Myocardial infarction: how to recognize and provide first aid?

Why does myocardial infarction develop?

Our heart is a tireless worker. In one minute it pumps more than five liters of blood and makes about one hundred thousand beats. The heart performs the most important functions for the human body:

• due to rhythmic contractions, it ensures blood flow through the blood vessels;
• saturates organs and tissues with oxygen;
• removes carbon dioxide and other harmful substances from the body.

With the development of myocardial infarction, the heart loses its ability to function normally, which often leads to disability and death.

The main cause of myocardial infarction is atherosclerosis, a chronic vascular pathology caused by impaired lipid and protein metabolism. During the disease, atherosclerotic plaques form in the lumen of blood vessels - dense formations of cholesterol, covered with fibrous tissue on top.

With certain changes in the body (stress, increased blood pressure), vascular spasm occurs, which often leads to rupture of an atherosclerotic plaque with the formation of blood clots. If this occurs in the heart muscle, then acute myocardial infarction develops. If in the intestines, then intestinal infarction, etc.

People with chronic diseases have an increased likelihood of developing myocardial infarction:

• diabetes mellitus;
• hypertension;
• coronary heart disease;
• varicose veins of the lower extremities.

About the danger of heart attack and the effectiveness of coronary stenting

What do we know about heart attack? Almost everyone has heard that this is a serious, deadly condition. In the relatively recent past, saving the life of a person with a massive heart attack was considered a truly remarkable result of treatment, and with the most favorable course of the disease it meant long months of strict regime, slow recovery, and loss of ability to work. Today, medicine poses different tasks: not just to save, but to return a person to normal life, and the provision of specialized medical care plays an important role here. At the same time, maintaining heart health depends on ourselves.

KONSTANTIN ALEKSENDROVICH KIREEV, head of the Center for X-ray endovascular diagnostics and treatment about the danger of heart attack and the effectiveness of coronary stenting:

— First of all, it is necessary to understand what acute myocardial infarction is. This is necrosis, that is, the death of a section of the heart muscle, developing as a result of a sudden, acute disturbance of blood flow in the coronary (related to the heart) artery system. Blockage of a branch of the coronary artery can be caused by its thrombosis, less often by embolism or long-term (more than half an hour) persistent spasm.

The most common cause of a heart attack is atherosclerosis, when atherosclerotic plaques form on the walls of blood vessels: they narrow the lumen of the coronary arteries and can also contribute to the destruction of their walls, which provokes the formation of blood clots and blockage.

An acute heart attack causes irreversible changes in the heart muscle: the death of part of the functional muscle cells of the heart (necrosis) and their subsequent replacement with connective tissue, that is, the formation of a post-infarction scar. The scar on the myocardium remains for life. It cannot resolve, and the heart always remembers the heart attack. Subsequently, a violation of the blood supply to the myocardium can lead to a disorder of cardiac activity: heart failure develops, that is, the heart does not perform its functions in full, accordingly, for the full existence of the whole organism there is simply not enough “power”.

In simple terms, due to an acute circulatory disorder, the heart gradually begins to “die”, and in order to save a person’s life, it is necessary to restore blood circulation as soon as possible. If medical care is not provided in a timely manner, a person with a heart attack may die within the first 24 hours. In general, the prognosis of the outcome of a heart attack depends on the size of the myocardial lesion, the severity of the course, the age of the patient, and the development of complications. But in any case, the prognosis of the disease is influenced by the timeliness of the start of treatment and its adequacy.

More than 5,000 myocardial infarctions are registered annually in the Chelyabinsk region, and this disease still remains one of the main causes of premature death. For a long time, the treatment of acute infarction in our area was far from the most advanced strategy. According to indications, thrombolytic therapy was carried out, that is, the administration of drugs that resolve the blood clot and restore the patency of the vessel. Such assistance was provided both by emergency medical teams before hospitalization and in intensive care units of hospitals. The success of treatment often depended on the correct choice of drug and the timely start of its use. Of course, there was no talk of the high effectiveness of drug therapy: a very high percentage of deaths (about 16−20%), and if a person remained alive, he became disabled, his heart could not work properly.

