Myocardial infarction: symptoms, early signs

Myocardial infarction( MI) is an acute form of ischemic heart disease, which is characterized by cardiac muscle necrosis.

The disease develops as a result of a sharp discrepancy between the need for oxygen in the heart and the ability to deliver it to the coronary arteries.

Causes of myocardial infarction

In almost 99% of cases, the main causative factor of myocardial infarction is atherosclerosis. This pathology is caused by high cholesterol in the blood, changes in the vascular wall and other factors that result in the formation of atherosclerotic plaques in the vessels.

Atherosclerosis can be inconspicuous for a long time. But if the plaque capsule is damaged, it forms a thrombus, which leads to occlusion of the artery. As a result, the blood supply to the heart is severely restricted or terminated, and the muscle is subjected to ischemia and subsequent necrosis.

Sometimes the cause of a heart attack is a physical or emotional load. Because of the increased cardiac activity, the myocardium experiences a greater than usual oxygen demand, but the altered arteries can not provide adequate delivery.

Symptoms of heart attack, signs in women and men

The pre-infarction period is manifested mainly by attacks of angina pectoris, it can last from 2-3 minutes to 1-1.5 months. At this time it is important to pay attention to these symptoms, and begin treatment - then myocardial infarction can be avoided.

Then follows the most acute period. A typical heart necrosis clinic includes the following symptoms:

• a sense of fear;
  
• pain in the heart;
  
• such signs of a heart attack in women, as a sharp weakness and lethargy;
  
• impaired consciousness( inhibition, apathy).

Symptoms of heart pain with a heart attack have some features. It is localized behind the breastbone, extends into the left arm, neck, scapula. Pain sensations are very intense, have a burning, tearing, pressing or compressive nature, do not weaken after taking nitroglycerin, last more than 30 minutes and do not depend on the position of the body. Often there are irregularities in the rhythm, which are manifested by irregularities, palpitation, dizziness. This is a painful or anginous variant of myocardial infarction.

There are more rare clinical forms of myocardial infarction, each of which has its own symptoms.

• asthmatic;
  
• abdominal;
  
• cerebrovascular;
  
• arrhythmic;
  
• is an asymptomatic.

The asthmatic variant of a myocardial infarction is manifested by symptoms of pulmonary edema - shortness of breath, rattling rales, coughing.

Abdominal pain is characterized by pain in the epigastric region of the abdomen, accompanied by hiccups, belching, vomiting, flatulence and diarrhea.

The cerebrovascular form of the infarct is characterized by the prevalence of signs of acute disturbance of cerebral blood supply( dizziness, loss of consciousness, vomiting or nausea, speech disorders).

Sometimes myocardial infarction occurs in an arrhythmic form, the main symptoms of which are palpitations, heart disruptions up to ventricular fibrillation. Particular difficulties in diagnosis appear in the low-symptom course of the disease. The only manifestation may be pain in the left arm or heartburn, a slight weakness.

Consequences of myocardial infarction

There are late and early consequences of myocardial infarction. Early complications( within 10 days from the onset of a heart attack):

• cardiogenic shock;
  
• acute left ventricular failure;
  
• arrhythmias( supraventricular or ventricular);
  
• cardiac conduction abnormality( sinoatrial block, AV block, leg block bundle);
  
• heart break;
  
• aneurysm of the left ventricular wall;
  
• cardiac tamponade( blood enters the pericardial cavity and squeezes the heart);
  
• thromboembolic complications( thrombosis of the arteries of the brain, limbs);
  
• aseptic pericarditis.

Late complications( later than 10 days):

• postinfarction angina;
  
• Dressler's syndrome( autoimmune lesions of the pleura, lungs, pericardium, joints);
  
• chronic heart failure;
  
• chronic aneurysm( protrusion) of the left ventricular myocardium;
  
• various rhythm disturbances.

Diagnosis

When diagnosing a heart attack, much attention is paid to the patient's complaints and clinical symptoms. Within 1.5 hours of the onset of a painful attack, motor excitation is observed, then a retardation occurs. Noticeable pallor of the skin, protruding sweat, cyanosis of the lips, fingertips, cold extremities.

On the third day of the disease, a toxic necrotic syndrome develops, manifested as a rise in temperature, a headache. With auscultation, there is a decrease in the sonority of the I tone in the region of the cardiac apex, II of the tone above the aorta, the "gallop rhythm" as a result of left ventricular overload, and arrhythmia. On the second day there may be a noise of friction of the pericardium sheets, which indicates the attachment of aseptic pericardium.

Laboratory methods

A very valuable diagnostic method is the determination in the blood of myocardial necrosis indices: cardiac troponins, CF-fraction of creatine phosphokinase, myoglobin, lactate dehydrogenase, alanine and aspartate aminotransferase. The most specific sign of necrosis of the heart muscle is an increase in the level of troponins I and T. The troponin test helps to diagnose the disease even before the appearance of changes on the ECG.

Instrumental methods

1. Electrocardiography: ECG at different periods of the disease shows a decrease or increase of the ST segment by several mm relative to the isoline, a Q( abnormal) tooth appears, the R tooth disappears, and various conduction and rhythm disturbances( blockade, arrhythmia, extrasystole) are observed. Depending on the type of leads in which there are changes, we can assume the localization of the infarction.
   
2. Echocardiography: with ultrasound of the heart, it is possible to identify affected areas of the myocardium, signs of ventricular expansion, to determine the presence of an aneurysm, to assess the degree of breach of contractility and other indicators of cardiac activity.
   
3. Radiography of the chest cavity: performed for the diagnosis of pulmonary edema, pneumonia and other complications of myocardial infarction.
   
4. Coronarangiography: is necessary in the event that operative treatment of disease is supposed. This study allows you to determine which of the coronary arteries are affected.

Principles of treatment

The best way to treat myocardial infarction is surgery, during which a thrombus is removed from the coronary vessel or angioplasty is performed. As a result, the viability of the ischemic myocardium is restored or the zone of necrosis is limited. If an emergency operation is not possible, conservative therapy is carried out, which includes: the

• diet;
  
• motor mode;
  
• medication.

Food should be light, not causing gas and stools. In the first 2 days the patient needs a complete bed rest. Then every day the volume of movements expands( at first it is allowed to turn in bed, then sit down, walk around the ward, etc.).To prevent thrombosis and pneumonia, breathing exercises and limb movements in bed are recommended.

Medical treatment

In case of myocardial infarction the following remedies are used:

• analgesics( narcotic and non-narcotic analgesics);
  
• disaggregants and anticoagulants( aspirin, clopidogrel, heparin, fractiparin);
  
• nitroglycerin;
  
• beta-blockers;
  
• diuretics( with pulmonary edema).

After surgical intervention, the next most effective treatment for myocardial infarction is thrombolytic therapy. To dissolve the thrombus use streptokinase, alteplase, urokinase, etc. Thrombolytic therapy has strict indications and contraindications.

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