Myocardial infarction: how to recognize and provide first aid?

Myocardial infarction: symptoms, signs of the need for first aid

Myocardial infarction in medicine is defined as the development of necrotic changes in the heart.
This is one of the most acute clinical forms of IHD (coronary heart disease). The disorder occurs due to acute insufficiency of blood flow due to a failure in the supply of oxygen to the heart muscle. A heart attack may be indicated by sudden sweating, nausea, pain in the sternum, forearm and other parts of the body. Heart attacks in men occur 5 times more often than in women, which is especially noticeable in young and middle-aged people. Heart attacks in women develop on average 10-12 years later than in men. Among the reasons is the later development of atherosclerotic changes, which is facilitated by less widespread bad habits and the protective effect of estrogens in women.

Modern diagnostic methods

If there is a suspicion of a heart attack, there is anamnestic data about coronary heart disease and characteristic clinical signs, the doctor prescribes a diagnostic program. It consists of the following methods:

• electrocardiogram;
• laboratory diagnostics.

Let's take a closer look at these research methods.

An electrocardiogram is a graphic representation of the conduction of an impulse along the myocardial fibers. If conductivity is impaired due to necrosis, this will be reflected in the recording. Based on changes in the ECG, the localization of the necrosis zone can be distinguished. Also, on the graph you can see the phase of the infarction - acute or subacute.

General blood analysis

There are no specific changes observed in a general blood test and therefore a diagnosis cannot be made on its basis. During a heart attack, leukocytosis develops, which occurs several hours after the start of the process and reaches a maximum by the end of the day. The elevated level lasts for several days and gradually returns to normal. Leukocytes do not increase significantly, as, for example, with infectious pathology, which allows for differential diagnosis. This is important in case of an atypical clinical picture of myocardial infarction, when the doctor may suspect several pathologies. In a general blood test, you can also see an increased ESR, which remains this way for several weeks. Eosinophils also increase and remain elevated for about a week.

Blood chemistry

Alanine aminotransferase (ALT)

Indicator of destruction of hepatocytes and cardiomyocytes. It increases with hepatitis of various etiologies, heart attack, toxic damage to internal organs. ALT is an active component of liver metabolism, an enzyme that accelerates the metabolism of amino acids. The highest concentration of the substance is found in the cells of the liver, kidneys, heart, as well as in skeletal muscle tissue. Since its localization is the cytoplasm, it is released into the blood when the cell membrane is destroyed. The more massive the area of ​​destruction, the higher the concentration of the enzyme in the blood. The peak activity of the enzyme during a heart attack is 12 hours.

An increase or normalization of ALT levels is a marker of the condition of patients of various profiles with diseases of internal organs and soft tissues. Depending on the disease, ALT can increase moderately or acutely, for example, the highest degree of concentration is observed in hepatitis.

In case of a heart attack, the de Ritis coefficient is used, which consists of comparing the activity of AST and ALT. If the value exceeds the norm, this indicates a heart attack, and if it is below its value, necrosis of the renal tissue or the active phase of hepatitis may have developed. Naturally, a diagnosis is not made based on the ALT indicator. For this, more specific markers are used. The level of transaminases is checked in a general biochemical analysis for differential diagnosis and monitoring of the patient’s general condition.

Aspartate aminotransferase (AST)

Marker of the condition of heart and liver tissues. Increases in viral hepatitis, toxic damage to heart tissue and hepatocytes. It is also used for preventive examination, if necessary, to confirm or exclude a heart attack. This substance is responsible for the exchange of amino acids in cells, so the largest amount is found in the cells of the liver, heart, skeletal muscles and red blood cells. If the cells of these organs are damaged, transaminase is released into the blood, where its increase can be detected. There is an acceptable level of the enzyme in the blood, because organ cells are periodically destroyed, but in pathological conditions this indicator increases several times or tens of times. The peak concentration in the blood is 12 hours after the onset of a heart attack. A comparison of ALT and AST indicators is also used. Each of these enzymes increases in certain pathologies, and during a heart attack their ratio is assessed. AST is not a specific indicator for a heart attack; it complements the overall picture of laboratory testing.

