Myocardial infarction: symptoms, causes, treatment,first aid

Update: December 2018

Any heart attack could potentially mean the onset.
myocardial infarction. Vital functions of all internal organs, including
including the heart, is provided with blood circulation.

Blood vessels and blood is a transport system that
supplies tissues with oxygen, nutrients and building
materials, and also displays decomposition products.

ATнезапное прекращение кровоснабжения отдельного тканевого
plot of the body and the resulting effects are called heart attack.
ATследствие этого, в обескровленном участке нарушаются
physiological processes, decay products accumulate, this
leads to necrosis (death).

Causes of myocardial infarction, provoking factors

The factors provoking the occurrence of myocardial infarction,
are physical and psychological stress at which
increased heart rate, increased muscle
Work dramatically increases the heart’s need for oxygen.

Atherosclerotic or congenital anomalies of the coronary vessels,
diabetes, in some cases infectious diseases
(infective endocarditis) that lead to clogged arteries
blood clots. If we talk about factors that increase the risk of
myocardial infarction, it is conditionally possible to distinguish two groups:

Lifestyle
Hypodynamia Sedentary life – the scourge of our time, a huge amount
technical advances make our lives much easier, but
it and slowly kills. Today’s children have almost forgotten about
outdoor games, they spend most of their time watching television or
by computer.
Emotional overstrain AT эту группу входят лица, образ жизни и профессиональная
whose activities are associated with prolonged stress loads.
And also people who, due to the peculiarities of their personality,
emotionally perceive the events of their lives.
Obesity The higher the degree of obesity, the greater the risk of
heart attack. With the increase in the weight of the patient, the body occurs
malfunctions of the general metabolism, in particular fat. Excess fat
deposited not only in the subcutaneous fat and abdominal
glands, but also on the surface of the heart, which can provoke
mechanical pressure on the coronary arteries.
Alcohol abuse Increases blood pressure, constant intoxication
significantly disrupts metabolic processes, leads to exhaustion
cardiac muscle (myocardial dystrophy).
Smoking Nicotine significantly reduces the level of oxygen in the blood, forming
pathological compounds with hemoglobin, while the level
hemoglobin in smokers often exceeds the norm, but it does not
copes with the transport of oxygen. ATторым неблагоприятным
the effect of nicotine is a violation of vascular tone and increase
blood pressure. Each cigarette causes a short-term
tachycardia, increasing myocardial oxygen demand.
Heredity Scientists have come to the unequivocal conclusion about the existence
hereditary predisposition to heart attack. E. Sh. Halden drew
attention that there is an external feature – a diagonal fold
earlobe, found in people with coronary artery disease
heart complicated by heart attack more often than in healthy people.
Health status
Atherosclerotic lesion of the coronary vessels This disease is associated with impaired fat metabolism, it
has many causes and quite complex pathogenesis. But the main
the essence is that on the inner walls of the vessels are deposited
atherosclerotic plaques that significantly narrow the lumen
vessels up to complete blockage, reduce elasticity and tone
make them brittle, disrupt normal blood flow, promoting
blood clots. Therefore, atherosclerosis is one of the important
factors of infarction (see details about Atherosclerosis
brain vessels).
Hypertonic disease Increased blood pressure increases the need
myocardium in oxygen. With inadequate treatment and malignant
forms of hypertension can develop left ventricular cardiac
failure.
Coronary heart disease IHD is a chronic violation of coronary circulation.
Indication of previously transferred heart attacks of various degrees
gravity.
Diabetes Stable increase in blood glucose is detrimental
affects the state of the vascular bed, changes the normal
blood formula, violates the transport function of hemoglobin.

Heart attack

AT течение инфаркта миокарда выделяют три основных периода.
The duration of each of the depends on the area of ​​the hearth
lesions, functionality of vessels that feed the heart muscle,
associated complications, correctness of therapeutic measures,
patient compliance with recommended regimens.

Острый период, в среднем при инфаркте с крупным
a lesion without complications last about 10 days. This is the most difficult
the period of the disease, during which the lesion is limited,
replacement of necrotic tissue with granulation begins. AT это время
the most terrible complications may occur, the highest
mortality. By the end of the period begin to return to normal
blood tests, improved electrocardiogram performance. The patient
transferred from the intensive care unit to the cardiological
department.

