Subsequent myocardial infarction - Causes, Symptoms and Treatment .MF .
First Aid and diagnostics
Complications and prognosis
myocardial infarction The danger is not just that it causes serious consequences, but also in the fact that it can occur in the same patienttwo or more times, each time leading to new problems with the cardiovascular system.According to statistics, reinfarction developed in 25 - 29% of all cases.
predict whether or not a second heart attack in a given patient, it is impossible.Some patients observe strict protective regime after the first heart attack, and still this pathology again overtakes them, in spite of all precautions.Some, on the contrary, continued to maintain the former way of life, with the same load, do not always take medicines, but reinfarction they arise.The same can be said about the consequences of repeated heart attacks - in some patients small foci of necrosis occur in the heart muscle remotely from the first post-infarction scar, and it can not have a negative impact on cardiac funct
There are recurrent and recurrent myocardial infarction.Considered recurrent heart attack, developed in the first two months after the previous one, that is, in the acute period.Reread myocardial two months or more after the previous one.
Subsequent myocardial happens melkoochagovogo and macrofocal (extensive), and can be in the same place as the old one, or be at other sites.
most frequent cause of any myocardial infarction is atherosclerosis and deposition of atherosclerotic plaques on the walls of the coronary arteries.This leads to overlap of the lumen, and as the proliferation of plaque and thrombus in it sedimentation occurs complete blockage of the lumen - occlusion.To enter the myocardium stops blood cells do not receive oxygen and die.Develops necrosis of cardiac tissue.In the case of re-infarction reason lies in the fact that atherosclerosis does not disappear, plaques continue to exist in the walls of coronary arteries and can cause their occlusion.Thus there is cell death at the periphery of the old scar, if the newly affected artery same as in the first myocardial or another heart wall, if there is another artery occlusion.
atherosclerosis and myocardial infarction occur in individuals with the following risk factors:
- Male gender.Men's risk of heart disease more than women, in connection with the "protective" effect of female sex hormones.But this ratio is applicable to a certain age, because after menopause women are just as vulnerable to coronary artery disease and heart attack as men.After 70 years, the incidence among them is the same.
- aged over 45 - 50 years.With aging, it is possible to reduce adapatatsionnye.
- Genetic predisposition.The presence of heart disease among close relatives.
- Obesity - waist circumference more than 102 cm for men and more than 88 cm for women, or body mass index over 25. It is calculated using the formula: BMI = height in meters / (body weight in kg) 2
- Diabetes adversely affects the aorta, coronary arteries and small vessels.
- Hypertension impairs the contractility of the heart, causing a thickening of its walls, which leads to an increased need for oxygen, and the coronary arteries to meet this need can not.
- High cholesterol levels in the blood - the main cause of plaque deposits.
- Malnutrition leads to an increase in cholesterol.
- A sedentary lifestyle contributes to excess weight, general detraining the body and heart.
- Chronic stress contributes psychogenic high blood pressure, persistent tachycardia, and other heart problems.
- Tobacco and alcohol abuse damage all vessels inside.
Precipitating myocardial factors:
- violation of the doctor's recommendations and the preservation of the former poor lifestyle choices (smoking, alcohol abuse)
- lack of compliance (adherence)
- frequent emotional excitement
- emergency exercise
- hypertensive crisis
symptoms remyocardial infarction
In most cases, reinfarction manifested the same symptoms as the previous one.The main complaint - intense pain in the chest, in the heart or the breastbone that occurs after the stress, exertion or at rest, protracted (15 - 20 minutes to several hours).Pain may be given in the arm, interscapulum in the jaw and neck, do not disappear when taking nitroglycerin, or a short-term effect of it.The pain is accompanied by general weakness, pallor, sweating.
Complaints may be more pronounced than in the previous myocardial infarction, and combined with the manifestations of complications, for example, expressed by asthma, and cyanosis of the skin coloration in pulmonary edema, loss of consciousness, sudden pressure drop and the overall state of severe heart failure and cardiogenic shock.
