Before a heart attack. Symptoms of a heart attack in women. What should be done in case of a heart attack? heart attack in men

Heart attack and acute coronary syndrome

Heart attack symptoms

Common signs and symptoms of a heart attack include:

• Chest pain or discomfort (angina pectoris) may present with a feeling of tightness, constriction, fullness, or pain in the center of the chest. With a heart attack, the pain usually lasts for a few minutes and may wax and wane in intensity.
• Discomfort in the upper body, including the arms, neck, back, jaw, or abdomen.
• Difficulty breathing.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.
• Women are less likely to have chest pain.

Emergency treatment for a heart attack

The American Heart Association and the American College of Cardiology recommend:

• If you think you are having a heart attack, call (03) right away. After calling (03), you need to chew an aspirin tablet. Be sure to tell the paramedic about this, then an additional dose of aspirin is not required.
• Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure that must be performed within 90 minutes of the onset of a heart attack. Patients suffering from a heart attack must be taken to a hospital equipped to perform PCI.
• Fibrinolytic therapy should be given within 30 minutes of a heart attack if the center that performs PCI is unavailable. The patient should be transferred to the PCI unit without delay.

Secondary prevention of heart attack

Additional preventive measures are needed to help prevent another heart attack. Before discharge, you need to discuss with the hospital doctor:

• Control of blood pressure and cholesterol levels (at discharge, statins, ACE inhibitors, beta-blockers are prescribed).
• Aspirin and the antiplatelet drug clopidogrel (Plavix), which many patients must take on a regular basis. Prasugrel (Effient) is a new drug that can be used as an alternative to clopidogrel for patients.
• Cardiac rehabilitation and regular exercise.
• Weight normalization.
• Smoking cessation.

Introduction

The heart is a complex organ in the human body. Throughout life, he constantly pumps blood, supplying oxygen and vital nutrients through the arterial network to all tissues of the body. To carry out this strenuous task, the heart muscle itself needs an adequate amount of oxygenated blood, which is delivered to it through a network of coronary arteries. These arteries carry oxygenated blood to the muscular wall of the heart (myocardium).

A heart attack (myocardial infarction) occurs when blood flow to the heart muscle is blocked, the tissue is starved of oxygen, and part of the myocardium dies.

Ischemic heart disease is the cause of heart attacks. Coronary artery disease is the end result of atherosclerosis, which obstructs coronary blood flow and reduces the delivery of oxygenated blood to the heart.

Heart attack

Heart attack (myocardial infarction) is one of the most serious outcomes of atherosclerosis. It can happen for two reasons:

• If a crack or rupture develops in an atherosclerotic plaque. Platelets linger in this area to seal and form a blood clot (thrombus). A heart attack can occur if a blood clot completely blocks the flow of oxygenated blood to the heart.
• If the artery becomes completely blocked due to the gradual increase in atherosclerotic plaque. A heart attack can occur if insufficiently oxygenated blood passes through this area.

angina pectoris

Angina pectoris, the main symptom of coronary artery disease, is usually perceived as chest pain. There are two types of angina pectoris:

• stable angina. This is a predictable chest pain that can usually be managed with lifestyle changes and medication, such as low doses of aspirin and nitrates.
• unstable angina. This situation is much more serious than stable angina and is often an intermediate stage between stable angina and a heart attack. Unstable angina is part of a condition called acute coronary syndrome.

Acute coronary syndrome

Acute coronary syndrome (ACS) is a severe and sudden heart condition that, with the necessary intensive treatment, does not turn into a full-blown heart attack. Acute coronary syndrome includes:

• unstable angina. Unstable angina is a potentially serious condition in which chest pain is persistent but blood tests do not show markers of a heart attack.
• myocardial infarction without ST segment elevation (not Q-myocardial infarction). It is diagnosed when blood tests and an ECG reveal a heart attack that does not involve the full thickness of the heart muscle. The damage to the arteries is less severe than in a major heart attack.

Patients diagnosed with acute coronary syndrome (ACS) may be at risk for a heart attack. Doctors analyze a patient's medical history, various tests, and the presence of certain factors that help predict which ACS patients are most at risk of developing a more severe condition. The severity of chest pain alone does not necessarily indicate the severity of the lesion in the heart.

Risk factors

The risk factors for a heart attack are the same as the risk factors for coronary heart disease. They include:

Age

The risk of coronary heart disease increases with age. About 85% of people who die from cardiovascular disease are over 65 years of age. Men, on average, have their first heart attack at age 66.

Floor

Men have a greater risk of developing coronary heart disease and heart attacks at an earlier age than women. The risk of cardiovascular disease in women increases after menopause, and they begin to suffer from angina pectoris more than men.

Genetic factors and family inheritance

Certain genetic factors increase the likelihood of developing risk factors such as diabetes, high cholesterol, and high blood pressure.

Race and ethnicity

African-Americans have the highest risk of cardiovascular disease due to their high incidence of high blood pressure, as well as diabetes and obesity.

medical background

Obesity and metabolic syndrome. Excess fat deposition, especially around the waist, can increase the risk of cardiovascular disease. Obesity also contributes to the development of high blood pressure, diabetes, which affect the development of heart disease. Obesity is especially dangerous when it is part of the metabolic syndrome, a pre-diabetic condition associated with heart disease. This syndrome is diagnosed when three of the following conditions are present:

• abdominal obesity.
• Low HDL cholesterol.
• High triglyceride levels.
• High blood pressure.
• Insulin resistance (diabetes or prediabetes).

Elevated cholesterol. Low-density lipoprotein (LDL) is the "bad" cholesterol responsible for many heart problems. Triglycerides are another type of lipid (fat molecule) that can be harmful to the heart. High-density lipoprotein cholesterol (HDL) is the "good" cholesterol that helps protect against cardiovascular disease. Doctors analyze a "total cholesterol" profile, which includes measurements of LDL, HDL, and triglycerides. The ratios of these lipids can affect the risk of developing cardiovascular disease.

High blood pressure. High blood pressure (hypertension) is associated with the development of coronary heart disease and heart attack. Normal blood pressure numbers are below 120/80 mmHg. High blood pressure is generally defined as blood pressure greater than or equal to 140 mmHg. (systolic) or greater than or equal to 90 mm Hg. (diastolic). Prehypertension is considered to be blood pressure with numbers 120 - 139 systolic or 80 - 89 diastolic, it indicates an increased risk of developing hypertension.

Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, greatly increases the risk of developing cardiovascular disease. In fact, heart disease and strokes are the leading causes of death in people with diabetes. People with diabetes also have a high risk of developing hypertension and hypercholesterolemia, bleeding disorders, kidney disease, and nerve damage, all of which can damage the heart.

lifestyle factors

Reduced physical activity. Exercise has a number of effects that benefit the heart and circulation, including cholesterol and blood pressure levels and weight maintenance. People who lead a sedentary lifestyle are almost twice as likely to suffer heart attacks compared to people who exercise regularly.

Smoking. Smoking is the most important risk factor for developing cardiovascular disease. Smoking can cause high blood pressure, cause lipid imbalance and make platelets very sticky, increasing the risk of clotting. While heavy smokers are at the highest risk, people who smoke as little as three cigarettes a day are at high risk of damaging their blood vessels, which can lead to poor blood flow to the heart. Regular exposure to secondhand smoke also increases the risk of cardiovascular disease in non-smokers.

Alcohol. Moderate alcohol consumption (one glass of dry red wine a day) can help increase your “good” cholesterol (HDL) levels. Alcohol can also prevent blood clots and inflammation. In contrast, drunkenness harms the heart. In fact, cardiovascular disease is the leading cause of death in alcoholics.

Diet. Diet can play an important role in protecting the heart, especially by reducing dietary sources of trans fat, saturated fat, and cholesterol and limiting salt intake, which contributes to high blood pressure.

NSAIDs and COX-2 inhibitors

All non-steroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, are a risk factor for the heart. NSAIDs and COX-2 inhibitors may increase the risk of death in patients who have experienced a heart attack. The greatest risk develops at higher doses.

NSAIDs include over-the-counter drugs such as ibuprofen (Advil, Motril) and prescription drugs such as diclofenac (Cataflam, Voltaren). Celecoxib (Celebrex), a COX-2 inhibitor available in the US, has been associated with cardiovascular risks such as heart attack and stroke. Patients who have had heart attacks should consult their doctor before taking any of these drugs.

The American Heart Association recommends that patients who have or are at risk of heart disease primarily use non-pharmacological methods of pain management (eg, physical therapy, exercise, weight loss to reduce stress on the joints, and heat or cold therapy). If these methods do not work, patients should take low doses of acetaminophen (Tylenol) or aspirin before using NSAIDs, the COX-2 inhibitor celecoxib (Celebrex) should be used last.

Forecast

Heart attacks can be fatal, become a chronic condition, or result in a full recovery. The long-term prognosis for the duration and quality of life after a heart attack depends on its severity, damage to the heart muscle, and preventive measures taken after that.

Patients who have had a heart attack have a higher risk of another heart attack. Although there are no tests that can predict if another heart attack will occur, patients can avoid another heart attack themselves if they follow a healthy lifestyle and adhere to treatment. Two-thirds of patients who have had a heart attack do not take the necessary steps to prevent it.

A heart attack also increases the risk of other heart problems, including abnormal heart rhythms, heart valve damage, and stroke.

