Extensive infarction of the heart: what it is, the consequences, the chances of survival
Myocardial infarction is the most severe form of ischemic heart disease that occurs as a result of acute failure of blood supply due to thrombosis of the coronary artery.
What a massive myocardial infarction, and what are its causes?
Infarct from blood circulation disorders and under-nutrition affects the whole myocardium, thus begins the necrosis of the heart muscle. The cause of myocardial infarction – obstruction of the lumen of the vessel that supplies the myocardium with blood. This can occur when the following pathologies:
- Coronarosclerosis (coronary atherosclerosis). Plaque overlying the lumen of the vessel, reaching the critical size.
- Hypertension. As a result of increased tonus of coronary vessels, their lumen is narrowed, and the walls thicken. In the presence of atherosclerotic plaque there is a complete blockage of the vessel. To provoke myocardial infarction, including extensive, can thrombus detachment during the spasm of blood vessels due to high pressure.
- Embolization of the coronary (coronary) arteries. A heart attack develops when coagulopathy as a result of thrombosis, with embolism.
- Surgical obstruction of the vessel after angioplasty.
There are a number of adverse factors, against which the risk of extensive myocardial infarction increases several times.
- Diabetes. Pathology does not directly cause a myocardial infarction. It’s all in the excess glucose that the body can’t digest. Violations occur in metabolism, develop atherosclerotic plaques and, in certain circumstances, this leads to a heart attack.
- Genetic predisposition. Talking about it can go if a heart attack is diagnosed in young people, and the predisposition can be also a to atherosclerosis and hypertension.
- Pathological processes in the kidneys.
- A wrong diet.
- Sedentary lifestyle and excess body weight (obesity) contribute to the development of stagnation and slowing of blood flow, leading to thrombus formation.
- Smoking, including passive, slows blood flow and causes spasm of blood vessels, resulting in ulcerated atherosclerotic plaque stick to the platelets, eventually completely blocking the lumen.
- Alcohol in large doses, has direct toxic effects on the liver, but also on the heart and blood vessels regular intake of alcohol leads to permanent increases in blood pressure with all its consequences.
- Frequent and excessive load on the nervous system. Stress and chronic fatigue do not go unnoticed for the body.
- Excessive physical load.
- Rheumatic heart disease – an inflammatory process in the walls of the heart, the main manifestation of rheumatic fever.
- Infectious disease. Especially if the disease is caused by streptococci or staphylococci.
- Elevated levels of LDL («bad» cholesterol) and low content of HDL («good» cholesterol) in the body.
- Excess triglycerides in the blood.
- Age and sex of the person. A heart attack develops more often in men than in women.
- Ecology. Environmental pollution, especially air.
Symptoms of extensive myocardial infarction and its stage of development
In the course of the disease there are several stages, each characterized by certain symptoms. Prodromal (pre-stroke) period. Can last from several hours to one month. At this time the increasing frequency of angina attacks. The acute phase (lasts from 30 minutes to 2 – 3 hours from the start of the attack). The first signs of a heart attack:
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- burning pressing pain, radiating to the left half of the body;
- a drop in blood pressure;
- arrhythmias (premature beats or atrial fibrillation);
- cold sweat;
- shortness of breath;
- even the pallor and blueness of the skin;
- dizziness and loss of consciousness;
- with the defeat of the posterior wall of the heart symptoms similar to food poisoning – nausea, vomiting, sharp pain in the stomach;
- infarct possible atypical symptoms, such as pain in the right hand;
- the person feels inexplicable anxiety and fear of death.
Acute phase (4 to 8 days after attack). At this time, decrease pain, in cardiac muscle forms the area of necrosis, because of this, there is an increase in temperature and blood pressure, symptoms of heart failure – irregular heart rhythm and shortness of breath. The subacute period (from 9 to 28 days). The area of necrosis is gradually replaced by scar tissue, the heart rate and blood pressure are normalized, the pain disappears.
Postinfarknetary period (the period of scarring, starts from 28 days and lasts 3 to 6 months). At this time, finally sealed the scar, and the heart begins to get used to new conditions of functioning, compensatory mechanisms develop. The patient experiences attacks of angina, it can still disturb heart rhythm disturbances and shortness of breath.
Atypical forms of extensive myocardial infarction
There are several clinical forms of atypical for extensive myocardial infarction symptoms. Gastralgia (abdominal) shape (3% of all cases) is reminiscent of the symptoms of pancreatitis:
- sharp or cramping pain in the upper abdomen;
- flatulence and diarrhea;
- hiccups, nausea and vomiting.
Angina form (most common):
- severe pain behind the breastbone, which gives the left side of the chest, left arm or shoulder blade;
- the attack can be cut short by using Nitroglycerin tablets;
- shortness of breath and coughing;
- pallor of the skin;
- anxiety and fear of death.
