Myocardial infarction - Causes, Symptoms and Treatment .MF .
Myocardial infarction - a medical emergency, most often caused by coronary artery thrombosis.The risk of death is very high especially in the first 2 hours of the start and very bychstro reduced when the patient arrives in the emergency department, and it is carried out the dissolution of a blood clot, called thrombolysis or coronary angioplasty.There are myocardial infarction with pathologic Q wave and without it.Typically area and greater depth of injury in the first case, and the risk of myocardial re second.Therefore, long-term prognosis about the same.
Causes of myocardial infarction
The most common heart attack affects people suffering from a lack of physical activity on the background of psychological and emotional overload.But he can combat and people with good physical preparation, even the young ones.The main causes that contribute to the emergence of a myocardial infarction are: overeating, poor diet, excess fat in the diet of animals, lack of physical activity, hypertension, bad habits.Th
The heart is a muscular sac, which surpasses the pump through the blood itself.But the heart muscle is supplied with oxygen through the blood vessels, suitable to it externally.And now, for various reasons, some of these vessels affected by atherosclerosis, and may not have enough blood flowing.There is coronary heart disease.When the blood supply to parts of myocardial infarction of the heart muscle is stopped suddenly and completely because of complete occlusion of the coronary artery.Typically, this results in the development of a blood clot in the atherosclerotic plaque, at least - a spasm of a coronary artery.Portion of the heart muscle deprived of food dies.In Latin dead tissue - a heart attack.
Symptoms of myocardial infarction
The most common manifestation of myocardial infarction is chest pain.Pain "gives" on the inner surface of the left hand, producing a tingling in his left hand, wrist and fingers.Other possible areas of irradiation are the shoulder girdle, neck, jaw, interscapular space, and mostly on the left.Thus, localization, and irradiation of the pain is not different from an attack of angina pectoris.
very strong pain in myocardial infarction, is perceived as a knife-like, tearing, burning, "the count in the chest."Sometimes this feeling is so intolerable that makes cry.As with angina, the pain may not occur, and discomfort in the chest: a strong sense of compression, compression of, heavy feeling "pulled together the hoop, squeezed in a vice, crushed heavy plate."Some people have only a dull pain, numbness of the wrist, combined with severe and prolonged chest pain or discomfort in the chest.
Home anginal pain in myocardial infarction, sudden, often at night or early morning hours.Pain develops in waves periodically reduced, but not stopped completely.With each new wave of pain or discomfort in the chest worse, fast peak and then subside.
Pain attack or chest discomfort lasts more than 30 minutes, sometimes for hours.It is important to remember that for the formation of myocardial infarction sufficient duration of anginal pain for more than 15 minutes.Another important feature is the absence of myocardial infarction or reduction in the pain at rest, or upon receipt of nitroglycerin (even repeated).
angina or myocardial infarction
place of pain in angina and myocardial infarction is the same.The main differences of the pain associated with myocardial infarction are:
- severe pain intensity;
- duration of more than 15 minutes;
- pain does not stop after taking nitroglycerin.
atypical form myocardial
addition to the typical characteristic of the tearing apart infartkta sharp chest pain, secrete several forms of heart attack, which can masquerade as other diseases of internal organs or does not manifest itself.These forms are called atypical.Let Raber them.
Gastritichesky option myocardial infarction. shown as severe pain in the epigastric region and reminds exacerbation of gastritis.Often, palpation, iepalpation of the abdomen, reply to posts soreness and muscle tension anterior abdominal wall.As a rule, this form affects the lower parts of the left ventricle miokrada, adjacent to the diaphragm.
asthmatic variant of myocardial infarction. This unusual type of heart attack and is very similar to an attack of asthma.It manifests itself hoarse dry cough, feeling of fullness in the chest.
silent myocardial option. manifested hudsheniem sleep or mood, a sense of indefinite discomfort in the chest ( "heart longing") in conjunction with severe sweating.Typically, this option is typical in middle and old age, especially for patients with diabetes.Such an early myocardial infarction is unfavorable, since the disease is more severe.
factors for myocardial infarction
risk factors for myocardial infarction are:
- age, the older a person becomes, the more the risk of a heart attack had increased.
- previous myocardial infarction, especially small-focal, ie,forming not-Q.