Persons at greatest risk. A heart attack is always more serious in some people, such as:

• Elderly.
• People with heart disease or multiple risk factors for cardiovascular disease.
• People with heart failure.
• People with diabetes.
• People on permanent dialysis.
• Women are more likely to die from a heart attack than men. The risk of death is highest in young women.

Factors that occur during a heart attack and increase the severity.

The presence of these conditions during a heart attack can contribute to a worse prognosis:

• Arrhythmias (abnormal heart rhythm). Ventricular fibrillation is a dangerous arrhythmia and one of the main causes of early death from a heart attack. Arrhythmias are more likely to occur within the first 4 hours of a heart attack and are associated with high mortality. However, patients who are successfully treated have the same long-term prognosis as patients without arrhythmias.
• Cardiogenic shock. This very dangerous situation is associated with very low blood pressure, decreased urine output, and metabolic disorders. Shock occurs in 7% of heart attacks.
• Heart block, also called atrioventricular (AV) block, is a condition in which the electrical conduction of nerve impulses to the muscles in the heart is slowed or interrupted. Although heart block is dangerous, it can be effectively treated with a pacemaker and rarely causes any long-term complications in patients who survive.
• Heart failure. The damaged heart muscle is unable to pump the blood needed for the tissues to function. Patients experience fatigue, shortness of breath, fluid retention occurs in the body.

Symptoms

The symptoms of a heart attack can vary. They may come on suddenly and be severe, or they may progress slowly, starting with mild pain. Symptoms may differ in men and women. Women are less likely than men to have classic chest pain, they are more likely to experience shortness of breath, nausea or vomiting, back pain and jaw pain.

Common signs and symptoms of a heart attack include:

• Chest pain. Chest pain or discomfort (angina) is the main symptom of a heart attack and can be felt as a feeling of tightness, tightness, fullness, or pain in the center of the chest. Patients with coronary artery disease who have stable angina often experience chest pain that lasts for a few minutes and then goes away. In a heart attack, the pain usually lasts for more than a few minutes and may go away but then return.
• Discomfort in the upper body. People who experience a heart attack may feel discomfort in their arms, neck, back, jaw, or stomach.
• Difficulty breathing may be accompanied by chest pain or be painless.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.

The following symptoms are less common for a heart attack:

• Sharp pain when breathing or coughing.
• Pain that is mostly or only in the middle or lower abdomen.
• Pain that can be caused by touch.
• Pain that can be caused by moving or pressing on the chest wall or arm.
• Pain that is constant and lasts for several hours (do not wait several hours if there is a suspicion that a heart attack has begun).
• Pain that is very short and lasts for a few seconds.
• Pain that radiates to the legs.
• However, the presence of these signs does not always rule out serious heart disease.

Painless ischemia

Some people with severe coronary artery disease may not have angina. This condition is known as silent ischemia. This is a dangerous condition because patients do not have the warning signs of heart disease. Some studies show that people with silent ischemia have a greater risk of complications and mortality than patients with angina pain.

What to do in case of a heart attack

People who experience symptoms of a heart attack should do the following:

• For angina patients, take a single dose of nitroglycerin (tablet under the tongue or in aerosol form) at the onset of symptoms. Then another dose every 5 minutes for up to three doses or until pain is relieved.
• Call (03) or dial the local emergency number. This should be done first if three doses of nitroglycerin do not relieve chest pain. Only 20% of heart attacks occur in patients with previously diagnosed angina. Therefore, anyone who develops symptoms of a heart attack should contact emergency services.
• The patient should chew aspirin (250 - 500 mg), which should be reported to the arrived emergency service, since an additional dose of aspirin in this case is not necessary to take.
• A patient with chest pain should be transported immediately to the nearest emergency room, preferably by ambulance. Traveling on your own is not recommended.

Diagnostics

When a patient with chest pain presents to the hospital, the following diagnostic steps are taken to determine heart problems and, if present, their severity:

• The patient should tell the doctor about any symptoms that may indicate heart problems or possibly other serious conditions.
• An electrocardiogram (ECG) is a record of the electrical activity of the heart. It is a key tool for determining whether chest pain is related to heart problems and, if so, how serious they are.
• Blood tests detect elevated levels of certain factors (troponins and CPK-MB) that indicate heart damage (the doctor will not wait for the results before starting treatment, especially if he suspects a heart attack).
• Imaging tests, including echocardiography and perfusion scintigraphy, can help rule out a heart attack if there are any questions.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures and records the electrical activity of the heart, and the ECG waveforms correspond to the contraction and relaxation of certain structures in the various parts of the heart. Certain waves on the ECG are named with the corresponding letters:

• R. P-waves are associated with atrial contractions (two chambers in the heart that receive blood from the organs).
• QRS. The complex is associated with ventricular contractions (the ventricles are the two main pumping chambers in the heart.)
• T and U. These waves accompany ventricular contractions.

Doctors often use terms like PQ or PR interval. This is the time required for the propagation of an electrical impulse from the atria to the ventricles.

The most important in the diagnosis and treatment of a heart attack are the ST segment elevation and the determination of the Q wave.

ST segment elevation: Heart attack. ST segment elevation is an indicator of a heart attack. It indicates that the artery of the heart is blocked and the heart muscle is damaged to the full thickness. Develops Q-myocardial infarction (myocardial infarction with ST-segment elevation).

However, ST elevation does not always mean that the patient is having a heart attack. Inflammation of the heart sac (pericarditis) is another cause of ST segment elevation.

Without ST segment elevation, angina pectoris and acute coronary syndrome develop.

A low or horizontal ST segment suggests conduction abnormalities and the presence of cardiovascular disease, even if there is no current angina. ST segment changes occur in about half of patients with various heart diseases. However, in women, ST segment changes can occur without heart problems. In such cases, laboratory tests are needed to determine the extent of damage to the heart, if any. Thus, one of the following conditions may develop:

• Stable angina (blood or other test results do not show any serious problems and chest pain disappears). During this period, 25 - 50% of people with angina pectoris or silent ischemia have normal ECG values.
• Acute coronary syndrome (ACS). It requires intensive treatment until it turns into a full-blown heart attack. ACS includes either unstable angina or non-ST elevation myocardial infarction (not Q myocardial infarction). Unstable angina is a potentially serious event where chest pain is persistent but blood tests do not reveal markers of a heart attack. In a non-Q myocardial infarction, blood tests detect a heart attack, but damage to the heart is less severe than in a full heart attack.

Echocardiogram (ECHOCG)

An echocardiogram is a non-invasive method that uses ultrasound to visualize the heart. You can determine the damage and mobility of sections of the heart muscle. Echocardiography can also be used as an exercise test to detect the location and extent of damage to the heart muscle during illness or shortly after hospital discharge.

Radionuclide methods (stress test with thallium)

Allow to visualize the accumulation of radioactive tracers in the region of the heart. They are usually administered intravenously. This method allows you to evaluate:

• Severity of unstable angina when less expensive diagnostic methods fail.
• The severity of chronic ischemic heart disease.
• The success of surgery for coronary heart disease.
• Whether there was a heart attack.
• The location and extent of damage to the heart muscle during illness or shortly after discharge from the hospital after a heart attack.

The procedure is non-invasive. It is a reliable method for a variety of severe heart conditions and can help determine if the damage is due to a heart attack. A radioactive isotope of thallium (or technetium) is injected into a patient's vein. It binds to red blood cells and travels with the blood through the heart. The isotope can be tracked in the heart using special cameras or scanners. The images can be synchronized with the ECG. The test is carried out at rest and during exercise. If damage is detected, the image is retained for 3 or 4 hours. Damage caused by a heart attack will be preserved on a rescan, and damage caused by angina pectoris will be leveled out.

Angiography

Angiography is an invasive method. It is used for patients in whom angina has been confirmed by stress tests or other methods and for patients with acute coronary syndrome. The course of the procedure:

• A narrow tube (catheter) is inserted into an artery, usually an arm or leg, and then passed through the vessels to the coronary arteries.
• A contrast agent is injected through a catheter into the coronary arteries and a recording is made.
• As a result, images of the coronary arteries appear, in which you can see the obstruction to blood flow.

Biological markers

When heart cells are damaged, they release various enzymes and other substances into the bloodstream. Elevated levels of these markers of heart damage in the blood or urine may help identify a heart attack in patients with severe chest pain and help guide treatment. Tests like these are often done in the emergency room or in the hospital when a heart attack is suspected. The most commonly defined markers are:

• troponins. The cardiac troponin T and I proteins are released when the heart muscle is damaged. These are the best diagnostic signs of heart attacks. They can help diagnose them and confirm the diagnosis in patients with ACS.
• myocardial creatine kinase (CPK-MB). CPK-MB is a standard marker, but its sensitivity is less than that of troponin. Elevated levels of CPK-MB can be seen in people without heart disease.

Treatment

Treatments for heart attack and acute coronary syndrome include:

• oxygen therapy.
• Relief of pain and discomfort using nitroglycerin or morphine.
• Correction of arrhythmia (irregular heart rhythm).
• Blocking further blood clotting (if possible) using aspirin or clopidogrel (Plavix) and anticoagulants such as heparin.
• The opening of the artery in which there was a violation of the blood flow should be done as quickly as possible by angioplasty or with the help of drugs that dissolve the blood clot.
• Beta-blockers, calcium channel blockers, or angiotensin-converting enzyme inhibitors are prescribed in order to improve the functioning of the heart muscle and coronary arteries.

