What is a sharp heart rate heart. Causes and mechanisms of vascular insolvency of the heart

- The focus of the ischemic necrosis of the heart muscle, developing as a result of an acute disruption of coronary blood circulation. Clinically manifests itself with burning, godes or compressive pains behind the sternum, giving into the left hand, a clavicle, a shovel, jaw, shortness of breath, a feeling of fear, cold. The developed myocardial infarction serves as an indication of emergency hospitalization in cardiological resuscitation. With non-evasion timely help Fully outcome is possible.

During this period, an acute left left ventilation deficiency (cardiac asthma, pulmonary edema).

Acute period

In the acute period of myocardial infarction, painful syndrome, as a rule, disappears. The preservation of pain is caused by a pronounced degree of ischemia of a nearinfarquet zone or the addition of pericarditis.

As a result of the processes of necrosis, myomalysis and perifocal inflammation, fever develops (from 3-5 to 10 or more days). The duration and height of the temperature lift during fever depend on the area of \u200b\u200bnecrosis. Arterial hypotension and signs of heart failure are preserved and growing.

Subighteous period

Paints are missing, the patient's condition is improved, the body temperature is normalized. Symptoms of acute heart failure become less pronounced. Tachycardia disappears, systolic noise.

Postinfarction period

In the post-infarction period, clinical manifestations are missing, laboratory and physical data practically without deviations.

Atypical Miocardial Infarction Forms

Sometimes there is an atypical course of myocardial infarction with localization of pain in atypical places (in the throat area, left hand, in the zone of the left blade or the cervical spine, in the epigastrium, in the lower jaw) or nonsense, leading symptoms of which may be cough and Heavy suffocation, collapse, swelling, arrhythmia, dizziness and perishes of consciousness.

The atypical forms of myocardial infarction are more common in older patients with severe signs of cardiosclerosis, insufficiency of blood circulation, against the background of the re-infarction of myocardium.

However, atypically proceeds only the longer period, the further development of myocardial infarction becomes typical.

The erased course of myocardial infarction is nonsense and accidentally discovered on the ECG.

Complications of myocardial infarction

Often complications arise already in the first hours and days of myocardial infarction, weighting its current. In most patients, in the first three days, various types of arrhythmias are observed: extrasystolia, sinus or paroxysmal tachycardia, flickering arrhythmia, complete intraventricular blockade. The most dangerous flickering of ventricles, which can go to fibrillation and lead to patient death.

Left-deceiving heart failure is characterized by stagnant, phenomena of cardiac asthma, pulmonary edema and is often developing in the acute period of myocardial infarction. The extremely severe degree of left ventricular failure is a cardiogenic shock, developing with an extensive infarction and usually leading to death. Signs of cardiogenic shock is a drop in systolic blood pressure below 80 mm Hg. Art., Violation of consciousness, tachycardia, cyanosis, reduction of diuresis.

The muscle fiber gap in the necrosis area can cause a tamponade of the heart - hemorrhage into the pericardia cavity. In 2-3% of patients, myocardial infarction is complicated by thromboembolism of the pulmonary artery system (may cause a lung infarction or sudden death) or a large circle of blood circulation.

Patients with an extensive transmural myocardial infarction in the first 10 days can die from gastroincing discontinuity due to acute cessation of blood circulation. With an extensive myocardial infarction, the inconsistency of scar tissue may occur, its esteem with the development of acute head aneurysm. Acute aneurysm can be transformed into chronic, leading to heart failure.

The fibrin deposition on the walls of the endocardium leads to the development of the closed thromboendocarditis, the dangerous possibility of embolism of the vessels of the lungs, the brain, the kidneys with the thrombotic masses. In a later period, post-infarction syndrome, manifested by Pericarditis, pleuritis, arthralgia, eosinophilia, can develop.

Diagnosis of myocardial infarction

Among the diagnostic criteria of myocardial infarction are essential of the disease, characteristic changes on the ECG, indicators of the activity of serum enzymes. Complaints of the patient with myocardial infarction depend on the form (typical or atypical) disease and the extensity of the defeat of the heart muscle. Myocardial infarction should be suspected with severe and long-lasting (longer than 30-60 minutes) the attack of the prudged pain, the conduction impairment and the rhythm of the heart, acute heart failure.

The characteristic changes in the ECG include the formation of a negative teeth of T (with a small-scale subendocardial or intramoral myocardial infarction), the Pathological complex QRS or Q (with a large-scale transmural myocardial infarction). At echoca, a violation of the locally reduced ventricle, thinning its wall is detected.

In the first 4-6 hours after a pain attack in the blood, an increase in myoglobin is determined - a protein that cars into the oxygen inside the cells. Extension of creatine phosphocinate (KFK) activity in the blood than 50% is observed after 8-10 hours from the development of myocardial infarction and decreases to normal in two days. Determining the level of KFK is carried out every 6-8 hours. Myocardial infarction is excluded for three negative results.

To diagnose myocardial infarction at a later date, resort to the definition of lactate dehydrogenase enzyme (LDH), the activity of which increases later KFK - after 1-2 days after the formation of necrosis and comes to normal values \u200b\u200bafter 7-14 days. Highly specialized myocardial infarction is to increase the mocardial contractile protein of troponin - troponin-t and troponin-1, which also increasing unstable angina. In the blood, the increase in ESP, leukocytes, aspartaminotransferase activity (ASAT) and Alaninotransferase (ASAT) is determined.

