Myocardial infarction

November 8, 2011

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Myocarditis   in medicine called heart muscle , According to which the blood enters the coronary arteries. If one of these arteries occludes a blood clot ( clot ), Is part of the heart without the oxygen is broken cell metabolism And develop irreversible changes. If you do not take urgent measures, a person can die within just 2 hours. Thus, myocardial infarction - this dangerous disease characterized by loss of heart muscle cells, which are formed in situ stroke scars of fibrous connective tissue.

Depending on the size of the focal lesion is isolated finely - And macrofocal myocardial As well as the current stage of the disease is sharp . subacute   and includes a post-infarction period. If necrosis covers the entire thickness of the infarction, a heart attack is called transmural . The most dangerous are macrofocal heart attacks since it captures the entire thickness of the heart muscle, a heart attack melkoochagovyj less traumatic, but the scars remain after all.

Unfortunately, myocardial infarction "younger", and today he can hit a man thirty years, although usually affects fifty years of age or older. A female disease rarely occurs before 50 years, but at this age is more often than men. It was a heart attack is now one of the main reasons disability , a mortality   when the disease is between 11 to 15%.

Also recovered from the heart attack pathological Q wave   without it, the depth and size Necrosis   greater in the first case. If the disease without tooth, it increases the risk of recurrence of the disease.

Sometimes the symptoms of myocardial infarction may be "masked" by other diseases of the heart, sometimes an attack can have symptoms of a heart attack attack asthma Ie manifest dry cough and a feeling of pressure in the chest. It is also possible, and with signs of myocardial gastritis Ie abdominal pain, abdominal muscle strain. Sometimes the disease is manifested only in the sense of discomfort in the chest, sweating and sleep disturbances, usually in old age and background Diabetes . All of these options occurrence and course of myocardial infarction called atypical And silent heart attack is more severe variant of all.

Typically, a heart attack occurs in those who suffer from coronary heart disease . atherosclerosis At elevated blood pressure .

You need to know the rules by which held resuscitation myocardial infarction That would hold emergency care if you notice a person even some symptoms of myocardial infarction. If suddenly there is severe pain in the chest, as well as nausea and respiratory failure, and after the dispersal of several tablets nitroglycerin   not getting better, you should immediately call the "ambulance." In addition, the need to immediately put the patient, lift your head, give one more tablet of nitroglycerin, and 1 tablet Aspirin   in particulate form or under the tongue. You also need to take 60 drops korvalola 1 tablet analginum 2 tablets ororata potassium ( panangina ), You can also put a mustard plaster on his chest.

The heart is a muscle of the bag, through which the blood is distilled. Samuel heart muscle oxygen supply special coronary vessels And if some of these vessels affected by atherosclerosis, the developing coronary heart disease. In this case, the movement of blood and it is difficult. If a developing myocardial infarction, due to blockage of the coronary artery clot blood supply of the heart suddenly stops, and deprived of food portions muscles die. Such thrombi in 95% is formed in the area atherosclerotic plaque . Therefore, the disease most often develops in the presence of atherosclerosis. Atherosclerosis in the walls of blood vessels are formed of fatty deposits and plaque accumulation, aided by an increased level cholesterol   in blood. Around the plaque formed a blood clot, the body as it "heals" education, and formed a clot. Sometimes, the plaque can be damaged when the pressure increases, and sometimes a heart attack can begin for no apparent reason, usually in the morning.

Almost half the cases seen in the background angina .

Also causes myocardial infarction scientists call an unhealthy diet, eating large amounts of fatty and salty foods, lack of exercise, sedentary lifestyle, bad habits.

Risk factors for heart attack are: male gender, age, heredity (if direct relatives had heart attacks or cerebral strokes ) Overweight , Diabetes, high blood pressure, elevated blood cholesterol, smoking, including passive previous myocardial infarction, commonly melkoochagovyj.

Symptoms of myocardial infarction

Usually heart attack begins with the appearance of pain in the chest, in the left side of the chest, sometimes it can be located under the shoulder blade, and even in the upper abdomen. This severe pain is given by the left hand in the form of tingling in the hand and fingers. Sometimes the pain may be given in the neck and jaw. In women during an attack of myocardial pain is localized mostly in the neck, abdomen and upper jaw, and the attack may resemble heartburn . Ie symptoms of heart attack are very similar to angina, they are observed, even in a state of complete rest.

