One of the most serious cardiological pathologies is myocardial infarction, a very dangerous disease, a consequence of coronary heart disease. This is the most common cause of premature death in the world.
From the timely provision of medical care depends on the survival of patients, the possibility of avoiding the occurrence of severe complications.
Heart disease characteristics and statistics
Heart attack, at which occurs irreversible damage to the cells of the organ due to a violation of its blood supply to and the consequent acute oxygen oxygenOdan. Such organs can be not only the heart, but also the brain, the kidney, the retina of the eye or the spleen.
In case of timely and qualified medical care the patient gets a chance to survive, however will not be able to return to the old life .Affected cells of the myocardium after a previous heart attack are replaced by a scar tissue that significantly limits the ability of the heart muscle to fully contract.
The patient has to reconsider his way of life, food ration, allowable physical activity of , exclude risk factors, so as not to get a relapse of the disease.
According to data provided to the Federation Council by the chief cardiologist of Russia, Professor I. Chazova, Russia is in second place in the prevalence of cardiopathology and mortality of the population from cardiovascular diseases. In addition, she provided the following data:
- Myocardial infarction caused 39% of all premature deaths in Russia;
- Death ends with 17% of cases of heart attack;
- Relapses occur in 11% of cases;
- Every day the emergency medical service of the Russian Federation receives more than 25,000 calls related to acute coronary syndromes;
According to the Committee on Social Policy of the Federation Council from the symptoms of cardiac ischemia, which results in myocardial infarction, suffer more than 7 million Russians .In addition:
- Diseases of the cardiovascular system are diagnosed in 31 million people in Russia;
- Every fourth man in our country over the age of 44 suffers from coronary disease, which means that he is at risk of suffering from myocardial infarction;
- The number of postinfarction patients is approaching 2.5 million people. This figure is 2% of the total Russian population.
The reason for this imbalance is the presence in the female body of estrogen , a hormone that exerts a protective effect. These differences are leveled by the 1960s and 1970s, when statistics show an increase in the incidence of heart attack in women to 50%.
Even the most modern cardiac center will not be able to provide full-fledged assistance to such a patient if it is not provided by in the first 1-2 hours after the onset of an attack. The main emphasis should be made on timely diagnosis and elimination of possible causes of this pathology.
Causes and Risk Factors
The main reason for the development of such cardiopathology is closure of one or several coronary arteries .This is due to the fact that the walls of the artery are damaged by atherosclerotic plaques, which protrude into the lumen of the vessel and significantly narrow its diameter. The degree of narrowing can reach 2/3 or more of the diameter of the vessel.
The contents of an atherosclerotic plaque, consisting of fat and protein mass, can enter the lumen of the vessel. The reaction becomes formation of a thrombus up to 1 cm long , which is the cause of cessation of blood flow and spasm of the coronary artery. There is occlusive obstruction - complete closure of the blood flow, and, as a consequence, necrosis of the myocardium.
Risk factors for that contribute to the onset of this disease in people with coronary heart disease, atherosclerosis of the coronary arteries:
- Severe or prolonged stress;
- Hypertensive;
- Severe infectious diseases
- Excessive physical activity;
- Injury, surgery;
- Overheating, subcooling.
Prognosis, possible complications of
What are the consequences of extensive myocardial infarction, will it lead to death, how high are the chances of surviving during the resuscitation and after what should be the rehabilitation? We will answer all questions in order.
According to medical statistics, about 40% of people who have had an attack die within the first year after the attack of the disease, 19% do not cross the five-year survival threshold, after relapse or complications of the disease. Severe consequences may be:
- pericarditis, leading to proliferation of connective tissue( "carapaceous heart");
- endocarditis resulting in thrombosis and thromboembolic syndrome;
- heart failure;
- arrhythmia;
- pulmonary edema;
- cardiogenic shock;
- myocardial rupture;
- ventricular aneurysm;
- termination of cardiac activity.
In the case of scar formation on the myocardium , the prognosis of survival can be considered favorable when the patient complies with the recommendations of the doctor and carrying out maintenance therapy.
Symptoms and first signs of
Depending on the period of myocardial infarction, there are distinctive symptoms that are very likely to diagnose this pathology. Infarction periods:
- pre-infarction
- acute
- acute
- subacute
- postinfarction
For the pre-infarction period, the following symptoms are typical:
- Long, high-intensity chest pains that are not stopped by the intake of nitroglycerin;
- Shortness of breath;
- Sweating;
- Arrhythmia;
- Nausea;
- Intolerance of any, the most insignificant physical exertion;
- The ECG shows signs of impaired blood flow to the myocardium.
The sharpest period lasts from one and a half to two hours .During it, the patient experiences:
- Intense pain of the squamous localization, which can be felt both to the left and right of the sternum, to cover the front part of the thorax, to give to the scapula, the lower jaw, to the neck, to the left arm;
- Fear of death, anxiety, apathy, hallucinations.
In some cases, may exhibit atypical symptoms of this disease :
- Gastralgic form - characterized by epigastric pain, nausea and vomiting.
- Asthmatic form - the patient experiences attacks of suffocation, coughing, covered with cold sweat.
- Edemas - there is shortness of breath, edematous syndrome.
