Complications of a heart attack in the acute period. Description of early and late complications in acute myocardial infarction

Early complications myocardial infarction:

1) cardiogenic shock is caused by a decrease in cardiac output, tachycardia, a drop in blood pressure, especially a drop in venous pressure (and, as a manifestation of the latter, by a decrease in the filling of the cervical veins and semi-fainting), signs of impaired peripheral circulation. 2) fraying heart failure 3) ruptured heart, pericarditis, ruptured heart is a rare complication of myocardial infarction, but leads to almost 100% mortality. More often occurs on the 5-6th day from the onset of a heart attack, but it can occur in the first days of the disease. Myocardial rupture is clinically manifested by severe pain that is not relieved by taking analgesics. With a rupture of the myocardial wall, a picture of cardiogenic shock and cardiac arrest caused by cardiac tamponade rapidly develop. With an extensive rupture, death occurs instantly, with a small rupture, within a few minutes or even hours. 4) thromboembolic complications, 5) aneurysm of the heart, This is a limited protrusion of the myocardial wall, usually of the left ventricle. More often, an aneurysm is formed in the acute, less often in the subacute period of myocardial infarction. Its formation is associated with the pressure that blood exerts on the damaged area of \u200b\u200bthe heart muscle. 6) acute disturbances of rhythm and conduction. (Violations of rhythm and conduction occur in the vast majority of patients with myocardial infarction.)

Late complications of myocardial infarction: 1)postinfarction Dressler's syndrome is a late complication that occurs one, several weeks after a heart attack as an immunological reaction to tissue necrosis. More often it manifests itself with a slight fever, signs of dry or effusion pericarditis and pleurisy, eosinophilia, sometimes arthralgia and other nonspecific reactions, a repeated increase in ESR.

2) chronic aneurysm of the heart, These are aneurysms that persist for more than 6 weeks. after myocardial infarction. They are less malleable and usually do not bulge during systole. Chronic aneurysms develop in 10-30% of patients after myocardial infarction, especially the anterior one. Chronic left ventricular aneurysms can cause heart failure, ventricular arrhythmias, and thromboembolism of the arteries of the systemic circulation, but are often asymptomatic. 3) chronic heart failure. Chronic heart failure is the inability of the cardiovascular system to provide the organs and tissues of the body with sufficient blood.

-Cardiogenic shock - a special and most severe form of left ventricular failure, leading in most cases to death, and occurs with extensive myocardial infarction.

Cardiogenic shock is caused by a decrease in cardiac output, tachycardia, a drop in blood pressure, especially a drop in venous pressure (and, as a manifestation of the latter, by a decrease in the filling of the cervical veins and semi-fainting), signs of impaired peripheral circulation. Clinic: 1 short-term phase of excitement (5-10 minutes): motor and speech excitement, complaints of pain, because the patient has hypersensitivity, muscle tension, rapid shallow breathing, tachycardia, increased blood pressure, fever, sweating.

P phase - torpid - the patient is lethargic, passive, there are no complaints due to loss of sensitivity.

Cold pale skin, cyanosis, sharpened facial features, impaired consciousness, drop in urine output (less than 20 ml per hour). Heart sounds are deaf, systolic murmur is heard, tachyarrhythmia, systolic pressure - 80-60 mm Hg, diastolic is not determined. Breathing is shallow, frequent or infrequent. Oliguria, up to anuria. There may be convulsions, involuntary discharge of urine and feces. In severe cases, consciousness is darkened, pulse and blood pressure are not determined, breathing fades, and death quickly occurs. In rare, prognostically relatively more favorable cases, cardiogenic shock is associated not so much with the extent of the lesion of the contractile myocardium, but with tachyarrhythmia, hypovolemia.

Urgent Care... To increase the blood flow from the periphery, the victim's legs should be raised by 15-20 "and left in this position (can be placed on 2-3 pillows). Introduction s / c, i / m or i / v 0.5-1.0 ml of 0.1% solution of atropine, as a rule, relieves bradycardia well.In the presence of signs of BCC deficiency and initially low CVP, treatment should be started with intravenous administration of low molecular weight dextrans such as rheopolyglucin.This drug promotes a fairly rapid recovery of BCC, normalizes impaired rheological properties of blood , improves microcirculation. Its daily dose should not exceed 1000 ml. The use of rheopolyglucin can be combined with other plasma substitutes. The daily volume of infusion therapy can be up to 5 liters or more. Correction of the volume deficit should be carried out under constant control of CVP, blood pressure and hourly urine output. Treatment principles cardiogenic shock adequate pain relief; sympathomimetics; fibrinolytic drugs and heparin; low molecular weight dextrans (rheopolyglucin); normalization of acid-base balance; auxiliary blood circulation (counterpulsation).

1) symptoms: Shortness of breath- the number of respiratory movements is more than 20 per 1 minute, arises from a decrease in heart contractions and stagnation of blood in the vessels of the pulmonary circulation. Shortness of breath in heart disease, inspiratory, often of a mixed nature, is noted during exertion and at rest; sometimes at night there are attacks of suffocation, accompanied by coughing and the separation of foamy pink sputum - cardiac asthma and pulmonary edema. Causes of shortness of breath: heart disease (coronary artery disease, arrhythmias, heart defects). Questions to ask the patient for shortness of breath are as follows:- Do you feel a lack of air?

Does it happen during exercise? - Do you wake up at night due to lack of air? - how many pillows do you sleep on? - Do you have a cough and a wheezing sound? Heartache arise due to insufficient blood supply to the myocardium, often of a compressive nature, localized behind the sternum, radiating to the left hand, left shoulder... Causes of coronary pain: angina pectoris, myocardial infarction, aortic stenosis. Questions to the patient to clarify the nature of the pain are as follows:

Did the pain appear during exercise? - in which place? - Does it disappear alone? - does it appear under stress? - do you take nitroglycerin? - what is the nature of the pain? - the duration of the pain?

Heartbeat - a feeling of heartbeats. Causes: tachycardia, extrasystole, atrial fibrillation, paroxysmal tachycardia, sometimes palpitations are felt even with a normal number of heartbeats. - Do you feel the rhythm right or wrong? - constantly or in fits? - what provokes an attack? - what stops? - what are you doing?

Edema arise due to stagnation of blood in the systemic circulation and sweating of the liquid part of the blood through the walls of the vessels in the tissue. Initially, with heart disease, liver swelling appears (increases), the lower legs later appear swelling on the sacrum, anasarca and cavity edema (hydrotorox-non-inflammatory exudative pleurisy, ascites). Fainting vasovaginal (vasodilation) and due to arrhythmias. The questions to the patient are as follows: - were there any harbingers? - how quickly did you go? - what was used?

Cough may be irritating, dry; with pulmonary edema with the release of pink foamy sputum. The reason is stagnation of blood in the pulmonary circulation.

Hemoptysis occurs with congestion in the pulmonary circulation.

Secondary symptoms: headache, dizziness, weakness, fatigue, insomnia. Patients of the cardiological profile, depending on the condition, are prescribed modes from strict bed (in the first days of myocardial infarction) to free. Given with recommendation: exclusion of night work, stress in case of arterial hypertension syndrome, exclusion of heavy physical labor in case of chronic heart failure syndrome, sufficient motor regime in case of coronary syndrome, up to 4 km per day. Diet number 10 it is prescribed for patients with chronic heart failure syndrome. The role of a nurse, given the introduction of the nursing process into practical health care, is increasing. A nurse, in addition to observing and caring for cardiac patients, participates in rehabilitation measures, medical examination, can conduct an educational program for patients (schools for patients with arterial hypertension). A nurse should conduct a nursing examination, make a nursing diagnosis, carry out independent nursing interventions, and provide emergency care if necessary.

2) Syndromes: myocardial ischemia (coronary), arrhythmic, hypertensive, acute vascular insufficiency, acute heart failure, chronic heart failure.

2.Arrhythmia syndrome

3.Hypertensive syndrome

Acute coronary insufficiency syndrome clinical syndrome of acute coronary insufficiency due to temporary disturbances of the coronary circulation. An attack of angina pectoris (angina pectoris) is based on oxygen starvation of the myocardium, which leads to the accumulation of acidic products of incomplete oxidation in the tissue of the heart muscle, irritating the receptor apparatus of the myocardium. The greatest importance belongs to atherosclerosis of the coronary vessels, the presence of which can be established in the vast majority of patients with angina pectoris. At the same time, there is no doubt that the frequency of attacks of angina pectoris, their intensity do not directly depend on the degree of atherosclerotic narrowing of the coronary vessels. The main significance in the origin of attacks of angina pectoris belongs to the functional moments that cause spasm of the coronary vessels. Thus, the nature and intensity of an attack of angina pectoris will depend on the strength of irritation and on the reaction of the vascular wall, the atherosclerotic lesion of which increases the tendency of the vessel to spasms. Angina pectoris, although immeasurably less common, can also be with rheumatism, disseminated antiitis, when coronary vessels are involved in the pathological process (coronaritis) Angina pectoris can develop without damage to the coronary vessels, for example, in untrained people after excessive physical exertion or during physical exertion in people suffering severe anemia (lack of oxygen in the blood).

Of great importance in the occurrence of attacks of angina pectoris is the accumulation of excess catecholamines (adrenaline and norepinephrine) in the heart muscle. The role of the nerve factor in angina pectoris also affects the undoubted connection of angina attacks with nervous overexertion, negative emotions, nicotinism, as well as the possibility of reflex genesis of angina pectoris in the presence, for example, of a focus of irritation in the gallbladder or exposure to cold on the receptors of the skin and mucous membrane of the upper respiratory ways

Clinic. An attack of angina pectoris occurs suddenly - there is a strong (or sometimes gradually increasing) pain behind the sternum of a compressing or pressing character, radiating most often to the left arm, left shoulder, left half of the neck and sometimes to lower jaw... With a significant spread of atherosclerosis of the coronary vessels, pain can cover both halves of the chest, the right arm. At the time of an attack of angina pectoris, the patient strives for maximum rest: stops if the attack occurs while walking, takes the most comfortable position if the attack occurs at rest; pulse, as a rule, quickens. The duration of an attack of angina pectoris is short - from 1-2 minutes to 15-20. If an attack of angina pectoris lasts more than 30-40 minutes, and especially with a longer duration of -60 minutes or more, you should always assume the possibility of various forms of myocardial infarction - from focal dystrophy (transitional forms) to small-focal infarction and even more common forms of myocardial necrosis ...

