in the blades. The incidence of gastralgiaversion of heart attack – 5%. Such a attack is observed in patients with lower myocardial infarction;
  • Arrhythmic variant of development of attack. To the fore in this case the disturbances of the heartbeat. Unexpressed pain, people usually do not pay attention to them. During the attack the weakness, some patients experience shortness of breath. The incidence of arrhythmic variant of infarction varies in the range from 1 to 5%;
  • Cerebrovascular variant of development of attack. The patient is disoriented in space, experiencing dizziness, may lose consciousness, and sometimes vomiting. Neurological symptoms often greases a clinical picture of infarction and to define it is possible only by results of an electrocardiogram. The incidence of cerebrovascular variants of development of attack varies from 5% to 10% and increases with age;
  • Oligosymptomatic variant of development of attack. Often myocardial infarction is detected by chance during an EKG. In this survey of patients shows that almost 90% of them indicated themselves unexplained weakness, loss of wellbeing and mood, chest pain, shortness of breath. But these symptoms forced them to go to the doctor. The incidence of oligosymptomatic variants of development of attack in the range of 0.5-20%. Most of these attacks happen in people with diabetes.

It is worth noting that atypical flows only the acute phase of a heart attack, all subsequent periods are characterized by a monotonous clinical picture.

The consequences of myocardial infarction

The consequences of myocardial infarction are often found in the first few hours after its manifestation. They substantially worsen the course of disease and affect the health of the patient.

During the first 3 days were most often developed various arrhythmias: shimmer is the most formidable consequence of a heart attack, it often goes into ventricular fibrillation and lead to death. It is established that the conduction disorders of the heart and its rhythm disruptions occur in 40% of patients in the late period. As for the early period, disturbances of heart rhythms recorded in 100% of patients.

  • Left ventricular heart failure is expressed in the symptoms of cardiac asthma, congestive rales in the maythe development of pulmonary edema. The most serious consequence of left ventricular failure is cardiogenic shock, which often leads to death. While systolic pressure falls below 80 mm Hg. article, the person loses consciousness, there is tachycardia and cyanosis. It is established that acute heart failure in the early period occurs in 50% of patients.
  • If the area of necrosis caused by infarction, there is a rupture of muscle fibers, it often leads to outpouring of blood into the cavity of the pericardium. This complication is called "cardiac tamponade".
  • In 2-3% of cases in patients, the obstruction by a blood clot of the pulmonary artery or the systemic circulation. It is a dangerous complication that often leads to sudden death.
  • In 8% of cases may develop acute mental disorder.
  • Sometimes patients are formed acute ulcers of the stomach and intestines. This happens in 3-5% of cases.
  • Acute aneurysm of the heart. If it becomes chronic aneurysm, it is likely that the patient will occur in heart failure. Congestive heart failure is developing in 12-15% of cases.
  • A massive heart attack a dangerous rupture of the ventricle due to acute cessation of blood flow. A particularly high risk of rupture of the ventricle during the first 10 days after the attack.
  • Upon completion of the acute phase of infarction in patients often occurs the deposition of fibrin on the walls of the endocardium. This further leads to the formation of mural thrombus. Its detached parts may cause embolism of the pulmonary, cerebral, renal vessels. Thromboembolic complications are recorded in 5-7% of cases.
  • Late complication of a heart attack is a post-infarction syndrome Dressler. It is expressed as arthralgia, pleurisy, fever, pericarditis and eosinophilia. Syndrome may develop in 1-3% of cases and is associated with the immune response of the organism to the formation of zones of necrosis.

Diagnosis of myocardial infarction

Diagnosis of myocardial infarction is built on ECG data, medical history and examination of indicators of activity of enzymes of blood serum

A survey of the patient. The patient's complaints depend on what form of infarct – typical or atypical, but also on how extensive the area of damaged heart muscle. The doctor is obliged to suspect a heart attack in the case when a person has chest pain persisted for half an hour andmore.

ECG. On an electrocardiogram during a heart attack to a negative T-wave or Q-wave or abnormal QRS complex.

A blood test. Depending on the time after the attack in the blood detect a rise of four indicators:

  1. For the first 4-6 hours after it has manifested pain attack in the blood is detected by increased amount of myoglobin is responsible for oxygen delivery to the cells.

  2. After 8-10 hours from the start of attack in the blood by half increases the level of creatine kinase. To normal, this figure will come only after 48 hours. If there are 3 negative result on CPK, a heart attack eliminate.

  3. After 24-48 hours from the start of the attack to confirm a heart attack are conducting a test to determine the enzyme lactate dehydrogenase, the level of which is increased in these terms. To normal, this figure will come only after 1-2 weeks.

  4. In addition, increased erythrocyte sedimentation rate, leucocytes, ASAT and Alat in the blood.

Echocardiography allows to determine violations of the contractility of the ventricle, and thinning its walls.

Coreografia reveals thrombotic occlusion of coronary arteries, decrease in ventricular contractility. In addition, this study provides information regarding the possibility of performing angioplasty or coronary artery bypass grafting.

