Acute myocardial infarction patient complaints. Acute myocardial infarction

The date: 03.03.2020

And how much time will need to restore after this severe ailment. Answer definitely on these issues in the framework of one article is difficult, since many factors may affect the quality and duration of the patient's rehabilitation: the severity of a heart attack, the presence of its complications, concomitant pathology, occupation, age, etc.
In this publication, you can familiarize yourself with the general principles of rehabilitation therapy after myocardial infarction. Such knowledge will help you draw up a general idea of \u200b\u200blife after this severe ailment, and you can formulate the questions you have to ask your doctor.

Basic principles of rehabilitation

The main directions of the patient's restoration after the myocardial infarction includes:

Gradual expansion of physical activity.
Compliance with diet.
Prevention of stress situations and overwork.
Work with a psychologist.
Fighting bad habits.
Treatment of obesity.
Medical prevention.
Dispensary observation.

The above-described activities should be applied in the complex, and their character is selected individually for each patient: it is this approach to recovery that the most fruitful results will give.

Physical activity

Physical activity is necessary to any person, but after myocardial infarction, its intensity should expand gradually. Forcing events with such pathology it is impossible, since this can lead to severe complications.

Already in the first days after the acute period of heart attack, the patient is allowed to get up from bed, and after stabilizing the state and transfer to the usual chamber - to make the first steps and hiking. The distance for a flat surface increases gradually and such walks should not cause patient fatigue and uncomfortable sensations (shortness of breath, etc.).

Also patients in the hospital are prescribed by LFC classes, which in the first days are always conducted under the supervision of an experienced physiotherapist physiotherapist. Subsequently, the same exercises can perform the patient and at home - the doctor will definitely teach it to control its condition and properly increase the load intensity. LFC classes contribute to the stimulation of blood circulation, normalize the work of the heart, activate their breathing, improve the tone of the nervous system and the gastrointestinal tract.

A favorable sign of successful rehabilitation are pulse indicators after physical exertion. For example, if in the first days of hiking, the pulse is about 120 beats per minute, then after 1-2 weeks, with the same intensity of walking, its frequency will be 90-100 shots.

Also for the rehabilitation of patients after myocardial infarction, various physiotherapeutic procedures, massages and respiratory gymnastics can be used. After stabilization of the patient's condition, he can be advised by sports that contribute to strengthening and increasing the endurance of the heart muscle and cause it to enrich oxygen. These include: sports walking, swimming and cycling.

Also gradually should expand the physical activity of the patient who has undergone myocardial infarction, in everyday life and at work. People whose profession is associated with significant loads, they are advised to think about changing the kind of activity. Such questions, patients can discuss with their attending physician who will help them make forecasts about the possibility of returning to a particular profession.

The resumption of sexual life of the myocardial infarction field is also better to discuss with its cardiologist, since any sexual intercourse is a significant physical activity and late resumption of sexual contacts can lead to severe complications. With uncomplicated cases, the return to intimate proximity is possible after 1.5-2 months after the attack of myocardial infarction. Initially, the patient is recommended to choose such a pose for sexual intercourse, in which the physical activity will be minimal for it (for example, on the side). The doctor may also recommend receiving nitroglycerin 30-40 minutes before intimate proximity.

Diet

The first diet of such a diet is prescribed in the acute period (i.e. the 1st week after the attack). Dishes from permitted products are prepared without adding a pair of salt or by boiling. Food should be rubbed and taken in small portions 6-7 times a day. During the day, the patient can consume about 0.7-0.8 liters of free fluid.
The second diet is appointed in the second and third week of the disease. The dishes are also prepared without salt and by boiling or pair, but can already be supplied not with rubbed, but crushed. Food remains fractional - up to 6-5 times a day. During the day, the patient can consume up to 1 liter of free fluid.
The third diet is prescribed to patients in the period of scarring the zone of the infarction (after the 3rd week after the attack). Dishes are prepared as well as without salt and by boiling or pair, but can already be squeezed with crushed or piece. Food remains fractional - up to 5-4 times a day. During the day, the patient can consume up to 1.1 liters of free fluid. By permission of a doctor, a small amount of salt may be administered to the patient's diet (about 4 g).

water vegetable and cereal soups (during the second diet, their preparation is allowed on a light meat broth);
non-fat fish;
veal;
chicken meat (without fat and skin);
cereals (Manka, oatmeal, buckwheat and rice);
omelet made of eggs, cooked for a pair;
fermented milk drinks;
butter (with a gradual increase in its amount to 10 g to the III period);
skimmed milk for adding tea and porridge;
wheat crumbs and bread;
safety sour cream to refuel soups;
vegetable refined oils;
vegetables and fruits (first boiled, then it is possible to introduce raw salads and purees of them);
rubber branch;
mors;
compotes;
kissel;
fastening tea;

From the diet of the patient with myocardial infarction such dishes and products should be excluded:

fresh bread;
doba and baking;
fat meat dishes;
sub-products and caviar;
canned;
sausages;
fatty products made of milk and whole milk;
egg yolks;
barley, pearl croup and millet;
bean cultures;
garlic;
white cabbage;
turnip and radish;
cucumbers;
spices and pickles;
fat animal origin;
margarine;
chocolate;
grapes and juice from it;
cocoa and coffee;
alcoholic beverages.

