Myocardial infarction: what it is, treatment methods and consequences. What is myocardial infarction? Why does it develop and why is it dangerous?

– the death of certain areas of the heart muscle, provoked by circulatory disorders, when a critically reduced amount of blood begins to flow into the organ through the coronary vessels.

Pathology can cause not only serious consequences, but also fatal. That is why, when the first signs appear, you need to seek help from specialists.

Pathology is often diagnosed in older people. Also at risk are patients who sedentary image life or are obese.

In addition, the cause of myocardial infarction may be:

• Psycho-emotional overload, frequent stress, nervous strain.
• Overeating.
• Hypertensive diseases.
• Sedentary lifestyle.
• Lack of animal fats in the diet.
• Bad habits, such as drinking alcohol or smoking.
• High cholesterol. When keeping large quantity substances on the walls of blood vessels begin to form blood clots.
• Diabetes.

It is diagnosed mainly in people who lead a predominantly sedentary lifestyle. In women, circulatory disorders occur at the age of 40 years, and in men - after 30 years.

First symptoms

The first obvious manifestation of myocardial infarction is strong pain behind the sternum. It manifests itself in the form of burning and squeezing and can radiate to the neck, shoulder, arm, jaw, or back.

Painful sensations also appear during the rest period. Also, the most pronounced symptom of myocardial infarction is the lack of relief after taking three tablets of the drug to normalize the functioning of blood vessels.

Other signs include:

• Labored breathing.
• Pallor skin.
• Sudden appearance of cold sweat.
• Nausea accompanied by vomiting.
• Abdominal pain.
• Feeling of fear.
• Headache and dizziness.
• Heart rhythm disturbance.

In some cases, loss of consciousness is observed. If these symptoms appear, you should consult a doctor. Timely assistance will help not only avoid serious consequences, but also save life.

Why is a heart attack dangerous?

Lack of therapy or delayed assistance can lead to various complications. Among them:

• Atrial fibrillation.
• Cardiogenic shock.
• Pulmonary artery thrombosis.
• Rupture of the spleen, which provokes strokes, pneumonia, and intestinal necrosis.
• Cardiac tamponade. The complication is fatal.
• Pericarditis, inflammation of the pleura, joint pain.

The occurrence of complications after a myocardial infarction significantly affects the patient’s life prognosis. Based on many years of research, it was found that mortality reaches about a third of all cases.

Diagnostics

First, the doctor assesses the patient's condition and conducts a survey to determine the presence of symptoms. The specialist also examines the medical history, which often helps determine the cause of the heart attack.

In addition, the following instrumental diagnostic methods are prescribed:

1. . The electrocardiogram reveals various changes characteristic only of a heart attack. The localization of the necrosis focus and period are also established.
2. . Helps restore vascular patency and establish the exact location of the lesion. It is carried out using x-rays and contrast agent, which is administered through a special probe.
3. Computer coronary angiography. Used to diagnose coronary artery disease to determine the degree of narrowing of the main arteries. The method allows you to determine the degree of development of a heart attack. This method used in rare cases, since not all clinics have equipment and specialists.

In addition, laboratory diagnostics are carried out, since as a heart attack develops, a change in blood composition is observed. Biochemical composition indicators are also monitored during therapy.

Treatment methods

The main goal of therapy is to restore blood circulation to the injured area and maintain it at the proper level. For this they use medications, and in severe cases surgical treatment may be required. Patients also need to follow a specially designed diet.

Drug therapy

With the aim of quick recovery blood circulation apply various drugs, which are prescribed depending on the degree of damage, the patient’s condition and individual characteristics.

These include:

• "Aspirin". Helps thin the blood and prevent the formation of blood clots on the walls of blood vessels.
• "Plavix", "Triclopidine". They have the same effect as the previous drug, but have a stronger effect.
• "Lovenox", "Fraxiparin". They are anticoagulants that act on coagulation and inhibit factors that influence the appearance of blood clots.
• "Streptokinase", "Reteplase", "Alteplase". They are thrombolytic agents that have the ability to dissolve a blood clot already formed in the vessels.

For the treatment of myocardial infarction, the use of a combination of several groups of drugs is indicated.

In the first hour acute development disorders require the use of thrombolytic agents. In case there are no results drug treatment, surgical intervention is prescribed. This may also be the only way to restore impaired blood circulation.

Surgery

After the patient’s stable condition has been achieved with the help of medications and the heart rate has returned to normal, surgery is prescribed.

Today, modern medicine can offer several methods:

• Stenting. The procedure is performed using a special stand, which is inserted into the narrowed areas of the coronary vessel through the femoral artery. The operation is performed under the control of an x-ray machine.
• Coronary artery bypass surgery. The procedure is carried out on open heart after opening chest. The essence of the method is to create an additional possibility of blood supply to the injured area of ​​the heart muscle. The operation is performed by transplanting the patient's veins. This way they are created additional paths blood flow.

From the video you can learn the main symptoms of myocardial infarction:

The choice of method for restoring blood circulation in the coronary vessels depends on the following indicators:

1. Presence or absence of post-infarction aneurysm.
2. Damage to more than two arteries or more than 50% narrowing.

During the recovery period after surgery great importance It has physical activity patient. During the first week, strict adherence to bed rest is required, and it is necessary to perform passive movements without getting out of bed. It could be breathing exercises under the supervision of specialists.

As you improve general condition the load should be gradually increased.

At the same time, you should also not get out of bed. After one week after the procedure, patients are allowed to eat and wash themselves.

In the second postoperative period, the patient is allowed to get up and walk around the bed. Over time, walks can be taken along the hospital corridor, gradually increasing the load. Patients switch to complete self-care.In the third period, a free mode is provided, which then turns into a training mode.

Diet

The diet is developed for each patient in individually. First of all, the general condition is assessed, the level of cholesterol in the blood and body weight are measured. 4-5 meals a day are recommended.

In cases of excess cholesterol levels, patients should limit the consumption of egg yolk, caviar and liver. At the same time, one third of all consumed fats should be plant origin. To reduce cholesterol, it is recommended to include apples and bananas in your diet.

In addition, the content of dietary fiber in foods is of great importance. They slow down the absorption of cholesterol into the intestines and maintain normal levels of cholesterol in bile.The patient is discharged from the hospital if there are no symptoms of the disease, a sufficient level of self-care and resistance to physical activity.

Prognosis and prevention

Myocardial infarction is a serious disease characterized by serious complications. A significant proportion of deaths occur in the first day after the attack. In cases where more than half of the myocardium is damaged, the heart muscle cannot function, which provokes death.

But even with smaller lesions, the heart cannot always cope with the load. As a result, heart failure develops. When the acute period is stopped, the prognosis is favorable.

In order to protect your body and prevent a heart attack, doctors recommend keeping healthy image life, stop drinking alcohol and smoking, eat right, eliminate psycho-emotional stress, control blood pressure and cholesterol levels in the blood.

Considered the most dangerous disease, which is characterized by impaired performance of the heart muscle as a result of tissue necrosis.

Symptoms are always pronounced, and lack of treatment leads to many severe consequences. That is why, when the first signs of a heart attack appear, you should call an ambulance. Only timely medical assistance will help avoid death.

Myocardial infarction and cerebral stroke are firmly ranked first in the world in mortality. We are used to hearing that one of our neighbors, colleagues, or relatives suffered a heart attack. For us, this disease is present somewhere nearby.

What it is? Myocardial infarction is a form of coronary heart disease (CHD), which can be considered a complication, since it is a condition in which the heart muscle experiences a sharp lack of oxygen and nutrients.

Thus, in 2011, 13 million people died from heart attacks worldwide. This is more than the populations of Denmark and Israel combined. If we take our country, then in Russia the mortality rate from acute heart attack myocardial disease broke all possible and impossible records and, according to 2012 data, amounted to 587 cases per 100 thousand population, including old people and infants. This means that within a year, every one of the 165 people you know or pass by will die from a heart attack.

In Russia, 43% of men who die from this disease die in the prime of life, or, as dry statistics say, “at economically active age.” If we take developed countries, then this figure is four times lower.

A third of patients with a heart attack die in the first 24 hours from the onset of the disease. This is partly caused by delaying emergency hospitalization until they “get it,” since 50% of them die before meeting doctors.

But even if the patient managed to be taken to the hospital and treated, then after discharge, which was done according to all the rules and with normalization of tests, 5-15% of those discharged will die within a year, and each subsequent year will claim the life of every 20th person (5 % in year). Therefore, coronary heart disease, and its most dangerous manifestation – myocardial infarction – is a very serious disease.

More men fall ill and die than women. Thus, myocardial infarction in women and men (incidence) correlates, according to various sources, from 1:2 to 1:6, depending on age. What kind of disease is this, how does it manifest itself, and how to treat it?

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What it is?

