Myocardial infarction (MI) is a very serious disease associated with damage to the heart muscle as a result of blockage of blood vessels by blood clots. The place where the death of the tissue occurred is covered with a scar. A new attack, which occurred within two months after the first, is called recurrent heart attack. If the disease occurs after a two-month period after the first attack and the completion of scarring, the heart attack is considered repeated. In terms of recurrent and repeated myocardial infarction never coincide, the first is always earlier than the second. Very often, repeated MI begins during the first year. At risk are men and the elderly. The attack is more complicated than in the first case, but the pain is weak, and may be absent. The disease is difficult to diagnose, therefore, the mortality rate is higher than with primary MI.
Features of Re-MI
Repeated myocardial infarction, as mentioned earlier, occurs after the lesion is finally healed after the first attack. A number of factors influence its clinical picture:
- duration between the first and second attacks;
- the size of the new myocardial lesion;
- initial state of the heart muscle.
The course of the recurring disease is heavier than the primary. An acute, and then a chronic form of heart failure develops. An atypical course of the disease often occurs: an asthmatic variant of a heart attack occurs, or it manifests itself in various forms of arrhythmia. Diagnosis of repeated MI using electrocardiographic examination is very difficult.
Sometimes a false normalization of the ECG is observed. A positive T wave may appear on it instead of a negative one, or the S – T interval will extend into an isoelectric line. To identify the localization of focal changes, several ECG sessions are performed, and then a comparative analysis of the results is made using the data of the previous disease. If, based on ECG comparison, repeated myocardial infarction is doubtful, then the exact conclusion about the presence of new foci of damage to the heart muscle is confirmed by a thorough analysis of the clinic of the disease, comparing blood tests, the patient’s condition, body temperature, and symptoms.
Reasons for Re-MI
With an individual tendency to form blood clots in the vessels, a new attack of the disease can occur in the following cases:
- Stop taking medications. The medications prescribed by the doctor after the first attack of the disease are aimed at relieving pain in the heart, and most importantly, at preventing the formation of new blood clots and changes in blood vessels. The patient, feeling better, willfully stops taking them or reduces their dosage, which is absolutely impossible to do.
- Failure to diet. Proper nutrition contributes not only to recovery after suffering, but also prevents the occurrence of repeated myocardial infarction. The use of fatty, salty, spicy, fried foods leads to the formation of blood clots and clogging of blood vessels. It should be remembered that a diet is necessary for life.
- Bad habits. A person who has had a heart attack and continues to smoke and drink alcohol is more likely to learn a second MI.
- Physical activity. Large loads make a sick heart work in an intense mode, therefore it is not recommended to engage in sports disciplines that require great effort. Moderate physical activity has a beneficial effect on the recovery processes of the heart muscle. It is recommended to perform therapeutic exercises, take long walks, perform aerobic exercises to prevent recurrent myocardial infarction.
- Emotional condition. Frequent stressful situations, endless worries and worries for any reason also contribute to a second attack. During stresses, myocardial oxygen demand increases due to an increase in heart rate, and because of circulatory disorders in the coronary vessels, this is not desirable, therefore unnecessary mental injuries must be avoided.
- Change of climatic conditions. After the disease, it is not advisable to dramatically change the climate so as not to provoke adverse physiological reactions of the body.
All causes of recurrent myocardial infarction are associated with the patient’s lifestyle and the recommendations of the attending doctor, so the disease can be prevented and avoided.
Symptoms of Re-MI
The patient needs to be very attentive to his health in order to notice the signs of MI in time. They do not at all coincide with those in the first case. The patient appears:
- acute short-term chest pain radiating to the neck and lumbar;
- nausea and vomiting;
- sticky dermis;
- dizziness and vomiting:
- drowsiness and weakness;
- general malaise;
- dry angry cough;
- heaviness in the chest;
- various forms of arrhythmia.