Sometimes reinfarction can occur in the form of painless and the patient observes a general malaise and weakness.There are also arrhythmic, asthma and abdominal options.
For arrhythmic forms reinfarction characterized by complaints of feeling heart palpitations, interruptions and fading of the heart.These symptoms manifest ventricular premature beats, atrial fibrillation, bundle branch block and other arrhythmias in myocardial.
Asthmatic option may not be accompanied by pain in the heart, as manifested by shortness of breath, feeling short of breath, choking cough with pink frothy sputum.These symptoms correspond to pulmonary edema, which is an unfavorable form of heart attack.
Abdominal different complaints of abdominal pain, and is often mistaken for a problem with the stomach and intestines due to concomitant nausea and vomiting, so the patient goes to the doctor later, it also significantly reduces the likelihood of a favorable outcome in recurrent myocardial infarction.
Emergency care for suspected myocardial infarction
When symptoms appear, do the following:
- put a patient in an elevated position, release the chest and neck of the compressive garment, open the window for oxygen;
- call an ambulance;
- nitroglycerin sublingual take one tablet every 5 - 10 minutes twice;
- chew an aspirin (Aspirin Cardio, cardiomagnil, tromboAss, etc.);
- when breathing stops and no pulse start rescue breathing and chest compressions until medical help arrives.
To diagnose reinfarction is very important to compare the ECG film, previously recorded in real time.Therefore, every patient with myocardial infarction should always be in possession of an electrocardiogram tape made during the last visit to the doctor.But it is not always possible to suspect a second heart attack, especially if the new necrosis area formed in the affected area of the same artery as the last time, or if signs of necrosis on the ECG masked atrial fibrillation or complete blockage of the left bundle branch block.Therefore, in diagnostically uncertain cases need to be guided, first and foremost, on the clinical manifestations, and if the doctor deems necessary hospitalization department with suspected reinfarction, better, of course, be examined in the hospital.
ECG - signs of myocardial infarction:
- signs of damage (necrosis) infarction of a heart wall (a deep Q wave in the respective leads with ST-segment elevation or negative tooth T);
- signs of postinfarction scar may redutsirovatsya or disappear completely.For example, if the front reinfarction symptoms disappear scar on the back wall, fixed on a previous ECG, and vice versa - the so-called "improvement" of the ECG caused by re-infarction;
- in the absence of reliable evidence of reinfarction indirect indication should be considered even short-segment elevation ST, as a sign of the acute stage of the process.
addition ECG weighty diagnostic value has echocardiography, as it allows to define areas of hypo- and akinesia, ie areas of impaired myocardial contractility, and to evaluate the function of the heart as a whole, such as ejection fraction, stroke volume, blood flow and the pressure level in the cellsheart, aorta and pulmonary artery.
From laboratory diagnostics presence of myocardial help reliably determine blood tests to the level of creatine phosphokinase (CK and CK - MB), troponin, lactate dehydrogenase (LDH), ALT and AST.
Norma CK - 10 - 110 IU or CK - MB is not more than 4 - 6% of the total CK.It should be remembered that CPK activity - increases through CF 3 - 4 hours after the start of pain in the heart and returned to nearly normal levels after 48 hours.
Normal blood troponin - troponin I 0.07 nmol / L, troponin T 0.2 - 0.5 nmol / L.Troponin I in the blood is determined up to 7 days, troponin T - 14 days.
Norma LDH - up to 250 U / L.There is growing within 2 - 3 days from the start of heart attack, returned to baseline levels by 10 - 14 per day.
Norma AST - up to 41 U / L (more specific for heart disease, and ALT - for liver disease).Growing a day, reduced at 7 days post infarction.the ratio of AST to ALT -
Rytis coefficient used for the differential diagnosis of myocardial damage and liver.If it is more than 1.33, a high probability of a heart attack, if less than 1.33 - liver disease.
greatest for cardiac possess MB - CPK and troponin test.In addition to these methods, are appointed by common blood and urine tests, blood chemistry, ultrasound of internal organs, chest X-ray and other methods determined by your doctor.