Подострый период, продолжается приблизительно
до 30 дня с момента развития heart attack. Replacing the affected
areas of connective tissue, improved: the general condition of the patient,
blood pressure numbers, pulse rate, cardiogram data.
Нормализуются реологические свойства blood. The patient is expanded
regimen, therapeutic gymnastics are introduced into the therapy complex. Ends
this period is the transfer of the patient to a spa treatment for
aftercare. And at this stage the patient may occur
complications that may lengthen its duration.

Период рубцевания в лучшем случае длится до 8
weeks, but in some cases can lengthen up to 4 months. how
as the name suggests, final healing takes place during this period.
affected area by scarring. Scar from a cured heart attack,
determined on the cardiogram for the rest of your life.

ATиды и симптомы инфаркта

Инфаркт миокарда: симптомы AT 30% случаев инфаркт
develops against the background of the so-called pre-infarction period, to
which include the following states:

  • destabilization of coronary heart disease, that is, increased
    attacks, reducing the effect of taking drugs nitroglycerin,
    reduced resistance to stress;
  • first occurrence of angina;
  • heart rhythm disturbances first identified;
  • appearance of heart failure symptoms, in the form of stagnant
    pneumonia.

AT остальных случаях симптомы острого инфаркта миокарда
develops suddenly. Heart attack отличается большим
variety. The most common variant of anginal (vascular), 90-95%
all heart attacks.

Ангинозный вариант протекает с выраженной болью
behind the sternum in the region of the heart, which sometimes gives to the left hand,
under the shoulder blade, in the neck area to the left. Patients describe pain as
pressing, piercing, compressing, tearing. The patient is restless
pale, breathing quickened, he rushes about. It is noted that with heart and
respiratory problems people experience a strong fear of death. ATажным
diagnostic sign is that pain is not
reacts to nitroglycerin, and practically does not decrease by taking
traditional pain medication.

These first symptoms of myocardial infarction are so common and
typical that other types of pain are considered atypical.

Obsteptomatic or “dumb” are a major medical problem.
heart attacks. They are usually found occasionally on cardiograms in
as cicatricial changes and proceed with very scarce
symptoms:

  • characterized by a state of general weakness
  • increased fatigue
  • hypotension, with moderately increased heart rate
    cuts.

Астматический вариант наблюдается чаще у
elderly people, long suffering from hypertensive and ischemic
diseases. Classic symptoms of heart attack, accompanied by them
pulmonary edema. Sometimes asphyxiation can be the first symptom of recurrence.
heart attack. Pulmonary edema in infarction is determined by a noisy, audible
at a distance of bubbling breathing, severe shortness of breath, up to
choking. Pale skin with a bluish tinge of nasolabial
triangle. A characteristic pain syndrome for a heart attack may
be present or be less intense.

Myocardial infarction with cardiogenic syndrome
shock.
ATид инфаркта с резко выраженным болевым синдромом,
cold sweat, cooling of the limbs, a sharp fall
blood pressure. This form of the disease is often mistaken.
take for internal bleeding or food poisoning.

Arrhythmic option. Heart attack begins with
an attack of arrhythmia, where she also acts as the leading symptom.
Confirmation of the diagnosis is found on the cardiogram.

Cerebral variant. ATедущие симптомы:
headache, sensory and motor disorders, nausea,
vomiting, visual disturbances. Heart symptoms may be erased.
The difficulty of diagnosis lies in the fact that stroke is in its
essentially brain infarction, that is, these two pathologies can be combined in
one patient.

Абдоминальный (гастралгический) вид. Begins
with a sharp pain in the stomach, nausea vomiting, abdominal distention. With
palpation of the abdomen is painful, the muscles are tense. Often take
abdominal infarction for perforated ulcer or acute
pancreatitis.

Diagnosis of heart attack

ECG – The first and main diagnostic method at the emergency stage
aid is an electrocardiogram, on which are determined
changes characteristic of only a heart attack, it can be installed on
локализацию очага поражения, период heart attack. Cardiogram
recommended for all the above symptoms.

