Myocardial infarction: clinical presentation, and treatment forms

Myocardial infarction - a type of coronary heart disease. When the disease develops ischemic myocardial necrosis, which occurs due to a violation of coronary circulation.

At all times, to a heart attack was focusedconcerned attention of experts, because of its frequency, severe, serious prognosis and high mortality of patients. Even the people who are faced with this disease, from the outset feel doomed. Myocardial developed with catastrophic consequences for health, permanently making the person unable to work.

The clinical picture of the disease

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From the defeat of the scope of the division of a heart attack depends on macrofocal and melkoochagovogo form. Based on the clinical course of disease, myocardial allocate 5 periods:

  1. preinfarction period It takes from several hours up to six months. According to the clinical characteristics of this stage of the disease is similar to the unstable, progressing angina and acute coronary insufficiency.
  2. The acute period It opens the development of acute myocardial ischemia andit ends with the formation of necrosis. It lasts from fifteen minutes to two hours. The person experiences severe pain which can spread towards the left arm, shoulder, lower jaw, ears, teeth, epigastric cavity. The larger the area of ​​necrotic lesions, so mercilessly on pain intensity, which may temporarily weaken, to then come back with a bang. Nitroglycerin is powerless in this situation (if there has been no case of myocardial atypical nature).
  3. The acute period - Final. He went from two days to two weeks. The pain usually disappears. If it persists, it indicates the possible development of pericarditis. Macrofocal infarction in the acute period is typically manifested heart failure and hypotension.
  4. Subacute period It occurs within 4-8 weeks after the onset of the disease. At this time, the scar begins to form. The pain of the patient is no longer concerned about the manifestations of acute heart failure gradually smoothed, chronic heart failure develops in individual cases. In 40% of cases of heart rhythm is unstable. Heart rate returns to normal, there is no longer a systolic murmur, blood enzyme activity is restored.
  5. post-MI (3-6 months after the onset of a heart attack)characterized by increasing the density of the scar. The myocardium is fully adapted to the new opportunities and working conditions. When prosperous recovery and variations in the state of the nervous system practically do not appear. However, in some cases, adverse circumstances retained the risk of recurrent angina, it can happen a second myocardial infarction or development of chronic heart failure.

When melkoochagovogo infarction not a patient is experiencing severe pain, as inmacrofocal. The intensity of the pain somewhat superior angina and not for so long continue. This form of the disease occurs without the development of heart failure, but often expressed arrhythmias.

Diagnosis of the disease

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For patients with myocardial infarction is only one way - in an intensive care unit or intensive care unit. Treatment aims to:

  • to stop pain;
  • limit the ischemic lesion;
  • restore or improve the blood flow to the affected area of ​​the coronary artery;
  • conduct prevention or treatment of complications;
  • resort to psychological and physical rehabilitation.

What you need to do before the arrival of the brigade Ambulance? The patient may receive 0.5 mg (1 tablet)nitroglycerin under the tongue, then, constantly monitoring your blood pressure, you need to take 0.5 mg of nitroglycerin repeated every 5-10 minutes. Furthermore, it should ingest aspirin 325 mg (a tablet to chew).

To arrest the pain syndrome, doctorsresorted to neuroleptanalgesia (combination of neuroleptics and analgesics) using fentanyl (2 ml 0 005% solution) and droperidol (taking into account the blood pressure) 2.5 (1 ml) and 4 mg; slow intravenous injection (2 ml / min) was administered 20 ml of 5% glucose solution or sodium chloride.

Maximum limit the affected area of ​​necrosisYou can using fibrinolytic drugs - they normalize the coronary blood flow. Also to solve this problem are relevant tools for hemodynamic unloading of the heart (vasodilators group and the group of beta-blockers).

Fibrinolytic agents (streptokinase,urokinase) is applied in the first 3 chasa (but not later than 12 hours) from the onset of infarction. Streptokinase is administered intravenously. To prevent allergic reactions, previously administered prednisolone. If the allergy is still there, on an emergency basis using steroids and antihistamines. Treatment of fibrinolytic agents is contraindicated with a history of bleeding prescription up to 10 days, injuries and surgical intervention, hemorrhagic diathesis, malignancies, diabetes. For patients with contraindications to fibrinolytic therapy alternative treatment becomes heparin.

In continuous mode, from 48 to 72 hoursintravenously administered nitrates (nitroglycerin, for example) or isosorbide dinitrate (izoket). Contraindications to the use of nitrates are: idiosyncrasy of the drug, hypotension, severe sinus tachycardia.

If it appears in the arterial patient historyhypertension, tachycardia, frequent premature beats, experts prefer to use beta-blockers (propranolol, propranolol, obzidan). Contraindications to their use: bradycardia, hypotension, heart block, bronchospasm, acute left ventricular failure.

Do not be afraid to live after a heart attack

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Very often, myocardial introduces humanin a heavy, oppressive state. The state of health is poor, and it seems like it will last forever. However, experts in one voice assert the opposite: a heart attack - not a sentence, but a reason to take seriously their health and start a new full life. What is needed, says MipSovetov!

Permanently give up cigarettes. This addiction increases the likelihood of a second heart attack in half!

Sit on a diet. The most important are your enemies - excess cholesterol and salt, which increases the burden on the cardiovascular system.

Do not be afraid to move. A person can not after a heart attack once againmove - misleading. Recommendation to completely abandon physical exertion get the unit affected by the disease. The rest of the move is not only possible, but imperative. Walk up and down the stairs, hiking. The load is increased gradually, after 5-6 weeks after a heart attack start with 20-minute walks a day, every day increasing the duration of 5 minutes.

Watch your weight. If you are a "sin" by several redundantpounds, please be resolve and get rid of them. So you protect yourself from possible reinfarction. If you are not sure of success, seek advice from a dietitian.

Measure the pressure. This should be done regularly, as highblood pressure - it is a big risk that the heart is about something "sick". The rate - less than 140/90 mm Hg. Art. Your task: to ensure that the tonometer displays your blood pressure below 130/80 mm mark Hg. Art.

Always remember that most of the people who have suffered a myocardial infarction, have a chance to fully restore health.

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