Myocardial infarction

Myocardial infarction is one of the clinical forms of IHD, which is accompanied by the development of myocardial ischemic necrosis due to circulatory disturbance of this site. According to statistics, this disease most often develops in males( women are twice as rare) in the age range from forty to sixty years. The risk of death with myocardial infarction is especially high during the first two hours of its onset.

Myocardial infarction - causes of

In most cases, myocardial infarction is affected by people who are not active enough against the background of psychoemotional overloads. However, a sedentary lifestyle is not a determining factor in the development of this disease and a heart attack can suddenly strike even young people with good physical fitness. The main reasons that contribute to the development of myocardial infarction include: bad habits( smoking, drinking alcohol), hypertension, inadequate motor activity, an overabundance of animal fat intake, malnutrition, overeating, obesity. In physically active people, the likelihood of developing a heart attack is several times less than that of the leading ones due to certain reasons, a sedentary lifestyle.

The heart is a muscular bag that works like a pump and pumps blood through itself. The supply of the heart muscle itself with oxygen takes place through the blood vessels that are suitable to it from the outside. For some reason, some of these vessels are clogged by atherosclerotic plaques, and therefore can not pass the necessary amounts of blood. Ischemic heart disease( ischemic heart disease) is developing. Myocardial infarction develops as a result of a sudden complete stop of the blood supply of a part of the heart muscle due to occlusion of the coronary artery. Most often this leads to a developed thrombus on an atherosclerotic plaque, much less often - a spasm of the coronary artery. A deprived portion of the heart muscle dies. Infarct - dead tissue( lat.)

Myocardial infarction - symptoms of

The main typical symptom of this disease is intense pain in the heart and behind the breastbone. The pain arises unexpectedly, in the shortest possible time, reaching a high degree of severity and "giving" to the interscapular space, the left scapula, the lower jaw and the left arm. Unlike the pain observed with angina pectoris, pain in myocardial infarction is much more intense and does not go away after taking nitroglycerin( sometimes not eliminated even by injections of morphine).In such patients it is necessary to take into account the presence of IHD in the course of the disease, as well as the displacement of pain in the left arm, lower jaw and neck. In addition, in elderly people this disease can manifest itself in the form of dyspnea and loss of consciousness.

50% of patients with harbingers of infarction are changes in intensity and frequency of angina attacks. They become more stubborn, occur much more often already with little physical exertion( sometimes they can arise even in a state of rest), last longer, and in their intervals in the heart area there is a feeling of pressure or dull pain. Sometimes a heart attack can be preceded not by pain, but by dizziness and a manifestation of general weakness.

In 15% of patients, the attack of pain lasts not more than one hour, in 40% of patients from two to twelve hours, in 45% of patients - on the order of one day.

In some patients, myocardial infarction is accompanied by suddenly developing shock and collapse. The patient turns pale, feels dizzy and sharp weakness, covered with sweat, there may come a short-term loss of consciousness, nausea, vomiting, diarrhea( rarely).The patient is haunted by a feeling of intense thirst. The skin becomes wet, gradually taking an ash-gray hue, and the tip of the nose and limbs are cold, the blood pressure drops sharply( sometimes it can not be determined at all).The pulse on the radial artery is not probed at all or very weak tension. During the collapse, the number of heartbeats may be slightly reduced, slightly enlarged or normal( tachycardia is more common), the body temperature is slightly increased. If the collapse and shock state continue for many hours and even a day, the prognosis of a normal outcome is significantly worsened. With myocardial infarction, serious abnormalities from the digestive tract can be observed-intestinal paresis, pain in the epigastric region, nausea and vomiting. No less serious violations can be observed from the side of the central nervous system - a fainting condition, a brief loss of consciousness, a general weakness, difficultly removable stubborn hiccups. With myocardial infarction, serious violations of cerebral circulation can occur, manifested by paresis, convulsions, coma, speech disturbance.

In 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, the body temperature does not exceed the threshold of 38 * C

clinical forms of myocardial infarction :

- Asthmatic form( disease begins attackcardiac asthma)

- Anginal form( heart attack begins with pain attacks in the heart and the sternum)

- Abdominal( starts with dyspepsiaAnd pain in the upper abdomen)

- Collapsoid form( illnesses preceded by collapse)

- Cerebral form( the disease begins with focal neurological symptoms)

- Mixed form

- Painless form( beginning of myocardial infarction latent)

Atypical forms of myocardial infarction

In addition to the characteristicFor a heart attack tearing the sharp pain behind the sternum, distinguish several forms of infarction that does not manifest themselves, or masquerading as other various diseases of internal organs.

Pain-free infarction form .This form is manifested by a feeling of discomfort in the chest, a marked sweating, a deterioration in mood and sleep. This form of heart attack is most common in senile and old age, especially with concomitant diabetes.

Asthmatic form of myocardial infarction .This type of heart attack its manifestations very similar to the attack of asthma and manifests a sense of fullness in the chest and a dry cough, hoarse.

Gastritic form of myocardial infarction .On the symptomatology very much reminds an exacerbation of a gastritis and is characterized by the expressed pain in an epigastric area. With palpation, the intensity and soreness of the muscles of the anterior abdominal wall is noted. In the gastritic variant, the lower parts of the myocardium of the left ventricle

are most often affected. Diagnosis of myocardial infarction

The diagnosis is based on a clinical assessment of the general condition of the patient and after differential diagnosis with such diseases as acute pericarditis, exfoliating aortic aneurysm, pulmonary embolism and spontaneous pneumothorax. One of the leading diagnostic methods is electrocardiography( ECG), on the basis of which it is possible to judge the localization and extent of myocardial damage and the prescription of the developed 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 the 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. For this purpose, the following drugs are used:

- Acetylsalicylic acid( aspirin) - due to inhibition of platelet thrombus formation is prevented

- Prasugrel, Ticlopidine, Clopidogrel( Plavix) - also prevent the formation of a thrombus, but they are much more powerful than aspirin

- Bivalirudin, Fraxsiparin, Lovenox, Heparin - anticoagulants, preventing the formation and spread of blood clots and acting on blood clotting

- Reteplase, Alteplase, Streptokinase- powerful thrombolytics that can dissolve the already formed thrombus

All of the above drugs are combined and vital for successful treatment of infarshe infarction.

The best modern method of restoring blood flow in the coronary artery is immediate angioplasty of the coronary artery with the subsequent installation of a coronary stent. If, for any reason, angioplasty can not be performed during the first hour of the infarct, thrombolytic agents are preferred.

In the event that all the above measures are impossible or do not help, the only means for restoring blood circulation( salvage of the myocardium) is an urgent aortic-coronary shunting.

The most critical are the first day of the disease. Further prognosis directly depends on the degree of damage to the heart muscle, the timeliness of the measures taken and the presence of concomitant cardiovascular diseases.