Immediate action

The same for patients with both ACS and heart attack.

Oxygen. It is usually given through a tube into the nose or through a mask.

Aspirin. The patient is given aspirin if it has not been taken at home.

Medications to relieve symptoms:

• Nitroglycerine. Most patients will receive nitroglycerin both during and after a heart attack, usually under the tongue. Nitroglycerin lowers blood pressure and dilates blood vessels, increasing blood flow to the heart muscle. Nitroglycerin is given intravenously in some cases (recurrent angina, heart failure, or high blood pressure).
• Morphine. Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels, increasing the flow of blood and oxygen to the heart. Morphine can lower blood pressure and make the heart work easier. Other drugs may also be used.

Removal of obstruction of the coronary blood flow: emergency angioplasty or thrombolytic therapy

In a heart attack, clots form in the coronary arteries, which interfere with the coronary blood flow. Removal of clots in the arteries should be done as soon as possible, this is the best approach to improve survival and reduce the amount of damage to the heart muscle. Patients should be admitted to specialized medical centers as quickly as possible.

Standard medical and surgical procedures include:

• Angioplasty, also called percutaneous coronary intervention (PCI), is the procedure of choice for emergency opening of the arteries. Angioplasty should be performed promptly for patients with a heart attack, preferably within 90 minutes of arrival at the hospital. In most cases, a stent is placed in the coronary artery to create an internal scaffold and improve the patency of the coronary artery.
• Thrombolytics dissolve the clot and are the standard medicines used to open arteries. Thrombolytic therapy should be carried out within 3 hours after the onset of symptoms. Patients who are admitted to a hospital that cannot perform PCI should receive thrombolytic therapy and be transferred to a PCI center without delay.
• Coronary bypass surgery (CABG) is sometimes used as an alternative to PCI.

Thrombolytics

Thrombolytic or fibrinolytic drugs are recommended as an alternative to angioplasty. These drugs dissolve the clot, or thrombus, that is responsible for the blockage of the artery and the death of heart muscle tissue.

Generally speaking, thrombolysis is considered a good choice for patients with myocardial infarction in the first 3 hours. Ideally, these drugs should be given within 30 minutes of arriving at the hospital unless an angioplasty is being performed. Other situations where thrombolytics are used:

• The need for long-term transportation.
• Long period of time before PCI.
• Failure of PCI.

Thrombolytics should be avoided or used with great caution in the following patients after a heart attack:

• In patients over 75 years of age.
• If symptoms continue for more than 12 hours.
• Pregnant women.
• People who have recently had an injury (especially a traumatic brain injury) or surgery.
• People with an exacerbation of peptic ulcer.
• Patients who have undergone prolonged cardiopulmonary resuscitation.
• When taking anticoagulants.
• Patients who have suffered major cow loss.
• Patients with a stroke.
• Patients with uncontrolled high blood pressure, especially when systolic pressure is above 180 mm Hg.

Standard thrombolytic drugs are recombinant tissue plasminogen activators (TPA): Alteplase (Actelise) and Reteplase (Retalise), as well as a new drug tenecteplase (Metalise). A combination of antiplatelet and anticoagulant therapy is also used to prevent clot enlargement and new clot formation.

Rules for the administration of thrombolytics. The sooner thrombolytics are given after a heart attack, the better. Thrombolytics are most effective within the first 3 hours. They can still help up to 12 hours after a heart attack.

Complications. Hemorrhagic stroke usually occurs on the first day and is the most serious complication of thrombolytic therapy, but fortunately this is rare.

Revascularization procedures: angioplasty and bypass surgery

Percutaneous coronary intervention (PCI), also called angioplasty, and coronary bypass surgery are standard surgeries to improve coronary blood flow. These are known as revascularization surgeries.

• Emergency angioplasty/PCI is a standard procedure for heart attacks and must be performed within 90 minutes of its onset. Studies have shown that balloon angioplasty and stenting fail to prevent cardiac complications in patients when performed 3 to 28 days after a heart attack.
• Coronary artery bypass surgery is usually used as an elective operation, but may sometimes be performed after a heart attack, angioplasty or thrombolytic therapy has failed. It is usually performed over several days to allow the heart muscle to recover. Most patients are suitable for thrombolytic therapy or angioplasty (although not all centers are equipped for PCI).

Angioplasty / PCI includes the following steps:

• A narrow catheter (tube) is placed in the coronary artery.
• The lumen of the vessel is restored by inflating a small balloon (balloon angioplasty).
• After the balloon is deflated, the lumen of the vessel increases.
• To keep the artery open for a long time, a device called a coronary stent is used - an expandable metal mesh tube that is implanted into the artery during angioplasty. The stent may be bare metal, or it may be coated with a special drug that is slowly released into the adjacent vessel wall.
• The stent restores the lumen of the vessel.

Complications occur in about 10% of patients (about 80% of them during the first day). The best results are achieved in hospitals with experienced staff. Women who undergo angioplasty after a heart attack have a higher risk of death than men. Restenosis after angioplasty. Narrowing after angioplasty (restenosis) can occur up to a year after surgery and requires a repeat PCI procedure.

Drug-eluting stents that are coated with sirolimus or paclitaxel may help prevent restenosis. They may be better than a bare metal stent for patients who have had a heart attack, but they can also increase the risk of blood clots.

It is very important for patients who have drug-eluting stents to take aspirin and clopidogrel (Plavix) for at least 1 year after stenting to reduce the risk of blood clots. Clopidogrel, like aspirin, helps prevent platelets from clumping together. If for some reason patients cannot take clopidogrel along with aspirin after angioplasty and stenting, bare metal stents without drug coating should be implanted. Prasugrel is a new drug that is an alternative to clopidogrel.

Coronary bypass surgery (ACS). It is an alternative to angioplasty in patients with severe angina, especially those with two or more blocked arteries. This is a very invasive procedure:

• The chest is opened, blood is pumped using a heart-lung machine.
• During the main phase of the operation, the heart stops.
• Bypassing the closed sections of the arteries, shunts are sewn, which are taken during the operation from the patient's leg, or from the arm and chest. Thus, blood flows to the heart muscle through shunts, bypassing the closed sections of the arteries.

Mortality in CABG after a heart attack is significantly higher (6%) than when the operation is performed electively (1-2%). How and when it should be used after a heart attack remains controversial.

Treatment of patients with shock or heart failure

Severely ill patients with heart failure or who are in a state of cardiogenic shock (this includes low blood pressure and other disorders) are intensively treated and observed: they give oxygen, administer fluids, regulate blood pressure, use dopamine, dobutamine and other means.

Heart failure. Furosemide is administered intravenously. Patients may also be given nitrates and ACE inhibitors if there is no sudden drop in blood pressure as indicated. Thrombolytic therapy or angioplasty may be performed.

Cardiogenic shock. The intra-aortic balloon pump (IABP) procedure may help patients with cardiogenic shock when used in combination with thrombolytic therapy. A balloon catheter is used that inflates and deflates in the aorta at certain phases of the cardiac cycle, thus raising blood pressure. An angioplasty procedure may also be performed.

Treatment of arrhythmias

Arrhythmia is a heart rhythm disorder that can occur in conditions of oxygen deficiency and is a dangerous complication of a heart attack. A fast or slow heart rate is common in patients with a heart attack and is usually not a dangerous sign.

Extrasystole or a very fast rhythm (tachycardia) can lead to ventricular fibrillation. This is a life-threatening arrhythmia in which the ventricles of the heart contract very quickly, without providing sufficient cardiac output. The pumping action of the heart, necessary to keep the blood circulating, is lost.

Prevention of ventricular fibrillation. People who develop ventricular fibrillation are not always subject to arrhythmia prevention and to date there are no effective drugs to prevent arrhythmias during a heart attack.

• Potassium and magnesium levels should be monitored and maintained.
• The use of intravenous and oral beta blockers may help prevent arrhythmias in some patients.

Treatment of ventricular fibrillation:

• Defibrillators. Patients who develop ventricular arrhythmias are given an electric shock with a defibrillator to restore a normal rhythm. Some studies show that implantable cardioverter defibrillators (ICDs) can prevent further arrhythmias and are used in patients who remain at risk for recurrence of these arrhythmias.
• Antiarrhythmic drugs. Antiarrhythmic drugs include lidocaine, procainamide, or amiodarone. Amiodarone or another antiarrhythmic drug may be used later to prevent subsequent arrhythmias.

Treatment of other arrhythmias. People with atrial fibrillation are at high risk of having a stroke after a heart attack and should be treated with an anticoagulant such as warfarin (Coumadin). There are also bradyarrhythmias (very slow rhythm disturbances) that often develop with a heart attack and can be treated with atropine or pacemakers.

Medications

Aspirin and other antiplatelet agents Anticoagulants are used in all stages of heart disease. They are divided into antiplatelet agents or anticoagulants. They are used along with thrombolytics, as well as for the prevention of a heart attack. Anticoagulant therapy is associated with a risk of bleeding and stroke.

Antiplatelet drugs. They inhibit the aggregation of platelets in the blood and therefore help prevent clotting. Platelets are very small and disk shaped. They are essential for blood clotting.