Acute myocardial infarction is the rapid death or necrosis of a part of the heart muscle due to a severe lack of blood supply to this area.

To avoid confusion, it should be said that a heart attack is a standard pathological process caused by blockage of the vessel leading to the organ arterial blood. Thus, an infarction of the kidney and spleen occurs. Got a cerebral infarction given name- stroke.

And myocardial infarction is so significant in terms of the number of victims that it is simply called a heart attack. Why does this pathology develop?

Causes of myocardial infarction and risk factors

If the coronary vessels that carry blood to the heart are healthy, then a heart attack will not develop. After all, its cause is three successive events, and a prerequisite is the presence of atherosclerosis and plaque inside the vessel:

• External release of adrenaline and acceleration of coronary blood flow. This is an ordinary situation, for example, anxiety at work, stress, high blood pressure, or physical activity, which may be very small;
• An increase in blood velocity in the lumen of the coronary vessel damages and ruptures the atherosclerotic plaque;
• After this, at the site of the rupture, the blood forms a durable clot, which falls out when the blood interacts with the plaque substance. As a result, blood flow below the accident site either stops or sharply decreases.

Most often, newly formed, “young” and unstable plaques disintegrate. The problem is that old plaques “sit” firmly, even if they block 70% of the lumen of the vessel, and young plaques that block 40% may be the cause. What causes plaques to form?

Risk factors

It is unlikely that new studies can add another risk factor to the existing ones. All of them are well studied:

• age of men over 40 years, women over 50 years;
• the presence of heart attacks or sudden cardiac death in relatives;
• smoking;
• overweight or obesity. The easiest way to determine it is by waist circumference: the norm for men is no more than 102, and for women – no more than 88 cm;
• physical inactivity and decreased physical activity;
• hypercholesterolemia – increased content of cholesterol, its atherogenic fraction;
• having a diagnosis arterial hypertension, or hypertension;
• diabetes;
• constant stress.

As you can see, only the first two factors cannot be changed in any way - they are unmodifiable. But the rest can be handled quite well!

In the same case, when a heart attack develops, how does it proceed? What are its symptoms?

The first signs and symptoms of myocardial infarction

Signs of myocardial infarction can be very diverse. But when making a diagnosis, looking ahead, we will say that in addition to the external picture of the disease, ECG data are taken into account, as well as the results of laboratory tests of some enzymes contained in the muscles that enter the blood during a heart attack

Characteristic first signs of a heart attack

The main sign is sharp pain in the chest (70-90% of all cases). It lasts more than 20 minutes, “rolling” in attacks. Each subsequent attack is stronger than the previous one.

• The nature of the pain is excruciating, pressing, gnawing, squeezing. It is immediately clear that the pain is “serious because it has never happened before”;
• Localization of pain is usually behind the sternum, or in the projection of the heart (50%). In 25% of cases, pain occurs in the periphery: left jaw, left shoulder blade, left arm and hand, left shoulder, spine, and even pharynx;
• The severity of pain, or intensity, varies. In severe cases, patients cannot endure and groan, but sometimes the pain is weak or absent altogether. Most often, this happens with diabetes mellitus, against the background of sensitivity disorders due to. There is “exorbitant” pain, which is not relieved even by morphine and promedol, or is relieved incompletely;
• The pain lasts no less than 20 minutes (minimum), but can last for several days, it is not relieved by nitroglycerin, or disappears for a short time with resumption;
• An attack is caused by physical activity, from defecation and making the bed to heavy work and sexual intercourse, stress, leaving the house in the cold, swimming in an ice hole, periods of sleep apnea, eating a large meal, and even moving the body from sitting to lying down.

To top it all off, we can say that a heart attack can occur at all, without any provocation, in the midst of complete rest.

What symptoms accompany a heart attack?

Most often, such characteristic accompaniments of acute coronary syndrome occur as:

• restlessness, general weakness, or agitation;
• fear of death, sweating, sallow complexion, severe pallor;
• gastrointestinal symptoms: nausea, diarrhea, vomiting and bloating;
• cardiac symptoms: pulse lability, thready pulse, decreased blood pressure;
• Cold sweat may appear.

Atypical course options

In addition to the classic, “anginal” myocardial infarction with severe chest pain, you need to be able to diagnose the main “masks”, or atypical variants. These include:

1. Abdominal option. There is complete confidence that the problem is in the “stomach”. Pain occurs in the abdomen, in the projection of the stomach, in the right hypochondrium, accompanied by nausea and vomiting, bloating;
2. Asthmatic, which can be a manifestation of acute cardiac asthma: suffocation, shortness of breath, and cough with foamy sputum Pink colour. More often it indicates acute stagnation in the pulmonary circulation. This happens often during repeated processes;
3. Arrhythmic option. Almost all symptoms are reduced to heart rhythm disturbances, the pain is mild;
4. Cerebral, “stroke-like” variant. It causes “floaters” before the eyes, intense dizziness, stupor, fainting, nausea and vomiting.

These variants can be expected in diabetes, in patients with a history of heart attacks, and in old age.

Stages of development

In order to know the “enemy in person”, let’s get acquainted with the periodicity of the disease. What happens in the heart muscle? There are several stages of the disease:

• Development, or acute period, up to 6 hours after onset. It is characterized by the most striking symptoms, including on the ECG. By the 6th hour, the formation of the zone of myocardial necrosis ends. This critical time. Later, it is no longer possible to restore dead cells.
• Acute period – up to 7 days. This is the time when greatest number complications, and in the myocardium there are processes of remodeling, or destruction of dead tissue by macrophages and the formation of pink, young connective tissue at the site of necrosis. She is good to everyone, but, alas, she cannot contract like a muscle;
• The period of healing, or scarring. The scar thickens and “matures”; this period ends a month after the attack;
• From a month onwards after a heart attack, PICS, or post-infarction cardiosclerosis, is determined. All those problems that have persisted by this period (arrhythmia, heart failure) will most likely remain.

Knowledge about the first symptoms of myocardial infarction is simply necessary for everyone. Here are the amazing numbers:

• If you do not consult a doctor, 28% of patients die in the first hour of a heart attack. During the first 4 hours, 40% of patients die; after 24 hours, half of all patients will be dead;
• Even if we take Moscow, then within the first 6 hours from the beginning about 8% of all patients end up in a specialized department, and in the USA this is 80%.

Why don’t people call an ambulance immediately, or at least half an hour after the onset of severe, unusual pain? Because Russian people are not accustomed to the fuss around them, and the patience of the Russian people is limitless. However, if you suspect a heart attack, you should immediately do the following:

• Pull yourself together;
• Put the patient in bed or on the sofa, prohibit him from getting up;
• Place nitroglycerin under the tongue, then after 3 minutes again (if the pain does not go away), and then another one;
• While the nitroglycerin is working, an ambulance is called;
• If possible, open the window and ventilate the room;
• If you have equipment, you need to measure your blood pressure, count your pulse, and check it for arrhythmia;
• Let the person know that they are not going to abandon him, reassure him. This is very important because with a heart attack there may be a fear of death;
• The patient can be given aspirin powder at a dose of 325 mg;
• When low pressure You can raise your legs by placing something under them.

This completes your participation in first aid for acute myocardial infarction, and all that remains is to wait for the cardiac team. Doctors immediately give oxygen, record an ECG, administer narcotic analgesics in case of severe pain, and if the diagnosis is 100% certain, they perform thrombolysis at home to dissolve the blood clot and allow blood to “break through” to the affected area of ​​the heart muscle.

Remember: necrosis (necrosis) is completed after 6 hours, so only within this time it is necessary to restore blood flow (recanalize) the thrombus. Therefore, the ideal option would be for doctors to arrive no later than the first hour after the onset of the illness.

But how to diagnose a heart attack? What helps doctors make the correct diagnosis?

Diagnostics - ECG, tests and ultrasound

First of all, a diagnosis of heart attack is assumed, based on the patient’s complaints, examination and medical history (presence of risk factors, angina). Instrumental diagnosis of classic acute coronary thrombosis is quite simple.

In the diagnosis of acute myocardial infarction, determining the level of enzymes is of great help: CPK-MB, creatine phosphokinase, which increases 3 hours after the onset of necrosis, reaches a maximum by the end of the first day, and after another day returns to normal. Troponins are examined and a troponin test is performed. In the general blood test, ESR and leukocytosis increase.

Cardiac ultrasound and other research methods are also used in diagnosis.

