Clinical course myocardial infarction often weighed down by various complications. Their development is due not only to the size of the lesion, but also to a combination of reasons (first of all, the state of the myocardium against the background of atherosclerosis coronary arteries, previous myocardial diseases, the presence of electrolyte disturbances).
Complications of myocardial infarction can be divided into three main groups:
electrical- rhythm and conduction disturbances (bradytachyarrhythmias, extrasystoles, intraventricular and AV blockades) - almost constant complications of macrofocal MI. Often arrhythmias are not life-threatening, but indicate serious disturbances (electrolyte, ongoing ischemia, vagal hyperactivity, etc.) that require correction;
hemodynamic due to violations of the pumping function of the heart (ALVO, ALV and biventricular insufficiency, CABG, ventricular aneurysm, expansion of the heart attack); dysfunction of the papillary muscles; mechanical disorders (acute mitral regurgitation due to rupture of papillary muscles, rupture of the heart, free wall or interventricular septum, LV aneurysm, papillary muscle tears); electromechanical dissociation;
jet and other complications- episthenocardial pericarditis, thromboembolism of small and large circle circulation, early postinfarction angina pectoris, Dressler's syndrome.
By time the appearance of complications of myocardial infarction classified into:
for early complications- occur in the first hours (often at the stage of transporting the patient to the hospital) or in the most acute period (3-4 days):
1) rhythm and conduction disturbances (90%), up to VF and complete AV block (the most frequent complications and the cause of mortality in prehospital stage). In most patients, arrhythmias occur during their stay in the department. intensive care and resuscitation (OITR);
2) sudden stop hearts;
3) acute failure pumping function of the heart - ALVN and CABG (up to 25%);
4) heart ruptures - external, internal; slow-flowing, instantaneous (1-3%);
5) acute dysfunction of the papillary muscles (mitral regurgitation);
6) early episthenocardial pericarditis;
for late complications(occur on the 2-3rd week, during the period of active expansion of the regime):
1) Dressler's postinfarction syndrome (3%);
2) parietal thromboendocarditis (up to 20%);
3) CHF;
4) neurotrophic disorders (shoulder syndrome, anterior chest wall syndrome).
Classification of complications of myocardial infarction by severity L.N. Nikolaeva and D.M. Aronov
Both early and late stages of myocardial infarction may arise acute pathology Gastrointestinal tract ( acute ulcers, gastrointestinal syndrome, bleeding, etc.), mental changes (depression, hysterical reactions, psychosis), heart aneurysms (in 3-20% of patients), thromboembolic complications - systemic (due to parietal thrombosis) and PE (due to thrombosis deep veins of the legs). Thus, thromboembolism is clinically detected in 5-10% of patients (at autopsy - in 45%), often asymptomatic and causes death in a number of hospitalized patients with MI (up to 20%).
Some older men with benign hypertrophy prostate acute atony develops Bladder(its tone decreases, there is no urge to urinate) with an increase in the volume of the bladder to 2 liters, urinary retention against the background of bed rest and treatment with narcotic drugs, atropine.
Fedorov Leonid Grigorievich
There are also several groups according to which all disorders that have arisen after an attack are classified.
Complications of a heart attack can be:
- Mechanical. They are accompanied by tissue tears.
- Electric. Violations develop heart rate and electrical conductivity.
- Embolic. Thrombosis is formed.
- Inflammatory.
Each of these conditions poses a specific health hazard.
Early
The development of early complications of myocardial infarction occurs during the first hours or days after the attack. This period is called acute.
Heart rhythm disorders and AV block
In the conducting system of the heart, special cells accumulate that generate and conduct nerve impulses... They are located in different parts of the organ, but they are connected to each other. If the heart attack has affected the pathways, then rhythm disruptions develop. Arrhythmia is also caused by metabolic disorders.
The cells located next to the damaged foci create pathological pulsation and slow down cardiac conduction.
The situation worsens with paroxysmal ventricular and. They are accompanied by acute and lead to the death of the patient.
