Myocardial infarction

Myocardium in medicine is called the cardiac muscle to which on coronary arteries blood arrives. If one of these arteries is corked by a blood clot (blood clot), the part of heart remains without oxygen, the metabolism of cells is broken, and irreversible changes develop. If not to take emergency measures, the person can die within only 2 hours. Thus, the myocardial infarction is the dangerous disease which is characterized by death of cells of a cardiac muscle, on site which postinfarction hems are formed of rough connecting fabric.

Depending on the amount of focal defeat allocate small — and a macrofocal heart attack, and also on a current stage the disease happens acute, subacute and includes the postinfarction period. If the necrosis covers all thickness of a myocardium, then such heart attack call transmural. Macrofocal heart attacks since it takes all thickness of a cardiac muscle are the most dangerous, the melkoochagovy heart attack is less traumatic, however hems after it remain forever.

Unfortunately, the myocardial infarction "looks younger", and today it can affect the thirty-year-old man though usually strikes fifty-year-old and is more senior. And at women the disease is rare when comes before 50 flyings, however at this age happens more often than at men. The heart attack is one of basic reasons of disability today, and mortality at a disease makes from 11 to 15%.

Also allocate a heart attack with a pathological tooth of Q and without it, and depth and the sizes of a necrosis are more in the first case. If the disease without tooth, then increases risk of a palindromia.

Symptoms of a myocardial infarction can sometimes "mask" under other heart diseases, the attack of a heart attack can sometimes have symptoms of an attack of bronchial asthma, i.e. be shown by dry cough and pressure sense in a breast. It is possible as well a heart attack with symptoms of gastritis, i.e. an abdominal pain, a peritoneum muscle tension. And sometimes the illness is shown only in the sensation of discomfort in a breast raised sweating and sleep disorders, usually at advanced age and against a diabetes mellitus. All these options of emergence and the course of a myocardial infarction are called atypical, and bezbolevy the option of a heart attack proceeds most heavier.

Usually the heart attack arises at those who suffer from coronary heart disease, atherosclerosis, with the increased arterial pressure.

It is necessary to know rules by which reanimation at a myocardial infarction is carried out to carry out acute management if you noticed at the person even separate symptoms of a myocardial infarction. If suddenly there is expressed thorax pain, and also nausea and disturbances of breath, and after a rassasyvaniye of several Tabulettaes Nitroglycerini it did not become better, then it is necessary to call at once in "Ambulance". Besides, it is necessary to lay at once the patient, to raise the head, to give one more Tabulettae Nitroglycerini, and also 1 tablet of Aspirin in the crushed look or under language. It is also necessary to accept 60 drops of Corvalol, 1 tablet of Analginum, 2 tablets of an ororat of potassium (Pananginum), it is also possible to apply a mustard plaster to a breast.

Heart represents a sack from a muscle through which blood is overtaken. The cardiac muscle with oxygen is supplied by special coronary vessels and if part of these vessels it is struck with atherosclerosis, then coronary heart disease develops. In this case the movement of blood and on them is complicated. If the myocardial infarction develops, then owing to obstruction of a coronary artery blood clot blood supply of heart suddenly stops, and, deprived of food, sites of a muscle perish. Such blood clots in 95% of cases it is formed around an atherosclerotic plaque. Therefore the disease most often develops against atherosclerosis. At atherosclerosis on walls of vessels deposits of fatty accumulation and plaques are formed that is promoted by the increased cholesterol level in blood. Around an atherosclerotic plaque the blood clot is formed, the organism as if "heals" education, and blood clot is formed. Such plaque can sometimes be damaged at increase of pressure, and the heart attack can sometimes begin without the visible reasons, usually in the morning.

Almost in half of cases it is observed against stenocardia.

Also the myocardial infarction reasons scientists call improper feeding, the use in food of a large number of greasy and salty food, a lack of physical activity, slow-moving way of life, existence of addictions.

Risk factors of development of a heart attack are: a male, age, heredity (if direct relatives had heart attacks or brain strokes), excess body weight, a diabetes mellitus, the increased arterial pressure, the increased cholesterol level in blood, smoking, including passive, earlier postponed myocardial infarction, usually melkoochagovy.

Myocardial infarction symptoms

Инфаркт миокардаUsually the myocardial infarction begins with emergence of pain behind a breast, in the left part of a thorax, it can sometimes be localized under a shovel and even in upper part of a stomach. This severe pain is given on the left hand in the form of feeling of a pricking in a hand and fingers. Pain can sometimes be given to a neck and a jaw. At women during a heart attack attack pain is most often localized in a neck, upper part of a stomach and a jaw, and the attack can remind heartburn. I.e. symptoms of a myocardial infarction are very similar to a stenocardia attack, they are observed even in a condition of absolute rest.

At a heart attack pain very strong, it is characterized as "a dagger in a breast", it tearing apart, sometimes even forcing to shout. Some complain of long dull ache in retrosternal area and numbness of wrists. Sometimes the disease is followed by feeling of a prelum from within, burnings and weights in a thorax as if "heart squeezed in a vice".