If the patient is taken to the hospital no later than 12 hours from the beginning of pain attack (or ECG changes in the form of painless), the greatest efficiency in the treatment of notes during emergency thrombolysis and balloon angioplasty.
Thrombolysis - is the use of drugs that can "dissolve" thrombus within the lumen of the coronary artery and restore blood flow to the lost portion of the myocardium.Used streptokinase, urokinase, alteplase.
Indications - Acute, including recurrent myocardial infarction with pathological Q waves and segment elevation ST, within 12 - 24 hours.
Contraindications - bleeding at any site in the last six months (in the stomach, intestines, bladder, uterine, etc.), stroke in the acute and subacute stage, dissecting aortic aneurysm, intracranial tumors, blood clotting disorders, severe surgery or trauma in the past month and a half.
Balloon angioplasty - endovascular (intravascular) the introduction and installation of the cylinder, an inflatable pressure and reducing the lumen.The technique is performed under the control of X-ray television.
applied either immediately for 12 - 24 hours from the start of heart attack (emergency angioplasty) or after 5 - 7 days after thrombolysis (delayed angioplasty) or in a planned manner with the successful removal of the occlusion thrombolysis.
Indications - remaining within a half - two hours after thrombolysis, pain and evidence of myocardial damage on the electrocardiogram (thrombolysis is not effective).
Contraindications - defined individually, as even in severe condition of the patient, for example, in the development of cardiogenic shock, it is preferred to carry out emergency angiography and angioplasty.
Drug therapy reinfarction
begins at the stage of the patient transport ambulance crews.Apply the following drugs in combination:
- betaadrenoblokatory - metoprolol, carvedilol;
- antiplatelet agents and anticoagulants - aspirin, clopidogrel, heparin, Plavix;
- nitroglycerin and long-acting analogues - nitroglycerin intravenously pektrol, nitrosorbid monocinque or tablets;
- ACE inhibitor - enalapril, perindopril;
- statins that reduce cholesterol - atorvastatin, rosuvastatin.
Lifestyle with recurrent myocardial infarction
To prevent post-infarction angina and reinfarction should follow the doctor's recommendations:
- a permanent, continuous, lifelong reception betaadrenoblokatorov, antiplatelet agents and statins
- lifestyle modification - rejection of bad habits, proper nutrition,exclusion of significant physical exertion and stress
- in acute myocardial (2 - 3 days) with strict bed rest (up to 7 - 10 days), followed by physiotherapy, prescription.After discharge from the hospital is required daily physical activity, but without the excessive loads, such as slow walking for short distances
- in the recovery period after myocardial shown sanatorium - resort treatment (indications and contraindications determined by the doctor during the hospital stay)
- the question ofrehabilitation or disability decided on the clinical - expert commission on place of residence, depending on the degree of circulatory disorders.Temporary disability (sick leave) is possible when re-infarction period not more than 90 - 120 days and at reconstructive operations on coronary vessels - up to 12 months.The return to work even if the good condition of cardio - vascular system is contraindicated for such employees, as employees of socially important professions (drivers, pilots, manager on the railroad, air traffic controller, etc.), working night or daily shifts, at an altitude of (crane), the facewhose work is connected with a long walking (postman, courier), and so on. d.
Complications of the disease
Subsequent myocardial infarction is often complicated by the development of acute heart failure, pulmonary edema, cardiogenic shock, cardiac arrhythmias, rupture of an aneurysm of the left ventricle, pulmonary thromboembolismartery.Prevention of complications is timely to seek medical help for pain in the heart, chronic administration of medicines, as well as regular visits to the doctor with the registration of the ECG.
Weather Forecast melkoochagovogo reinfarction favorable.For macrofocal or extensive myocardial less optimistic prognosis, because in this form often develop complications and mortality within the first 10 - 14 days is 15 - 20%.Mortality in men older than 60 years of re-infarction, and 14% in women older than 70 years - 19%.
therapists Sazykina OJ