Acute vascular insufficiency syndrome In the pathogenesis of acute vascular insufficiency, the first place is occupied by a violation caused by a discrepancy between the blood supply and the metabolic needs of the brain. There is a decrease in cardiac output or a decrease in systemic vascular resistance, resulting in a drop in blood pressure and fainting. The amount of cardiac output depends on the stroke volume and the number of heartbeats, with insufficient stroke volume or an inadequate number of heartbeats, cardiac output decreases, which causes a decrease in blood pressure and fainting.

With bleeding and dehydration, the blood supply to the peripheral vascular system decreases, which leads to a decrease in the volume of circulating blood, a drop in venous pressure; decreased blood flow to the right heart, decreased circulation in the lungs, and decreased blood flow to the left heart. The stroke volume of the left ventricle decreases. All this leads to less filling of the arterial system, that is, with blood loss and dehydration, the main hemodynamic factor of collapse is a decrease in the volume of circulating blood.

Rhythm disorder syndrome heart rhythm is a very common syndrome caused by both cardiac pathology and a variety of extracardiac moments, and sometimes an unidentified cause (idiopathic rhythm disturbance). The heart rhythm disturbance is based on a change in the basic properties of the cells of the cardiac conduction system (PSS) - automatism, excitability and conductivity. The main structure of the PSS is a pacemaker cell, which, unlike the others, has the ability to self-generate impulses. This property is due to the electrophysiological phenomenon of spontaneous depolarization - the spontaneous flow of ions through the cell membrane in the resting phase, due to which the potential difference on both sides of the membrane changes and conditions for pulse generation are created.

3) Methods. For to identify symptoms and syndromes and to identify a specific disease, an examination is carried out.

Subjective examination includes the identification of complaints (major and minor), medical history, life history.

Objective examination.

On examination of a patient with circulatory diseases, we determine the state of consciousness, position in bed, possibly orthoped, skin color (acrocyanosis), chest deformity - "heart hump", the presence of edema, ascites, pulsation in the heart, pulsation in the epigastrium, pulsation of the jugular vessels. On palpation: we determine the pulse (frequency, rhythm, filling and tension) and the apical impulse (normally in the 5th intercostal space along the mid-clavicular line, 1 cm inward), in the pathology "cat's purr" - tremor of the chest in the region of the heart .Percussion allows you to determine the boundaries of relative cardiac dullness (normally the right one - 1 cm outward from the right edge of the sternum, the left one coincides with the projection of the apical impulse, the upper one - along the third edge), with heart defects and arterial hypertension, we can reveal a change in the boundaries. Auscultation- the most valuable method for the study of heart diseases, we determine the number of heart contractions (in No. 60 - 80), rhythm and heart sounds. In case of heart pathology, in the presence of anatomical changes in the valves (defects), noises appear; they differ from tones in longer duration. Laboratory methods examinations used in diseases of the cardiovascular system: general blood test, general urine analysis, biochemical blood test (SRV, total protein, cholesterol, lipids, transaminases) blood for sterility, serological blood test. The diagnostic value of laboratory methods is different. Complete blood counts change when inflammatory diseases: rheumatic disease, myocarditis, endocarditis: accelerated ESR, leukocytosis. If the patient has arterial hypertension, proteinuria is possible in the general analysis of urine. Angina pectoris, myocardial infarction, atherosclerosis, arterial hypertension accompanied by hypercholesterolemia, determined in a biochemical blood test. In the presence of myocardial infarction, the level of transaminases in the biochemical blood test rises, the blood is examined for coagulogram coagulation. Serological blood tests are performed to diagnose rheumatic disease, rheumatoid arthritis. Blood for sterility, blood culture is taken if you suspect septic endocarditis. Instrumental methods examinations used in diseases of the circulatory system: chest and heart X-ray, coronary angiography, angiography; ultrasound procedure hearts. Functional methods examinations: ECG, VEP, CGD, REG, Holter monitoring. The diagnostic value of each examination method is different. Chest X-ray allows you to determine the configuration of the heart, ultrasound of the heart allows you to determine the configuration, wall thickness, valve defects, and diagnose heart disease. For the diagnosis of myocardial infarction, arrhythmias, ECG is the leading one. VEP and monitoring are used to diagnose angina pectoris, to detect arrhythmias.

4) Syndromes:myocardial ischemia (coronary), arrhythmic, hypertensive, acute vascular insufficiency, acute heart failure, chronic heart failure.

1.Ischemia syndrome (coronary syndrome) occurs when the blood supply to the myocardium is disturbed (coronary artery disease, angina pectoris, myocardial infarction). Clinical manifestations: pain behind the sternum of a compressive nature, occurs during exertion, lasts 5-10 minutes, disappears at rest or after taking nitroglycerin, radiates to the left shoulder, arm, scapula.

2.Arrhythmia syndrome observed in many heart diseases: defects, coronary artery disease. Patients feel palpitations, a feeling of beats in the heart, heart sinking, cardiac arrest, interruptions in the work of the heart, fainting is possible. It manifests itself in various rhythm disturbances: tachycardia, bradycardia, extrasystole, paroxysmal tachycardia, atrial fibrillation, heart block. Diagnosis of arrhythmias is carried out on the basis of complaints, frequency and nature of the pulse, heart rate, ECG data.

3.Hypertensive syndrome caused by an increase in blood pressure, observed with hypertension, aortic heart disease. Manifestations of hypertensive syndrome: headache, dizziness, nausea, vomiting, confusion is possible. Diagnostics: measurement of blood pressure and detection of a high level, above 140/90 mm Hg. Art.

4 vascular insufficiency syndrome manifests itself in the form of fainting, collapse, shock. All types of vascular insufficiency are characterized by weakness, pallor of the skin, skin moisture. Diagnostic criterion: low blood pressure, below 100/60 mm Hg.

5 acute heart failure syndrome manifests itself in the form of cardiac asthma and pulmonary edema. It is observed with myocardial infarction, heart defects, arrhythmias, arterial hypertension. The main manifestation is sudden, more often at night, shortness of breath, shortness of breath, an attack of suffocation, possibly the separation of pink sputum.

6 chronic heart failure syndrome occurs as a result of stagnation of blood in the large and small circle of blood circulation, is observed in many heart diseases: defects, arrhythmias, myocardial infarction, arterial hypertension. The manifestations are as follows: shortness of breath, enlarged liver, edema, ascites, hydrothorax.

13.) Aortic stenosis : Narrowing creates an obstacle for blood flow from the left ventricle to the aorta during ventricular systole, due to narrowing, left ventricular hypertrophy occurs. The defect is compensated for a long time, sometimes within 20 - 30 years. There are no complaints at the time of compensation of the defect, later dizziness, fainting, chest pains, palpitations and shortness of breath occur. Examination: pallor, increased apical impulse. Palpation: systolic tremor in the second intercostal space on the right, increased apical impulse. Percussion: displacement of the borders of the heart to the left. Auscultation: systolic murmur with the epicenter in the second intercostal space to the right of the sternum, tone 2 is weakened. BP - systolic is reduced and diastolic is slightly increased.

Revealing of defects is based on the data of objective research and data of instrumental examination: X-ray of the chest organs (dimensions of the heart and its parts, configuration); Ultrasound of the heart (changes in valves and degree, walls and cavities of the heart); ECG (hypertrophy of the ventricles, atria, rhythm disturbances) Nursing process for heart defects. 1st stage: examination of the patient. When detecting complaints of palpitations, shortness of breath, dizziness, fainting, cardialgia, especially in the presence of a rheumatic history, the nurse may suggest the presence of decompensated heart disease. After an objective examination, the general condition of the patient can be determined: satisfactory, moderate, severe. At the second stage, the nurse identifies the patient's problems and formulates a nursing diagnosis: shortness of breath, palpitations, interruptions, cardialgia, fainting, dizziness, weakness. At the third stage of the nursing process, he plans independent and dependent nursing actions (interventions). At the fourth stage, it implements the planned. An example of independent nursing interventions is the provision of emergency care for fainting, cardialgia, palpitations. Dependent nursing interventions - preparing patients for laboratory and instrumental studies (ultrasound, ECG) Prevention : treatment of diseases leading to defect, prevention of rheumatic attacks. Dispensary observation is carried out similarly to observation in chronic rheumatic heart disease.

15) Arterial hypertension-

is an increase in blood pressure (systolic\u003e 139 mm Hg, diastolic\u003e 89 mm Hg).

Distinguish between primary and secondary hypertension.

Clinic (AG).The disease proceeds chronically with periods of exacerbation of symptoms. The course of the disease can be slow and rapidly progressive. 0The clinic is determined by the degree of increase in blood pressure, damage to target organs and the presence of concomitant clinical conditions. In the initial period of the disease, the clinic is not pronounced, the patient may not be aware of an increase in blood pressure for a long time. However, he may already have such nonspecific complaints as fatigue, irritability, decreased performance, insomnia, dizziness, etc. Subsequently, a typical complaint for patients appears: headache more often in the occipital region, pressing, bursting character, accompanied by dizziness, tinnitus, flashing "flies" before the eyes. The pain is worse in a horizontal position. A feeling of a "heavy head" is also characteristic in the morning and towards the end of the working day. Over time, complaints from the affected target organs appear (heart pain, interruptions, shortness of breath, blurred vision, memory loss, etc.). 1/3 of patients with high blood pressure do not have any symptoms for a long time and hypertension is detected by chance. Currently, an almost universal survey of the population is being carried out to identify high blood pressure.

