A serious complication of coronary heart disease is myocardial infarction. The formation of an intracoronary thrombus in patients with this diagnosis occurs quite often. If earlier older people fell into the risk zone, now a heart attack is also diagnosed in people 30-40 years old. The reason may be lifestyle and irresponsible attitude to one's he alth. Heart attack pain varies, so it's important to recognize the danger and get help quickly.
Causes of myocardial infarction
Many reasons can provoke such a pathology, but experts most often distinguish the following:
Atherosclerosis. Atherosclerotic plaques on the walls of blood vessels provoke the development of ischemia. Against this background, the lumen of the vessels narrows to critical values, and the myocardium suffers from a lack of oxygen and nutrition
- Thrombogenesis. The blood supply to the heart muscle is disturbed if the vessel is blocked by a thrombus.
- Embolism rarely provokes a heart attack, but in some cases it can cause an acuteischemia.
- Congenital and acquired heart defects. Pain during a heart attack in this case appears due to organic damage to the heart muscle.
- Surgical obturation, which is possible during mechanical opening of the artery or ligation during angioplasty.
Most often, doctors are faced with situations where several causes simultaneously become provocateurs for the development of a heart attack.
Who is at risk?
Pain from myocardial infarction is more at risk for patients with the following conditions and pathologies:
- Over 40 years old.
- Men risk more.
- In the presence of congenital heart defects.
- If diagnosed with angina pectoris.
- If body weight is significantly higher than normal.
- After a lot of stress.
- High blood sugar.
- Presence of bad habits: smoking, abuse of alcoholic beverages, drugs.
- Sedentary lifestyle.
- High blood pressure.
- Inflammatory damage to the heart: endocarditis, rheumatic heart disease.
- Disturbances in the development of blood vessels supplying the heart with blood.
If none of the above suits you, then this does not mean that there is a 100% guarantee to avoid a heart attack and pain in the heart.
Symptomatics
The nature of the pain and its intensity during an attack depend on several points:
- The size of the necrotic lesion.
- Locations of the pathological site.
- Stages of a heart attack.
- Forms of the disease.
- Individual characteristics of the organism.
- From the state of the vascular system.
The disease can occur in two forms: typical and atypical.
How the typical shape manifests
A vivid picture of a heart attack is often observed with extensive damage to the heart. The course of the disease passes through several periods.
Pre-infarction. In almost half of patients, this period may be absent, since the pain of a heart attack appears suddenly. Many patients feel retrosternal pain before an attack, which gradually become more intense and prolonged. At this moment, a feeling of fear may appear, the mood drops.
The most acute period lasts from half an hour to several hours. Patients are interested in the question: if a heart attack, what pains accompany a person? Unpleasant sensations can be as follows:
- Resternal pain that radiates to the left arm, possibly to the jaw or collarbone.
- Pain can be between the shoulder blades, in the shoulder.
- Pain sensations are burning, cutting or pressing.
- Within a few minutes, the intensity of pain reaches its maximum and can persist for an hour or more.
The acute period often takes about 2 days. If there has already been a heart attack, then the duration can increase up to 10 days. For many, angio pain subsides at this time, if this does not happen,that it is possible to assume accession of a pericarditis. During this period, the disturbed rhythm also persists, blood pressure is lowered.
The subacute period can take up to a month for some patients. Pain after myocardial infarction practically disappears, the heart rate and conduction gradually normalize, but the blockade cannot be regressed.
The course of the pathology ends with the post-infarction period. It can last up to six months. The necrotic area is completely replaced by connective tissue. Heart failure is compensated by hypertrophy of the normal myocardium. With extensive lesions, full compensation is impossible, and there is a danger of progression of heart failure.
How it starts
The onset of pain coincides with the appearance of general weakness, the release of profuse and sticky sweat, the heart rate quickens and the fear of death appears. Physical examination reveals:
- Pale skin.
- Tachycardia.
- Shortness of breath at rest.
- Blood pressure in the first minutes of an attack rises, and then drops sharply.
- Muffled heart sounds.
- Breathing becomes hard, wheezing appears.
Against the background of necrosis of the tissues of the heart muscle, the body temperature rises to 38 degrees and above, it all depends on the size of the necrotic area.
With a microinfarction, the symptoms are smoother, the course of the pathology is not so clear. Moderate tachycardia appears, heart failure rarely develops.
Pain in myocardial infarction most often occursearly in the morning or at night. It happens all of a sudden. A clear sign of a heart attack is the lack of effect when taking Nitroglycerin.
Atypical shape
An atypical form of a heart attack makes it difficult to make an accurate diagnosis, when the localization of pain is not the same as with a typical heart attack. There are several forms:
- Asthmatic heart attack. The patient suffers from coughing, asthma attacks, profuse cold sweat.
- Gastralgic form. Pain during a heart attack appears in the epigastric region, nausea begins with vomiting.
- Edematous form is diagnosed with a massive focus of necrosis, which leads to the development of heart failure with edema and shortness of breath.