In the future, the diet of a person who has undergone a heart attack can expand, but such changes should be coordinated with his attending physician.

Prevention of stressful situations, overwork and work with a psychologist

Sick after a heart attack may need help a psychologist, since they often develop depression.

After the myocardial infarction suffered, many patients after the appearance of any pain in the heart area are experiencing various negative emotions, fear of death, anger, sense of inferiority, confusion and excitement. Such a state can be observed about 2-6 months after the attack, but then it gradually stabilizes and the person returns to the familiar rhythm of life.

Elimination of frequent attacks of fear and excitement during pain in the heart can be achieved by clarifying the patient causes such symptoms. In more complex cases, it may be recommended to work with a psychologist or receiving special sedatives. In this period, for the patient, it is important that close and relatives in every way supported it, encouraged his attempts to adequate physical exertion and did not belong to it, as an infallible and seriously ill.

Often, the psychological state of the patient after a heart attack leads to the development of depression. It can be caused by a sense of inferiority, fears, experiences about what happened and the future. Such long-term conditions need qualified medical care and can eliminate autogenic workouts, psychological unloading sessions and a psychoanalyst or psychologist.

An important point for the patient after the myocardial infarction becomes becoming the ability to properly manage their emotions in everyday life. Such adaptation to negative events will help to avoid stressful situations that often become the causes of subsequent infarction and a sharp increase in blood pressure.

Many patients with such pathology as a history of history are interested in the possibility of returning to the previous place of work. The duration of rehabilitation after a heart attack can be about 1-3 months and after its completion it is necessary to discuss with the doctor the opportunity to continue his career. To resolve such a question, it is necessary to take into account the nature of the patient's profession: a schedule, the level of emotional and physical exertion. After evaluating all these parameters, the doctor will be able to recommend you with a suitable solution to this issue:

a return period to ordinary work;
the need to transfer to easier work;
a change of profession;
disability registration.

Fighting bad habits

The myocardium suffered infarction should be the reason for the failure of bad habits. Alcohol, narcotic drugs and smoking have a number of negative and toxic effects on vessels and myocardiums, and the refusal of them can protect the patient from the development of repeated attacks of this cardiac pathology.

Especially dangerous for persons with predisposition to myocardial infarction smoking, since Nicotine can lead to generalized atherosclerosis of vessels and contributes to the development of spasm and sclerosis of coronary vessels. The awareness of this fact can be excellent motivation to combat smoking, and many may be from cigarettes on their own. In more complex cases, any available funds can be used to get rid of this induluction dependency:

assistance of a psychologist;
coding;
medication;
igloreflexotherapy.

Treatment of obesity

Obesity becomes the cause of many diseases and has a direct impact on the heart muscle, which is forced to provide blood extra body weight. That is why after transferring myocardial infarction to all patients with obesity, it is recommended to begin fighting overweight.

Patients with obesity and a tendency to a set of unnecessary kilograms are recommended to be observed not only the rules for the diet, which is shown during the period of rehabilitation after a heart attack, but also adhere to therapeutic diet number 8:

reducing the calorie content of the daily menu due to easily digestible carbohydrates;
limitation of free fluid and salt;
exception from the diet of food, which excite appetite;
cooking by steam processing, boiling, baking and extinguishing;
replacing sugar on sugar substitutes.

To determine their normal weight, it is necessary to determine the body mass index, which is calculated by dividing the weight (in kg) on \u200b\u200bthe growth rate (in meters) erected into a square (for example, 85 kg: (1, 62 × 1, 62) \u003d 32, 4) . In the process of getting rid of excess weight, it is necessary to strive to ensure that the body mass index does not exceed 26.

Medical prophylaxis

After discharge from the hospital, the patient recommends a reception of various pharmacological preparations, the action of which can be directed to a decrease in blood cholesterol levels and stabilization of blood sugar levels. The list of drugs, dosages and the duration of their reception are selected individually for each patient and depend on the indicators of diagnostic data. Before discovering with a doctor, it will be necessary to discuss the purpose of a drug, its side effects and the possibility of its replacement by analogs.

Dispensary observation

After discharge from the hospital, the patient who suffered a myocardial infarction must periodically visit his cardiologist and to measure pulse and blood pressure daily. During test inspections, the doctor conducts such studies:

blood tests;
Echo-kg;

Based on the results of such diagnostic research, the doctor can adjust further reception of drugs and make recommendations on possible physical exertion. If necessary, the patient may be recommended to conduct a sanatorium-resort treatment, during which he can be appointed:

massage;
gas and mineral baths;
sleep outdoors;
physiotherapy, etc.