• Aspirin. Aspirin is an antiplatelet drug. Aspirin should be taken immediately after the onset of a heart attack. An aspirin tablet can either be swallowed or chewed. It is better to chew an aspirin tablet - this will speed up its action. If the patient has not taken aspirin at home, it will be given to him in the hospital and then taken daily. The use of aspirin in patients with a heart attack leads to a decrease in mortality. It is the most common antiplatelet agent used in people with cardiovascular disease and is recommended to be taken daily at a low dose on an ongoing basis.
• Clopidogrel (Plavix) - belongs to the thienopyridine series, this is another antiplatelet drug. Clopidogrel is taken either immediately or after a percutaneous intervention, and is used in patients with heart attacks, as well as after initiation after thrombolytic therapy. Patients who are implanted with a drug-eluting stent should take clopidogrel along with aspirin for at least 1 year to reduce the risk of thrombosis. Patients hospitalized for unstable angina should receive clopidogrel if they cannot take aspirin. Clopidogrel should also be given to patients with unstable angina for whom invasive procedures are planned. Even conservatively treated patients should continue taking clopidogrel for up to 1 year. Some patients will need to take clopidogrel on an ongoing basis. Prasugrel is a new thienopyridine that can be used instead of clopidogrel. It should not be used by patients who have had a stroke or transient ischemic attack.
• IIb/IIIa receptor inhibitors. These are powerful blood thinners such as abciximab (Reopro), tirofiban (Aggrastat). They are given intravenously in a hospital, and can also be used for angioplasty and stenting.

Anticoagulants. They include:

• Heparin is usually given during treatment along with thrombolytic therapy for 2 days or more.
• Other intravenous anticoagulants that may also be used are Bivalirudin (Angiomax), Fondaparinux (Arikstra), and enoxaparin (Lovenox).
• Warfarin (Coumadin).

When taking all these drugs, there is a risk of bleeding.

Beta blockers

Beta-blockers reduce the heart muscle's need for oxygen, slow the heart rate, and lower blood pressure. They are effective in reducing mortality from cardiovascular disease. Beta-blockers are often given to patients during the initial phase of their hospitalization, sometimes intravenously. Patients with heart failure or who may develop cardiogenic shock should not receive intravenous beta blockers. Long-term oral beta-blockers for patients with symptomatic coronary artery disease, especially after a heart attack, are recommended in most cases.

These drugs include propranolol (Inderal), carvedilol (Coreg), bisoprolol (Zebeta), acebutolol (Sektral), atenolol (Tenormin), labetalol (Normodin), metoprolol, and esmolol (Breviblok).

Heart attack treatment. The beta-blocker metoprolol may be given within the first few hours after a heart attack to reduce damage to the heart muscle.

Prophylaxis after a heart attack. Beta-blockers are taken orally on a long-term basis (as maintenance therapy) after the first heart attack to help prevent recurrent heart attacks.

Side effects of beta-blockers include fatigue, lethargy, vivid dreams and nightmares, depression, memory loss, and dizziness. They can lower HDL (“good” cholesterol). Beta-blockers are divided into non-selective and selective drugs. Non-selective beta-blockers such as carvedilol and propranolol can cause contraction of bronchial smooth muscle resulting in bronchospasm. Patients with asthma, emphysema, or chronic bronchitis should not take non-selective beta-blockers.

Patients should not abruptly stop taking these drugs. Abruptly stopping beta-blockers can lead to a sharp increase in heart rate and blood pressure. It is recommended to slowly reduce the dosage until the complete cessation of administration.

Statins and other cholesterol-lowering lipid-lowering drugs

After being admitted to the hospital for acute coronary syndrome or a heart attack, patients should not stop taking statins or other medications if their LDL (“bad” cholesterol) levels are elevated. Some doctors recommend that LDL levels should be below 70 mg/dL.

Angiotensin-converting enzyme inhibitors

Angiotensin-converting enzyme inhibitors (ACE inhibitors) are important drugs for the treatment of patients who have had a heart attack, especially for patients at risk of developing heart failure. ACE inhibitors should be given on the first day to all patients with a heart attack, unless contraindicated. Patients with unstable angina or acute coronary syndrome should receive ACE inhibitors if they have signs of heart failure or evidence of decreased left ventricular ejection fraction on echocardiography. These drugs are also widely used to treat high blood pressure (hypertension) and are recommended as first line therapy for people with diabetes and kidney damage.

ACE inhibitors include captopril (Capoten), ramipril, enalapril (Vazotec), quinapril (Accupril), Benazepril (Lotensin), perindopril (Aceon), and lisinopril (Prinivil).

Side effects. Side effects of ACE inhibitors are rare but may include cough, excessive drop in blood pressure, and allergic reactions.

Calcium channel blockers

Calcium channel blockers may improve the condition in patients with unstable angina whose symptoms do not improve with nitrates and beta-blockers, or are used in patients in whom beta-blockers are contraindicated.

Secondary prevention

Patients can reduce their risk of having another heart attack by following certain preventive measures, which are explained at the time of discharge from the hospital. Following a healthy lifestyle, in particular a certain diet, is important in preventing heart attacks and should be followed.

Arterial pressure. Target blood pressure numbers should be less than 130/80 mm Hg.

LDL cholesterol ("bad" cholesterol) should be substantially less than 100 mg/dl. All patients who have had a heart attack should receive statin advice before being discharged from the hospital. In addition, it is important to control cholesterol levels by reducing saturated fat intake to less than 7% of total calories. It is necessary to increase the intake of omega-3 fatty acids (they are rich in fish, fish oil) to reduce triglyceride levels.

Physical exercises. Duration 30-60 minutes, 7 days a week (or at least 5 days a week).

Weight loss. Combining exercise with a healthy diet rich in fresh fruits, vegetables, and low-fat dairy helps you lose weight. Your body mass index (BMI) should be 18.5-24.8. Waist circumference is also a risk factor for developing a heart attack. Waist circumference for men must be less than 40 inches (102 cm) and for women less than 35 inches (89 centimeters).

Disaggregants. Your doctor may recommend that you take aspirin (75-81 mg) on ​​a daily basis. If you have had a drug-eluting stent, you must take clopidogrel (Plavix) or prasugrel (Effient) along with aspirin for at least 1 year after surgery. (Aspirin is also recommended for some patients as primary prevention of a heart attack.)

Rehabilitation. Physical rehabilitation

Physical rehabilitation is extremely important after suffering a heart attack. Rehabilitation may include:

• Walking. The patient usually sits in a chair on the second day, and begins to walk on the second or third day.
• Most patients have a low level of exercise tolerance early in their recovery.
• After 8-12 weeks, many patients, even those with heart failure, feel the benefits of exercise. Exercise recommendations are also given at discharge.
• Patients usually return to work in about 1-2 months, although the timing may vary depending on the severity of the condition.

Sexual activity after a heart attack is very low risk and is generally considered safe, especially for people who engage in it regularly. The feeling of intimacy and love that comes with healthy sex can help offset depression.

Emotional rehabilitation

Depression occurs in many patients with ACS and heart attack. Studies show that depression is a major predictor of mortality for both women and men. (One reason could be that depressed patients take their medications less regularly.)

Psychotherapy, especially cognitive behavioral therapy, can be very helpful. For some patients, it may be appropriate to take certain types of antidepressants.

Information provided by the site.

In cardiology, there is a group of deviations, which is called too generically to understand the essence of the phenomenon.

One of them is the so-called heart attack. This is a simple, philistine name.

According to the clinical classification, the pathological process corresponds to a heart attack or unstable angina in the active phase (just at the time of the attack).

The danger of the phenomenon is obvious. Regardless of the type, there is death or necrosis of the heart tissue, myocardium, a decrease in the intensity of contractions, a drop in blood output and, as a result, ischemia, a weakening of general hemodynamics. Possible death of the patient.

Treatment is carried out strictly in a hospital. At the outpatient level, therapy continues and is adjusted, the condition is monitored by a cardiologist in the clinic.

Regardless of the type of disease-causing process, the essence is approximately the same.

During the influence of one or another factor, there is a violation of the normal blood supply to the myocardium through special arteries, called coronary.

The result is acute ischemia (oxygen starvation) of tissues. A similar phenomenon corresponds to an attack of angina pectoris, and if the degree of blood flow disturbance is high, a heart attack.

During the episode, there is a slowdown or complete cessation of local hemodynamics, necrosis of cardiomyocytes (actually the units that make up the active muscle layer of the heart).

The process is accompanied by intense pain in the chest and other symptoms.

Outside of competent medical care, there is a decrease in myocardial contractility, blood output is insufficient.

Nutrition of the brain, organs and systems weakens. Hence additional manifestations, such as fainting and others.

The probability of death depends on the area affected. The larger the focus, the higher the risk of death.

A heart attack is an emergency condition accompanied by necrosis of cardiomyocytes and generalized symptoms, hemodynamic disturbances.

Recovery is carried out urgently, in a hospital or intensive care unit.

Classification

The main criterion is the nature of the pathological process. It has already been mentioned in passing that a heart attack is a simplified name for two phenomena.

Which ones:

angina pectoris

It proceeds relatively sluggishly, in addition, the indicators of the tonometer are unstable, and there is no significant increase in numbers. But this is the first wake-up call, he points to the need for treatment.

Transformation, progression occur in a short period of time, sometimes a few months are enough. Recovery under the supervision of a cardiologist.

Excessive stress on the heart leads to chronic malnutrition. Sooner or later, a heart attack will come. Angina pectoris is possible, but not required.