With long-term elevated blood pressure, the pathological process involves such internal organs (target organs) as

Heart (left ventricular hypertrophy),

Retinal arteries (increased tone, narrowed),

Arteries of large and medium caliber (atherosclerotic lesions of the carotid, iliac, femoral arteries, aorta),

Kidney (proteinuria and / or creatinemia 1.2-2.0mg / dL)

Complications: The final outcome of vascular and internal organ damage is the development of concomitant clinical conditions: stroke, myocardial infarction, angina pectoris, chronic heart failure, renal failure, diabetic nephropathy, hypertensive retinopathy (degenerative changes, hemorrhages in the fundus, edema of the optic nipple), peripheral lesions arteries, diabetes mellitus.

7) Endocarditis - inflammation of the valvular or parietal endocardium: 1) subacute bacterial 2) protracted infectious. Etiology. More often, the causative agents of the disease are streptococci or staphylococci, less often gram-negative bacteria (intestinal, Pseudomonas aeruginosa, Proteus, etc.), pneumococci, fungi. Clinic: Fever of the wrong type is characteristic, often with chills and sweat, sometimes with joint pain, pallor of the skin and mucous membranes. A long, febrile course is possible. In case of primary endocarditis that develops on intact valves, functional murmurs can be heard at first, later a heart defect forms, often aortic. With secondary endocarditis, the nature and localization of the existing murmurs change due to progressive deformation of the valves or the formation of a new defect. With myocardial damage, arrhythmias, conduction disturbances, signs of heart failure appear. Almost constant vascular lesions in the form of vasculitis, thrombosis, arterial aneurysms and hemorrhages localized in the skin and various organs (hemorrhagic rash, cerebral vasculitis, kidney and spleen infarctions, mycotic arterial aneurysms, etc.). Signs of diffuse glomerulonephritis, liver enlargement, mild jaundice, and splenic hyperplasia are often noted. Forecast always serious, however, with prolonged and persistent therapy, in a significant part of cases, recovery and restoration of working capacity occurs. Prevention: timely sanitation of chronic foci of infection, hardening of the body. Preventive rational antibacterial prophylaxis (in short courses) in patients with heart defects in the event of intercurrent diseases, during surgical interventions and invasive instrumental research (catheterization of the heart, kidneys, etc.). Treatment:early and etiotropic, taking into account bacteriological data. In / m 20 million per day Benzylpenicillin. In combination with Streptomycin (1 g per day) or Gentamicin .. Semi-synthetic. Penicillins (Amoxicillin). Cephalosporins (Kefzol up to 10 g / m). Duration up to 4 weeks. Increased immunity - antistaphil, gamoglobulin, antistaphil. plasma. Prednisolone up to 30 mg. per day. Heparin 20,000 per day / m. Inhibitors of proteolytic enzymes (Contrikal 60000 IU intravenously drip). Surgical treatment - removal of the affected valve.

23) Angina - a disease characterized by attacks of chest pain due to physical or emotional stress due to an increase in myocardial oxygen demand.

The most common form of ischemic heart disease.

Clinic: pain occurs during physical or emotional stress, increases with its continuation, is localized in the middle part of the chest, is diffuse in nature. The pain radiates to the neck, shoulder, epigastrium, back, increases with cold, overeating. It passes after rest or taking nitroglycerin.

Painless angina pectoris: shortness of breath, choking, heartburn, coming arrhythmia, weakness in the left hand.

Urgent care for a pistupe:. With an attack of angina pectoris, the patient must stop physical activity

Nitroglycerin can be taken every five minutes - until the painful attack stops, but no more than three tablets in 15 minutes. The action of nitroglycerin lasts for a short time, only 10-15 minutes. Therefore, it can be taken many times throughout the day.

Dispensary observation is carried out by the district patient, the frequency of examinations is 2-4 times a year, depending on the functional class of the STE. The volume and frequency of laboratory and instrumental examinations: general blood test - once a year; lipid spectrum and alpha-cholesterol - 2 times a year; ECG, functional tests and veloergometry - 2-3 times a year, depending on the functional class nocardia.

Preventionangina pectoris is mainly the prevention of atherosclerosis. ... Shown a rational diet with restriction of animal fats and easily digestible carbohydrates

Excluded: fatty meat and fish broths, fatty meat, fried fish, smoked meats, herring, red fish, caviar, jellied meat, all canned food, marinades, sauces, gravies, peppers, horseradish, alcohol, strong tea, coffee, white bread, pasta, horns, noodles, flour, cakes, muffins. The creation of conditions for the development of collateral circulation in the system of the coronary arteries of the heart is facilitated by physiotherapy exercises (especially dosed walking). Patients with stable exertional angina are recommended daily walking (5-10 km) at a pace that does not cause seizures. It is very important to exclude smoking, but for a long time, the abuse of alcoholic beverages is unacceptable. But smokers should do this with caution,

24) Myocardial infarction - myocardial necrosis due to blockage of the coronary vessel, mainly affects the left ventricle ... Ethology: reasonsmost often angina attacks are pain in the region of the heart. Pain appears in response to a mismatch between blood flow and muscle demand. This condition occurs when the coronary vessels are blocked by an atherosclerotic plaque, less often due to arterial spasm, and even less often due to thromboembolism. With an increase in load (running, walking, stress), the myocardium requires more energy and oxygen, the source of which is blood. But because of the obstructed vessels of the heart, an increase in blood flow does not occur, and the cells begin to die. At first, the pathological process has the character of ischemia (literally - exsanguination) - the state of cells in the absence of nutrition. Then necrosis occurs - complete death of muscle tissue

Periods of flow:1)preinfarction(discomfort, discomfort)

2)sharpest(extremely intense pain, pressing, bursting, dagger. pain lasts 30 minutes to a day, is not relieved by nitroglycerin. a feeling of fear, excitement. on examination: pale skin may be cyanosis. Auscultation: deaf heart sounds, rhythm disturbance, more often tachycardia, may develop shock (lowering blood pressure, heart failure, shortness of breath) for several hours.

3)Acute(the final formation of a necrosis focus, usually the pain disappears, and the symptoms of heart failure may persist or increase by 2 seconds. the temperature rises. the larger the zone of necrosis, the higher t. rhythm disturbance is 90%.) 1 day.

4)subacute(there are no pains, heart failure decreases, but in some patients it can turn into chronic heart failure ... in 40% of the rhythm disturbance remains, the norm, the state of health improves) 1 week-1 month.

5) Postinfarction(scar formation at the site of necrosis, period of complete adaptation to conditions) up to 2-6 months

Atypical forms:1) peripheral. (Localization of pain in the throat region, vertebral column, general weakness develops, rhythm disturbance) 2) abdominal. (In the epigastric region) 3) asthmatic. (Suffocation in the most severe course of the disease) 4) colaptoid (no pain, a sharp decrease in blood pressure, headache, darkening in the eyes, cold clammy sweat.) 5) arrhythmic (rhythm disturbance, etc.) 6) cerebral (dizziness, nausea, vomiting, speech impairment, weakness in the limbs) 7) erased 8) combined.

Symptoms:

1) Pain, feeling of fullness and / or squeezing in the chest 2) Pain in the jaw, toothache, headache 3) Shortness of breath 4) Nausea, vomiting, general feeling of pressure under the spoon (upper center of the abdomen) 5) Sweating 6) Heartburn and / or indigestion 7) Pain in the arm (most often in the left, but possibly in either arm) 8) Pain in the upper back 9) General painful sensation (vague feeling of ailment)

Diagnosticiana: complaints, taking an analysis, objective studies, instrumental methods (ECG), laboratory (KLA - leukocytosis, increased ESR)

Emergency care for myocardial infarction:

2. Reducing the load on the heart - lie down, take sedatives.

3. Reception of nitroglycerin under the tongue before the relief of a painful attack.

4. Aspirin 325 mg - chew.

5. Try to relieve pain (analgin, nonsteroidal anti-inflammatory drugs).
If you suspect cardiac arrest (lack of consciousness, breathing, pulse on the carotid arteries, blood pressure), you should immediately start resuscitation measures:
A precordial blow (a short, hard punch to the sternum). May be effective in the first seconds of ventricular fibrillation. If ineffective, it is necessary to immediately begin chest compressions and ventilation of the lungs using the mouth-to-mouth or mouth-to-nose method. These activities should be continued until the arrival of the ambulance.

21) Ischemic heart disease (CHD) - a disease caused by organic damage to the coronary arteries (stenotic

atherosclerosis, thrombus) or a violation of their functional state (spasm, dysregulation of tone), with a well-defined symptom complex, including acute and chronic pathological processes:

Angina pectoris,

Myocardial infarction,

· sudden death,

Heart rhythm disorder,

· heart failure,

· Postinfarction cardiogenic complications.

10-20% of the population suffers from IHD, many of them are young people. Mortality in the Republic of Belarus is 33%, men die 3 times more often than women.

Risk factors:

Smoking,

· arterial hypertension,

Hypercholesterinemia,

· diabetes,

endocrine changes

Classification(WHO 1979)

IHD forms:

· Sudden coronary death (primary cardiac arrest);

Angina pectoris:

Voltage:

Emerging for the first time,

Stable,

· Progressive;

Spontaneous (special), Prinzmetov's angina pectoris;

Myocardial infarction:

Large focal,

· Small focal;

Postinfarction cardiosclerosis;

· Violation of the heart rhythm (indicating the form);

· Heart failure (indicating the form and stage).

22) Angina pectoris - a disease that belongs to ischemic heart disease, characterized by attacks of chest pain due to physical or emotional stress due to an increase in myocardial oxygen demand.

Etiology:

Atherosclerosis of the coronary arteries,

Inflammatory degenerative process in the vascular wall,

Neurovegetative reasons,

Hormonal disorders,

Receptor disorders,

Disorders of the mechano-sensitive function of the endothelium,

· Dysfunction of platelets.

