Myocardial infarction: how to recognize and provide first aid?

Why does myocardial infarction develop?

Our heart is a tireless worker. In one minute it pumps more than five liters of blood and makes about one hundred thousand beats. The heart performs the most important functions for the human body:

• due to rhythmic contractions, it ensures blood flow through the blood vessels;
• saturates organs and tissues with oxygen;
• removes carbon dioxide and other harmful substances from the body.

With the development of myocardial infarction, the heart loses its ability to function normally, which often leads to disability and death.

The main cause of myocardial infarction is atherosclerosis, a chronic vascular pathology caused by impaired lipid and protein metabolism. During the disease, atherosclerotic plaques form in the lumen of blood vessels - dense formations of cholesterol, covered with fibrous tissue on top.

With certain changes in the body (stress, increased blood pressure), vascular spasm occurs, which often leads to rupture of an atherosclerotic plaque with the formation of blood clots. If this occurs in the heart muscle, then acute myocardial infarction develops. If in the intestines, then intestinal infarction, etc.

People with chronic diseases have an increased likelihood of developing myocardial infarction:

• diabetes mellitus;
• hypertension;
• coronary heart disease;
• varicose veins of the lower extremities.

Diagnostics

After the ambulance arrives, the patient, as a rule, undergoes an urgent electrocardiogram, according to the readings of which the development of a heart attack can be determined. At the same time, doctors collect anamnesis, analyzing the time of onset of the attack, its duration, pain intensity, its localization, irradiation, etc.

The following changes can be considered electrocardiographic criteria for the development of an attack:

• damage or arched growth of the st segment, which can merge with a positive t wave or even turn into a negative t wave;
• the appearance of a pathologically altered q wave with a decrease in the amplitude of the r wave. sometimes there may be a complete disappearance of the r wave with the formation of qs;
• the appearance of a negative, often symmetrically located T wave.

In addition, acutely occurring bundle branch block may be indirect signs of the development of a heart attack. Also, the diagnosis of myocardial infarction is based on the detection of markers of damage to the muscle tissue of the heart.

Today, the most convincing (obvious) marker of this type can be considered the troponin level in the blood, which will be significantly increased when the described pathology occurs.

Troponin levels may rise sharply in the first five hours after a heart attack and may remain elevated for up to twelve days. In addition, to detect the pathology in question, doctors can prescribe echocardiography.

Clinical options for the development of myocardial infarction

The classic form of myocardial infarction is accompanied by a severe pain syndrome of a compressive, tearing, burning nature. The pain is most often localized behind the sternum, but can also radiate to the left arm, left shoulder, lower jaw, and interscapular area. As a rule, the pain lasts more than 20 minutes and is not relieved by nitroglycerin within 5 minutes.

Other symptoms of classic myocardial infarction:

• increased sweating;
• psychomotor agitation;
• feeling of fear of death.

There are also atypical options for the development of myocardial infarction:

• abdominal form. In this case, the patient experiences heartburn, nausea, vomiting, pain in the upper abdomen;
• arrhythmic form. Characteristic signs are heart rhythm disturbances, a feeling of interruptions in the heart;
• asthmatic form. The main symptoms are shortness of breath, suffocation;
• painless form. It is characterized by the absence of pain or the presence of mild pain that occurs at varying frequencies. This form especially often develops in patients with diabetes mellitus and in people who have already suffered a myocardial infarction in the past.

Why is the painless form dangerous? First of all, the development of sudden cardiac death. In addition, if in the acute period a myocardial infarction occurs without clear clinical symptoms, then in the future this can lead to the development of chronic heart failure.

The painless form of myocardial infarction can be recognized by other signs. For example, a person may experience shortness of breath, increased fatigue, and exercise intolerance.

The main signs of a heart attack in women and men

1. Chest discomfort - most heart attacks are accompanied by a feeling of discomfort in the central part of the chest that does not go away within a few minutes (pressure, squeezing or pain). 2. Discomfort in other areas of the upper body - pain or discomfort in one or both arms, back, neck, jaw or stomach. 3. Difficulty breathing (whether accompanied by a feeling of discomfort or not). 4. Cold sweat, nausea or dizziness.

The main sign of a heart attack in both men and women is pain or discomfort in the chest. However, women are more likely than men to experience other signs of a heart attack: difficulty breathing, nausea/vomiting, and back or jaw pain.

First aid for myocardial infarction

In providing first aid, the principle of the “golden hour” is very important, from the moment the symptoms of the disease appear until the patient is admitted to the hospital. In critical situations, even more rapid action is required. The severity of the condition during a heart attack depends on how much the lumen of the vessel is blocked by a thrombus. If occlusion (complete obstruction) of a vessel occurs, a critical condition develops. The patient has 20–40 minutes left, after which necrosis of the cardiac tissue occurs.

It is very important not to wait for the pain to subside or for the work day to end. If symptoms characteristic of a heart attack appear, you should immediately take the necessary medications and call an ambulance.

Before doctors arrive, a person with coronary syndrome should be provided with first aid.