Cerebral form, its symptoms are similar to stroke. Appears dizziness, and various neurological symptoms. Edematous form – in addition to the basic signs of heart attack myocardial infarction the patient has edema, ascites develops.
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Asthmatic form – symptoms of heart attack resemble bronchial asthma attacks. The main symptom in this case, increasing shortness of breath. Painless for pathology – the absence of pain is typical for people with diabetes because they have impaired sensitivity. Atypical pain syndrome. The pain is not localized behind the breastbone and radiates to the arms, shoulder, lower jaw or the iliac fossa.
The consequences of a massive heart attack
Pathology can lead to a number of complications that deadlines are divided into early and late. Early complications:
- different types of arrhythmias and conduction disturbances (blockages);
- acute heart failure (shock, pulmonary edema);
- rupture of the myocardium in violation of the integrity of the walls;
- cardiogenic shock;
- regurgitation of the mitral valve;
- aneurysm of the left ventricle;
- hypotension as a result of adverse drug action and side effects after administration of streptokinase;
- breathing disorders due to the use of narcotic analgesics;
- paralysis of the limbs;
- reactive autoimmune complications;
- cardiac arrest and death.
- syndrome Dressler (post-myocardial infarction syndrome) is a combination of pericarditis, pleurisy, pneumonia, inflammatory processes in the joints and fever;
- aneurysm of the heart;
- a blockage of the veins (thromboembolic disorders);
- chronic heart failure.
Diagnosis of a massive heart attack
Conventionally, the diagnosis can be divided into:
- early (ECG, echocardiography, specific blood tests for cardiotropic proteins);
- delayed (coronary angiography).
Yet the basis of diagnosis are clinical signs and specific ECG changes. Additionally, the patient can do an ultrasound of the heart that show the limits of defeat of the heart muscle.
Aid with extensive myocardial infarction
When the first symptoms should call an ambulance, thus to specify that you need the consultation of intensive care and cardiology. Pending the arrival of medical personnel should immediately provide aid, no matter what type of infarction is the place to be – the front, rear wall or the interventricular septum.
- The patient should sit or lay on a hard surface, legs bent at the knees.
- Unfasten the gates of the clothes, loosen the tie, open the Windows to provide fresh air.
- Give a Nitroglycerin tablet.
- If you are not allergic to Aspirin, the patient should slowly chew the drug in a dose of 300 mg.
- If the patient is unconscious, he needs to throw back his head, and the urge to vomit, the head should be turning.
- During cardiac arrest, required CPR – chest compressions and artificial respiration.
- Before the arrival of the medical team of the patient, if conscious, you should try to calm down, as panicking will only aggravate the situation.
The ambulance crew carries out following manipulations:
- relieves pain drugs;
- to confirm the diagnosis an ECG;
- when expressed violations of the breath gives humidified oxygen through a special mask or catheter;
- in marked excitement and fear applies tranquilizers;
- after that, the patient hospitalitynet to the emergency room or intensive care unit where, if necessary, conduct a full range of resuscitation, including artificial ventilation, defibrillation of the heart or electrical cardioversion.
Treatment in a hospital
In the treatment of extensive myocardial infarction required:
- bed rest;
- complete emotional tranquility;
- a special diet;
- continuous monitoring of the functioning of all body systems.
Drug therapy is the main method of treatment of extensive myocardial infarction. The doctor prescribes the drugs aimed at the elimination of symptoms and normalization of the patient’s condition and blood vessels:
- antiplatelet therapy – medicines to thin the blood and improve yield strength (Aspirin);
- analgesia (Nitroglycerin and analgesics);
- normalization of cardiac rhythm – getting rid of the arrhythmia (Amiodarone, Lidocaine);
- prevention of blood clots (equity-anticoagulants – Heparin, Lovenox, Bivalirudin, and antiplatelet agents – Clopidogrel, plavix);
- the elimination of the existing in the body of blood clots (thrombolytics – Streptokinase, Alteplase).
With extensive myocardial damage, often resort to surgery – coronary artery angioplasty or coronary artery bypass grafting.
Rehabilitation after a massive heart attack
After discharge from the hospital to the patient, a period of rehabilitation. It is best to spend time in the cardiology sanatorium under the supervision of a physician. To extensive the heart attack was not repeated (often in this case, the prognosis will be unfavourable, and the chances of survival is minimum), the patient will have to adhere to certain rules and radically change lifestyle:
- give up bad habits – alcohol and Smoking;
- a special diet;
- to limit the physical strain on the body;
- to avoid stressful situations;
- often fresh air;
- strictly adhere to all doctor’s appointments.