From this article you will learn: what is the pre-infarction condition, what are its causes and symptoms. What you need to do in order to avoid the development of myocardial infarction.
Background of the article:
- The reasons for the pre-infarction state
- Characteristic symptoms
- Diagnosis
- Treatment methods
- Forecast
Pre-infarction is a disease associated with a sudden restriction of the blood supply to the heart muscle, which does not lead to cardiac cell death.
This term is often used by doctors to explain the seriousness and danger of the condition to the patient and his relatives, emphasizing the possibility of developing a myocardial infarction( abbreviated MI).The diagnosis behind it is unstable angina.
A patient with a pre-infarction condition has a rather high risk of a life-threatening myocardial infarction, and therefore he needs urgent medical care. If properly treated, the danger to the health and life of a person with unstable angina is significantly reduced.
With the help of modern methods of drug therapy and minimally invasive surgical interventions, many patients manage to completely eliminate symptoms of pre-infarction and reduce the risk of myocardial infarction.
Cardiologists, therapists and cardiac surgeons are in the process of pre-infarction.
Causes of pre-infarction status of
Three factors involved in the development of pre-infarction:
- The discrepancy between the needs of the heart muscle and the delivery of blood through the coronary arteries.
- Rupture of atherosclerotic plaque and thrombosis.
- Spasm of the coronary arteries.
1. Inconsistency between needs and delivery of oxygen
Unstable angina occurs due to an increase in myocardial oxygen demand or because of reduced delivery of coronary arteries.
The increased need of cardiac muscle in these substances can be caused by:
- Increased body temperature.
- Increased heart rate.
- Very strong increase in blood pressure( BP).
- Thyrotoxicosis( a disease of the thyroid gland, in which many thyroid hormones are produced).
- Pheochromocytoma( adrenal tumor that produces norepinephrine).
- Use of cocaine or amphetamines.
- Aortic stenosis. Congestive heart failure.
Aortic stenosis Reduced oxygen delivery may be caused by:
- anemia;
- hypoxia( decreased oxygen saturation of the blood);
- decrease in blood pressure.
Doctors believe that the discrepancy between the request and delivery of oxygen to the heart muscle is responsible for about a third of cases of pre-infarction.
2. Rupture of atherosclerotic plaque and thrombosis
Most of the cases of unstable angina are caused by a sudden narrowing of the coronary artery lumen, which causes a deterioration in the blood supply of a part of the heart muscle. This narrowing most often develops due to atherosclerosis - a disease in which fats and cholesterol, forming plaques( atheromas), are deposited in the inner layer of the arteries. As it grows, the atherosclerotic plaque gradually causes narrowing of the artery lumen, causing the development of symptoms of stable angina.
Most cases of pre-infarction are caused by an atheroma rupture. At the site of damage to the vascular wall, a thrombus is formed, which sharply worsens the blood flow along the affected artery and causes symptoms of the pre-infarction state. This place is unstable, at any time the thrombus that appeared in it can completely cut off the coronary artery and cause MI.
3. Spasm of the coronary arteries
Rarely pre-infarction can be caused by a spasm of the arteries, which temporarily blocks blood flow and causes an attack of angina pectoris. In most of these cases, an atherosclerotic plaque also participates in the development of vasospasm. Other causes include cocaine use, cold weather, emotional stress.
Coronary spasm Symptoms of
Symptoms of pre-infarction are practically the same as those of myocardial infarction, therefore, when they occur, it is urgent to see a doctor. These include:
- Pain, discomfort or chest compressions.
- Intensive sweating.
- Shortness of breath.
- Nausea and vomiting.
- Pain or discomfort in the back, neck, lower jaw, upper abdomen, in the hands or shoulders. Dizziness or sudden weakness.
- Accelerated heart beat.
The clinical picture of unstable angina has the following characteristics:
- symptoms began within the previous month and gradually become more severe;
- angina attacks restrict physical activity and daily activities;
- symptoms suddenly become more frequent, severe and prolonged, they occur with less physical exertion;The
- attack occurs in a state of rest, without any stress or stress. In some patients, angina develops during sleep;
- symptoms do not pass during rest or after taking nitroglycerin.
Compared to men, women with pre-infarction are more likely to experience shortness of breath, nausea, pain in the back or lower jaw. Although the main first signs of unstable angina in the representatives of both sexes - pain or discomfort in the heart.
Diagnosis
Sometimes, on the basis of the clinical picture, even an experienced cardiologist can not distinguish the pre-infarction state from the present MI.To establish the correct diagnosis and determine the tactics of treatment for a patient with pain in the heart area, the following is done:
- Electrocardiography( ECG) is a test that records electrical activity in the heart with the help of electrodes attached to the patient's skin. Abnormal impulses may indicate a deficiency of oxygen in the myocardium. In many patients with pre-infarction, the ECG can be normal, especially if it is not recorded during an attack. In some patients, unstable angina from small-focal myocardial infarction can not be distinguished with the help of ECG.