Creatine kinase MB

This substance is an isoenzyme, a marker of the condition of the heart muscle. Takes part in the metabolism of creatine and creatine phosphate. This substance is contained only in the myocardium, and therefore increases in its diseases - myocarditis, heart attack, rhabdomyolysis, pericarditis. The level of the substance is a marker during the acute and subacute phases of the process. A short-term increase in the indicator is observed during cardiac surgery, which reflects the reaction of the myocardium to treatment. The maximum concentration during a heart attack is observed 12 hours after the onset. High activity indicates a significant size of the affected area. The increase in this CPK fraction is compared with the general indicator of the substance in the body. In principle, assessment of the level of CPK MB is used for early diagnosis of myocardial damage, as well as for differentiating the condition from other diseases. An increase in the marker can indicate, in addition to a heart attack, conditions such as shock, poisoning and intoxication, infectious lesions of heart tissue.

Troponin I

A protein that is found in high quantities in skeletal muscles and myocardium. There are varieties of this protein that are responsible for different phases of muscle contraction. All these proteins are cardiac-specific and indicate the state of the myocardium. Damage to cardiac myocytes leads to the release of the substance into the blood, where it can be detected using laboratory testing. The area of ​​necrosis affects the level of increase in troponin levels in the blood. Troponin I is the most sensitive and specific for infarction. Elevated troponin persists for 5-6 days after the onset of the pathological process.

Myoglobin

This is a protein that is found in muscle cells and contains iron molecules. Similar in structure to hemoglobin, an iron-containing blood protein. The function of myoglobin is also similar - it transports oxygen to myocytes, muscle cells. With necrosis, muscle cells are destroyed, myoglobin is released and enters the bloodstream, where it can be detected. Protein is excreted from the blood along with the kidneys. It can be detected in the blood within a few hours after the onset of the pathological process; within 2-3 days it can still be detected. This marker is one of the first to react, which increases its diagnostic value. With necrotic changes, it increases 7-10 times, depending on the area of ​​necrosis. For comparison, the period of peak increase in other markers is 12 hours, while for myoglobin it is 6 hours. Normalization of analyzes occurs just as quickly. They can remain elevated for longer than a day if complications occur, for example, expansion of the area of ​​necrosis. Sometimes new foci occur, then myoglobin increases again, which requires dynamic monitoring of the indicator. A negative test result is also important, which, in comparison with the clinical picture, allows one to exclude pathology. In addition to a heart attack, myoglobin may indicate long-term compartment syndrome. muscle pathologies, inflammatory processes.

Causes of myocardial infarction

Myocardial infarction develops for various reasons, some of which are contributed by the person himself, others by his environment. Let us highlight 3 main groups of provoking factors:

1. Factors that directly depend on the person - eating large amounts of fatty foods, smoking, excessive alcohol consumption.
2. Factors that indirectly depend on a person are obesity, menopause and postmenopause.
3. Factors that do not depend on a person - old age, genetic predisposition.

Myocardial infarction develops with atherosclerosis and inflammation in the walls of the arteries resulting from trauma, radiation exposure, vascular embolism, congenital anomalies and disruptions of the hematopoietic apparatus.

What could cause it to appear?

The main cause of the pathology is damage to the inner lining of the coronary artery. This is a vessel that nourishes the tissues of the heart. As long as its diameter does not narrow and the walls remain elastic, no negative changes occur. Reducing the lumen limits blood flow. A similar picture emerges when:

• atherosclerosis;
• spasm of the coronary arteries;
• increased blood viscosity;
• formation of blood clots - thrombi.

The disease can be triggered by the influence of negative factors, which include:

• hormonal disorders;
• long-term treatment with corticosteroids;
• hypertonic disease;
• obesity;
• smoking;
• alcohol consumption;
• sedentary lifestyle;
• emotional overload.

In rare cases, myocardial infarction can be triggered by other internal pathologies: rheumatism, cancer, severe allergic reactions.

Heart attack: symptoms and first signs

• Patients do not always associate symptoms of a heart attack with the manifestation of this pathology. The patient’s feelings depend on what period of its development the disease is at. Common signs of a heart attack:
• severe dizziness, feeling of lack of air, shortness of breath;
• feeling of chronic fatigue, cold sweat on the body;
• uneven heartbeat, severe arrhythmia;
• pain impulses in the arms, forearms, shoulders, side, sternum;
• nausea, unpleasant heaviness in the stomach, loss of consciousness.

