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Myocardial infarction

Myocardial infarction

Myocardial infarction is a disease that is a form of coronary heart disease. The death of a part of the myocardium is associated with an acute insufficiency of its blood supply.

The main cause of myocardial infarction is the blockage of the coronary arteries, as a result of which the blood supply to the heart is disrupted. In myocardial infarction, part of the heart muscle dies off, and the muscle tissue is subsequently replaced by scar tissue.

The main symptom of myocardial infarction is chest pain, but pain may or may not be present in other parts of the body.

One of the most modern methods of treating myocardial infarction is the dissolution of a blood clot formed in a coronary artery. After treatment in a hospital (a mandatory stage), a long period of rehabilitation follows, which should include an increase in the physical activity of a person who has suffered a myocardial infarction. The level of possible physical activity is determined by a specialist doctor.

Prevention of the development of myocardial infarction is important, which includes a certain diet, avoiding fatty foods (and foods rich in carbohydrates), quitting smoking and much more. Myocardial infarction requires immediate hospitalization, otherwise the risk of developing dangerous complications greatly increases.

Myocardial infarction can be classified in several ways. The first of them is based on the stages of development of the disease. In this case, the pre-infarction period, the most acute period, the acute period, the subacute period, as well as the scarring period are distinguished. The duration of the pre-infarction period can vary from a few minutes to one and a half months; this period is characterized by an increase in the intensity and frequency of unstable angina attacks. It is important to know that if you immediately consult a doctor and begin to receive treatment, then the development of myocardial infarction can be avoided. The most acute period, as a rule, occurs suddenly - it is impossible to predict its beginning. The duration of the acute period is approximately equal to ten days, during which the place of necrosis is clearly marked and a scar begins to form - muscle tissue is replaced by scar tissue. In the acute period, patients sometimes experience an increase in body temperature. The subacute period lasts about eight weeks, during which the scar is finally formed - the processes of its compaction are underway. The duration of the last - postinfarction - period is up to six months. During this period, the patient undergoes rehabilitation, his condition stabilizes. However, it is during this period that it is necessary to carefully monitor your health, since it is at this time that there is a possibility of re-development of myocardial infarction. The second classification option is associated with the extent of the lesion: in this case, there is a distinction between large-focal myocardial infarction and small-focal myocardial infarction. There are other classification options.

Closing the lumen of the coronary artery entails the development of myocardial infarction. The coronary artery is an artery whose function is to supply blood to the heart muscle. Closing the lumen of any hollow organ is called obturation.

The cause of myocardial infarction is atherosclerosis of the coronary arteries. In most cases, this is the case. In 93-98%, it is the blockage of the vessels supplying the heart muscle, thrombus or plaque that is the cause of the development of myocardial infarction in a patient. However, surgical obstruction (for example, due to ligation of an artery) or embolization of a coronary artery can also lead to a heart attack, although in a much smaller number of cases. Separately considered is a heart attack that develops with existing heart defects. These defects include, for example, a significant discharge of the coronary arteries from the pulmonary trunk.

Ischemia is a predictor of heart attack. Coronary artery disease may or may not lead to this condition. In addition, coronary artery disease can last as long as you want - for years and decades. At some stage, damage can occur (during this period lasts from four to seven hours), as a result of which the functionality of the heart muscle is disrupted. However, the changes that occurred during this period are reversible. The necrosis that occurs after injury is an irreversible process. After one to two weeks, the area with dead tissue begins to scar, and this process lasts for one or two months. With scarring, normal myocardial tissue is replaced by scar tissue.

Chest pain is the main symptom of myocardial infarction. This is, indeed, the main clinical sign of this disease. The pain, as a rule, is characterized by a rather high degree of intensity, but it can also be variable in nature, that is, the patient may feel discomfort in the chest cavity, pain in the scapula, arm. Belly. Sometimes myocardial infarction develops without accompanying pain. In about a third of cases of large-focal myocardial infarction, patients develop symptoms of heart failure: patients complain of an unproductive cough, shortness of breath, and arrhythmias are often found in patients.

Diagnosing myocardial infarction can be difficult. We are talking about those cases when the symptoms of this disease are atypical, in accordance with this, the following atypical forms of myocardial infarction are distinguished - abdominal, asthmatic, painless, cerebral forms.
The abdominal form of myocardial infarction is associated with a situation when the symptoms of this disease are pain in the upper abdomen and its bloating, nausea and vomiting, and hiccups. In the case of the abdominal form, the symptoms of myocardial infarction are similar to the main symptoms of a disease such as acute pancreatitis.
The asthmatic form of myocardial infarction is a situation where the symptoms of the disease are more associated with the appearance of shortness of breath, which tends to increase. Therefore, in this case, we can talk about some similarity with the clinical picture of an attack of bronchial asthma.
The painless form of myocardial infarction is quite rare, mainly with the development of this disease in patients with diabetes mellitus. Such patients do not feel pain because one of the manifestations of diabetes is loss of sensitivity.
In cerebral myocardial infarction, the symptoms of this disease are, as a rule, impaired consciousness and dizziness. Patients may also have neurological symptoms. The cerebral variant of the disease is also called cerebral, as a rule, in this case there are no pains in the heart. But headaches may appear. The reason for their occurrence is a decrease in the blood supply to the brain.