The situation changed fundamentally in 2011, when, as part of the healthcare modernization program in Chelyabinsk, they began to perform emergency operations for acute myocardial infarction - percutaneous coronary interventions, including stenting of the coronary arteries. This was an undeniable breakthrough for Chelyabinsk healthcare.

Coronary stenting is the most effective way to treat acute myocardial infarction due to the complete elimination of circulatory disorders through direct and immediate impact on the infarction. The essence of the method is to install a special stent into the affected vessel through the radial artery (on the wrist) in order to restore blood flow. A stent is a metal mesh structure that resembles a hollow tube of small diameter. Using a special balloon, a folded stent is inserted into the artery, under the control of an X-ray machine, it is delivered to the site of narrowing of the vessel, then, when the balloon is inflated under pressure, it is expanded and implanted, expanding and supporting the affected vessel in the area of ​​blockage or critical narrowing and restoring blood flow. Also, in order to make the intervention most effective and safe, a wide range of special drugs are used.

The advantages of stenting also lie in the fact that this operation is low-traumatic, practically painless, has a small number of complications, reduces the length of hospital stay from 15-17 to 7-11 days, makes it possible for the patient to become active early and refer him for rehabilitation to a sanatorium. resort conditions. Thanks to stenting in acute myocardial infarction, mortality has decreased by almost half, and today it is about 6%. But the most important thing is that after a heart attack the patient can return to a normal, fulfilling life, to his work.

COMMENT BY EVGENY MIKHAILOV, chief freelance cardiologist of the South Ural Health Directorate, candidate of medical sciences:

— During a heart attack, approximately half the thickness of the heart muscle dies in the first three hours, and in the next three hours the entire thickness of the muscle dies. Therefore, stenting in the acute period of myocardial infarction is effective if it is performed as early as possible, no later than the first 6 hours from the onset of the infarction, optimally - up to 2-3 hours. Restoring blood flow in a clogged artery in this time period, before the development of irreversible changes in the myocardium, sharply reduces the area of ​​the infarction, and sometimes makes it possible to “interrupt” its development. When we intervene after these 6 hours, we can only reduce the area of ​​necrosis, but not save from myocardial infarction. Because patients arrive too late, half of them do not survive.

Here, a lot depends on how quickly the patient or his relatives call an ambulance. People should know the clinical manifestations of myocardial infarction. If you suddenly experience severe, usually frightening, pain in the chest that cannot be relieved by taking nitroglycerin, you should not hesitate, call an ambulance immediately. Thus, first aid will be provided on the spot: the team carries out intensive therapy to relieve pain and dissolve the blood clot, and will deliver you to the hospital as quickly as possible. But I repeat once again, the most important thing is to call an ambulance on time!

About the work of the X-ray surgical service

Four days a week we receive patients from 4 districts of Chelyabinsk and 7 municipalities of the Chelyabinsk region, a population of 700 thousand people. Today, percutaneous coronary interventions are one of the priority areas of work for the Road Clinical Hospital. It should be noted that we provide emergency assistance to everyone without exception, and not just assigned citizens. Among the hospitals of the Russian Railways-Medicine health care network from Kaliningrad to Khabarovsk, we have the largest volume of emergency coronary stenting operations.

We are interested in ensuring that a patient who came to us sick leaves us relatively healthy, relatively quickly, so that he can return to work with minimal loss of quality of life. Every effort is being made to achieve this. All actions of medical personnel are very clearly organized to quickly determine treatment tactics - from the emergency department to the patient’s admission to the cath lab or intensive care unit. We not only strive to provide this assistance as quickly as possible, but we also have every opportunity to do so.

Effective results are also facilitated by the fact that practical work is always carried out in close connection with science. On the basis of the road hospital there are two main departments of the South Ural State Medical University, which means the introduction of modern technologies into the treatment process, continuous training of specialists, provision of advisory assistance, joint analysis of the treatment and clinical cases.

