Acute myocardial infarctionoccurs in women and more often in men. It is necrosis of the affected area of the cardiac tissue due to reasons that we will discuss later. There is a direct connection between angina and myocardial infarction; but if in angina the disturbance of cardiac muscle blood supply occurs for a short time and is a reversible process, then with myocardial infarction, this process of disturbing the supply of oxygen and food by the blood is already irreversible and stable.
After healing of the affected part of the tissue of the heart muscle, it is replaced by cicatrical (connective), which leads to a significant deterioration of the heart.
Let's talk about the first signs, symptoms and treatment of acute myocardial infarction and the principles of providing first-aid and emergency medical assistance to medical workers.
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Causes
Factors provoking the development of the disease are: nervous, emotional or physical overstrain, heavy muscle work, fast walking. The risk increases smoking, overload of the stomach with abundant food, especially greasy, and also the reception of alcoholic beverages.
Myocardial infarction can develop for various reasons. The first and most important reason is the organic narrowing of the lumen of the coronary artery or its large branches on any segment due to the developmentatherosclerotic process.
Another reason -spasm of the coronary artery,that is, pathological temporary contraction of the walls of the vessel and the cessation of nutrition of a certain area of the heart muscle.
The third important cause of myocardial infarction isformation of a thrombus in the coronary arteries.The tendency to thrombosis is determined by such factors as the narrowing of the vessel due to the formed atherosclerotic plaques, violation of the smooth surface of the inner wall of the vessel, changes in the anti- system of the body.
An important factor contributing to myocardial infarction is the state of collateral (accessory) circulation. The weaker the development of auxiliary vessels that feed the heart muscle, the greater the risk of a heart attack. Since in sports people, the collateral circulation is well developed, the chances of getting an infarct in athletes are much less than in people untrained. At present, people have a notion of "running away from a heart attack which means daily running.
First signs and symptoms
Myocardial infarction in 90% of cases begins with severe pain syndrome.Pain appears in the heart area, as well as behind the breastbone, and sometimes cover the entire chest. The patient feels that in the chest area he has a red-hot iron.
Pain in myocardial infarction is very intense ("tearing") character and can be so strong, that the patient loses consciousness and develops a shock - there is pallor, cold sweat, falls sharply pressure.
If angina pectoris pain can be removed with nitroglycerin or validol, then with myocardial infarction these medications are powerless.
In rare cases, myocardial infarction develops without pain and manifests itself immediately as symptoms of cardiovascular failure.This is more often observed in patients of elderly and advanced age, suffering more or less longly myocardial lesions on the basis of cardiosclerosis. This option is also often found with repeated myocardial infarctions.
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After the attack of acute pain passes, the patient's condition improves somewhat, butAfter two or three days there are signs of a circulatory disorder. These include, in the first place, cardiogenic collapse, cardiac asthma and pulmonary edema.
Cardiogenic collapsecharacterized by a sharp drop in blood pressure, the appearance of a weak frequent pulse. The patient is covered with a cold sweat. He has shortness of breath and cyanosis of the lips (cyanosis).
Whenpulmonary edemaon the foreground appear phenomena from the lungs - choking, coughing with the release of foamy pink sputum, a sharp weakness.
If the infarction stagnant increase in the myocardium affects the right heart (right half), then the patient developsswelling of the liver.
If the myocardial infarction does not end with the death of the patient, then later part of the heart tissue in place of necrosis is replaced by a connective scar tissue. This tissue is not working, and therefore in the future the patient develops chronic heart failure.
First aid first aid
Patients with acute myocardial infarction in need of urgent hospitalization and treatment in a hospital. Treatment of myocardial infarction should be started as soon as possible. Very often it happens that the sick man should render himself first aid.
With a strong attack of angina (pre-infarction), the patient should put a pill under the tongueNitroglycerin. If the pain does not pass, then after 5 minutes the patient should take a second pill and, if pain persists for the next 5 minutes, another tablet (only 3 tablets, sometimes it is allowed to take nitroglycerin up to five tablets with an interval every 6 minutes for half an hour).
If after a three-time intake of Nitroglycerin pain does not go away, you need to urgently call an ambulance.
