A serious complication of coronary heart disease is myocardial infarction. The formation of an intracoronary thrombus in patients with this diagnosis occurs quite often. If earlier, older people fell into the risk zone, then at the present time a heart attack is diagnosed in people 30-40 years old. The reason may be a lifestyle and an irresponsible attitude to their health. The pain with a heart attack can be different, so it is important to recognize the danger and quickly help.
Causes of myocardial infarction
Many reasons can provoke such a pathology, but experts most often distinguish the following:
- Atherosclerosis. Atherosclerotic plaques on the walls of blood vessels provoke the development of ischemia. Against this background, the lumen of the vessels narrows to critical values, and the myocardium suffers from a lack of oxygen and nutrition.
- Thrombosis. The blood supply to the heart muscle is disturbed if there is a blockage of the vessel with a blood clot.
- Embolism rarely provokes a heart attack, but in some cases can cause the development of acute ischemia.
- Congenital and acquired heart defects. Pain with a heart attack in this case appears due to organic damage to the heart muscle.
- Surgical obstruction, which is possible during mechanical opening of the artery or ligation with angioplasty.
Most often, doctors are faced with situations where at the same time several reasons become provocateurs of the development of a heart attack.
Who is at risk?
Patients are more at risk of getting pain with myocardial infarction in the presence of the following conditions and pathologies:
- Over the age of 40.
- Men risk more.
- In the presence of congenital heart defects.
- With a diagnosis of angina pectoris.
- If body weight significantly exceeds the norm.
- After a lot of stress.
- Elevated blood sugar.
- The presence of bad habits: smoking, abuse of alcoholic beverages, drugs.
- Sedentary lifestyle.
- High blood pressure.
- Inflammatory heart disease: endocarditis, rheumatic heart disease.
- Disturbances in the development of blood vessels supplying the heart.
If none of the above applies to you, then this does not mean that there is a 100% guarantee to avoid heart attack and heart pain.
Symptomatology
The nature of the pain and its intensity during the attack depend on several points:
- The size of the necrotic lesion.
- The location of the pathological site.
- Stages of a heart attack.
- Forms of the disease.
- The individual characteristics of the body.
- From the state of the vascular system.
The disease can occur in two forms: typical and atypical.
How a typical form manifests itself
A vivid picture of a heart attack is often observed with extensive damage to the heart. The course of the disease passes through several periods.
Preinfarction. In almost half of patients, this period may be absent, since pain with a heart attack appears suddenly. Many patients feel chest pains before an attack, which gradually become more intense and prolonged. At this moment, a feeling of fear may appear, the mood is falling.
The sharpest period lasts from half an hour to several hours. Patients are interested in the question: if there is a heart attack, what pains accompany a person? Unpleasant sensations may be as follows:
- Chest pain that radiates to the left hand, possibly to the jaw or collarbone.
- Pain can bother between the shoulder blades, in the shoulder.
- Pain sensations have a burning, cutting or pressing character.
- Within a few minutes, the intensity of the pain reaches its maximum and can persist for an hour or more.
The acute period often takes about 2 days. If there has already been a heart attack, then the duration may increase up to 10 days. For many, at this time, the pain of the pain subsides, if this does not happen, then we can assume the attachment of pericarditis. During this period, also the disturbed rhythm persists, blood pressure is lowered.
The subacute period in some patients may take about a month. The pains after myocardial infarction practically disappear, the heart rate and conduction gradually normalize, but the blockade is not amenable to regression.
The course of the pathology ends with a post-infarction period. It can last up to six months. The necrotic area is completely replaced by connective tissue. Heart failure is compensated by normal myocardial hypertrophy. With extensive lesions, complete compensation is not possible, and there is a danger of progression of heart failure.
How does it begin
The onset of pain coincides with the appearance of general weakness, the release of profuse and sticky sweat, the heart rate quickens, and the fear of death appears. Physical examination reveals:
- Pallor of the skin.
- Tachycardia.
- Dyspnea at rest.
- Blood pressure rises in the first minutes of an attack, and then drops sharply.
- Heart sounds are muffled.
- Breathing becomes hard, wheezing appears.
Against the background of necrosis of the tissues of the heart muscle, the body temperature rises to 38 degrees and above, it all depends on the size of the necrotic area.
With a microinfarction, the symptoms are smoothed out, the course of the pathology is not so clear. Mild tachycardia appears, heart failure rarely develops.
Pain with myocardial infarction most often appears early in the morning or at night. It happens all of a sudden. A clear sign of a heart attack is the lack of effect when taking Nitroglycerin.
Atypical form
An atypical form of a heart attack makes it difficult to make an accurate diagnosis when the localization of pain is not the same as with a typical heart attack. There are several forms:
- Asthmatic heart attack. The patient is tormented by coughing, asthma attacks, and profuse cold sweat.
- Gastralgic form. Pain with a heart attack appears in the epigastric region, nausea begins with vomiting.
- The edematous form is diagnosed with a massive focus of necrosis, which leads to the development of heart failure with edema and shortness of breath.