Compliance with uncomplicated cardiologist and rehabilitol recommendations, making adequate adjustments to lifestyle and regular dispensary inspections after a myocardial infarction will allow patients to undergo a complete rehabilitation course that can help efficiently restore after illness and warn the development of heavy complications. All activities recommended by the doctor will allow patients who have suffered a myocardial infarction:

prevent complications;
slow down progression;
adapt the cardiovascular system to the new state of myocardium;
increase endurance to physical stress and stressful situations;
get rid of excess weight;
improve well-being.

Smirnova L. A., Therapist, talks about rehabilitation after myocardial infarction:

The heart is the most important organ of man. That is why it is extremely important that it was absolutely healthy. To the deepest regret, with age in most people, various problems begin to appear in this area. Diseases of the heart and vessels are very common, and not only in our country. To complete the coordination of the diagnosis and methods of treatment of any of the disease, a system of international classification was developed on the ICD code.

A sharp heart attack arises as a consequence of coronary heart disease.

Myocardial infarction

Myocardial infarction is the death of heart tissues as a result of cessation of blood flow into the organ. In the system developed by the World Organization, this diagnosis can be found under the IBC code 10. These problems, unless we are talking about congenital pathologies, are the result of the disease of the organism vascular system. Acute myocardial infarction is a direct consequence of coronary heart disease.

Causes of Development of Ischemia

Ischemic heart disease is characterized by the occurrence of the difference between the blood flow and real blood flow to the organ. Some reasons for the occurrence of this disease do not depend on the patient, but many of the provoking factors can and should be excluded from the life of the IBS suffering as soon as possible. Acute myocardial infarction (OIM) on the background of the IBS can develop in the following cases:

- Sclerotic plaques hit the vessels of the coronary blood circulation over time begin to collapse, and as a result, the blockage of the arteries that feed the heart occurs.
Thrombosis of amazed arteries.
Coronary arteries can be subjected to a complete or partial spasm - most often this is a sign of eating cocaine.

In this case, the term is accepted in medicine - acute coronary syndrome (OX). Doctors often diagnose a combination of several factors causing OIM. The reasons for which these problems arise are quite well studied. These are most often attributed to:

the presence of hereditary factors;
violation of nutrition rate and, as a result, obesity;
bad habits;
low motor activity;
blood diseases;
arterial hypertension and a number of other reasons.

For course, they allocate the steps

Pre-infarction - its duration can be from several hours to several days. During this period, there is a decrease in the gaps between the attacks of angina. These attacks can constantly increase, pain is not expressed, gradual general deterioration of well-being.
The most acute - and goes into myocardial necrosis. The duration of this phase is from twenty minutes to two hours. Characteristic symptoms of the acute period are unbearable pain in the progreded area, which are given in the left hand or left blade, the patients sometimes speak about pains in the top of the abdomen and their pains in the lower jaw. At this stage, it is impossible to remove pain syndrome with the help of Nitroglycerin. In addition to acute pain, other symptoms are joined at this time, such as changing the color of the skin, increased sweating, the strongest excitation associated with the fear of death.

Sometimes it is possible to observe the signs of this disease: nausea, vomiting, the difficulty of breathing, the formation of the lips, strong edema. Sugar diabetes patients may be completely absent. In the presence of these symptoms, doctors talk about atypical forms of myocardial infarction.

A sharp period - at this time the pain practically disappears. It happens, because the nerve endings in the affected area are completely dying. The patient may have an increase in body temperature and hypotension enhancement. It lasts this period from two days to two weeks.
Subacute - takes from 4 to 8 weeks. It is characterized by the beginning of the formation of a scar at the site of a necrotic focus. The temperature of the patient comes to normal, and symptoms of heart failure become less pronounced.
The post-infarction period - the scar is fully formed, and the heart begins to adapt to new conditions.

Myocardial infarction does not have any one common classification. Most often apply the division of this disease, taking into account various parameters.

On the area of \u200b\u200bthe lesion:

finely food - dieting heart fabric;
the large-scale - the area exposed to necrosis is quite large.

According to the multiplicity of the disease:

primary;
recurrent - repeated heart attacks for eight weeks after the first;
repeated - if the heart attack happens more than two months.

At the occurrence (topography):

infarction of the right ventricle;
heart attack left ventricle. Here they allocate the heart attack of the front wall of the left ventricular heart, the infarction of the back or side wall and the interventricular partition. The heart attack of the left ventricle happens much more often. This is due to the fact that this heart department begins the greatest load on blood pumping.
atrial infarction

At the depth of the defeat:

intramural (located in the thickness of myocardium);
subendocardial (myocardial necrosis adjacent to the outer shell of the heart);
subepicardial (myocardial necrosis adjacent to epicardia, internal heart shell);
transmural (the muscular wall of the heart is affected by the entire depth, this kind of infarction is only when).

By availability of complications:

uncomplicated;
complicated.

Very often, the complications of myocardial infarction are observed in the first hours of disease development. It can also be various types of arrhythmias, and eaters, and a cardiogenic shock, leading to a fatal outcome.

Diagnostics

Modern medicine today has all the possibilities to quickly and accurately diagnose this disease.