Coronary angiography (coronary art) allows you to establish a thrombotic occlusion of the coronary artery and a decrease in the ventricular contractility, as well as assess the possibilities of carrying out an aortocortonary shunting or angioplasty - operations that contribute to the restoration of blood flow in the heart.

Treatment of myocardial infarction

With myocardial infarction, emergency hospitalization in cardiological resuscitation is shown. In the acute period, the patient is prescribed to bed and mental peace, fractional, limited in volume and calorie content. In the subacute period, the patient is translated from resuscitation to the cardiology department, where the treatment of myocardial infarction continues and a gradual expansion of the regime is carried out.

The relief of pain syndrome is carried out by a combination of narcotic analgesics (fentanyl) with neuroleptics (droperidol), intravenous administration of nitroglycerin.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, cardiogenic shock. Antiarrhythmic agents (lidocaine), ß-adrenoblays (atenolol), thrombolytics (heparin, acetylsalicyl k-ta), CA anthongists (verapamil), magnesia, nitrates, spasmolytics, etc.

In the first 24 hours after the development of myocardial infarction, it is possible to restore perfusion by thrombolysis or emergency balloon coronary angioplasty.

Forecast with myocardial infarction

Myocardial infarction is heavy, conjugated with dangerous complications of the disease. Most of the deaths are developing in the first day after myocardial infarction. The pump ability of the heart is associated with the localization and volume of the infarct zone. If more than 50% of myocardial is damaged, as a rule, the heart cannot function, which causes a cardiogenic shock and the death of the patient. Even with less extensive damage, the heart does not always cope with loads, resulting in heart failure.

After an acute period, the forecast for recovery is good. Adverse perspectives in patients with complicated myocardial infarction.

Prevention of myocardial infarction

Related conditions for the prevention of myocardial infarction are healthy and active image life, refusal of alcohol and smoking, balanced nutrition, elimination of physical and nervous overvoltage, control of blood pressure and blood cholesterol.

Myocardial infarction is acute ischemic necrosis of the heart muscle due to the inconsistency of the coronary blood circulation by the needs of myocardium with a long-lasting spa of coronary arteries or their blockage (thrombosis).

There are large-scale, transmural (with Q, Q-Myocardial Infarction tooth) and finelyocopy (without q, non-q-myocardial infarction), myocardial infarction.

The localization of myocardial infarction: front, side, rear wall of the left ventricle, the interventricular partition and relatively rarely rarely right ventricles.

Classification of clinical types of myocardial infarction (Tetelbaum, 1960):

1. Zaga-pain (classic Status Anginosus) type; fifty%

2. Peripheral type; 25%

3. Abdominal type; five%

4. cerebral type; 10%

5. Brave type; 10%

6. Arrhythmic type.

7. Asthmatic type.

8. Combined type

Forms of peripheral type of pain localization: levolochny, left-hand, topless, mandibular, gentle-sizzic.

Abdominal type on clinical signs Looks like: On the sharp abdominal catastrophe in the type of body ulcers, gastric bleeding, intestinal obstruction; to the picture of the inflammatory process in the abdominal cavity (cholecystitis, pancreatitis, appendicitis); Food disease.

Cerebral type - the beginning of myocardial infarction in the form of fainting, hypertensive crisis, hemiplegia (stroke), toxicoinfection.

Brave type - the beginning of myocardial infarction total heart failure, collapse.

Arrhythmic type - in the absence of pain syndrome, transient arrhythmias appear.

Asthmatic type - the beginning of myocardial infarction with acute left left vehicles (lung swells).

Myocardial infarction flow periods:

1) pre-infarction (from several days to 1-3 weeks),

2) the most acute

3) sharp

4) subacute.

1. The pre-infarction period is characterized by a clinic of progressive, unstable angina. Intensity is growing, duration, frequency of attacks, they arise with less physical activity, are slower under the influence of peace or nitroglycerin. In the intervals between the attacks of the angina, there remains a stupid pain or a sense of constraint in the chest (pressure). The appearance of the stenocardia of rest in a patient with a stress angina.

The negative dynamics of the ECG is noted: ischemic change in the ST segment and the T - the "sharp coronary" T is a pointed, symmetrical). There are no changes from the general and biochemical blood tests.

2. The acute period of myocardial infarction - time from the appearance of the first clinical electrocardiographic signs acute ischemia Myocardial before the formation of the focus of necrosis (about 2-3 hours). It is characterized by an extremely intense, acute, "darge" pain, irradiating to the left blade, in the left hand. The pain is wearing a wave-like character, it can continue for several hours and even the day, it is not borne by taking nitroglycerin, accompanied by a feeling of fear, excitement.

In case of inspection, the pallor of the skin and mucous membranes, acricyanosis is detected.

The palpation of the heart area reveals the displacement of the stroller of the dust and down, it becomes low, non-resident and spilled. Small voltage and filling pulses, frequent, can be arrhythmical. The blood pressure during the painful attack may increase, then decreases.

Percussion reveals the displacement of the left border of relative dullness of the dust, the expansion of the head of the heart. With auscultation, weakening the first tone, the deaf of the tones, the rhythm of the gallop, systolic noise at the top of the heart and aorta, various types of rhythm disorders (extrasystolia, paroxysmal tachycardia, flickering arrhythmia).

