heart attack - it's the sudden circulatory failure myocardial layer of the heart, the formation of which is due to thrombotic or spastic vascular lesions of the coronary segment followed nekrotizirovaniem infarction in the food area of the lesion.
Clinical death from a heart attack can be formed even in the first minutes of the opening of the clinical symptom, and provocation of death in most cases is the presence of extensive areas of myocardial infarction.According to the figures of the world of statistics, acute heart attack takes prevailing position as etiopathogenetic factors causing death in the general population.
consequences of a heart attack, as a rule, are irreversible, so it is important early verification of the pathological condition and adequate prevention of repeated incidents.
cause heart attacks
Authentic etiological factor for heart attack, as a manifestation of the pathological changes that occur in various cardiac pathologies, is atherosclerotic va
In partial obliteration of the lumen of the coronary vessel often develops a heart attack at night in the form of short-term pain in the projection of retrosternal area.This form of heart attack clinicians describe the term "angina", but these pathological states have a number of clinical differences (a heart attack intensity of pain more severe, lasting more than 30 minutes, is not stopped by oral nitroglycerin).Thus, the basic category of risk for a heart attack up patients with atherosclerotic and ischemic heart disease.
There are not modifiable risk criteria of heart attack in the form of advanced age, gender, male gender, race to the African-American race and genetic determination.Risk factors contributing to the development of a heart attack, it should include the so-called dismetabolic syndrome (increase in atherogenic forms of cholesterol), decompensated for diabetes, low tolerance to physical activity, prolonged intake of drugs the group of non-steroidal anti-inflammatory drugs in high dosages.
Symptoms and signs of a heart attack
first signs of a heart attack is the appearance of pronounced prolonged pain in the retrosternal region, accompanied by a feeling of tightness in the chest and the inability to perform full breaths.In some situations, retrosternal pain occurs after prolonged pain in the divisions of the upper half of the torso, neck and shoulder girdle.The classic version of retrosternal pain is long lasting and can be dull, aching, cutting, but most patients describe this state as "an intense burning sensation behind the breastbone."Pain syndrome, even after brief duration may be accompanied by severe disorders of the rhythm of cardiac activity, which is expressed in the form of the appearance of sensations disruption of the heart.
typical for heart attack is impossible without the development of respiratory disorders of varying intensity, manifested in the form of progressive dyspnea occurring after the intense physical activity, and in a state of absolute physical and psycho-emotional well-being.
presence of clinical manifestations such as nausea and vomiting may mimic other pathological conditions that have nothing to do with the defeat of the structures of the cardiovascular system, but these symptoms often accompany during a heart attack.In this situation, the only criterion for the differential diagnosis of a lack of communication of occurrence of these symptoms with the fact of the meal.Frequent heart attacks negatively affect the blood supply of the brain structures, and therefore, patients in the interictal period a marked weakness, inability to perform a minimum of physical activity and even a momentary loss of consciousness.
addition to the characteristic symptoms indicating the development of the developed clinical picture of a heart attack, there are a variety of symptoms, which act as its predecessors.Patients suffering from frequent heart attacks can predict the onset of the disease state and to take those drugs for a heart attack, that allow in the short term to stop pain and prevent complications.In each case, there are a variety of clinical symptoms-precursors, but in most cases there is a sharp heart palpitations, insomnia and a sense of "inner trembling."
In establishing a preliminary diagnosis of "heart attack" the doctor should follow a differentiated approach to history taking, clarifying the patient's complaints and evaluation criteria for objective examination, as there is a whole spectrum of clinical entities, accompanied by the development of similar clinical symptoms.Thus, in intercostal neuralgia observed the development of the expressed pain in the chest, but in this situation, as a rule, there is no correlation of pain with psychological and emotional or physical stress, which occurs during a heart attack.Despite the apparent differences in the symptoms of these conditions is fundamental test with nitroglycerin, which relieves pain during a heart attack as soon as possible and not have any effect on pain in intercostal neuralgia.
to the state of aggravating for heart attack and provoking repeated episodes of acute coronary insufficiency, in the absence of preventive measures include: various forms of violation of the rhythm of cardiac activity, cardiogenic shock, decompensated heart failure.
In most situations, a bright clinical picture and data of objective examination of the patient allow the prehospital properly set a preliminary diagnosis of "heart attack", but reliable criteria for determining the cause of the development of life-threatening patient condition are these instrumental examination.
establish the presence of ischemic myocardial damage as pathogenetic basis for the development of a heart attack allows you to conduct routine electrocardiographic examination, and there are specific electrocardiographic signs as ischemia and development of irreversible necrotic changes in the myocardium.Echocardioscopy a heart attack has little practical use since the early period of myocardial ischemia not develop specific signs of heart muscle having pathognomonic ultrasonic skialogiyu.The only laboratory methods for diagnosis of myocardial infarction, as a background condition for the development of a heart attack, is the definition of specific biological markers (troponins and creatine kinase) levels which increases with necrotic changes in the myocardium.
First aid for heart attack
When detecting the first signs of a heart attack need to have the patient maximum coordinated aid before the arrival of professionals ambulance because this pathological state relates to the category of rapidly progressing, and are prone to severe complications up todeath.
priority measures to assist the patient with prolonged acute pain in the retrosternal region, which is the main clinical criteria of heart attack, is to take the patient a single therapeutic dose of Nitroglycerin in spray or tablet form.In the absence of a visible positive effect in the form of relief of pain attack and reduce the progression of dyspnea, valid is the repeated administration of a single dose of nitroglycerin in 5-10 minutes.