Risk factors:

Smoking,

· arterial hypertension,

Hypercholesterinemia,

· diabetes,

5) endocrine changes

Clinic:

pain occurs during physical or emotional stress, increases with its continuation, is localized in the middle of the chest, is diffuse in nature. The pain radiates to the neck, shoulder, epigastrium, back, increases with cold, overeating. It passes after rest or taking nitroglycerin.

Sninocardia rest arises in connection with physical effort more often at night, and is often accompanied by a feeling of lack of air, suffocation.

Painless angina : shortness of breath, choking, sometimes weakness at rest.

Diagnostics:

Collection of anamnesis,

Complaints,

ECG, daily monitoring,

Step test,

Bicycle ergometry,

Pharmacological tests,

8) caranarography

Treatment in the interictal period: decrease frequency of attacks until complete elimination (lifestyle changes, influence on risk factors), as well as beta adreno blockers, calcium antagonists.

25) Myocardial infarction-myocardial necrosis due to narrowing or blockage of the coronary vessel. MI almost always affects the ventricles, mainly the left one. TREATMENT:

1. Relief of pain syndrome (emergency care). The pain itself, affecting the sympathetic nervous system, can significantly increase the heart rate, blood pressure (BP), as well as the work of the heart, which makes it necessary to stop the pain attack as soon as possible. It is advisable to give the patient nitroglycerin under the tongue. To relieve a painful attack, are used morphine, which is administered intravenously fractionally from 2 to 5 mg every 5-30 minutes as needed until complete (if possible) relief of pain. The maximum dose is 2-3 mg per 1 kg of the patient's body weight. The hypothesis that neuroleptanalgesia (a combination of fentanyl and droperidol) has a number of advantages has not received clinical confirmation. Attempts to replace morphine with a combination of non-narcotic analgesics and antipsychotics in this situation are unjustified.

2. After the provision of emergency care, an ECG is recorded, and the patient on a stretcher, bypassing the emergency room, is hospitalized in the intensive care unit.

3. Active therapeutic tactics with the inclusion of reperfusion therapy (thrombolytics, balloon angioplasty or CABG) - the most effective method limiting the size of MI, improving the near and long term prognosis. Early (up to 4-6 hours from the onset of the disease, optimally - for 2-4 hours, after 12 hours it is useless) the use of intravenous thrombolysis by introducing streptokinase, a recombinant tissue plasminogen activator (Aktilize) and other similar drugs reduces hospital mortality by 50% (fibrinolysin are not used), then an infusion of heparin 1000 units / hour is carried out for 24-48 hours under the control of APTT (activated partial thromboplastin time), which should be extended no more than 1.5-2.5 times compared to the initial level ( up to 60-85 seconds at a rate of 27-35 seconds). Subsequently, the patient is transferred to indirect anticoagulants, taking into account the prothrombosed time - phenylin, neodikumarin. Antiplatelet agents are used - acetylsalicylic acid, clopidogrel.

4. Intravenous administration of nitrates ((1% solution of nitroglycerin - 10 ml, 0.1% solution of isoketa - 10 ml) with MI in the first 12 hours of the disease reduces the size of the necrosis focus, affects the main complications of MI, including deaths and frequency development of cardiogenic shock.

5. B-blockers: anaprilin, obzidan. intravenous administration of b-blockers on the 1st day of myocardial infarction, reduces mortality in the 1st week by about 13-15%.

6. Inhibitors of angiotensin-converting enzyme (ACE inhibitors) are able to stop expansion, dilatation of the left ventricle, thinning of the myocardium, i. E. to influence the processes leading to remodeling of the left ventricular myocardium and accompanied by a serious deterioration of myocardial contractile function and prognosis. ACE inhibitors begin 24–48 hours after the onset of MI.

7. Calcium antagonists: they are not currently used in the treatment of myocardial infarction, since they do not have a beneficial effect on the prognosis.

8. To investigate the lipid spectrum, with a total cholesterol level above 5.5 mmol / l, recommend a hypolipidemic diet and taking statins to the patient.

9. Symptomatic treatment: cardiac glycosides, diuretics, potassium preparations, antiarrhythmics, analgesics.

CARE FOR MYOCARDIAL INFARCTION:

Regime: in the first hours and days of the disease - strictly bed rest, complete physical and mental rest (intensive care unit), a ban on visiting relatives. On the second day - passive movement in bed, then active movement of the limbs in bed under the supervision of an exercise therapy doctor, subsequently the patient gets up independently and walks around the bed.

2. Diet: in the first two days of severe MI, the patient is given 7-8 times 50-75 g of weak semi-sweet tea with lemon, slightly warm, diluted juices. Rosehip broth, liquid jelly, cranberry juice. Subsequently, the diet expands, easily digestible, semi-liquid food is given 5-6 times a day in small portions, with salt restriction to 5 g per day, liquid - up to 0.8 - 1.2 liters per day, with edema - according to diuresis.

3. Rendering emergency care: in case of pain in the region of the heart - put the patient to bed, calm down, give nitroglycerin under the tongue every 15 minutes, put mustard plasters on the region of the heart, urgently call a doctor. Introduce analgin, papaverine, dnmedrol. Prepare narcotic analgesics: 1% promedol. Antiarrhythmic drugs: 1% lidocaine, 10% novocainamide. With cardiogenic shock - everything is the same, plus drugs that increase blood pressure: dopamine, dobutamine, 1% mezaton, 0.2% norepinephrine, cardiac glycosides (strophanthin). 4. Monitoring the patient's condition: pulse, heart rate, respiratory rate, blood pressure, temperature, diuresis, stool, monitor the general condition of the patient, deterioration - an urgent call to the doctor 5. Prevention: work and rest, exercise therapy, diet. Continuation of inpatient treatment in a sanatorium (rehabilitation department). Rational employment. 6. Dispensary observation of a cardiologist - 2 times a month, taking an ECG.

27) Cardiac Asthma: Cardiac Asthma - an attack of shortness of breath with a feeling of suffocation, caused by acute stagnation of blood in the pulmonary vessels due to the difficulty of its outflow into the left ventricle of the heart.

The cause is narrowing of the left atrioventricular opening (mitral stenosis) or left ventricular heart failure with myocarditis, acute heart attack myocardium, extensive cardiosclerosis, left ventricular aneurysm, aortic heart defects, mitral valve insufficiency, as well as with arrhythmias and paroxysmal significant increases in blood pressure, accompanied by overstrain of the left ventricular myocardium (for example, with pheochromocytoma).

The onset of cardiac asthma is facilitated by an increase in the volume of blood circulation (for example, during exercise, fever), an increase in the mass of circulating blood (for example, during pregnancy, after the introduction of large amounts of fluid into the body), as well as the horizontal position of the patient; this creates conditions for increased blood flow to the lungs. Due to stagnation of blood and an increase in pressure in the pulmonary capillaries, interstitial pulmonary edema develops, disrupting gas exchange in the alveoli and the patency of the bronchioles, which is associated with the occurrence of shortness of breath; in some cases, breathing disorder is aggravated by reflex bronchospasm.

Symptoms: The occurrence of cardiac asthma in the daytime is usually directly related to physical or emotional stress, increased blood pressure, an attack of angina pectoris; sometimes an attack is provoked by copious food or drink. Before the development of an attack, patients often feel tightness in the chest, palpitations.

When cardiac asthma occurs at night (observed more often) the patient wakes up from a feeling of lack of air, shortness of breath, tightness in the chest, the appearance of a dry cough; he experiences anxiety, a feeling of fear, his face is covered with sweat.

During an attack, the patient, as a rule, begins to breathe through the mouth and must sit up in bed or get up, since dyspnea decreases with an upright position of the body (orthopnea). The number of breaths reaches 30 or more per minute; the ratio of the duration of exhalation and inhalation usually changes little. In the lungs, hard breathing is heard, sometimes (with bronchospasm) dry wheezing rales (usually less abundant and less "musical" than in bronchial asthma), often fine bubbling moist rales in the subscapularis on both sides or only on the right.

Subsequently, a picture of alveolar pulmonary edema may develop with a sharp increase in shortness of breath, separation of light or pink foamy liquid when coughing. With auscultation of the heart, changes characteristic of mitral or aortic defect are determined, and in the absence of a defect, a significant weakening of the first heart sound or its replacement with systolic murmur, an accent of the second tone over the pulmonary trunk, often a gallop rhythm. As a rule, tachycardia is noted, and with atrial fibrillation, a significant pulse deficit.

When providing emergency care to a patient with an attack of cardiac asthma, it is necessary:
1) reduce the increased excitability of the respiratory center;
2) to reduce stagnation of blood in the pulmonary circulation;
3) increase the contractility of the myocardium (left ventricle).

14) AH- Arterial hypertension-is a disease, the main manifestation of which

is an increase in blood pressure (systolic\u003e 139 mm Hg, diastolic\u003e 89 mm Hg).

Distinguish between primary, or essential hypertension, and secondary, or

symptomatic hypertension.

AG (primary, essential) is a chronic disease characterized by a persistent increase in blood pressure caused by impaired neurohumoral regulation of vascular tone and heart function and is not primarily associated with organic diseases of any organs and systems.

Secondary (symptomatic) hypertension is a disease in which high blood pressure is a symptom of another disease (kidney disease, endocrine glands, central nervous system, heart defects, aortic atherosclerosis, etc.). AH (primary) accounts for 80-85% of all cases of increased blood pressure. Etiology and pathogenesis. One of the main etiological factors AH - an increase in the activity of the sympathoadrenal system, persistent excitement of the cerebral centers of blood pressure regulation due to acute or prolonged neuropsychic stress, ultimately leading to persistent spasm of arterioles, increased synthesis of renin, antotensin I and II, aldosterone, antidiuretic hormone. An important role is also played by endothelial dysfunction, which may be due to a genetic predisposition, the presence of risk factors - age, smoking, physical inactivity, obesity, hypercholesterolemia, diabetes mellitus. The pathogenesis of hypertension is complex and multifactorial. It involves catecholamines, insulin, endothelium, hemodynamic and natriuretic factors, cardiovascular remodeling.

Risk factors affecting the prognosis of a patient with hypertension.