- diabetes is a risk factor for myocardial infarction, becauseelevated level has an additional adverse effect on the heart vessels and hemoglobin, the oxygen-impairing its function.
- smoking, the risk of myocardial infarction with smoking, both active and passive, simply inhaling smoke from a smoker increases of 3 and 1.5 times respectively.And this factor as "meticulous" that is saved for the next 3 years after keak patient quit smoking.
- hypertension, high blood pressure above 139 and 89.
- high cholesterol, contributes to the development of atherosclerotic plaques in the arteries, including the coronary.
- obese or overweight promotes blood holestrina and consequently worsens the blood supply to the heart.
prevention of myocardial infarction
Methods of prevention of myocardial infarction are similar to the prevention of coronary heart disease.
likelihood of developing complications of myocardial infarction Myocardial infarction
dangerous in many ways, its unpredictability and complications.The development of myocardial infarction complications depends on several important factors:
- magnitude of heart muscle damage than the Large Live over the area struck by the myocardium, the expression of complications;
- localization zone of myocardial damage (front, rear, left ventricular lateral wall, etc.)., Is found in most cases of myocardial infarction in the anterior septal region of the left ventricular apex capture.Less frequently in the area of the lower back and the wall
- time blood flow restoration in the affected heart muscle plays a very important, sooner medical care will be provided, the less damage to the area.
Complications of myocardial infarction
Complications of myocardial infarction mainly arise in the vast and deep (transmural) damaged the heart muscle.It is known that infarction is a necrosis (necrosis) of a certain area of the myocardium.This muscle tissue, with all its inherent properties (contractility, excitability, conductivity, etc.), Is converted into connective tissue, which can only act as a "frame".As a result, the thickness of the heart wall is reduced, and the size of the left ventricular cavity increasing, which is accompanied by a reduction of its contractile capacity.
major complications of myocardial infarction are:
- fibrillation is the most frequent complication of myocardial infarction.The greatest danger is a ventricular tachycardia (a type of arrhythmia in which the role of pacemaker take the hearts of the ventricles) and ventricular fibrillation (chaotic contraction of the ventricles).However, we need to remember any hemodynamically significant arrhythmia requires treatment.
- heart failure (reduced contractility of the heart) is in myocardial infarction quite often.Reducing the contractile function is proportional to the size of the infarct.
- hypertension by increasing the heart's need for oxygen and tension in the wall of the left ventricle increases the infarct, and its extension.
- mechanical complications (cardiac aneurysm, rupture of the interventricular septum) usually develop within the first week of myocardial infarction and clinically manifested by a sudden deterioration in hemodynamics.Mortality in these patients is high, and often only an emergency operation can save their lives.
- recurrent (repeated continuously) pain syndrome occurs in approximately one third of patients with myocardial infarction, thrombus rasstvorenie no effect on its prevalence.
- Dressler's syndrome - post-infarction syndrome, which is manifested by inflammation of the heart bags, lung and inflammatory change in the lungs themselves.The occurrence of this syndrome is associated with the formation of antibodies.
- Any of these complications can be fatal.
diagnosis of acute myocardial infarction
Acute myocardial infarction is diagnosed on the basis of 3 main criteria:
- characteristic clinical picture - myocardial infarction, a strong, often tearing, pain in the heart or in the sternum, radiating to the left shoulder blade,arm, lower jaw.The pain lasts for more than 30 minutes, while taking nitroglycerin is not fully reversible, and not only a long time reduced.There is a feeling of lack of air, it can appear cold sweats, severe weakness, decreased blood pressure, nausea, vomiting, feeling of fear.Long-term pain in the heart, which extend over 20-30 minutes and do not pass after taking nitroglycerin, may be a sign of myocardial infarction.Call an ambulance.
- characteristic changes in the electrocardiogram (signs of damage to certain areas of the heart muscle).Usually it obpazovanie Q waves and ST elevation segments of interested leads.
- characteristic changes in laboratory parameters (blood increased levels of markers of cardiac damage cardiac muscle cells - cardiomyocytes).
Emergency care in myocardial infarction
ambulance should be called if this is the first in the life of angina, as well as if:
- chest pain or its equivalents are amplified or lasts longer than 5 minutes, especially if all this is accompanied by a deteriorationbreathing, weakness, vomiting;
- chest pain has not stopped or increased within 5 minutes after the resorption of 1 nitroglycerin tablet.
