Transmural infarction is a common and extremely dangerous disease, which is accompanied by necrosis of the heart muscle. It is worth noting that mortality in case of development like pathology is very high, especially if signs of heart damage were not noticed on time, and the patient did not receive the necessary medical care. That is why it is important to know how this form of heart attack manifests itself and what kind of help a sick person needs.
Transmural myocardial infarction: what is it?
To begin with, it’s worth understanding the meaning of the term. Surely many people know that heart attacks are accompanied by the death of parts of the heart muscle. This happens due to a sharp cessation of blood flow to the heart, as a result of which the tissues do not receive oxygen and nutrients necessary for life.
As you know, the heart wall consists of three layers - this is the epicardium (outer layer), the mural muscle layer and the endocardium (inner part of the muscle). With the intramural form of the disease, necrosis affects only one layer. Acute transmural infarction is a pathology in which necrotic processes are observed in all layers of the heart. It is worth saying that this is the most dangerous form of such an ailment.
In modern medicine, pathology is classified based on the localization of foci of necrosis. The most common transmural infarction of the anterior myocardial wall, namely the left ventricle. Only in one out of five cases does necrosis affect the wall of the right ventricle. In about a third of patients, the walls of the atria are also involved.
Causes of the disease
In almost every case, transmural infarction is the result of coronary heart disease. As already mentioned, with insufficient oxygen and nutrients, muscle cells begin to die - this is how necrosis develops. According to statistics, in 90% of cases, the cause is atherosclerosis of the coronary vessels, which provide blood flow to the myocardium.
The so-called atherosclerotic plaque forms on the vessel wall. Under the influence of certain factors, part of the plaque breaks away from the wall and blocks the lumen of the coronary artery. Acute transmural infarction, as a rule, progresses rapidly in situations where myocardial oxygen demand rises sharply - this can happen, for example, with strong physical exertion, fever, severe emotional stress.
Acute transmural myocardial infarction: risk factors
As you can see, necrotic lesions of the heart are not an independent pathology. In most cases, they develop against the background of existing ischemia and atherosclerosis. Therefore, several risk factors can be distinguished:
- The genetic predisposition of the patient, which is associated with certain anatomical features and hereditary diseases.
- There is also a factor of age. Transmural infarction is more often diagnosed in people over 45 years old, and men are more prone to this pathology.
- An increase in blood cholesterol (it is precisely because of this that plaques form on the walls of blood vessels, which subsequently block the blood flow).
- Improper nutrition (eating fatty and fried foods increases the likelihood of developing atherosclerosis).
- Obesity (it is in most cases associated with malnutrition, and an increase in body weight increases stress on the heart).
- Hypodynamia (a sedentary lifestyle leads to a gradual weakening of the heart muscle, after which the myocardium is very difficult to cope with any physical exertion).
- Constant stresses, nervous exhaustion, emotional stress leads to a change in the hormonal background, which affects the work of the cardiovascular system.
- Smoking (according to statistics, in 35% of cases of cardiac muscle necrosis are associated with this bad habit).
The main symptoms: how to determine a heart attack?
The signs of necrosis can be different - it all depends on the degree of damage, the age of the person, the presence of concomitant diseases, etc. Cases of asymptomatic heart attack are known. Nevertheless, some of the main symptoms can be distinguished:
- In most cases, a person complains of sharp compressive pain behind the sternum - it clearly gives to the left shoulder blade, arm, lower jaw, ear and even teeth.
- The pain is undulating and prolonged - attacks can be repeated for several hours or even days.
- Tachycardia develops, and the patient, as a rule, clearly feels frequent and even painful heart contractions.
- There is also a feeling of short-term fading of the heart.
- There are external signs of a heart attack - the skin and mucous membranes of a person sharply turn pale.
- Against the background of necrosis, cardiac asthma often develops - the patient notes severe shortness of breath, sharp attacks of suffocation.