Danger of complications

It is known that, in principle, a person does not die from an uncomplicated heart attack. Death occurs from complications. What are the complications of coronary thrombosis? Isn't a dead section of the heart enough? It turns out not enough. A heart attack can be complicated by:

• Pulmonary edema (shortness of breath, cyanosis, cold sweat, cough with foamy sputum, wheezing, foam at the mouth);
• Cardiogenic shock, which develops against the background of an extensive heart attack and is associated with a decrease in cardiac function, includes pain and arrhythmic shock;
• Ventricular fibrillation, which is the most dangerous rhythm disorder. Without defibrillation, death is inevitable. Develops already in the first hours after the onset of a heart attack;
• Ventricular extrasystoles, idioventricular rhythm and other arrhythmias;
• Impulse conduction disorders and severe blockades;
• Asystole (complete electrical “silence” of the heart);
• Rupture of the heart (wall of the left ventricle). Occurs with an extensive transmural zone of necrosis;
• Intracavitary thrombosis;
• Rupture of the interventricular septum and separation of papillary muscles and heart valves.

Besides these very severe complications, some of which are certainly fatal, myocardial necrosis in the right ventricle may occur as a complication of necrosis on the left.

To top it all off, after a large number of muscle structures enter the bloodstream, Dressler's syndrome develops, associated with autoimmune inflammation, and is manifested by fever, polyarthritis and pericarditis. It occurs 2 weeks after a heart attack.

In order to avoid complications, including fatal ones, hospitalization for myocardial infarction is needed as early as possible.

Treatment of myocardial infarction, drugs

Competent treatment of acute myocardial infarction has its own goals. We will not talk here about pain relief, oxygen supply, or actions in case of sudden cardiac arrest. We will talk about the principles of treatment of ordinary and uncomplicated myocardial infarction in the most general and accessible form.

Thrombolysis

If you try to dissolve a fresh thrombus, then the chances of restoring 55% of the necrosis zone are available in the first 1.5 hours from the onset of a heart attack; by the end of the 6th hour this percentage drops to 15%. If you consult a doctor later, thrombolysis is pointless.

Think about it: a delay in thrombolysis of half an hour shortens the patient's life by a year, and an hour's delay leads to an increase in the risk of death by 20% per year even 5 years after a heart attack.

Heparin and anticoagulants

It is known that a week of heparin use reduces mortality by 60%. At the same time, blood fluidity increases and thrombotic complications, for example, inside the chambers of the heart, are prevented. Low molecular weight heparins are currently used.

Antiplatelet therapy

Prevents the formation of new blood clots. For this, “cardiac” aspirin is used in a dose of 75 to 325 mg. Clopidogrel, which is prescribed after illness for a year, is highly effective.

Nitrates

These drugs facilitate the work of the heart, reduce vasospasm and reduce the load on the heart, improving the outflow from it, since blood is deposited in the vessels of the skin and muscles. The drugs are taken both in the form of an inhalation spray and in the form of tablets and infusions.

BAB (beta-blockers)

They protect the heart from increased work in case of adrenaline release into the blood. As a result, the need for raw oxygen does not increase, ischemia does not occur, and there is no heartbeat. This mode of heart operation can be called “energy saving”.

ACE inhibitors

In addition to the fact that angiotensin-converting enzyme inhibitors prevent an increase in blood pressure, they reduce the myocardial oxygen demand, and also prevent the appearance of atherosclerotic plaques and slow down their growth. As a result, they reduce the risk of recurrent heart attack and mortality.

In addition to these drugs, which are prescribed in various combinations to almost all patients, statins are prescribed that correct fat metabolism (after discharge), calcium blockers, and aldosterone receptor blockers in patients with a pronounced decrease in systolic output.

Surgery

In case of acute myocardial infarction, the following can be performed:

• PCBA, or percutaneous balloon coronary angioplasty. It allows you to restore blood flow and implant a stent, and is an alternative to thrombolysis. The disadvantage is the impossibility of performing PCI after 12 or more hours from the onset of a heart attack, as well as the high cost. The purpose of the operation is to mechanically expand the vessel in the area of ​​thrombosis, “press” the thrombus into the wall of the vessel and install a rigid tube - a stent.
• CABG, or coronary artery bypass surgery. As a rule, it is carried out no earlier than a week after the development of thrombosis, due to high risk early complications. The purpose of the operation is to build new vascular “bridges” and improve myocardial vascularization.
• Intra-aortic balloon counterpulsation. This is a method of unloading the heart in both systole and diastole by installing a balloon in the aorta. It is performed in case of cardiogenic shock, septal rupture and is regarded as a temporary effect before surgery.

We have talked enough about what it is - myocardial infarction, and what the consequences and prognosis may be if you do not seek urgent help in a timely manner. Rehabilitation after myocardial infarction aims to reduce social, physical and even psychological consequences disease, and prevent the possibility of relapse and other fatal complications.

It is known that, unlike a stroke, after a heart attack, about 80% return to normal (everyday) life after six months, and in the case of mild course– in 2-3 months. As for professional rehabilitation, patients who have suffered a heart attack can no longer work as pilots, machinists, dispatchers, or in other responsible jobs.

An important component of rehabilitation is the treatment of post-infarction depression, which occurs in every 20th patient.

Physical rehabilitation involves increasing physical activity, which, with a competent approach (physical therapy), can reduce mortality by a quarter.

• The main thing in rehabilitation is the identification of four functional classes and the correspondence of programs to their capabilities.

Patients should have different levels of physical activity, depending on the severity of the condition, the presence of post-infarction angina, and arrhythmias. Thus, class 1 has no restrictions at home, and in patients of class 4, any physical activity provokes angina attacks.

Also important is nutrition, prevention of weight gain, taking antiplatelet agents, statins under the control of biochemical blood tests, support normal level blood pressure and treatment of associated diseases - for example, diabetes or hypertension.

This is the only way to reduce the risk of recurrent myocardial infarction and its long-term complications.

The main cause of myocardial infarction is the blockage of one of the vessels of the branched circulatory network by a thrombus. In this case, the supply of oxygen in the heart muscle cells is only enough for 10 seconds. In the next 30 minutes, the muscle remains viable, after which irreversible consequences begin. It is very important to begin treatment of a heart attack and prescribe the right medications in the first minutes, since irreversible consequences of heart cells occur within three to six hours.

Diagnosis and subsequent treatment after a heart attack, including necessary medicines, is established based on the results of the examination and available signs. In case of myocardial infarction they are of the following nature:

Specific heart pain and requires painkillers.

Presence of changes in the electrocardiogram.

The results of a biochemical blood test confirming damage to heart muscle cells.

Testing blood serum for troponins (a specific protein of the heart muscle). A troponin test is taken daily for 8-10 days.

In some cases, radioisotope research methods are prescribed to confirm the diagnosis of myocardial infarction. This approach will make it possible to more accurately identify foci of heart muscle necrosis and determine necessary treatment and prescribe the most appropriate means.

Main signs of the disease

Treatment for myocardial infarction should begin immediately if the following symptoms are present:

Burning severe pain is observed in the heart area for more than 30 minutes.

The pain syndrome does not decrease, even if drugs such as nitroglycerin have been taken.

Painful symptoms are accompanied by nausea, vomiting, severe weakness, headache or dizziness.

Sometimes the symptoms of myocardial infarction may not be clear enough, which makes diagnosis difficult and makes it impossible to prescribe treatment and necessary funds. Myocardial infarction may have atypical forms and symptoms characteristic in such cases:

Gastric type. Asthmatic type. Arrhythmic type. Cerebral type. Painless type

First aid

How to treat a heart attack in the first minutes after the onset of a crisis? At the first signs of myocardial infarction, an ambulance is called and treatment begins. You can use those aids, which are currently at hand. Treatment in this case involves reducing the load in the heart area. For this purpose, the patient can be placed on a raised headboard and provided with access to fresh air.

It is recommended to give sedatives. Also suitable are drugs such as nitroglycerin and others like it. If possible, take beta blockers: metaprolol, atenolol. If the patient has previously taken similar medications, then an additional dose is prescribed. To reduce pain during myocardial infarction, it is recommended to give painkillers: baralgin, analgin, aspirin. This type of treatment continues until the doctors arrive.

Basic treatment

Treatment of a patient with myocardial infarction should be aimed at speedy restoration and maintenance of blood flow in the affected area of ​​the heart. As practice shows, the maximum effective treatment in the first hours after myocardial infarction - this is stenting. In some cases, the only possible way to save the heart muscle is to prescribe coronary artery bypass grafting.

As auxiliary treatment for myocardial infarction are prescribed medications, the purpose of which is to perform several tasks at once:

Medicines intended to thin the blood and prevent blood clots. This effect can be achieved by prescribing medications from a series of disaggregants, anticoagulants, etc.

For myocardial infarction, treatment in a hospital involves the prescription of a painkiller. You can use drugs - narcotic and non-narcotic analgesics. It is also possible to reduce the pain syndrome during myocardial infarction due to the need of the heart muscle for oxygen. Treatment involves the use of medications with antianginal action and nitro preparations.

Antihypertensive drugs are prescribed to normalize blood pressure.

In case of cardiac arrhythmia, antiarrhythmic agents are prescribed.