During the survey of the respiratory organs, Tahipne is revealed. With the development of acute left-scale deficiency over the light - dull tympanitis in the revenue departments, there is also a weakening of vesicular respiration and consistently - attitudes, finely, medium and large-tape wet wets that extend to the upper departments. With the development of pulmonary edema - bubbling breathing with the release of pinkish color of foamy sputum.

3. The acute period of myocardial infarction is characterized by the disappearance of pain, lasts 7-10 days. Previously arising symptoms of acute heart failure and arterial hypotension can be maintained and even increasing. These objective research remains the same.

In the acute period of myocardial infarction, signs of resorption of necrotic masses and aseptic inflammation in tissues adjacent to the necrosis zone are detected - fever occurs.

4. Subacle period of myocardial infarction - the formation of a connective tissue scar on the site of necrosis, remodeling of the left ventricle. The duration of the subacute period is 4 - 6 weeks.

Features of the manifestation of different forms of myocardial infarction.

Clear division of the flow of myocardial infarction and clinical signs are characteristic of myocardial infarction with Culza Q (transmural).

Basic clinical manifestation myocardial infarction without teeth Q (Non-Prommural) - painful syndrome in the form of a delayed attacks of the stenocardium of rest (duration of more than 20-30 minutes), poorly bubble nitroglycerin. The pain intensity is less than with myocardial infarction with q (transmural). The progressary pain may be accompanied by common symptoms: increasing weakness, sweating, shortness of breath, transit of rhythm and conduction disorders, decrease in blood pressure.

Myocardial infarction without teeth Q can manifest non-intensive but frequent attacks Stenicard stress.

An objective study does not give specific features confirming the diagnosis. With auscultation, weakening should appear, additional tones (III or IV). Possible transient violations of the heart rate and changes in blood pressure.

Confirm or refute the presence of myocardial infarction without teeth q can only targeted laboratory and instrumental research.

The forecast of the course of the disease and the likelihood of mortality in acute myocardial infarction is determined by the main clinical signs (the degree of heart failure, arrhythmia), localization infarction (worse in front of the forefront).

Clinical calipo myocardial infarction classification (Killip) is based on the assessment of the severity of heart failure, is prognostic:

Class I- without signs of insufficiency of blood circulation; mortality up to 5%.

Class II - signs of blood circulation deficiency are expressed moderately, there are signs of destroying failure (listened to the rhythm of gallop, in the lower parts of the lungs - wet whears, signs of venous stagnation - hepatomegaly, swelling); mortality 10-20%.

Class III-acute left ventricular failure (pulmonary edema); Mortality 30-40%.

Class IV-cardiogenic shock (blood pressure less than 90mm Hg., Constriction of peripheral vessels, sweating, violation of consciousness, oliguria); Mortality of more than 50%.

Laboratory and instrumental diagnostics.

General blood test: In the first days, neutrophilic leukocytosis appears (up to 10-12 10 9 / l), which is normalized to the tenth day. The Eight-tenth day increases the ESP and can be maintained for several weeks.

Biochemical blood test: improving the activity of the MB-fraction of creatinophosphokinease, the first fraction of lactate dehydrogenase, asate and amalate, an increase in myoglobin, troponin. Non-specific changes: increased urea, CRH, fibrinogen, serumcoid, silic acids, glucose.

Coagulogram: an increase in the AFTV, the prothrombin index.

ECG: Changes depend on the stage of myocardial infarction (ischemic, damage, acute, subacted, scar).

The focus of myocardial lesions with a heart attack consists of a necrosis zone adjacent to it zone of damage, which goes into the zone of ischemia.

The ischemic stage continues only 15-30 minutes, is characterized by the formation of the "coronary" teeth of T. This stage can not always register.

The stage of damage continues from several hours to several days, it is characterized by an arcuate lift or depression of the ST segment, which goes into the "coronary" teeth and merges with it. The R teeth R reduced or appeared a pathological tooth Q: QR or QR ventricular complex with Non-Prommural infarction and QS with a transmural infarction.

The acute stage lasts up to 2-3 weeks, is characterized by an increase in the depth of the tooth Q. The ST segment approaches the insulation, a negative, symmetrical "coronary" teeth of T.

The staging stage is characterized by the absence of the damage zone (the ST segment is returned to the insulation, the "coronary" T - negative, symmetrical persistent, or even increases, is preserved "pathological" q (more than 1/4 of the prong value R). The end of the subacute stage is the lack of a teeth. T.

The scar stage is characterized by the resistant preservation of the "pathological" teeth Q. ST on the insulatory segment, the prog is positive, smoothed or negative, there are no dynamics of its changes.

Topic diagnosis of myocardial infarction:

For infarction of the front wall and the tops are characterized by changes in ECG in leads I, II, AVL and V 1-4,

For the front-wind wall - in leads I, II, AVL, V 5-6,

For the front part of the interventricular partition in leads V3,

For posterprafragmal wall III, II, AVF,

For posterior -III, II, AVF, V 5-6,

For the rear wall (common) - III, II, AVF, V 5-7.

Complications of myocardial infarction:

Rhythm disorders (extrasystole, paraxismal tachycardia, cleaning arrhythmiablockades); acute blood circulation deficiency (fainting, collapse, cardiogenic shock, pulmonary edema, cardiac asthma); pericarditis; thromboendocarditis; Heart aneurysta; thromboembolism; Heart Tamponade; post-infarction syndrome Dressler (pneumonite, pleurisy, pericarditis); acute erosive-ulcerative lesions of the gastrointestinal tract; gastric bleeding; paralytic intestinal obstruction; bladder paresis; Chronic blood circulation failure.

