A man's heart is working constantly throughout his life and he needs a constant supply of oxygen and nutrients. To do this, the heart has its own extensive system of blood vessels, which in appearance resembles a crown or a crown. Therefore, the vessels of the heart are called coronary or coronary. The work of the heart and the continuous movement of blood through the vessels of the heart must also be continuous.
Myocardial infarction - is necrosis (death) of heart muscle caused by an acute violation of the coronary circulation as a result of mismatch between the demand of the heart muscle of oxygen and its delivery to the heart.
Over the past 20 years, mortality from myocardial infarction in men increased by 60%. A heart attack is much younger. It is now not uncommon to see the diagnosis for thirty years. While he was spared women and 50 years, but then the incidence of heart attacks in women compared with the incidence in men. A heart attack is also a major cause of disability and mortality among all patients is 10-12%.
In 95% of cases of acute myocardial infarction is the cause of coronary artery thrombosis in an atherosclerotic plaque. When atherosclerotic plaque rupture and its erosion (formation of ulcers on the surface of the plaque), crack the inner lining of the vessel below the injury site to adhere platelets and other blood cells. A so-called "platelet plug". It thickens and grows rapidly in size and eventually closes the artery. This is called occlusion. Supply of oxygen the heart muscle cells, which are fed enough roofed artery for 10 seconds. Another 30 minutes of cardiac muscle remains viable. Then begins the process of irreversible changes of the heart muscle, and the third-sixth hour of the start of occlusion of the heart muscle dies on this site.
There are five periods in the development of myocardial infarction:
1. Predinfarktny period. It lasts from several minutes up to 1.5 months. Usually at this time are becoming more frequent bouts of unstable angina, increasing their intensity. If the time to begin treatment, heart attack can be avoided.
2. The acute period. Often occurs suddenly. During this period, forming the flow infarkta.Varianty option may be the following:
Anginal (pain). This is the most frequent variant in which flows 90% of heart attacks. It starts strong pain, crushing, burning, compressing, or Expander nature of the sternum. The pain is worse, giving in the left shoulder, arm, clavicle, scapula, the lower jaw on the left. The duration of pain attack from several minutes to 2-3 days. Most patients have a sense of fear, autonomic reactions (cold sweat, paleness or redness of the face). Asthmatic - when the heart attack begins with wheezing, asthma or cardiac pulmonary edema. This variant is more common in elderly patients and patients with recurrent myocardial infarction.
When abdominal variant heart begins with pain in the abdomen. The patient may have nausea and vomiting, and abdominal distension. Sometimes a variant of myocardial flow is taken as a surgical disease.
Occasionally encountered arrhythmic version of myocardial infarction. He may start a sharp quickening heart rate, or vice versa complete atrioventricular block, when the heart rate slows dramatically and the patient loses consciousness. Cerebral (brain) version of a myocardial infarction occurs if the pain in my heart and not because of reduced blood supply to the brain, headaches, dizziness, visual disturbances. Sometimes there may be paralysis and paresis of the limbs.
3. The next period is called acute. It lasts about 10 days. During this period, finally a zone of dead heart muscle and on-site necrosis begins to form a scar. During this period may increase the body temperature.
4. About 8 weeks continued the next period - sub-acute. During this time, fully formed and sealed scar.
Five. Further, during the last 6 months post infarction period in which to place the patient's condition stabilized. In the same period of possible re-infarction, the occurrence of angina or heart failure.
The diagnosis is established by the presence of three criteria:
changes in the electrocardiogram
changes in biochemical indicators of blood, speaking of the heart muscle cell damage.
Treatment of myocardial infarction necessarily performed in a hospital in the intensive care unit. The sooner the patient gets there, the better the outcome. However, treatment should begin immediately. Before the arrival of an ambulance should put the patient, give him nitroglycerine. Treatment starts with a struggle with the pain. If it can not be reduced by nitroglycerin or other nitrates administered opioids intravenously. Pain should be removed because it can lead to cardiogenic shock from which the patient is very difficult to deduce. Next, using drugs of different groups.
To improve the patient's condition can be in three ways:
Dissolve the blood clot formed in the arteries. This is the most modern method of treatment and it is called thrombolysis. The sooner the drug is injected to dissolve the clot, the better the result. The maximum effect is achieved within the first hour of early myocardial infarction. This time even the name "gold". The dissolution of thrombus in 6 hours can be saved only about 5% of the affected heart muscle. Used drugs streptaza, kabikinaza.
Reduce the load on the heart. Appointed by drugs that reduce blood pressure, reduce blood volume, heart rate slows, and thus reduce the need for heart muscle of oxygen and to extend the life of the starving cells in the infarct zone. Improve the metabolism in the myocardium (preductal, vitamin E).
Treatment of heart attack is not limited to treatment in hospital. Once a hospital begins a long rehabilitation period, which lasts up to 6 months. During this period, gradually increasing exercise. Myocardial infarction completely changes a person's life. Such patients should be aware that medications be taken for life. Of bad habits to break. Blood pressure control. But you can live after a heart attack, you can live fully, listening to the advice of doctors.