1. main:

Age over 55 years for men and 65 years for women,

Smoking,

Cholesterol more than 6.5 mmol / l,

Family history (early cardiovascular disease)

Obesity.

2.additional:

Decreased HDL,

Raising LDL

Microalbuminuria in patients with diabetes mellitus,

Violation of TSH,

Hypodynamia,

Increased fibrinogen

Socio-economic factors of high risk

Ethnic High Risk Factors

High risk geographic factors.

16) Hypertensive crises in hypertension:One of the most common and severe complications of hypertension is hypertensive crisis (HA) a sudden sharp increase in blood pressure, accompanied by severe clinical manifestations.

There are 2 types of HA.

Civil Code of the 1st order(adrenal, hyperkinetic) is characterized by an increase in blood pressure (mostly SBP by 80-100 mm Hg). It develops more often in young people. Arises suddenly against the background of a satisfactory condition: a sharp throbbing headache, vomiting, patients are agitated, frightened, trembling, face, chest, neck are covered with red spots, a feeling of heat, the skin is moist. P8 - tachycardia (110-130). The crisis develops relatively quickly, the duration of the crisis is up to 2-3 hours, it is easily stopped. Ends with profuse urination of light urine. Usually no complications.

Civil Code of the II order(hypokinetic, noradrenal type). Develops more slowly. Lasts up to several days. It is more difficult. Characterized by an increasing headache, dizziness, transient impairment of vision, hearing, compressive pain in the heart, bradycardia. Patients are inhibited, the face is puffy, confusion, convulsions, paresis, paralysis are possible. Acute left ventricular failure, rhythm disturbance may occur. Increased blood pressure is more diastolic (up to 140-160 mm Hg). After a crisis, a lot of protein, casts, and erythrocytes are excreted in the urine. HA of the second order develops in the later stages of hypertension, often gives complications (ALVO, MI, stroke, eclamisia).

HA requires the provision of NP to prevent the development of complications from vital organs and systems.

Myocardial infarction is a very serious attack. It is a consequence of coronary artery disease. The death of a certain part of the heart muscle is observed due to a violation of its blood supply. This means that part of the myocardium completely dies off, stops functioning. Already now you can roughly imagine what the complications of myocardial infarction will be, because in this case the heart will not be able to perform its previous functions in full.

Myocardial infarction on ECG

Classification and features of complications

All complications can be divided into several groups:

• mechanical - are ruptures;
• electrical - manifested in malfunctions of the heart and impaired conduction;
• embolic - the formation of blood clots;
• ischemic - expansion of the dead part of the myocardium;
• inflammatory nature.

Also, complications are divided into two groups, depending on the time of their occurrence, these are early and late.

Early complications of myocardial infarction

They occur within the first hours or days after the onset of the attack. They develop during the acute period of a heart attack. The most dangerous complication is acute heart failure. AHF usually appears quite often, the severity of the condition directly depends on the size of the affected muscle area. No less serious and cardiogenic shock.

Cardiogenic shock is characterized by a significant decrease in the contractile function of the heart. It is caused by the death of a large part of the myocardium. Usually it reaches 50%. It is most often seen in women. It develops in people suffering from diabetes. It can be observed with anterior wall infarction. Treatment in this case consists in taking nitroglycerin. Also, the patient is prescribed cardiac glycosides, ACE inhibitors. The complex should take diuretics, vasopressors, beta-adrenostimulants. In severe forms, surgery may take place.

Rupture of the interventricular septum. It usually occurs in the first few hours after the onset of MI. Such complications of acute heart attack are often observed in women. Diagnosed in the elderly. Hypertension, tachycardia - factors conducive to rupture. Drug treatment consists in the use of vasodilators, but only surgical intervention is indicated to completely eliminate the ruptures.

Thromboembolism. It is considered an equally dangerous complication. It develops in the acute period of myocardial infarction. To combat it, intravenous heparin is administered in the first 24 hours. This is followed by treatment with warfarin.

Early pericarditis. Most often, this complication is observed after a transmural infarction, characterized by damage to all layers of the heart muscle. It develops 1-4 days after the onset of the attack. The basis of treatment is the intake of acetylsalicylic acid, which thinns the blood.

Arrhythmia on ECG

Arrhythmia. It is observed immediately after the onset of a heart attack, and poses a particular threat to life, because most often it is about ventricular fibrillation. In this case, the activity of the heart begins to stop, followed by its arrest. Then there is a need for electrical defibrillation of the heart. In connection with such a danger, arrhythmia requires increased attention, an urgent start to the struggle.

Pulmonary edema. Most often it becomes a complication of transmural myocardial infarction, but it can also be diagnosed with minor muscle lesions. Caused by acute heart failure. It is determined in the first 7 days after the onset of the attack. In this case, treatment should begin immediately. The patient is injected with diuretics. Glycosides are prescribed. They help relieve the condition.

If we consider late complications, then they develop several weeks after the attack, sometimes after a month. The most common are: arrhythmia and chronic heart failure, but in fact there are more complications.

Postinfarction syndrome. This is a whole set of consequences, such as pericarditis, pleurisy and pneumonitis. Even if one ailment is first diagnosed, then over time the rest of the listed ones join it. In this case, the patient is prescribed hormonal treatment. Late pericarditis may also occur and is usually diagnosed after 6-8 weeks. He is treated with aspirin and glucocorticoids.

ECG for heart failure

Chronic heart failure. It is manifested by constant shortness of breath. Often accompanied by a lack of oxygen, the formation of edema. This is due to the fact that the heart is not able to pump the required volumes of blood, therefore, cannot provide the tissues with oxygen in the required amount. Doctors recommend a healthy lifestyle. Abandonment of addictions is mandatory. Beta blockers are prescribed. They help reduce the oxygen requirements of the heart.

Postinfarction cardiosclerosis. It begins with the fact that the dead parts of the myocardium are replaced by connective tissue. So the contractile function of the heart is disrupted, interruptions in its work begin. Heart failure develops. The patient is obliged to constantly monitor his emotional and physical state, to take medications.

Regardless of which complications of myocardial infarction we are talking about - early or late, we will highlight several basic recommendations that will help reduce the likelihood of their occurrence:

1. having determined the onset of myocardial infarction, start providing first aid as early as possible;
2. to calm the patient as much as possible, because stress and nervous tension only aggravate the situation.

Note! If the person does not give in to persuasion, give him a sedative to drink. For example, an infusion of valerian or motherwort.

Valerian tincture

Another important recommendation is that when you call an ambulance, immediately order a cardiology team that has experience in such cases, all the medicines and equipment that you may need to provide emergency care.

Complications of myocardial infarction

Acute myocardial infarction (AMI) is dangerous in itself. But, in addition, its numerous complications, which sometimes become an immediate threat to human life, carry an additional danger.

Early and late complications of heart attack

- repeated heart attack;

- unstable angina pectoris (called early postinfarction);

- acute heart failure;

- arrhythmias and heart block;

- Acute disturbance of cerebral circulation caused by ischemia of a part of the brain;

- thromboembolism;

- heartbreak;

- acute aneurysm of the heart;

- Acute ulcers or erosion of the stomach and intestines.

Late complications of myocardial infarction usually occur 10 days or more after a cardiovascular accident.

- postinfarction syndrome;

- thromboendocarditis;

- the formation of a blood clot in the left ventricle and others.

Characteristics of early complications of acute myocardial infarction

Re-infarction

It is no secret that patients who have already had one heart attack have a fairly high chance of a repeat of what happened. Repeated heart attacks are more dangerous than those that happened for the first time. This is due to the fact that even after the first event, scarring of the heart muscle occurred, and the compensatory capabilities of the body became less. In addition, after a primary heart attack, a large number of pain receptors in the heart often die, pain sensitivity also decreases due to atherosclerosis of the cerebral vessels. These changes lead to the fact that a person remains "on his feet" during a state that brings him closer to a new heart attack - he simply does not understand that something bad is happening to him. He continues to receive physical exertion and experience emotional stress, and the latter can most likely lead to a recurrence of the disease, an increase in the heart attack zone, the development of cardiac arrhythmias and other complications, sometimes incompatible with life.

Acute heart failure

Acute heart failure (AHF) is the most common cause of death in patients with heart attacks. It can take several forms:

- Cardiac asthma. With her, a person suddenly feels shortness of breath, suffocation, fear. Hands and feet may turn blue and cold. In cardiac asthma, relief often comes with taking several nitroglycerin tablets.

- Pulmonary edema. With pulmonary edema, noisy, rapid, possibly even bubbling breathing will appear, a cough with foamy pink sputum... A favorable outcome is possible only in the event of emergency assistance.

- Cardiogenic shock. In the first minutes, a person is often excited, complains of chest pain, weakness, dizziness or shortness of breath - it all depends on the brightness of certain manifestations of a heart attack. After some time, the blood pressure drops sharply, and the patient becomes lethargic, almost does not react to what is happening around. He becomes covered with cold sweat, legs and hands become colder and become bluish. If urgent medical assistance is not provided, the person falls into a coma and dies.

Rhythm and conduction disorders as complications of myocardial infarction

Within 2-6 hours after the development of a heart attack, almost all patients develop arrhythmias. Ventricular fibrillation, asystole, complete atrioventricular block can lead to death of patients. Most often, such arrhythmias occur in the first 6 hours after the onset of the disease.

Other rhythm disturbances are less dangerous, although some of them (for example, "jogging" ventricular tachycardia or progressive intraventricular blockade) can later become more severe and ultimately cause death.

Arrhythmia often seriously aggravates the course of myocardial infarction. But there are also such rhythm disturbances that cardiologists call "heart attack companions": they often accompany it, but do not pose a serious threat to life. These include an increase in sinus rhythm, atrioventricular block I-II degree (Mobitz 1), supraventricular extrasystoles (extraordinary contractions of the heart), as well as rare ventricular extrasystoles.

Heartbreak

This complication usually occurs in the first few days after a heart attack, and very rarely if more than 5 days have passed since its moment.