Heart failure
Myocardial infarction is accompanied by cell death. In the damaged area, cardiomyocytes die, and the muscles lose their contractile ability. Due to a decrease in the pumping function of the heart, enough blood does not enter the vessels, and stagnant processes are formed, arterial blood decreases. In the future, microcirculation is disturbed, gas exchange worsens, the work of all organs and systems is inhibited. This is accompanied by irreversible changes that can lead to death.
Cardiogenic shock
Acute form heart failure is accompanied by cardiogenic shock. In this condition, in addition to breathing disorders, the patient experiences hypotonic failures that are difficult to control, impaired consciousness and kidney function due to insufficient blood supply to these organs.
At cardiogenic shock severe disruptions in pumping function and heart rate occur. The condition can lead to tamponade of the ventricles with hemorrhage in the heart bag and death of the patient.
Gastrointestinal complications
In this case, the stomach and intestines are affected. On the mucous membrane of organs, erosion, ulcers are formed, paresis of the stomach and intestinal atony develop.
These problems arise due to insufficient blood flow to the organs and the use of Aspirin.
The causes of paresis and atony are the use of medications, in frequency, the introduction narcotic analgesics.
Complications can also occur due to the formation of small blood clots in the vessels. gastrointestinal tract.
Stomach damage is indicated painful sensations in the abdomen, bloating, stool abnormalities and other signs.
Acute aneurysm
With extensive lesions, Heparin is immediately administered, so the chances of the problem developing are small.
Often it takes life away in the first hour after a heart attack, before qualified help has arrived. However, those who are lucky enough to survive during the first days and even months are in danger of complications of myocardial infarction. There are many of them and they are often unpredictable. With the development of a complicated heart attack, death may occur within the first year after the attack.
Classification
Complications of myocardial infarction can occur during any period of the illness. There is an acute period, subacute and postinfarction. The first lasts up to 10 days from the onset of the disease, the second - about a month, the duration of postinfarction - up to six months.
Complications are divided into several groups:
- mechanical (breaks);
- electrical (arrhythmias and conduction disorders);
- embolic (thrombosis);
- ischemic (an increase in the area of necrosis);
- inflammatory.
Complications are early and late. Early complications occur in the first minutes, hours or days. Late complications occur during the subacute and post-infarction period.
Complications in the acute period
Acute heart failure (left ventricular) and cardiogenic shock
These are the most severe early consequences of myocardial infarction. AHF of the left ventricular type develops quite often. Its severity depends on the size of the myocardial lesion. is considered a severe stage and is characterized by a decrease in the pumping function of the heart as a result of tissue necrosis. In cardiogenic shock, about 50% of the left ventricular myocardium is affected. More common in the elderly, women, sick diabetes mellitus, people with a history of heart attack, with anterior infarction.
Treatment consists of taking nitroglycerin, ACE inhibitors, cardiac glycosides, diuretics, beta-adrenostimulants, vasopressors. Endovascular methods include coronary angioplasty and intra-aortic balloon counterpulsation. In severe cases, it is carried out surgical intervention.
Rupture of the interventricular septum
Occurs in the first five days from the onset of myocardial infarction. More often it happens in women, the elderly, with hypertension, high heart rate, with anterior heart attacks. Usually shown earlier surgical treatment, the use of endovascular methods is possible. From medicines, vasodilators are prescribed.
Mitral insufficiency
In most cases, mild to moderate mitral regurgitation develops after myocardial infarction. It is usually transient. Life-threatening severe form due to rupture papillary muscle, which usually happens on the first day after the onset of a heart attack. This complication occurs most often with infarction of the lower localization.
Postinfarction syndrome
With postinfarction syndrome, the pleura, pericardium, and lungs are simultaneously inflamed. It happens that only one pathology develops, most often it is pericarditis, to which pleurisy and pneumonitis can join. This syndrome occurs as an immunological response of the body to tissue necrosis. Shown hormonal treatment.
Late pericarditis
It is believed that the disease has an autoimmune mechanism of development. It occurs in the period from 1 to 8 weeks after the onset of myocardial infarction. Aspirin is indicated first, then glucocorticoids may be prescribed.
