Among people with vascular and heart disease, one of the main causes of increased mortality is considered to be a heart attack. The non-standard onset of the disease, that is, when an individual feels severe pain in the abdomen, this is the abdominal form of myocardial infarction. The classic picture is acute chest pain that occurs suddenly and radiates to the scapular region on the right, neck and shoulder joint. The person has difficulty breathing and feels fearful.
General information
Individuals suffering from chronic ailments of the gastrointestinal tract, pain in the abdomen, upset stool, nausea do not cause concern, since they consider these phenomena to be quite natural, given the existing pathology. However, such signs may indicate an abdominal form of myocardial infarction. Most often gastralgictype occurs with a diaphragmatic heart attack. It is more susceptible to males. The danger is that the symptoms are similar to intoxication, that is, with an atypical clinic for a heart attack. Unlike other forms, the abdominal one goes through only two stages - the most acute (lasting no more than two hours), it is characterized by pronounced necrosis of the heart muscle, and acute (in time it lasts no more than twelve hours), when the intensity of symptoms decreases.
The main syndrome of the abdominal form of acute myocardial infarction is the strongest pain in:
- epigastric region;
- right hypochondrium;
- right abdomen.
By nature, it is burning, sharp and does not leave after taking Nitroglycerin.
Uncharacteristic development of myocardial infarction
The increase in the number of atypically occurring variants of the disease is associated with a change in the age structure of patients. On the one hand, a heart attack often affects young citizens, and on the other hand, it is increasingly observed in the elderly. In this case, it is often repeated and develops against the background of various concomitant pathologies. The last factor affects the course and clinic of the disease. All variants of a heart attack that have an uncharacteristic onset are conventionally divided into painless and painless. Atypical myocardial infarction of the abdominal form refers specifically to pain. This phenomenon causes some difficulties in diagnosis, since the localization of the pain syndrome is atypical. Pain is mainly felt by the individual in the epigastric, iliac, umbilical (umbilical)area, as well as in the area of the hypochondria. Therefore, a person is sure that the pain is caused by problems with the gastrointestinal tract. There are many cases when a heart attack of this form provoked an exacerbation of acute pancreatitis, cholecystitis, appendicitis and other diseases. For timely and reliable diagnosis of the gastralgic form of infarction, it must be taken into account that the predominant localization of the pain syndrome in such patients is the abdominal region. The abdominal form of myocardial infarction, as well as other variants with an atypical onset, is most often the lot of elderly citizens with signs of atherosclerosis and hereditary predisposition.
Reasons
Gastralgic form occurs in the case of pathological vasoconstriction as a result of their defeat by a mixture of fats, i.e. atherosclerotic plaques. A peculiar clinical picture is due to the proximity of the dead area to the diaphragm. In addition to atherosclerosis, the causes of a heart attack are:
- alcohol abuse;
- tobacco smoking;
- obesity;
- angina;
- pericarditis;
- diabetes mellitus;
- heredity.
Circulatory failure in IHD contributes to the formation of necrosis in the heart muscle. In the acute course of this process, a condition occurs, which is called a heart attack. The anterior wall of the left ventricle is most commonly affected. But the abdominal form of myocardial infarction is characterized by necrosis in the back wall of the muscle of the main human organ, which is quite close toaperture. The exclusivity of this pathology is that the patient is disturbed by pain in an atypical place - in the epigastric (epigastric) region and under the ribs on the left side. Unfortunately, a blurred or unclear clinical picture is the reason for the error in making the initial diagnosis.
Diagnostic measures
For the purpose of differential diagnosis, a troponin test is performed at the prehospital stage. It shows the presence in the blood of elements of the breakdown of myocardiocytes. At later stages of a heart attack, C-reactive protein, moderate leukocytosis are detected. And the indicators of the activity of liver cells undergo changes both in pancreatitis and hepatitis, and in the abdominal form of myocardial infarction. Therefore, this variety almost always causes difficulties in differential diagnosis.
The main clinical feature is pain in the abdomen, or rather, in the epigastric region or the left hypochondrium. Often there is a false diagnosis of pancreatitis. Abdominal pain is characteristic of the posterior localization of the infarction. At the same time, diaphragmatic muscles are partially involved in the process.
Differential diagnosis of abdominal myocardial infarction
Due to atypical signs, it is carried out with pathologies such as:
- appendicitis;
- perforated ulcer;
- cholecystitis;
- toxic food infection;
- intestinal obstruction;
- pancreatitis.
After collecting an anamnesis of the whole family, complaints of the individual and his examination, they putpreliminary diagnosis, and accurate - only after laboratory and instrumental types of examinations. In differential diagnosis, the result of the ECG taken in the first minutes of the onset of pain and the questioning of the individual are important.
Signs
Symptoms of the abdominal form of myocardial infarction appear in the first hours of the disease. Pain (pain), which appears unexpectedly against the background of emotional or physical overstrain, is considered the main symptom. Often a person is not able to describe the nature of the pain syndrome, since there is no clear localization of it, and the intensity is weakened after taking Drotaverine or Nitroglycerin. And changing the position of the torso has no effect on her.
