Heart attack symptoms
Myocardial infarction - an acute disease of the heart muscle, characterized by one or more foci of necrosis due to circulatory disorders.This is the most severe form of coronary heart disease.The patient needs bedrest.Diagnosis is based on three clinical signs: strong characteristic anginal pain lasting longer than 30 minutes, not sagging after taking nitroglycerin;ECx data (pathological Q wave or QS complex as an indication of necrosis, ST-segment elevation and negative T wave);increasing enzyme FC-MB in serum.How to use folk remedies myocardial see here.
observed more frequently in men aged 40-60 years.Men myocardial infarction more common than in women, especially at a young age.At the age of 41- 50 years this ratio was 5: 1, and between 51- 60 years - 2: 1.Later, the difference disappears due to the growth rate of heart attack in women.It is believed that citizens suffer from myocardial infarction more often than rural residents, but here plays the role, apparently unequal level of diagnostic ca
risk of myocardial infarction (based on the American Heart Association)
risk of myocardial infarction low - 6- 13 points, the average - 14-22 points, high - 23 points.
People, stroke, diabetes patients are genetically predisposed to heart disease, the risk of myocardial infarction is much higher.
1. Localization (right ventricular, left ventricular, septal, and others.);
2. At a depth of myocardial necrosis (penetrating, non-invasive, focal, distribution);
3. At current stages of myocardial infarction:
4. In the presence of complications:
5. In depth lesions: transmural myocardial infarction (process captures the entire thickness of the heart muscle), intramural (with necrosis foci in the thickness of the heart muscle)and subepi-cardiac and subendocardial infarction (adjacent to the endocardium or epicardium).
6. The three main areas of the heart muscle changes in myocardial: necrosis, prenekroticheskaya area and distant from the area of necrosis.The outcome is the formation of muscle necrosis of connective tissue scar.
7. Clinical variants of myocardial infarction flow: a typical (or pain), and atypical, including: asthma, abdominal, arrhythmic, tserebrovaskulyany and painless (oligosymptomatic), as well as with atypical localization of pains.
Most often a heart attack develops in the anterior wall of the left ventricle, the blood supply in the basin of the most commonly affected by atherosclerosis of the anterior descending branch of the left coronary artery.The second place is occupied by the frequency of myocardial left ventricular posterior wall.This is followed by the defeat of the interventricular septum and papillary muscles.
1. Pain shape (typical development version)
The typical course of severe myocardial infarction are five periods: prodromal, acute, acute, sub-acute and after infarct.
prodromal period, or so-called preinfarction state, observed in more than half of the patients.Clinically it is characterized by the occurrence or significantly increased frequency and increased severity of angina attacks, as well as the general state changes (weakness, fatigue, depressed mood, anxiety, sleep disturbance).The action of conventional analgesics in patients who receive them, it is usually less effective
acute period (the time from the occurrence of myocardial ischemia prior to the first manifestations of his necrosis).
features a typical attack of pain in myocardial infarction:
1. Characteristics of pain: suddenly appears chest pain is very intense, burning radiating to the left arm, left shoulder, abdomen, back.
2. Duration of pain: pain lasts on average more than 30 minutes, sometimes even 1-2 days.
3. drug reactions: pain is not relieved by nitroglycerin or validol for anesthesia needed medical assistance.
4. The response to physical stress: pain increases, required bed rest and a decrease in any physical activity.
5. Other signs of pain: pain attack may be accompanied by feelings of fear, severe weakness, feeling short of breath, fear of death, usually marked profuse sweating, shortness of breath at rest, are not uncommon (especially in the lower localization of myocardial infarction) and nausea and vomiting.This is often in patients in a state of extreme emotional stress, alcohol intoxication.
Myocardial infarction occurs at any time of the day, most often at night, early morning hours.Extremely rarely the pain is absent.
On examination, the patient determined by the pallor of the skin and the symptoms associated with intense pain (pained expression on his face, restlessness or stiffness, cold clammy sweat).In the first minutes the blood pressure increases, then decreases progressively as a manifestation of developing cardiac reflex and acute circulatory failure.The sharp decline in blood pressure usually associated with the development of cardiogenic shock.
acute period begins immediately after the acute period and lasts for about 2 days - until the final delimitation of necrotic focus (in this period, one part of the muscle cells located in periinfarkislotnoy zone dies, another is restored).In cases of recurrent myocardial infarction during the duration of the acute period may be extended to 10 days or more.
