Myocardial infarction is a serious disease that develops as a result of ischemia, i.e., prolonged circulatory disorders in the cardiac muscle. Most often, the myocardial damage occurs in the left ventricle and is characterized by the development of necrosis (area of necrosis) of the tissue.
The most common cause of this illness is a blockage of one coronary artery by a blood clot. As a result, cells in the affected area, deprived of food, die and develops a heart attack. If assistance does not arrive on time, the probability of death of the patient. But those patients who then was lucky to survive, are at risk because of a myocardial infarction can develop complications. About them we’ll talk. But first, let us consider the most dangerous form of this disease, to which the history of large (extensive) myocardial infarction. Often the death of the patient occurs in the first hours after an attack even before medics arrive. In the case of small focal lesions of the heart muscle the probability of full recovery of the patient is much higher.
This is a history of large defeat when the necrosis spreads to a large enough portion of the heart muscle. If it affects the whole thickness of the myocardium, it is called transmural myocardial infarction. The name comes from the Latin trans – “through” and murus “wall”. Thus, the necrotic area affects all the layers of the heart muscle: epicardium, myocardium, endocardium. Cells die in the lesion, and subsequently are replaced by scar (connective) tissue that has the ability to shrink.
Transmural myocardial infarction is characterized by the following symptoms:
- There is a strong pain behind the breastbone. If we talk about the intensity (strength) of pain, it is often people who have experienced a heart attack, compare it with a knife. The patient can not accurately determine the location of pain. It has a diffuse character. May radiate to left arm or shoulder blade. Taking drugs – unlike the situation with angina – does not help. Pain not associated with physical activity. The same intensity and during movement and at rest.
- The skin of the patient covered with cold sweat.
- You may experience nausea and vomiting.
- The breathing is difficult.
- The skin has a pale color.
- Pressure can be high or low.
- The patient experiences dizziness can be loss of consciousness.
If a patient time does not help in myocardial infarction, he may die. It is this:
- To call an ambulance.
- To ensure the flow of fresh air. Open a vent or window.
- It is convenient to place the patient in bed in a semi-sitting position. The head should be raised.
- Hesitate to undo the collar, remove the tie.
- To give a pill Nitroglycerin and Aspirin. Optionally, if medics have not yet arrived, and the pain has subsided, repeat the drug Nitroglycerin.
- You can put on the chest of the patient is shown the yellow card.
- Give pain medication “for Pain” or “Baralgin”.
- In the case of cardiac arrest to do chest compressions and artificial respiration. For this the patient is placed on a flat hard surface. His head thrown back. 4 pressing on the sternum – breathe.
If the attack caught a sick one at home, he should first open the door and call the ambulance. This is to ensure that doctors were able to get in if the patient loses consciousness.
Then you can start taking medicines.
Primary diagnosis of myocardial infarction is the responding physicians with ECG. It clearly shows pathological Q-wave, and detects the ST-segment elevation.
The patient is hospitalized and placed in ICU. There is a further diagnosis of myocardial infarction:
- Repeated ECG.
- Echocardiography helps to identify the area of infarction.
- In the biochemical analysis of blood to determine LDH, ALT, CPK, MB-CPK and myoglobin.
- Done a troponin test.
- General blood work will show increased level of white blood cells and later increased erythrocyte sedimentation rate.
They can occur at any period of the disease. Complications of acute myocardial infarction are divided into early and late.
Early complications develop in the first few minutes, hours or days after a seizure. These include:
- Cardiogenic shock.
- Pulmonary edema.
- And congestive heart failure.
- Conduction disturbances and rhythm, especially, is often ventricular fibrillation.
- The formation of blood clots.
- Cardiac tamponade occurs due to rupture of the wall of the heart muscle (rarely).
In addition, myocardial infarction is dangerous for its late complications that develop in the subacute and post-infarction phase of the disease. Usually they occur after approximately 3 weeks after the incident of the attack. These include:
- Syndrome or post-infarction Dressler’s syndrome.