When a heart attack pain is severe, it is characterized as "a dagger in the chest," she rending, sometimes even forcing screaming. Some complain about the long dull retrosternal pain and numbness in the wrist area. Sometimes the disease is accompanied by a feeling of compression within, burning and heaviness in the chest, as if the "heart squeezed in a vise."

Typically, the pain of a heart attack begins in the morning or at night, develops in waves, without stopping completely, and for the development of the disease long enough 15 minutes of pain. Usually twinge last more than half an hour, maybe a few hours, and even at rest the pain does not decrease, and tablets nitroglycerin   It does not contribute to improvement. Besides pain, symptoms of myocardial infarction are a decrease in blood pressure, which is associated with a decrease in cardiac contractility because of myocardium deprived of food. Sometimes it can develop rapid irregular heartbeat, which is an unfavorable sign, and observed nausea . breathlessness . weakness . paleness   and even cyanosis of the skin . tremors in the muscles . cold sweat . semiconscious state , The body temperature rises somewhat. Can start resistant hiccough Sometimes observed enteroplegia , stomach ache.

Patients may experience fear and anxiety of approaching death, and often it depends on the size of the affected area of ​​the myocardium. Exist normal psychological reactions   human illness and neurotic When the person needs professional help of the doctor.

Diagnosis of myocardial infarction

Myocardial infarction was diagnosed on the basis of three key criteria: strong, torn chest pain, radiates to the left arm, fingers, shoulder blades, jaw, continuing more than 30 minutes, and do not disappear after taking nitroglycerin. If you are experiencing these symptoms, you need as quickly as possible to call "ambulance." If you have prolonged pain the patient will be assigned to conduct electrocardiography . Echocardiography   prolonged pain syndrome; blood chemistry . Identify the amount of necrosis allows positron emission tomography . If the patient suffers from coronary heart disease, may also hold an emergency coronary angiography . If there are doubts about the diagnosis may conduct studies on the identification of necrosis using radioisotope methods.

It should be noted that the clinical picture of myocardial infarction is very diverse, so the correct diagnosis in a short time is difficult. Almost 20% of patients the disease may be asymptomatic. Typically, the hospital carried out differential diagnosis of myocardial infarction with other diseases - aneurysm of the thoracic aorta . acute myocarditis . spontaneous pneumothorax   etc.

Treatment of myocardial infarction

The goal of treatment of patients with myocardial blood flow is an early resumption of the affected part of the heart muscle. The arsenal of modern medicine is used for this purpose several types of medicines which can be combined depending on the stage of the disease.

Because drugs are used acetylsalicylic acid Which prevents the formation of thrombi, thrombolytics, capable of dissolving blood clots already formed, heparin Influencing blood clotting and others. By the way, started early thrombolytic therapy   reduces the likelihood of death, it is best to begin within 6 hours after symptom onset of myocardial infarction. For use of thrombolytics, there are contraindications, it brain tumors Recently transferred severe injuries, surgery for up to 2 weeks. Liver and kidney disease, tuberculosis   and other important organs of the disease and eliminate their use. If you can not use thrombolytics, and in cardiogenic shock, restoring blood flow to the heart muscle, the procedure can be carried out direct coronary artery angioplasty and to establish Coronary Stent . A stent is a frame which supports the vessel disclosed.

However, if these procedures have not led to an improvement, the surgical treatment of myocardial infarction. Conduct operations coronary artery bypass grafting   (or surgical revascularization ) To restore the circulation of the heart muscle. The operation is necessary when myocardial rupture, ventricular septal.

However, besides the restoration of blood flow to the heart muscle, treatment is aimed at reducing the size of myocardial damage by applying beta-blockers , such as atenolol . labetalol   etc. They also make the heart work more economical, which plays an important role in the disease. Pain stoped by reception nitroglycerin   (0, 5 mg under the tongue) and analgesics, Morphine . omnopona . pantopon Better intravenously. Appointed as a means to combat arrhythmias . It arrhythmias are the main possible complications after myocardial infarction, and the cause of death of patients before the arrival of doctors.

The scheme treatment of myocardial infarction in the 24-72 hours may be as follows: introduction Heparin   intravenously (20-40 thousand. units.) nitroglycerine   (intravenous administration at a speed of 5-10 ug per second) streptokinase   in 2 divided doses intravenously (1-1, 5 million. u). Also used beta-blockers , eg, propranolol   20 mg in one step, Aspirin   - 0, 5 mg per day, and, if necessary, tranquilizers several times a day.

With cardiac arrest   It applies a standard set of measures of cardiopulmonary resuscitation. At the same time in the hospital under observation for a blood pressure patient, his heart rate, kidney function, etc.