• Diabetes. Systemic endocrine disease associated with insufficient production of insulin or a decrease in tissue sensitivity to it.

Both options have a poor prognosis without treatment. And therapy does not give a 100% guarantee of complete recovery.

The hallmark of the pathological process is a generalized vascular lesion, it is determined by stenosis, that is, narrowing.

Hence the secondary atherosclerosis, including the structures of the lower extremities, brain, coronary arteries.

• Other diseases of the hormonal profile. There is hypercotricism, that is, excessive synthesis of thyroid substances, excessive production of cortisol by the adrenal glands, and other phenomena.

All of them are the culprits of vasoconstriction. Treatment is planned. Launched forms are stopped in a hospital under the supervision of a group of specialists in order to avoid fatal consequences.

Risk factors

• Smoking. Patients who use tobacco have a 70% higher risk of having a heart attack than those who lead a healthy lifestyle. Studies show that not only experience plays a role, but also individual resistance to poisonous agents, which is genetically determined. Therefore, the same time of tobacco consumption will cause different consequences for two different people. A drop of nicotine does not always kill, but the results are inevitable. When they arise - in a month, a year or more, no one will say. It is necessary to monitor the patient's condition.
• Alcohol consumption. Ethyl alcohol leads to general vascular disorders, blood pressure levels quite quickly. But again, individual resistance to ethanol plays a role, which is different for everyone.
• Obesity. Not the increased weight itself matters, but what stands behind it. In this case, we are talking about a violation of lipid metabolism. Fats are unevenly distributed, there is a deviation of their normal deposition. The process is corrected with great difficulty, the main way to avoid adverse consequences is to change the very principle of nutrition (in other words, diet).
• Insufficient or excessive physical activity. In the first case, stagnant processes begin, myocardial contractility and vascular stenosis decrease. In the other, there is proliferation of cardiac tissues, compression of the coronary arteries. Both options are unfavorable. If the former is potentially curable, the latter has negative prospects.
• Age 45+, male.

trigger factors

• Stressful situation. Associated with the release of large amounts of cortisol and adrenaline, which provoke stenosis of the coronary arteries. Depending on the amount of narrowing, one of two variants of a heart attack is observed.
• Excessive physical activity. The required level of activity depends on the individual characteristics of the patient's body, his fitness. It is enough for someone to climb the stairs to the third floor to provoke an attack, for another, even a kilometer of running is not enough.
• Hypothermia. Exception to the rule.

The causes of a heart attack are both cardiac and non-cardiac. A group of factors plays a role, in combination they lay the foundation for the pathological process. Eliminating a trigger or moment of risk is not enough. We need to fight all three categories.

Symptoms and early signs of a heart attack

Manifestations are specific, but there are no differences in symptoms in women and men. If you look closely, this gives reason to suspect an attack immediately.

Approximate clinical picture:

• Pain in the chest of varying degrees of intensity are typical symptoms of a heart attack. Against the background of angina pectoris, it is medium in strength, burns, presses. Gives to the left hand and shoulder blade. Lasts no more than 30 minutes. With a heart attack, the manifestation is much more active, occurs suddenly, lasts over half an hour. Attempts to independently delimit the two states are futile. Instead of dubious exercises, it is better to call an ambulance.
• Dyspnea. In complete peace. The patient is unable to take in air to meet the need. Such symptoms are determined by a violation of gas exchange.
• Feelings of anxiety, panic, fear. Corresponds to a neurotic state.
• Loss of consciousness. Up to several times in a row. An alarming sign, indicates a weakening of the power of the brain.
• Cyanosis of the nasolabial triangle. Blueness around the mouth.
• Paleness of the skin.
• Arrhythmia by the type of bradycardia (weakening of the frequency of contractions).

Signs of a heart attack develop almost at once, and the duration of the episode is from 10 minutes to 30 minutes with angina pectoris, and more against the background of a current heart attack.

How to recognize an emergency?

It is not easy to do this without qualifications. A distinction is made between the main types of coronary insufficiency, it is also required to distinguish the described disease from intercostal neuralgia, perforated gastric ulcer, pneumonia and other phenomena.

What characterizes heart pain:

• Lack of response to breathing. Inhalation and exhalation do not affect the intensity of the syndrome. What can not be said about the signs of extracardiac discomfort.
• No change when moving. If you stand up, sit down, lie down - the power of manifestation will be the same. This is a feature of heartache.

With intercostal neuralgia, the pain intensifies both when inhaling and when moving.

A perforated ulcer is determined by a sharp, cutting sensation in the abdomen and epigastric region. It is this nature of pain that makes it possible to distinguish the state from others.

Pneumonia causes predominantly respiratory symptoms.

Diagnosis falls on the shoulders of doctors. It makes no sense to guess on the coffee grounds. The brigade should be called. You can recognize an attack by the nature of the pain, its duration, additional manifestations.

First aid

Before the arrival of doctors, at home, you only need to stabilize the patient's condition. Not to cure it, but only to normalize the situation.

Sample algorithm:

• To seat the patient, put a roller of clothes or underwear under his back. It is impossible to fit, because normal gas exchange will be disturbed, pulmonary edema or other additional complications will occur.
• Open the window, ensure the flow of fresh air into the room.
• Give the patient a Nitroglycerin tablet to relieve pain. With a heart attack, the measure may be ineffective, but other drugs should not be taken. The state is unstable, any influence from the outside leads to an aggravation of the situation.
• Loosen the collar, remove tight body jewelry.

Upon the arrival of the doctors, a brief description of the condition should be given. Transportation to a cardiological hospital is indicated.

Effective measures can only be taken in the hospital. First aid for a heart attack consists of two things: calling an ambulance, stabilizing the condition of the injured person.

Necessary examinations

Upon admission to the department, the diagnosis is carried out urgently. Usually, the results are not expected, urgent measures are shown to bring the main vital signs back to normal. Then more careful work is needed.

Indicative list of activities:

• Oral questioning of the patient and collection of anamnesis. It matters, including what kind of attack, how often they occur (if they were before).
• Measurement of blood pressure and heart rate.
• Daily monitoring. Registration of the same indicators within 24 hours using a Holter monitor. It can be carried out repeatedly to clarify conditions. The study answers the question about the dynamics of blood pressure and heart rate throughout the day, depending on circadian phenomena.
• Electrocardiography. Shows even a slight arrhythmia. All functional deviations are clearly visible.
• Echocardiography. Demonstrates defects and degree of destruction of cardiac tissues. This visual technique, in fact, is a variant of ultrasound.
• A blood test is general, biochemical and hormones.

Treatment

An approximate scheme of drug correction involves a long course of taking such drugs:

• Angiagrengants. For blood thinning. Aspirin Cardio will do. This is a mandatory pharmaceutical product.
• Statins. In order to eliminate cholesterol plaques in the coronary arteries and not only. Atoris as the main one. It is possible to use analogues at the discretion of a specialist.
• Beta blockers. Metoprolol, Anaprilin.
• Antihypertensives as needed. Reduce blood pressure.
• Nitroglycerin for pain relief. They are not taken constantly, but as part of the removal of an uncomfortable sensation.
• Diuretics. Regularly (several times a week) to remove excess fluid from the body.
• Cardioprotectors. Mildronate and others like him.
• Preparations of potassium, magnesium. In order to restore local metabolism.

Surgical treatment is indicated for vascular abnormalities, significant stenosis, or advanced atherosclerosis.

The nature of the intervention is determined by a specialist. Most often, stenting or shunting is performed.

The transferred attack imposes some restrictions on the patient's life:

• It is necessary to completely give up smoking and alcohol.
• You can't be physically overwhelmed. Only walking and light physical education, prescribed by a doctor.
• You should also adjust your diet. Fatty and fried foods are excluded, fortification of the menu is shown. Salt no more than 7 grams per day.

An approximate list of products is indicated in the treatment table No. 10. Based on the list presented, conclusions can be drawn. All controversial points are recommended to be discussed with a nutritionist.

Forecast

Against the background of unstable angina pectoris of the first or second functional class, it is favorable.

The survival rate is close to 80-90%. 3-4 - already much worse. It is impossible to radically restore the original position. The probability of a lethal outcome is 30-50% or so.

A heart attack leads to death much more often. It is impossible to say anything specific. The issue is resolved individually, after a long period of dynamic observation.

Finally

A heart attack is a simple term for coronary insufficiency. The process is developing rapidly, gross changes without competent medical care are likely.

Treatment is urgent, carried out in a hospital. Depending on the cause, the duration of recovery is from six months to a lifetime.

It is difficult to predict the outcome. A group of factors is taken into account: from age and gender to heredity and the presence of somatic pathologies.

In the fight against cardiovascular diseases, a special place is given to myocardial infarction or heart attack. In the medical community, this clinical condition has long been called the "silent killer", and all because it develops secretly for a long time or manifests itself with mild symptoms, and then strikes a crushing blow, which most often causes death. The danger of myocardial infarction is also indicated by statistics, according to which a critical decrease in blood flow to the coronary vessels is the leading factor in mortality among the general population.

Why does myocardial infarction develop, is it possible to recognize an exacerbation of the condition in a timely manner, and how to provide first aid in case of a heart attack? We will answer all your questions in this article.