Usually pain at a heart attack begins in the morning or at night, develops wavy, without stopping completely, and for development of a disease there is enough 15 minutes of long pain. Usually the attack of pain to last more than half an hour, and can also several hours, and even at rest pains do not decrease, and Tabulettaes Nitroglycerini do not promote improvement of a state. Except pains, symptoms of a myocardial infarction are lowering of arterial pressure that is connected with reduction of sokratitelny ability of heart because of the sites of a myocardium deprived of food. Also the speeded-up spasmodic heartbeat can sometimes develop that is an adverse sign, nausea, short wind, weakness, pallor and even cyanosis of face skin, a shiver in muscles is also observed, cold sweat, a subconscious state, body temperature raises a little. The persistent hiccups can begin, paresis of intestines, an abdominal pain is sometimes observed.

Patients can feel fear of the coming death and alarm, and often it depends on the sizes of an affected area of a myocardium. There are normal psychological reactions of the person to an illness, and neurotic when it is necessary for the person the professional help of the doctor.

Diagnosis of a myocardial infarction

The myocardial infarction is diagnosed on the basis of three main criteria: the severe, tearing apart breast pain, irradiruyushchy in the left hand, fingers, shovels, a jaw, proceeding more than 30 minutes, and also not disappearing after nitroglycerine reception. If you observe similar symptoms, it is necessary to call "Ambulance" as soon as possible. In the presence of long pains to the patient carrying out an electrocardiography, echocardiography at a long pain syndrome will be appointed, and also biochemical analysis of blood. Gives the chance to reveal necrosis size positron emission tomography. If the patient has coronary heart disease, can carry out the emergency coronary angiography also. If there are doubts concerning the diagnosis, can conduct researches on identification of the centers of a necrosis by means of tracer techniques.

It should be noted that the clinical picture of a myocardial infarction is very diverse therefore it is correct to make the diagnosis in short terms difficult. Almost at 20% of patients the illness can proceed asymptomatically. Usually in hospital differential diagnosis of a myocardial infarction with other diseases – aneurism of a chest aorta, acute myocarditis, spontaneous pheumothorax, etc. is carried out.

Treatment of a myocardial infarction

Инфаркт миокардаThe purpose of treatment of the patient with a heart attack is the fastest resuming of blood circulation to the struck part of a cardiac muscle. In an arsenal of modern medicine several types of medicines which are combined depending on a disease stage are applied to these purposes.

From drugs acetylsalicylic acid which prevents formation of blood clots, the trombolitik capable to dissolve already created blood clots, the heparin influencing coagulability of blood and some other are used. By the way, the thrombolytic therapy early begun reduces probability of a lethal outcome, it is the best of all to begin it within 6 hours after the beginning of an attack of myocardial infarction. For use of trombolitik there are also contraindications, these are brain tumors, recently postponed severe injuries, surgical interventions for up to 2 weeks. Diseases of a liver and kidneys, tuberculosis and other diseases important body also exclude their use. In case of impossibility of use of trombolitik, and also at cardiogenic shock, for recovery of a blood flow to a cardiac muscle, procedure of direct angioplasty of a coronary artery and establishment of a coronary stent can be carried out. The stent represents a framework which supports a vessel opened.

However if these procedures did not lead to improvement, then surgical treatment of a myocardial infarction is applied. Operation of aortocoronary shunting (or surgical revascularization) for recovery of blood circulation of a cardiac muscle is performed. Operation is necessary at ruptures of a myocardium, interventricular partitions.

However, in addition to recovery of a blood flow to a cardiac muscle, treatment is directed to reduction of the amount of damage of a myocardium by use of beta-blockers, such as atenolol, labetalol, etc. Also they do cardiac performance of more economical that plays an important role at an illness. Pain is stopped by nitroglycerine reception (0,5 mg under language), and anesthetics, morphine, Omnoponum, pantopon, better intravenously. Also means for fight against arrhythmias are appointed. Arrhythmias are the main possible complications after the postponed myocardial infarction, and a cause of death of patients before arrival of doctors.

The scheme of treatment of a myocardial infarction for 24-72 hours can be following: administration of heparin intravenously (20-40 thousand units), nitroglycerine (intravenously, with rate of administering of 5-10 mkg a second), Streptokinasa in 2 receptions intravenously (1-1,5 million units). Also beta adrenoblockers, for example, propranolol on 20 mg in one step, aspirin – 0,5 mg a day, and, if necessary, tranquilizers several times in days is applied.

At a cardiac standstill the standard set of actions of cardiopulmonary reanimation is applied. At the same time in a hospital it is observed the arterial pressure of the patient, his pulse, work of kidneys, etc.

It is important to take all measures in the first 24 hours after myocardial infarction symptoms, then the forecast more favorable appeared. It is necessary to bring the patient to cardiological department as soon as possible, only in the conditions of a hospital it is possible to recover a blood stream and activity of a myocardium, and also to dissolve blood clot, interfering with formation of new.

