Postinfarkny stenocardia

Description:

Postinfarction stenocardia develops at 25% of the hospitalized patients, at a successful  thrombolysis the risk is even higher than it. The ongoing or renewed ischemia often demonstrates increase in a zone  of a myocardial infarction or about a repeated heart attack and as the lethality at these states increases twice, the repeated  thrombolysis or a coronary angiography with  balloon coronary angioplasty or  coronary shunting are shown to such patients.

Symptoms of Postinfarkny stenocardia:

Early postinfarction stenocardia can be shown at rest or at the minimum FN (on self-service) by anginous pain or its equivalents (attacks of KA). St testify to weight of this:
• emergence of attacks at rest (without growth of the ABP) or at the minimum FN in the first days of a myocardial infarction;
• ST segment shift out of a myocardial infarction zone ("ischemia at distance"). At the same time the forecast is worse, than at patients with ischemia in an infarctive zone;
• disturbances of a rhythm or a hemodynamics in the period of an attack or right after it.

Reasons of Postinfarkny stenocardia:

At a myocardial infarction usually there is a full death of the cardiac muscle which is below that place where there was a problem in an artery. In this site there is a death of both muscular tissue, and all nerve terminations, and he has not an effect in any way. But if in this area there are live muscle fibers, then early postinfarction stenocardia will develop.

Treatment of Postinfarkny stenocardia:

Treat this stenocardia as unstable (as the mechanism of their development similar): at once limit a physical activity, the positive effect from treatment will not be gained yet. Enter intravenously anti-anginal means: AB (to lower ChSS to 60 beats/min), nitrates (raise doses of anticoagulants), sometimes BMKK (for prevention of a spasm of coronary arteries). Appoint 1% Solution Nitroglycerini (with a speed of 10 — 15 thaws a minute; there is usually enough 3 — 5 intravenous infusions), it is oral — AB (propranolol of 20-40 mg 2 times a day), IAPF. If the patient initially received these HP, then they are applied in high doses. Such patients should carry out coronary angiography. If the heavy stenosis is found, then it is shown to PChKA or TLT. If the stenosis of high degree is revealed, then carry out AKSh. At impossibility of immediate implementation of PChKA or AKSh and existence of signs of hemodynamic instability, heavy dysfunction of LZh apply VABK.