Transmural myocardial infarction: what is it, dangers and treatment

An infarction is a phenomenon in which a part of an organ begins to die due to a lack of blood supply.

Myocardial infarctions - heart muscle - are often and extremely life-threatening, because they are heard by many people interested in medicine and taking care of their own health.

Let's figure out what a transmural myocardial infarction is and how this condition differs from other forms.

Content

  • 1 Features
  • 2 Causes and risk factors
  • 3 Complications and consequences
  • 4 Symptoms
  • 5 Diagnostics
  • 6 First Aid
  • 7 treatment tactics
  • 8 forecast
  • 9 Rehabilitation
  • 10 Prevention

Features


prefix "trans" in medicine and biology means «through», «through» .Transmural differs from other types of infarction in that it causes the death of cells not only in the middle heart muscle, but also in other layers of the heart - the epicardium and endocardium.

Necrotic foci, that is, the area where the cells died out, underwent necrosis, penetrated the heart wall right through. Other forms of myocardial infarction do not affect the outer and inner membranes of the heart, limiting only to the middle, muscle shell.

About 1/5 of all sudden deaths occur in the transmural infarction .In men, the disease is 5 times more common than in women. Of all those who survived this form, up to 19-20% die in the first month.

Causes and risk factors

Heart attacks occur as a result of insufficient blood supply to the organ or its site. Having lost access to oxygen and nutrients, cells begin to die, that is, necrosis occurs. Transmural myocardial infarction occurs according to the same scheme.

Disorders of blood supply arise because the lumen of the coronary artery is blocked by the atherosclerotic plaque .As a result, the heart loses oxygen and nutrients, but in a calm state it is not dangerous.

When an is a stressful situation or a person is engaged in intensive labor of , the blood flow rate increases, a turbulent turbulence develops around the plaque. It damages the inner surface of the vessel and causes the formation of a thrombus, which further complicates the blood supply to the heart.

As a result of the lack of oxygen that is supplied to the cells of all three layers of the heart together with blood, the death of these cells begins.

The root cause of this type of heart attack is the presence of sclerotic plaques in the coronary arteries. Risk factors are:

  • Age( transmural infarction - a disease of people over 45 years of age);
  • Genetic predisposition;
  • Increased cholesterol in the blood;
  • Obesity;
  • Tobacco smoking;
  • Hypodinamy;
  • Stressful situations;
  • Incorrect diet;

At the same time, more than 35% of cases are associated with smoking , which makes it the most important risk factor.

Complications and consequences

Of all types of infarction, this species is the most dangerous, as it affects all three of the heart's shells. Depending on the area of ​​non-trichotic changes, small-focal and large-focal transmural infarction is distinguished. The last is characterized by numerous and very dangerous complications of , among which:

  • Thromboembolism;
  • Pulmonary edema( causes, clinic, tactics of care);
  • Paralyzed limbs;
  • Violations of speech;
  • Fibrillation of the ventricles, which leads to death;
  • Failure of various organs and systems;
  • In severe cases, a heart break.

Small blood clots, which are formed in large numbers during a heart attack, can be recorded with blood flow to the brain or spinal cord, plugging capillaries and depriving blood supply to separate parts of these organs. This is the cause of speech or paralysis .

Clogging of blood vessels with thrombi can lead to the failure of any organs and is one of the most dangerous complications.

The heart rupture of occurs suddenly and represents a violation of the integrity of the heart in an area affected by necrosis. The larger this area is over the area, the greater the probability of a rupture.

Ventricular fibrillation is a phenomenon in which instead of normal contractions of , the ventricles of the heart begin to tremble .At the same time, they can not push blood out, because of what blood supply of all organs and systems that remain without the intake of oxygen and nutrients ceases.

Ventricular fibrillation can soon turn into fluttering - a tremor with a frequency of up to 400 Hz. In this condition, the heart too can not provide blood circulation, and therefore death soon begins.

Symptoms of

Symptoms can be different and depend on the characteristics of the course of the disease. But there is also the group of symptoms common to the majority of those suffering acute transmural myocardial infarction:

  • Frequent painful heartbeat( tachycardia);
  • Sensation of "fading" of the heart;
  • Acute compressive pain, which gives to the left arm, left scapula, left half of the lower jaw, teeth, left ear;
  • Blurred skin and mucous membranes;
  • Wavy, prolonged pain, which can not be released from a few hours to a day;
  • Asthma attacks( cardiac asthma).