In most cases, instant death occurs, less often a heart rupture develops gradually, manifesting itself as very intense pains in the chest area, from which even narcotic analgesics do not help. Along with the pain, the phenomena of cardiogenic shock increase.

Sometimes an internal rupture of the heart occurs, in which the outer walls of the organ remain intact. With an internal rupture of the heart, the papillary muscles that hold the valves in the correct position can come off, or the interventricular septum ruptures. Such events dramatically complicate the course of a heart attack, but, unlike an external rupture of the heart, the patient can almost always be saved. Treatment in such cases is only surgical.

Pericarditis

On the second or fourth day after a heart attack, the patient may experience pericarditis, an inflammation of the connective tissue membrane of the heart. With pericarditis, chest pains reappear, which the patient describes as constant, dull, aching. The pain is worse if the person coughs or takes a deep breath. Often, with pericarditis, the body temperature rises to 37-38 ° C.

As a rule, it is enough to take aspirin or other drugs of the group of non-steroidal anti-inflammatory drugs for all the phenomena to subside over time.

Thromboembolism

Heart rhythm disturbances (atrial fibrillation, etc.) lead to the appearance of blood clots in the heart chambers. In the future, these blood clots are very often washed out into the blood and with its current enter various organs, leading to thromboembolism.

Thromboembolism of the cerebral vessels leads to stroke. When the blood vessels of the intestinal mesentery are blocked by a thrombus, a sharp pain in the abdomen and symptoms of intestinal obstruction develop. Thromboembolism of the vessels of the extremities causes gangrene.

The likelihood of developing thromboembolism with a heart attack is 5-10%. Most often, blood clots go to the vessels of the lungs, which is very dangerous.

Postinfarction syndrome (Dressler syndrome)

The emergence aching pain in the chest, weakness and temperature increased to 37-38 ° C 2-6 weeks after a heart attack indicates the development of Dressler's syndrome. With this complication, the pain subsides on its own after a few days, the temperature also gradually normalizes. Aspirin, other NSAIDs, glucocorticosteroid hormones can help the patient recover.

Mental disorders

Transient mental disorders with a heart attack are not uncommon, especially when it comes to the first two weeks after it and about patients over 60 years old.

Patients may behave inappropriately: episodes of depression are replaced by euphoria, during which a person is excited, talks a lot, tries to get up and walk around the room. Sometimes, at first glance, a mild mental disorder can turn into delirium with clouding of consciousness and the appearance of hallucinations. If a person is not helped during this period, in the future he may develop phobias, neuroses and sleep disturbances.

Erosion and ulcers of the stomach and intestines

In the first 10 days after the development of myocardial infarction, abdominal pain of varying intensity may appear, accompanied by loose stools, less often - vomiting of coffee grounds or tarry black liquid feces. In this situation, it is necessary to look for an ulcerative lesion of the digestive tract and prescribe antiulcer therapy.

Late complications of myocardial infarction

Chronic heart failure (CHF)

The death of a part of the heart muscle can lead to the development of CHF, a condition in which a beating heart cannot provide adequate blood circulation and blood supply to organs and tissues.

The classic signs of heart failure are palpitations and shortness of breath on exertion, and swelling in the legs. With the help of pharmaceuticals, it is usually possible to reduce the manifestations of CHF. Physical therapy can also have a beneficial effect.

Left ventricular aneurysm

An aneurysm is a pathological saccular swelling of the heart wall. It usually occurs in the infarction zone in patients with extensive damage to the heart muscle.

Aneurysm manifests itself as symptoms of heart failure. It can lead to life-threatening arrhythmias, blood clots in the heart, and further thromboembolism. Many patients with left ventricular aneurysms require surgical treatment.

Rhythm and conduction disturbances

Myocardial infarction can lead to various arrhythmias and conduction disorders, from not dangerous to health to fatal.

If there is a possibility that the arrhythmia will lead to the death of a person, the patient can be installed with a pacemaker-defibrillator, which responds to the sudden violation of the rhythm and restores normal heart function. In other cases (atrial fibrillation), the patient's own sinus rhythm is restored or the optimal heart rate is maintained.

Intracardiac blockages are also very diverse. Some require the installation of an artificial pacemaker - a special device that sets the heart to the correct rhythm of contractions, and for the treatment of others, drug therapy is sufficient.

Sleep disturbances and complications after myocardial infarction

Sleep disorders always negatively affect the quality of our life: with vigor we lose vitality and strength. In addition, sleep disturbances can become a serious threat to human health and even life, especially for those of us who have suffered acute myocardial infarction.

Such a seemingly harmless phenomenon like snoring occurs in at least 30% of people with coronary heart disease, and is a symptom of a formidable disease - sleep apnea syndrome. With this syndrome of respiratory arrest at night, when a person is sleeping, they lead to acute oxygen starvation of the heart muscle and provoke the development of a heart attack - both the first and repeated. The likelihood of a recurrence of a cardiovascular accident in people with sleep apnea syndrome increases fivefold! But this is only if the sleep apnea syndrome remains untreated.

Therapy for this disease has long been developed, it is effective from the first days and completely eliminates respiratory pauses in a sleeping person. If you snore, and even more so if you have had a heart attack, you should be diagnosed at a sleep center and get qualified assistance... You can do this by contacting the sleep medicine department of the Barvikha sanatorium. The doctor will select an effective treatment regimen for sleep apnea syndrome and will help eliminate any other sleep disorders, if any. In this case, the likelihood of both the first and repeated myocardial infarction will decrease many times.

it is no secret that patients who have already had one heart attack have a fairly high chance of a recurrence. Repeated heart attacks are more dangerous than those that happened for the first time. This is due to the fact that even after the first event, scarring of the heart muscle occurred, and the compensatory capabilities of the body became less. In addition, after a primary heart attack, a large number of pain receptors in the heart often die, pain sensitivity also decreases due to atherosclerosis of the cerebral vessels. These changes lead to the fact that a person remains "on his feet" during a state that brings him closer to a new heart attack - he simply does not understand that something bad is happening to him. He continues to receive physical exertion and experience emotional stress, and the latter can most likely lead to a recurrence of the disease, an increase in the heart attack zone, the development of cardiac arrhythmias and other complications, sometimes incompatible with life.

More interesting articles on this topic:

Complications of myocardial infarction

The prognosis of patients with MI is determined by complications that develop in the early and late stages of the course of the disease. Early complications develop in the most acute and acute period of myocardial infarction. Late complications usually include complications that develop in the subacute and postinfarction periods of the course of the disease. Early complications of myocardial infarction include:

Acute heart failure;

Information relevant to "Complications of myocardial infarction"

Introduction Causes of myocardial infarction Symptoms of myocardial infarction Forms of infarction Factors of development of myocardial infarction Prevention of myocardial infarction The likelihood of complications of myocardial infarction Complications of myocardial infarction Diagnosis of acute myocardial infarction Emergency care for myocardial infarction Help before re-arising "An ambulance should have myocardial infarction"

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Fig. 97. Large-focal myocardial infarctions The figure shows that the recording electrode A, located above the area of \u200b\u200btransmural infarction, will not record the R wave, since the entire thickness of the myocardium has died and there is no excitation vector here. Electrode A will register only pathological Q wave (display of the vector of the opposite wall). In the case of subepicardial

Risk factors for the development of myocardial infarction are: 1. age, the older a person becomes, the higher the risk of a heart attack increases. 2.Previously postponed myocardial infarction, especially small focal, i.e. non-Q generator. 3. diabetes mellitus is a risk factor for the development of myocardial infarction, because an increased level has an additional detrimental effect on the blood vessels of the heart

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Complications of hypertension and the main complications arising against the background of hypertensive crises are presented in tables 11 and 12. Table 11 COMPLICATIONS OF ARTERIAL HYPERTENSION 1. From the side of the cardiovascular system: angina pectoris and myocardial infarction, acute heart failure / cardiac asthma and pulmonary edema /,

Fedorov Leonid Grigorievich

There are also several groups according to which all disorders that have arisen after an attack are classified.

Complications of a heart attack can be:

• Mechanical. They are accompanied by tissue tears.
• Electric. Disorders of heart rhythm and electrical conduction develop.
• Embolic. Thrombosis is formed.
• Inflammatory.

Each of these conditions poses a specific health hazard.

Early

The development of early complications of myocardial infarction occurs during the first hours or days after the attack. This period is called acute.

Heart rhythm disorders and AV block

In the conducting system of the heart, special cells accumulate that generate and conduct nerve impulses. They are located in different parts of the organ, but they are connected to each other. If the heart attack has affected the pathways, then rhythm disruptions develop. Metabolic disorders also cause arrhythmias.

The cells located next to the damaged foci create pathological pulsation and slow down cardiac conduction.

The situation worsens with paroxysmal ventricular and. They are accompanied by acute and lead to the death of the patient.

Heart failure

Myocardial infarction is accompanied by cell death. In the damaged area, cardiomyocytes die, and the muscles lose their contractile ability. Due to a decrease in the pumping function of the heart, enough blood does not enter the vessels, and stagnant processes are formed, arterial blood decreases. In the future, microcirculation is disturbed, gas exchange worsens, the work of all organs and systems is inhibited. This is accompanied by irreversible changes that can lead to death.

Cardiogenic shock

Acute form heart failure is accompanied by cardiogenic shock... In this condition, in addition to breathing disorders, the patient experiences hypotonic failures that are difficult to control, impaired consciousness and kidney function due to insufficient blood supply to these organs.

With cardiogenic shock, severe disruptions in pumping function and heart rate occur. The condition can lead to tamponade of the ventricles with hemorrhage in the heart bag and death of the patient.

Gastrointestinal complications

In this case, the stomach and intestines are affected. On the mucous membrane of organs, erosion, ulcers are formed, paresis of the stomach and intestinal atony develop.

These problems arise due to insufficient blood flow to the organs and the use of Aspirin.

The causes of paresis and atony are the use of medications, in frequency, the introduction of narcotic analgesics.

