Extensive heart attack

Author: ambulance doctor Deryushev A.N.

Myocardial infarction - acute oxygen starvation (hypoxia) of the heart muscle - myocardium, which occurs when the coronary vessel is blocked, that is, one of the blood vessels that supply the myocardium with blood rich in oxygen. This condition develops usually sharply, suddenly, but appears against a background of a long process of changes in the vascular wall. Similar changes are associated with the formation of atherosclerotic plaques, as a manifestation of the general process of atherosclerosis.

Of great importance in this is the presence of risk factors, among which the lifestyle is perhaps the first place, namely the violation of categories related to the concept of lifestyle, and leads to serious vascular catastrophes - such as myocardial infarction and stroke (cerebral infarction). Among these reasons it is necessary to name the most important: smoking, sedentary lifestyle, wrong attitude to stressful situations, abundant fatty and fried foods, especially rich in cholesterol, that is, containing animal fats.

An infarct can occur both against a background of such manifestation of coronary heart disease as angina, and against the background of relative health, when the arisen attack of pain in the heart leads to the formation of a heart attack.

Classical clinic of myocardial infarction consists in the appearance of an attack of burning pain behind the sternum, which appears against the background of a physical or nervous load, or at rest. The pain is constant, it is not removed by the usual methods, that is, the intake of nitrates (nitroglycerin, isoket), it does not bring relief of such pain. Pain can irradiate (give) to the left arm, under the left scapula, to the left side of the neck. Simultaneously there is general weakness, a sticky cold sweat, lowering blood pressure, heart rate may change both in the direction of acceleration and in the direction of loss. All this clinical picture is the reason for urgent medical treatment, since timely rendered emergency care at the prehospital stage, as well as the continuation of this assistance already in a hospital environment is important not only for the patient's continued health, but also often for life in general . Since both the myocardial infarction and its complications are extremely life-threatening conditions.

The magnitude of the infarct is determined, first of all, by the diameter of the clogged vessel - after all, the larger the vessel, the larger the area of ​​the heart muscle it supplies with blood. Left without blood supply - the area of ​​the myocardium first experiences oxygen starvation (hypoxia), then ischemia, and then tissues deprived of oxygen begin to die - a zone of necrosis is formed. The more this zone, the more extensive is the heart attack. Sometimes the necrosis zone can capture the whole wall (anterior, posterior, lateral) of the heart, with the transition to another wall, the septum, etc., depending on localization.

In addition, the infarction zone also depends on the timeliness of the beginning of the care - the earlier the patient will receive assistance at the prehospital stage, and the sooner he is taken to the cardiac hospital - the more chances he has that the infarction zone will be less. In the pre-hospital stage, anesthesia is used, in some cases, pain syndrome uses narcotic analgesic morphine, nitrates are used, drugs that have disaggregation properties (aspirin, clopidogrel), oxygen therapy. If there is a possibility and no contraindications at the prehospital stage, a thrombolysis procedure can be performed, provided that the heart is constantly monitored, and if necessary, defibrillation.

Treatment of acute myocardial infarction in the hospital is carried out in the intensive care unit and includes both conservative and cardiac surgical methods according to established standards. First aid for angina and myocardial infarction should be comprehensive.

Unfortunately, extensive myocardial infarction often occurs with complications at the very beginning of the disease, so with a large heart attack, cardiogenic shock can often develop. This greatly aggravates the patient's condition and can lead to death even at the prehospital stage, especially if the patient does not immediately seek help, or he does not have the opportunity to receive emergency care in a short time.