Coronary angiography method – X-ray method of research,
in which a coronary vascular system is contrasted through a probe,
and under x-rays see blood flow through the vessels. Method
allows you to determine the patency of blood vessels and more accurately indicate
localization of the focus.

Method компьютерной коронарографии – чаще используют при
ischemic disease to determine the degree of vasoconstriction,
which shows the likelihood of development heart attack. This method in
Unlike radiographic coronary angiography, more expensive, but more accurate.
It is less common due to lack of equipment and
professionals owning the methodology.

Laboratory diagnosis – When myocardial infarction occurs
characteristic changes in the composition of blood and biochemical parameters,
that control throughout the treatment.

First aid and treatment of myocardial infarction

First aid for myocardial infarction

A person with suspected heart attack must be laid down,
release airway from pressure clothing, (tie,
scarf). The core with the experience with you may be drugs
nitroglycerin, you need to put 1 tablet under his tongue, or
inject if it is spray. Nitroglycerin preparations
should be given every 15 minutes before the arrival of the doctors. Well if under
Aspirin and aspardine – drugs containing
acetylsalicylic acid, they have an analgesic effect and
prevent the formation of blood clots. With cardiac arrest and respiration
patient needs to undergo artificial respiration and indirect massage
heart, before the arrival of doctors.

Attention:

  • Nitroglycerin preparations не только расширяют коронарные сосуды,
    they have the same effect on brain vessels if a person
    to be in an upright position a sharp outflow of blood is possible and
    sudden short-term loss of consciousness (orthostatic
    collapse), falling sick can get hurt. Nitroglycerine
    should be given to the patient while lying or sitting. Orthostatic
    the collapse passes on its own if you put a person and raise
    his legs, after 1-2 minutes.
  • If a patient has a heavy, noisy, bubbling breath, he cannot
    stack, as this will aggravate the condition. Such a patient
    need to sit down comfortably and securely.

First aid in the ambulance

Until arrival at the hospital, the patient continues to conduct
necessary treatment in accordance with the leading symptoms:

  • give oxygen;
  • provide access to a vein;
  • trying to stop pain syndrome is not narcotic or
    narcotic analgesics (droperidol, morphine hydrochloride), in
    depending on its severity, in the absence of effect
    may use inhaled anesthesia with nitrous oxide (intensive care
    equipped with portable anesthesia machines), or enter
    Sodium hydroxybutyrate i.v., this drug except sleeping pills and
    anesthetic effect, protects organs from oxygen
    fasting;
  • for the prevention of blood clots and sucking already
    existing used heparin;
  • normalize blood pressure, with a high value of blood pressure
    Lasix is ​​administered, at low prednisone, hydrocortisone;
  • for the prevention or relief of arrhythmias, lidocaine is administered in / to
    saline solution.

Hospital treatment

In the acute period of treatment of heart attack rely on the leading syndromes,
The main task of the doctor is to stabilize the vital
patient functions and limiting the spread of the lesion.
The maximum possible resumption of coronary circulation.
Prevention of complications.

  • Relief of pain, simultaneous prevention
    cardiogenic shock.

– If pain persists after 30 – 40 minutes, repeat
Droperidol is administered with fetanil. These drugs have a side effect.
effect – respiratory depression. – Therefore, you can replace them with a mixture
Analgin with Relanium or 0.5% Novocain; a mixture of analgin,
Dimedrol and Promedol in 20 ml of saline. Have these
mixtures can be a vomiting side effect, for prevention
0.1% atropine solution is injected subcutaneously. – In the absence of effect –
anesthesia nitrous oxide.

  • In the asthmatic variant with pulmonary edema.

The patient needs to maximize his upper body.
Three times with an interval of 2-3 minutes nitroglycerin (isoket) under the tongue.
Effective inhalation of oxygen with alcohol. Waiting for a doctor when
the absence of oxygen, near the face of the patient (without closing the respiratory
ways!) you can keep the fabric, abundantly moistened with alcohol or vodka.
With elevated or normal blood pressure intravenously
jet injected lasix (furosemide) in large doses. Hypotension
in / in prednisone administered, drip reopolyglukine infused

  • With arrhythmias

Tachycardia (rapid pulse) is stopped by a solution of isoptin. AT
case of atrial fibrillation and flutter – novokinamid,
Panangin, Unithiol. With no effect applied
electro-fibrillation. Bradycardia (rare pulse) – in / in lead
Atropine, izadrin 1 tablet under the tongue. If there is no effect –
alupenta in / in and prednisone.