Myocardial infarction can be treated not only by using such drugs. Treatment primarily depends on the general condition of the patient and concomitant diseases. Prescribed medications should not carry side effects and disrupt the functioning of other organs.

Myocardial infarction - treatment of myocardial infarction

1. Description of the disease. MYOCARDIAL INFARCTION is an acute disease caused by the development of one or more foci of necrosis in the heart muscle and manifested by impaired cardiac activity. It is observed more often in men aged 40-60 years.

As a rule, the basis of myocardial infarction is a lesion coronary arteries hearts with atherosclerosis, leading to a narrowing of their lumen. Often, the atherosclerotic process is accompanied by thrombosis (blockage of blood vessels) in the affected area of ​​the vessel, as a result of which the flow of blood to the corresponding area of ​​the heart muscle is completely or partially stopped. The formation of a blood clot is facilitated by disturbances in blood coagulation processes, often observed in such patients. Spasm of the branches of the coronary arteries plays a certain role. The occurrence of myocardial infarction contributes to hypertonic disease, diabetes mellitus, obesity, nervous tension And mental trauma, smoking. In most cases, myocardial infarction develops against the background of angina pectoris, in which sudden physical or mental stress can cause myocardial infarction.

The main manifestation of myocardial infarction is prolonged attack intense chest pain caused by acute anemia of a section of the heart muscle deprived sufficient quantity nutrients and oxygen. Usually the pain is squeezing, tearing, burning, localized in the center of the chest (behind the sternum) or to the left, often spreading upward and to the right, radiating to the left hand or both hands, in the back, lower jaw. As a rule, the attack lasts several hours, and sometimes even days, accompanied by severe weakness, a feeling of fear of death, as well as shortness of breath and other signs of cardiac dysfunction.

Unlike angina, the pain of myocardial infarction usually does not disappear after readmission nitroglycerin. Myocardial infarction often develops during an exacerbation of coronary heart disease, which is manifested mainly by an increase in frequency and intensification of angina attacks, and a decrease in the effectiveness of nitroglycerin. This period is called pre-infarction, or the period of progressive angina; its duration ranges from several days to several weeks. It is during this period that measures to prevent myocardial infarction are most effective.

2. Treatment of myocardial infarction. Patients with a heart attack require urgent hospitalization and inpatient treatment, and in the first days it is better in the intensive care ward. Naturally, in acute period The main place in the complex of therapeutic measures is given to various medications. However, already during a hospital stay, the patient can undoubtedly benefit from medicinal plants that have vasodilating, antiplatelet and anticoagulant effects, increase the tone of the heart muscle, have a calming effect and stimulate intestinal function.

The role is especially growing medicinal plants in the process of rehabilitation of patients who have suffered a myocardial infarction. The volume and nature of herbal medicine depends on the condition of the patients and the symptoms that they experience in the post-infarction period. Treatment of myocardial infarction in the absence of any serious complex heart rhythm disturbances, chronic circulatory failure and other disorders, the method of using medicinal plants is fundamentally the same as in the treatment of stable angina pectoris, since it persists to one degree or another. Therefore, its functional class must be taken into account.

The course of myocardial infarction is highly variable. Although the disease is rightly considered severe and life-threatening, the prognosis for most patients is quite favorable. Duration of treatment, incl. sick leave, are determined by the course of the disease, the presence or absence of complications, etc.

When treating myocardial infarction it is necessary fractional meals(at least 4 times a day, so as not to overload the stomach) and varied, but in the first days of illness with significant restrictions on caloric content and volume; Fruit and vegetable purees (from apples, beets, carrots, prunes) are preferred, which promote normal bowel movements. Foods that cause bloating, such as peas, milk, fresh cabbage, kvass, are excluded from the diet, because the resulting rise of the diaphragm impedes the work of the heart and impairs its blood supply. Prohibited fatty varieties meat, smoked products, salty products, any kind alcoholic drinks. Subsequently (as directed by the doctor), the diet is enriched with proteins (boiled lean meat and fish, cottage cheese) and carbohydrates (bread made from flour coarse, vegetables, buckwheat, oatmeal, etc.). It is necessary to monitor bowel function; bowel movements should be regular (preferably daily, but at least once every two days). In the absence of independent stool, laxatives or a cleansing enema are used only as prescribed by a doctor.

The daily routine must be strictly regulated. You need to get up and go to bed at the same time every day. Sleep duration is at least 7 hours. Haste, fast walking in cold air can provoke an attack. Work should not be accompanied by physical and nervous tension. It is prohibited to work on the night shift, in hot shops, etc. Weekends and vacations should be spent in the fresh air; walks and other individually dosed measures are beneficial. physical exercise, which train the cardiovascular system, improve the contractility of the heart muscle and its blood supply. Meals should be four times a day, varied, rich in vitamins and limited in calories (no more than 2500 kcal per day). At proper nutrition the patient should not gain weight. Quitting smoking and alcohol abuse – the necessary conditions prevention of myocardial infarction. Since nervous breakdowns are the direct cause of the attack, it is very important to maintain normal relationships in the family and work collective. Patients with heart disease should be warned against jogging. long distances, long hours of exercise, treatment with prolonged hunger. These events often only bring harm. The nature of health treatment should be agreed upon with your doctor.

3. Treatment of myocardial infarction with collections of medicinal plants.

Collection 1: 100 g chamomile (flowers); 100 g St. John's wort (herb); 100 g immortelle (flowers); 100 g. birch buds. Grind the collection in a coffee grinder and pour into a glass jar with a lid. Brew 1 tablespoon of the mixture into 0.5 liters. boiling water, leave for 20 minutes. strain. Take one glass of warm liquid with a teaspoon of honey on an empty stomach for 20 minutes. before meals and before bed. In the evening after taking the decoction, do not eat or drink anything else. The course is conducted once every five years. This remedy prevents the development of sclerosis and heart attack.

Collection 2: St. John's wort herb – 1 hour; Scutellaria rhizome – 1 hour; Viburnum bark – 1 hour; Heart-shaped linden flowers – 1 hour; Common raspberry shoots – 1 hour; Astragalus wooliflora herb – 1 hour; Blood-red hawthorn fruits – 1 hour; Coltsfoot leaves – 1 hour; Rowan fruits – 1 hour; Common wormwood herb – 1 hour; Lavender herb – 1 tsp.

Collection 3: Sweet clover herb – 1 hour; Rhizome of valerian officinalis – 1 hour; Angustifolia fireweed herb – 1 hour; Peppermint leaves – 1 hour; Rose flower petals – 1 hour; Blood-red hawthorn fruits – 1 hour; Meadowsweet herb – 1 tsp.

Collection 4: Artemisia herb – 1 hour; Angelica rhizome – 1 hour; Rowan fruits – 1 hour; Fragrant dill fruits – 1 hour; Viburnum flowers – 1 hour; Red clover flowers – 1 hour; Peppermint herb – 1 hour; May rose hips – 1 hour; Marsh cudweed grass – 1 hour; Oat straw – 1 hour; Fragrant rue herb – 1 tsp.

Collection 5: Three-leaf leaves – 2 hours; Whole strawberry plant – 2 hours; Dream leaves – 1 hour; Calendula officinalis flowers – 1 hour; Dill fruits – 1 hour; Blood red hawthorn flowers – 2 hours; Peppermint leaves – 1 hour; Sweet clover herb – 2 hours. Collections No. 2-5 are prepared as follows: mix 2-3 tablespoons of pre-crushed collection, pour into a thermos (1 liter) in the evening, pour boiling water over it. The next day, drink the entire infusion in 3 doses over 20-40 minutes. warm before meals. To improve the taste, you can add honey, sugar, jam. General course treatment for 4-5 months (with periodic change of collection every 2-3 months). Before taking this or that collection, it is advisable to familiarize yourself with the contraindications for the herbs included in this collection. Only 1 year after myocardial infarction, you can take short breaks in herbal medicine (6-8 days), while changing the composition of the preparations.

4. Recipes and methods used in traditional medicine in the treatment of myocardial infarction.

Recipe 1: In the first days of myocardial infarction, it is recommended to drink carrot juice with vegetable oil 2 times a day: 0.5 cups of juice and 1 teaspoon of oil.

Recipe 2: To normalize cardiac activity: pour 410 g of olive or sunflower oil into 110 g of freshly picked cornflower grass (at the beginning of flowering), close tightly with a lid and place in the sun for 20 days, then strain. Take 1 teaspoon in the morning on an empty stomach.

Recipe 3: Fill a glass liter jar a third full with garlic, fill it completely with vodka and seal tightly. Keep the mixture for at least 2 weeks in a warm place (in daytime It is even recommended to expose it to the sun), then strain. Start taking 2 drops diluted in warm water in 20–30 minutes. before lunch. Gradually adding 1 drop per day, bring the dose to 25 drops, and then take it, reducing the number of drops in the reverse order.