Parietal thromboendocarditis
It develops after transmural myocardial infarction. It is characterized by the formation of blood clots on the walls of the heart chambers.
Chronic heart failure
With this complication, the heart is not able to pump blood in the required volume, and therefore supply tissues and organs with oxygen. Characteristic signs- shortness of breath and swelling. Required to lead healthy image life, get rid of bad habits, monitor the pressure. Typically, beta blockers are prescribed to reduce the oxygen demand of the heart muscle.
Chronic aneurysm of the heart
Chronic aneurysm is formed 1.5 - 2 months after the onset of myocardial infarction. By this time, it is completely scarred, interferes with the work of the heart, and contributes to the development of heart failure. Drug treatment is indicated. In some cases it is necessary surgery, in which the aneurysm is excised, and the defect in the heart muscle is sutured.
Postinfarction cardiosclerosis
It develops as a result of the replacement of the myocardial tissues that died during an infarction connective tissue... Such a diagnosis is made 2-4 months after the onset of a heart attack. As a result of the formation of scar areas, the contractile function of the heart worsens, which leads to a violation of the heart rhythm and conduction, as well as to the development of heart failure. Shows the limitation of physical and emotional stress, constant medication. In the case of severe rhythm disturbances, it may be necessary surgery.
Other complications
After myocardial infarction, complications from the side are not excluded genitourinary system and gastrointestinal tract, mental disorders (psychosis, depression).
Myocardial infarction - insidious disease that takes the lives of many people. Death does not always occur, but even a surviving patient can face serious complications, the likelihood of which is very high. Complications of myocardial infarction manifest themselves in different ways, much depends on the time that has passed after the attack, the patient's condition and other factors.
Classification of complications
Complications can be categorized by different factors... For example, there are the following consequences of a heart attack:
- Electrical. These are conduction and rhythm disturbances. Such complications are almost permanent after large-focal MI. Most often, arrhythmias are not life-threatening, however, they speak of serious disorders that require correction.
- Hemodynamic complications resulting from violations of the pumping cardiac function, mechanical disorders, electromechanical dissociation.
- Reactive and other complications.
By the time of manifestation, complications are divided into:
- Early consequences. They are complications that occur in the first hours or in the first 3 or 4 days after an attack.
- Late complications. They develop at 2 or 3 weeks during the expansion of the regimen.
Complications of the acute period
Complications acute period are cardiogenic period and heart failure. They are considered the earliest and most severe. Heart failure often develops after MI. Each patient has its own severity of this complication, it all depends on the area of the lesion of the heart muscle. In severe stages, acute failure leads to cardiogenic shock. It is a decrease in the pumping function of a muscle due to tissue necrosis. Such complications are more common in older patients and those with diabetes mellitus.
However, during the acute period, other early negative consequences are possible:
- Mitral insufficiency... This frequent complication occurs often too. It can manifest itself in moderate and mild form... Mostly failure mitral valve has a transient form. The severe form is provoked by the rupture of the papillary muscle. This manifestation of insufficiency is very dangerous. Mitral insufficiency develops with inferior myocardial infarction.
- Rupture of the interventricular septum. It can occur in the first five days after an attack. This type of complication is observed more often in patients with hypertension, in women, and the elderly.
- Rupture of the free wall of the LV. It only happens with the transmural type of MI. The risk is high in those patients who have had a heart attack for the first time, women, the elderly, and those with hypertension.
- Thromboembolism. It develops in the first ten days after 24 hours after the attack. Thromboembolism of the main circle of blood circulation is observed with anterior myocardial infarction.
- Early pericarditis. This inflammatory process, which develops in ten percent of cases. Usually, pericarditis is observed in the first four days, when all three cardiac layers are affected.
- Pulmonary edema. It occurs in the first week after an attack. The reason is acute heart failure.
- Arrhythmia. Exactly this frequent consequence, which occurs in 90% of cases.