Complications can also occur due to the formation of small blood clots in the vessels of the gastrointestinal tract.

Painful sensations in the abdomen, bloating, stool disturbances and other signs indicate a lesion in the stomach.

Acute aneurysm

With extensive lesions, Heparin is immediately administered, so the chances of developing the problem are small.

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Accompanied by the death of myocardial tissue. Due to the processes taking place in the tissues against the background of this pathological condition, complications of myocardial infarction can appear both a few days after the onset of the attack, and after a few months. The occurrence of complications of this acute disorder worsens the prognosis and increases the risk of death. More often complications arise in cases where the treatment of a heart attack was started 1-2 days after the onset of the attack.

Early complications

When it comes to complications of myocardial infarction, the classification subdivides all possible disorders, depending on the time of their occurrence, into:

• early;
• late;
• distant.

It is believed that the more time has passed since the onset of an attack, the lower the risk of life-threatening disorders associated with damage to myocardial tissue. Thus, early complications of myocardial infarction are the most dangerous. They can occur during the first days after an attack. Early complications include severe rhythm and conduction disturbances.

The first rhythm disturbances in myocardial infarction are divided into the following categories:

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• non-life-threatening;
• prognostically unfavorable;
• life-threatening.

Non-life-threatening cardiac arrhythmias, which are almost 100% observed in heart attacks, include:

• sinus arrhythmia;
• tachycardia (<110/мин);
• bradycardia (heart rate\u003e 50);
• ventricular and atrial extrasystoles;
• pacemaker migration;
• transient AV block of the 1st degree.

The prognostically unfavorable conditions arising against the background of this pathological condition include:

• bradycardia (<50/мин);
• sinus tachycardia (heart rate\u003e 110 / min);
• idioventicular rhythm;
• sinoauricular block;
• atrial fibrillation;
• AV block II-III degrees;
• supraventricular paroxysmal tachycardia;
• sick sinus syndrome.

Life-threatening rhythm disturbances include paroxysmal ventricular fibrillation. Asystole and subnodal complete AV block are considered dangerous.

Heart failure

Acute heart failure is a common complication of ischemic heart disease. The degree of dysfunction of the left and right ventricles depends on the size of the area of \u200b\u200bnecrosis. In cases where small areas of the myocardium are affected, the remaining healthy tissue can compensate for the work of the damaged ones. However, if large volumes of tissue are affected, there is a deterioration in heart rate.

Often the development of this complication of a heart attack occurs against the background of necrotic damage of at least ¼ of the mass of the left ventricle. In addition, a similar complication can occur against the background of the death of the tissues of the papillary muscles. Severe arrhythmias, which interfere with the heart's ability to contract normally, can contribute to the appearance of such a disorder. This condition is manifested by moist wheezing and pulmonary edema.

Cardiogenic shock often develops against the background of ischemic heart disease and heart attack. This is the last phase of the development of acute heart failure. This condition can occur when more than 40-50% of myocardial tissues die, when the remaining healthy areas cannot replenish the work of dead cells.

Important information: The likelihood of recurrent myocardial infarction

This condition is characterized by a sharp drop in blood pressure, which leads to disruption of blood microcirculation in all vital organs and becomes the cause of the development of multiple organ failure. Patients lose consciousness and often fall into a coma. the brain suffers the most from lack of oxygen and nutrients. In the future, the work of other organs begins to be disrupted.

Gastrointestinal complications

Deterioration of the work of the digestive tract against the background of a heart attack is an acute reaction of the body to stress and disruption of the central nervous system due to a decrease in the level of saturation of brain tissue with oxygen. Often there is a rapid development of paresis, accompanied by stagnant processes. Often, against the background of a heart attack, ulcers develop rapidly on the walls of the intestines and stomach. Massive bleeding may occur.

The development of this complication after a heart attack can be observed both in the first minutes of the attack, and after a few days or even weeks. In severe cases, this complication can cause perforation of the wall of the stomach or intestines and the development of peritonitis. In almost 95% of cases in patients who have recently experienced a heart attack, this complication becomes the cause of death.

Acute ischemic myocardial damage can create conditions for pathological stretching and protrusion of tissues in the region of the chamber walls or ventricles. The formation of such a defect causes a decrease in the release of blood. There is an imbalance between the efforts made by the heart muscles and the pulse, which in this case will be low.

Aneurysm is associated with high risk tears of tissues. In addition, such a defect creates conditions for the aggravation of the existing insufficiency of the heart function. Rhythm disturbances and severe manifestations of blood stagnation in the area of \u200b\u200bthe formed cavity may be present. The development of an aneurysm creates conditions for thrombus formation.

Myocardial rupture

Among dangerous consequences heart attack, a rupture of the myocardium stands out in the area where the formed fibrous scar cannot withstand the load of the pressure inside the heart. In most cases, rupture of the wall in the area of \u200b\u200bthe scar occurs within the first 2 weeks after the attack. More often this complication occurs in women. Exercise after an attack can contribute to the problem.

The tears in the heart wall can be external and internal. External ruptures are accompanied by the outflow of blood into the pericardial region and lead to the formation of a hemotamponade of the heart. Internal tears are accompanied by damage to the papillary muscle or interventricular septum. All forms of heart rupture in most cases are fatal without timely surgical intervention.

Thromboembolism

In myocardial infarction, complications associated with blood clotting disorders occur frequently. Heart failure, accompanied by stagnant processes, contributes to the formation of blood clots. In addition, an enlarging aneurysm can contribute to the appearance of blood clots. Against the background of a heart attack, there is often an aggravation of stagnation in lower limbs and the development of thrombophlebitis.

Important information: Symptoms and consequences of a microinfarction (myocardial infarction) on the legs in men and women

The separation of a blood clot is associated with a high risk of thromboembolism, that is, the migration of blood clots along blood vessels into the lungs, kidneys, brain and other organs. Moving along the blood vessels, blood clots get stuck in the places of their narrowing, blocking the blood flow. This causes the death of large areas of tissue due to the prevention of the supply of nutrients and oxygen to them.

Pericarditis

Pericarditis most often occurs 3-4 days after the onset of the attack. This condition is characterized by the involvement of the outer shell of the heart in the pathological process, i.e. pericardium. The development of this complication after myocardial infarction in men occurs much more often than in women. However, in women more often pericarditis leads to rapid death.

With this complication, the pericardium is rapidly affected by the inflammatory process. This leads to the appearance of intense pain syndrome, aggravated by any movement, coughing or deep breathing.

Early and late complications of myocardial infarction differ in the time interval in which they occur after the attack. For the late, the appearance of the first signs is characteristic 2-3 weeks after the onset of the attack. Late complications can be fatal.

Chronic aneurysm

A complication of heart attack, such as chronic aneurysm, develops approximately 6-8 weeks after scar formation. The scar gradually stretches even after the pressure inside the heart has stabilized. In this case, the aneurysm does not stop increasing in size, which becomes the cause of the progression of the violation of blood ejection.

Dressler syndrome

The development of this complication of heart attack occurs between 2 and 6 weeks after the attack. This condition occurs due to the entry into the bloodstream of a large number of breakdown products of myocardiocytes. These substances act as autogens that provoke malfunction immune system and the development of an autoimmune response. The first manifestation of the syndrome is an increase in body temperature. In the future, autoimmune disorders such as:

• pleurisy;
• pericarditis;
• vasculitis;
• pneumonitis;
• eczema;
• glomerulonephritis;
• synovitis, etc.

Autoimmune reactions make it difficult to repair damaged areas of the myocardium and worsen the prognosis of survival.

Early complications of myocardial infarction occur in the acute period of cardiac catastrophe. They can develop within a few hours or days after the first signs of ischemia appear. Such complications are considered the most dangerous, they are often fatal. The risk of developing them is extremely high. The consequences of a heart attack that occur a few weeks or months after the attack, when the patient switches to a more active lifestyle, are classified as late.

What is myocardial infarction

Myocardial infarction occurs most often due to atherosclerosis. Harmful lipoproteins are deposited on the walls of blood vessels, as a result of which plaques are formed. This dramatically impairs the blood supply to the heart muscle, and coronary heart disease develops. With the further progression of this pathology, a focus of necrosis (necrosis) may occur in the myocardium, this condition is called a heart attack by doctors.

The disease occurs abruptly and is characterized by extremely severe chest pain, which radiates to the left side of the body. Unlike angina pectoris, an attack cannot be relieved with conventional vasodilators, such as nitroglycerin. The death of parts of the myocardium cannot pass without a trace for the body, a heart attack is often complicated by severe heart disorders.

Possible consequences of a heart attack

Already during the transportation of the patient to the hospital or in the first hours after the onset of acute necrosis, early consequences of myocardial infarction may appear. What is it and how to avoid it? Complications can be divided into several groups:

1. Consequences associated with acute heart failure: cardiogenic shock, pulmonary edema.
2. Ruptures and other damage to the heart muscles: interventricular septum, ventricular wall, papillary muscle, ventricular aneurysm, pericarditis.
3. Blood clots in the heart cavity and arteries.
4. Arrhythmic disorders.

The most dangerous early complications of myocardial infarction are acute heart failure and thromboembolic disorders. Arrhythmia after an attack occurs in the vast majority of cases; some types of such disorders can also lead to serious consequences. If the patient has signs of pulmonary edema or cardiogenic shock, emergency care should be provided as early as possible. These conditions are often the cause of death for the patient.

Cardiogenic shock and pulmonary edema

The human heart acts as a pump supplying tissues and organs with blood and oxygen. If this function is impaired, then cardiogenic shock occurs. The heart stops pumping blood, and the organs experience acute oxygen starvation. Sometimes this condition develops before it appears. pain syndrome... The patient's blood pressure drops sharply, the skin becomes covered with cold sweat and becomes gray.

The following causes of cardiogenic shock after myocardial infarction can be distinguished:

1. The development of a reflex reaction to sharp pain during an attack.
2. Heart rhythm disturbances.
3. Severe necrotic lesions prevent the heart muscle from contracting fully. This type of shock is the most dangerous and leads to death in 90% of cases.