- Cerebral form - accompanied by symptoms of cerebral ischemia due to atherosclerosis of the arteries, supplying blood to the brain.
- Rubbed and asymptomatic form.
The first first aid that the doctor can do
Before the arrival of emergency medical care , you can somewhat ease the condition of the patient .For this, the following measures are taken:
- The patient should be placed in a semi-sitting position with legs slightly bent at the knees, relax the collar, tie, remove tight clothing;
- Place a tablet of Nitroglycerin under the tongue;
- Give the chewed Aspirin tablet;
- Allow fresh air to enter the room.
Diagnosis
For the initial diagnosis, the physician collects an anamnesis, analyzes the nature of the pain, assesses the external condition, conducts palpation and listens to the heart. These methods can be identified:
- Pulse rate increase;
- Systolic Noise;
- Disturbances of cardiac tones of various origin.
Symptomatic symptoms may be lowering of blood pressure, increase in body temperature to 38 ° C during the week .
To clarify the diagnosis laboratory blood tests are used, which can determine the following changes:
- Elevated level of leukocytes;
- Increased level of erythrocyte sedimentation rate;
- Biochemical symptoms of the inflammatory process;
- The appearance of biochemical markers of necrosis of myocardial cells.
The most important diagnostic method for is the electrocardiogram( ECG) .Analyzing its results, it is possible to determine such characteristics of the infarction:
- Localization of
- Prevalence of
- Depth of
- Complications of
In a separate article you will find the signs of ECG with myocardial infarction with photo and decoding.
Tactics of treatment
Treatment of an infarction passes only in the conditions of the cardiological department of the hospital. Indications for hospitalization are ECG results indicating a pathological process, symptoms of heart failure. The main tasks of this period:
- Pain relief,
- Reduction of the cardiac necrosis area,
- Restoration of blood flow in the coronary arteries,
- Reduction of the risk of thrombosis,
- Heart discharge, fighting with arrhythmia,
- Maintaining the optimal blood pressure level.
narcotic analgesics ( Morphine, Promedol, Fentanyl, Omnopon) are used to eliminate pain in the acute and acute period.
They are administered intravenously by in the first minutes of medical care, effectively anesthetized. If it is necessary to stop fear or unnecessary excitement, then tranquilizers ( Relanium, Diazepam) are used.
Dissolution of blood clots and restoration of blood flow in coronary and small arteries of the myocardium is the goal of thrombolytic therapy of .The timely use of thrombolytics reduces the size of the focus of myocardial necrosis, which greatly improves the prognosis of the disease.
Streptolinase, Fiboinolysin, Alteplase have a thrombolytic activity. Prevents thrombosis Heparin, it prevents thromboembolism.
Contraindications for it are the sudden occurrence of bleeding .It is necessary to exclude the history of stroke, GI disease with mucosal lesions, recent surgical interventions.
Therapy for the treatment of myocardial infarction includes application of anticoagulants , the main drug from this group is Aspirin( acetylsalicylic acid).Its use does not allow platelets to stick together and attach to the walls of blood vessels, and red blood cells are easily transported along the bloodstream.
An important part of drug therapy is the use of ACE inhibitors to slow cardiac activity, reduce pressure, dilate blood vessels. Indication for their use is acute heart failure. This is Captopril, Ranipril, Enalapril.
In addition, cardioprotectors are prescribed for the treatment of arrhythmia, limitation of the myocardial lesion zone. These can be beta-adenoblockers( Atenolol, Propranolol), nitrates in the form of intravenous infusion Nitroglycerin, vitamins.
The rehabilitation period requires the continuous use of medicinal agents for the prevention of thrombosis and arrhythmia , maintaining the optimal level of blood pressure. In addition to them, you can use recipes of traditional medicine in the form of tinctures and broths of aloe, hawthorn, calendula, motherwort.
A significant part of maintenance therapy for those who underwent myocardial infarction is the compliance with the diet and the optimal and dosed physical load of the .
Low-fat, easily digestible food, useful for vessels and cardiac muscle, is required. These can be cereals, sour-milk products, dried fruits, juices, light vegetable and fruit salads.
To prevent stagnant phenomena, is recommended to practice exercise therapy, dosed walking under the guidance of a specialist, it is necessary to start these exercises as early as possible.
Rehabilitation after a heart attack can occur in cardiologic sanatoria, if there is no contraindication for this. The special commission decides whether or not to give a disability after a myocardial infarction, whether it is possible to return to work after rehabilitation.
Prevention measures
In order not to be exposed to such a disease as myocardial infarction, it is necessary to prevent the occurrence of arteriosclerosis of the vessels. To this end, preventive measures are taken:
- Introduction of fiber and vegetable fiber in the diet, reducing the proportion of fatty, fried, smoked food.
- Maintaining an active lifestyle;
- Combating bad habits, smoking, drinking alcohol;
- Prevention of stress by mastering the methods of relaxation, auto-training;
- Control of cholesterol, blood sugar, timely treatment of chronic diseases;
- Consultation of a specialist in the appearance of symptoms of angina pectoris, ECG.
This cardiopathology requires immediate medical attention, treatment in the hospital. In order to rehabilitate after a heart attack was successful, you need to take the medications recommended by your doctor, keep to a diet, and practice physical therapy.