Causes of a heart attack

The key factor in the developing necrosis of a part of the myocardium is atherosclerotic damage to the vessels that feed the heart muscle. In this regard, an increased level of cholesterol in the blood, the presence of diabetes mellitus, long-term use of high-dose non-steroidal anti-inflammatory drugs, constant stress, a sedentary lifestyle, as well as smoking, alcohol addiction, obesity and harmful food addictions lead to the slow development of the disease. In addition, for the most part, an acute heart attack overtakes elderly people who have crossed the 55-year mark, although if there are predisposing factors, a heart attack can also occur in a 20-year-old young person.

We also add that in young women a heart attack occurs much less frequently than in men. Nature took care to protect the fairer sex, giving them the opportunity to bear healthy offspring. But with the onset of menopause, after the age of 50, the risk of a heart attack in women and men is equalized. There is another feature that should be mentioned. Men are much more likely to suffer a heart attack, while the survival rate of women in this case is much lower. That is why it is so important to know the signs of a heart attack and respond appropriately to them.

Nonspecific signs of a heart attack

First of all, we will describe completely unusual signs, which, nevertheless, may portend the development of myocardial infarction. These include:

1. Heartburn

A symptom familiar to people with stomach diseases, in fact, may not be heartburn at all, but angina pain, which is localized in the upper part of the stomach.

2. Snoring and sleep apnea

Constant night snoring and sleep apnea should also alert a person, because the sudden onset of such symptoms may be associated with pathologies of the heart and blood vessels.

3. Sleep disturbance and anxiety

Insomnia is a sign of many diseases, and therefore not everyone will associate it with the approach of myocardial infarction. However, if you wake up at night and cannot fall asleep for a long time, and in addition to insomnia you are overcome by anxious feelings, you should listen to yourself. You may also be experiencing other, more characteristic symptoms of a heart attack. In any case, a doctor's consultation will not be superfluous.

4. Wheezing

The air coming out of the lungs with a whistle should at least be alarming. It is especially worth paying attention to this symptom if it is combined with the appearance of cold clammy sweat and unreasonable anxiety.

5. Inflammation of the gums

Some doctors speak out about the connection of a developing heart attack with periodontal disease, and therefore, having noticed inflammation of the gums surrounding the teeth, be on the alert, as an approaching heart attack may appear.

Early signs of a heart attack

As practice shows, the first signs of this dangerous condition may appear several months before the development of a heart attack. The following symptoms can warn about the development of the disease:

1. Chest pain

It all starts, as a rule, with mild discomfort in the chest, which gradually turns into pain, characterized by a pressing, squeezing and burning character. With the approach to a heart attack, the pain begins to radiate to the left shoulder, jaw, neck, left shoulder blade or arm. Moreover, pain symptoms occur periodically, over several weeks, both during physical exertion and during rest. If the pain that appears does not subside over time, you need to urgently go to the hospital.

2. Shortness of breath

This is the second most common sign of an impending heart attack. Given that the lumen of the vessels that deliver oxygen to organs and tissues gradually narrows, a person begins to experience a lack of air and slight suffocation during physical exertion, for example, when playing sports. However, with deterioration in standing, an attack of shortness of breath appears after climbing stairs or a short walk. Moreover, with the approach of a critical condition, shortness of breath can occur after sudden movements, turns of the body, and even at rest. In the case when the lack of air is combined with severe pain in the chest and left side of the body, it is necessary to inform the doctor as soon as possible.

3. Increased sweating

Another sign of the condition under consideration may be excessive sweating. As a rule, a person rarely pays attention to this symptom, especially in hot summers. However, if you start to break out in a cold sweat for no apparent reason, even in a cool room, you should sound the alarm and try to find out the reasons for this phenomenon.

4. Increased pulse and increased heart rate

With rare jumps in the pulse, there is no reason to worry about your health. However, if the palpitations persist for a long time and are accompanied by excessive sweating, shortness of breath, weakness and dizziness, it is time to call for help, because all these symptoms clearly indicate an impending attack.

5. Swelling and heaviness in the legs

The approach of a heart attack can also be seen by regularly appearing edema. They can be identified by bags under the eyes that appear after sleep, by swelling of the fingers, which makes it difficult to remove the ring, or by traces of rubber bands in socks. If you find it difficult to put on shoes that were once comfortable, and as the evening approaches, it becomes more and more difficult for you to move around due to heaviness in your legs, there is a reason to visit a doctor and find out the cause of the swelling.

6. Fatigue and fatigue

By the appearance of fatigue, it is difficult to suspect a developing myocardial infarction. Most people experience this symptom almost constantly, escaping from it with strong tea, coffee and other invigorating drinks. However, if you feel “broken” in the morning, and short-term physical activity tires you to the limit, stop attributing everything to increased stress and lack of rest. Contact a specialist to undergo the necessary examinations, and it is quite possible that your appeal will allow timely detection of the development of a deadly condition.

7. Nausea

This symptom can occur for a variety of reasons. By itself, it does not cause much concern, however, coupled with shortness of breath, pain radiating to the left arm or shoulder blade, dizziness and palpitations, it may indicate the development of an attack.

8. Dizziness

An early sign of myocardial infarction may be dizziness, which initially occurs after sports or heavy physical exertion. With the development of the disease, the head may be spinning even after climbing the flight of stairs to the second floor. Such a symptom should alert a person, because the closer the heart attack, the more pronounced the signs of poor health of the patient become.

Clear signs of a heart attack

With the approach of a myocardial infarction, the symptoms of this dangerous condition become more pronounced. Its most obvious sign is pain, which becomes brighter and is described by patients as "intense burning behind the sternum." And besides pain, in this condition, other obvious signs of a heart attack appear:

1. Numbness of the limbs

The appearance of "cotton" legs or "goosebumps" running down the arms indicates that for some reason the blood has stopped flowing to the limbs. If this symptom does not go away within 1-2 minutes, there is a high probability that a heart attack is to blame. You need to immediately tell others about this and ask for help.

2. Loss of coordination

In the last days before an attack, the patient, as a rule, has signs of impaired coordination of movement. Suddenly he finds himself unable to move his arm, turn his neck, or move his shoulder.

3. Problems with speech

If a person is conscious, but at the same time has difficulty pronouncing words and cannot speak normally, an ambulance should be called immediately. Along with impaired coordination of movement, slurred speech can be mistaken for alcohol intoxication, but this prejudice is too dangerous, because if you do not provide qualified assistance to the patient in time, you can put his life in danger.

4. Fainting and loss of consciousness

In a state when the whole body is fettered by unbearable pain, dizzy, cold sweat covers the forehead, and panic fear fetters the heart, a person can easily lose consciousness. But in these very moments he needs emergency medical care, while delay can threaten death.

As a rule, a pain attack covering the body, coupled with other severe symptoms, lasting more than 5 minutes, turns into a heart attack, which means it requires immediate medical attention.

First aid for a heart attack

Feeling the approach of a heart attack, you should immediately call an ambulance. At the same time, be sure to tell the doctors about the sensations that you experience (painful or pressing sensations). In addition, tell the doctors the drugs that were taken before the development of the attack.

Before the arrival of specialists, it is important to alleviate your condition as much as possible. To do this, lie on a hard surface with 1-2 pillows under your head. It is advisable to lie still, without movement, so as not to provoke pain, slowly inhaling, holding the air in the lungs for 10-15 seconds, and then exhaling slowly.

To ensure proper breathing, it is important to unfasten the belt, loosen the top button of the shirt and remove the tie. It will be better if this is done by a person who is next to you in difficult times. He will also be able to open the windows in the room and provide a much-needed supply of fresh air at this moment.

If possible, blood pressure should be measured. If it is elevated, you can take a vasodilator drug (Validol, Nitroglycerin). But with severe weakness and low pressure, taking Nitroglycerin is prohibited! Otherwise, before the arrival of doctors, the patient should be provided with complete rest.

As you can see, a heart attack is a serious and extremely dangerous condition that can threaten a person's health and even life. Only by listening to your body and paying attention to the above symptoms can you sound the alarm in time and ward off this threat from yourself. Good health to you!

Almost everyone has experienced this situation: a neighbor, relative or work colleague was taken away in an ambulance with a heart attack. Subsequently, the patient was diagnosed with a heart attack, severe arrhythmia, or aortic aneurysm. However, all these cases have a common pattern - the serious condition of the patient and the real threat to life.

It is good if people are next to such a patient and call an ambulance. The count of time during a heart attack goes literally for minutes, death can come suddenly. That is why everyone should know the first signs of a heart attack, what is necessary and what is strictly forbidden to do in this case.

Heart attack: what is it?

A heart attack is an acute condition, characterized by particular severity and caused by the rapid development of heart failure. A pronounced spasm of the coronary vessels or their blockage by a thrombus leads to the death (necrosis) of the myocardial area.

An attack of heart failure can occur both in heart patients (hypertension, diagnosed heart disease, etc.), and in completely healthy people. Often, an acute condition occurs in emotionally labile women with a history of vegetovascular dystonia. The peak of heart attacks occurs in the spring, days of magnetic storms and hot weather.

Women of childbearing age are at least at risk. Hormones and an extensive network of small coronary vessels (a physiological feature of the female body) save them from a heart attack. However, with the onset of menopause in women, they begin to occur equally often with "male". Moreover, the stronger sex has a great chance of survival: women often die before the arrival of emergency help.

