Myocardial infarction (according to ICD-10 I21) is a complex lesion of the heart with subsequent necrotization of a certain area. When an attack occurs, the patient often dies.
If there are acute pains behind the sternum, which give into the arm, as well as the lower jaw, you need to immediately call an ambulance. It is worth noting that if the pain arose due to a heart attack, then it cannot be stopped with nitroglycerin. In this case, the patient must be placed in a hospital where he will receive emergency medical care.
What is a heart attack?
Myocardial infarction (ICD-10 I21) is a dangerous pathology of the heart muscle, which is accompanied by necrosis. The mortification of the affected muscle tissue occurs as a result of a change in the arteries, which provokes the arrest of blood microcirculation in the vessels.
Violation of the circulatory process for more than 15 minutes threatens with irreversible consequences and impaired functioning of the heart muscle. As a result, dead muscle cells are replaced by connective tissue, which manifests itself in the subsequent formation of scar tissue.
It manifests itself in the form of burning chest pains of an intense nature. In addition, it is observed:
- cold sweat;
- labored breathing;
- feeling of fear.
If this symptom occurs, you should immediately call an ambulance. The disease is diagnosed by conducting electrocardiography and echocardiography.
Main classification
There are several types of myocardial infarction, given the various factors and characteristics of the disease. Often there is a typical form of the disease, which is divided into the following types:
- subendocardial;
- subepicardial;
- intramural;
- transmural.
Types of myocardial infarction also differ in the area of the lesion. That is why it is very important to conduct timely diagnosis in order to determine the location. Among the varieties of this disease, atypical forms are also found, in particular, the following can be attributed to them:
- abdominal;
- cerebral;
- osmotic;
- asymptomatic.
Focusing on the multiplicity, doctors distinguish primary, repeated and recurrent types of myocardial infarction.
What are the types
The area of necrosis is determined by the ratio with the depth of the lesion. This parameter largely depends on the location of the necrotic area. According to the classification according to the area of the lesion, small focal subendocardial myocardial infarction is distinguished, which is characterized by small sizes of damage. It is localized in the lower part of the heart muscle. The necrotic area is small only at the very beginning of the onset of an attack, however, it is diagnosed only after the elimination of especially dangerous attacks. When conducting an ECG, violations are practically not manifested.
A small-focal instrumental type of disease is characterized by the fact that necrotic lesion is found in the inner region of the myocardium. This kind of heart attack is considered one of the most dangerous. If treatment is not done in a timely manner, then the doctor can correct the violation. This species gives a minimum of complications and has a good prognosis for recovery.
Large focal transmural myocardial infarction is considered one of the most dangerous species, as it provokes the greatest number of deaths. The affected area is a significant area of the heart muscle. With transmural myocardial infarction on the ECG, a course of changes is noted, which indicates the course of the most severe form of the disease.
The large-focal non-transmural type is characterized by the fact that there is a risk of the formation of dangerous complications, despite the fact that the clinical picture is not so acute. Sometimes a patient may die. The myocardium is not completely affected.
Stages of the disease
The classification of myocardial infarction is determined by the external and internal manifestations of a similar pathology. When a large focal lesion occurs, such phases of the disease are distinguished as:
- pre-infarction;
- sharpest;
- spicy;
- subacute;
- post-infarction.
With timely access to a doctor, a pre-infarction form of the disease is diagnosed. Patients in this case complain of acute bouts of angina pectoris, which worsen over time. The acute form in some cases is called ischemic. It lasts from 30 minutes to 2 hours. As a result of this, intense pain occurs, which begin very sharply.
The acute form is characterized by the fact that tissue necrosis of the heart muscle occurs. It lasts for 2 days. During this time, the lesion site becomes outlined, which is why it is very easy to detect it during the diagnosis. In relapses, an increase in the affected area occurs for 10 days or more. During this stage, the temperature rises and fever develops.
In the subacute stage, the necrotic area is replaced by connective tissue. An aggravation of the pathology may also occur, problems with the respiratory system are observed, and stagnant manifestations are also possible.
At the post-infarction stage, a scarring process occurs. The end of this period ends 6 months after the attack.
What are the types of disease
There are several different types of myocardial infarction, which depend on the particular course of the disorder. The first type of disease is associated with ischemia. Spontaneous myocardial infarction is caused by a primary coronary event, in particular, such as rupture, erosion, stratification of an atherosclerotic plaque.
The secondary form of the disease is also associated with the course of ischemia. Type 2 myocardial infarction is caused by an increased oxygen demand of the affected myocardium. It can also manifest as a decrease in blood circulation, anemia, embolism, heart rhythm disturbance, arterial hypertension or hypotension.