For any of the above symptoms of recurrent myocardial infarction and abnormalities in the state of health that are different from the usual ones, and not even related to the work of the heart, an individual who already had a heart attack should consult a doctor and undergo an examination in order not to miss the re-illness.
Diagnostics
For the diagnosis of re-MI use:
- ECG diagnostics - often difficulties arise due to the preserved changes after a previous illness.
- Laboratory studies - determination of the concentration of troponins in the blood. Evaluation of the measurement results of this indicator makes it possible in acute repeated myocardial infarction to differentiate severe pain in the chest.
- Echocardiography - with its help, new foci of myocardial damage are detected and the function of muscle contraction is evaluated.
- Coronaroangiography - allows you to conduct a study on the patency of the vessels that feed the heart.
Re-MI Treatment
The main objective of the treatment process is to restore blood flow in a damaged vessel. A patient with repeated myocardial infarction (ICD-10 code I 22) must be hospitalized and undergo the following treatment:
- Medication. It is prescribed from the first day of the disease and includes the following groups of drugs: nitrates, statins, ACE inhibitors, anticoagulants, antiplatelet agents, beta-blockers.
- Thrombolysis - the introduction of drugs to dissolve a blood clot.
- Balloon angioplasty - blood flow in a damaged vessel is restored. To do this, a catheter with a balloon is inserted into the vessel, swelling it widens the lumen, and blood begins to flow into the damaged area.
- Coronary artery bypass grafting - surgical intervention is applied, a bypass vessel is applied, thereby disturbing blood flow is restored.
After discharge from a health care facility, treatment continues at home.
Repeated myocardial infarction
This is an acute abnormal condition, accompanied by necrosis of cells located along the lower wall of the myocardium. It arises due to a lack of oxygen due to clogging of the right coronary artery with a thrombus. Lack of restoration of blood flow within half an hour is fatal. The disease most often affects people from forty to sixty years old. Just after the age of forty, an increase in the formation of atherosclerotic plaques is observed. The following factors contribute to this:
- coronary artery disease;
- heart attack;
- bad habits: smoking and alcohol;
- obesity;
- hypertension;
- low physical activity.
Of particular importance in the development of this disease is a genetic predisposition. The severity of symptoms of repeated lower myocardial infarction depends on the lesion of the number of layers of the lower myocardial wall. Often, the disease manifests itself acutely and is accompanied by the following symptoms:
- severe chest pain extending to the arm;
- dyspnea;
- the occurrence of an attack at night or early in the morning;
- increased sweating;
- the emergence of a sense of fear;
- gastric or bronchial variant of the course of heart attack is possible.
The development of the disease and prognosis depend on the time of medical care provided, the physical condition of the patient and the time elapsed from the first attack of myocardial infarction.
The consequences of a heart attack
After a secondary MI, various complications often arise. Most often, the consequences of repeated myocardial infarction can be:
- Heart rhythm disturbance - occurs in almost all patients.
- Heart failure - appears a few months after the illness and is associated with impaired pumping function of the heart. As a result of this pathology, stagnant blood phenomena are formed in various organs and tissues, followed by hypoxia. The following symptoms are inherent in the disease: cough, shortness of breath, dizziness, and general weakness.
- Aneurysm of the heart - a section of the heart muscle is thinning, contractility is lost. The patient's heart rhythm is disturbed, shortness of breath appears, the heartbeat becomes more frequent, attacks of cardiac asthma occur.
- Cardiogenic shock - the contractility of the heart muscle is sharply reduced. The blood supply to vital organs is disturbed. As a result, pressure drops sharply, limbs become cold, oliguria occurs, palpitations, weakness, pulmonary edema and fainting are possible.
- Thromboembolic complications - cause abnormal processes in the body in the form of circulatory disorders, the occurrence of inflammatory processes.
- Heart rupture - is rare and leads to instant death of a person.
To prevent the occurrence of repeated MI, it is necessary to lead a correct lifestyle, eat well, take medications prescribed by your doctor.