The main causes of a heart attack:

• Developing myocardial infarction - necrosis of the heart muscle begins 30 minutes after the onset of the attack, such patients often have a history of cardiac ischemia, angina pectoris;
• Rhythm disturbance - severe tachycardia (heart rate "gallop"), atrial fibrillation (rapid heartbeat is replaced by fading);
• Aortic aneurysm - often combined with aortic defect and arrhythmia, its detachment provokes a sharp deterioration in the condition at night in bed;
• Pulmonary embolism - often develops against the background of thrombophlebitis of the legs and in old age, death occurs in a matter of minutes;
• Progressive heart failure is the result of long-term cardiosclerosis, hypertension and other heart diseases, a sharp weakening of myocardial contractions can occur after the flu, emotional reactions (both positive and negative), physical activity, atmospheric pressure drop.

Smoking is the first enemy of blood vessels. Women's addiction to cigarettes - a pack or more a day - causes frequent heart attacks at a young age.

Harbingers of a heart attack

Recent medical studies, in particular by scientists at Harvard University, have identified symptoms that occur about a month before a heart attack. A cardiologist should be consulted in cases where the following conditions are found:

• Exorbitant fatigue - not the usual after a working day or household chores, but a complete lack of strength to perform simple actions (go to the store, climb the stairs). Fatigue does not go away even after a good sleep. Often, women note that the usual load (for example, a bag or a light bag of groceries) feels heavier. Many patients note more pronounced weakness, numbness or goosebumps on the fingers of the left hand.
• Slight pains in the chest can migrate (either it pricks under the breast on the left, then it presses behind the sternum). At best, a woman takes Corvalol, Corsiz or valerian drops. However, these drugs have only a calming effect, but do not improve the blood supply to the myocardium.
• Shortness of breath occurs with little exertion and sometimes at rest. When climbing stairs, a woman has to stop to catch her breath.
• In the morning and during the day there is dizziness, up to staggering and the need to sit down. In this case, the body is covered with cold sweat, the skin turns pale.
• Edema - women, especially lovers of high heels, note that swelling on their legs has become stronger, does not disappear even after sleep. Often the hands swell (it is impossible to remove the ring from the finger), the face (swollen eyes in the morning).
• Influenza state - many recall the fact that shortly before a heart attack they experienced a flu-like condition (fever, body aches, runny nose and cough).

The first symptoms of an impending heart attack indicate oxygen starvation of the myocardium and a decrease in contractility. Without medical intervention, acute ischemia - a heart attack - develops as a result.

Important! With similar symptoms, a microinfarction can occur. Occurring myocardial necrosis is often diagnosed later during the ECG. A microinfarction transferred “on its feet” is dangerous with a high risk of developing an extensive heart attack in the future.

Symptoms of a heart attack: how to distinguish from angina pectoris?

Most often, a heart attack occurs in the morning. Heart patients are "used" to their illness and do not pay due attention to some deterioration in their condition, continuing their usual life - take a shower, get ready for work, etc. A heart attack overtakes suddenly:

• Severe chest pain, pressing or sharp, accompanied by palpitations (the heart jumps out of the chest) or fading (a feeling of cardiac arrest). The pain can radiate to the neck, lower jaw, under the shoulder blade and arm on the left. Sometimes there is a feeling that the pain is localized in the stomach.
• The attack is accompanied by nausea and heartburn, rarely vomiting.
• Shortness of breath - the patient captures air through the mouth. With severe tachycardia, there is a feeling of a coma in the throat. In the future, when breathing, wheezing is heard, a wet cough sometimes appears with blood. This indicates progression of heart failure and pulmonary edema.
• The skin turns pale, covered with cold sweat. With the development of heart failure, cyanosis (cyanosis of the skin) develops, the extremities become cold.
• Dizziness often provokes a person to fall to the ground. The patient's eyes and facial expressions express a genuine fear of disaster, but often he cannot even ask for help. It often takes 10 seconds from falling to losing consciousness, although this option is not required.
• The pressure during a heart attack rises, but sometimes remains within acceptable limits.

Important! Patients with diabetes often develop a "silent", asymptomatic heart attack.

A heart attack can mimic angina pectoris, exacerbation of stomach ulcers, and bronchial asthma. To recognize a heart attack, you should know:

• Neither anti-asthmatic sprays (Salbutamol) nor acid-lowering drugs (Renii, Almagel) will help.
• An attack of angina pectoris, unlike a true heart attack, lasts no more than 10 minutes. and is easily treated with nitroglycerin.
• With a heart attack, nitroglycerin does not help, and the attack lasts 30 minutes or more.
• Angina pain is always associated with physical or emotional stress. A heart attack often occurs at rest.
• Rest, taking a comfortable position by the patient does not bring relief. If, with a drop in pressure (hypotension, anemia, etc.) and a pre-fainting state, the patient is awakened with ammonia (bring it to the nose on a cotton swab), such a technique is useless during a heart attack.

Heart attack: what to do to save life?

Many people who have experienced a heart attack complain about the callousness of the people around them: a person who has fallen on the street is often mistaken for a drunk and shunned. In the meantime, time is running out, and the chances of survival are getting smaller. First aid for a heart attack:

• Raise the patient's head (if he fell), unfasten the top buttons, loosen the belt. Open windows indoors.
• Urgently call an ambulance. If the patient is in a public place, shout for a doctor or nurse to be found. Their help will be needed for massage in case of cardiac arrest.
• Urgently put the patient under the tongue Nitroglycerin. Before the arrival of the ambulance, if the pain does not go away, you can give up to 3 tab. with an interval of 5 min. The fastest effect is given by sprays with nitroglycerin - Nitrospray. Nitroglycerin lowers blood pressure! In order to avoid cardiogenic shock, its intake should be limited if the upper a/d is below 100.
• In the best case, give the patient Aspirin at a dose of 300-500 mg (1/2 or a whole tablet). The patient must chew it! The use of Aspirin in the first 30 minutes from the onset of an attack will avoid the formation of a blood clot and increase the chances of survival. You should notify the emergency doctor about taking Aspirin.
• If you have a tonometer, before the arrival of an ambulance, you should measure the pressure.

Important! In case of a heart attack, you should by any means attract attention to yourself and ask for help. If the attack happened on the road, you need to stop the car on the side of the road, turn on the headlights or press the horn.

Special techniques that should not be used in case of a heart attack:

• deep cough

The technique of deep coughing for a heart attack - inhale deeply and cough until sputum is discharged - is widely spread on the Internet. However, in the authoritative Journal of General Hospital Rochester, in which the article was allegedly first published, it is not and never was!

The effectiveness of this method is also not confirmed by the US Heart Association. From a medical point of view, a deep cough can help with arrhythmias, but will only aggravate the condition in myocardial infarction, when any exercise is not desirable. You can't cough during a heart attack!

• Hot water bottle

The old remedy - a heating pad with hot water - will at best aggravate the patient's condition. Heat will provoke the spread of the necrotic focus and increase the area of ​​​​the infarction.

• Antiarrhythmic drugs

Antiarrhythmics and adrenergic blockers (Risoprol, Verapamil, etc.) should be taken if they were previously prescribed by a doctor (history of arrhythmia) or the patient has a rapid pulse. Self-administration of these drugs is not desirable.

Development Forecast

Cigarettes are the enemy of vessels No. 1

During a heart attack, it is important not to waste precious time. In many cases, it is the timely provision of qualified medical care that can save a person's life! You should not be afraid of the reproaches of the emergency doctor who arrived about the diagnosis of "heart attack". Human life is much more expensive, and what kind of attack happened, they will figure it out already in the hospital.

Symptoms of a heart attack in women in 60% of cases are fatal. Such disappointing figures are largely due to the failure to provide or untimely proper medical care. The most unfavorable prognosis is pulmonary thrombosis and aortic dissection. With thromboembolism, death occurs in a matter of minutes, as a rule, even before the ambulance arrives. Aortic dissection in 90% of cases is fatal even with timely assistance.

To minimize the risk of a heart attack, no matter how trite it sounds, you should lead a healthy lifestyle. However, even the absence of bad habits (smoking, alcohol), rational nutrition and sports do not guarantee complete protection against heart disease. The constant companions of modern life - stress, excessive tension - make the heart work at the limit of its capabilities, which sooner or later leads to an inability to fully cope with the load.

Take care of your heart, take care of your nerves and remember: experiences, achievements, failures - "everything passes." “If a problem can be solved, it is worth looking for a solution. If the problem is unsolvable, then there is no point in worrying.” Last but not least, visit your doctor regularly and get tested. After all, it is easier to correct minor violations than to treat a developed heart disease.

The name "heart attack" can hide a wide range of pathological conditions caused by diseases of the heart and blood vessels, which periodically or systematically remind themselves of themselves in this way, even despite the fact that the patient is constantly taking treatment. These are life-threatening attacks, etc. Sometimes a heart attack occurs in people who, in general, are not very sick, but not very healthy either, whose nervous system is especially sensitive to any influences. This group includes patients diagnosed with her characteristic panic attacks and adjustment disorders.

Heart attack, but the reasons are different

Usually people call a heart attack everything that is accompanied by acute intense prolonged (20-30 minutes or more) pain in the heart and evaluate it with one word “bad”, which includes other symptoms (, arrhythmia attack,).

The reason for them may be:

• , which is usually preceded by unstable angina;
• , often developing as a result of a sedentary lifestyle in old age, thrombophlebitis of the venous vessels of the legs;
• Exfoliating that occurs at any age against the background of arterial hypertension;
• , formed as a result of a weakening of the contractility of the heart, the cause of which could be various diseases of the cardiovascular system (arterial hypertension, atherosclerotic, aortic defects, etc.)