Treatmentuncomplicated myocardial infarction.

Myocardial infarction is delivered on a stretcher or rent In the resuscitation cardiology department.

Therapeutic program includes: relief boring attack, restoration of the main coronary blood flow and preventing further thrombosis, limiting the size of the myocardial infarction, warning development of arrhythmias.

The pain syndrome is born with narcotic analgesics (morphine), neuroleptangesis.

For recovery of coronary blood flow, thrombolytic, antithrombotic drugs are used (streptokinas once, anticoagulants 3-5 days after 24 hours after the introduction of streptinase, acetylsalicylic acid).

In order to limit the sizes of myocardial infarction, nitrates are used intravenously with the transition to prolonged nitrates, ß-adrenoblays.

According to the testimony: inhibitors of angiotensin surgery enzyme, calcium antagonists.

The physical rehabilitation of patients is carried out under the control of the doctor, taking into account the class of clinical severity of myocardial infarction.

Surgical I. interventional treatment HebS.Optimal treatment of stenosing atherosclerosis is the restoration of adequate blood supply in the zone of ischemia. Currently, aorticoronary artery shunting and various interventional methods (percutaneous transversum angioplasty, stenting, atherectomy, laser angioplasty) are used. The choice of the method of surgical treatment is determined by the data of the clinic and coronary angiography.

Aorticoronary artery shunting using vascular grafts allows you to get a long effect of liquidation of the zone of ischemia. However, the method is traumatic (thoracotomy) requires expensive special equipment (extracorporeal blood circulation).

Interventional methods of intravascular interventions allow us to obtain long-term preservation of the result, to repeatedly make endovascular procedures with low risk of complications.

When stenting the coronary arteries in areas of a significant narrowing of their lumen, an implantation in the coronary artery of a metal stent, a drug-coating stent (drugs violating cell division), conductor with a radioactivity source (antiproliferative influence of ionizing radiation), laser conductor is used. Stenting is combined with pre-pativity (expansion of cylinder) stenosis. Stenting is carried out, among other things, in case of acute myocardial infarction.

Atherectomy - removal of endothelium hyperplasia or atherosclerotic plaques, forming stenosis, with blades, drills.

The disadvantage of all endovascular methods, including percutaneous transluminal angioplasty (to a greater extent) and stenting, atherectomy and laser angioplasty, is the process of reserving.

Acute myocardial infarction - the death of a portion of the heart muscle caused by circulatory disorder. The heart attack is one of the main causes of disability and mortality among the adult population.

Causes and mechanisms of vascular insolvency of the heart

Features of the heart of the heart - permanent reductions in myocardium - determine a very high level of metabolic processes in its cells, a lot of oxygen consumption and nutrients. Such a mode of activity requires an uninterrupted inflow of highlyoxygenic (rich oxygen) blood, which is provided by an extensive network of cardiac vessels beginning with the aorta in the form of coronary (corneous) arteries.

The opposite side of the effectiveness of the heart muscle is its high sensitivity to oxygen starvation. With violation of nutrition in myocardium, pathological phenomena develop, very quickly taking irreversible character.

If the lack of blood flow is not critical, reversible ischemia arises (anemia) of the portion of the heart muscle, which is manifested by angina patient pains for the sternum. With the complete termination of blood flow to a particular area, the cascade of pathological processes is developing - the accumulation of toxic exchange products is accumulated, which are not derived, the transition to anaerobic (oxygen-free) mode of operation using the internal energy reserves of cells.

Own energy reserves (glucose and ATP) are very quickly (about 20 minutes) are depleted, and the bloodstanding of the heart muscle dies. This is a myocardial infarction - necrosis, the dimensions of which depend on the level of overlapping of the vessel (large or fine branches), the rates of initiation of ischemia (with a gradual cessation of blood supply, partial adaptation is possible), the age of the patient and many other factors. For example, a sharp transmural myocardial infarction (with necrosis, all the thickness of the heart muscle), which has a very difficult course, develops with occlusion (overlapping) of the large branch of the coronary vessel.

Cancer cutout with myocardial infarction

Among the causes of the violation of the blood supply to the myocardium, the block of lumen of the vessel atherosclerotic plaque or thrombus is most often found (these phenomena can be combined). In addition, there is a sharp spasm of coronary arteries under the action of physical (cold) or chemical (poisons, drugs) of factors. Heavy anemia, in which there is a sharp decrease in hemoglobin blood content, and therefore its ability to transport oxygen, can also cause myocardial ischemia. The inconsistency of the blood supply to the increased needs is found with a sharp hypertrophy of the heart muscle - cardiomyopathy.

Predisposing infarction factors

Some diseases and pathological conditions are increased risk factors in terms of the development of acute myocardial ischemia. These include:

• Diabetes.
• Hypertonic disease.
• Ischemic heart disease (IBS), manifested by the attacks of angina (especially its unstable forms).
• Increased cholesterol content and some lipoprotein fractions.
• Excessive body weight.
• Smoking.
• Alcohol abuse.
• Error in the diet (great consumption of salt, animal fats).
• Cardiac arrhythmia.
• Long stressful situations.
• The age of 60 years old (although in recent years has been observed "rejuvenation" of infarction).
• Male floor (after 70 years, the number of men and women suffering from heart attack is aligned).

