Early complications of myocardial infarction occur in the acute period of cardiac catastrophe. They can develop within a few hours or days after the first signs of ischemia appear. Such complications are considered the most dangerous, they often lead to death. The risk of their development is extremely high. The consequences of a heart attack that occur a few weeks or months after the attack, when the patient switches to a more active lifestyle, are considered late.
What is myocardial infarction
Myocardial infarction occurs most often due to atherosclerosis. On the walls of blood vessels harmful lipoproteins settle, resulting in the formation of plaques. This dramatically worsens the blood supply to the heart muscle, and coronary heart disease develops. With further progression of this pathology in the myocardium, a focus of necrosis (necrosis) may occur, this condition is called a heart attack by doctors.
The disease occurs sharply and is characterized by extremely strong pains behind the sternum, which give to the left side of the body. Unlike angina pectoris, an attack cannot be removed with conventional vasodilators, such as nitroglycerin. The death of myocardial sites cannot pass without leaving a trace for the body; myocardial infarction is often complicated by severe heart disorders.
Possible consequences of a heart attack
Even during the transportation of the patient to the hospital or in the first hours after the onset of acute necrosis, the early consequences of myocardial infarction may appear. What is it and how to avoid it? Complications can be divided into several groups:
- Consequences associated with acute heart failure: cardiogenic shock, pulmonary edema.
- Ruptures and other damage to the heart muscles: interventricular septum, ventricular wall, papillary muscle, ventricular aneurysm, pericarditis.
- The formation of blood clots in the cavity of the heart and arteries.
- Arrhythmic disorders.
The most dangerous early complications of myocardial infarction are acute heart failure and thromboembolic disorders. Arrhythmia after an attack occurs in the vast majority of cases, some types of such disorders can also lead to serious consequences. If the patient has signs of pulmonary edema or cardiogenic shock, emergency care should be provided as soon as possible. These conditions often cause the death of the patient.
Cardiogenic shock and pulmonary edema
The human heart works like a pump supplying tissues and organs with blood and oxygen. If this function is violated, then cardiogenic shock occurs. The heart stops pumping blood, and organs experience acute oxygen starvation. Sometimes this condition develops before the pain syndrome appears. The patient's blood pressure drops sharply, the skin becomes covered with cold sweat and acquires a gray tint.
The following causes of cardiogenic shock after myocardial infarction can be distinguished:
- The development of a reflex reaction to sharp pain during an attack.
- Heart rhythm disturbances.
- Severe necrotic lesions do not allow the heart muscle to fully contract. This type of shock is the most dangerous and leads to death in 90% of cases.
Cardiogenic shock usually occurs with extensive heart attacks, when about 50% of the heart muscle is damaged. This complication is more susceptible to patients with diabetes.
If the patient has signs of cardiogenic shock, emergency care is provided according to the following algorithm:
- The patient is laid with raised legs. Conduct oxygen therapy. “Heparin” is administered intravenously in an amount of 5000 IU, glycosides are indicated to normalize the heart rhythm.
- If the above measures did not help, then make a dropper with sodium chloride (200 ml of a 0.9% solution). In this case, it is necessary to control respiration, blood pressure and heart rate.
- In the absence of effect, if hypotension persists, make a dropper with 200 mg of "Dopamine" in a glucose solution. The rate of fluid administration is regulated as blood pressure rises.
- If the pressure was never brought back to normal, then the therapy is supplemented by the drip of norepinephrine in a glucose solution.
All activities must be carried out under close monitoring of heart rate and heart rate.
Another serious early complication of myocardial infarction is pulmonary edema. It occurs due to stagnation of blood in the respiratory system. This consequence of a cardiac catastrophe occurs during the first week after myocardial necrosis. The patient has a sharp weakness, shortness of breath, cough with sputum, then suffocation increases and a bluish skin color appears.
Pulmonary edema is a consequence of acute heart failure. The recommendations for treating this condition are as follows:
- the introduction of diuretics and cardiac glycosides;
- oxygen therapy;
- "Nitroglycerin" and analgesics (in the presence of pain).
Help with pulmonary edema should be done immediately, as this process progresses rapidly, and the patient may die from suffocation.
Mechanical damage to the heart
After a heart attack, the elasticity and elasticity of the myocardium are sharply violated. This leads to mechanical damage and tearing of tissues.
