Stage of myocardial infarction and their symptoms
Myocardial infarction is an irreversible death (necrosis) of heart muscle cells, which develops due to acute disorders of coronary circulation. The most common cause of this is a thrombosis of one of the arteries supplying the heart muscle.
There are separate stages of myocardial infarction, each of which is characterized by certain clinical manifestations and require appropriate medical approach and treatment.
Stage of development of a heart attack
The clinical course of a typical heart attack, decided to allocate 5 stages:
Let us consider the duration of each stage and its basic characteristics.
The duration of this stage of myocardial infarction ranges from several minutes to two months.
Clinical sign of this stage is progressive angina with increasing number of pain attacks. The pain intense, and the attacks each time become longer.
More than half of the patients in this period, you may notice transient ECG changes and signs of instability of the myocardium.
The acute phase
In most patients, this stage develops suddenly, within a few hours. The ECG of the patient showing the signs of myocardial necrosis.
In this period, identify different clinical variants of the further course of myocardial infarction:
- angina (pain) is an option. Occurs in 90% of cases. Characterized by severe constant burning pain in the sternum. The pain spread to the left arm, shoulder blade, nape of the neck, clavicle and lower jaw. This state lasts for half an hour and is accompanied by a sharp feeling of fear and excitement. Is not relieved by taking nitroglycerin;
- asthmatic variant of the disease. Signs similar to the typical picture of asthma and are accompanied by worsening shortness of breath and difficulty breathing. This variant is more common in patients with severe hypertension and repeated episodes of myocardial infarction;
- abdominal option. Develops when the location of the necrosis in the lower parts of the heart muscle. Pain occur in the abdomen and can be accompanied by vomiting, nausea and diarrhea. This option is particularly difficult to diagnose because the clinical picture is more like a poisoning or other pathology of the digestive tract;
- arrhythmic option. Is accompanied by transient cardiac arrhythmias, blockades, can occur with pre-existing conditions and loss of consciousness;
- cerebral version of the disease. Begins with signs of disturbance of cerebral circulation: headache, dizziness, speech disorder, gait, epileptic seizures, etc.
In rare cases, the patient with myocardial infarction has no complaints and takes this condition without even knowing about violations in the work of the heart. Signs of a heart attack can then be detected on an ECG. Such a rare form of heart attack occurs in patients with diabetes mellitus in anamnesis.
The acute phase
This stage lasts about 10-12 days. During this time, the clearly defined boundaries of necrosis of the heart muscle and begins to form scar.
Clinically, this stage may be observed:
- the rise in body temperature;
- increase in ESR and white blood cells;
- increased activity of heart enzymes (creatine phosphokinase, aspartate aminotransferase, troponin, myoglobin protein cardiospecific);
- typical ECG changes (positive dynamics of ST segment, tines T and the pathological Q wave).
The subacute period
This stage lasts up to 2 months and completed the formation of connective tissue scar. The patient’s condition almost returned to normal, disappear or flatten the symptoms of heart failure. Some patients at the end of this stage may develop pericarditis, pleurisy, pneumonia, fever, joint pain and hives (Dressler syndrome).
Lasts up to six months. At this time, the heart adapts to new conditions of work and the consolidation of the scar. Reducing the amount of shrinking of the heart cells, the patient may experience symptoms of angina, congestive heart failure. Often during this period, developing re-infarction. On ECG there are signs formed before the end of the scar.
The key diagnostic parameters of the disease are:
- the typical clinical picture (in cases of angina variant);
- ECG changes. Allow you to put a correct diagnosis the majority of patients. The main symptoms of heart attack are: the appearance of pathological Q wave or QS complex, ST segment, and some others;
- dynamics of activity of enzymes in the blood. Changes of enzymes clearly relate to specific indicators and time that has passed from the alleged onset of the disease.
Varieties and classification of infarction
In addition to allocating specific development stages of a heart attack klassificeret:
- the volume of the lesion on small — and large-focal;
- current patterns: repeated, protracted, recurrent and monocycline;
- the location of the lesion: the apical, the left and right ventricle, infarction of the septum and others;
- anatomy: transmural, intramural, subepicardial etc.
Complications and consequences of disease
Complications of infarction determine severity of the disease, complicate its flow and often cause death. There are complications of the early and late period.
Early complications appear in the first few days or hours after the start of a heart attack. Such complications include:
- cardiogenic shock;
- acute heart failure;
- violation of rhythm and conductivity;
- a broken heart;
- aneurysm of the heart;
The previously frequent complication is the variability and development of extrasystoles, blocks and arrhythmias. Such processes are aggravated course of the disease, which ultimately can lead to heart failure.
Rupture of the heart occurs very rarely and appears when the total defeat of the heart muscle. For external gaps, the disease ends in death in any patient.
In late period, there may be involvement of pleura, lung and pericardium. Uncommon stiffness and soreness of the joint of the left shoulder.
In some patients there are mental disorders, especially among the elderly. They become irritable, develops hypochondria, hysteria and depression.
Approaches to therapy
The treatment of the disease is made on several fronts:
- elimination of pain. At home in the first place taking nitroglycerin and in the hospital to relieve pain neuroleptics and narcotic analgesics;
- restriction of range. It is necessary to restore coronary blood flow and the heart to provide sufficient amount of blood. Use of thrombolytic preparations, beta-blockers and vasodilators;
- improves the blood flow in the area of narrowing of the coronary artery;
- treatment of associated symptoms and complications;
- psychological and physical recovery of the patient.
Myocardial infarction is a severe pathology, the outcome of which depends on timely diagnosis and the therapy. You should know how to recognize the disease in its early stages and prevent its beginning through preventive interventions.