Classification of ischemic myocardial damage

There are various criteria for the classification of heart attack. Some of them:

• In terms of damage zone - large-scale and small-scale.
• In the depth of damage to the heart muscle - transmural (for the entire head of the heart wall), intramural (necrosis in the thicker of the wall), subendocardial (damage to the inner layer), subepicardial (outer layer).
• According to topography - left-chelochelocked (front wall, rear and side walls, interventricular septum), right-handed.

Pain attack for more than 20 minutes - one of the diagnostic criteria of heart attack

Symptoms of heart attack

In the development of the pathological process, several periods are allocated, each of which has its duration and symptoms.

Pre-infarction period May last from a few minutes to months. It is characterized by the increase in the attacks of angina and the strengthening of their intensity.

Ostive periodin which the development of ischemia and necrosis of the heart muscle takes place, lasts up to several hours. May have a typical and atypical flow option.

Pain, or an angin version, is typical (about 90% of all cases). It is characterized by pain behind the sternum of the high intensity of the burning or grain character, which can irradiate (give) in the left limbs, jaw, neck. There may be fear of death, sweating, pale or redness of the skin of the face, shortness of breath. The severity of pain depends on the magnitude of the lesion zone - the large-scale heart attack causes more severe symptoms than finely food. The pain is not borne by nitroglycerin.

Atypical options may flow over asthmatic type (have symptoms of bronchial asthma attack), abdominal (with symptoms acute belly), arrhythmic (in the form of an attack of cardiac arrhythmia), cerebral (with a violation of consciousness, dizziness, paralysis, vision disorder).

The sharp period lasts about 10 days. The necrosis zone is finally executed and is eliminated, the absorption of decay products and the formation of the scar begins. Pain syndrome disappears or decreases. It is possible to increase the temperature, the phenomena of hypotension and heart failure.

Subighteous period (about two months) - stage of formation and sealing scar. There is no pain syndrome, the condition is gradually improving. The well-being in this period is largely determined by the nature and amount of changes that occurred in the heart muscle.

Postinfarction period, or rehabilitation (up to six months), is characterized by the lack of clinical and laboratory signs of a heart attack (changes on the ECG - they will remain life), but in this phase it is possible to develop heart failure, angina stress and repeated heart attack.

Complications of myocardial infarction

Acute myocardial ischemia, in itself, being a difficult state, can even more accomplish the addition of complications.

Most frequent complications:

• Heart rhythm (paroxysmal tachycardia, extrasystolia, flickering arrhythmia). This situation as the appearance of ventricts with the transition to their fibrillation may cause the patient's death.
• Heart failure is associated with violation of the left ventricle to pump blood by vessels. It can lead to a pulmonary edema, and a deadly outcome against the background of a sharp drop in pressure and cessation of renal filtering.
• Thromboembolia pulmonary artery Capably lead to pneumonia, light and death infarction.
• The Heart Tamponade can occur when the heart muscle break in the infarct zone and the breakthrough of blood to the pericardia cavity. The condition is life-threatening in which urgent help is required.
• Acute - empty of the scar tissue area with extensive lesions of myocardium. In the future, it may be the cause of heart failure.
• Thrombendocarditis - the deposition of fibrin on the inner surface of the heart. His separation is able to cause a stroke, mesenteric thrombosis (closure of the branch of the vessel, the supply intestine), followed by a sample of the intestine, damage to the kidneys.
• Post-infarction syndrome - general name remote complications (Pericarditis, pleurrites, arthralgia).

Some ECG signs of acute myocardial infarction

Diagnosis of heart attack

In the diagnosis of infarction, the history of the history (the circumstances of the course of the disease and the preceding life, found out in the survey of the patient and its relatives), laboratory and instrumental research methods.

Anamnesis

It turns out that the bouts of pains of different frequencies and intensity, risk factors (smoking, stress, chronic diseases). In case of inspection it is possible to identify overweight, indirect signs increased pressure (Capillary network on the face) and others. Zadrocked pain, lasting for more than 20 minutes, is considered one of the diagnostic criteria of a heart attack.

Laboratory methods

Laboratory research methods with a heart attack detect the following changes:

• Blood clinic. Leukocytosis (increasing the number of leukocytes), an increase in ESP.
• Blood biochemistry. Increase the activity of Alt, AST, LDH, Creatine, Mioglobin, which is an indicator of damage to the heart muscle. It is possible to change the level of electrolytes, iron.

Instrumental research techniques

• ECG - characteristic signs of heart attack (negative Tusk T, pathological complex QRS, etc.). Removing the cardiogram in different leads helps to determine the localization of the necrotic focus (for example, the front or rear wall of the left ventricle, etc.).
• EchoCG - local (limited) violation of the reduction of the affected ventricle.
• Coronary angiography - the narrowing or overlapping of the vessel that feeds myocardium is revealed. It should be noted that when conducting this method Its studies can be used to assist (after filing a contrast substance through the same catheter in the vessel introduced drug Treatment or a stent expander is installed).

Coronary angiography at heart attack

Treatment of myocardial infarction

Emergency care (is carried out directly during a painful attack and further in a specialized clinic):

• Providing a patient of full rest.
• Dacha sublingual (under the tongue) nitroglycerin and Corvalol inside.
• Immediate transportation for further treatment In the department of cardiological resuscitation (preferably on specialized resuscitation).