Diagnostics of

In order to diagnose transmural myocardial infarction, should be performed with ECD .Since electrocardiography is based on the study of electrical potentials in different parts of the heart, and with necrosis the pattern of distribution of these potentials changes drastically, an experienced specialist will be able, based on the ECG and find out where the lesion is located, and approximately its area, and distinguish transmural infarction from other types of necrotic changesin heart.

You can learn about the area of ​​the affected area on the basis of the blood test .So, after a heart attack, the number of white blood cells( leukocytes) increases. Leukocytosis can last up to 14 days, and when the number of leukocytes begins to decrease, the sedimentation rate of red cells( erythrocytes) increases.

First aid

Transmural infarction is a very dangerous condition, death can occur suddenly and at any time, therefore, an intervention should begin before the doctor arrives. Here is the list of such events:

  • Call an ambulance;
  • Take the patient to the horizontal position;
  • Patient should take nitroglycerin - 1 tablet. If the pain does not go away, after 5 minutes, take another one. More than 3 tablets should not be taken;
  • You should also take an aspirin tablet;
  • In case of shortness of breath and wheezing in a patient, the patient should be placed in a sitting position, and under the back, he should slip a cushion or pillow.

More on helping a patient with a heart attack and loss of consciousness see the video:

These simple activities will help save a patient's life before the arrival of specialists.

Tactics of treatment

At the hospital phase of , the treatment is based on three directions:

  • Combating pain syndrome and psychological consequences;
  • Control of thrombosis;
  • Fighting heart rhythm disturbances.

uses strong drugs, including morphine and promedol, to relieve the patient of the pain syndrome, and tranquilizers, for example, Relanium, are used to fight fears and excitement.

Thrombolytic therapy is aimed at eliminating blood clots in the coronary vessels and restoring the normal blood supply to the heart. For this, drugs such as fibrinolysin, alteptase, heparin are used. The fight with blood clots should start as early as the first hours after a heart attack.

For the control of arrhythmias use the drugs that block beta-adrenoreceptors( atenolol), and nitrates( already mentioned nitroglycerin).

In this case, maintenance therapy can continue for the rest of the patient's life.

Forecast

Prognosis depends on the area of ​​the affected heart. The lesion of more than 50% of the myocardium results in the death of .Even with a small area of ​​the lesion, the possibility of death due to thromboembolism or a heart rupture remains possible.

Even if the acute period has been passed and no serious complications have arisen, the prognosis is considered as a conditionally unfavorable due to irreversible changes in muscle tissue that result from a heart attack.

Rehabilitation

During the rehabilitation period , the correct nutrition of the is very important. Food should be rough, easily digestible and taken in small portions 5-6 times a day. At first, the diet should consist of cereals, dried fruits, juices and kefir. Also, dried apricots, beets and other products that help to empty the intestines.

Over time, the diet expands, and the diet becomes normal, but fatty foods with high cholesterol should be avoided throughout life.

Physical rehabilitation includes gradual return to the patient of the motor activity of .In the early stages it is important to prevent stagnant phenomena in the lungs, muscle atrophy and other consequences of an immobile lifestyle. Gradually, as the patient recovers, he begins physical exercises, walking.

It is advisable to conduct rehabilitation activities in sanatoria .The rehabilitation period is individual and depends on both the area of ​​the heart and the complications.

Prevention


Prevention measures are reduced to eliminating the risk factors listed above. To avoid a tramural infarction, it is necessary: ​​

  • Refuse to smoke;
  • Observe low-cholesterol diet;
  • Reduce consumption of table salt;
  • Fighting obesity;
  • Monitor the pressure( it should not exceed 140/90 mm Hg);
  • Avoid strong stress;
  • Avoid heavy physical activity.

From other types of myocardial infarction, the transmural infarction differs in that it affects not only the myocard, but also two other cardiac membranes( epicardium and endocast), consisting of connective tissue. For this reason, the likelihood of heart rupture and thromboembolism increases.