Myocardial infarction requires hospital treatment. The patient is being treated in the intensive care unit of the hospital, the sooner the patient gets there with a diagnosis of myocardial infarction, the more effective the treatment results will be. However, the treatment itself must begin immediately after the onset of the attack - with the provision of first aid to the patient. Before the arrival of an ambulance, it is necessary to put the patient to bed and try to cope with the pain. First, you must immediately give the patient a nitroglycerin tablet. If nitroglycerin did not give a positive effect, then the arrived ambulance will inject narcotic analgesics intravenously. Thus, the very first and very important stage in the case of myocardial infarction is to get rid of pain, since otherwise it can lead to the development of cardiogenic shock. It is very difficult to get the patient out of this state. Subsequently, drugs of different groups are used.

There are several ways to improve the patient's condition with myocardial infarction. There are three of them.
The first is to dissolve the thrombus formed in the coronary artery. This method of treatment is called thrombolysis. At this point in time, this is the best method of treating the disease. The result directly depends on the time of administration of the drug capable of dissolving a thrombus - the faster, the more effective (the best result can be during the first hour - "golden" - after the onset of a heart attack). If the clot dissolves only six hours after the onset of the heart attack, then only about 5% of the affected heart muscle can be saved.
The second is to reduce the stress on the heart. For this purpose, the patient is prescribed to take drugs that help lower blood pressure, reduce the heart rate, and reduce the volume of circulating blood.
The third is to improve the metabolism in the heart muscle. For this purpose, the patient is prescribed preductal, vitamin E.

A long period of rehabilitation is characteristic of myocardial infarction. It lasts up to six months. This means that myocardial infarction is treated not only in inpatient conditions, but a mandatory stage is treatment after the hospital. During the rehabilitation period, a person gradually increases physical activity. A person who has suffered a myocardial infarction should know that throughout his future life he will have to take certain medications and control his blood pressure. In addition, such a person will have to get rid of bad habits, if any. However, do not think that after a heart attack, life will become incomplete. This is not so - especially if all the recommendations of the doctors are strictly followed.

If there is a threat of a heart attack, then the patient needs to start coughing heavily. Such statements can now be found on the Internet. The presentation of such content is sent by email. Don't believe it. It's a delusion. The argument that vigorous coughing can improve blood circulation has not been proven and is unlikely to be proven. On the contrary, a patient with a threat of a heart attack needs, as soon as possible, to ensure peace and call an ambulance.

Physical activity is contraindicated after myocardial infarction. This is another misconception that is widespread among the population. On the contrary, the rehabilitation period is significantly facilitated in the case of early activation of a patient who has suffered a myocardial infarction in conjunction with physiotherapy exercises. All this significantly reduces the risk of complications. Conversely, lack of exercise greatly increases the risk of recurrent myocardial infarction. The specialist will select the level of physical activity possible for the patient himself.

The prognosis in the treatment of myocardial infarction is poor. To be more precise, it is conditionally unfavorable, since after the development of this disease, ischemic changes occur in the heart muscle, which are irreversible. These changes can lead to the development of various complications.

The dietary regimen is the main measure for the prevention of myocardial infarction. In this case, we are talking about people who suffer from sclerosis of the coronary vessels of the heart. It is important to know that overeating is very harmful to the health of every person, but this is especially true for the above group of people.
If a person is prone to the development of obesity, then he must choose those foods that are not characterized by high calorie content in his diet. In this regard, preference should be given to those products that contain a small amount of carbohydrates and fats. But the consumption of proteins in no case can be below the norm - 100-150 grams. It is desirable to eat vegetables and fruits. It is scientifically proven that vitamin C helps to prevent the development of atherosclerosis, therefore, in addition to vegetables and fruits, you can use infusions of black currant and rose hips, which are rich in this vitamin.
However, in addition to the need to maintain a certain dietary regimen, important points in the prevention of myocardial infarction are the passage of iodine treatment from time to time, rational rest (really rest on weekends and on vacation - that's what they are given), giving up bad habits (smoking, drinking alcohol, etc. etc.), physiotherapy exercises, as well as effects on the nervous system. The latter implies the provision of normal sleep (at least seven hours at night, preferably one to two hours during the day), the correct change of activity - rest and work.

Myocardial infarction can lead to serious complications. They can be divided into early (develop in the first days of the disease) and late (develop two to three weeks after the onset of the disease). The first group of complications includes cardiogenic shock, acute heart failure, rhythm and conduction disturbances, and others. The second group of complications includes, for example, chronic circulatory failure. Some of the complications can be both early and late - for example, thromboembolism, cardiac aneurysm, etc. Most often there are cardiac arrhythmias and conduction disturbances, especially when it comes to a large-focal form of the disease - so if you track the work on special monitors the patient's heart on the first day after the onset of a heart attack, it turns out that almost all patients have these complications.

Cardiogenic shock is a serious complication of myocardial infarction. The manifestations of this complication are severe arterial hypotension, impaired consciousness, and decreased contractility of the heart muscle. Getting a patient out of cardiogenic shock is not an easy task. Three degrees of cardiogenic shock can be distinguished. It is mild, moderate, and severe. E.I. Chazov proposes the following classification scheme for the forms of cardiogenic shock. In connection with this classification, cardiogenic shock is divided into the following forms.
The first is reflex cardiogenic shock. In this case, the shock develops against the background of the existing pain. However, if myocardial infarction is characterized by a painless form, then there may be no pain.
The second is arrhythmic cardiogenic shock. In this case, shock can develop against the background of tachyarrhythmias, tachycardia, and also against the background of atrioventricular blockade.
The third, true cardiogenic shock, is the most severe form of shock known. In this case, it has subdivisions. This is a moderately severe cardiogenic shock (or grade I - the changes are not very pronounced), severe (or grade II) and reactive (or grade III - as a rule, such a cardiogenic shock is irreversible).

Watch the video: ECG for Beginners. ECG Diagnosis of ST Elevation Myocardial Infarction STEMI (October 2020).