Troponin test in myocardial infarction

Troponin test in myocardial infarction is highly specific diagnostic method, which allows to determine the increase in the number of myocardial protein isoforms of troponin in the blood. The level of troponin-1 and troponin-T after 3-4 hours after a seizure increases considerably, which allows to speak with confidence about myocardial infarction. Troponin will remain in the blood at a high level even for two weeks. Therefore, even if the person for some reason did not get to a medical facility, the ability to determine his myocardial infarction still remains.

Modern medicine considers troponin test as an integral part of the diagnosis of myocardial infarction. Its indisputable advantage is the fact that it allows you to determine even a small muscle injury of the myocardium.

First aid for a heart attack

First aid for a heart attack should be provided immediately.

It is crucial to call an ambulance, but before her arrival to abide by the following algorithm:

  • The patient should adopt a sitting position. For this it under the headboard you can put the pillow;
  • To ensure access of air is necessary to unbutton the collar of the shirt, remove the neck drawing all her accessories (scarves, ties, etc.);
  • Under the language of the person needs to put a Nitroglycerin tablet or spray him in the mouth one dose this tool, if it is at hand in the form of a spray. If Nitroglycerin is taken first, then the dose should be reduced by half;
  • Repeat Nitroglycerin every 5 minutes. The maximum number of receptions – 3 times;
  • In addition to Nitroglycerin is possible for the victim to give half Aspirin and plavix;
  • If an ambulance is delayed, it is possible to make the patient an injection of Dipyrone or Baralgin, which will reduce pain.

It's all actions that may be performed by people without medical training to help the patient with a heart attack.

Recovery and rehabilitation after a heart attack

Rehabilitation of patients after infarction is a complex of measures aimed at the treatment of the disease, and on prevention of its complications. Well-built therapy can restore physical activity, to correct possible psychological violations and to bring him back to work.

The patient should gradually restore lost physical activity. In the first days after the infarction shows a strict bed rest with the patient in the intensive care unit. Doctors are required to carry out continuous monitoring of all vital signs. If complications do not develop heart attack, then on the second day the patient is allowed to sit and to sit up in bed. At the same time, you can begin to perform gymnastics under the strict monitoring of heart rate and blood pressure.

On the fourth day the patient is transferred to a General ward, and he can begin to use the shared bathroom. The patient is discharged on day 16 to 21, before that he performed the test with the dosed physical loading. It allows assessing the body's readiness to move and to assume the risk of myocardial ischemia and other delayed in time complications. If this risk is high, the time of activation of the patient push. Further rehabilitation is carried out in sanatoriums cardiac orientation.

Most people who have had a heart attack, required a psychologist or psychiatrist. The fact that violations of psychiatric disorders are observed in 30% of such patients. These violations are expressed in the propensity to depression, insomnia andincreased anxiety. From 1 to 5% of patients suffer acute psychosis. At the discretion of the doctor in such patients prescribed antidepressants, hypnotics and sedative drugs.

Mandatory patient counseling prior to discharge for possible return to work, and also of some mode of physical activity he needs to stick to.

After discharge from hospital, patients must follow specific diet, to take drugs, do physical exercises.

Diet. It is important that the meals that gets sick was low in cholesterol and saturated fat. Every day should be included in the menu, fresh vegetables (preferably green) and fruits. Meat animals should be replaced by poultry and fish, butter and margarine – olive oil.

Exercise. For people after myocardial infarction have created special programs that allow dosing of physical load, contributing to accelerated social and psychological adaptation. Initial training should take place under strict supervision of doctors, you can then begin to perform the exercises at home. In each case, the load is determined individually after the patient test with the dosed physical loading. Useful classes at the gym, on bike paths, in the pool. Drills should be conducted at least three times a week.

The medication

All the people who have suffered myocardial infarction should receive drug therapy.

Among the recommended medicines:

  • Lipid-lowering drugs. So, taking Simvastatin, Atorvastatin, Pravastatin reduces the risk of a second heart attack. It is established that statins reduce the number of deaths from such complications of myocardial infarction, like unstable angina, cardiosclerosis, angina;
  • Antiplatelet agents.
  • The presence of symptoms of heart failure requires taking ACE inhibitors. Patient begins to give these medications in the acute phase of infarction, then the dose is adjusted;
  • Beta-blockers reduce the risk of sudden death after a heart attack by 32% and reduces overall mortality by 23%. It can be drugs such as Timolol, Metoprolol, Bisoprolol, etc.

Prevention of heart attack

Prevention of heart attack is reduced to the following steps:

  • Daily monitoring of arterial pressure;
  • Control levelcholesterol and blood sugar;

  • Absence of harmful habits;
  • Proper nutrition with the rejection of the fried, fatty, smoked and canned products. Reduction of salt intake;
  • Increase physical activity;
  • Avoidance of stressful situations;
  • Timely and adequate treatment of all diseases related to heart and blood vessels.

Myocardial infarction is a frightening disease, but maintaining a healthy lifestyle can significantly reduce the risk of developing it.

* There are contraindications, before applying you should consult with a specialist