Transmural infarction is a common and extremely dangerous disease, which is accompanied by necrosis of the heart muscle. It is worth noting that the mortality in case of development like a pathology is very high, especially if the signs of heart damage were not noticed in time, and the patient did not receive the necessary medical care. That is why it is important to know how this form of heart attack manifests itself and what kind of help a sick person needs.
Transmural myocardial infarction: what is it?
First of all, it is worth understanding the meaning of the term. Surely many people know that heart attacks are accompanied by the death of sections of the heart muscle. This happens due to a sharp cessation of blood flow to the heart, as a result of which the tissues do not receive the oxygen and nutrients necessary for life.
As you know, the wall of the heart consists of three layers - thisepicardium (outer layer), mural muscle layer and endocardium (inner part of the muscle). In the intramural form of the disease, necrosis affects only one layer. Acute transmural infarction is a pathology in which necrotic processes are observed in all layers of the heart. It is worth saying that this is the most dangerous form of such a disease.
In modern medicine, pathology is classified based on the localization of foci of necrosis. The most frequently observed transmural infarction of the anterior wall of the myocardium, namely the left ventricle. Only in one of five cases, necrosis also affects the wall of the right ventricle. In about a third of patients, the walls of the atria are also involved.
Causes of disease development
In almost every case, transmural infarction is the result of coronary heart disease. As already mentioned, with insufficient oxygen and nutrients, muscle cells begin to die - this is how necrosis develops. According to statistics, in 90% of cases the cause is atherosclerosis of the coronary vessels, which provide blood flow to the myocardium.
A so-called atherosclerotic plaque is formed on the vessel wall. Under the influence of certain factors, part of the plaque breaks away from the wall and blocks the lumen of the coronary artery. Acute transmural infarction, as a rule, progresses rapidly in situations where myocardial oxygen demand rises sharply - this can happen, for example, with strong physical exertion, fever, strongemotional stress.
Acute transmural myocardial infarction: risk factors
As you can see, necrotic lesions of the heart are not an independent pathology. In most cases, they develop against the background of already existing ischemia and atherosclerosis. Therefore, several risk factors can be identified:
- Genetic predisposition of the patient, which is associated with certain anatomical features and hereditary diseases.
- There is also an age factor. Transmural infarction is more often diagnosed in people older than 45 years, and men are more prone to this pathology.
- Increase in the level of cholesterol in the blood (it is because of this that plaques form on the walls of blood vessels, which subsequently block the blood flow).
- Improper diet (eating fatty and fried foods increases the likelihood of developing atherosclerosis).
- Obesity (in most cases it is associated with malnutrition, and weight gain increases the load on the heart).
- Inactivity (a sedentary lifestyle leads to a gradual weakening of the heart muscle, after which it is very difficult for the myocardium to cope with any physical activity).
- Constant stress, nervous exhaustion, emotional stress leads to changes in hormonal levels, which affects the functioning of the cardiovascular system.
- Smoking (according to statistics, in 35% of cases of necrosis of the heart muscle is associated with this bad habit).
Main symptoms: howidentify a heart attack?
Signs of necrosis can be different - it all depends on the degree of damage, the age of the person, the presence of concomitant diseases, etc. There are known cases of asymptomatic infarction. However, some main symptoms can be identified:
- In most cases, a person complains of acute squeezing pain behind the sternum - it clearly radiates to the left shoulder blade, arm, lower jaw, ear and even teeth.
- The pain is undulating and prolonged - attacks can recur for hours or even days.
- Tachycardia develops, and the patient, as a rule, clearly feels frequent and even painful heartbeats.
- There is also a feeling of short-term fading of the heart.
- There are also external signs of a heart attack - the skin and mucous membranes of a person turn pale sharply.
- Against the background of necrosis, cardiac asthma often develops - the patient notes severe shortness of breath, sudden attacks of suffocation.
Diagnostic measures
When the first violations appear, it is worth immediately taking the sick person to the hospital department, where the appropriate diagnosis and treatment will be carried out. The main diagnostic method for myocardial necrosis is electrocardiography, because with such a procedure it is possible to record electrical potentials in different parts of the heart.
Competently conducted and decipheredan electrocardiogram allows the doctor to determine the localization of necrosis (for example, lower transmural infarction), the extent of the pathological process and the depth of the lesion, the duration of the disease.
In addition, a blood test is required. With a heart attack, there is an increase in the erythrocyte sedimentation rate, an increase in the number of leukocytes, the appearance in the blood of specific enzymes and compounds that are normally found inside myocardial cells.
First Aid Rules
Acute transmural infarction of the anterior wall of the myocardium is a pathology that develops very quickly. Its symptoms can appear almost at any time, so you should familiarize yourself with the rules for helping the patient. Naturally, first of all, you need to call an ambulance.
Waiting for the doctors, a person needs to lie down. An exception is a situation in which there is severe shortness of breath and distinct wheezing when breathing - in this case, it is better to seat the patient by placing a pillow or roller under his back. It is recommended to take an aspirin tablet. You also need to give the person nitroglycerin - first one tablet, and if the pain does not go away, then after five minutes another one (but not more than three).
Heart attack regimen
Depending on the results obtained during the diagnosis, the doctor prescribes treatment. Initial therapy usually consists of three main parts:
- Taking painkillers in order to alleviate the patient's condition. Quite often, pain can be stopped only withwith the help of strong drugs, including Promedol and Morphine. The appearance of symptoms and the diagnosis of "myocardial infarction" are stressful for a person, and excitement and fear only increase the load on the heart - the patient is prescribed sedative medications.
- The treatment regimen includes nitrates and beta-blockers, which helps to eliminate arrhythmia and restore heart rhythm.
- With transmural infarction, there is a high probability of thrombus formation, which is fraught with necrosis of other organs and the spread of the process to neighboring areas of the myocardium, damage to the nervous system and even death. Therefore, the fight against thrombosis should be started already in the first hours after the onset of symptoms. For this purpose, thinning preparations are used that contain heparin and fibrinolysin. Naturally, when taking such drugs, there is a possibility of massive hemorrhage, because the blood stops clotting, so it is important to carefully monitor the patient's condition.
Treatment must be carried out in a hospital - the patient must be under the supervision of a doctor around the clock.
Consequences and complications of the disease
Transmural infarction is the most complex and dangerous form of myocardial necrosis, especially when it comes to macrofocal necrosis. The disease is fraught with consequences - the development of pulmonary edema, paralysis of the limbs, speech disorders. Sometimes a heart attack entails further pathologies of the vascular system, in particular a stroke.
To the consequences of this pathology alsoinclude thromboembolism, ventricular fibrillation, cessation of work of various organs and even their systems. Such cases often end in death, even if the patient was provided with medical care. Another deadly complication is heart failure. With a strong contraction of the myocardium and an increase in pressure inside the ventricles and atria, there is a risk of violation of the integrity of the muscle in the area of necrosis.
Rehabilitation and prognosis
Unfortunately, the prognosis for such a disease is not very favorable - in about 50% of cases, patients (especially when it comes to the elderly) die. If, nevertheless, it was possible to restore normal blood circulation, there is still a risk of complications in the future, since changes in myocardial tissues have occurred.
That is why the rehabilitation period is so important. Patients are advised to eat simple, light and high-calorie foods. It is also important to gradually return to physical activity, since inactivity is fraught with muscle atrophy and congestion in the lungs. Of course, all activities related to physical activity must be strictly controlled by a specialist.
Supportive care and constant medical supervision are essential for the rest of your life. Of course, patients need to monitor nutrition, avoid stress and intense physical activity, prevent a strong increase in blood pressure and stop smoking.