All these diseases can complement each other, exist in isolation, but each of them can be asymptomatic or atypical, which is why the concept of “heart attack” is so widely used and it’s good, because a person who does not have a medical education will be able to explain the essence of the problem in a nutshell.

You don't have to be a doctor to distinguish a life-threatening attack from a condition that requires the use of sedatives, you just need to know the symptoms of a heart attack well. Life is such that any of us can find ourselves in a situation where another person needs help, and conscience will not allow to pass by, because myocardial infarction at the beginning of its development (until a diagnosis is made) is also called a heart attack.

Real heart attack

pain with a heart attack, which are based on the death of myocardial cells resulting from the closure of a vessel by a thrombus, or a sharp spasm of arterial vessels, leading to a violation of the blood supply to the heart muscle (ischemia), quite long (up to half an hour). In addition, they are distinguished by a special intensity, and seizure relief with nitroglycerin or other drugs by mouth, usually has no effect , do not alleviate suffering by changing the position of the body, access to fresh air, ammonia and rest.

In addition to pain, the course of a heart attack, depending on its cause, may be accompanied or expressed by other symptoms:

1. A feeling of fear and anxiety (), forcing the patient to take a motionless frozen posture with a reflection of horror in the eyes.
2. Strong palpitations and / or heart rhythm disturbances.
3. Unpleasant sensations behind the sternum, in the arm, in the back and neck.
4. Feeling short of breath, shortness of breath, general weakness.
5. Vertigo, nausea, heaviness in the epigastrium, as if food were stuck, sometimes with heartburn and/or vomiting.
6. Sweating, pallor or cyanosis (cyanosis) of the skin, possibly a decrease in the temperature of the extremities.

It is not out of place to focus on such a heart attack, which is called a "silent heart attack", which proceeds almost imperceptibly, without any symptoms and can happen to each of us, but patients who suffer are more prone to such MI.

What to do in case of a heart attack?

It is better for the sick person to do nothing, it is advisable to call someone to have another person provide first aid for a heart attack.

In such situations, one must keep in mind the likelihood of myocardial infarction, therefore, tactics should be appropriate:

• Measurement of pulse (number of beats, rhythm, filling, tension) and (if there is a tonometer);
• under the tongue;
• An urgent call on 103, starting with the words "heart attack", because with a heart attack, and other similar conditions, every minute counts.

Of course, heart problems can catch a person in any place where there is no apparatus for measuring blood pressure and nitroglycerin, so the very first aid for a heart attack should be to let the emergency medical workers know about the patient as soon as possible.

Call 103 - heart attack

A person who calls an ambulance about a heart attack cannot be accused of going out of his way and making a diagnosis. What kind of attack - the doctors will figure it out, and the spoken words have a magical effect: the station dispatcher knows that a catastrophe has occurred, the patient's serious condition is urgent, therefore, a cardio team is required. Sometimes it is these words that save lives, so it would be appropriate to briefly touch on some emergency cases that are difficult to diagnose in the first minutes.

The threat to human life is: an attack of shortness of breath, proceeding according to the type, can quickly transform into pulmonary edema or develop into in case of extensive myocardial infarction. An attack of tachycardia with a gallop rhythm, as a rule, complements the phenomena of suffocation. Patients suffering chronic heart failure, know what palpitations and painful sensations of acute lack of air are, accompanied by anxiety, sweating, cyanosis, they must constantly keep all the necessary medicines nearby, but, meanwhile, they are always very frightened, because in most cases these attacks “grab” at night. Needless to say, for people who are nearby, these phenomena will have the significance of a heart attack, which requires immediate call for an ambulance.

Video: recognizing and helping with a heart attack

Attack of the heartbeat, unusual in frequency and rhythm, arising against the background of some kind of cardiac pathology, often have to be attributed to heart attacks and life-threatening conditions. Patients who are often visited by attacks of arrhythmia also take heaps of drugs, they know when and what they themselves try not to take to extremes or relieve an arrhythmia attack on their own (reception,). But ... anything happens, and when the situation gets out of control of the patient, he calls an "ambulance", which deals with the relief of an attack at the patient's home.

What is done for arrhythmias?

There are various types of arrhythmias, dangerous and not very dangerous, for example, if not everyone, then many have heard about such a rhythm disorder as atrial fibrillation. For the first time, an attack of this kind of arrhythmia frightens the patient, he feels that something terrible is happening to his heart, so the best solution would be to urgently seek medical help. In addition, this condition usually requires hospitalization. Of course, by calling 103, a person will report that he is having a heart attack.

An ambulance doctor can relieve an arrhythmia attack with the help of antiarrhythmic drugs, It is better for the patient and his relatives not to do this. An individual approach is needed here, drugs that restore the rhythm have their own indications and contraindications, and there is no single algorithm for stopping an attack of all arrhythmias. Usually, in such cases, verapamil is used, which is administered intravenously, and along the way, the issue of hospitalization in a specialized hospital is decided.

As for the attack of tachycardia, the patient usually copes with it himself with the help of β-blockers, for example. However, such self-activity is possible if the cause is known, the diagnosis is established and treatment is prescribed, otherwise, you need to consult a doctor.

Clue in the nature of pain

Sometimes it is really very difficult to distinguish between heart pain, and, accordingly, a heart attack from pain of another origin, including cardiac, but there are still differences:

gender, age, atherosclerosis

Probably, angina pectoris is one of the most frequent "affairs of the heart", more than half of people with problems of the cardiovascular system suffer from this disease. arterial vessels in general, and, in particular, is the main cause of the development of angina pectoris, the clinical expression of which can be considered a heart attack.

insufficiency of blood supply to the myocardium due to blockage of the coronary arteries with the risk of formation and occurrence of a heart attack

Heart failure in patients with atherosclerosis is formed when there is a disproportion between the needs of the heart muscle in oxygen and the possibilities of blood circulation in the arterial vessels of the heart. This is especially pronounced if a person receives additional physical activity, and the heart has to work hard to provide the tissues of the body with the necessary substances. The situation will be complicated by the insufficiency of detours with which the body could compensate for the violation of blood flow. In addition, a negative effect in this case is given by factors that negatively affect the arteries of the heart:

• In the systole phase (myocardial contraction), the loaded heart muscle compresses the small arterial vessels, obstructing their blood flow.
• Increased end-diastolic volume, increased pressure in the LV (left ventricle), reduced myocardial contractility leads to increased pressure within the heart muscle.

Symptoms of a heart attack stem from the formed coronary insufficiency. Due to the imbalance between the transport of oxygen with the blood and the need of the heart muscle for it, the myocardium begins to experience oxygen starvation and, under conditions of hypoxia, responds with ischemia. This should be remembered by people at risk for myocardial infarction (gender, age, weight, excessive exercise, bad habits, hypercholesterolemia, atherosclerosis).

Attack with unchanged vessels

It should be noted that signs of an angina attack are not excluded in people with unchanged heart vessels.

"Seize the heart" can in other cases:

1. Increased production of physiologically active substances (catecholamines) and their accumulation in the myocardium during psycho-emotional and / or physical stress causes the heart to work intensively which is manifested by rapid heartbeat. Under conditions of stress on the heart muscle, the myocardium requires an additional volume of oxygen, which cannot be delivered due to vasospasm and blood flow disturbance caused by catecholamines. These active substances include the so-called "hormone of fear" - adrenaline, the production of which is sometimes provoked by the patients themselves - lovers of various kinds of extreme sports. Contributes to a strong heartbeat, attacks of shortness of breath and angina pectoris another hormone of the adrenal glands - norepinephrine, called the "hormone of rage", which is actively synthesized during stress. People with vegetative-vascular dystonia are very familiar with paroxysms caused by the influence of the sympathetic-adrenal system. They are distinguished by a variety of symptoms and are often classified as a panic attack: the vessels are clean, the heart is healthy, and signs of an angina attack are evident.
2. Under the influence of the sympathetic-adrenal system, activation of coagulation factors of hemostasis. When there is no agreement in the processes of coagulation and anticoagulation, the prerequisites are created for the formation of disseminated intravascular coagulation (), which further exacerbates coronary insufficiency, if it occurs, and contributes to the development of myocardial ischemia.
3. If the movement of blood along the microcirculatory bed encounters an obstacle on its way, then it goes around along the lateral vessels (collaterals). This adaptive mechanism exists in case of unforeseen circumstances and is especially developed in women, which is programmed by nature (pregnancy, childbirth), and the male gender is considered a risk factor. Women are protected by collaterals, however, for the time being, until hormonal function fades with the onset of menopause. After 60 years, both sexes are equally likely to get a heart attack. Underdevelopment of collaterals(workarounds) reduces the body's defenses, and a heart attack will come faster in such people compared with patients who are all right in this regard. Clearly, young women of reproductive age benefit.

If a person is lucky, then during a heart attack, a sudden onset of acute coronary insufficiency can turn on mechanisms that compensate for blood circulation and thereby prevent the formation of an ischemic focus. In an attempt to adapt to circumstances, existing fistulas are revealed, and new ones are urgently formed. In addition, the myocardium tries to supplement the supply of oxygen by increasing its extraction from the arterial blood. However The “coronary supply” is not bottomless, and as it depletes, the symptoms of a heart attack become more and more pronounced.