- Thromboembolic complications.
- Cardiac aneurysm.
- Chronic heart failure (CHF).
Consider the most severe complications of myocardial infarction.
Often develops left ventricular OSN, i.e., the myocardial damage occurs in the region of the left ventricle. This is a very severe complication. It includes cardiac (heart), asthma, pulmonary edema, and cardiogenic shock. The severity of the DOS depends on the volume of the affected area.
In the result of cardiac asthma are filled with serous fluid perivascular and peribronchial spaces – this leads to a deterioration of the exchange and further penetration of the liquid into the lumen of the alveoli. This liquid mixes with the exhaled air, and foam is formed.
Cardiac asthma is characterized by sudden onset, usually at rest, often at night. The patient experiences acute shortness of breath. In the sitting position gets a little easier. In addition, there are:
- Pale skin.
- Cold sweat.
- In the lungs moist rales are listened.
A characteristic feature of cardiac asthma from the bronchial is the fact that difficult to breath. Whereas in the case of bronchial asthma, on the contrary, the patient experiences difficulty exhaling.
If such a situation does not take urgent measures not to hospitalize a patient for the provision of skilled care, is developing pulmonary edema.
- Loud gurgling and bubbling breath, which is heard in the distance.
- Allocation of the mouth pink or white foam.
- Respiratory motion – 35-40 per minute.
- Auscultation audible rales multiple krupnorazmernye, to muffle the tones of the heart.
- The foam fills the entire tracheobronchial way.
With abundant foaming the death of the patient can occur within just a few minutes.
Further develops cardiogenic shock.
It can be identified by the following features:
- The blood pressure is usually below 60 mm Hg. article
- Oliguria (decrease in the number of detachable urine) or anuria (complete absence of urine).
- Moist and pale skin.
- Cold extremities.
- The body temperature is lowered.
- Deaf heart sounds.
- Crackles in the lung auscultation.
- The breathing is superficial, frequent.
- CNS disorders (matted or loss of consciousness).
Described the early complications of myocardial infarction occur most often and require immediate medical attention. Among the late complications of this pathology is the most common post-infarction syndrome and heart failure.
This condition is called Dressler’s syndrome appears as a simultaneous inflammation of the pericardium, pleura and lungs. But sometimes pericarditis develops only and then, after some time, join pleurisy or pneumonia (or both pathology at once). This syndrome is a reaction to necrotic changes in the myocardium and appears quite often.
When this complication of myocardial infarction there are difficulties with the pumping of the heart muscle of needed blood volume. As a result, all the organs suffer from lack of nutrition and oxygen supply. This pathology is evident edema and sometimes shortness of breath even at rest. At HSN the patient must lead an exceptionally healthy lifestyle.
Doctors say conditionally poor prognosis of myocardial infarction. This is due to the fact that after the disease in the heart muscle, an irreversible ischemic changes. They cause complications of myocardial infarction, which often become a cause of death after the disease.
Medical history myocardial infarction begins with the 19th century. At the autopsy of deceased patients was described individual cases of this disease. A detailed description of myocardial infarction in 1909 for the first time gave Soviet scientists at that time worked at the University of Kiev, Professor, Russian therapist Vasily Armenovich Samples and a member of the Academy of medical Sciences of the USSR, the therapist Nikolai Dmitrievich Strazhesko.
They described how the disease develops myocardial infarction and explained her symptoms and diagnosis, and also noted different clinical forms of this pathology. They said that special attention should be paid to thrombosis of the coronary (coronary) arteries, it is the most common cause of a heart attack. This brought them international fame. Thus, a medical history of myocardial infarction began with their jointly published work.
These two great Soviet scientists began to work together and to study diseases of the vascular system after 1901 N. D. Strazhesko married to Natalya Vasilyevna Obraztsova (daughter of V. P. Obraztsov). In 1909, these scientists first in the world to set a lifetime diagnosis of coronary thrombosis.