Sudden cardiac death includes complete cardiac arrest, preceded by signs that suggest the presence of myocardial ischemia. It is accompanied mainly by manifestations of the blockade of the left bundle branch block. In addition, type 3 myocardial infarction may have signs of coronary artery thrombosis. This can be seen during coronary angiography. Sudden cardiac death develops even before blood samples have been taken or before the formation of biomarkers of myocardial necrosis in the blood.
It is worth noting that the 4th type of disease is divided into 2 stages. Type 4 myocardial infarction may be associated with invasive percutaneous surgery or stent thrombosis.
Type 5 disease is associated with coronary artery bypass grafting.
Localization of lesion centers
By the location of the affected area of the heart, such types of diseases are distinguished as:
- heart ventricular infarction;
- interventricular septum;
- insulated type;
- right ventricle.
The location of the arterial obstruction may be at the junction of the heart departments, in particular, the upper lateral, posterolateral, inferolateral types of heart attack are distinguished.
Complicated and uncomplicated forms
A heart attack with a slight necrotic lesion may well occur on its own, without signs of concomitant diseases. With an uncomplicated form of pathology, as well as with proper treatment, the affected areas of the heart muscle are scarred and can, after some time, fully restore performance. In the case of an extensive heart attack, various concomitant diseases occur, among which the following should be highlighted:
- arrhythmia;
- cardiogenic shock;
- embolism;
- rupture of the walls of the heart;
- pulmonary edema;
- vascular aneurysms.
After complications arise, the predictions of survival and recovery of required functions are almost always negative.
Typical and atypical forms
According to the existing classification of myocardial infarction, doctors distinguish a typical and atypical form of the disease. Classical (that is, a typical heart attack) has several stages, each of which is accompanied by characteristic signs. An atypical form of pathology can be:
- abdominal;
- asthmatic
- cerebral;
- asymptomatic.
The abdominal course is characterized by intense pain in the right hypochondrium, as well as in the abdominal cavity. However, signs of the disease may appear, such as:
- nausea;
- bloating;
- prolonged diarrhea.
During the study, other diseases that have similar symptoms should be excluded. To do this, you need to conduct a comprehensive diagnosis of the cardiovascular system. The asthmatic form of a heart attack proceeds with the following symptoms:
- severe choking;
- excruciating cough;
- palpitations
- a sharp drop in pressure;
- arrhythmia.
A similar form is observed with repeated attacks. During the diagnosis, you need to constantly monitor the state of the heart muscle using an electrocardiogram. The cerebral form of the disease is characterized by the absence of pain in the sternum, however, there are signs of brain damage.
Types of heart attack with signs of other diseases
If patients have diabetes, often an asymptomatic heart attack occurs. The only sign of the disease is increased fatigue and shortness of breath after intense physical exertion, which previously had no effect on well-being.
Another sign of an atypical type of heart attack is angina pectoris. Exacerbation of pain is observed only during walking. Often, patients are not even aware of the presence of the disease. The diagnosis can only be made with an ECG.
The difference between the disease in women and men
Until recently, a heart attack was more common in men, however, over the past few years, attacks have become more frequent in women. In case of symptoms such as a feeling of weakness, swelling, insomnia, feelings of anxiety and shortness of breath, you should immediately consult a doctor for diagnosis.
With a heart attack, women experience pain in the left shoulder, neck and affect the jaw. The adaptation period in this case is much easier, and patients often return to a normal rhythm of life.
In men, signs of a heart attack do not appear for a long time. From the very beginning of the onset of an attack, malaise, dizziness, nausea are observed. Painful sensations affect the upper back, limbs, and jaw. Sometimes there are breathing problems, burning in the throat, hiccups, pallor of the skin.
Causes of occurrence
The main reasons that provoke the development of a heart attack include the following:
- diabetes;
- hypertension;
- smoking;
- excess weight;
- alcohol abuse;
- frequent stress and emotional stress.
In addition, the disease can occur in people who overexert the body with training and physical activity.
The main symptoms
Each of the stages of a heart attack has its own specific signs. Among the first signs, you can distinguish pressure in the region of the heart, a feeling of contraction, as well as painful sensations that extend to the shoulders and back. These symptoms are similar to the course of angina pectoris, however, unlike this disease, it does not arise as a result of physical activity, but even at rest.
The pain is accompanied by attacks of arrhythmia and increased pressure. In some cases, the temperature rises to 40 degrees, there is an increase in heart rate, which is accompanied by bouts of vomiting and weakness.
Treatment
Treatment of a heart attack is carried out in a hospital, since such a disease poses a serious threat to the life of the victim. The doctor prescribes all medicines strictly individually. After discharge from the hospital, the doctor prescribes a long rehabilitation period. All patients must undergo rehabilitation sanatorium treatment, as well as regularly observed by a cardiologist.
The goal of treating a heart attack is to reduce pain, as well as eliminate the causes of the attack.