Recipe 4: For heart disease: pour 1 cup of boiling water into 1 tablespoon of chopped eryngium herb, collected during flowering, put on fire, bring to a boil and boil for 5 minutes. Take 1 tablespoon 4-5 times a day for 2-3 weeks.

Recipe 5: To improve heart function: brew 0.5 liters. boiling water 1 tablespoon of centaury herb and leave in a warm place for 1 hour. Drink in equal portions throughout the day for 30 minutes. before meals. Take for 2-3 weeks.

Recipe 6: For pain in the heart, an infusion of chickweed (chickweed) herb helps: pour 0.5 liters. boiling water 1-2 handfuls of herbs and leave, wrapped, for 6 hours. Take 1/2 cup 3-4 times a day for 30 minutes. before meals for 2-3 weeks.

Recipe 7: To improve heart function: pour 0.5 liters. boiling water 5 tablespoons of dried and crushed nettle herb, collected before flowering. Boil for 5 minutes. on low heat. Take 1/2 cup with honey or sugar 4 times a day. You can drink a decoction of the roots: pour 1 cup of boiling water over 15 g of crushed roots, simmer over low heat for 10 minutes. leave for 30 minutes. Take 2-3 tablespoons 2-3 times a day for 30 minutes. before meals for 3-4 weeks.

Recipe 8: To improve heart function: pour 3 parts of vodka into 2 parts of shepherd's purse herb (by volume, not by weight), leave for 9 days and strain. Take 20 drops with a spoonful of water, 3 times a day for 3-4 weeks.

Recipe 9: To normalize cardiac activity: pour 0.5 liters. boil a handful of rosehip flowers (preferably fresh), leave for 0.5-1 hour and strain. Take 1 tablespoon 3 times a day for 30 minutes. before meals for a month.

Recipe 10: To relieve pain in the heart: fill a glass jar 2/3 of its volume with staminate (larger in size) birch catkins, fill them to the top with vodka, close and leave for 14 days. Do not strain. Take from 20 drops to 1 teaspoon 3 times a day for 30 minutes. before meals. When using this tincture, pain in the heart subsides, shortness of breath disappears, and vigor appears.

Recipe 11: Tincture helps with heart disease walnut with vodka: pour 30 finely chopped unripe fruits into 1 liter. alcohol or vodka and leave in the sun for 14 days. Take 20 drops 3 times a day for 3-4 weeks.

Recipe 12: To restore the cardiovascular system: chop 5 tablespoons of young pine needles (spruce, pine, fir, juniper), pour 0.5 liters. water, put on fire and bring to a boil. Cook over low heat for 10 minutes. leave for 6-8 hours in a warm place, strain. Drink 0.5 glasses 4-5 times a day. Needles remove radionuclides, chemical and other foreign inclusions from the body.

Recipe 13: For cardiac edema: pour 1 cup of boiling water over 1 tablespoon of hernia herb and leave in a thermos for 2 hours. Drink 1/3 cup 3 times a day for 30 minutes. before meals for one month.

Recipe 14: For edema associated with heart failure: prepare a decoction of horsetail: 2 tablespoons of chopped herbs are poured into a glass of boiling water, boil for 30 minutes. and drink 1/3 glass 3-4 times a day.

Recipe 15: To relieve cardiac edema: pour 1 glass of boiling water over 2 g of crushed coffin root or leaves, hold for 30 minutes. After cooling, strain in a water bath. Take 1 tablespoon 4-6 times a day. Chickens are treated for 3-4 weeks. Such courses can be repeated several times a year.

Recipe 16: Sucking sunflower oil is a way to treat the entire body at the same time, prevents and cures initial stage heart attack. The method is simple, harmless and effective. Sometimes there is a temporary exacerbation, which is the result of relaxation of the foci of the disease. The method is as follows: Vegetable oil(preferably sunflower or peanut) in an amount of no more than 1 tablespoon is concentrated in the front of the mouth, the oil is sucked like candy. You should not swallow the oil. The sucking procedure is done very easily, freely, without tension for 15-20 minutes. First, the oil becomes thick, then liquid, like water, after which it should be spat out. The spit out liquid should be white like milk. If the liquid is yellow, then the sucking process has not been completed. It is necessary to prolong the sucking process, after which it is necessary to rinse the mouth. The spit out fluid is infectious and should be spat into the toilet or buried in the ground. This procedure should be done once, preferably in the morning on an empty stomach, or in the evening before bed. To speed up treatment, you can do the procedure several times a day. It does no harm. During sucking, the body is freed from harmful microbes, gas exchange increases, metabolism is activated and improved.

Before starting any prescriptions, be sure to consult with your doctor.

Heart attack treatment and symptoms | How to treat a heart attack

Myocardial infarction, or simply heart attack, occurs due to a blockage blood vessel. If part of the heart muscle is deprived of blood flow, the damage can be permanent and the heart dies. Having a heart attack is scary, but most people who have one recover and return to normal life. A heart attack can also damage the pacemaker and cause arrhythmia. Studies have shown that one in four heart attacks goes undetected, and such hidden symptoms heart attacks appear only on the ECG.

The key to successful treatment of a heart attack is the speed with which the blockage in the artery is cleared. This reduces the likelihood of permanent heart damage.

Heart attack treatment in hospital

After the patient is delivered, an ECG or blood test immediately confirms the diagnosis.

The first treatment for a heart attack is aspirin, given by an emergency physician or primary care physician. Aspirin prevents further blockage.

An oxygen mask will also help limit damage.

To relieve heart attack symptoms, the patient may be given morphine or another strong opiate.

During heart attack treatment, doctors try to dissolve the clot causing the blockage with drugs or perform angioplasty.

Speed ​​is the key to successful treatment of a heart attack. The ambulance doctor will begin treatment on the way to the hospital.

A rehabilitation schedule means that with the help of professionals, the patient can recover from a heart attack as quickly as possible.

Risk of developing myocardial infarction with arterial hypertension

Despite a significant reduction in the incidence of strokes, data from prospective studies published after 1990 indicate a significant predominance of strokes over the incidence of myocardial infarction. The ratio of the incidence of stroke and myocardial infarction is 1.38 according to the total data of 12 studies, and in the so-called Eastern studies (STONE, Syst-Eur, Syst-China, NICS) reaches 7.3. When excluding the results of the latter from general analysis a 30% predominance of the incidence of strokes over the incidence of myocardial infarction remains. This situation, which arose at the turn of the century, was called the “stroke paradox.”

In China and Japan, strokes are the leading cause of death. The absolute number of strokes in China is comparable to the number worldwide.

In Russia, more than 450 thousand new cases of stroke are registered annually, more than 40% of them are fatal. More than a million people have suffered a stroke, about 80% of them became disabled. The incidence of disability after a stroke in Russia is 3.2 per 10 thousand population.

The relationship between the risk of stroke and the level of systolic and diastolic blood pressure

IN epidemiological studies a direct linear relationship has been established between the incidence of primary stroke and blood pressure levels, including in the range of normal values. In 3 cases, heart attack symptoms develop in individuals with normal blood pressure.

For a long time, diastolic pressure received more attention than systolic pressure. Majority clinical trials for the treatment of arterial hypertension, patients were classified according to the level of diastolic blood pressure, so for a long time we did not have data on the significance of the level of systolic blood pressure. The reality turned out to be the opposite of expectations. In the MRFIT study, the relative risk of stroke in patients with elevated systolic and diastolic blood pressure was 8.2 and 4.4, respectively. Similar results were obtained in Framingham and other studies. These data explain high frequency stroke and other cardiovascular complications in isolated systolic hypertension.

Isolated systolic hypertension

In the Framingham Study, patients with isolated systolic hypertension aged 65 to 84 years had a two-fold increase in the risk of stroke in men and a one-and-a-half-fold increase in women. Because isolated systolic hypertension results in part from decreased elasticity of the great arteries, it has been suggested that arterial stiffness itself, rather than systolic blood pressure, is a factor in increasing the risk of stroke. However, analysis of data from the Framingham study confirmed the primary importance of increasing systolic blood pressure as such, as well as a direct strong relationship between the risk of stroke and its level. Moreover, two large clinical trials showed that lowering systolic blood pressure was associated with a 40% and 50% lower incidence of stroke. Numerous clinical studies have demonstrated that reducing elevated systolic and diastolic blood pressure in middle-aged and elderly people is accompanied by a significant reduction in the incidence of stroke.

Antihypertensive therapy

Since 1967, in individuals with a significant increase in blood pressure (grade 2, 3), the incidence of strokes and other complications of arterial hypertension has clearly decreased with antihypertensive therapy. Subsequent studies have shown that the risk of stroke is reduced even with the first degree of increase in blood pressure, regardless of age. An isolated increase in systolic blood pressure turned out to be very sensitive to antihypertensive therapy, and not at all resistant, as had long been assumed. The treatment did not lead to an acceleration of stroke development (similar concerns have also been expressed), but on the contrary, was accompanied by a significant reduction in stroke development. Concerns that antihypertensive therapy would increase the incidence of syncope, impaired consciousness, falls, or depression were not confirmed.