Surgical treatment - one of the modern methods of help with heart attack

Specialized treatment

• Relieving pain syndrome (apply narcotic analgesics and neuroleptics).
• The dissolution of the thrombus located in the coronary vessel by introducing special thrombolytic agents (streptase, kabicinase). The method is very effective, but has limited time - assistance must be provided for the first hour after the attack, in the future the percentage of the rescued mass of myocardium falls rapidly.
• Antiarrhythmic drugs.
• Improving metabolic processes in the heart muscle.
• Reducing the volume of circulating blood to reduce the load on the heart.
• Surgical treatment methods are balloon angioplasty coronary vessels, the introduction of the stent (tubular strut), an aortocortonary shunting (providing bypass blood flow by imposing a shunt to a damaged vessel).
• Anticoagulants (heparin, aspirin) to reduce blood coagulation and thrombosis prevention.

The forecast for a heart attack is always serious and depends on the volume of affected myocardium, the localization of the necrotic focus (for example, when involving the damage to the conductive heart system, the forecast is deteriorating), the age of the patient concomitant diseases, the timeliness of treatment, the presence of complications, etc. is high percentage of residual phenomena and occurrence disability.

After passing the acute period, patients show rehabilitation with a gradual increase in load levels. In the future, medical observation is needed, the preventive technique of antichangal drugs.

Infarct Prevention serves a refusal to harmful habits, the fight against overweight, rational moiety, labor and recreation, timely treatment with the appearance of angina patient pain.

The heart that has ever suffered from severe ischemia, will never be the same. If at least one coronary attack is present in your history, it is necessary to carefully monitor your condition. Adhering to uncomplicated recommendations, it is possible to significantly reduce the risk of severe complications.

Myocardial infarction: acute period and development of pathological changes

International classification of diseases highlights various forms Ischemia, the names of the disease may differ depending on the severity of the lesion, starting with a stable angina and ending with the attack of the heart muscle necrosis. The definition of pathology on ECG depends on the stage of development of ischemia. The necrotic process of the heart muscle is made much more complicated than the damage to the front wall, as it is not always visualized on the electrocardiogram.

Acute myocardial infarction is manifested by heart activities and other characteristic symptoms, accompanied by numerous complications and represents a threat to life

The following stages of formation of the necrosis of the heart muscle are distinguished:

• Damage to muscle fibers. In connection with the violation of the normal inflow of blood coronary arteries There is a resistant ischemia. The absence of oxygen negatively affects the state of cardiomyocytes, in the affected area they begin to collapse. Still live fibers react to ischemia, pain arise. Stage lasts from several hours to 2-3 days.
• The period of acute manifestation of clinical signs. Depending on the severity of ischemia in various areas, death may form or easy damage fabrics.

Attention! An experienced doctor is able to diagnose characteristic features, such as: burning and grazing pain behind the sternum, fear of death, dizziness.

Within two weeks, the focus of inflammation continues to be formed. Deciphering ECG helps to detect the pathological tooth Q. On the periphery of the necrotized site, the zone of ischemia is formed.

Acute myocardial infarction is an undisputed leader in mortality in the whole world

• Oim in a subacute stage. There is a final stabilization of muscle tissue. The area of \u200b\u200bnecrosis becomes clearer, and the damaged areas are restored. It is difficult to say with accuracy how much this stage lasts. It usually its duration is up to 3 months, in severe cases - up to 1 year.
• Scar Stage. Signs of the most acute period finally disappear, a person practically cease to disturb the graceful pains for sternum, dizziness and weakness. Adaptive mechanisms involve the formation of fibrous tissue on the site of the affected focus. Healthy areas are hypertrophy, trying to compensate for the decrease in the functioning area of \u200b\u200bthe heart.

If a conclusion was granted, in which the attack of ischemia is described, one should be on guard.

Important! Light manifestations of IBS in the absence of appropriate treatment with time can switch to heavier forms.

Dangerous complication is the lack of left ventricle, followed by a cardiogenic shock.

Myocardial infarction: causes and diagnostics

Spontaneous occurrence of a heart attack is a rather frequent phenomenon. A person can engage in the usual activity while burning prudent pain will not caress him by surprise. Doctors refer to this ailment to polyethological diseases and argue that OIM is formed only if there are predisposing factors.

The most common cause of acute myocardial infarction - atherosclerosis

The cause of ischemia is the blockage of coronary vessels:

• blood clots with coronary thrombosis;
• atherosclerotic bluster.

Etiology of IHD may be associated with the following states:

• high blood cholesterol (a connection with atherosclerosis is established);
• endocrine pathologies;
• blood pathologies (hypercoagulation, thrombosis);
• arterial hypertension;
• bad habits;
• elderly age and the presence of concomitant diseases of the circulatory system.

The diagnosis of OIM necessarily includes an electrocardiogram that will help identify pathological deviations. The blood test is done to detect neutrophilic leukocytosis. Additional diagnosis of myocardial infarction, its acute form is made by identifying in the blood of biochemical markers of necrosis (KFK-MB, tropinine, myoglobin).

How does the necrosis of the heart muscle on the ECG

The manifestations of the disease on the electrocardiogram can vary depending on the localization of the lesion, its magnitude and the degree of severity of the necrotic process. In turn, there are general signs for most forms of the disease.