The first data doctor receives from the patient himself reporting the strong pains that he could not remove with the help of Nitroglycerin.
The next step in the inspection may become palpation (the presence of pulsation in the field of cardiac top) and auscultation (the presence of characteristic changes of the tones and the rhythm of the heart of the heart).
The exact data on the presence of a heart attack can be obtained when removing the electrocardiogram. This procedure today has an ambulance doctor.
Show a typical picture of such a heart damage can also conduct blood test (the presence of cell destruction enzymes).
X-ray examination of coronary vessels using the introduction of a contrast agent allows you to accurately determine the degree of their blockage.
Computer tomography helps to identify the presence of thrombus in the heart.

If the first signs of acute myocardial infarction appeared, the patient needs to ensure complete peace and urgently cause ambulance. With a given disease, the chance of preserving human life will depend on the rate of first emergency care. During the first twenty minutes, the heart works using its internal reserves, and only then the tissue is starting. Upon arrival of ambulance, the brigade will conduct urgent preferences. It most often consists in removing pain syndrome. With acute myocardial infarction, pain can be stopped only by narcotic analgesics. Further, "Aspirin" or "heparin" is used to prevent thrombosis.

Treatment in the hospital. The patient is urgently placed in the intensive care of the cardiological department, where the treatment has been continued to maintain cardiac activity. Thrombolytic therapy is most important in the early stages of the development of infarction, which is aimed at dissolving thrombus and restoration of coronary arteries. For the same purpose, anticoagulants are used. Treatment will include a number of drugs to eliminate problems with arrhythmia. There are also minimally invasive surgical methods to restore sufficient blood supply to the heart. It may be the introduction of a wall or catheter, which are entered into the vessel and normalize its lumen. Usually this surgical manipulation is produced in the first 24 hours after the patient's admission to intensive care.

Rehabilitation

Myocardial infarction is a severe disease that can lead to disability or even death. A negative forecast is usually more likely to have people with repeated heart attack. Considering this circumstance, a person after the acute infarction must take carefully to subsequent rehabilitation, which begins almost immediately after passing the acute stage of infarction. After passing the acute stage of the infarction. After passing the infarction of the heart, the heart is much more difficult to perform its functions, so the patient will have to hold a whole.

To such actions can be attributed:

Permanent reception of medicines to reduce blood consumption and to expand vessels.
Bringing in the norm of cholesterol content.
Monitor blood pressure.
Recovery as far as possible contractual heart functions.
Improving motor activity.
Return of ability to work.

All activities intended to restore the patient require the joint efforts of the doctor and the patient. It is an integrated approach that will give the opportunity to return to active life as soon as possible. The patient, transferring the heart attack, must completely abandon any bad habits. Revise your diet and avoid any stressful situations. All the cardiologists transferred to everyone recommend constantly to engage in therapeutic physical education. After inpatient treatment, patients are desirable to continue their recovery in specialized sanatoriums or rehabilitation centers. It is here that qualified specialists have all the possibilities to provide effective and physical, and psychological assistance.

Acute myocardial infarction is one of the most dangerous complications of coronary heart disease. Pathology is associated with the emergence of necrotic processes in the heart muscle due to oxygen starvation of fabrics. What is this condition, and how to deal with him, we'll figure it out further.

What it is?

Pathology is accompanied by a dieting one or more sections of the heart muscle. It happens because the coronary blood circulation is occurring. Heart sections can remain without oxygen for many reasons, but the main is considered the presence of a thrombus in the artery that feeds the heart muscle.

In such an infectious state, the myocardial cells "live" about half an hour, after which they die. Pathology is accompanied by numerous complications caused by irreversible processes as a result of a violation of the rear wall of the left ventricle.

This form of infarction can cause loss of legal capacity and disability!

Causes of development and risk factors

The stop of the coronary blood circulation can be caused by several reasons. It:

Atherosclerosis. Chronic arterial disease, which is characterized by the formation of dangerous thrombov. If you do not interfere with their development, they will increase in the amount and eventually block the artery and blood supply.
Sharp spasm coronary arteries. This can occur from cold or exposure to chemicals (poisons, drugs).
Embolism. This pathological process, in which particles appear in lymph or blood, which should not be there, which leads to a violation of local blood supply. The reason for the acute myocardial infarction most often becomes fat embolism, when the fat droplets fall into the blood.
Launched anemia. In this state, there is a sharp decrease in the hemoglobin in the blood, therefore, the transport functions of the blood decrease, so oxygen does not flow in due.
Cardiomyopathy. The sharp hypertrophy of the heart muscle is characterized by inconsistency in the level of blood supply with increased needs.
Surgical interventions. During the operation there was a complete dissection of the vessel across or a bandage.

In addition to the main reasons, risk factors can also be distinguished - pathological conditions that can lead to a heart attack. These include:

cardiovascular diseases (often ischemic heart disease);
diabetes;
previously suffered myocardial infarction;
hypertonic disease;
increased cholesterol;
smoking or alcohol abuse;
obesity;
improper nutrition (salt and animal abuse);
increased concentration in triglyceride blood;
age older than 40 years;
chronic stress.