SHEP randomized trial

The first randomized study in patients, SHEP, examined the incidence of stroke in older adults with isolated systolic hypertension in diuretic- and placebo-treated groups. This study showed that heart attack treatment was safe and worthwhile, leading to a significant reduction in stroke rates. Of particular interest is that patients in the active heart attack treatment group had more low frequency strokes of all types, both ischemic and intracerebral and subrachnoid hemorrhage. The second randomized trial, SYST-EURO, found a 42% reduction in stroke rates in patients over 60 years of age after 2 years of follow-up with therapy based on the dihydropyridine calcium antagonist nitrendipine. However, there was no increase in the incidence of other cardiovascular complications.

Symptoms of myocardial infarction

The clinical situation caused by both myocardial infarction and severe or uncontrolled hypertension is critical in terms of outcome and requires both rapid but carefully balanced interventions. An acute coronary situation with increased blood pressure may be a transient consequence of acute stress or a consequence of previous, often previously undiagnosed hypertension. In rare cases, this situation may be due to the presence of a true hypertensive crisis occurring with coronary insufficiency and/or dissecting aortic aneurysm. When myocardial infarction is combined with uncontrolled hypertension, 2 main questions arise:

Drug of choice for lowering blood pressure.

Adequate duration and degree of blood pressure reduction to maintain full thrombolysis potential.

How to treat a heart attack?

Therapy for myocardial infarction

Aggressive therapy until blood pressure normalizes (except in the situation of dissecting aortic aneurysm) is not required and can be dangerous. As a rule, for the treatment of a heart attack, a reduction in blood pressure by 15-20% during the first 24 hours is sufficient. The order of action is still controversial: restoration of coronary blood flow against the background of high blood pressure or lowering blood pressure. In the first case, the risk of hemorrhagic stroke increases, in the second - the likelihood of developing severe myocardial and valve dysfunction, as well as arrhythmias. Apparently, a tactic for treating a heart attack is required that combines the influence on both conditions from the first minutes. Practices for the management of this group of patients vary widely. Unfortunately, only suboptimal tactics or the use of measures with questionable clinical benefit are often observed.

In patients with myocardial infarction and high risk, thrombolysis is a class Ib indication for SBP > 180 mmHg. Art. and DBP > 110 mm Hg. Art. Intravenous nitroglycerin is contraindicated in patients with ACS and SBP.< 90 мм рт. ст. а также при выраженной брадикардии (< 50 уд./мин).

Tactics for managing patients with myocardial infarction

Data from controlled clinical trials completed over the past 5 years allowed a significant revision in 1999 of the management of patients with myocardial infarction and the previous version of the 1996 recommendations. In particular, early use of BB is recommended regardless of not only thrombolysis, but also primary angioplasty. The effectiveness of early administration of a beta-blocker has also been established for myocardial infarction without ST-segment elevation. Relative indications (class Na) for the use of BB in the post-infarction period have been supplemented suffered a heart attack myocardium without ST segment elevation. The use of BB for moderate and severe left ventricular failure in the post-infarction period has moved from absolute contraindications into relative indications. The lower limit of SBP is indicated as 100 mm Hg. Art. for the use of ACE inhibitors in the first 24 hours of MI.

To select optimal antihypertensive therapy in the post-infarction period, an assessment of a number of conditions and risk factors is necessary.

Life after a heart attack

The first step to recovery after heart attack treatment is to strengthen your heart so it can cope with everyday stress. Therefore, during your week-long stay in the hospital, you will not just lie in bed, but will begin to do special exercises usually with a physiotherapist or nurse. Risk factors for coronary heart disease will be identified and changes made to prevent future heart attacks.

Many people make a full recovery after heart attack treatment, largely thanks to a structured rehabilitation program. Important role plays in recovery positive thinking. After such a life-threatening event, it is easy to become depressed - many people fear another heart attack, which can lead to severe stress. Research has shown that a positive attitude speeds up the process of recovery and return to normal life.

Myocardial infarction

Myocardial infarction

Myocardial infarction – one of the most pressing problems of practical healthcare.

Back in 1969, at a meeting of the WHO Executive Committee in Geneva, the minutes recorded: “Coronary heart disease has reached enormous prevalence, affecting ever younger people. In the coming years, this will lead humanity to the greatest epidemic if we are not able to change this trend based on studying the causes and prevention of this disease.”

Coronary heart disease has been called the disease of the 20th century. According to WHO, about 500 people per 100,000 population aged 50–54 years die from myocardial infarction. In recent years, mortality from myocardial infarction has decreased slightly in the United States and a number of European countries, but it still ranks first in the mortality structure.

In 20% of cases, the disease is fatal, with 60-70% dying in the first 2 hours of the disease. Hospital mortality 10%. Therefore, a paramedic needs to know the manifestations of the disease and be able to provide emergency care. Men get sick more often than women: before 50 years old 5 times, after 60 years old 2 times. Average age patients 45-60 years old. IN last years“rejuvenation” is noted. Myocardial infarction kills young men under 40 years of age.

Myocardial infarction – the most severe form of coronary artery disease, characterized by the development of necrosis in the heart muscle due to impaired coronary circulation. The term was proposed by P. Marie in 1896 (France).

In 1903, the clinic was described in detail by V.P. Obraztsov and N.D. Strazhesko - domestic therapists. What is the cause of a heart attack?

Etiology

Most often, the cause is atherosclerosis of the coronary arteries (90% of people over 60 years of age suffer from atherosclerosis; in modern conditions, atherosclerosis is observed more often in 25-35 year olds).

Hypertonic disease.

Myocardial infarction occurs in 26-35% of patients with hypertension.

Neuropsychic stress.

Physical overexertion

Increased blood clotting – coronary artery thrombosis.

The immediate cause of Q-wave MI is thrombolytic occlusion of the coronary artery. In MI without a Q wave, the occlusion is incomplete, rapid reperfusion occurs (spontaneous thrombus lysis or reduction of concomitant coronary artery spasm), or the cause of MI is microembolism of small coronary arteries by platelet aggregates.

Risk factors

Physical inactivity – (Goethe’s “Idle life” is premature old age, a sedentary lifestyle, transport, television, etc.)

Obesity. According to WHO, more than 50% of women, more than 30% of men, and more than 15% of children are overweight. Obese people live an average of 10 years less.

Smoking. The likelihood of a myocardial infarction is 6-12 times greater than that of non-smokers. In neighboring Finland, smoking kills 630 men aged 35-64 every year.

Alcohol. (50% of deaths are related to alcohol). Engineer P., 40 years old, suffered from rare symptoms of angina pectoris. One day, after an important task, I went to see my friends and drank 100 grams. cognac On the way home he died on the street. Alcohol abuse in most cases explains the cause of early heart attacks (before 40 years of age).

Hereditary predisposition. Has an effect in 25% of cases. So-called “familial heart attacks” often occur.

Diabetes.

In general, myocardial infarction is a disease of civilization, since in major cities get sick more often than in small and rural areas. In rural areas it is 10-12 times less than in cities. It has been established that myocardial infarction and sudden death occur within 10 years in 25% of people with risk factors, and among the rest of the population of the same sex and age, they are 4 times less likely.

Clinic

The clinic distinguishes stages:

Pre-infarction

1. Subacute

   Scarring

Classification

According to the depth of the lesion(based on electrocardiographic data):

Transmural or large-focal (“Q-infarction”) – with ST elevation in the first hours of the disease and the formation of a Q wave subsequently

According to the clinical course:

Uncomplicated myocardial infarction

Complicated myocardial infarction

By localization:

Left ventricular infarction (anterior, posterior or inferior, septal)

Right ventricular infarction

Distinguish 2 main types of myocardial infarction(THEM): "MI with a tooth Q » (or Q - heart attack") and “MI without a tooth Q » .

Synonyms for the term MI with a Q wave: small-focal, subendocardial, non-transmural, or even “microinfarction” (clinically and according to the ECG, these variants of MI are indistinguishable).

Myocardial infarction manifests itself in the following clinical forms :

Typical pain - angina

Asthmatic

Gastralgic (abdominal)

Painless (arrhythmic)

Cerebral

Latent (low-symptomatic)

Clinical picture of a typical form

The main symptoms of myocardial infarction are pain. The pain is of a compressive, pressing, burning nature, localized behind the sternum, radiating to the left half of the body (left arm, shoulder, scapula, left half of the lower jaw, interscapular area). Unlike angina, the pain is more intense, lasts longer (30-40 minutes or more), and is not relieved by nitroglycerin. As a rule, elderly and senile people experience shortness of breath, suffocation, and weakness. Cold, sticky sweat often appears.