Before the arrival of the "First Aid" it is possible to chew the Aspirin tablet, which is then washed down with water.
Further treatment is carried out by medical specialists: analgesic treatment, treatment to prevent formation blood clots, treatment to support the work of the heart in case of heart failure, treatment to eliminate rhythm disturbances and etc. In some cases, surgical restoration of the patency of the coronary arteries is applied, but this is if there is a possibility and conditions for such treatment.
At the beginning of the treatment, the main emphasis is on medication.
Of medicinal plants, only plants that have soothing and coronary-expanding properties are used.
REMEMBER that the treatment of plants with acute myocardial infarction can only be ancillary.
Folk remedies not for first aid
Extracts, decoctions, infusions of various herbs can only supplement or temporarily replace the effect of chemical medicines. So, for example, the auxiliary therapeutic effect of hawthorn preparations will consist in the fact that it has a vasodilating, soothing effect and lowers arterial pressure.
The role of medicinal plants significantly increases in the recovery (rehabilitation) period, which begins with the third or fourth week of the disease. It lasts a long time, and, of course, all this time the patient can not be kept only on pharmaceutical preparations. The method of application of medicinal plants is almost the same as in chronic heart failure and angina pectoris.
Leonurus preparationsreduce blood pressure, have a calming effect.
Flowers and leaves of lily of the valley and adonisalso have a weak cardiotonic effect and favorably affect the patient's condition.
When myocardial infarction is used: arnica mountain (inflorescence), astragalus woollyflower (grass or flowers), valerian root, sweet potato grass, watch leaves three-leaved, rhizome of elecampane high, flowers and leaves of wild strawberry, marshmallow shoots, meadow clover flowers, horse chestnut flowers, labradore grass, cuff leaves common, herbs lemon balm and peppermint, rose petals of the Crimean flower, dill vegetable (whole plant), fennel fruits, dandelion root of the drug, fruits rose hips, corn stigmas, leaves of mother-and-stepmother, flowers of immortelle sandy, grass swamp grass, grass of oregano, grass of willow white, leaves of small-leaved beetle, fruits mountain ash, raspberry shoots, chicory root of common, burdock root of large, chicory root of common, grass of St. John's wort, perforated straw of oats, rhizome of the Baikal skullcap, herb rue fragrant, flowers and lavender grass, guelder rose flowers, medicinal sage herb, broadleaf lime flowers, carrot roots, cranberry fruits, garlic and onions (whole plant).
For the treatment of myocardial infarction(NOT IN THE ACUTE STAGE!)folk medicine also recommends the following herbal medicinal folk remedies.
The hazel is dendritic (hazel).Preparations from hazelnut dilate the vessels of the heart and are therefore indicated in all types of ischemic disease. Tinctures and infusions of common hazelnut lower blood pressure, act on the nervous system as calming agent and enhance the action of painkillers for myocardial infarction and angina pectoris.
Leaves and bark hazel in folk medicine are used and as a good tool for the treatment of hypertensive disease and prostate adenoma in men.
Infusion:A tablespoon of chopped and dried leaves or bark pour a glass of boiling water. Infuse 1 hour in warmth. Drink 2 tablespoons 3-4 times a day.
Pasternak inoculum.Preparations from parsnip are a good antispasmodic, and also softly lower arterial pressure and dilate the blood vessels of the heart.
Medicinal raw materials are the roots and seeds of parsnip. Of these, Furocumorin tablets are prepared, which are taken with ischemic heart disease (1 tablet 4 times a day).
Olive.Infusions and decoctions of olive leaves are used in folk medicine as a coronary dilatation and antiarrhythmic remedy. Extracts from olive leaves have a pronounced hypotensive effect.
Tincture.100 g of kidneys together with the leaves, pour 300 ml of 96% alcohol. Insist 7 days in a dark and warm place. Strain. Drink 30 drops 3-4 times a day for ischemic heart disease, hypertension and atherosclerosis.
Infusion.2 tablespoons dried and chopped leaves with buds, pour 300 ml of boiling water. Insist 1 hour, strain. Drink one third of the glass 3-4 times a day.