Symptoms

Like any other heart disease, acute myocardial infarction is characterized by pain in the heart. Among other symptoms can be allocated:

strong compressive pain in the chest, which is periodic and reminds of itself several times a day, and it can be very intense and give to other places, without lying in one place;
unbearable pain in the heart, which is impossible to remove nitroglycerin;

If, after receiving nitroglycerin, the pain did not pass, another 300 mg should be taken and urgently cause ambulance!

pain in the left hand, blade, shoulder, neck or jaw;
acute air shortage, which may be observed due to blood supply disorders;
dizziness, weakness, increased sweating, nausea and even vomiting (these manifestations often accompany pain);
the violation of the pulse, which carries a bruising or slow character.

Stages

The development of acute myocardial infarction can be divided into four:

Phase Damage. The acute stage of the course of the disease. Duration - from 2 hours to days. It is during this period that the process of dying myocardium in the affected area occurs. According to statistics, most people die at this stage, so it is imperative that it is imperative to diagnose the disease in a timely manner!
Acute. Duration - up to 10 days. During this period there is an inflammatory process in the infarct zone. Phase is characterized.
Prostula. Duration - from 10 days to month or two. At this stage there is a scar.
Scarring phase or chronic. Duration - 6 months. Symptoms of heart attack are not manifested, however, the risk of developing heart failure, angina and repeated heart attack is preserved.

What complications may be?

Acute myocardial ischemia can even more complicate the following manifestations:

Violation of heart rhythm. The flickering of ventricles with the transition to fibrillation may cause fatal outcome.
Heart failure. A dangerous state can cause swelling of the lungs, cardiogenic shock.
Thromboembolia of the pulmonary artery. May be caused by pneumonia or lung infarction.
Tamponade heart. This happens when the heart muscle is breaking in the heart attack zone and blood breakthrough into the pericardia cavity.
. At the same time, the state of the portion of the scar tissue occurs, if there was an extensive lesion of myocardium.
Post-infarction syndrome. This can be attributed to, pleurisy, arthralgia.

Diagnostics

Successful is a complex process that consists of several stages:

Collect Anamneza. The doctor finds out whether the attacks of pain of different frequencies and localization in the past. In addition, he conducts a survey to find out if the patient has a patient to the risk group, whether myocardial infarction has been in blood relatives.
Laboratory studies. In the analysis of blood on acute myocardia, an increase in the number of leukocytes and an increase in the rate of settlement of erythrocytes (ESO) is indicated. At the biochemical level, an increase in activity is revealed:

aminotransferase enzymes (ALT, AST);
lactate dehydrogenase (LDH);
creatineineins;
mioglobin.

Using instrumental research techniques. At the ECG (electrocardiography), a characteristic sign of heart attack is considered a negative teeth T and the pathological complex QRS, and on EchoCG (echocardiography) - a local violation of the reduction of the affected ventricle. Coronary angiography reveals a narrowing or overlap of the vessel that feeds myocardium.

Emergency care and treatment

Emergency can be attributed to the reception of nitroglycerin tablets (up to 3 pieces) and the immediate challenge "ambulance". The main activities for the treatment of acute heart attack can only be performed by the medical staff.

Allocate several principles of therapy:

Restoration of blood circulation in coronary arteries. After the patient's arrival in the cardiorean compartment, all necessary research is carried out to confirm the diagnosis. After this, the sharp need to quickly restore blood circulation in coronary arteries. One of the main methods is thrombolysis (the dissolution of the thrombus cells inside the vascular bed). As a rule, for 1.5 hours of thrombolytics dissolve the thrombus and restore normal blood circulation. The most popular means are considered:

Alplaza;
Relay;
Ansrereza;
Streptokinase.

Purchase syndrome. To eliminate pain, use:

Nitroglycerin under the tongue (0.4 mg), however, nitrates are contraindicated at low arterial pressure;
beta blockers that eliminate myocardium ischemia and reduce the infarct zone (usually prescribed 100 mg of metoprolol or 50 mg of atenolol);
narcotic analgesics - in special cases, when nitroglycerin does not help, morphine intramuscularly introduces the patient.

Surgical intervention. It may be necessary to conduct stenting to restore blood flow. A metal structure is carried out with a thrombus, which expands and expands the vessel. Planned operations are carried out to reduce the zone of necrotic lesions. Also to reduce the risk of re-infarction is carried out an aortocortonary shunting.
Common events. The first few days of the patient is in the intensive care unit. The mode is a strict bed. It is recommended to exclude visits to relatives in order to protect the patient from the excitement. During the first week, he may gradually begin to move, but observing all the recommendations of the doctor by diet and physical exertion. As for the diet, it is necessary to eliminate sharp, salty and pended dishes in the first week, and the menu is enriched with fruits, vegetables, poured dishes.

After discharge, it should be observed systematically at a specialist and take appointed cardiopreparations. Exclude smoking and abandon alcohol, as well as avoid stress, perform the worst physical exertion and follow the body weight.