The first signs of a heart attack are not always obvious, but they attract attention. There are several periods of development of pathology:

• Pre-infarction stage - the first signs here are increased fatigue, weakness, fatigue, a feeling of squeezing and rapid heartbeat. There is no significant pain yet. In a patient with myocardial infarction, the lips and nail plates turn blue, the pulse becomes erratic and uneven. At this time, the severity of the disease increases, the duration of the period ranges from a couple of hours to a month.
• The most acute stage of heart attacks is pain. The patient begins to feel as if his chest is being squeezed in a vice. Behind the sternum there is a burning sensation, fiery heat, pulsating pain. With the development of an extensive heart attack, the pain is severe and prolonged. Strong and abrupt impulses are observed in young patients. Muffled pain, indicating myocardial infarction, is more often observed in patients with diabetes mellitus. The duration of the period is from half an hour to 2-4 hours. Complications that pose a direct threat to life are possible.
• Acute stage of a heart attack - among the first symptoms, the final formation of a focus of dead tissue and the occurrence of life-threatening conditions are noted. The duration of the period is 2-14 days.
• Subacute period - dead areas are replaced by connective tissue. The duration of the stage is 6-8 weeks.
• The post-infarction period lasts from two months to six months. During this time, the body adapts to new conditions.

If there are signs of a heart attack, you should not self-medicate; you should urgently consult a doctor, undergo an examination and get specialist recommendations.

What it is

Myocardial infarction, or heart attack, most often occurs in older patients. The risk group includes women over 55 years of age and men over 45 years of age.

Doctors classify pathology according to the time of its occurrence:

• primary infarction – occurring for the first time;
• recurrent infarction – diagnosed within 1.5 months after the first attack;
• repeated heart attack – occurring after 6 weeks from the date of the first incident.

Several departments can be affected at once. In this case, we are talking about an extensive heart attack. Pathology can only affect the left ventricle - its septum or walls. The tissue of the right ventricle dies less often.

Where is the pain hidden during myocardial infarction?

Pain during myocardial infarction is localized in the chest area, spreading mainly to the left side of the chest space or being fixed in the central zone. The patient’s appearance also attracts attention: the skin is pale, moist, blue discoloration is visible in the area of ​​the nasolabial triangle.

Myocardial infarction is often characterized by pain spreading to the left or right arm. Patients often talk about unpleasant sensations in their wrists, so similar to being put on squeezing handcuffs. The pain can go to the left shoulder blade and spread around the neck. The abundance of such places often complicates diagnosis, especially since pain symptoms are cyclical, increase and disappear in waves, and then everything repeats again.

Sometimes symptoms are observed for several days, and people do not rush to see a doctor because they are not aware of the development of signs of a dangerous disease. Another interesting symptom of a heart attack is known, when a person experiences hallucinations against the background of acute intense pain.

Atypical forms of the disease attract attention when the symptoms and first signs of a heart attack are manifested not by pain, but by shortness of breath, a feeling of lack of air and an irregular heartbeat. Acute infarction develops when a focus of necrotic tissue is finally formed. At this time, the pain disappears, the pressure drops, and the pulse quickens. The pain may persist if the affected area during a heart attack expands.

Why choose us

• high efficiency;
• full cycle of treatment;
• individual approach depending on the stage of development of the disease;
• the competencies of our specialists are recognized in the professional community;
• The center’s employees conduct educational conferences and master classes on diseases of the cardiovascular system. Our doctors regularly receive invitations from federal television channels with offers to participate in various health programs.

We treat not only the symptoms, but also the cause that led to the heart attack!

Scheme of development of myocardial infarction

The atherosclerotic plaque loses its integrity and undergoes rupture. Its surface is corroded by erosion, which provokes inflammation. Plaque rupture is possible under the following circumstances: increased blood pressure, serious and exhausting physical activity, smoking, etc.

A blood clot forms that blocks the lumen of the coronary artery (thrombosis). The blockage occurs due to the clumping of platelets. A thrombus forms inside the plaque when its membrane ruptures, and only then comes out, closing the lumen of the coronary artery. If the blockage is sudden, a through myocardial infarction develops with necrotization of the entire thickness of the heart muscle. This is one of the most severe forms of the disease due to the high risk of death.

The coronary artery narrows sharply. With spontaneous or drug-induced dissolution of a blood clot and incomplete blockage of the artery, non-through infarctions are formed.

How to give first aid

The main sign of a heart attack is pressing or sharp pain behind the sternum. The patient needs emergency care, so the first action if a heart attack is suspected should be to call the cardiac team.