Carrot juice.All patients who underwent myocardial infarction, it is recommended to drink a half cup of carrot juice with 1 teaspoon of sunflower oil daily.
Cookcomposition: take 10 g of freshthe leafy stems of parsley,chop and pour 1 literwhite or red natural grape wine,add2tablespoons of wine vinegar and boil on low heat for 10 minutes. Then add 300 g of honey to the mixture and boil for another 5 minutes. In hot form, pour into bottles, seal and after cooling, keep in the refrigerator. Take 1-3 tablespoons a day for all heart diseases as a general restorative.
Cookmixture:125 g of crushed fruitfigs,250 grams of ground without seeds (but with peel)lemons,250 gramshoneyand 50 gof vodka.All stir with a wooden spoon and store in the refrigerator. Take 1 tablespoon 3-4 times a day as a restorative for all heart diseases.
In glassbirch sapdissolve a tablespoonhoneyandjuice of half a lemon.Drink at one time in small sips in the morning on an empty stomach with hypertension, edema, heart edema, insomnia.
100 g of dry ground grassSt. John's Wortpour 2 liters of water. Boil on low heat for 10 minutes, insist 1 hour at room temperature, strain. Add 200 ghoney,stir. Store in a sealed container in the refrigerator. Take one third of the glass three times a day with a weakened cardiac activity.
With pain in the heart with ischemic disease, as well as after a heart attack, folk medicine advises to apply the followingcomposition:
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- 5 heads of garlic;
- 5 lemons with skin;
- , kg of honey.
All grind in a meat grinder, mix with honey, infuse for 7 days. Take 1 tablespoon 3 times a day on an empty stomach. The course of treatment is 2 months. The drug is one of the best after a heart attack and myocardial infarction with persistent ischemic disease.
With a weakened heart, disruptions in his work, folk medicine advisespeppermint.A teaspoon of dry chopped leaves pour a glass of steep boiling water and leave for 1 hour. Strain. Drink 1 glass in the morning on an empty stomach for a long time. Do not take breaks in treatment for six months.
To prevent myocardial infarction and stroke are useful fresh fruitsirgi,as well as infusions and decoctions of them and leaves of irgi with kidneys.
With heart disease is usefulpotato diet:a patient during the day give up to 1 kg of boiled unsalted potatoes (5-6 receptions of 200 g). To improve the taste, freshly prepared sour milk can be added to the potatoes.
With pain in the heart, coronary artery disease, hypertension and palpitation of the North Caucasus peopleleaves of large-flowered magnolia.100 g of fresh chopped magnolia leaves pour 500 vodka or alcohol and insist in a dark place for 7 days, periodically shaking the contents. Strain. Take 20 drops with water 2-3 times a day.
With angina pectoris, heart failure after a heart attack, with hypertension and chronic heart failure takeastragalus fluffy-flowered.100 g of fresh ground astragalus grass fill with 1 liter of dry white wine, insist in a dark cool place for 3 weeks, shaking periodically, strain. Take 1 tablespoon 3 times daily before meals.
The advice of the traditional healer Irina Vasilyeva
But what advice the well-known healer Irina Vasilieva gives to her patients-hearts:
."1. Put the kidneys, lungs, intestines and liver in order.
- Learn to limit the depth of breathing. Develop a habit in case of danger to reduce the depth of breathing and stretch the stomach. Practice lying in bed. This simple trick helps you out and does not have any bad consequences. In addition, you need to try to avoid stress. Learn auto-training!
- With severe heart pains, take a half-caplet of any valerian root infusion into your mouth. A mixture of valerian with hawthorn, drops of Zelenin works very well. Do not swallow immediately, hold in your mouth for 5-10 minutes, then swallow. During this time you will have time to stick out your stomach, reduce your breathing and massage your heart meridian.