We should always evaluate our work in accordance with global standards so that we can understand whether we are doing good or bad work. Thus, it is considered that a medical organization is working well when 70% of patients with heart attacks undergo coronary stenting. In 2021, this figure was 76%. In my opinion, today everything that is necessary is being done to save lives and preserve people’s health.

How not to “live to have a heart attack”

There are major risk factors that can lead to the development of myocardial infarction. We can influence some of them, but not others. You cannot influence, for example, gender (men are more susceptible to coronary heart disease), age, family history, or hereditary predisposition. However, we can significantly reduce the adverse effects of factors such as arterial hypertension, smoking, diabetes, high cholesterol, excess weight, and a sedentary lifestyle. All these factors, both in combination and each independently, provoke the development of atherosclerosis, which, as I have already said, is the main cause of myocardial infarction.

We conducted a study of medical and social status, quality of life, and the presence of risk factors for atherosclerosis in a group of patients diagnosed with myocardial infarction. 200 people took part in the survey, all residents of Chelyabinsk, under the age of 65 (this age group is at risk of premature death, a generation that in 10 years will give the expected average life expectancy in the country).

The results of the study revealed that the lifestyle of our patients leaves much to be desired. Every second patient smokes, 90% have a smoking history of more than 20 years, 2/3 of patients smoke a pack of cigarettes or more per day. Arterial hypertension was detected in 70% of patients, while only 20% of them take antihypertensive drugs; diabetes mellitus - in 40%, high cholesterol - in 42%, obesity - in 55%, that is, in every second person studied.

Moreover, every third out of 200 patients suffers from a second heart attack, because people neglect secondary prevention, in particular, drug therapy and giving up bad habits. Many patients, feeling almost healthy after stenting, want to forget about the disease as soon as possible. However, we must not forget about it. In order for the heart to work efficiently, for a year you need to take special medications to thin the blood, improve cardiac output, contribute to minimal changes in the myocardium after a heart attack, and statins to lower cholesterol levels. It is also necessary to give up smoking, alcohol, monitor your weight, adhere to a certain diet, etc. The result of non-compliance with these recommendations is always disastrous.

I note that the number of patients in whom a heart attack is not associated with atherosclerosis, but is most likely caused by a sharp spasm of the coronary artery against the background of severe stress or a large loss of fluid and, as a consequence, thickening of the blood and the formation of a blood clot, in the study group is very, very small .

Indeed, people think little about their health, they ignore alarming symptoms due to an irresponsible attitude towards themselves or out of ignorance, although there is enough necessary information in the media and on the Internet, there are very good social advertising videos. But citizens simply do not pay attention to this.

Today, medical capabilities make it possible to save the lives of patients even with severe heart attacks. But not only doctors, but also ordinary people should be wary in this regard. Without this, no technology will help. Atherosclerosis is a very vicious disease; it affects many vessels, not only those related to the heart, but also in the brain and limbs. Therefore, proper attention to your health is so important.

Give up bad habits and “fast food”, add more physical activity to your life, devote at least 30 minutes a day to physical exercise and walking in the fresh air. Also, do not skip medical examinations and consult a doctor on time.

Even if you undergo a medical examination once every three years, this will allow you to identify existing health problems and correct them before the bell rings.
Now there are very good and affordable medications that can not only improve the situation, but actually affect the prognosis for a person’s life. A heart attack can be prevented, and not at the cost of any incredible efforts or means. You just need to be a little more attentive to yourself. Share

Clinical options for the development of myocardial infarction

The classic form of myocardial infarction is accompanied by a severe pain syndrome of a compressive, tearing, burning nature. The pain is most often localized behind the sternum, but can also radiate to the left arm, left shoulder, lower jaw, and interscapular area. As a rule, the pain lasts more than 20 minutes and is not relieved by nitroglycerin within 5 minutes.

Other symptoms of classic myocardial infarction:

• increased sweating;
• psychomotor agitation;
• feeling of fear of death.