Video: Training film about pathology

In a brief educational roller, you can visually see what the patient looks like a patient with an acute myocardial infarction, how diagnosis and treatment is carried out:

So, the projections of recovery in acute myocardial infarction depend on the volume of lesion and localization of the necrosis focus. In addition, accompanying diseases and heredity play a major role. In any case, with timely and qualified treatment, the chances of successful recovery increase. Do not tighten the visit to the doctor!

Moscow State Medical and DentalUniversity

Department of Therapy

MEDICAL HISTORY

General

Complaints for admissionon pain compressing nature behind the sternum, irradizing in the left hand, a duration of more than 30 minutes (not bubbling nitroglycerin), general weakness, sense of lack of air, death fear, headache, increased sweating.

Anamnesismorbi.

For a long time (about 10 years), it suffers from hypertension (notes episodes of headaches, dizziness, fast fatigue), with maximum lifts of systolic blood pressure to 220 mm Hg. Art. Regular treatment has not been conducted. Previously, the manifestations of IBS was not. During the last week began to mark pain behind the sternum duration of about 1 min. The pains occurred after exercise and disappeared alone independently, nitroglycerin and similar drugs did not accept the patient with the purpose of stopping the attacks. On February 27, 2004, the patient was at work in a state of rest (physical and emotional loads was not), goded, burning pains for the sternum, irradizing in the left hand, durability of more than 30 minutes, weakness, sense of lack of air, death fear, headache The sweating has increased. Was called SMP. The patient with a diagnosis of IBS, a acute myocardial infarction was delivered to GKB No. 20, where it was hospitalized with a diagnosis of IHD, a sharp advanced myocardial infarction.

Anamnesisvitae.

Brief biographical data - Born in the village, a donated child, in a full family. Grew and developed age, respectively.

Family history - Married, 2 children.

Gynecological anamnesis - menstrual cycle for 28 days, regular menstruation, the date of the latter - 10.02.04, the number of pregnancies - 5, clans - 2, abortions - 3.

Labor history - graduated from 8 classes of an average educational school since 1977 he studied in a trade college in a specialty merchant, since 1981-1989 worked in the store by the seller, since 1989-1997 head. Department. Since 1998, he has been working in a fleet of the conductor. At work moderate physical exertion (running sitting).

Household anamnesis - Domestic conditions in childhood and at the moment satisfactory. Leads a sedentary lifestyle.

Transferreddiseases - Since 1994 - hypertensive disease.

Allergological anamnesis - Allergic reactions to dust, pollen of plants, animal wool, drugs, domestic chemistry denies.

Bad habits - Does not smoke, alcohol does not abuse.

Heredity - Not burdened.

Status preasens.

The condition of the patient of the moderate severity, the consciousness is clear, oriented over time and place. The situation is active. The constitutional type is normal-bench. Temperature of the body - 37.2c, height - 160 cm, weight - 80 kg.

Skin Covers - Color pink, voltage and elasticity are somewhat reduced. Pink mucous membranes, the language is covered on the back of a white bloom. The subcutaneous fat fiber is unnecessarily developed, the thickness of the skin fold at the navel level is 5 cm. No swelling.

The lymph nodes - submandibular, cervical, occipital, inspection, connectible, axillary, elbow, inguinal, retroperitoneal is not palpable.

Muscular system - The degree of muscle development is sufficient, the tone is somewhat low, there is no pain in palpation.

Bone system - deformations, there are no curvatures, there is no pain in palpation and phable. The joints of the usual configuration, movement in full in all joints, soreness during palpation and passive movements are not.

Nervous system - smell, taste, vision, hearing are not changed, the coordination of movements is not broken.

Respiratory system

Inspection of the chest

Breathing through the nose is not difficult. Breath type - chest. Rhythmic breathing, ChDD - 18 per minute. The thoracic shape is correct, the chest is symmetrical, both half are evenly involved in the act of breathing.

Palpation of chest

There is no soreness at palpation of the chest. Voice trembling is carried out equally on symmetrical sections of the chest, not changed. Chest during elastic squeezing.

Perkness lung

Comparative percussion - Throughout all the extent, a clear pulmonary percussion sound is heard.

Topographic percussion

Upper lung border on right left

The standing height of the tops in front of 3 cm 3 cm

Standing height of tops from behind 7 cervical vertebra

Width of the crench fields 5 cm 5 cm

Lower lung border

By okodiscruited line VI edge

On the mid-clavical line VI edge

On the front axillary line VII edge VII edge

On average axillary line VIII edge VIII edge

On the rear axillary line IX edge IX edge

On the blade line x edge x edge

By the oil-star line Xi edge xi edge

Respiratory excursion of the lower edge of the lungs

On the average axillary line inhale 6 cm 6 cm, exhale 4 cm 4 cm

Auscultation

Main respiratory noise - Listens to vesicular breathing, is evenly carried out in all departments.

Side respiratory noise - Not detected

Bronchophony - weakened, over the symmetric sections of the chest is the same on both sides.