Rupture of the interventricular septum is usually observed in elderly patients and hypertensive patients. This complication can occur within 5 days after a heart attack. The following symptoms are noted in patients:
- an increase in the liver and heart volume;
- severe chest pain that is difficult to stop;
- difficulty breathing
- arrhythmia;
- bulging neck veins.
Such heart damage can be complicated by cardiogenic shock. At the first stage of treatment, vasodilator drugs are used. But only surgical intervention helps to completely bridge the gap.
Rupture of the outer wall of the ventricle also occurs due to impaired tissue strength after necrosis. This dangerous early complication of myocardial infarction is accompanied by bleeding and can lead to a shock condition. A person feels severe chest pain, shortness of breath, wheezing is heard in the lungs. Due to a sharp drop in pressure, the patient is in a fainting state, his pulse is poorly defined. To repair this damage, surgical intervention is necessary. A “patch” of special material is applied to the gap.
Mitral valve insufficiency
Mitral valve insufficiency is one of the dangerous consequences of myocardial infarction. What is it and why does such a violation arise? Due to a violation of the strength of the heart tissue, rupture of the papillary muscles can occur. As a result, the valve does not close completely. Such a complication occurs in 1% of cases. There is pulmonary edema, noises are detected in the heart. Such a pathology can only be treated surgically. Without surgery, a fatal outcome is possible in 50% of cases.
Ventricular aneurysm
Aneurysm of the left ventricle occurs after a transmural (extensive) form of heart attack. Scar tissue forms on the damaged area, this disrupts the contractile function of the heart. Most often, aneurysm is formed in middle-aged and elderly men. The patient is concerned about manifestations of cardiac asthma: shortness of breath, cough, blue skin. The patient does not tolerate even a small physical exertion. Conservative treatment does not bring effect, cardiac surgery is required.
Pericarditis
Pericarditis with myocardial infarction occurs in 10% of cases. It usually develops in the first 4 days. This is inflammation of the outer lining of the heart. It occurs with a deep lesion, when all 3 layers are affected by pathology: myocardium, pericardium and endocardium. The patient feels chest pains that are pulsating in nature. Unpleasant sensations intensify with inhalation and exhalation. Usually, the appointment of "Aspirin" helps. This drug relieves inflammation and thins the blood.
Thromboembolism
The risk of thromboembolism with myocardial infarction is especially high in the first 10 days. Blood clots can form in the cavity of the heart. During this period, symptoms may be erased. Blood clots become extremely dangerous when they go outside and clog the lumen of the vessels of another organ. The patient feels severe pain due to the cessation of blood flow. Thrombosis can cause gangrene of various organs. Most often, blood clots block blood flow in the lungs or lower extremities. To avoid this pathology, patients in the post-infarction period are prescribed intravenous or subcutaneous administration of Heparin.
Arrhythmia
Arrhythmic disorders after a heart attack occur in most patients. Signs of this condition are a frequent pulse, a feeling of fatigue, dizziness, and sometimes chest pain. Rhythm disturbances are stopped by the use of cardiac glycosides. With bradycardia, pacemakers are used.
A dangerous type of arrhythmia is ventricular fibrillation. In this case, the heart can stop at any moment. If such a dangerous complication is detected on the ECG, resuscitation measures and the use of a defibrillator are necessary.
Rehabilitation
How to live after myocardial infarction to avoid complications? This question is of interest to every patient who has suffered a heart catastrophe. In the first week after an attack, the likelihood of complications is very high. Therefore, patients are prescribed a gentle regime with a gradual increase in load.
In the first two days, the healing of sites of necrosis begins. At this time, bed rest is required, physical activity is strictly contraindicated. Sitting on the bed is allowed only on the third or fourth day.
On the fifth day, patients can get out of bed and walk around the room a bit. On the 6th day, patients can go out into the corridor, but do not climb stairs. Walks should take place in the presence of medical staff, so that if necessary assistance is provided on time.
If after a week there are no unpleasant consequences, then the patient is allowed to walk for 30 minutes. You can take a shower and independently perform hygiene procedures. In this case, the water should be at room temperature.