There are also atypical options for the development of myocardial infarction:

• abdominal form. In this case, the patient experiences heartburn, nausea, vomiting, pain in the upper abdomen;
• arrhythmic form. Characteristic signs are heart rhythm disturbances, a feeling of interruptions in the heart;
• asthmatic form. The main symptoms are shortness of breath, suffocation;
• painless form. It is characterized by the absence of pain or the presence of mild pain that occurs at varying frequencies. This form especially often develops in patients with diabetes mellitus and in people who have already suffered a myocardial infarction in the past.

Why is the painless form dangerous? First of all, the development of sudden cardiac death. In addition, if in the acute period a myocardial infarction occurs without clear clinical symptoms, then in the future this can lead to the development of chronic heart failure.

The painless form of myocardial infarction can be recognized by other signs. For example, a person may experience shortness of breath, increased fatigue, and exercise intolerance.

What symptoms of a microinfarction do women experience?

The disease is very “insidious”, since the symptoms of a microinfarction in women are not always noticeable. Because of this, the diagnosis is made after the fact when other diseases occur.

One of the first symptoms is sudden chest pain. Pain may be present in the left side of the shoulder girdle, shoulder blade and jaw.

According to statistics, women are less likely to pay attention to the symptoms of a heart attack, as they are less sensitive to pain. Also, microinfarction often goes unnoticed by patients over 55-60 years of age and diabetics.

First aid for myocardial infarction

In providing first aid, the principle of the “golden hour” is very important, from the moment the symptoms of the disease appear until the patient is admitted to the hospital. In critical situations, even more rapid action is required. The severity of the condition during a heart attack depends on how much the lumen of the vessel is blocked by a thrombus. If occlusion (complete obstruction) of a vessel occurs, a critical condition develops. The patient has 20–40 minutes left, after which necrosis of the cardiac tissue occurs.

It is very important not to wait for the pain to subside or for the work day to end. If symptoms characteristic of a heart attack appear, you should immediately take the necessary medications and call an ambulance.

Before doctors arrive, a person with coronary syndrome should be provided with first aid.

Correct algorithm of actions:

1. Place the person in a semi-sitting position. For example, you can put the patient in bed and place pillows under his back. A semi-sitting position reduces the load on the heart.
2. Provide the patient with complete physical and mental rest, try to calm him down. Physical and emotional stress increases myocardial ischemia and increases the need for oxygen in the heart muscle.
3. Free your body from constrictive elements of clothing - remove your tie, belt, unbutton your shirt collar.
4. Create an influx of fresh air - open a window or vent.
5. Give the patient half a tablet of aspirin to chew. This will reduce the area of ​​the heart attack and reduce the risk of death.
6. If possible, you need to measure the person's blood pressure.
7. If you have high blood pressure, be sure to give a drug for hypertension, as well as nitroglycerin. Nitroglycerin capsules are placed under the tongue and sprayed under the root of the tongue as a spray.

General signs of microinfarction

Since the symptoms of a microinfarction can easily be confused with a regular illness, it is important to pay attention to the appearance of several signs at the same time.

What symptoms indicate a microinfarction:

• increased temperature, which causes necrosis of cardiac tissue;
• feeling of pain and aches in the joints;
• dizziness, weakness, possible loss of consciousness;
• swelling;
• sudden pain in the chest, radiating to the stomach, shoulder, shoulder blade;
• the appearance of shortness of breath, acute lack of air;
• pain in the solar plexus area;
• cyanosis of the nasolabial triangle, lips.

Usually the attack lasts 40 minutes, and if no serious consequences occur, the symptoms go away. But this does not mean that they can be ignored. If signs of a microinfarction appear, you should immediately consult a doctor.

Complications

Complications of myocardial infarction are early and late. As a rule, early complications develop in the first hours of a heart attack during hospitalization or for several days after the attack. The occurrence of complications is significantly influenced by the timeliness of first aid and hospitalization.

The most common early complications include:

• disturbances in the rhythm and conduction of the heart, which in most cases are fatal;
• rupture of the heart muscle;
• development of acute left ventricular failure, which is accompanied by pulmonary edema.