A characteristic feeling is the fear of death. Patients say so later: “I thought the end had come.” They are either afraid to move or moan and rush about. Here is how Nodar Dumbadze described the pain during myocardial infarction in the novel “The Law of Eternity”: “The pain arose in the right shoulder. Then it crawled towards my chest and got stuck somewhere under my left nipple. Then it was as if someone’s calloused hand penetrated into my chest, grabbed my heart and began squeezing it like a bunch of grapes. She squeezed slowly, diligently: one-two, two-three, three-four... Finally, when there was not a blood left in the squeezed out heart, the same hand indifferently threw it away, the heart stopped. No, first it fell down, like a sparrow falling on the window glass, it began to beat, flutter, and then became silent. But a stopped heart is not yet death - it is eyes wide open from incredible horror, painful anticipation: will the damned heart beat again or not?

According to the symptoms of the acute phase of myocardial infarction, the following clinical variants are distinguished:

Painful – a typical clinical course, the main manifestation of which is anginal pain, independent of posture and body position, movements and breathing, resistant to nitrates; the pain has a pressing, suffocating, burning or tearing character with localization behind the sternum, throughout the anterior chest wall with possible irradiation to the shoulders, neck, arms, back, epigastric region; combinations with hyperhidrosis, severe general weakness, pallor of the skin, agitation, and restlessness are typical.

Abdominal– manifested by a combination of epigastric pain with dyspeptic symptoms – nausea, not bringing relief by vomiting, hiccups, belching, severe bloating; possible irradiation of back pain, tension abdominal wall and pain on palpation in the epigastrium.

Atypical pain– in which the pain syndrome is atypical in location (for example, only in areas of irradiation - throat and lower jaw, shoulders, arms, etc.) and/or in nature.

Asthmatic– the only symptom in which is an attack of shortness of breath, which is a manifestation of acute congestive heart failure (cardiac asthma or pulmonary edema)

Arrhythmic– in which cardiac arrhythmias are the only clinical manifestation or prevail in clinical picture.

Cerebrovascular– in the clinical picture of which signs of disorder predominate cerebral circulation(more often dynamic): fainting, dizziness, nausea, vomiting; focal is possible.

Asymptomatic(asymptomatic) – the most difficult option to recognize, often diagnosed retrospectively using ECG data.

Diagnostic criteria

At the prehospital stage of medical care, the diagnosis of acute myocardial infarction is made based on the presence of the following:

Clinical picture

Electrocardiogram changes.

Clinical criteria:

In the painful version of a heart attack, the following have diagnostic value:

intensity (in cases where similar pains have occurred previously, during a heart attack they are unusually intense).

duration (an unusually long-lasting symptom that persists for more than 15-20 minutes)

patient behavior (excitement, motor restlessness)

ineffectiveness of sublingual administration of nitrates.

Electrocardiographic criteria – changes that serve as signs:

damage - an arcuate elevation of the ST segment with a convexity upward, merging with a positive T wave or turning into a negative T wave (an arcuate depression of the ST segment with a convexity downward is possible)

large-focal or transmural infarction - the appearance of a pathological Q wave and a decrease in the amplitude of the R wave or the disappearance of the R wave and the formation of QS.

small focal infarction - the appearance of a negative symmetrical T wave

Biochemical markers of myocardial necrosis

The main marker of myocardial necrosis is an increase in the level of cardiac troponins T and I. An increase in the level of troponins (and subsequent dynamics) is the most sensitive and specific marker of MI (myocardial necrosis) with clinical manifestations corresponding to the presence of acute coronary syndrome (an increase in the level of troponins can be observed with damage myocardium of “non-ischemic” etiology: myocarditis, pulmonary embolism, heart failure, chronic renal failure).

Determination of troponins makes it possible to detect myocardial damage in approximately one third of patients with myocardial infarction who do not have an increase in CF CK. An increase in troponins begins 6 hours after the onset of MI and remains elevated for 7 to 14 days.

The “classical” marker of MI is an increase in the activity or increase in the mass of the MB isoenzyme CPK (“cardiospecific” isoenzyme creatine phosphokinase). Normally, the activity of CPK MB is no more than 3% of the total CPK activity. With MI, there is an increase in CK MB of more than 5% of total CK (up to 15% or more). Reliable lifelong diagnosis of small-focal MI became possible only after the introduction into clinical practice of methods for determining the activity of CF CPK.

Echocardiography .

Echocardiography is widely used to identify areas of regional contractility impairment. In addition to identifying areas of hypokinesia, akinesia, or dyskinesia, an echocardiographic sign of ischemia or infarction is the absence of systolic thickening of the left ventricular wall (or even its thinning during systole). Echocardiography allows you to identify signs of MI of the posterior wall, MI of the right ventricle, and determine the localization of MI in patients with left bundle branch block. Echocardiography is very important in the diagnosis of many complications of MI (rupture of the papillary muscle, rupture of the interventricular septum, aneurysm and “pseudoaneurysm” of the left ventricle, effusion in the pericardial cavity, detection of blood clots in the cavities of the heart and assessment of the risk of thromboembolism).

Treatment of uncomplicated myocardial infarction

General management plan for patients with MI can be represented in the following form:

Relieve pain, calm the patient, give aspirin.

Hospitalize (deliver to hospital).

An attempt to restore coronary blood flow (myocardial reperfusion), especially within 6-12 hours from the onset of MI.

Measures aimed at reducing the size of necrosis, reducing the degree of dysfunction of the left ventricle, preventing recurrence and recurrent MI, reducing the incidence of complications and mortality.

Pain relief

The cause of pain in MI is ischemia of viable myocardium. Therefore, to reduce and relieve pain, all therapeutic measures aimed at reducing ischemia (reducing the need for oxygen and improving oxygen delivery to the myocardium) are used; oxygen inhalation, nitroglycerin, beta blockers. First, if there is no hypotension, take nitroglycerin under the tongue (if necessary, again at intervals of 5 minutes). If there is no effect from nitroglycerin, the drug of choice for pain relief is morphine - IV every 5-30 minutes. until the pain is relieved. In addition to morphine, promedol is most often used - intravenously. In most cases, relanium is added to narcotic analgesics (under blood pressure control).

For difficult to stop pain syndrome use repeated administration of narcotic analgesics, the use of nitroglycerin infusion, and the use of β-blockers. In the absence of contraindications, β-blockers are prescribed as early as possible: propranolol (obzidan) IV 4 times a day; metoprolol - IV, then metoprolol orally 3-4 times a day.

Intravenous infusion of nitroglycerin is prescribed for intractable pain syndrome and signs of ongoing ischemia.

At the first suspicion of MI, all patients are advised to prescribe aspirin earlier (the first dose of aspirin 300-500 mg should be chewed and washed down with water).

If necessary, carry out resuscitation measures– electric pulse therapy, defibrillation – shock 5500-7700 in mechanical ventilation, cardiac massage, intracardiac adrenaline during cardiac arrest.

Intensive, dynamic, cardiac monitoring of the patient, monitoring of hemodynamic parameters, diuresis, and intestinal activity are necessary. Depending on the patient’s condition, they are transferred after 3-5 days to the general ward.

A new chapter in medicine is the surgical treatment of coronary artery disease and myocardial infarction by restoring blood flow.

Treatment. Hospital stage

Mode – bed with gradual expansion, according to exercise therapy regimes.

Diet – with restriction of salt, liquid, fat, mechanically, chemically gentle, according to indications - potassium diet

Drug treatment:

Anti-ischemic drugs

Anticoagulants

Antiplatelet agents

Coronary revascularization

Long-term therapy

Anti-ischemic drugs

These drugs reduce the myocardial oxygen demand (lowering heart rate, arterial pressure and contractility of the left ventricular myocardium) and promote vasodilation.

Intravenous or oral nitrates are effective for symptomatic treatment for emergency relief of anginal pain (I-C).

Calcium antagonists reduce symptoms in patients already taking beta blockers and nitrates; they are advisable to use in cases of contraindications to the use of beta blockers and in groups of patients with vasospastic angina (I-B).

Nifedipine and other dihydropyridines should not be used without combination with beta blockers (III-B).

Anticoagulants

Unfractionated heparin (UFH) intravenously;

Low molecular weight heparin (LMWH) subcutaneously;

Most anticoagulants are effective in reducing the risk of death and myocardial infarction, but they also increase the risk of bleeding complications.

Anticoagulant therapy should be selected based on the risk of ischemic and hemorrhagic events.

Several anticoagulants are available, namely: UFH, LMWH, fondaparinux, bivalirudin.

Aspirin is recommended for all patients unless there are contraindications. The initial loading dose is 160-325 mg (without enteric coating), the maintenance dose for long-term use is 75-100 mg.

For all patients, an initial loading dose of clopidogrel of 300 mg is recommended, followed by daily intake at a dose of 75 mg. Clopidogrel should be prescribed for 12 months in the absence of increased risk bleeding.