Cold sweat, low blood pressure, pallor of the dermis - these are all companions of gastralgic pain. In addition, the individual has the following clinical picture:
- bloating;
- nausea and vomiting;
- dermis wet and cold;
- stool disorder;
- heart rate fluctuates;
- cardiac sounds are muffled, systolic murmur and additional tones appear;
- cardiac asthma;
During an attack, the patient has a fear of death.
Symptoms of the abdominal form of myocardial infarction most often appear after eating. This phenomenon is associated with poor blood supply to the muscles of the heart during the work of the gastrointestinal tract. When examining the abdomen, there is no tension. The temperature in the acute period is also not observed. After a few hours, the pain syndrome moves tochest area.
Abdominal form of myocardial infarction: first aid
Individuals with a severe gastralgic clinic, which is atypical for the picture of "acute abdomen", are hospitalized in the cardiology department to clarify the final diagnosis. Until the paramedics arrive:
- The patient is placed in a horizontal position.
- It is desirable to provide fresh air.
- If possible, measure the pressure. With high numbers, it is allowed to give the medicine that the patient has taken before.
To exclude erroneous hospitalization in an infectious or surgical he althcare institution, the patient is given an ECG before his hospitalization. In the gastralgic form, the results obtained after registration of cardiac activity correlate with the lower (posterior) infarction.
After diagnosis (in the absence of restrictions and contraindications), thrombolysis is allowed at the prehospital stage. In addition, Heparin, antiplatelet agents, must be administered. In cardiogenic shock, infusions of infusion solutions are indicated.
After analgesia, the individual is taken in a supine position to a multidisciplinary hospital-type he althcare facility. Where additional laboratory and apparatus types of examinations are performed. The choice of treatment method - angioplasty, bypass, stenting of coronary vessels - is determined by the attending doctor.
Location and nature of pain
In the abdominal form of myocardial infarction, the pain is localized in the upper half of the abdomen. However, patients feel it in the region of the heart and behind the sternum. With a second heart attack, the nature of the pain and its irradiation change. Therefore, the factors that caused it must be differentiated.
Mostly pain occurs after emotional or physical stress and can coincide with eating. It grows gradually, becoming the strongest after thirty to sixty minutes from the onset of the attack. Often the individual is seized with a panic, and he feels the fear of death. Reception of "Nitroglycerin" facilitates it for a certain period. The pain is accompanied by nausea, vomiting is quite rare.
Therapy
Treatment of the abdominal form of myocardial infarction is carried out in a round-the-clock hospital for 25-35 days. This is necessary for constant monitoring of the state of the individual. The patient is obliged to observe bed rest and exclude any situations that can provoke overexertion. Pharmacotherapy is aimed at eliminating symptoms and preventing the development of complications. Doctors recommend taking medicines belonging to the following pharmacological groups:
- ACE inhibitors;
- calcium blockers;
- nitrates;
- sedative;
- analgesics;
- thrombolytics;
- beta blockers;
- disaggregants;
- anticoagulants.
In the abdominal form, symptoms are observed similar to a malfunction in the gastrointestinal tract, so the patient is shown drugs to prevent bile secretion, reduce acidity, and increase intestinal efficiency.
If there are complications andconcomitant ailments, the appointment of other drugs is allowed.
During inpatient treatment, the individual necessarily performs special exercises to restore the previous physical condition. The course of physical therapy is designed for the entire recovery period, i.e. from six to twelve months.
In addition, dietary nutrition is necessary, since the abnormal process is accompanied by dyspeptic manifestations.
Surgery
Surgery is necessary when the patient is in serious condition. Most often this happens with untimely diagnosis. The following surgical methods are used:
- Aortocoronary bypass surgery - allows you to restore blood flow bypassing the dead area.
- Coronary angioplasty - a metal tube is inserted into the narrowest part of the vessel, thanks to which the blood flow is normalized.
Prevention measures
To rule out a second heart attack, doctors advise:
- keep active;
- give up cigarettes and alcohol;
- visit a cardiologist every year;
- control blood pressure and cholesterol levels;
- pass the necessary examinations, including angiography of the heart vessels, ECG and others;
- adjust the diet - exclude fried and fatty foods, enrich it with cereals and legumes, fish, nuts, vegetables, lean meats;
- stick to the daily routine;
- sign up for a pool or cardio workout;
- take medications prescribed by the doctor - angioprotectors, beta-blockers, anticoagulants, calcium antagonists, sedatives;
- treat co-morbidities.
Failure to follow the above recommendations is fraught with relapses.
Complications
The abdominal form of myocardial infarction, the clinic of which is described in the article, with erroneous diagnosis and treatment is complicated by the following pathological conditions:
- rupture of heart tissue;
- acute heart failure;
- pericarditis;
- postinfarction syndrome;
- thrombosis;
- arrhythmias;
- neurotrophic disorders;
- aneurysms.
Sudden coronary death overtakes an individual if timely assistance is not provided. In addition, you should definitely go through a rehabilitation course.
Forecast
It is complicated by the fact that at the stage of diagnosis this pathology is not immediately recognized, which is dangerous with serious consequences. In stationary conditions, the lethal outcome is very low and amounts to about twenty percent. Approximately eight percent die within a year of suffering a heart attack.