Help before arrival "Ambulance" myocardial infarction
What should be done if you suspect a heart attack?There are some simple rules that will help you save zhezn another person:
- patient bed, raise the head, again give a nitroglycerin tablet under the tongue and in powdered form (chew) 1 tablet of aspirin;
- additionally take 1 pill dipyrone or baralgina, 60 drops or korvalola valokardin, 2 tablets panangina or potassium orotate, put yellow card in the region of the heart;
- urgently call a team of emergency medical services ( "03").
should be able to reanimate each
chances of survival of the patient, the higher the earlier initiated resuscitation (they should begin not later than one minute from the start of cardiac catastrophe).The rules of the basic resuscitation:
If the patient has no response to external stimuli, immediately go to step 1 of this Regulation.
Ask someone, for example, the neighbors call "ambulance."
properly routed resuscitated by ensuring airway patency.To do this:
- patient should be put on a firm, level surface and maximum throw back his head.
- to improve the airway from the mouth need to remove dentures or other foreign bodies.If vomiting occurs, turn the patient's head to one side, and the contents of the mouth and throat using a swab to remove (or improvised).
- Check for spontaneous breathing.
- If no spontaneous breathing, start artificial respiration.The patient must lie in the prescribed position on the back with a sharply upturned posterior head.Pose can be achieved by putting a cushion under the shoulders.You can hold his head.Lower jaw must be pushed forward.Assists takes a deep breath, open your mouth, quickly brings it to the patient's mouth and lips tightly pressed to her mouth, takes a deep breath, ie,as it blows air into his lungs and inflates them.To air out through the nose is not resuscitated, hold his nose with your fingers.Then, providing assistance leans back and again takes a deep breath.During this time, the patient's thorax collapses - going passive exhalation.Then, again assisting with blows air into the patient's mouth.For hygienic reasons, the patient's face in front of the air blowing can be covered with a handkerchief.
- If no carotid pulse, mechanical ventilation is required to combine with carrying out chest compressions.To perform chest compressions, place your hands on one another so that the base of the palm lying on the sternum, was strictly on the midline and 2 fingers above the xiphoid process.Without bending your hands and using your own body weight, 4-5 cm fluently moves sternum to the spine.This shift occurs compression (compression) of the chest.Spend a massage so that the duration of compressions was equal to the interval between them.The frequency of compressions should be about 80 per minute.In the pauses in the hands leave the patient's sternum.If you spend resuscitation alone, having done 15 chest compressions, do two consecutive injection of air.Then repeat chest compressions combined with mechanical ventilation.
- Do not forget to constantly monitor the performance of your resuscitation.Resuscitation effective if the patient turns pink skin and mucous membranes, narrowed pupils, and there was a reaction to light, renewed or improved spontaneous breathing, heart rate appeared on the carotid artery.
- Continue resuscitation until emergency crews arrived.
myocardial infarction Treatment
main goal in the treatment of patients with acute myocardial infarction is to as quickly as possible the renewal and maintenance of blood flow to the affected area of the heart muscle.To do this, modern medicine offers the following tools:
Aspirin (acetylsalicylic acid) - inhibits platelets and prevents the formation of a blood clot.
Already more than a dozen years for the prevention of thrombosis and myocardial used acetylsalicylic acid, but long-term use of the drug can lead to problems with the gastrointestinal tract, such as heartburn, gastritis, nausea, stomach pain, etc.To avoid these undesirable effects, it is necessary to make money in a special enteric coating.For example, one can use the drug Thrombotic ACC each tablet is coated with a special film coating resistant to gastric acid and dissolves only in the intestine.Thus, the substances that make up the drug, do not harm the stomach.For best results, this tool is recommended to take every day, not courses.
heparin, low molecular weight heparin (Lovenox, Fraksiparin) Bivalirudin - anticoagulants acting on blood clotting and factors that lead to the formation and spread of blood clots.
Thrombolytics (streptokinase, alteplase, reteplase, and TNK-aza) - powerful drugs that can dissolve the clot formed uzhu.
All of the above groups of drugs used in combination and are necessary in the modern treatment of patients with myocardial infarction.