Correct algorithm of actions:

1. Place the person in a semi-sitting position. For example, you can put the patient in bed and place pillows under his back. A semi-sitting position reduces the load on the heart.
2. Provide the patient with complete physical and mental rest, try to calm him down. Physical and emotional stress increases myocardial ischemia and increases the need for oxygen in the heart muscle.
3. Free your body from constrictive elements of clothing - remove your tie, belt, unbutton your shirt collar.
4. Create an influx of fresh air - open a window or vent.
5. Give the patient half a tablet of aspirin to chew. This will reduce the area of ​​the heart attack and reduce the risk of death.
6. If possible, you need to measure the person's blood pressure.
7. If you have high blood pressure, be sure to give a drug for hypertension, as well as nitroglycerin. Nitroglycerin capsules are placed under the tongue and sprayed under the root of the tongue as a spray.

Clinical picture of atypical cases

Unfortunately, sometimes a heart attack develops in a non-standard way, complicating its diagnosis and early detection.

For example, some patients may experience the following hidden symptoms of narrowing of the coronary arteries:

• sensations of pain in the lower jaw, left arm or even leg, left side;
• the occurrence of pain in the epigastric region, with the addition of nausea, bloating, vomiting;
• some patients may simply not have enough air, in the absence of other symptoms.

Somewhat less frequently, during the attacks in question, symptoms similar to manifestations of completely different ailments may occur:

• an attack of the asthmatic type with the development of bronchospasm, pulmonary edema, severe shortness of breath, etc.;
• an attack similar to an exacerbation of pancreatitis - with the occurrence of nausea, profuse vomiting, general weakness, and abdominal pain;
• an attack of a neurological type, with the development of neurosis, a panic attack, with disorders of consciousness, vision, with the appearance of dizziness, headaches.

The described clinical picture should also force the patient to urgently call an ambulance - independent treatment in such cases is prohibited!

Complications

Complications of myocardial infarction are early and late. As a rule, early complications develop in the first hours of a heart attack during hospitalization or for several days after the attack. The occurrence of complications is significantly influenced by the timeliness of first aid and hospitalization.

The most common early complications include:

• disturbances in the rhythm and conduction of the heart, which in most cases are fatal;
• rupture of the heart muscle;
• development of acute left ventricular failure, which is accompanied by pulmonary edema.

The last stage of left ventricular failure is cardiogenic shock, in which myocardial contractility sharply decreases and the blood supply to all organs is disrupted. The condition is accompanied by a strong drop in blood pressure, a decrease in body temperature, pale skin, difficulty breathing, oliguria, and loss of consciousness. The probability of death with cardiogenic shock is 90%.

Late complications of myocardial infarction:

• early post-infarction angina. A person who has such a complication does not tolerate even the slightest physical activity. Any activity causes squeezing pain behind the sternum. Even simple self-care activities lead to pain. The pain is less severe than during a heart attack itself, but quite painful;
• chronic heart failure, which is accompanied by shortness of breath, edema of the lower extremities, enlarged liver, and the development of chronic left ventricular aneurysm.

Symptoms of a heart attack

Harbingers of a heart attack can be a wide variety of pain that occurs not only in the heart area, but under the shoulder blades, in the stomach or throat. Nagging pain in the limbs may also indicate problems with the functioning of the heart.

The main symptom of a heart attack is sharp, unbearable pain in the chest. The attack may last several minutes or not go away for hours. A heart attack can be primary (spontaneous) or repeated at regular intervals.

In medicine, there are five main types of heart attack, each of which manifests itself with different symptoms. A typical form of heart attack develops with a sharp burning pain in the heart area.

In the asthmatic form, a sudden attack of suffocation occurs. The patient does not have enough air, his breathing quickens several times. The eyelids, fingers, lips and nose area acquire a rich blue tint. The underlying skin suddenly turns pale. Such a heart attack may be accompanied by hemoptysis, coughing and noisy, uneven breathing.

The arrhythmic form is directly related to changes in heart rate. The patient's pulse quickens, the heartbeat becomes visually noticeable, and blood pressure decreases several times. This form of heart attack most often leads to clinical death.

The cerebral form is accompanied by a sudden loss of consciousness. Moreover, the initial signs of a heart attack are very similar to a stroke. The patient cannot pronounce words coherently, his speech becomes incomprehensible, coordination of movements is impaired, and sharp pain occurs in the chest area.

The abdominal form of heart attack is considered the rarest. Pain in this case does not occur in the heart area, but in the abdominal cavity closer to the stomach. According to some signs, such an attack resembles an exacerbation of an ulcer or gastritis. A heart attack is accompanied by profuse sweating, rapid heartbeat, tachycardia, arrhythmia, nausea and vomiting.

Rehabilitation

a cardiologist twice a month . During the second year after the attack, it is necessary to visit a general practitioner once every four months. If necessary, each of these specialists can refer the patient to a rehabilitation center or sanatorium.

For successful rehabilitation, it is important for the patient to strictly follow all the doctors’ recommendations:

• take necessary medications. These may be statins, anticoagulants, antihypertensive drugs;
• maintain a balance between sleep, work and rest;
• walk in the fresh air more often;
• avoid stress. After a heart attack, a person should receive only positive emotions.