In a situation when a heart attack occurs in a patient for the first time, you must be a challenge to teams of emergency medical care with hospitalization in profile hospital even if complete relief of pain in the prehospital phase.The indications for hospitalization of patients diagnosed with pathogenic form of heart attack (myocardial infarction, unstable angina, acute coronary syndrome) is not cropped pain and progression of hemodynamic and respiratory disorders.
order to eliminate pathogenic link atherosclerosis and emergency lysis existing thrombotic masses, patients in the prehospital recommended oral aspirin at a dose of 500 mg.It is imperative to notify the doctor ambulance on the admission of drugs before hospitalization with an indication not only of the pharmacological group, and dosage.The structure of the emergency treatment of heart attack include a wildcard oxygen therapy.
Relief pronounced prolonged pain during a heart attack is realized by the use of drugs neyroleptanalgezii (means combining analgesic and neuroleptic action).For this purpose it is necessary to use a 0.005% solution of fentanyl in a dose of 1 ml, and 0.25% sodium droperidol at a dose of 2 ml by intravenous, bolus.In a situation where an intense pain is accompanied by increased excitability of the patient during a heart attack, it is advisable to use intravenous narcotic drugs (1% morphine solution at a dose of 1 ml).
Treatment of heart attack
therapeutic measures used in heart attack, should be pathogenetically justified and etiologically directed.Pharmacological treatments vary on the basis of long-term administration.There medicaments for emergency medical correction of heart attack and also for lifetime maintenance therapy.
Due to the fact that the basis for the development of a heart attack put education impediment to the normal blood flow in coronary vessels due to the development of blood clots in the lumen, a prerequisite for improving the condition of the patient and reduce the risk of irreversible changes in the myocardium is the removal of thrombotic masses in every possible method.The most effective method to eliminate luminal obstruction of the vessel is performing angioplasty in the form of percutaneous coronary intervention.The effectiveness of this method depends on the timing of application (no more than 90 minutes from the debut of a heart attack).
Numerous randomized trials have proven completely ineffective and inappropriate to apply percutaneous coronary bypass patients after more than three days from the debut of a heart attack.In 10% of cases after angioplasty marked complication of restenosis, which is formed within six months from the application of surgical treatment.In order to prevent restenosis recently developed technique of application of stents with a special coating (sirolimus, paclitaxel).All patients who have been implanted with the stent, it is recommended not only in the postoperative period, but also for life to take clopidogrel, 1 capsule in the evening.
In a situation where there is no possibility of the surgery, an alternative method is the use of an adequate scheme of thrombolytic therapy with drugs that target the lysis of thrombotic masses and restore normal blood flow.Note that the efficacy of thrombolytic therapy limited time intervals, namely it is necessary to apply the preparations of this type in the first three hours from the beginning of a heart attack.The limiting factors for the use of thrombolytic therapy are: older age of the patient having a medical history of previous stroke, pregnancy and acute massive blood loss, the presence of the patient's ulcer of the stomach, long-term use of anticoagulants.
To reduce the risk of progression of formation of thrombotic complications, as well as preventing the formation of new blood clots is expedient to combine anticoagulant and antiplatelet drugs.Currently, in terms of the emergency treatment of heart attack is used Aktelize, Metalize (100000-250000 IU).The most severe and frequent complication of the use of drugs of this pharmacological group is the development of hemorrhagic type of stroke.
In order to stimulate protein synthesis and improve the metabolic processes in the body, intensifitsirovaniya process of scarring in the necrotic zone used drugs group of anabolic steroids (Retabolil 1 time in 10 days, 5% solution in a dose of 1 ml, Fenobolin intramuscularly at a dose of 1 ml of 1% solution1 per week).Absolute contraindications to the use of drugs of this pharmacological group are any cancer, pregnancy and severe hepatic impairment.
Patients who have a heart attack develops on the background of congestive heart failure, it is recommended in addition to standard medical treatment to apply adequate scheme of diuretic therapy with a primary parenteral route of administration (Furosemide intravenously 20 mg 1 to 2 times a day).
prevention of heart attack
forecast of a heart attack depends on the preventive measures that are used by patients in poslepristupnom period.Applying preventive measures are aimed primarily at preventing repeat episodes of heart attack as well as reducing the risk of death.According to statistics, the development of acute coronary syndrome is triggered by failure to comply with the patient the recommendations of the attending physician in full in the prevention of heart attack.In addition, in the absence of prophylactic treatment, a heart attack may provoke severe violations of rhythm of heart activity and damage to valvular.
Note that in some situations the patient after an episode of heart attack may develop painless form of myocardial ischemia, which is not accompanied by the formation of the classical clinical symptoms and at the same time has a high risk of cardiovascular events, including death.
as a preventive measure should be considered a dynamic control of blood pressure and retention of these indicators at the level of less than 140/90 mm Hg, which all patients suffering from heart attacks on a background of hypertension, it is recommended regular intake of drugs antihypertensive categoryand compliance with the rules on compensation of eating behavior (limit salt intake and observance of water regime).As the antihypertensive agent should prefer Drugs group of beta-blockers (metoprolol in a daily dose of 200 mg orally), which are the drugs of choice as prophylaxis of recurrent episodes of myocardial infarction and heart attack.The mechanism of the positive impact of these drugs is realized by reducing the need of the heart muscle of oxygen, reducing heart rate.