Among people with vascular and heart diseases, heart attack is considered one of the main causes of increased mortality. The non-standard onset of the disease, that is, when the individual feels severe pain in the abdomen, is the abdominal form of myocardial infarction. The classic picture is acute pain in the chest, which occurs suddenly and radiates to the scapular region on the right, neck and shoulder joint. A person has difficulty breathing and a feeling of fear.
general information
Individuals suffering from chronic gastrointestinal ailments, pain in the abdomen, upset stool, nausea do not cause concern, as they consider these phenomena to be quite natural given the existing pathology. However, such signs may indicate an abdominal form of myocardial infarction. Most often, the gastralgic type occurs with a diaphragmatic heart attack. Male subjects are more prone to it. The danger is that the symptomatology is similar to intoxication, i.e., with a clinic unusual for a heart attack. Unlike other forms, the abdominal one goes through only two stages - the most acute (lasting no more than two hours), it is characterized by pronounced necrosis of the heart muscle, and acute (in time it lasts no more than twelve hours), when the intensity of the symptoms decreases.
The main syndrome of the abdominal form of acute myocardial infarction is severe pain in:
- epigastric region;
- right hypochondrium;
- right half of the abdomen.
By nature, it is burning, acute and does not leave after taking "Nitroglycerin".
Uncharacteristic development of myocardial infarction
An increase in the number of atypically occurring variants of the disease is associated with a change in the age structure of patients. On the one hand, a heart attack often affects young citizens, and on the other, it is more often observed in older people. Moreover, it is often repeated and develops against the background of various concomitant pathologies. The last factor affects the course and clinic of the disease. All variants of a heart attack that have an uncharacteristic onset are conditionally divided into painless and painful. Atypical abdominal myocardial infarction refers specifically to pain. This phenomenon causes some difficulties in diagnosis, since the localization of the pain syndrome is atypical. In general, the individual feels pain in the epigastric, iliac, umbilical (umbilical) region, as well as in the region of the hypochondria. Therefore, a person is sure that the pain is caused by problems with the gastrointestinal tract. There are many cases when a heart attack of this form provoked an exacerbation of acute pancreatitis, cholecystitis, appendicitis and other diseases. For timely and reliable diagnosis of the gastralgic form of a heart attack, it is imperative to take into account that the predominant localization of pain in such patients is the abdominal region. The abdominal form of myocardial infarction, as well as other options with an atypical onset, is most often the lot of elderly citizens with signs of atherosclerosis and a hereditary predisposition.
Causes
The gastralgic form occurs in the case of pathological narrowing of the vessels as a result of their defeat with a mixture of fats, i.e., atherosclerotic plaques. The peculiar clinical picture is due to the close location of the necrotic site to the diaphragm. In addition to atherosclerosis, the causes of a heart attack are:
- alcohol abuse;
- smoking;
- obesity;
- angina pectoris;
- pericarditis;
- diabetes;
- heredity.
Circulatory failure in coronary heart disease contributes to the formation of necrosis in the heart muscle. In the acute course of this process, a condition called a heart attack occurs. Most often, the anterior wall of the left ventricle is affected. But the abdominal form of myocardial infarction is characterized by necrosis in the back wall of the muscle of the main organ of a person, which is pretty close to the diaphragm. The exclusivity of this pathology is that the patient is disturbed by pain in an atypical place - in the epigastric (epigastric) region and under the ribs on the left side. Unfortunately, a blurry or unclear clinical picture is the cause of the error in the initial diagnosis.
Diagnostic measures
For the purpose of differential diagnosis, a troponin test is performed at the prehospital stage. It shows the presence in the blood of the decay elements of myocardiocytes. At later stages of a heart attack, a C-reactive protein, moderate leukocytosis, is detected. And indicators of liver cell activity undergo changes both in pancreatitis and hepatitis, and in the abdominal form of myocardial infarction. Therefore, such a variety almost always causes difficulties in conducting differential diagnostics.
The main clinical feature is pain in the abdomen, or rather, in the epigastric region or the left hypochondrium. Often there is a false diagnosis of pancreatitis. Abdominal pain is characteristic of the posterior localization of a heart attack. Moreover, the diaphragmatic muscles are partially involved in the process.
Differential diagnosis of abdominal myocardial infarction
Due to atypical signs, it is carried out with such pathologies as:
- appendicitis;
- perforated ulcer;
- cholecystitis;
- toxic food infection;
- intestinal obstruction;
- pancreatitis
After collecting the anamnesis of the whole family, complaints of the individual and his examination, a preliminary diagnosis is made, and the exact diagnosis is made only after laboratory and instrumental types of examinations. In differential diagnosis, the result of the ECG taken in the first minutes of the onset of pain and the questioning of the individual are important.
Signs
Symptoms of the abdominal form of myocardial infarction appear in the first hours of the disease. Pain (pain), which appears unexpectedly against the background of emotional or physical strain, is considered the main symptom. Often a person is not able to describe the nature of the pain syndrome, since there is no clear localization of it, and the intensity decreases after taking Drotaverin or Nitroglycerin. A change in the position of the body does not have any effect on it.
