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Myocardial infarction


Heart disease caused by insufficiency of its blood supply with a focus of necrosis (necrosis) in the heart muscle (myocardium); the most important form of coronary heart disease. Myocardial infarction is caused by an acute blockage of the lumen of a coronary artery by a thrombus, a swollen atherosclerotic plaque.
Symptoms and course:
The onset of myocardial infarction is considered to be the emergence of an intense and prolonged (more than 30 minutes, often many hours) chest pain (anginous state) that cannot be stopped by repeated nitroglycerin intakes; sometimes in a picture of an attack, suffocation or pain in the epigastric region prevails. Complications of an acute attack: cardiogenic shock, acute insufficiency of the left ventricle up to pulmonary edema, severe arrhythmias with a decrease in blood pressure, sudden death. In the acute period of myocardial infarction, arterial hypertension is observed, which disappears after pain subsides, pulse increases, body temperature rises (2-3 days) and the number of leukocytes in the blood, followed by an increase in soe, increased activity of the enzymes creatine phosphorophenase, aspartate aminotransferase, lactate dehydrogenase, and etc.. pericarditis (pain in the sternum, especially when breathing, is often heard pericardial friction noise). Complications of acute phase include, besides the above mentioned acute psychosis, recurrent infarction, acute left ventricular aneurysm (bulging of its thinned necrotic portion), lacerations - infarction, interventricular septum and the papillary muscles, cardiac insufficiency, various disturbances of rhythm and conduction, bleeding from acute ulcers stomach, etc. With a favorable course of the process in the heart muscle enters the stage of scarring. A complete scar in the myocardium is formed by the end of 6 months after a heart attack.
Recognition is carried out on the basis of the analysis of the clinical picture, characteristic changes in the electrocardiogram during dynamic observation, and an increase in the level of cardiospecific enzymes. In doubtful cases, echocardiography (detection of "fixed" zones of the myocardium) and radioisotope examination of the heart (myocardial scintigraphy) are performed.
Treatment:
Urgent hospitalization of the patient is necessary. Before the ambulance arrives, it is necessary to give the patient nitroglycerin (from one to several tablets with an interval of 5-6 minutes). Validol in these cases is ineffective. At the hospital, attempts are possible to restore coronary vascular patency (melting of blood clots with the help of streptokinase, stertodekazy, alvesin, fibrinolysin, etc., the introduction of heparin, urgent surgical intervention - emergency aorto-coronary bypass surgery). Required painkillers (narcotic analgesics, analgin and its drugs, possible anesthesia with nitrous oxide, etc., epidural anesthesia - the introduction of painkillers under the membrane of the spinal cord), nitroglycerin (intravenous and oral), calcium channel antagonists (veraiamil, nifedipine, synovitis) are used , betaadrenoblockers (obzidap, anaprilin), antiplatelet agents (aspirin), treat the complications. Rehabilitation (restoration of a stable level of the patient’s health and ability to work) is of great importance. The activity of the patient in bed - from the first day, sitting down - from 2-4 days, getting up and walking - for 7-9-11 days. The terms and amount of rehabilitation are selected strictly individually, after the patient is discharged from the hospital, it is completed at the clinic or sanatorium.