Acute myocardial infarction

Description:

It is one of clinical forms of coronary heart disease proceeding with development of an ischemic necrosis of the site of the myocardium caused by absolute or relative insufficiency of its blood supply.
The myocardial infarction is one of the most often found diseases in the countries of the West. At an acute myocardial infarction about 35% of the diseased, and a little more than a half of them die before get to a hospital. Another 15-20% of the patients who transferred an acute stage of a myocardial infarction die within the first year. The risk of the increased mortality among the persons who had a myocardial infarction even in 10 years is 3,5 times higher, than at persons of the same age, but without myocardial infarction in the anamnesis.

Symptoms of the Acute myocardial infarction:

Most often patients with an acute myocardial infarction complain of pain. At some patients she is so strong that they describe it as the most expressed from pains which they ever happened to test. The heavy, squeezing, breaking off pain usually arises in the depth of a thorax and on character reminds usual attacks of stenocardia, however more intensive and long. In typical cases pain is felt in the central part of a thorax and/or in the field of an epigastrium. Approximately at 30% of patients it irradiates in upper extremities, is more rare to the area of a stomach, back, taking a mandible and a neck. Pain can irradiate even to the area of a nape, but never irradiates below a navel. Cases when pain is localized below a xiphoidal shoot or when patients deny communication of pain with heart attack, are the reasons of statement of the wrong diagnosis.
Often pains are followed by weakness, perspiration, nausea, vomiting, dizziness, excitement. Unpleasant feelings appear usually at rest, is more often in the morning. If pain begins during an exercise stress, then unlike a stenocardia attack, it, as a rule, does not disappear after its termination.

However there is pain not always. Approximately at 15-20%, and apparently, even at bigger percent of patients the acute myocardial infarction proceeds without serious consequences, and such patients can not ask for medical care at all. To a thicket bezbolevy the myocardial infarction is registered at patients with a diabetes mellitus, and also at elderly people. At elderly patients the myocardial infarction is shown by suddenly arisen asthma which can pass into a fluid lungs. In other cases the myocardial infarction, both painful, and bezbolevy, is characterized by a sudden loss of consciousness, feeling of sharp weakness, developing of arrhythmias or just inexplicable sharp lowering of arterial pressure.

In many cases at patients reaction to pain in a thorax dominates. They are uneasy, excited, try to kill pain, moving to beds, writhing and being extended, try to cause short wind or even vomiting. Otherwise patients behave during a stenocardia attack. They aim to reach motionless position because of fear of resuming of pains. Pallor, perspiration and a cold snap of extremities are often observed. The retrosternal pains proceeding more than 30 min. and the perspiration observed at the same time demonstrate high probability of an acute myocardial infarction. In spite of the fact that pulse and arterial pressure remain with many patients within norm, approximately at 25% of patients with a front myocardial infarction observe manifestations of hyperreactivity of a sympathetic nervous system (tachycardia and/or a hypertension), and almost at 50% of patients with the lower myocardial infarction observe signs of the raised tone of a sympathetic nervous system (bradycardia and/or hypotonia).

Reasons of the Acute myocardial infarction:

The myocardial infarction develops as a result of obturation of a gleam of a vessel krovosnabzhayushchy a myocardium (coronary artery). The reasons can become (on occurrence frequency):

  1. Atherosclerosis of coronary arteries (thrombosis, obturation plaque) 93-98%
  2. Surgical obturation (bandaging of an artery or dissection at angioplasty)
  3. Embolization of a coronary artery (fibrinferments at a coagulopathy, a fatty embolism etc.)
  4. Spasm of coronary arteries

Treatment of the Acute myocardial infarction:

Treatment at early stages at an opportunity comes down to elimination of pain, recovery of a coronary blood-groove (thrombolytic therapy, angioplasty  of coronary arteries, AKSh). At the expressed heart failure in the conditions of clinic statement of intra aortal balloon counterpulsation is possible.
In case of a cardiac standstill it is necessary to begin cardiopulmonary resuscitation immediately. Availability of automatic outside defibrillators increases survival in such situations.
It is necessary to give to the patient nitroglycerine (in tablets or in an aerosol) if the pain syndrome is not eliminated, it is necessary to call an ambulance crew, the doctor will appoint narcotic analgetics - morphine, etc. In the presence at the patient of an arterial anoxemia (saturation of an arterial blood oxygen <90 a target="_blank" href="index-2094.htm" tppabs="medicalmeds.eu/pulmonologiya/odischka/">of an asthma or other symptoms of heart failure give the moistened oxygen (through a mask or a nasal catheter) with a speed of 2-5 l/min. The arterial anoxemia is whenever possible defined by a pulsoksimetriya. The patient with the expressed excitement, alarm, fear (which do not disappear after introduction of a narcotic analgetic) can appoint a tranquilizer (for example, diazepam intravenously of 2,5-10 mg). It is also important to calm the patient and his relatives.
Carries out antithrombocytic (клопидогрель, acetylsalicylic acid), thrombolytic therapy (Streptokinasa, an alteplaza),  anticoagulants (unfractionated heparin) apply.