Circulatory system system

Inspection of the heart of the heart

The chest in the heart area is not deformed. The top push is visually determined.

Palpation

Cardiac push is not determined, the top push is located in the V inter estreon on the left by the middle-clearable line, positive, loose, 1 cm wide, low.

Percussion

G.ani.tsy relative dullness of the heart

Right - in the IV intercosta for 1 cm. The duck from the right edge of the sternum.

Left - in V inter estreon by 1 cm Knutrice from the mid-clavical line.

Upper - at level III edge

Paboutpeluchsuspensive dullness of the heart

Right - 3 cm

Left - 8 cm

Shared - 11 cm

Width vascularaboutgo beam- 5 cm

Heart configuration - Normal

G.andnits of the absolute stupidity of the heart

Right - left edge of sternum

Left - on the mid-croilent line

Top - at level IV rib

Auscultation

Rhythmic heart tones, muted, i tone weakened, II tone loud, listened to III tone (rhythm of gallop), no noise. Rhythm of the heart is right

Research vessels

Inspection of vessels

There are no arteries with the visible pulsation, the symptom of the Mussy is negative, the arteries are dense.

Palpation

The pulse on the left hand coincides with the pulse on the right hand, full, intense, normal value, uniform, frequency 105 ice / min, no pulse deficiency. The capillary pulse is absent.

Auscultation

Double tones of Traube and the noise of Drozier over the femoral artery are not listened.

Research by Ven.

There is no swelling and visible pulsation of the cervical veins, the pulse is weakly expressed, negative, with auscultation there is no noise of the wag.

Blood pressure - right hand - 140/90 mm RT Art, left hand - 140/90 mm Hg. Art.

System of organsfoodevaria

Inspection

Oral cavity - Pink mucosa, wet, no rash. Pink language, wet, covered on the back of a white bloom. The mucous membrane, solid sky, pink coloring. Pink color, wet, smooth. The almonds of medium sizes, swelling and plaque are not.

Stomach - The correct shape, symmetrical, do not detect hernia. There is no visible intestinal peristaltics. Subcutaneous veins are not expanded. There is an excessive development of subcutaneous fatty fiber. Abdominal circle - 100 cm.

Palpation of belly

Surface palpation - The abdominal wall is soft, painless, divergence of direct abdominal muscles, no hernia. Symptom of brush-blubberg negative.

Deep palpation - Palpation is painless.

Percussion

A tympanic sound is listened to the entire surface of the belly.

Auscultation

In the auscultation of the intestine, the rumbling is listened, the noise of the friction of the peritoneum is not. Peritoneal symptoms are negative.

Liver and gallbladder

Inspection - There is no visible increase and ripple liver, the gallbladder is not palpable.

Palpation - The lower edge does not protrude from under the rib arc, smooth, painless, soft consistency.

Percussion - borders of the liver in the Kurova 9 - 8 - 7 cm.

System of urinary organs

Urination is free, painless. Daily diuresis 1.5 l, no dysuric disorders.

Inspection - Lumbar region unchanged.

Palption The kidneys is painless, the urinary bubble disease is not.

Percussion - The symptom of Pasternatsky is negative, there is no urinary bubble pain.

Examination plan

1) Common blood test

2) biochemical blood test

3) general urine analysis

6) Radiography of the chest

Additional examination data

Commonblood test 27.02.04

Erythrocytes 3.9 million / l

Leukocytes 10.2 thousand / l

Rangered 1%

Segmented 76%

Eosinophils 0%

Basophiles 0%

Monocytes 3%

Lymphocytes 20%

SE 43 mm / h

Blood chemistry 27.02.04

Cholesterol 5.17 mmol / l

Protein total 75 / l

Globulins 26 g / l

Albumin 46 g / l

Fibrinogen 3 g / l

Bilirubin total 10 μmol / l

Creatine 1.4 mg%

Urea 3.7 mmol / l

Sugar 5.6 mmol / l

General urine analysis 27.02.04

Number of 100 ml

Straw

Acosite reaction (pH 6.0)

Specific weight 1016.

Transparent

Protein - Negative

Sugar - Negative

Epithelial cells 1-2 in sight

Leukocytes 1-2 in sight

Bacteria - Negative

ECG27.02.04

Pathological teeth Q, the rise of the ST segment, negative teeth t in leads I, AVL, V 2 -V 6

Radiography of the chest 04.03.04

An increase in left ventricle, lengthening and sealing aorta, arterial hypertension in the lungs.

Echocardiography 04.03.04

Seal of aortic, moderate thickening of the interventricular partition, expanding the left heart offices with a decrease in the reduction of the left ventricle. Hypokinesia zones in the field of advanced segments.

Diagnosis and its rationale

Diagnosis of IBS, acute transmural advanced myocardial infarction raised on the basis.

The painful syndrome - at the time of arrival, the patient complained about the intensive pain of the compressive nature of the sternum, irradiating into the left hand, a duration of more than 30 minutes, alone.