All patients with contraindications to aspirin should be given clopidogrel instead.

Coronary revascularization

Revascularization is performed to relieve anginal pain, eliminate myocardial ischemia and prevent its progression to MI and death. Indications for myocardial revascularization and approaches to its implementation (PCI or CABG) depend on the volume and severity of the lesion and are determined by coronary angiography, the patient’s condition and concomitant pathology.

Long-term treatment

Long-term treatment includes lifestyle changes and drug therapy to control all risk factors affecting the long-term prognosis after acute coronary syndrome, as well as the treatment required for myocardial infarction.

Statins are recommended for all patients (in the absence of contraindications), regardless of cholesterol levels, starting from the early stages (1-4 days after admission) to achieve LDL level<100 мл/дл (< 2,6 ммоль/л) (I-B).



Long-term administration of ACE inhibitors is indicated for all patients with left ventricular ejection fraction ≥ 40%, diabetes, arterial hypertension, chronic kidney disease in the absence of contraindications

ACE inhibitors are indicated in the treatment of all patients to prevent recurrent ischemic events.

Angiotensin receptor blockers are indicated in all patients with ACEI intolerance and heart failure or MI with left ventricular ejection fraction.< 40%

Complications of myocardial infarction

The main disorders of MI include :

heart rhythm disturbances,

heart failure,

myocardial rupture,

heart aneurysm,

thromboembolism,

pericarditis,

recurrence of myocardial infarction,

post-infarction angina.

Rehabilitation

Taking into account the social significance, rehabilitation of patients plays an important role, which is the most important condition for successful treatment.

“Rehabilitation” - restoration of ability.

All patients who have had a myocardial infarction should undergo an ECG-guided stress test or an equivalent noninvasive ischemia test 4 to 7 weeks after discharge.

Based on cardiovascular health and exercise capacity assessments, patients should be advised about the timing of resumption and level of physical activity, including leisure, work and sexual activity.

Kinds:

Medical– therapeutic measures, early hospitalization, drug treatment, prevention of complications, active clinical observation.

Physical– restoration of physical performance (adequate activation, exercise therapy, physical training)

Psychological– personality correction, psychological adaptation.

Professional– employment, professional retraining.

Socio-economic– issues of relationships between the patient and society, the patient and family, pension provision.

Stages of rehabilitation:

Inpatient (sick leave)

Sanatorium

Polyclinic

Prevention

M.N. Mudrov “It is easier to prevent a disease than to treat it”

Primary prevention is a healthy lifestyle.

Physical activity - combating physical inactivity, exercise therapy, health groups, morning exercises, “running from a heart attack,” etc.

Prevention of nervous stress, conflict situations, auto-training, psychotherapy, positive emotions.

To give up smoking.

Prevention of overload – compliance with the work and rest regime.

Balanced diet.

Sanitary education work. Hygienic education.

Medical examinations of a healthy population, annual clinical examination of the population for the purpose of early detection of cardiovascular pathology.

Weight control, waist circumference measurement.

Control of lipid spectrum.

Secondary prevention, medical examination

Dynamic observation

Drug treatment

What is myocardial infarction

Myocardial infarction is a clinical form in which an acute disruption of the blood supply occurs and, as a result, necrosis (infarction, death) of a section of the heart muscle, accompanied by impaired circulation.

Myocardial infarction in 90% of cases occurs due to long-term progression. Men aged 42-67 years are most often affected. The heart is supplied with blood through the right and left coronary arteries, which arise from the base of the aorta. As a result, the vessels form plaques that block the lumen of the coronary arteries.

Normally, the coronary arteries, due to their expansion, are capable of increasing coronary blood flow 5-6 times to compensate for physical activity and stress. When the arteries narrow, this compensatory mechanism does not work: any load leads to oxygen “starvation” (ischemia) of the myocardium.

Myocardial infarction can develop without load, with a sharp blocking of coronary blood flow, for example, with rupture and thrombosis of an atherosclerotic plaque, as well as with a sharp spasm of the coronary artery.

Clinical signs of a heart attack appear if the lumen of the artery decreases by more than 80%. Necrosis of the bloodless myocardium occurs 30-90 minutes after the cessation of blood supply. Therefore, doctors have only 1-2 hours to prevent the death of the heart muscle using drugs and/or intervention aimed at opening the blocked artery. Without this, irreversible damage develops - myocardial necrosis, which forms within 15-60 days.

Myocardial infarction is an extremely dangerous condition, the mortality rate reaches 35%.



Causes of myocardial infarction

In 95% of cases, the disease manifests itself against the background of atherosclerotic lesions of the coronary arteries. In the remaining cases, necrosis develops due to a sharp spasm of the coronary arteries. There are factors that contribute to the progression and increase the risk of developing myocardial infarction:

• smoking;
• past infections;
• low levels of high-density lipoproteins in the blood;
• sedentary lifestyle;
• elderly age;
• poor environmental conditions in the place of residence;
• excess body weight;
• , ;
• history of myocardial infarction;
• congenital underdevelopment of the coronary arteries;
• long-term use;
• oncological diseases.



Symptoms of myocardial infarction

Here are the classic signs of a heart attack:

• acute strong pressing, bursting pain behind the sternum, radiating to the neck, left shoulder, between the shoulder blades;
• shortness of breath, cough;
• feeling of fear;
• pale skin;
• increased sweating.

Symptoms for atypical forms of myocardial infarction

Abdominal form - characterized by pain in the upper abdomen (episgastric region), hiccups, bloating, nausea and vomiting.

Asthmatic form - occurs after 50 years and is manifested by intense shortness of breath, suffocation, dry and wet, medium and coarse wheezing in the lungs.

Painless form - occurs in 1% of cases, usually in patients with. It manifests itself as weakness, lethargy, and lack of subjective sensations. A previous heart attack is detected by routine electrocardiography (ECG).

The cerebral form is characterized by impaired blood supply to the brain. In 40% of cases it occurs with infarction of the anterior wall of the left ventricle. Clinic: dizziness, impaired consciousness (muscle paresis), disorientation in time and space, loss of consciousness.

The collaptoid form is a manifestation of cardiogenic shock, which is the most dangerous complication of myocardial infarction. Clinic: a sharp drop in blood pressure, dizziness, darkening of the eyes, profuse sweating, loss of consciousness.

The edematous form is manifested by shortness of breath, weakness, edema, accumulation of fluid in the chest and abdomen (ascites), enlargement of the liver and spleen (hepatomegaly) due to increasing right ventricular failure.

The combined form is characterized by various combinations of atypical forms of infarction.

Classification of myocardial infarction by stages

The most acute stage lasts up to 120 minutes from the cessation of blood supply.

The acute stage lasts up to 10 days; at this stage, the heart muscle has already collapsed, but the formation of necrosis has not begun.

The subacute stage lasts up to 2 months. Characterized by the formation of scar tissue (necrosis).

The post-infarction stage lasts up to six months. During this period, the cardiac scar is finally formed, the heart adapts to new operating conditions.

Based on the prevalence of the pathological process, large and small focal infarctions are distinguished.

Large-focal (transmural, or extensive) infarction - damage to a large area of ​​the myocardium. The process is developing very quickly. In 70% of cases, changes in the heart are irreversible. The patient can avoid severe complications of a large-focal infarction, in particular, if medical assistance is provided no later than 3-4 hours.

Small focal infarction - damage to small areas of the heart muscle. It is characterized by a milder course and less pronounced pain syndrome than large-focal. In 27% of cases, a small-focal infarction develops into a large-focal one. Occurs in every fourth patient. The prognosis is favorable, complications occur in 5% of cases, usually with delayed treatment.



Diagnosis of myocardial infarction

The disease is diagnosed using an ECG. Additionally, ultrasound of the heart, coronary angiography, myocardial scintigraphy and laboratory tests are prescribed: complete blood count, cardiotropic proteins in the blood (CF-CK, AST, LDH, troponin).



Treatment of myocardial infarction

At the slightest suspicion of myocardial infarction (retrosternal pain), you need to call an ambulance.

The disease is treated only in a hospital and even in an intensive care unit. Strict bed rest is required for 3-7 days. Then motor activity is expanded on an individual basis. Medicines prescribed include painkillers (Morphine, Fentanyl), antiplatelet drugs (Acetylsalicylic acid, Clopidogrel), anticoagulants (Heparin, Enoxaparin), thrombolytic drugs (Streptokinase, Alteplase), beta-blockers (Propranolol).

The most effective and promising method of treatment is emergency (up to 6 hours) opening of a blocked coronary artery using balloon angioplasty with the installation of a coronary stent. In some cases, urgent coronary artery bypass grafting is performed.

The recovery (rehabilitation) period lasts up to six months. During this time, patients gradually increase physical activity, starting with 10 steps per day. Medicines are taken for life.

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