- Acute LV aneurysm. It develops with the transmural form of myocardial infarction. This is a consequence of dangerously severe heart failure, shock may occur.
Late aftermath
The most common late complications of myocardial infarction are chronic insufficiency heart and chronic arrhythmias. Other possible consequence during the acute period - postinfarction syndrome. Its manifestation is combined with inflammation of the lungs and pleura. Pericarditis may develop, followed by pneumitis and pneumonitis. This syndrome is the body's immunological response to tissue necrosis.
Late pericarditis may also develop as autoimmune disease... Development - from the first to the eighth week. Parietal thromboendocarditis may result from transmural infarction. In its process, blood clots form on the vascular walls.
Chronic heart failure is a dangerous consequence. Its danger is due to the fact that the heart cannot to the fullest pump blood, so organs and tissues do not receive the required amount of oxygen. Symptoms such as shortness of breath and swelling are observed.
A chronic aneurysm may develop after one or two months. During this time, her scarring occurs, she begins to interfere with cardiac activity. Then heart failure develops.
The result of the replacement of dead myocardial tissues with connective tissue is postinfarction cardiosclerosis. Scars form on the heart, therefore, the contractile heart function suffers, which subsequently leads to a violation of the heart rhythm and conduction.
Other complications
After weeks or even months, anterior syndrome may develop. chest... It manifests itself as persistent pains of varying intensity in the parasternal areas. There is pain on palpation of the sternocostal joints.
Another consequence is shoulder syndrome, when pain is formed in this area. This can reach such an extent that the patient is unable to fully move. shoulder joint... In the affected limb, vasomotor disorders are observed. True reasons such complications are not fully understood, there is an assumption that the main role play autoimmune mechanisms.
With complicated myocardial infarction, the consequences may be associated with the gastrointestinal tract. Paresis of the gastrointestinal tract often develops. Gastrointestinal bleeding is possible. On the part of the genitourinary system, urinary retention may occur, which is often manifested in elderly men who have prostate adenoma. Mental disorders of a hypochondriac, neurotic, affective, anxiety-phobic and anosognostic nature are also possible.
Treatment of complications
Complications after a heart attack require careful attention and effective immediate treatment. Treatment depends on the type of complication and its severity. Arrhythmias are successfully treated with constant cardiac monitoring. If significant and persistent bradycardia is detected, which cannot be eliminated with drugs, and the patient is getting worse, an artificial pacemaker is temporarily used. With ciliary arrhythmias, cardiac glycosides are prescribed. However, sometimes the rapid ventricular rate does not recede, and heart failure worsens. In this case, electrical defibrillation is performed. Atrioventricular conduction disorders in combination with bradycardia are effectively treated with atropine.
If medicines do not help, use an artificial pacemaker. The indications for this method are severe violations intraventricular conduction, incomplete transverse blockade of the Mobitz type. For the treatment of frequent and multiple ventricular extrasystoles use lidocaip. If this treatment is ineffective, procainamide is prescribed.
If there is ventricular tachycardia, there is an immediate introduction of one hundred milligrams of lidocaine. If no effect is observed for several minutes, electrical defibrillation is performed. In case of sudden cardiac arrest, an external heart massage should be done immediately, artificial respiration, as well as establish an artificial pacemaker.
If pulmonary edema develops, it is necessary to give the person a semi-sitting position so that it is comfortable for him, inject morphine with atropine and give oxygen. Venous tourniquets can be applied to multiple limbs, however, they must be temporarily loosened every twenty minutes. It is important to administer diuretics to the person quick action, cardiac glycosides. Since the patient is prone to ventricular arrhythmias, glycosides do not need to be administered quickly and a lower dose should be chosen.
With cardiogenic shock important point treatment of complications of myocardial infarction is the elimination of factors that further reduce cardiac output... Usually, strophanthin, isoproterenol, glucagon, etc. are injected intravenously. It is important to administer oxygen therapy and combat metabolic acidosis.
More active treatment required in the case of thromboembolic complications. In this case, anticoagulants are used.