The last stage of left ventricular failure is cardiogenic shock, in which myocardial contractility sharply decreases and the blood supply to all organs is disrupted. The condition is accompanied by a strong drop in blood pressure, a decrease in body temperature, pale skin, difficulty breathing, oliguria, and loss of consciousness. The probability of death with cardiogenic shock is 90%.

Late complications of myocardial infarction:

• early post-infarction angina. A person who has such a complication does not tolerate even the slightest physical activity. Any activity causes squeezing pain behind the sternum. Even simple self-care activities lead to pain. The pain is less severe than during a heart attack itself, but quite painful;
• chronic heart failure, which is accompanied by shortness of breath, edema of the lower extremities, enlarged liver, and the development of chronic left ventricular aneurysm.

Indications and contraindications for the treatment method

Indications for stenting are:

• Myocardial infarction with ST segment elevation.
• Unstable angina and myocardial infarction without ST segment elevation.
• Stable ischemic heart disease.

There are no absolute contraindications to stenting of coronary arteries. The main contraindication is the impossibility of prescribing antiplatelet therapy.

Relative contraindications: acute renal failure, chronic renal failure, ongoing gastrointestinal bleeding, fever of unknown origin, possibly infectious, untreated active infectious process, acute stroke, severe anemia, malignant uncontrolled arterial hypertension, severe electrolyte disturbances, lack of contact with the patient due to with a psychological condition or serious illness, severe concomitant pathology in which coronary angiography can complicate the course of the disease, patient refusal of necessary further treatment (coronary angioplasty, coronary artery bypass grafting, valve replacement), digitalis intoxication, documented anaphylactic reaction to a contrast agent, severe illness peripheral vessels, impeding access to the vascular bed, decompensated congestive heart failure or pulmonary edema, severe coagulopathy, aortic valve endocarditis.

Rehabilitation

a cardiologist twice a month . During the second year after the attack, it is necessary to visit a general practitioner once every four months. If necessary, each of these specialists can refer the patient to a rehabilitation center or sanatorium.

For successful rehabilitation, it is important for the patient to strictly follow all the doctors’ recommendations:

• take necessary medications. These may be statins, anticoagulants, antihypertensive drugs;
• maintain a balance between sleep, work and rest;
• walk in the fresh air more often;
• avoid stress. After a heart attack, a person should receive only positive emotions.

Therapy

The patient is taken to intensive care, where complex therapy is carried out. When treating a heart attack, the speed of reaction is very important: the faster the patient gets to the hospital and receives proper care, the higher the chances of a positive outcome and the absence or minimum number of complications.

Doctors use drugs that help dissolve a blood clot, painkillers, and medications to lower blood pressure and reduce blood circulation. Also, as part of treatment, it is necessary to achieve a decrease in heart rate, which is achieved by taking beta-blockers.

The rehabilitation period after inpatient treatment is no less important than the therapy itself. The recovery period lasts up to 6 months. The patient may be prescribed medications that must be taken constantly. Also, to maintain normal condition, it is necessary to follow a diet, in particular, eliminating fatty and fried foods from the diet, as well as stopping smoking and drinking alcohol.

If the doctor's recommendations are followed, the patient can count on a long and fulfilling life.

How the treatment method works

Coronary artery stenting for myocardial infarction includes the following steps:

1. A stent is inserted into the narrowing of the coronary artery using a special balloon catheter. A stent is a stainless metal tube with many cells of various configurations.
2. When the balloon is inflated, the stent expands in diameter and is pressed tightly into the artery wall, increasing the lumen of the narrowed vessel, which allows blood to flow freely to the heart.
3. The balloon is deflated and removed, while the stent remains permanently in place at the site of narrowing or blockage.

Coronary artery bypass grafting is performed on an open heart. The idea is to create a bypass (shunt) from the aorta to the coronary artery, bypassing the site of blockage or narrowing. Usually the material for the shunt is the person’s own vein; sometimes it is necessary to use artificial material. Your attending physician will tell you in more detail about the stages of coronary artery bypass surgery itself.