Cold sweat, low pressure, pallor of the dermis are all companions of gastralgic pain. In addition, the individual has the following clinic:
- bloating;
- nausea and vomiting;
- the dermis is wet and cold;
- upset stool;
- heart rate goes astray;
- cardiac tones are deaf, systolic murmur and additional tones appear;
- cardiac asthma;
During an attack, the patient has a fear of death.
Symptoms of the abdominal form of myocardial infarction most often appear after eating. This phenomenon is associated with poor blood supply to the muscles of the heart during the operation of the gastrointestinal tract. When examining the abdomen, there is no tension. Temperature in the acute period is also not observed. After a few hours, the pain syndrome moves to the sternum.
Abdominal myocardial infarction: first aid
Individuals with a severe gastralgic clinic, which is atypical for a picture of an “acute abdomen”, are hospitalized in the cardiology department to determine the final diagnosis. Until the doctors arrive:
- The patient is given a horizontal position.
- It is advisable to provide fresh air.
- If possible, measure the pressure. With high numbers, it is allowed to give the medicine that the patient took earlier.
To exclude erroneous hospitalization in an infectious or surgical healthcare institution, the patient is given an ECG before hospitalization. In the gastralgic form, the results obtained after registration of cardiac activity are correlated with a lower (posterior) heart attack.
After diagnosis (in the absence of restrictions and contraindications) thrombolysis is allowed at the prehospital stage. In addition, “Heparin”, antiplatelet agents, are necessarily introduced. With cardiogenic shock, infusion of infusion solutions is indicated.
After an analgesia of an individual in a lying position, they are taken to a multidisciplinary healthcare institution of a stationary type. Where do additional laboratory and hardware types of examinations. The choice of treatment method - angioplasty, bypass surgery, stenting of the coronary vessels - determines the attending doctor.
Location and nature of pain
With the abdominal form of myocardial infarction, the pain is localized in the upper abdomen. However, patients feel it both in the region of the heart and behind the sternum. With a repeated heart attack, the nature of the pain and its irradiation change. Therefore, the factors that became its cause must be differentiated.
Basically, pain occurs after emotional or physical stress and may coincide with a meal in time. It grows gradually, the strongest becomes thirty to sixty minutes after the onset of the attack. Often, the individual is panicked, and he feels the fear of death. Reception of "Nitroglycerin" facilitates it for some period. The pain is accompanied by nausea, vomiting is quite rare.
Therapy
Treatment of the abdominal form of myocardial infarction is carried out in a round-the-clock hospital for 25-35 days. This is necessary for continuous monitoring of the state of the individual. The patient is required to observe bed rest and exclude any situations that can provoke overstrain. Pharmacotherapy is aimed at eliminating symptoms and preventing the development of complications. Doctors recommend taking medications that belong to the following pharmacological groups:
- ACE inhibitors;
- calcium blockers;
- nitrates;
- sedatives;
- analgesics;
- thrombolytics;
- beta blockers;
- disaggregants;
- anticoagulants.
In the abdominal form, symptoms similar to a malfunction in the digestive tract are observed, therefore, the patient is shown medications to prevent bile secretion, reduce acidity, and increase intestinal efficiency.
In the presence of complications and concomitant ailments, the appointment of other drugs is allowed.
During inpatient treatment, the individual must perform special exercises to restore his previous physical condition. The course of physiotherapy exercises is designed for the entire recovery period, that is, from six to twelve months.
In addition, dietary nutrition is necessary, since the abnormal process is accompanied by dyspeptic manifestations.
Surgical intervention
The operation is necessary when the patient is in serious condition. Most often this happens with untimely diagnosis. The following surgical methods are used:
- Coronary artery bypass grafting - allows you to restore blood flow bypassing the dead area.
- Coronary angioplasty - a metal tube is inserted into the narrowest point of the vessel, due to this the blood flow is normalized.
Preventive actions
To exclude a repeated heart attack, doctors advise:
- lead a mobile lifestyle;
- give up cigarettes and alcohol;
- visit a cardiologist annually;
- control pressure and cholesterol concentration;
- undergo the necessary examinations, including angiography of the blood vessels of the heart, ECG and others;
- adjust the diet - exclude fried and fatty foods, enrich it with cereals and legumes, fish, nuts, vegetables, lean meats;
- adhere to the daily routine;
- sign up for a pool or cardio workout;
- take medications prescribed by the doctor - angioprotectors, beta-blockers, anticoagulants, calcium antagonists, soothing;
- treat concomitant ailments.
Failure to comply with the above recommendations is fraught with relapse.
Complications
The abdominal form of myocardial infarction, the clinic of which is described in the article, with an erroneous diagnosis and treatment is complicated by the following pathological conditions:
- rupture of heart tissue;
- acute heart failure;
- pericarditis;
- post-infarction syndrome;
- thrombosis
- arrhythmias;
- neurotrophic disorders;
- aneurysms.
Sudden coronary death overtakes an individual with failure to provide timely assistance. In addition, you should definitely undergo a rehabilitation course.
Forecast
It is complicated by the fact that at the diagnostic stage this pathology is not immediately recognized, which is dangerous with serious consequences. Under stationary conditions, the lethal outcome is very low and amounts to about twenty percent. Approximately eight percent die within a year of a heart attack.