Pre-hospital assistance:

1. Make sure that the victim is not exposed to physical stress.
2. Place the patient in bed with the pillows slightly raised under the head.
3. Relieve external pressure - take off your shoes, remove your belt or tie, unbutton your shirt collar.
4. Provide a flow of fresh air into the room.
5. Monitor heart rate and blood pressure. Provide the numbers to the emergency physician.
6. Calm the victim, make sure that panic does not increase.
7. Give a glass of water to drink.

It is possible to take medications before the team arrives. If a person has previously suffered from angina, he is given the usual drug to improve cardiac circulation. The tablet should be placed under the tongue so that the victim slowly dissolves it. To protect against thromboembolic disorders, the use of blood thinners is recommended. They prevent platelet aggregation and slow down the death of cardiomyocytes.

If there is no consciousness, a weak pulse and unstable breathing, cardiopulmonary resuscitation is performed. This is a complex consisting of indirect cardiac massage and artificial respiration. Its goal is to support life until doctors arrive. To pump blood, rhythmic pressure is applied to the sternum area, and to ventilate the lungs, air is forcibly inhaled into the victim’s mouth while the nose is pinched.

Diagnosis and treatment for heart attack

An experienced doctor makes an accurate diagnosis at the first signs of illness. To help him - characteristic symptoms, a detailed clinical picture of a heart attack, electrocardiography indicators and identification of blood biomarkers indicating necrotic changes in the heart area. The first examinations upon treatment include a general blood test, biochemistry, echocardiography, and emergency selective coronary angiography.

Cardiologists deal with heart attacks; treatment depends on the severity of the pathology and how severe the symptoms are. The first signs of a heart attack in a woman or man indicate the need for urgent medical attention. The first and main tasks of doctors are to stop the development of necrosis of cardiac tissue, eliminate pain and associated complications.

In therapy, priority is given to the administration of painkillers, thrombolytic therapy, antiplatelet agents, and intravenous anticoagulants. In case of heart attacks, surgery of the heart muscle is possible - stenting and coronary artery bypass grafting.

Early consequences of myocardial infarction1

Starting from the first hours after a heart attack and up to 3-4 days, early consequences of a heart attack may develop, including:

• acute left ventricular failure, which occurs when the contractility of the heart decreases. When it occurs, shortness of breath, tachycardia, and cough appear;
• cardiogenic shock. This is a severe complication of acute coronary syndrome, developing as a result of a significant deterioration in the contractility of the heart muscle due to extensive necrosis;
• disturbances of cardiac rhythm and conduction are observed in 90% of patients with acute MI.
• Attacks of early post-infarction angina (PSA). PSC is the occurrence or increase in frequency of angina attacks 24 hours and up to 8 weeks after the development of MI.
• pericarditis is an inflammatory process that develops in the outer lining of the heart, the pericardium. It occurs in the first or third day of the disease and can manifest itself as pain in the heart area, which changes with a change in body position, and an increase in body temperature.

In 15-20% of heart attack cases, thinning and bulging of the heart wall occurs, most often of the left ventricle. This condition is called cardiac aneurysm. As a rule, it develops with extensive damage to the heart muscle. Factors predisposing to the development of cardiac aneurysm also include violation of the regime from the first days of the disease, concomitant arterial hypertension and some others.

A special group consists of thromboembolic consequences, in which the lumen of the vessels is completely or partially blocked by blood clots. This often occurs against the background of concomitant varicose veins, blood coagulation disorders and prolonged bed rest.

Due to impaired blood supply, acute coronary syndrome can be complicated by gastrointestinal problems, such as erosions and acute ulcers of the gastrointestinal tract. Mental disorders may also occur - depression, psychosis. They are facilitated by old age and concomitant diseases of the nervous system.

Prognosis after heart attacks

In case of heart attacks, you should be observed by a specialized specialist. After an illness, the situation may be complicated by cardiac arrhythmias, acute heart failure, cardiogenic shock, pericarditis, mental disorders and other pathologies. A professional doctor will help reduce the risks of exacerbations after myocardial infarction.

Our clinic provides services to patients with all types of cardiac pathologies, including those who have suffered a cerebral infarction (ischemic stroke). It is these complications of brain damage that are considered one of the main causes of increased mortality throughout the world. Despite this, our doctors do everything possible to maintain and improve the quality of life of their patients.

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.