In the first hours of the acute period disappears anginal pain.Save pain possible in the development of inflammation of the pericardium, as well as continuing or recurrent course of myocardial infarction.Heart failure and hypotension, as a rule, remain and may even progress, and in some cases they arise even after the acute period.Violations of rhythm and conduction of the heart are determined by the overwhelming majority.
resorption syndrome that develops in the acute phase of myocardial infarction is characterized by the occurrence of febrile reactions (the body temperature rarely exceeds 38.5 ° C) and elevated erythrocyte sedimentation rate.
Subacute period corresponding to the time interval of the total distinguishing necrosis before its replacement with a gentle connective tissue, continues for about 1 month.Clinical symptoms associated with a decrease in the mass of functioning myocardium (heart failure) and its electrical instability (cardiac arrhythmia), manifested in different ways during this period.The general health of patients usually improves.Shortness of breath at rest, as well as auscultation and radiographic signs of stagnation of blood in the lungs decrease or disappear.
sonority heart sounds gradually increased, but in most patients completely is not restored.Systolic blood pressure in the majority of patients gradually increases, and reaches at the initial value.If myocardial infarction developed on the background of arterial hypertension, the systolic blood pressure is significantly lower than before myocardial infarction, diastolic whereas not significantly altered ( "decapitated" hypertension).
must know that the angina may be absent;their loss in patients suffering from angina to myocardial infarction indicates complete blockage of the artery in which the pool to myocardial ischemia occurred periodically.
postinfarction period following an acute, complete for myocardial infarction, since the end of the period is expected in the final formation of a dense zone of myocardial scar.It is believed that the typical course macrofocal myocardial infarction after infarct period ending on the date corresponding to about 6 months from the date of occurrence of necrosis focus.During this period, gradually developing compensatory hypertrophy of the surviving myocardium, heart failure due to which, if it occurred in earlier periods of myocardial infarction, some patients may be liquidated.However, when large amounts of myocardial damage full payment is not always possible, and symptoms of heart failure persist or grow.
From atypical forms of myocardial infarction is most common variant of asthma that flows by type of cardiac asthma or pulmonary edema.He observed in extensive damage of the heart muscle, repeated heart attacks, against the background of already existing circulatory failure, if Cardiosclerosis.It occurs in 5-10% of patients.In half of the cases combined with suffocation retrosternal pain.The development of cardiac asthma may contribute to a sharp increase in blood pressure.
The basis of this syndrome is an extreme degree of left ventricular failure and stagnation of blood in the lungs.Suddenly there is a feeling of lack of air, developing into asthma, and the associated fear of death.The patient becomes very restless, "can not find a place," takes a forced sitting position, leaning his hands on the bed to enhance the respiratory movements.The respiration rate increases up to 80-90 min.The character of breath: after a short breath exhalation should be extended.The expression pained person sick, exhausted, pale skin, lips cyanotic, stands a cold sweat.
Breathing becomes noisy, choking, wheezing are heard in the distance.Appears cough, soon begins to separate liquid, frothy sputum or pinkish color with blood.Abdominal
embodiment myocardial infarction observed in 2-3% of patients, mainly in its lower or nizhnezadney localization.Pain focusing in the epigastric region.Patients with excited, rushing, moaning, the skin at the time of amplification of pain are covered later.However, the stomach feeling does not cause significant pain, abdomen remains soft, there are no signs of peritoneal irritation.
pain in the epigastric region can join nausea, vomiting, painful hiccups, diarrhea.This may give rise to erroneous conclusions about the food poisoning or gastroenteritis.
Cerebrovascular form can occur in the form of fainting or stroke.Cerebrovascular accidents is usually transient.Signs of vascular brain damage (speech disorder, cerebral stroke).Along with brain stroke in the acute phase of myocardial infarction occur, and other neurological disorders: syncope, loss of consciousness.
stroke is often a complication of myocardial infarction.Clarifies the situation a careful examination of the heart, ECG, biochemical blood tests.
arrhythmic version begins with various arrhythmias - episodes of atrial fibrillation, tachycardia, frequent premature beats.The pain is absent or appears after the arrhythmia occurred.AMI may manifest severe tachyarrhythmias with lowering blood pressure, sudden-death due to ventricular difibrillyatsii (less asystole).
myocardial infarction diagnosis proof in the simultaneous presence in the clinical picture of the patient's anginal attack, increase the number of enzymes (CPK, LDH, etc.) In the blood, the characteristic ECG changes.