Diagnostic measures
When the first violations appear, it is worth immediately delivering the sick person to the hospital ward, where appropriate diagnosis and treatment will be carried out. The main diagnostic method for myocardial necrosis is electrocardiography, because with this procedure, you can fix the electrical potentials in different parts of the heart.
Properly performed and decrypted electrocardiogram allows the doctor to determine the localization of necrosis (for example, lower transmural infarction), the degree of spread of the pathological process and the depth of the lesion, the duration of the disease.
In addition, a blood test is needed. With a heart attack, an increase in the erythrocyte sedimentation rate, an increase in the number of leukocytes, the appearance in the blood of specific enzymes and compounds that are normally found inside myocardial cells are observed.
First Aid Rules
Acute transmural infarction of the anterior myocardial wall is a pathology that develops very quickly. Symptoms of it can appear at almost any moment, so you should familiarize yourself with the rules for helping the patient. Naturally, first of all, you need to call an ambulance crew.
Waiting for doctors, a person needs to lie down. The exception is the situation in which there is severe shortness of breath and distinct wheezing when breathing - in this case, it is better to sit the patient by placing a pillow or roller under his back. It is recommended to take an aspirin tablet. You also need to give the person nitroglycerin - first one tablet, and if the pain does not go away, then after five minutes one more (but no more than three).
Heart attack treatment regimen
Depending on the results obtained during the diagnosis, the doctor prescribes treatment. Initial therapy, as a rule, consists of three main parts:
- Acceptance of painkillers in order to alleviate the patient's condition. Quite often, pain can be stopped only with the help of strong drugs, including Promedol and Morphine. The onset of symptoms and the diagnosis of "myocardial infarction" are stressful for a person, and excitement and fear only increase the load on the heart - the patient is prescribed sedatives.
- The treatment regimen includes taking nitrates and beta-blockers, which helps to eliminate arrhythmia and restore heart rate.
- With transmural infarction, there is a high probability of blood clots, which is fraught with necrosis of other organs and the spread of the process to neighboring areas of the myocardium, damage to the nervous system and even death. Therefore, the fight against thrombosis should begin in the first hours after the onset of symptoms. For this purpose, thinning preparations that contain heparin and fibrinolysin are used. Naturally, when taking such medications there is a possibility of massive hemorrhage, because the blood stops clotting, so it is important to carefully monitor the patient's condition.
Treatment is necessarily carried out in stationary conditions - the patient must be under the supervision of a doctor around the clock.
The consequences and complications of the disease
Transmural infarction is the most complex and dangerous form of myocardial necrosis, especially when it comes to large focal necrosis. The disease is fraught with consequences - the development of pulmonary edema, paralysis of the extremities, and speech disorders. Sometimes a heart attack entails further pathologies of the vascular system, in particular a stroke.
The consequences of this pathology also include thromboembolism, ventricular fibrillation, the cessation of various organs and even their systems. Such cases often end in death, even if the patient was provided with medical care. Another deadly complication is rupture of the heart. With a strong contraction of the myocardium and an increase in pressure inside the ventricles and atria, there is a risk of impaired muscle integrity in the area of necrosis.
Rehabilitation and forecasts
Unfortunately, the prognosis for such a disease is not very favorable - in about 50% of cases, patients (especially when it comes to older people) die. If, nevertheless, it was possible to restore normal blood circulation, there is still a risk of complications in the future, since myocardial tissue changes have occurred.
That is why the rehabilitation period is so important. Patients are advised to eat simple, light and high-calorie foods. It is also important to gradually return motor activity, since inactivity is fraught with muscle atrophy and congestion in the lungs. Of course, all activities related to physical activity should be strictly controlled by a specialist.
Supportive therapy and constant monitoring by a doctor are necessary until the end of life. Of course, patients need to monitor nutrition, avoid stress and intense physical exertion, prevent a significant increase in blood pressure and stop smoking.