- The external course of the meridian of the heart begins in the armpit basin, passes along the ulnar side of the shoulder and forearm, both on the left and right hand, then - along the ulnar edge of the hand and ends at the nail little finger. The direction of flow in the meridian is from the shoulder to the little finger. It is very useful to rub the meridian from the elbow to the little finger, with effort until the heat in the hand. Try it now! For this, roll up the sleeves and rub until the appearance of heat, the elbow margin of the forearm and hand. First on the left, and then on the right hand. Now find the pulse on your wrist, count the heart rate. If the heart beats often and strongly, it needs to be reassured. To do this, massage slowly and strongly the wrist area between the first and second wrinkles. If the pulse is rare and weak, the heart needs to be toned. For this, quickly and easily squeeze the tip of the little finger at the elbow bed: be careful! Strain your throat. Blood pressure may rise.
- Place your right palm under your left breast on your heart. Cover your eyes. Think of the heart with gratitude. Thank him for the work, calm him, stroke, tightly pressing his palm to his chest, with light circular motions, so that the skin shifts. Tell the heart a sweet word, wish him luck.
Wish with passion, with confidence: as you say, it will be so! - love and peace.
Talk with your heart and help him constantly.
- In the morning, moisten the cotton wool in the valerian tincture and wear on your chest all day. You can wear on your chest in a special bag valerian root and clove of garlic.
You can prepare yourself medicine in the morning for the whole day: take a piece of bread the size of a finger. Cut it into 4 parts and for each drop 2-4 drops of valerian infusion. Every four hours take a piece in your mouth. Shake and hold for a few minutes in your mouth, then swallow.
This must be done before disappearing completely, no matter what kind of heart problems. "
.Recommendations of Wangi
Bulgarian healer Vanga for the prevention of heart disease recommends that every person four times a year drink on4days of tea fromblue hawthorn flowers.
Treatment in the early stages, if possible, reduces to the elimination of pain, the restoration of coronary blood flow of the coronary arteries. In case of cardiac arrest (as a result of ventricular fibrillation), cardiopulmonary resuscitation should be started immediately. The availability of automatic external defibrillators increases survival in such situations.
Treatment of myocardial infarction in the hospital: drugs, tablets medicines
Elimination of pain, dyspnea and anxiety
If an attack of anginal pain (pain in the heart) does not weaken in a few minutes after the termination of physical activity or he appeared at rest, the patient should take Nitroglycerin in the form of a pill under the tongue (, mg) or in the form of an aerosol (, mg in dose).
If the attack does not disappear after 5 minutes, you can take Nitroglycerin repeatedly. If the symptoms persist for the next 5 minutes after re-ingestion, call the ambulance and take Nitroglycerin again.
If the pain persists at the time of arrival of the ambulance brigade, the doctor applies morphine. Preliminary 10 mg Morphine hydrochloride is diluted in 10 ml, a% solution of sodium chloride or distilled water. The first dose of 2-5 mg (i.e., 2-5 ml of the solution) is administered intravenously. Then additionally inject 2-5 mg every 5 to 15 minutes until pain or side effects are eliminated.
Also with an analgesic purpose, it is possible to use neuroleptanalgesia - a combination of narcotic analgesic fentanyl (, 5 mg) and neuroleptic droperidol (-10 mg, depending on the level blood pressure). If necessary, neuroleptanalgesia is repeated at a lower dose.
If the patient has arterial hypoxemia (saturation of arterial blood with oxygen 0%), dyspnea or other signs of heart failure are injected with oxygen (through a mask or nasal catheter) at a rate of 2-5 l / min.
Patients with severe agitation, anxiety, fear (which do not disappear after the introduction of a narcotic analgesic) can be prescribed a tranquilizer (for example, diazepam intravenously, -10 mg). It is also important to calm the patient and his loved ones.
Antiplatelet therapy
All patients with myocardial infarction should take Acetylsalicylic acid, previously chewed, in a loading first dose of 150-300 mg. For these purposes, the enteric-soluble form is not suitable, since the onset of its action is slow.
With severe nausea, vomiting, concomitant diseases of the stomach, intravenous injection of acetylsalicylic acid in a dose of 250-500 mg is possible.
Further, Acetylsalicylic acid is indicated by such patients for life at a dose of 75-150 mg / day. In the presence of contraindications to Acetylsalicylic acid, Clopidogrel is used in a first loading dose of 300 mg and subsequently 75 mg / day.