Consequences such as rupture of the septum between the ventricles and tearing of the nipple muscle strongly and dramatically worsen the patient's condition. Surgery is sometimes required. The presence of postinfarction syndrome determines the temporary discontinuation of anticoagulant treatment and the appointment of anti-inflammatory treatment based on the use of acetylsalicylic acid.
Prophylaxis
The risk of complications can be reduced. The first thing to remember in order to prevent an attack is to take all prescribed medications, the prescribed regimen and the doctor's recommendations. No independent intervention! The rest of the prevention recommendations relate to the lifestyle that must also be maintained in order to prevent myocardial infarction altogether:
- exclude smoking and alcohol intake (before myocardial infarction, you should not take more than 30 grams of alcohol)
- avoid psycho-emotional overload.
- to maintain optimal body weight, a special diet should be followed after myocardial infarction.
- control blood pressure and cholesterol levels.
- physical activity is allowed only as directed by a doctor.
After myocardial infarction, for the purpose of prevention and treatment, diet No. 10 is prescribed, which implies three diets. Compliance with these diets is an integral part of preventing complications.
The first diet is prescribed in the acute period. Dishes are prepared from permitted steamed products or by boiling without salt. During the day, the patient should eat 6 or 7 times in small portions. The second diet is prescribed 2 or 3 weeks after the attack. Dishes are prepared according to the same principle, however, they may not be mashed, but chopped. The amount of food intake is 5 or 6 times. This is followed by a third diet. Dishes are prepared in the same way, but can be served in pieces or chopped. The amount of food intake is 4 or 5 times.
Complications (MI) can be life threatening. To avoid this, it is necessary to collect all the will, tune in and comply with all prescriptions and preventive measures. It is important to understand that life and health are often in the hands of the patients themselves.
Complications of myocardial infarction usually occur within a year after the attack. Their development may be due to untimely initiation of therapy, the extent of tissue damage, as well as non-compliance by a sick person medical advice lifestyle change.
About what possible complications with a heart attack, there can be, as well as how to prevent their development, and this article will tell.
Features and clinical manifestations of the disease
Myocardial infarction is dangerous disease, during which a person has a lack of blood supply to the heart muscle. This leads to tissue death and the development of necrosis.
The hallmarks of an acute heart attack are:
- severe pain that can radiate to the left side of the chest and have a pressing, burning or stabbing character,
- shortness of breath and fear of death,
- lack of air, panic,
- dizziness,
- increased sweating,
- anxiety,
- increased heart rate more than 90 beats per minute.
In this state, the pain can persist for half an hour. In some cases, the attack is accompanied by severe pain which last for several hours.
Remember! If you experience chest pain that cannot be relieved with regular Nitroglycerin, it is important to call a doctor as soon as possible. It is very dangerous to self-medicate in such a state, as these signs may indicate a developing heart attack.
Classification of complications
AMI can be early and late. The first group of complications develops during the acute period of the disease (in the first 2 weeks after the attack).
Late complications occur within a year after a heart attack.
Also, all the consequences of a heart attack are divided into three groups:
- Electrical complications. They develop as a result of disturbances in the rhythm of the myocardium and its conduction.
- Hemodynamic. They arise due to dysfunction of the heart.
- Reactive. This category includes such consequences as pericarditis, vascular thromboembolism, angina pectoris.
Types of complications
Most often, after a heart attack, patients experience the following complications:
- acute or chronic heart failure;
- arrhythmia;
- heartbreak;
- aneurysm;
- thromboembolism;
- secondary attack.
Each of these complications has its own characteristics of development and course. Let's consider them in more detail.
Heart failure
During a heart attack, part of the myocardial tissue dies off, therefore, in the damaged area, the heart cells can no longer contract. This impairs the functions of the organ, due to which a person develops heart failure in an acute form.
This condition can manifest itself in the form of pulmonary edema or shock in a cardiogenic form. Typical manifestations complications in this case will be wheezing, shortness of breath, shortness of breath, severe pain in the heart, pressure surges.