- Blood tests, which detect certain substances that enter the bloodstream when cardiac cell death. With the help of these tests, differential diagnosis is performed between the pre-infarct and myocardial infarction.
- Echocardiography is an ultrasound examination of the heart, by which it is possible to evaluate the contractile function of the heart, as well as to reveal its structural disturbances.
Click on photo to enlarge Treatment methods
Treatment of pre-infarction condition consists of two stages:
- Pain relief.
- Prevention of disease progression and myocardial infarction.
To determine the right treatment strategy, doctors assess each patient's risk of developing cardiovascular complications in the near future. This evaluation is carried out on a special scale, which includes the following indicators:
- the age of the patient;
- presence of other risk factors for cardiovascular diseases( such as smoking, high blood cholesterol, hypertension, diabetes mellitus);
- results of laboratory examination;
- character changes on the ECG.
Based on an assessment of the risk of developing MI, doctors choose a conservative or invasive patient management strategy.
Conservative treatment strategy
A conservative strategy for the treatment of pre-infarction is used with a low risk of developing a heart attack in the near future. It involves the provision of drug therapy, which includes the following groups of medicines:
- Antiaggregants - prevent the formation of thrombi in the site of damaged atherosclerotic plaque, worsening platelet aggregation( adhesion).It has been scientifically proven that the use of antiplatelet agents in patients with pre-infarction status reduces the risk of MI and stroke. The most commonly prescribed drugs from this group include aspirin, clopidogrel( plavix), and ticagrelor( brilite).The main side effect of antiplatelet agents is an increased risk of bleeding.
- Anticoagulants are drugs that affect the factors of blood coagulability and prevent the formation of blood clots. These drugs are prescribed only in the acute period of pre-infarction. These include heparin, enoxaparin, fondaparinux.
- Statins are drugs that reduce blood cholesterol levels. These include atorvastatin, simvastatin, rosuvastatin.
- Beta-blockers are drugs that reduce blood pressure and pulse rate and have antiarrhythmic action. Due to these effects, beta-blockers reduce the burden on the heart and reduce the risk of myocardial infarction. To this group belong metoprolol, nebivolol, bisoprolol, carvedilol.
- Angiotensin converting enzyme inhibitors are medicines that promote vascular relaxation, lower blood pressure and reduce heart burden. These include ramipril, perindopril, lisinopril.
- Nitrates are drugs that dilate the blood vessels. Thanks to this action, they improve the blood supply of the myocardium and relieve the attack of angina pectoris. Despite its effectiveness in eliminating pain in the heart, nitrates do not reduce mortality and the risk of myocardial infarction. The most commonly used drugs are nitroglycerin and nitrosorbit.
If medication fails to eliminate pre-infarct symptoms, doctors recommend an invasive treatment strategy.
Invasive treatment strategy
An invasive treatment strategy is used in patients with unstable angina that have a high risk of developing myocardial infarction, or in the ineffectiveness of conservative drug therapy.
The purpose of the invasive strategy is to detect the place of narrowing of the coronary artery, which is responsible for the appearance of the pre-infarction state, and its elimination.
Click on photo to enlarge For coronary artery pathology, coronary angiography is performed - a minimally invasive examination, during which a contrast agent is injected into the lumen of these vessels by means of a thin catheter and radiography is performed. After performing coronary angiography and finding the sites of constriction of the arteries of the heart, doctors can restore their patency with:
- Angioplasty and stenting is a minimally invasive operation consisting of enlarging the artery lumen with a special balloon and stent( intravascular prosthesis) wound to the site of the vessel narrowing with a thin catheter.
- Bypass surgery is an open heart surgery, during which cardiosurgeons create a bypass for the blood flow( shunt), bypassing the site of the narrowing of the coronary artery.
With these operations, most patients manage to significantly improve blood supply to the heart muscle and avoid the development of myocardial infarction. It should be remembered that conducting surgical treatment of unstable angina does not mean that medication can be abandoned.
Changing the lifestyle of
Regardless of the chosen treatment strategy, all patients diagnosed with "preinfarction" are recommended to adhere to the rules of a healthy lifestyle, which includes the following:
- quitting;
- healthy eating;
- physical activity;
- blood pressure monitoring;
- maintaining a normal weight;
- refusal from abuse of alcoholic beverages;
- control of stress.
Forecast
The prognosis for unstable angina depends on many factors that affect the risk of myocardial infarction. According to statistical data, pre-infarction leads to the death of 4.8% of patients within 6 months.