Anticoagulants
Apply unfractionated Heparin for 48 hours. At the beginning, 60 IU / kg of intravenous strontium (but not more than 4000 IU) is injected intravenously, then continuously intravenously at an initial rate of 13 IU / kg / h (but not more than 100 IU / h). The further dose is selected, being guided by APTT (Activated partial thromboplastin time or APTT) - this is the time for which a blood clot forms after adherence to plasma of calcium chloride and other reagents. APTTV is the most sensitive indicator of blood coagulability, determined when examining the hemostasis system (hemostasiograms). (The norm of APTTV is 30-40 seconds on the average. -approx. Ed.),which should be -2 times greater than normal and monitored at 3, 6, 12, 24 hours.
It is also possible to use low molecular weight heparin (Enoxaparin), which is administered under the skin of the stomach at a dose of 1 mg / kg 2 times a day to 5-7 days. 15 minutes before the first subcutaneous (subcutaneous) injection, 30 mg of this drug should be injected intravenously. The dose of the first 2 injections is not more than 100 mg. The advantages of low molecular weight heparin before unfractionated are: ease of administration and there is no need for constant monitoring of blood coagulation.
Sometimes Fondaparinux is used in a dose, mg under the skin of the stomach 1 time per day. This drug is most convenient to use and unlike Heparin does not cause thrombocytopenia.
Thrombolytic therapy
Thrombolytic therapy is indicated for myocardial infarction with ST segment elevation on the ECG. Its effectiveness has been convincingly proved, it allows to restore coronary blood flow, limit the size of the infarction and reduce mortality. Thrombolysis is carried out as early as possible and within 12 hours from the onset of the disease. To do this, use Streptokinase in a dose, million ME intravenously for 100 ml, a solution of sodium chloride for 30-60 minutes.
Alteplase is also used for 100-200 ml of isotonic solution according to the scheme: 15 mg intravenously struino, then, 5 mg / kg for 30 minutes (but not more than 50 mg) and further, mg / kg for 60 minutes (but not more than 35 mg). Alteplase has advantages over Streptokinase in the form of more efficient restoration of coronary blood flow due to tropism to fibrin thrombus, as well as lack of antigenicity.
Beta-blockers
In the absence of contraindications apply Metoprolol, Propranolol or Atenolol. However, the effectiveness of intravenous beta-adrenoblokatorov in the early stages is not proven and increases the risk of developing cardiogenic shock.
Emergency First Aid
I result the algorithm of actions for acute myocardial infarction as the tasks of stage-by-stage treatment.
Task 1.Cessation of pain: Omnupon, Promedol, Morphine (depending on the condition intramuscularly or intravenously). To increase the effects of drugs add neuroplastic drugs (Aminazine). Sometimes for the removal of pain resort to the use of nitrous oxide.
Task 2.Prevent or reduce the development of coronary artery thrombosis: Heparin 1, 00-2, 00 units intramuscularly twice daily in the first 3-5 days (under the control of coagulability); Fibrinolysin 15 000-25 000 units in 300 ml of physiological solution drip for two days.
The combination of direct anticoagulants with fibrinolytic drugs may halt the formation of a thrombus.
After removal of acute phenomena, anticoagulants of indirect action are appointed: Neodicumarin (in, g) or Pelentan (in, g), and also more slowly acting Phenylin (3 g two to three times a day) for a period, the duration of which is determined by the content of the prothrombin of the blood ("prothrombin time" should fall to 60-50 and even up to 40% of its normal values).
Task 3.Fighting cardiovascular insufficiency. With a fall in blood pressure, Norepinephrine is prescribed (1-2 ml,% solution intravenously in a glucose solution dropwise); Mesaton (1-2 ml of 1% solution).
The use of solutions of common salt, glucose, blood substitutes, blood transfusion, successfully used in collapses, is usually inexpedient.
Along with cardiac tonic, cardiac glycosides should be used (Strophantine or Korglikon intravenously with glucose).
Infusions have to be repeated 2-3 times a day, depending on the patient's condition.
Source: O.G.G.G. N. Official and traditional medicine. The most detailed encyclopedia. - Moscow: Publishing house Eksmo, 2012.
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