- The cerebral form is often characteristic of elderly patients. In addition to typical heart attacks, symptoms of cerebral ischemia with dizziness appear, there may be loss of consciousness.
- The arrhythmic form is manifested by paroxysmal tachycardia.
- Peripheral infarction. Pain in the arm, under the scapula, in the lower jaw. Often the symptoms are similar to those of intercostal neuralgia.
Some patients may have an erased form, when typical symptoms are practically absent.
How to distinguish a heart attack from other cardiac pathologies
You can recognize the moment when a person needs emergency help by the following symptoms that appear simultaneously:
- Chest pain and tightness.
- Headache appears.
- Nausea with vomiting.
- Shortness of breath and profuse sweating.
- Disruption of the gastrointestinal tract.
- Pain in the arm, shoulder, back.
- Irregular heartbeat.
- General malaise.
Localization of pain in angina pectoris and myocardial infarction is the same, but these two pathologies can be distinguished. Characteristic of a heart attack:
- Intense pain.
- Pain continues for more than 15 minutes.
- It is impossible to stop the pain of myocardial infarction with Nitroglycerin.
If you suspect a heart attack, you should urgently call an ambulance to reduce the likelihood of complications.
Complications
If pain persists after a heart attack, then an examination is required. After the pathology, it is necessary to closely monitor the slightest deviations in the state of he alth in order not to miss the development of complications. And they can be like this after a heart attack:
- Failures in the work of the heart.
- Arrhythmia.
- High blood pressure.
- Heart muscle damage.
- Postinfarction syndrome.
First Aid
The prognosis for a patient with a heart attack depends on the speed and correctness of first aid. After calling an ambulance should be as follows:
- Lay the person on a flat surface and raise their head a little. If there is shortness of breath, then you can take a sitting position with your legs down.
- Provide airflow: open the window, unbutton the top buttons of the clothes.
- If there is no allergy, then the patient should be given an Aspirin tablet, which promotes the resorption of a blood clot. The drug does not give a therapeutic effect, but reduces the intensity of pain.
- "Nitroglycerin" does not reduce pain, but helps to remove shortness of breath. It is necessary to give the drug after 15-20 minutes, but not more than 3 tablets.
- If epigastric pain appeared during an attack of myocardial infarction, then you can give an anesthetic, take a soda solution to eliminate heartburn.
Medications taken may not improve a person's condition, but will help the ambulance team make a diagnosis easier.
Diagnosis
Basic criteria for a diagnosis of a heart attack:
- Changes in the cardiogram.
- Shifts in enzymatic activity in blood serum.
To clarify the diagnosis, laboratory and instrumental diagnostics are carried out.
Lab test
In the first hours after an attack, a blood test shows an increased level of myoglobin protein, which is directly involved in the transport of oxygen into cardiomyocytes. Within 10 hours, the content of creatine phosphokinase increases by more than 50%, and its indicators normalize only by the end of 2 days. The analysis is carried out every 8 hours, and if a negative result is obtained three times in a row, a heart attack can be ruled out.
At the late stage of a heart attack, it is important to determine the level of LDH, the activity of this enzyme increases 1-2 days after an attack.
In the general blood test, the erythrocyte sedimentation rate increases, leukocytosis is observed.
Instrumental diagnostics
Suggests holding:
- Electrocardiograms. The doctor notes the appearance of a negative T wave or its biphasic, deviations in the QRS complex and signs of arrhythmia, conduction disturbance.
- X-ray examination is usually not scheduled due to poor information content.
- After a day or two, coronary angiography is performed, which helps to identify the place of arterial obstruction.
After identifying the extent and localization of necrosis and assessing the contractility of the heart, the doctor prescribes therapy.
Therapy
A patient with a suspected heart attack is taken to the intensive care unit of cardiology. The sooner treatment begins, the better the prognosis. The purpose of treatment activities is:
- Stop pain.
- Limit the necrotic area.
- Prevent complications.
Using drugs from several groups for different therapies:
- To eliminate pain, "Nitroglycerin" is administered intravenously by drip, give "Morphine" and "Atropine" intravenously.
- Thrombolytic therapy involves the reduction of the area of necrosis. For these purposes, a thrombolysis procedure is performed and fibrinolytics ("Streptokinase"), antiaggregants ("Thrombo-ASS"), anticoagulants ("Heparin", "Warfarin") are prescribed.
- To normalize heart rate and eliminate heart failure, prescribe"Bisoprolol", "Lidocaine", "Verapamil".
- Therapy of acute heart failure is carried out using cardiac glycosides: "Korglikon", "Strophanthin".
- Neuroleptics and sedatives help to eliminate increased nervous excitement.
Prognosis for the patient depends on the speed of care and timely resuscitation.
Preventive measures
To prevent relapse, it is important to follow these guidelines:
- Get regular maintenance treatment.
- Strictly follow all the recommendations of the attending doctor.
- Adjust the diet: exclude fatty foods, fast foods.
- Provide balanced exercise.
- Eradicate bad habits.
Any pain in the heart should not go unnoticed. Timely examination will prevent the development of the disease.