Discharge home from the hospital is usually carried out during the second week. Before this, the medical staff conducts simple physical exercises with the patient. With normal health, the patient is allowed to climb the stairs one floor.
An individual approach to the rehabilitation of patients after myocardial infarction is needed. The duration of the recovery period may be different. It is necessary to carefully monitor the well-being of the patient. Even with slight signs of deterioration after myocardial infarction, the load should be reduced.
Rehabilitation is considered successful if in the post-infarction period the patient does not have bouts of angina and signs of heart failure, blood pressure does not exceed 130/80, and the level of glucose and cholesterol remains within normal limits.
Lifestyle after a heart attack
Upon discharge from the hospital, the cardiologist gives recommendations to the patient about lifestyle, diet, labor and rest. What rules should be followed to avoid complications and a second attack?
The doctor may prescribe a patient with exercise therapy after myocardial infarction. A set of exercises should be selected individually for each patient. This can be light gymnastics to prevent stagnation and maintain muscle tone or leisurely walks in the fresh air. The patient can perform the exercises on his own only after discharge from the hospital. In this case, you need to monitor the heart rate and respiration. Large physical exertion must be avoided, otherwise ischemic manifestations may return.
Emotions, stress, and overwork should also be avoided. With mental stress, the heart rate increases, and the myocardium again experiences a lack of oxygen.
High cholesterol foods are excluded from the diet. You should also completely abandon the use of alcohol and smoking. The patient is not recommended to dramatically change the climate, this creates an excessive load on the heart.
Each patient who has had myocardial infarction should be under the supervision of a cardiologist, regularly undergo an ECG and take all necessary tests.
Disability after a heart attack
The question of the disability group after myocardial infarction is decided individually for each patient. After the attack, the patient is issued a sick leave for a period of 4 months. This time is necessary for the restoration of the body and rehabilitation. Then the patient is sent to the commission to decide on the need to assign a disability group. Many patients manage to remain able-bodied and go to work. In other cases, the commission assigns the 2nd disability group and extends the sick leave for another 1 year.
After this period, the commission again considers the issue of the disability group. This takes into account the patient’s ability to service themselves, to perform the same work with the same quality, education, position, as well as the possibility of adaptation of the body. Based on this, the commission can either remove disability or establish the disability of the following groups:
- 3rd group. It is assigned for small dysfunctions in the work of the heart and blood vessels to patients who previously engaged in mental or light physical work.
- 2nd group. It is established in case of more serious violations, when deviations in the work of the heart cannot be eliminated even by surgery. The 2nd group is also appointed if the patient suffers from angina attacks that occur during physical and mental stress. In this case, the patient is allowed simple work.
- 1st group. Appropriated in the most severe cases, if the patient loses self-care skills, suffers from heart failure or constant pain in the heart.
If the painful manifestations are permanent and are not stopped by therapy, then they draw up an indefinite disability.
In addition, all those who have suffered myocardial infarction are prohibited the following types of labor:
- hard physical work;
- work at height;
- labor associated with prolonged stay on the legs;
- classes related to stress and psycho-emotional stress;
- work on conveyors where a quick reaction is needed;
- night and daily shifts;
- labor in chemical plants and in adverse climatic conditions.
These restrictions apply to patients without a disability group.
Forecast
Life expectancy after myocardial infarction depends on several factors. Doctors often find it difficult to give an exact answer to this question. If myocardial infarction occurred for the first time, then, according to statistics, mortality is about 10% in the first month. If the patient was able to survive this period, then during the first year the survival rate is 80%, and within 5 years - 70%.
If a person has suffered an extensive heart attack, then usually this dramatically reduces life expectancy. Important factors are also the patient's age, localization of necrosis, the presence of concomitant diseases and the effectiveness of rehabilitation. If a person has suffered a heart attack at a young age, then he can completely restore the heart and survive to advanced years. If the attack occurred in an elderly person with hypertension, obesity or diabetes, then the situation may be more sad. According to statistics, such patients live about 1 year.
The number of heart attacks suffered to a lesser extent affects life expectancy than the nature and extent of necrotic changes. There were cases when patients suffered several attacks, but survived to old age. Conversely, young patients died of a single heart attack while still being transported to the hospital. The prognosis of this disease depends on the characteristics of the course of the pathology and in many respects on the person’s lifestyle during the rehabilitation period.