Resort-necrotic syndrome - poor well-being, an increase in body T (37.2 C), an increase in the level of AST (0.75 μmol / l), leukocytosis (10.2 thousand / l), accelerated ESP (43 mm / h), raising KFK-MV (16 me / l) and lifting LDH 1 (7 me / l).

Hypertensional syndrome - headaches, dizziness, fast fatigue, raising the garden to 220 mm RT Art, ECG and EhCG - signs of hypertrophy of myocardium left ventricle.

Change syndrome on ECG - pathological teeth Q, the rise of the ST segment, negative teeth tons in leads I, AVL, V 2 -V 6 - which indicates an acute stage of the myocardial infarction. The return of the ST segment on the isoline with the persistent pathological teeth Q and negative T - the transition to the subacute stage.

Laboratory syndrome is an increase in KFK-MV (16 me / l), lifting LDH 1 (7 me / l).

Heart failure syndrome - fast fatigue, shortness of breath at night and with a light physical activity, with an objective study - the dilatation of the left ventricle, the rhythm of the gallop, the data Echocrium and the RG of the chest cell - hypertension in the small circle circle, reduction of contractile ability, dilatation of the left ventricle.

Differential diagnosis

1) Acute pericarditis - pain is associated with breathing phases, movements, increase in the lying position, with an objective study of the heart, the noise of fridge friction is revealed, on the ECG high t and lifting the ST above the isoline in all leads.

2) Thrombembolism of the pulmonary artery is the beginning of the disease after surgery in patients with deep thrombosis veins of the lower extremities, the presence of clinical and ECG syndromes of infarction of light and infarction of pleuropneumonia with hemlohemia, the noise of friction of the pleura, cyanosis, the lack of symptoms on the ECG characteristic of the myocardial infarction.

3) aortic aortic aneurysm - sudden long-term oversized pain, lack of ECG signs of myocardial infarction, asymmetry of the pulse and hell on their hands and legs.

This patient has no symptoms characteristic of these diseases, but there are symptoms confirming the diagnosis of acute myocardial infarction.

Treatment

1) Mode - bed with subsequent expansion.

2) Table number 10.

3) fibrinolities (streptocinase 1.5 million units / in drip in 100 ml of 0.9% NaCl solution).

4) Oxigenotherapy.

5) Anticoagulants (heparin 25000 df / to 5000 users 4 times a day).

6) Antiagregants (aspirin 1/2 tablets 1 time per day).

7) ACE inhibitors (Anap 1 tablet 1 time per day).

8) Polarizing mixture (5% glucose 250 ml, 4% potassium chloride 100 ml, insulin 6 units) V / in drip 1 time per day.

9) Nitroglycerin.

10) Nitrosorbit.

11)? -Adrenoblocators (metoprolol).

Diary

The general condition is satisfactory, complaints for shortness of breath with moderate loads, T body 36.7 C. Objectively - the tones of the heart are weakened, pulse 75 ° C / min, AD 135/85 mm RT Art, Chadd - 17 per minute. In the light breath of vesicular, there are no wheezes. Language, oral mucosa wet, pink. The belly is symmetrical, do not break, with a painless palpation.

The overall condition is satisfactory, no complaints, t body 36.9 C. Objectively - the tones of the heart are weakened, pulse 80 ° C / min, Hell 140/85 mm RT. Art., Chdd - 16 per minute in the lungs breath vesicular, there are no wheezes. Language, oral mucosa wet, pink. The belly is symmetrical, do not break, with a painless palpation.

E.picris

The patient is located on inpatient treatment in the cardiology department from February 27, 2004 on the occasion of IBS, acute transmural advanced myocardial infarction related - hypertension III, obesity II complication is heart failure II.

The patient came with complaints of squeezing sacrifice pain, irradiating into the left hand, a duration of more than 30 minutes, general weakness, a sense of lack of air, death fear, headache, increased sweating.

An objective-increased body weight, an increase in body t (37.2C), tachycardia (105 ° C / min), with percussion - expansion of heart boundaries, with auscultation - weakened i tone over the top, listened to III tone (protodiastic rhythm of gallop).

Studies have been made - general blood test, biochemical blood test, general urine analysis, ECG, ECCG, chest radiography.

Clinical syndromes were isolated - pain, resorbative-necrotic, hypertensional, changes syndrome on ECG, laboratory syndrome, heart failure syndrome.

Appointed treatment - thrombolytics, anticoagulants, disagrements, nitrates, ACE inhibitors, potassium preparations.

At the moment, the patient's condition is satisfactory, the outcome of the disease as a result of treatment is an improvement.

Recommendations - therapeutic physical culture, avoid severe physical exertion, emotional stress, stress, diet with low content of animal fat, and digestible carbohydrates rich in polyunaturated fatty acids, anti-beerogenic substances, vegetable fiber, seafood, accommodation in environmentally friendly terrain, frequent outdoor walking , Spa treatment. Periodically observe the cardiologist. With the sensation of symptoms of angina, taking nitroglycerin.

The forecast is favorable.