Myocardial infarction

As shown by the statistical study, myocardial infarction usually develops in men aged 40 to 60 years. In women the disease occurs in about half to two times less.

Myocardial infarction in patients with coronary heart disease (CHD), atherosclerosis, hypertension. Risk factors for myocardial infarction include Smoking (as it causes constriction of the coronary arteries and reduces the supply the heart muscle with blood), obesity, lack of physical activity.

At the same time myocardial infarction may be the first manifestation of coronary artery disease.

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

Oxygen and nutrients to the cells of the heart muscle delivers a special extensive network of blood vessels called coronary. In myocardial infarction there is a blockage of one of these vessels by a blood clot (in 95% of cases the clot in the coronary artery is formed in the region of an atherosclerotic plaque). Oxygen supply to cardiac muscle cells, which harbored a blocked artery, will last for 10 seconds. About 30 minutes cardiac muscle remains viable. Then begins the process of irreversible changes in cells and the third and sixth hour from the beginning of occlusion, the heart muscle in this area is killed. Depending on the size of the lost area is isolated large and small coronary. If necrosis captures the entire thickness of the myocardium, it is called transmural.

The clinical picture of myocardial infarction is diverse, which complicates the correct diagnosis as soon as possible.The diagnosis is established on the basis of three criteria:

  • typical pain
  • ECG changes
  • changes of indicators of biochemical analysis of blood, suggesting damage to the cells of the heart muscle.

In doubtful cases, doctors use additional studies, such as radionuclide methods for detection of necrosis of the myocardium.

Typically in myocardial infarction identified the following characteristics:

  • long-term intensive simeuse-pressive pain behind the sternum in the heart region, may radiate to arm, neck, back or shoulder blades;
  • the pain does not go after taking nitroglycerin;
  • pale skin, cold sweat;
  • fainting.

Not always the disease manifests such a classic pattern. A person can feel only discomfort in the breast or disruption of the heart. In some cases pain is absent. In addition, there are atypical cases of myocardial infarction, when the disease is manifested by difficulty in breathing with shortness of breath or abdominal pain. Such cases are particularly difficult to diagnose.

In the absence of timely treatment of myocardial infarction can cause acute heart failure, cardiogenic shock, cardiac arrest, cardiac arrhythmias and other dangerous conditions.

Complications associated with myocardial infarction, they require urgent medical care.

If you notice or close the symptoms described earlier, you need to urgently call an ambulance. Before the arrival of the doctor should first aid is to give the guests a comfortable sitting or lying position, give nitroglycerin (its resolves under the tongue) and aluminum (30-40 drops inside).

In order to avoid mistakes at the slightest suspicion on a heart attack patient as soon as possible delivered to the hospital. Treatment of myocardial infarction is necessarily performed in the intensive care unit of a hospital.

Treatment includes painkillers, drugs that promote dissolution of the formed clot, medication, reducing blood pressure, reducing blood volume, reducing heart rate. The effectiveness of the treatment depends on the time elapsed since the onset of the disease before reaching the hospital.

After the hospital begins a very important period of rehabilitation, which lasts up to 6 months. The doctor will prescribe you the necessary treatment. Some medications have to take the rest of my life. However, when performing assignments, quitting Smoking and dieting people after myocardial infarction for years to live a full healthy life.

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

The diagnosis of coronary heart disease is the basis for the evaluation of coronary arteries using coronary angiography (coronary angiography). In a special way made x-rays allow us to determine the exact location of atherosclerotic plaques and the degree of narrowing of the coronary arteries. If indications are found the narrowing can be extended from the inside of the vessel – this procedure is called coronary angioplasty. In addition, the coronary artery may be implanted stent – a metal frame that will support the expanded state of the vessel. In some cases, carry out a complicated operation coronary artery bypass, when you insert additional vessels between aorta and the coronary arteries, bypassing the area of narrowing of the coronary vessel and creating the opportunity to divert the blood flow to the heart muscle.

Myocardial infarction

Myocardial infarction is one of the clinical forms of ischemic heart disease, occurring with ischemic necrosis of myocardium caused by absolute or relative deficiency of its blood supply.

Large-focal (transmural), Q-myocardial

Small, not Q-infarction

Localization of necrosis.

Myocardial infarction of left ventricle (anterior, lateral, bottom, rear).

Isolated myocardial infarction of the apex of the heart.

Myocardial infarction of the interventricular septum (septal).

Myocardial infarction of the right ventricle.

Co-localization: back-lower, anterior-lateral, etc.

Myocardial infarction develops as a result of obturation of the lumen of the vessel supplying the myocardium (coronary artery). Reasons may be (frequency of occurrence):

Atherosclerosis of the coronary arteries (thrombosis, obstruction plaque) 93-98%

Surgical obstruction (ligation or artery dissection during angioplasty)

Embolization of the coronary artery (thrombosis with coagulation, fat embolism, etc.)

Isolated infarction heart defects (abnormal discharge of the coronary arteries from the pulmonary trunk)

Ischemia can be a predictor of heart attack and last indefinitely. When the exhaustion of compensatory mechanisms speak about the damage when suffering the metabolism and function of the myocardium, however, the changes are reversible. Stage damage lasts 4 to 7 hours. Necrosis is characterized by irreversible damage. 1-2 weeks after infarction the necrotic area begins to replaced by scar tissue. Final scar formation takes place in 1-2 months.

The main clinical symptom is intense chest pain (anginal pain). However, pain can carry variable character. The patient may complain of discomfort in the chest, pain in the abdomen, throat, arm, shoulder blade, etc. Often the disease is silent in nature, which is typical for patients with diabetes. Pain syndrome persists for more than 15 minutes and docked a few hours, or after the application of narcotic analgesics, nitrates ineffective. Sometimes profuse sweat. In 20-30% of cases with history of large lesions develop signs of heart failure. Patients note shortness of breath, non-productive cough. Uncommon arrhythmia. Usually these are different forms of arrhythmia, or atrial fibrillation. Often the only symptom of myocardial infarction is sudden cardiac arrest. Contributing factors are physical stress, emotional stress, a state of fatigue, hypertensive crisis.

Atypical forms of myocardial infarction

In some cases, the symptoms of a heart attack can wear atypical character. This clinical picture makes diagnosis of myocardial infarction. There are the following atypical forms of myocardial infarction:

Abdominal form symptoms of a heart attack presents with pain in the upper abdomen, hiccups, bloating, nausea, vomiting. In this case, the symptoms of a heart attack can resemble the symptoms of acute pancreatitis.

Asthmatic form – the symptoms of a heart attack presents with progressive shortness of breath. Symptoms of heart attack are similar to symptoms of bronchial asthma attacks.

Atypical pain syndrome when infarction may be represented by pain localized in the chest and in the hand, shoulder, lower jaw, iliac fossa.

Painless form of myocardial infarction is rare. Such a development of heart attack is the most typical for patients with diabetes who have impaired awareness is one of the manifestations of the disease (diabetes).

Cerebral form, symptoms of infarction presented with dizziness, impaired consciousness, neurological symptoms.

Blood cardiotropic proteins (MB-CPK, AST, ЛДГ1, troponin)