Atypical variants of myocardial infarction
Myocardial infarction - necrosis of a larger or smaller area of the heart muscle.Because of this, the heart can not cope fully with the responsibilities for pumping blood throughout the body.
With myocardial infarction, our natural blood pump signals with all its might for a breakdown.After all, if he can not provide normal blood circulation - the tissues will not get proper nutrition, a person will die. It is no coincidence that the most indicative symptom of myocardial infarction is a very sharp, sometimes unbearable pain in the chest of the ( the patient says that it was as if struck with a swing in the chest - namely into the heart area).With this symptom, the diagnosis of MI is unmistakable.
But the human body is not created by nature for a copy of .In a number of cases, because of the anatomical and physiological characteristics of the body, myocardial infarction manifests itself completely atypically - sometimes even strange, to an unsophisticated view, with symptoms. Therefore, distinguish atypical variants of this disease.
Causes of atypical forms of myocardial infarction
Atypical forms of myocardial infarction are most often observed by clinicians in elderly people who developed cardiosclerosis( partial replacement of connective muscle tissue) and circulatory failure due to age-related changes andBecause of diseases of the cardiovascular system.
With such forms, only the onset of myocardial infarction will be atypical.Further, the clinical picture develops in a classical manner.
Classification of atypical forms of myocardial infarction
Atypical variants of myocardial infarction are:
- abdominal( with abdominal pain, vomiting, diarrhea);
- is asthmatic( with manifestations according to the type of bronchial asthma);
- edematous( with occurrence of edemas);
- arrhythmic( with one or another disturbance of the heart rhythm);
- is collapsoid( with a disturbance of consciousness, this form is also called painless ischemia);
- cerebral( with cerebral manifestations);
- peripheral( with it pain can manifest anywhere, only not in the projection of the heart);
- is a low-symptom( or erased), up to barely distinguishable features;
Abdominal form of myocardial infarction
This variant of myocardial infarction develops in the event that necrosis occurs in the posterior part of the heart adjacent to the diaphragm.Symptoms are similar to the clinic of diseases of the abdominal cavity. There are sharp pains in the abdomen( mostly in its upper floors or under the right costal arch), marked nausea, repeated vomiting, which is very tiring to the patient, because it occurs even with an empty stomach.The abdomen is swollen, the gases do not depart, as in the case of paresis of the intestine, or they leave hardly.In other cases, to the contrary, there may be hyperactivity of the intestine with abundant gas escape and diarrhea.
Asthmatic form of myocardial infarction
This form of myocardial infarction resembles an attack of bronchial asthma.The patient begins to choke, develops a pronounced cough with sputum discharge. There is even a sense of fear of death due to the inability to breathe normally. Correct diagnosis is problematic if the difficulty of breathing is more observed on exhalation - in fact such a symptom is very typical for true bronchial asthma.
In this case, the patient suddenly develops and swells - first local, then extensive, may even appear water in the abdominal cavity( ascites).Edema is accompanied by an increase in the liver, shortness of breath, in a number of cases - a feeling of suffocation.
Pain manifestations with this form of myocardial infarction are minimal or completely absent.A variety of forms of arrhythmias are observed( from the rapidity of the rhythm to the chaotic contraction of the heart muscle) - up to the development of so-called atrio-ventricular blockades( when electrical impulses are blocked in the cells of the heart muscle).
In most cases, develops without pain, even minimal.Instead, the patient has signs of cerebral circulatory insufficiency - dizziness, "flies" and darkening in the eyes, a premorioral condition.
Appears in the form of cerebral circulatory insufficiency - but, in contrast to the collaptoid form, it is characterized by more pronounced dizziness( up to the confusion of consciousness), nausea and vomiting, a sharp weakness in the upper and lower extremities.As a variety, an insult form may develop with speech and motor impairment.
In this variant of myocardial infarction, the patient indicates a completely atypical pain for the heart disease:
- , when left hand is in the patient, painfully pulls the left arm( in the clinic, funny cases were recordedThe little finger of the left arm was hurting, there were no other signals of IM at all);
- with levolopatochnoy form is disturbed by sharp, sometimes unbearable painful lumbago in the left scapula;
- , the throat-pharyngeal form is characterized by pain in the throat - practical doctors report cases where patients suspected angina and consulted with otolaryngologists;
- with an invertebral form of pain very much resemble pain syndrome, as in osteochondrosis;
- the mandibular form is characterized by pains in the entire lower jaw or in its left half, which confuses and leads the person to the dentist.
The name speaks for itself: Myocardial infarction is manifested by a minimum of common signs that are often not given any importance.There is weakness, a general bad state, a decline in strength - their patients can write off for fatigue, excessive work load, long stay without leave, even laziness. This is one of the most insidious forms of myocardial infarction, because it is often diagnosed with a delay.Because of this, time is wasted, and therapeutic measures begin too late.
It is shown by a combination of different atypical forms.Thus, the patient can simultaneously experience abdominal pain, as in the abdominal form, accompanied by dizziness and twilight consciousness, as in the cerebral variant.
Diagnosis of atypical forms of myocardial infarction
To be sure of the diagnosis, an ECG should be done, which will confirm the necrosis of the site of the heart muscle. Difficult diagnostics with electrocardiography is observed in arrhythmic form - arrhythmia can mask ECG signs of myocardial infarction to varying degrees. A doctor should not take off the attack of an arrhythmia and do an electrocardiogram again.
Since atypical forms of myocardial infarction simulate diseases of other organs and systems, it is necessary to perform examinations, excluding these diseases:
- CT( computed tomography);
- EEG( electroencephalography)
- and others.
For example, with pain in the right hypochondrium, simulating manifestations of cholelithiasis, ultrasound should be done.But remember that additional methods of research should be done very quickly, so that treatment of myocardial infarction can begin immediately.
Actions for the appearance of the described symptoms
Do not attempt to diagnose yourself for yourself and differential diagnosis with the symptoms described.Due to the "insidiousness" of atypical forms of myocardial infarction, even experienced doctors sometimes have difficulty in recognizing them. In case of any of the above signs( even in the slightest manifestation), immediately call an ambulance team that will be able to confirm the diagnosis of myocardial infarction with the help of an ECG and take emergency measures, up to the hospitalization of the patient to the clinic.
Kovtonyuk Oksana Vladimirovna, medical reviewer, surgeon, consultant doctor