Rehabilitation of the patient after the postponed disease can last several weeks. At first the patient is allowed to sit independently on a bed and a chair, a little later – to go on chamber, to climb steps, etc. Also the sanatorium therapy can be appointed.

After passing of a course of treatment of a myocardial infarction the diet consisting of easy, not greasy food registers, it is also necessary to control work of intestines, not to allow locks.

The course of a myocardial infarction can be divided into several periods. Usually the disease begins with short-term heartaches or a breast, during it reduction of blood supply of heart begins. Further the acute period during which the necrosis of fabrics begins follows, it lasts about 8-10 days. After acute the subacute period which usually to last one and a half or two months begins, at this time there is a scarring. The period of an illness can sometimes be longer because of development of complications. The postinfarctive period when there is a gradual recovery of an organism after the postponed myocardial infarction is considered the last stage. At this time the patient still needs a bed rest and supervision of the doctor.

Complications of a myocardial infarction

Инфаркт миокардаThe heart attack represents necrosis of a certain zone of a cardiac muscle therefore on site a necrosis connecting fabric because of what heart wall thickness at increase in the size of a left ventricle decreases and to decrease in its sokratitelny ability is formed. At extensive injuries of a myocardium heavy complications of this disease also develop.

Development of heart failure, reduction of sokratitelny ability of heart, cardiogenic shock, pericardis, cardiorrhesis, arterial hypertension, and also arrhythmia, and its look – ventricular tachycardia and fibrillation of ventricles can be observed. Cardiogenic shock comes because of disturbances of sokratitelny ability of heart and decrease in its minute volume. Various mechanical damages, for example, cardiac aneurism which are usually observed in the first week after a disease can become complications after the postponed myocardial infarction also. Aneurism of heart represents formation of a sacculate cavity which contains blood clots. Sometimes at patients after a myocardial infarction, the postinfarction syndrome (so-called "Dressler's syndrome") which is characterized by manifestations of a pericardis and pneumonia is observed.

More than at a third of patients who had a myocardial infarction the recurrent pain syndrome is observed. It should be noted that all complications of a myocardial infarction demand the emergency medical care.

Development of possible morbid conditions of a heart attack depends on the size of damage of a myocardium, on time for which the blood flow to the struck part of a cardiac muscle was recovered (i.e. the earlier medical care, the less zone of a necrosis was provided), as well as on an arrangement of these damages, most often the heart attack affects front area of a cardiac muscle and takes a top.

Prevention of a myocardial infarction

For prevention of this dangerous disease, it is necessary to diagnose and carry out timely treatment of chronic diseases, including atherosclerosis, ischemia of heart, a hypertension, etc. To prevent a myocardial infarction, it is necessary to refuse addictions, first of all smoking, an alcohol abuse. It is necessary to eat properly, eating as little as possible animal fats and the food rich with cholesterol, to control body weight, and also to lead a new life, to care for the health, to play sports, physiotherapy exercises, more often to happen in the fresh air. By the way, regular exercise stresses reduce risk of repeated development of a disease by 30%. It is necessary to eat as much as possible green vegetables, fruit, bread and coarse flour, fish, to try not to use salt. It is necessary to add a food allowance with vitamin C, for example, in the form of blackcurrant infusion, or ascorbic acid. The constant control of arterial pressure will help to take medicine for its increase in time that increases load of heart.

Prevention of a myocardial infarction demands to set the correct mode of rest and work, to sleep not less than 7 hours a day, to spend days off in the fresh air.

Reanimation at a myocardial infarction

Инфаркт миокардаThe earlier resuscitation actions will be begun, the it is more than chances to survive at the patient. It is necessary to begin them from first minute of displays of a myocardial infarction. Of course, first of all, it is necessary to call "Ambulance". Lay the patient on a plain firm surface, having enclosed the roller or a towel under shoulders, throw back his head for passability of respiratory tracts.

If the person does not breathe independently, then it is necessary to carry out artificial ventilation of the lungs. For this purpose providing first aid blows into an open mouth of the patient air from the mouth, as if inflating lungs. The nose of the patient is held by fingers. Then revivifying leans back back, again gathers air in a mouth and presses the lips to lips of the patient and blows air.

If at the same time on a carotid artery pulse is not probed, then it is at the same time necessary to do an indirect cardiac massage. For this purpose put the hands one on another so that the basis of a palm was located on a breast midline, is 2 fingers higher than a xiphoidal shoot. Hands at an indirect cardiac massage are not bent, and under pressure of the weight of the body, breast shift to a backbone is made. Such compressions, or prelums, there have to be about 80 in a minute. It is possible to make it so: 15 pressings on a breast, then – 2 inflations of air to repeat. If all of you do correctly, then at the patient skin has to turn pink, appear a photoharmose, breath was resumed and pulse appeared.

Section: Cardiology