  • One of the causes of impaired coronary circulation is
    clogging them with blood clots.

They fight with medicaments by applying fibrolysis therapy.
based on streptokinase and its analogues. Contraindications to
All types of bleeding are the same. therefore
against the background of this treatment strictly monitor the condition of the patient and
control platelet count and clotting time.

Surgery

After reaching a stable state, recovery
normal heart rhythm, and other vital signs
indications are performed surgical treatment to restore
patency of the coronary vessels. To date, spend such
interventions:

  • Stenting – introduction to the constricted coronary vessel
    metal frame (wall). With this operation, the chest does not
    open, the walls are injected with a special probe to the required place through
    femoral artery under x-ray control.
  • AKSH – coronary artery bypass surgery. The operation is performed on
    open heart, its essence is that they create an additional
    possibility of blood supply to the affected lesion by transplant
    patient’s own veins, creating additional paths to the current
    blood.

Indications for surgical treatment and the choice of the type of intervention
depends on the results of coronary angiography:

  • the defeat of two arteries of their three, or the degree of narrowing more
    50%
  • presence of post-infarction aneurysm

Of great importance in the treatment of myocardial infarction is
двигательный режим пациентаAT первом периоде от 1 до 7 дня,
recommended strict bed rest, in which from
achieve a stable state is recommended to perform passive
lying motion in bed and breathing exercises under observation
medical staff. Further, as the motor condition improves
activity is recommended to constantly expand daily adding
active movements (turns, sitting in bed,
self-catering, washing, etc.).

ATо втором периоде при переводе на палатный режим, пациенту
allowed to get up, walk first near the bed, then along the corridor
gradually increasing the load. AT коридорах кардиологических
departments there is a special marking for therapeutic walking, on
which indicate the day of the illness, the patient must undergo daily
this distance. The patient goes to full self-care.

AT третьем периоде, больному предоставляют свободный режим,
gradually switching to a rehabilitation and training regime in
conditions of the sanatorium.

Diet

The patient’s nutritional guidelines are individually tailored;
depending on the patient’s condition, laboratory parameters
(cholesterol level), its body weight. Patients are recommended 4-5
single meals. If the cholesterol level exceeds the norm, enter
restrictions on the use of egg yolk, brain, liver,
caviar

One third of the fats consumed should be vegetable fats.
Cholesterol is reduced if the menu includes foods rich
pectin (apples, bananas), the content is of great importance
a large number of dietary fibers that inhibit absorption in
intestinal cholesterol, maintain a stable level of it in
bile. Criteria for discharge of a patient with myocardial infarction from
Hospital:

  • relief of the main symptoms of the disease
  • possibility of self-service
  • sufficient resistance to physical exertion (patient without
    deterioration can be overcome by one flight of stairs and
    take walks from 0.5 to 3 km in a few steps over
    days)

Psychological rehabilitation

In patients after myocardial infarction up to 4 months
persist personal response to the disease,
concerns about the outcome of the disease, the future prospects of personal and
social life. If the patient does not render timely
psychological help may occur:

  • Neurosis, which are characterized by increased irritability,
    mood swings, sleep disorders, obsessive
    fears.
  • Either the hypochondriacal development of the personality – “going into a disease”,
    the patient requires special attention because he considers himself to be
    verge of death, while objectively his condition
    satisfactory.

Psychological rehabilitation направлена на возвращение пациента
to work and the restoration of his status in the family.

Nontraditional therapy method

For the treatment and prevention of coronary heart disease and heart attack
myocardium, with great success apply hirudotherapy – treatment
leeches. Assign from 4 to 8 pieces of leeches in the heart area from 2 to
4 times with an interval of 2-3 days.

Leech saliva contains a special enzyme that inhibits clotting.
blood and preventing the formation of blood clots. Infection and
suppuration of bite sites is not observed, since hirudia have
bactericidal properties. Hirudotherapy is contraindicated in
болезнях,  сопровождающихся повышенной кровоточивостью.

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