Cardiogenic shock usually occurs with extensive heart attacks when about 50% of the heart muscle is damaged. Patients with diabetes mellitus are more susceptible to this complication.

If the patient has signs of cardiogenic shock, emergency care is provided according to the following algorithm:

1. The patient is placed with raised legs. Oxygen therapy is performed. Intravenous "Heparin" is injected in the amount of 5000 IU, glycosides are shown to normalize the heart rate.
2. If the above measures did not help, then make a dropper with sodium chloride (200 ml of 0.9% solution). In this case, it is necessary to control breathing, blood pressure and heart rate.
3. In the absence of effect, if hypotension persists, make a dropper with 200 mg of "Dopamine" in a glucose solution. The rate of fluid administration is adjusted as the blood pressure rises.
4. If the pressure was never brought back to normal, then the therapy is supplemented with drip injection of norepinephrine in a glucose solution.

All activities must be carried out under close monitoring of the pulse and cardiac activity.

Another severe early complication of myocardial infarction is pulmonary edema. It occurs due to stagnation of blood in the respiratory system. This consequence of the postponed cardiac catastrophe occurs within the first week after myocardial necrosis. The patient develops severe weakness, shortness of breath, cough with phlegm, then suffocation increases and a bluish skin color appears.

Pulmonary edema is a consequence of acute heart failure. The recommendations for treating this condition are as follows:

• the introduction of diuretics and cardiac glycosides;
• oxygen therapy;
• "Nitroglycerin" and analgesics (in the presence of pain syndrome).

Assistance with pulmonary edema is necessary immediately, as this process progresses rapidly, and the patient may die from suffocation.

Mechanical damage to the heart

After suffering a heart attack, the elasticity and elasticity of the myocardium is sharply disturbed. It leads to mechanical damage and tissue tears.

Rupture of the interventricular septum is usually observed in elderly patients and hypertensive patients. This complication can occur within 5 days after a heart attack. Patients have the following symptoms:

• increased liver and heart volume;
• severe chest pain that is difficult to stop;
• difficulty breathing;
• arrhythmia;
• bulging of the cervical veins.

This heart damage can be complicated by cardiogenic shock. At the first stage of treatment, vasodilating drugs are used. But only surgical intervention helps to completely eliminate the gap.

A rupture of the outer wall of the ventricle also occurs due to a violation of the strength of tissues after necrosis. This dangerous early complication of myocardial infarction is accompanied by bleeding and can lead to shock. The person feels severe pain in the chest, shortness of breath, wheezing is heard in the lungs. Due to a sharp drop in pressure, the patient is in a semi-fainting state, his pulse is poorly determined. Surgery is required to repair this damage. A "patch" made of a special material is applied to the place of the rupture.

Insufficiency of the mitral valve

It is one of the dangerous consequences of myocardial infarction. What is it and why does such a violation occur? Due to a violation of the strength of the heart tissue, rupture of the papillary muscles can occur. As a result, the valve does not close completely. This complication occurs in 1% of cases. Pulmonary edema occurs, murmurs are determined in the heart. This pathology can only be treated surgically. Without surgery, death is possible in 50% of cases.

Ventricular aneurysm

Left ventricular aneurysm occurs after a transmural (extensive) form of myocardial infarction. Scar tissue forms on the damaged area, this disrupts the contractile function of the heart. Most often, aneurysm is formed in middle-aged and elderly men. The patient is worried about the manifestations of cardiac asthma: shortness of breath, cough, blue skin. The patient does not tolerate even a little physical activity. Conservative treatment does not work, cardiac surgery is required.

Pericarditis

Pericarditis occurs in 10% of cases. It usually develops in the first 4 days. This is an external inflammation. It occurs with a deep lesion, when all 3 layers are affected by the pathology: the myocardium, pericardium and endocardium. The patient feels chest pains that are pulsating in nature. The unpleasant sensations intensify with inhalation and exhalation. Usually the appointment of "Aspirin" helps. This medication relieves inflammation and thins the blood.

Thromboembolism

The risk of thromboembolism in myocardial infarction is especially high in the first 10 days. Blood clots can form in the heart cavity. During this period, the symptoms may be erased. Blood clots become extremely dangerous when they come out and clog the lumen of the vessels of another organ. The patient feels severe pain due to the cessation of blood flow. Thrombosis can cause gangrene of various organs. Most often, blood clots block blood flow to the lungs or lower extremities. To avoid this pathology, intravenous or subcutaneous administration of "Heparin" is prescribed to patients in the post-infarction period.

Arrhythmia

Arrhythmic disorders after a heart attack occur in most patients. Signs of this condition are rapid pulse, fatigue, dizziness, and sometimes chest pain. Arrhythmias are stopped by the use of cardiac glycosides. For bradycardia, pacemakers are used.

A dangerous type of arrhythmia is ventricular fibrillation. In this case, the heart can stop at any time. If such a dangerous complication is detected on the ECG, resuscitation and the use of a defibrillator are necessary.

Rehabilitation

How to live after myocardial infarction to avoid complications? This question is of interest to every patient who has suffered a cardiac catastrophe. In the first week after an attack, the likelihood of complications is very high. Therefore, patients are prescribed with a gradual increase in load.

In the first two days, the healing of the areas of necrosis begins. At this time, bed rest is required, physical activity is strictly contraindicated. Sitting on the bed is allowed only on the third or fourth day.

On the fifth day, patients can get out of bed and walk a little around the ward. On the 6th day, patients can go out into the corridor, but they should not climb stairs. The walks should take place in the presence of medical staff, so that assistance can be provided on time if necessary.

If after a week there are no unpleasant consequences, then the patient is allowed to walk for 30 minutes. You can take a shower and do your own hygiene procedures. In this case, the water should be at room temperature.

Discharge home from the hospital usually takes place within the second week. Before this, the medical staff conducts simple physical exercises... With normal health, the patient is allowed to climb the stairs one floor.

An individual approach to the rehabilitation of patients after myocardial infarction is required. The duration of the recovery period may vary. It is necessary to carefully monitor the patient's well-being. Even with small signs of deterioration after myocardial infarction, the load should be reduced.

Rehabilitation is considered successful if, in the post-infarction period, the patient does not have angina attacks and signs of heart failure, blood pressure does not exceed 130/80, and glucose and cholesterol levels remain within normal limits.

Post-heart attack lifestyle

Upon discharge from the hospital, the cardiologist gives recommendations to the patient about lifestyle, diet, work and rest. What rules must be followed to avoid complications and a second attack?

The doctor may prescribe the patient exercise therapy after myocardial infarction. The set of exercises should be selected individually for each patient. This can be light exercise to prevent congestion and maintain muscle tone, or leisurely walks in the fresh air. The patient can perform exercises on his own only after discharge from the hospital. In this case, you need to monitor the heart rate and respiration. Large physical exertion must be avoided, otherwise ischemic manifestations may return again.

You should also avoid emotional distress, stress and overwork. With mental stress, the heart rate increases, and the myocardium again experiences a lack of oxygen.

Foods high in cholesterol are excluded from the diet. You should also completely stop drinking and smoking. The patient is not recommended to drastically change the climate, this creates an excessive load on the heart.

Each patient who has had myocardial infarction should be under the supervision of a cardiologist, regularly undergo an ECG and take all the necessary tests.

Disability after a heart attack

The question of the myocardial group is decided individually for each patient. After suffering an attack, the patient is issued a sick leave for a period of 4 months. This time is necessary for the restoration of the body and rehabilitation. Then the patient is sent to the commission to decide on the need to assign a disability group. Many patients manage to stay able to work and go to work. In other cases, the commission assigns the 2nd disability group and extends the sick leave for another 1 year.

After this period, the commission again considers the issue of the disability group. This takes into account the patient's ability to serve himself independently, to perform the previous work with the same quality, education, position, as well as the ability of the organism to adapt. Based on this, the commission can either remove the disability or establish the incapacity for work of the following groups:

1. 3rd group. It is assigned for minor dysfunctions in the work of the heart and blood vessels to patients who were previously engaged in mental or light physical work.
2. 2nd group. It is established in case of more serious violations, when abnormalities in the work of the heart cannot be eliminated even by surgery. The 2nd group is also assigned if the patient suffers from attacks of angina pectoris arising from physical and mental stress. In this case, the patient is allowed to do simple work.
3. 1st group. Assigned in the most severe cases, if the patient loses self-care skills, suffers from heart failure or constant pain in the heart.

If the painful manifestations are permanent and cannot be stopped by therapy, then they issue an indefinite disability.

In addition, the following types of work are prohibited for all who have had myocardial infarction:

• hard physical work;
• work at height;
• work associated with long-term stay on the feet;
• classes related to stress and psycho-emotional stress;
• work on conveyors where quick response is needed;
• night and daily shifts;
• work in chemical plants and in adverse climatic conditions.

These restrictions also apply to patients who do not have a disability group.

Forecast

The myocardium depends on several factors. Doctors often find it difficult to give an exact answer to this question. If myocardial infarction occurred for the first time, then, according to statistics, the mortality rate is about 10% in the first month. If the patient was able to survive this period, then during the first year the survival rate is 80%, and within 5 years - 70%.

If a person has suffered a massive heart attack, it usually drastically shortens life expectancy. The age of the patient, the localization of necrosis, the presence of concomitant diseases and the effectiveness of rehabilitation are also important factors. If a person suffered a heart attack at a young age, then he can fully restore the work of the heart and live to old age. If the attack occurs in an elderly person with hypertension, obesity, or diabetes mellitus, then the situation may be more sad. According to statistics, such patients live for about 1 year.

The number of heart attacks transferred to a lesser extent affects life expectancy than the nature and volume of necrotic changes. There were cases when patients suffered several attacks, but lived to old age. Conversely, young patients died from a single heart attack while being transported to the hospital. The prognosis of this disease depends on the characteristics of the course of the pathology and, in many respects, on the lifestyle of a person during the rehabilitation period.