As a result of shock, a person may have impaired consciousness and hypotension.
With prolonged violation contractile functions the patient's heart may develop chronic form myocardial insufficiency. This disease will continually progress and impair circulation.
The complication is manifested by the following symptoms:
- weakness,
- dizziness,
- shortness of breath even at rest
- pain in the right hypochondrium,
- swelling in the evening
- accumulation of fluid in the abdominal cavity.
Arrhythmia
If a part of the heart muscle is damaged by a heart attack, in which the pathways are located, a person may experience arrhythmia. Moreover, rhythm disturbance can occur due to the influence of metabolic changes observed during an attack.
The most severe are ventricular and atrial fibrillation, as they can cause acute heart failure and death.
Important! Heart rhythm disturbances are not always an early complication. Arrhythmia can be caused by curative therapy when a person is injected special preparations dissolving a blood clot in a blocked vessel. This leads to the resumption of blood circulation and a sharp change in heart rate.
Heartbreak
Heartbreak- This is a real complication that occurs when there is a defect in the myocardium that has arisen after an attack. This area will contain dead tissue with altered properties. Gradually, it will become defenseless to tension and will be subject to destruction.
Usually, a ruptured heart occurs in severe heart attack 5-6 days after the attack. This complication can be internal or external. With such changes, the patient can only be helped by an urgent surgical intervention.
Unfortunately, due to the compression of the heart and its pronounced damage, this complication usually ends in death, and the person dies in a few minutes.
Aneurysm
Aneurysm- This is a pathological protrusion of one of the walls of the myocardium after a heart attack. This is usually an early complication that occurs in the first days after the attack.
It is very difficult to treat aneurysm, as it affects the walls of the myocardium. In such a state, a person throughout his life will need to be extremely careful not to cause an aneurysm to rupture.
Thromboembolism
A heart attack provokes severe pathological changes in a person. As a result, after an attack, the patient has an increased tendency to thrombus formation. There may also be a circulatory disorder, which will only worsen due to the immobility of the patient in the first days of the illness.
In a similar state, a person can form blood clots. They are usually localized in the left ventricular cavity.
When racing blood pressure, which often happens in hypertensive patients, such blood clots can clog the vessels, provoking thromboembolism. This can lead to repeated heart attack, stroke. The defeat of small arteries threatens an attack of angina pectoris.
Treatment of this condition should be carried out with the use of drugs that thin the blood and prevent blood clots. Otherwise, the patient's condition may worsen.
Abdominal syndrome
This complication often occurs not only after a heart attack, but also after other serious pathologies.
Abdominal syndrome has the following manifestations:
- abdominal pain,
- bloating,
- stomach ulcers
- high temperature
- violation of the stool.
Secondary infarction
In those patients who suffer from running form atherosclerosis or a tendency to form blood clots, the development of a secondary heart attack is observed shortly after the first attack.
Due to the fact that the body has not yet had time to recover from the consequences of an attack, a secondary heart attack leads to much more serious complications.
Prevention of complications
To protect yourself from the complications of a heart attack, the patient should definitely adhere to the following recommendations:
- In the first days after the attack, observe strict bed rest.
- Take all medicines prescribed by your doctor. Treatment should be supervised by a specialist.
- Be sure to comply diet food(diet number 10). In this case, it is worth completely abandoning fatty, alcoholic, limiting the use of sweet, spicy, sour and starchy foods.
- During the recovery period, regularly perform special exercises and exercise therapy.
- Give up bad habits (smoking).
- Avoid stress and nervous strain. Also, a person should change the mode of work and rest, sleep at least 8 hours a day.
- Limit heavy physical exercise, especially lifting weights, running, push-ups.
- Maintain body weight. It is very dangerous to gain weight after a heart attack.
- Control blood pressure and cholesterol levels.
- Regularly see a doctor (cardiologist, therapist).
Disclosure of personal data
The system of postgraduate medical education in Russia
The essence of a major transaction for LLC Help on the size of the transaction what is determined
Equations with one variable Card for knowledge correction
Building a pie chart