Myocardial infarction - one of the clinical forms of ischemic heart disease, which is accompanied by the development of ischemic myocardial necrosis due to circulatory disorders of the site.According to statistics, the disease often occurs in males (women are half as likely) in the age range from forty to sixty years.The risk of death after myocardial infarction is particularly high during the first two hours of its start
Myocardial infarction - Causes
In most cases, myocardial infarction prone people leading an active lifestyle is not enough against the background of psycho-emotional overload.However, a sedentary lifestyle is not a determining factor in the development of the disease and a heart attack can suddenly slay even young people with a good physical preparation.The main reasons contributing to the development of myocardial infarction include: bad habits (smoking, alcohol), hypertension, lack of motor activity, an overabundance of food consumed in animal f
Heart - muscular sac that acts as a pump and distilled through the blood itself.Supply of the heart muscle with oxygen occurs through suitable thereto outside the blood vessels.For whatever reasons, some of these vessels occluded by atherosclerotic plaques, thereby unable to pass the required volume of blood.Developing coronary heart disease (CHD).Myocardial infarction develops as a result of sudden full stop blood supply to part of the heart muscle due to coronary artery blockage occurring.Most often, this leads to a blood clot has developed atherosclerotic plaque, much less frequently - coronary artery spasm.Stripped of the power portion of the heart muscle dies.Heart attack - dead tissue (Lat.)
Myocardial Infarction - Symptoms
main typical symptom of this disease is an intense pain in the heart and chest.The pain occurs suddenly, as soon as possible reaching the high intensity and "giving" in interscapulum, left shoulder, jaw and left arm.In contrast to the observed pain in angina pectoris, the pain in myocardial infarction is much more intense and persist after taking nitroglycerin (sometimes not removed even injections of morphine).These patients should take into account the presence of coronary artery disease in the course of the disease, as well as the displacement of pain in the left arm, jaw and neck.In addition, the elderly, the disease may manifest as shortness of breath and loss of consciousness.
50% of patients harbingers of heart attack is to change the intensity and frequency of angina attacks.They become more resistant, there are already more often with little physical exertion (sometimes can occur even at rest), last longer, and their spacing in the heart there is a feeling of pressure or a dull ache.Sometimes a heart attack may not be preceded by pain, dizziness and general weakness, and the manifestation.
15% of patients with pain attack lasts no more than one hour, 40% of patients from two to twelve hours, 45% of patients - about one day.
Some patients with myocardial infarction accompanied by developing a sudden shock and collapse.The patient turns pale, feels dizzy and severe weakness, perspiring may occur brief loss of consciousness, nausea, vomiting, diarrhea (rarely).The patient was haunted by the feeling of strong thirst.The skin becomes moist and gradually taking the ash-gray color, and the tip of the nose and limbs cold drops sharply blood pressure (sometimes may not be determined).Radial pulse is not detectable at all or very low voltage.During the collapse of the heart rate may be slightly decreased, slightly increased or normal (tachycardia is more common), the body temperature slightly increased.If the collapse and shock continues for hours or even days, the forecast of a normal outcome is much worse.Myocardial infarction may occur serious violations of the gastrointestinal tract - intestinal paresis, pain in the epigastric region, nausea and vomiting.No less serious violations can be observed on the part of the central nervous system - fainting, brief loss of consciousness, weakness, removable hard stubborn hiccups.Myocardial infarction can develop serious disorders of cerebral circulation, manifested paresis, convulsions, coma, speech impairments.
addition to the above specific symptoms patients may experience common symptoms: blood increases the number of red blood cells, and there are other biochemical changes, there is a fever, body temperature does not exceed the threshold of 38 * C
clinical forms of myocardial infarction :
- Asthmatic form (the disease begins an attack of cardiac asthma)
- Anginal shape (a heart attack begins with pain attacks in the heart and the sternum)
- Abdominal (begins with dyspepsia and pain in the upper abdomen)
- kollaptoidnye form(illness preceded the collapse)
- Cerebral form (illness begins with focal neurological symptoms)
- mixed form
- Painless form (early myocardial infarction hidden)
Atypical forms of myocardial infarction
addition to typical infarct tearing apart sharpchest pain, there are several forms of heart attack, does not manifest itself, or masquerading as various other diseases of internal organs.
form Painless myocardial .This form manifests a sense of discomfort in the chest, severe sweating, deterioration of mood and sleep.This form of heart attack most often occurs in old and old age, particularly with concomitant diabetes mellitus.
Asthmatic form of myocardial infarction .This type of heart attack its manifestations very similar to the attack of asthma and display a sense of stuffiness in the chest and a dry cough, hoarse.
Gastriticheskaya form of myocardial infarction .By their symptoms very similar to the aggravation of gastritis and is characterized by severe pain in the epigastric region.On palpation of tension and muscle soreness the anterior abdominal wall.When gastriticheskom variant most often affects adjacent to the diaphragm lower parts of the left ventricular myocardium
diagnosis of myocardial infarction
Diagnosis is based on clinical evaluation of the general condition of the patient and after the differential diagnosis of diseases such as acute pericarditis, dissecting aortic aneurysm, pulmonary embolismarteries and spontaneous pneumothorax.One of the main diagnostic methods is electrocardiography (ECG), on the basis of data which can be seen on the localization and extent of myocardial injury and the limitations of established process.For heart attack is characterized by a change in laboratory parameters of blood: increased levels of cardiac markers - cardiomyocytes
Myocardial infarction - Treatment
main goal of treatment of a patient with acute myocardial infarction is as quickly as possible the renewal and further maintenance of the blood circulation to the affected area of the heart muscle.To this end, the following drugs:
- acetylsalicylic acid (aspirin) - due to inhibition of platelet prevent blood clots
- Prasugrel, ticlopidine, clopidogrel (Plavix) - also prevents blood clots, but are much more powerful than aspirin
- Bivalirudin, Fraksiparin, Lovenox, Heparin - anticoagulants that prevent the formation and spreading of blood clots and acts on blood clotting
- reteplase, alteplase, streptokinase - Powerful drugs thrombolytics, can dissolve already formed thrombus
All these drugs are used in combination, and are essential for the successful treatment of myocardial infarction.
best modern method of restoring blood flow in the coronary artery is immediately angioplasty of the coronary artery with the subsequent installation of coronary stent.If for some reasons angioplasty can not be carried out during the first hour of a heart attack - preferred is the use of thrombolytic drugs.
If all the above measures are not possible or do not help, the only way to restore blood flow (myocardial salvage) is holding an emergency coronary artery bypass surgery.
Most critical are the first day of the disease.Further outlook depends on the extent of damage of the heart muscle, timeliness of measures taken and concomitant cardio - vascular diseases.