It is important to take all measures it is in the first 24 hours after symptoms have appeared myocardial infarction, whereas a more favorable prognosis. It is necessary as soon as possible to bring the patient to the cardiology department, because only in a hospital, you can restore blood flow and myocardial activity, as well as dissolve the clot, preventing the formation of new ones.

Rehabilitation of patients after the disease may last several weeks. First, the patient is allowed to sit alone on the bed and a chair, a little later - to walk the ward, climb stairs, etc. It may also be administered spa treatment.

After treatment of myocardial infarction registers diet Consisting of a light, non-greasy food, also need to control bowel movements, prevent constipation .

During myocardial infarction can be divided into several periods. Usually the disease begins with a short-term pain in the heart or the breastbone, during this reduction in the blood supply of the heart begins. Followed by acute phase During which tissue necrosis begins, it takes about 8-10 days. After an acute begins subacute period Which usually last a half or two months, this time there is scarring. Sometimes the disease period may be longer because of the development of complications. The final step is considered after infarct period when there is a gradual recovery of the body after myocardial infarction. At this time, the patient still need bed rest and medical supervision.

Complications of myocardial infarction

Myocardial necrosis is a defined area of ​​the heart muscle, resulting in situ formed connective tissue necrosis, because of which the wall thickness decreases with increasing size of the heart left ventricular contractility and decreasing its capacity. It is in extensive damage to the myocardium and develop severe complications of the disease.

There may be a development of heart failure, a decrease in cardiac contractility, cardiogenic shock . pericarditis . cardiorrhexis . hypertension , and arrhythmia And its view - ventricular tachycardia   and ventricular fibrillation . Cardiogenic shock occurs because of violations of cardiac contractility and cardiac output drops it. Also, complications after myocardial infarction may be different and mechanical damage, for example, cardiac aneurysm That usually observed in the first week of the disease. Heart aneurysm sac is the formation of a cavity, which contains blood clots. Sometimes patients after myocardial infarction observed Dressler's syndrome (the so-called " Dressler's syndrome "), Which is characterized by symptoms pericarditis   and pneumonia .

More than a third of patients who have suffered a myocardial infarction, there is recurrent pain. It should be noted that all the complications of myocardial infarction require emergency medical care.

Development of possible pathological states depends on the size of myocardial infarction lesions, the time for which has been restored blood flow to the affected part of the heart muscle (that is, the sooner medical assistance was provided, the lower zone of necrosis), as well as the location of these lesions most often affects the front region infarct cardiac muscles and captures the tip.

Prevention of myocardial infarction

To prevent this dangerous disease, it is necessary to diagnose and treat chronic diseases, including atherosclerosis . cardiac ischemia . hypertension   etc. To prevent a heart attack, you need to give up bad habits in the first place by Smoking Area From alcohol abuse . It is to eat by eating as little as possible of animal fats and foods rich in cholesterol, weight control, and lead a new life, to take care of their health, exercise, physical therapy, spend more time outdoors. By the way, regular physical activity reduces the risk of recurrence of the disease by 30%. It is necessary to have as many green vegetables, fruits, bread and wheat flour, fish, try not to use salt. It is necessary to supplement the diet vitamin C For example, as an infusion of black currant or ascorbic acid. Continuous monitoring of blood pressure will help in time to take medication for it to increase, which increases the workload on the heart.

Prevention of myocardial infarction required to establish the correct mode of work and rest, sleep at least 7 hours per day, to spend a weekend outdoors.

Resuscitation in Myocardial Infarction

The earlier started resuscitation, the greater the chance of survival in a patient. They have to start from the first minutes of myocardial infarction symptoms. Of course, first of all, you need to call "ambulance." Place the patient on a firm, level surface by placing a towel or roll the shoulders, zaprokinte his head for airway management.

If the person is not breathing on their own, then you need to spend ventilatory . To do this, first aid injected into the patient's mouth open air out of his mouth, as if inflating the lungs. The nose of the patient is pinched fingers. Then reanimating leans back in his mouth again gaining air and presses his lips to the lips of the patient and blows air.

If the carotid pulse is not detectable, it simultaneously to do chest compressions . To do this, put your hands on one another so that the base was located on the palm of the midline of the sternum for 2 fingers above the xiphoid process. Hands at chest compressions do not bend, and under pressure from the weight of his body, made the displacement of the sternum to the spine. Such compression or compression should be about 80 per minute.