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Myocardial infarction: clinical picture, forms and treatment

Myocardial infarction – a kind of coronary heart disease. At a disease the ischemic necrosis of a myocardium which arises because of violation of coronal blood circulation develops.

At all times the concerned attention of experts that is caused by its frequency, a heavy current, the serious forecast and high mortality of patients was riveted on a heart attack. And people who faced this disease, from the very beginning feel the fateful. The heart attack develops with catastrophic consequences for health, for a long time doing the person disabled.

Clinical picture of a disease

Division of a heart attack into krupnoochagovy and melkoochagovy forms depends on the volume of defeat. Proceeding from the clinical course of a disease, allocate 5 periods of a heart attack:

  1. The preceding infarction period borrows from several hours to one and a half months. According to clinical characteristics this stage of a disease is similar to the unstable, progressing stenocardia and sharp coronary insufficiency.
  2. The sharpest period opens development of sharp ischemia of a myocardium and comes to an end with formation of its necrosis. Lasts from a quarter of hour till two o'clock. The person feels the strongest pain which can spread towards the left hand, a shovel, the lower jaw, an ear, teeth, a nadchrevny cavity. The more area of necrotic defeat, the neshchadny on intensity pain which can weaken for a while that then to return with a new force. Nitroglycerine in this situation is powerless (if the case of a heart attack of atypical character does not take place).
  3. The sharp period – final. It proceeds from two days to two weeks. Pain, as a rule, disappears. If it remains, it indicates possible development of a perikardit. The Krupnoochagovy heart attack in the sharp period typically proves heart failure and arterial hypotonia.
  4. The subsharp period comes in 4–8 weeks after an onset of the illness. At this time the hem starts being formed. Pains of the patient do not disturb any more, manifestations of sharp heart failure gradually smooth out, chronic heart failure in some cases develops. In 40% of cases the warm rhythm remains unstable. Heart rate returns to normal, systolic noise is not observed any more, activity of enzymes of blood is restored.
  5. The Postinfarktny period (3-6 months after development of a heart attack) is characterized by increase of density of a hem. The myocardium completely adapted for new opportunities and working conditions. At safe recovery of a deviation is able and activity of nervous system are practically not shown. However in certain cases at adverse combination of circumstances the risk of development of returnable stenocardia of tension remains, there can be a repeated myocardial infarction or development of chronic heart failure.

In case of a melkoochagovy heart attack the patient feels not such severe pain, as at the krupnoochagovy. Pain surpasses an attack of stenocardia in intensity a little and not so long proceeds. Such form of a disease proceeds without development of heart failure, but is often expressed by arrhythmias.

Diagnosis of a disease

At pronouncement of the diagnosis consider data of the typical anamnesis and clinic, results of laboratory methods of research. As the most informative consider indications of an electrocardiography.

It is possible to call the anamnesis and clinic typical if the attack of pains behind a breast proceeds of half an hour till one o'clock. At the atypical anamnesis and an ill-defined pain syndrome the doctor is guided first of all by analyses of laboratory data and the electrocardiogram.

At a myocardial infarction the general blood test specifies on giperleykotsitoz and sharp increase in SOE. Changes in biochemical blood test by all means affect indicators of a kreatinfosfokinaza (KFK), a laktatdegidrogenaza (LDG), aspartataminotransferaza (ASAT) and an alaninaminotransferaza (ALAT). At first their level increases by 50% of the upper bound of norm, later indicators of ALAT, ASAT and LDG become maximum (by 2-3rd days), KFK – in the first days after an onset of the illness.

Treatment of a disease

For patients with a myocardial infarction a way one - in resuscitation unit or the block of intensive therapy. Treatment pursues the following aims:

  • to stop a pain syndrome;
  • to limit area of ischemic defeat;
  • to restore or improve a blood-groove in the damaged zone of a coronary artery;
  • to carry out prevention or treatment of complications;
  • to resort to psychological or physical rehabilitation.

What it is necessary to make before arrival of an ambulance crew? The patient can accept 0,5 mg (1 tablet) of nitroglycerine under language, then, constantly controlling arterial pressure, it is necessary to accept on 0,5 mg of nitroglycerine repeatedly each 5-10 min. Besides, it is necessary to take inside aspirin of 325 mg (to chew a tablet).

To stop a pain syndrome, physicians resort to a neyroleptanalgeziya (a combination of antipsychotic preparations and analgetics) with fentanyl use (2 ml 0, 005% solution) and a droperidola (in view of arterial pressure) from 2,5 (1 ml) to 4 mg; slowly intravenously (2 ml/min.) 20 ml of 5% solution of glucose or sodium chloride enter.

As much as possible it is possible to limit a defeat zone to a necrosis, using fibrinolitichesky preparations - they normalize a coronary blood-groove. Also for the solution of this problem means are actual for haemo dynamic unloading of heart (group of vazodilatator and group of beta-blockers).

Fibrinolitichesky preparations (streptokinase, urokinaza) apply in the first 3 hours (but no later than 12 hours) from the beginning of a heart attack. Streptokinase is entered intravenously kapelno. To avoid allergic reactions, previously enter Prednisolonum. If the allergy after all arose, in the emergency order use glucocorticosteroids and antihistamines. Treatment by fibrinolitichesky means contraindicated in the presence in the anamnesis of bleedings prescription till 10 days, injuries and surgeries, hemorrhagic diathesis, malignant new growths, diabetes. For patients with contraindications to fibrinolitichesky therapy the geparinoterapiya becomes alternative treatment.

In the continuous mode from 48 to 72 hours intravenously kapelno appoint nitrates (nitroglycerine, for example) or isosorbide dinitrate (isosiberian salmons). Become contraindications to use of nitrates: individual intolerance of a preparation, arterial hypotension, the expressed sinusovy tachycardia.

If in the anamnesis of the patient arterial hypertension, tachycardia, a frequent ekstrasistoliya appears, experts prefer to use beta adrenoblokatory (propranolol, anaprilin, obzidan). Contraindications to their application: bradycardia, arterial hypotension, blockade of heart, bronchospasm, sharp left ventricular insufficiency.

Be not afraid to live after a heart attack

Very often postponed heart attack enters the person into a serious, oppressive condition. The health leaves much to be desired, and it seems that so will be always. However experts unanimously go on the return: a heart attack - not a sentence, but an occasion seriously to treat the health and to begin new full-fledged life. That for this purpose it is necessary, Mirsovetov tells!

Forever refuse cigarettes. It is an addiction increases probability of repeated heart attack twice!

Go on a diet. Your most important enemies - excess cholesterol and salt which increase load of cardiovascular system.

Be not afraid of the movement. The person after a heart attack cannot move once again - delusion. The recommendation completely to refuse physical activities is received by units of victims of an illness. The rest can move not only, but also it is extremely necessary. Go up-down a ladder, make foot walks. Loading increases gradually: 5-6 weeks later after a heart attack begin with 20-minute walk in day, daily increasing its duration for 5 minutes.

Watch weight. If you "sin" with several extra kilos, stock up with determination and get rid of them. So you will secure yourself against a possible repeated heart attack. If are not sure of success, address for council to the nutritionist.

Measure pressure. It is necessary to do it regularly as the raised blood pressure is a big risk of that heart just about "will get sick" with something. Norm - less than 140/90 mm of mercury. Your task: to watch that the tonometer displayed your pressure a mark lower than 130/80 mm of mercury.

Always remember that the most part of people who had a myocardial infarction, have chance completely to restore health.

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