- For elderly patients, a cerebral form is often characteristic. In addition to typical heart attacks, symptoms of cerebral ischemia with dizziness appear, and there may be a loss of consciousness.
- The arrhythmic form is manifested by paroxysmal tachycardia.
- Peripheral infarction. Pain in the arm, under the shoulder blade, in the lower jaw. Often the symptoms are similar to manifestations of intercostal neuralgia.
In some patients, an erased form may occur when the typical symptoms are practically absent.
How to distinguish a heart attack from other cardiac pathologies
It is possible to recognize the moment when a person needs emergency assistance by the following symptoms that appear simultaneously:
- Pain in the sternum and feeling of constriction.
- Headache appears.
- Nausea with vomiting.
- Dyspnoea and profuse sweating.
- Violation of the gastrointestinal tract.
- Pain in the arm, shoulder, back.
- Impaired heartbeat.
- General malaise.
The localization of pain in angina pectoris and myocardial infarction is the same, but these two pathologies can be distinguished. A heart attack is characterized by:
- Intense pain.
- The pain syndrome lasts more than 15 minutes.
- It is impossible to stop the pain with myocardial infarction "Nitroglycerin".
If you suspect a heart attack, you must urgently call an ambulance team to reduce the likelihood of complications.
Complications
If pain persists after a heart attack, then an examination is required. After the pathology, it is necessary to carefully monitor the slightest deviations in the state of health, so as not to miss the development of complications. And they can be after a heart attack such:
- Malfunctions of the heart.
- Arrhythmia.
- High blood pressure.
- Damage to the heart muscle.
- Postinfarction syndrome.
First aid
The prognosis for a patient with a heart attack depends on the speed and accuracy of first aid. After an emergency call should be as follows:
- Lay the person on a flat surface and slightly raise his head. If there is shortness of breath, then you can take a sitting position with legs down.
- Ensure air access: open the window, unfasten the upper buttons of clothing.
- If there is no allergy, then the patient should be given an Aspirin tablet, which helps dissolve the blood clot. The drug does not give a therapeutic effect, but the intensity of the pain reduces.
- "Nitroglycerin" does not reduce pain, but helps to remove shortness of breath. It is necessary to give the drug after 15-20 minutes, but not more than 3 tablets.
- If during an attack of myocardial infarction epigastric pain appeared, then you can give an anesthetic, to eliminate heartburn, take a soda solution.
The medicines taken may not improve the condition of the person, but the ambulance team will help to make the diagnosis easier.
Diagnostics
The main criteria for diagnosing a heart attack:
- Changes in the cardiogram.
- Shifts in enzymatic activity in blood serum.
To clarify the diagnosis, laboratory and instrumental diagnostics are performed.
Laboratory research
In the first hours after the attack, a blood test shows an increased level of myoglobin protein, which is directly involved in the transport of oxygen into cardiomyocytes. Within 10 hours, the content of creatine phosphokinase increases by more than 50%, and its indices normalize only by the end of 2 days. The analysis is carried out every 8 hours, and if a negative result is obtained three times in a row, a heart attack can be excluded.
At a late stage of a heart attack, it is important to determine the level of LDH, the activity of this enzyme increases 1-2 days after the attack.
In a general blood test, the erythrocyte sedimentation rate increases, leukocytosis is observed.
Instrumental diagnostics
It involves:
- Electrocardiograms. The doctor notes the appearance of a negative T wave or its biphasicity, deviations in the QRS complex and signs of arrhythmia, impaired conduction.
- X-ray examination is usually not prescribed due to poor information content.
- After a day or two, coronary angiography is performed, which helps to identify the site of obstruction of the artery.
After revealing the vastness and localization of necrosis and evaluating the contractility of the heart, the doctor prescribes therapy.
Therapy
A patient with a suspected heart attack is delivered to the intensive care unit of cardiology. The faster the healing action begins, the more favorable the prognosis. The purpose of treatment is:
- Stop pain.
- Limit the necrotic area.
- Prevent the development of complications.
Several groups of drugs are used for various therapies:
- To eliminate pain, "Nitroglycerin" is administered intravenously by drip, give "Morphine" and "Atropine" intravenously.
- Thrombolytic therapy involves a reduction in the area of necrosis. For these purposes, a thrombolysis procedure is performed and fibrinolytics (Streptokinase), antiplatelet agents (Thrombo-ACC), anticoagulants (Heparin, Warfarin) are prescribed.
- To normalize heart rhythm and eliminate heart failure, Bisoprolol, Lidocaine, and Verapamil are prescribed.
- Therapy of acute heart failure is carried out with the use of cardiac glycosides: Korglikon, Strofantin.
- Antipsychotics and sedatives help eliminate increased nervous agitation.
The prognosis for the patient depends on the speed of care and timely resuscitation.
Preventative measures
To prevent relapse, it is important to observe the following recommendations:
- Regularly undergo maintenance treatment.
- Strictly follow all the recommendations of your doctor.
- Correct the diet: eliminate fatty foods, fast foods.
- Provide dosed physical activity.
- Eradicate bad habits.
Any pain in the region of the heart should not go unnoticed. Timely examination will prevent the development of the disease.