1. Violation of the conduction rate (arrhythmic shock).
Myocardial infarction affects not only myocarditis - muscle cells, but also suffers the vascular system.Heart gets in unusual operating conditions, for which the optimization is needed is some reorganization.But this adjustment takes time.Therefore, the heart tries to use more cuts deliver blood in human organs.Arrhythmias arising in myocardial infarction can be either temporary or permanent.It is very dangerous so-called atrial fibrillation.
2. True cardiogenic shock - the most severe complication of myocardial infarction, which often ends in death.The cause of shock is quickly arose and extensive necrosis of the left ventricle muscle (more than half of his muscle mass), which is accompanied by a sharp decrease in the volume of blood ejected.In this case the patient does not move sharply weakened, pain is not complaining, answers the questions with difficulty, often falls into the inhibited state can be loss of consciousness.The face is pale, with blue lips and mucous membranes, cold extremities, the skin acquires a "marble" pattern, covered by abundant cold sticky sweat.
One of the major signs of cardiogenic shock is a catastrophic drop in blood pressure - less than 80 mm HgOften the systolic pressure is determined.Pulse weak filling, frequent, more than 100-120 beats per minute.When blood pressure reduction of 60/40 mmHg lowerthe pulse becomes thready, at a lower pressure pulse is not detectable.Breathing frequent and shallow (25-35 min).The light on the background of arterial pressure drop is increasing congestion, until edema.Reduced urine output, until the complete lack of urine.
3. Acute heart failure. weakness of the left ventricle is not always manifested in the form of cardiac asthma and pulmonary edema.Many patients with left ventricular failure is more moderate.The patient feels a little short of breath, his heart palpitations (more than 100 beats per minute), bluish lips.Blood pressure is maintained at a normal or slightly reduced level.In the back-bottom of the lungs auscultated often a small amount of wet finely wheezing.An extreme form of left ventricular failure is cardiac asthma.
4. Heart Break. cardiac muscle rupture occur in patients with primary transmural myocardial infarction.Reinfarction rarely complicated fractures.The mortality rate in this case is very high.Most fractures occur in the first three days of the disease, often in the first day.There are external and internal ruptures of the heart, are more common outside.The gap is usually on the front wall of the left ventricle closer to the apex.Most patients die in the first day of myocardial rupture.
5. heart aneurysm.This common complication transmural myocardial infarction is a bulging or diffuse saccular cavity usually containing mural thrombus.Most aneurysms are often located in the apex of the left ventricle or near it.An aneurysm is formed in 10-15% of patients in the first week of myocardial infarction.Chronic aneurysm is the result of scarring the walls of acute aneurysm.
Acute heart aneurysms may be complicated by rupture within the first 3 weeks of early myocardial infarction.About 70% of patients with chronic postinfarction aneurysm die within 3-5 years from heart failure, arrhythmias or recurrent myocardial infarction.
one of the following criteria is sufficient for the diagnosis of acute myocardial infarction.
Typical rise and gradual decline (cardiac troponin) or more rapid rise and fall (CK MB Download now) biochemical markers of myocardial necrosis in conjunction with one of the following symptoms:
a) clinical picture of ACS;
b) the appearance of pathological Q waves on the ECG;
c) ECG changes indicative of myocardial ischemia appearance: the appearance of lifting or ST-segment depression, blockade LNPG;
g) the signs of loss of viable myocardium or violation of local contractility using techniques that allow visualization of the heart.
main clinical and laboratory signs of myocardial infarction are:
1. Increased body temperature (subfebrile to 38,5-39 ° C).
2. leukocytosis, usually not exceeding 12-15 x 109 / l.
4. A small stab shift blood to the left.
5. The increase in ESR.
enzyme diagnostics. The level of enzyme activity can be judged on the severity of myocardial infarction.