"Q-infarction" - with the formation of pathological teeth Q, sometimes the ventricular QS complex (more often a large-scale transmural myocardial infarction)

ECG with necrotic defeat of the heart has a number of features:

• in the damage stage: the rise of the S-T segment is higher than the insulance, the prong R has a reduced amplitude, the presence of a pathological teeth Q depends on the formation of necrosis, at this stage it may be absent;
• the sharpest stage is characterized by: a slight decrease in the S-T segment, the appearance of the pathological teeth q, the negative Tustern T;
• the third stage of the development of the disease is divided into two parts: first the ECG contains a negative Tusch t with a large amplitude, as it decreases and rises to the insulance;
• in the scarring stage, the normal type of electrocardiogram is restored, the tooth q may disappear, the S-T segment returns to the insulation, the Tusk T becomes positive.

Restoration normal work Hearts after transferred to Oim is individual. In some people, signs of illness disappear very quickly and its presence in history is almost impossible to establish an ECG, in other pathological tooth Q can be maintained for a long time.

What features is not a Q-infarction

The small-scale lesion is transferred easier than the large-scale form of the disease. Clinical signsThe characteristic non-Q-form of the disease is less pronounced. An insignificant stubble pain may be present, which resembles the attack of angina.

"Not Q-infarction" is not accompanied by the appearance of q q, is manifested by negative T-teeth (more often small myocardial infarction)

Important! With this type of disease, an electrocardiogram without a pathological teeth Q is observed.

Some people who survived the small-scale form of myocardial necrosis will learn about the presence of pathological changes only during a planned examination, for example, a medical board. It is necessary to pay attention to the Tusch T, which, with such a form of the disease, it is much changed, it becomes a dugorby or joined.

Acute coronary heart attack

Since the symptoms of ischemia can vary considerably, there are cases when necrosis of the heart muscle was mistaken for angina.

Before proceeding with the treatment of coronary syndrome, it is recommended to make an electrocardiogram that helps to establish a view of the ailment:

• Acute. There is a blocking of a blood vessel by a thrombus or an atherosclerotic blushing, which causes ischemia transmural damage to the heart muscle.
• Oim without lifting segment S-T. ECG of this species is observed at the initial stages of the necrotic process. When fixing small-scale changes, the S-T segment is at the usual level, and the pathological prong of Q is most often no. Difference from angina is the presence of necrosis markers.

Typical cases of myocardial infarction are characterized by extremely intense pain syndrome with localization of pain in the chest and irradiation into the left shoulder, neck, teeth, ear, clavicle, lower jaw

Important! When entering the hospital patient, as a rule, a general diagnosis of "coronary syndrome" is made, which can be with the lifting of the S-T segment or without lifting it on the electrocardiogram.

After inspection by a cardiologist and collecting complaints is held additional examinationpromoting the differentiation of unstable angina and necrosis of the heart muscle.

Myocardial infarction: how to provide emergency care

If you suspect a heart attack, you should call an ambulance. Self-medication can lead to irreversible difficult consequences.

Important! "If you have already arose before sharp pain Behind the sternum, it is fraught with an increase in the focus of necrosis. From how correctly the first help will be rendered, the further success of the treatment of alend depends. "

Until medical workers Go to the patient, the algorithm of action is as follows:

• the patient must fully relax, it is desirable to take a horizontal position, to send close clothes, open the window, create a quiet place in the room;
• you can try to stop the attack, it is able to slightly reduce the spasm of coronary vessels;
• proponal assistance does not imply special preparations (thrombolitics, anticoagulants), their reception should be carried out in the hospital under the control of the doctor, independently give the patient similar medications very risky;

To slow down the further development of atherosclerosis, it is important to prevent the formation of fat plaques in the vessels. For this purpose, drugs are prescribed from the Statin Group

• if you suspect a heart stop, you should immediately start making a patient with an indirect massage, which is represented in the form of 30 clicks on the chest, sometimes it may be necessary for artificial ventilation of the lungs.

The attack of Oim is completely born only by narcotic analgesics. To prevent the recurrences of the disease under the hospital, specific therapy may be assigned, which implies a set of drugs to reduce the load on the heart and protect the muscle tissue from the manifestations of ischemia.

Complications of acute myocardial infarction

Even if no manifestations of necrosis have been preserved on the electrocardiogram, and you feel satisfactory, you should periodically be examined to eliminate dangerous complications.

Oim can cause such serious consequences:

• heart failure;
• the nearest complication is a cardiogenic shock;
• (as a result of heart failure);
• dressler syndrome (autoimmune lesion of the heart muscle);
• change of rhythm and conductivity (arrhythmias, blockades).

Often complications arise already in the first hours and days of myocardial infarction, weighting its flow

Medicine the twenty-first century does not stand still, it carefully studies the problems of each cardiological patient. To eliminate the difficult consequences of the disease, there are a number of drugs that will help reduce the load on the heart, restore the tone of the vessels and protect the fabric from the development of ischemia. The right first aid rendered during the initial period of illness, and careful compliance with the recommendations of doctors will help reduce the risk of complications.

Signs of acute myocardial infarction

People who first suffered from the necrosis of the heart muscle, for a long time remember its manifestations. In some cases, symptoms can be somewhat erased, depending on the presence of related pathologies or in the small-scale form of the disease.

Attention! If you suffer from diabetes mellitus, it is difficult to understand that in reality occurs with the heart. The sensitivity of the tissues decreases, in connection with which some people calmly carry the disease "on the legs".

You really overtake the attack of this serious illness if:

• Sign of the sharpest stage It is a pain of the sternum of the zhugochi and a grain character, which gives to the left hand, the shovel, neck, jaw. It may be accompanied by the disorder of the stomach, spasms in the abdomen, numbness of the limbs.