Recovery after secondary MI. Cardiologist's advice
The recovery process after repeated myocardial infarction begins in a hospital under the supervision of doctors and continues after discharge of the patient. During this period, the individual's task is to gradually resume physical abilities and reduce the risk of complications. To do this, you need:
- Exercise stress. In the first days after returning home, the patient is recommended to rest more and use walking stairs or short walks as physical activity. Every day you should gradually increase physical activity over several weeks and strictly monitor the state of health. The advice of a cardiologist will help you create a cardiac rehabilitation program. It may include various exercises, but aerobic exercise is preferred, which strengthens the heart, improves blood circulation and lowers blood pressure. The patient is allowed to ride a bicycle, walk and swim quickly.
- Lifelong need. Cardiologists are advised to constantly take two groups of drugs for people who have suffered a heart attack: antiplatelet agents that affect blood coagulation and inhibit the formation of blood clots and statins, which lower cholesterol. This is especially necessary for patients who have a stent. Some patients, for their own reasons, stop taking these important medicines, and then a repeated myocardial infarction occurs after stenting, which ends in death.
- Diet. Changing your diet helps reduce the risk of complications and subsequent heart attacks. Every day it is advisable to eat dishes of vegetables and fruits. They contain minerals and vitamins. To reduce blood cholesterol, you need to cook dishes from herring, mackerel, sardines, salmon, eat seeds, nuts, olive oil and overseas avocado fruit. In addition, cardiologists recommend consuming table salt in minimal quantities. This will help reduce the likelihood of many ailments.
Doctors have learned to treat myocardial infarction, and for patients it often proceeds unnoticed. It is important to remember that the formation of plaques in blood vessels and blood clots on them does not stop after the patient is restored. For those who have suffered a primary and, especially, repeated MI, the risk of developing a subsequent attack is very high.
First aid for repeated MI
If a person has pain in the chest, perspiration, heart rhythm disturbance, general malaise, he should be given a Nitroglycerin tablet and immediately call an ambulance.
We must remember that the sooner qualified medical care is provided for repeated myocardial infarction (ICD-10 code I 22), the greater the chance of successful treatment. The patient must be hospitalized, they make him a cardiogram. Well, if there is an opportunity to compare the results with the previous study. According to existing methods, cardiologists can immediately restore blood flow through the affected artery, reducing myocardial damage. To do this, use special medications that contribute to the dissolution of blood clots, or conduct angiography followed by stenting of the damaged vessel. Both methods give a positive effect only in the first hours after the onset of an attack. This once again suggests that the patient needs to be urgently taken to a medical facility, and not to wait until the end of the attack.
Prevention of Re-MI
The following measures are recommended for the prevention of recurrent and repeated myocardial infarction:
- Healthy eating As a result of malnutrition, atherosclerosis often develops with the formation of blood clots in blood vessels, which can enter the heart cavity with a blood stream. Therefore, it is necessary to remove foods rich in cholesterol from the diet, and eat more plant foods.
- Drug treatment. Therapy carried out in a medical institution does not end when a patient is discharged. He must constantly take without fail all the medications prescribed by the doctor. Otherwise, a third heart attack is possible.
- Physical activity. To prevent recurrent myocardial infarction, you should abandon the exhausting exercises, and go to physical therapy classes and take long walks in the fresh air.
- Monitor body weight, prevent obesity.
- Refuse bad habits - smoking and alcohol.
- Constantly monitor blood pressure.
- Eliminate stressful situations.
The quality of life will become much higher if you carefully consider your health and follow the doctor's recommendations.
Conclusion
Recurrent and repeated myocardial infarction dramatically reduces the contractile activity of the heart muscle, which contributes to the rapid progression of heart failure. People suffering from coronary heart disease, which causes a heart attack, should take care of their health and carefully follow all the doctor’s prescriptions. Only in this way can serious consequences be avoided.