Myocardial infarction – heart disease caused by insufficient blood supply with a focus of necrosis (necrosis) in the heart muscle (myocardium); the most important form of ischemic heart disease. Acute blockage of the lumen of the coronary artery by a thrombus, a swollen atherosclerotic plaque, leads to myocardial infarction.
Symptoms and course
The beginning of myocardial infarction is considered the appearance of intense and prolonged (more than 30 minutes, not often many hours) retrosternal pain (anginal condition), which is not stopped by repeated nitroglycerin administration; sometimes in the picture of the attack, suffocation or pain in the epigastric region prevails. Complications of an acute attack: cardiogenic shock, acute left ventricular failure up to pulmonary edema, severe arrhythmias with a decrease in blood pressure, sudden death. In the acute period of myocardial infarction, arterial hypertension is observed, which disappears after pain subsides, increased heart rate, an increase in body temperature (2-3 days) and the number of leukocytes in the blood, followed by an increase in ESR, an increase in the activity of creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase, etc. Epistenocardic pericarditis may occur (pain in the sternum, especially when breathing, pericardial friction rub is not often heard). The complications of the acute period include, in addition to the above: acute psychosis, recurrent infarction, acute aneurysm of the left ventricle (protrusion of its thinned necrotic part), ruptures of the myocardium, interventricular septum and papillary muscles, heart failure, all kinds of rhythm and conduction disturbances, bleeding from acute ulcers stomach, etc. With a favorable course, the process in the heart muscle passes into the stage of scarring. A full-fledged scar in the myocardium is formed by the end of 6 months after his heart attack. recurrence of a heart attack, acute aneurysm of the left ventricle (protrusion of its thinned necrotic part), ruptures of the myocardium, interventricular septum and papillary muscles, heart failure, all kinds of rhythm and conduction disturbances, bleeding from acute stomach ulcers, etc. With a favorable course, the process in the heart muscle passes into the scarring stage. A full-fledged scar in the myocardium is formed by the end of 6 months after his heart attack. recurrence of a heart attack, acute aneurysm of the left ventricle (protrusion of its thinned necrotic part), ruptures of the myocardium, interventricular septum and papillary muscles, heart failure, all kinds of rhythm and conduction disturbances, bleeding from acute stomach ulcers, etc. With a favorable course, the process in the heart muscle passes into the scarring stage. A full-fledged scar in the myocardium is formed by the end of 6 months after his heart attack.
Diagnosis
It is carried out on the basis of a test of the clinical picture, characteristic changes in the electrocardiogram during dynamic observation, an increase in the level of cardiospecific enzymes. In doubtful cases, echocardiography (detection of “fixed” myocardial zones) and a radioisotope study of the heart (myocardial scintigraphy) are performed.
Treatment
The patient needs urgent hospitalization. Before the ambulance arrives, you will need to give the patient nitroglycerin (from one to several tablets with an interval of 5-6 minutes). Validolin these cases is ineffective. In the hospital, attempts to restore the patency of the coronary vessels are possible (melting of blood clots using streptokinase, stretodecase, alvesin, fibrinolysin, etc., the introduction of heparin, urgent surgical intervention – urgent aortocoronary bypass grafting). Mandatory painkillers (narcotic analgesics, analgin and its products, possible anesthesia with nitrous oxide, etc., epidural anesthesia – the introduction of painkillers under the membranes of the spinal cord), nitroglycerin is used (intravenously and orally), calcium channel antagonists (veraamil, nifedipine, senzit) , beta-blockers (obzidap, anaprilin), antiplatelet agents (aspirin), treat complications. Of great importance is rehabilitation (restoration of a stable level of health and workability of the sick person). The activity of the sick person in bed – from the first day, sitting down – from 2-4 days, getting up and walking – for 7-9-11 days. The period and volume of rehabilitation are selected strictly individually, after the patient is discharged from the hospital, it ends in a clinic or sanatorium.