Patient complaints with myocardial infarction depend on the form (typical or atypical) disease and extensity Defeating of the heart muscle

• Characteristic signs of ischemia: dizziness, malaise, shortness of breath, fast fatigue. It is cold sweat, a man during an attack is absolutely not able to engage in familiar activities.
• Racing (it can fall or rose to critical values), the pulse becomes more often, there is a strong excitement for its condition and life. Sometimes the body temperature increases, there are signs of the organism intoxication by particles of dead tissues.

It has a clinical optional option (abdominal, asthmatic, collaptoid, arrhythmic, etc.). Depending on the form of the disease, nausea or cough may occur, which bring additional difficulties in the diagnosis of the disease.

Attention! There are cases when the patient came to the hospital with suspicions of the pathology of the gastrointestinal tract or lungs, but only with a thorough examination, signs of the necrosis of the heart muscle were revealed.

If it does not make a diagnosis on time, heavy syndromes may occur, which are rissed to the patient's life.

Treatment of acute myocardial infarction

The complex of symptoms, characteristic ischemic disease, does not apply to the states that "will be held". The disappearance of the graceful pain behind the sternum does not carry full recovery. Even a small focus of necrosis is able to seriously affect the work of the heart.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, cardiogenic shock

In the initial period of the disease, a very strong pain arises, which requires the use of intensive therapy:

• nitroglycerin in a standard dose of 0.4 mg (to enhance the speed of action, it is recommended to put under the tongue, you can use up to 3 tablets);
• beta-adrenobloclars that are struggling with ischemia and contribute to the protection of hearts from death (standard drugs are "metoprolol" and "Atenolol");
• in severe cases, when there is a significant necrotic process, narcotic analgesics are introduced intravenously, for example, morphine.

Myocardial infarction is dangerous primarily by their complications. In order to restore damaged tissues and reduce the burden on the patient heart, a special therapy is selected by a cardiologist.

The drugs with a serious myocardial infarction are permanently accepted, and not only in the acute period, for the prevention of relapse, assigns:

• Thrombolytics (streptocinase, urocinase). Pathogenesis of the disease most often consists in violation of blood inflows by coronary vesselswhich are blocked by a thrombus.
• Beta adrenoblockers. Reduce the need for oxygen, reduce the burden on the heart muscle. They are often used in medicinal therapy arterial hypertension. Preparations of this group are able to reduce blood pressure.

The relief of pain syndrome is carried out by a combination of narcotic analgesics

• Anticoagulants and antiagregants. Treatment standards include funds that are able to ignite blood. The most popular today is acetylsalicylic acid. It is contraindicated in gastritis and bronchial asthma.
• Nitrates. It is appropriate to the use of nitroglycerin in the first minutes of the attack, its beneficial effect on the protection of cardiomyocytes from ischemia is proved. When it is applied, the risk of complications, including cardiogenic shock, decreases.

If you fulfill all clinical recommendations, many dangerous complications can be avoided. The presence of OIM in history makes a person more vulnerable. Even a minor physical activity can lead to a re-attack. To make life easier, experts in the field of cardiology have been provided for an action algorithm to improve the condition of the patient.

So that your life after transferred heart attack has become the same, it is necessary to drastically change your lifestyle. Properly selected medical therapy Under Oim, this is not all. Harmful food, severe physical work, chronic stress and the presence of concomitant diseases can negatively affect the rate of restoration of the body. The doctors of the whole world have developed clinical recommendations aimed at improving the condition of the patient.

The necessary conditions for the prevention of myocardial infarction are the maintenance of a healthy and active lifestyle, abandonment of alcohol and smoking, balanced nutrition

Acute myocardial infarction implies only proper nutrition:

• products C. low content cholesterol;
• fresh fruits, vegetables, berries, which using a large amount of vitamins contribute to the regeneration of cardiac fibers;
• a special diet is required, implying an exception to the fatfud, chips, crackers, etc.;
• refusal to drink alcohol and coffee.

If a person is often enough for his heart, he appears shortness of breath after a minor physical activity, the extremities or jumps pressure - this can be an alarming bell in the progression of the disease.

Prevention of acute myocardial infarction requires you careful control over your own health, which implies:

• getting rid of bad habits (nicotine negatively affects the vessels and heart, coffee increases the need for oxygen);
• moderate physical exertion (excellent choice will be in the fresh air);
• lack of stress, learning relaxation methods;
• saving weight within the norm;
• periodic measurement of blood pressure and pulse.

It's easier to avoid it easier than then all my life to deal with it. Among people who are accustomed to regular physical Loads, Eating the right food and try to look positively on life, ischemic heart disease occurs much less often.

Acute myocardial infarction as rehabilitation

The development of the disease and the rehabilitation of patients in each individual case can pass in different ways. Some people endure ischemia, which is very dangerous, and at the same time they are calmly engaged in familiar activities. Other patients after the disease are forced to avoid unnecessary loads, some of them even proceed to the design of disabilities. Properly selected sports will help you to recover faster.

LFC after acute myocardial infarction implies:

• moderate dynamic loads (running, skating or rollers, cycling, swimming);
• respiratory gymnastics (for example, a set of stronal exercises);
• indian yoga.

But static exercises with high load cores are categorically contraindicated.

Attention! Half weight lifting can contribute to the emergence of a re-attack. It should also be remembered that it is necessary to start gymnastics before in the stage of scar formation.