The myocardial infarction is one of clinical forms of coronary heart disease, followed by development of an ischemic necrosis of the myocardium caused by absolute or relative insufficiency of coronary circulation.
Atherosclerotic defeat of coronary arteries of large or average caliber is the cornerstone of development of a myocardial infarction. Most often thrombosis atherosclerotic of the changed coronary artery with development of its trombotichesky occlusion is a proximate cause of development of a myocardial infarction. Thrombosis arises in the place of a rupture of an atherosclerotic plaque.
In a pathogeny of a myocardial infarction has value and a spasm of coronary arteries which can precede thrombosis.
Clinical options of a myocardial infarction differ depending on a clinical picture which characterizes a disease debut.
• The anginous form - a myocardial infarction begins with the anginous status — an attack of the pains which are localized behind a breast or in the heart which more often is pressing, squeezing, which is tearing apart or burning character, intensive, quite often intolerable, irradiating in the left hand, a left shoulder-blade, the left half of a neck, the mandible lasting for hours which are not stopped nitroglycerine. Pain quite often is followed by fear of death, emergence of cold sweat. • The asthmatic form - a myocardial infarction begins with an attack of cardiac asthma. • The arhythmic form - a myocardial infarction begins with a paroxysm of disturbance of a cordial rhythm. • The Kollaptoidny form - a myocardial infarction begins with development of a collapse. • The cerebral form - a myocardial infarction begins with emergence of focal neurologic symptomatology in connection with development of a cardio-cerebral syndrome. • The abdominal form - a myocardial infarction begins with emergence of pains in epigastriums, the dispeptic phenomena. • Asymptomatic form. Latent beginning of a myocardial infarction.
The myocardial infarction quite often gets the complicated current that causes quite high lethality at this disease.
In the acute period of a myocardial infarction development of the following complications is possible: • disturbances of a rhythm and conductivity; • acute heart failure (cardiac asthma, fluid lungs); • cardiogenic shock; • heart aneurism; • a rupture of a myocardium with a cardiac tamponade; • pericardis; • tromboembolic episodes; • acute erosion and ulcers of a digestive tract.
Treatment of a myocardial infarction
At suspicion on development of a myocardial infarction urgent hospitalization in specialized infarctive department is necessary. The principles of treatment of a myocardial infarction include: • stopping of a painful attack (neyroleptanalgeziya); • attempt of the emergency revascularization of a myocardium (thrombolysis or koronaroplastik); • anticoagulating and lezagregantny therapy; • anti-anginal therapy; • therapy by inhibitors of the angiotensin-converting enzyme (ACE); • symptomatic therapy (treatment of complications).
Except medicamentous therapy, at patients with a myocardial infarction the physical and psychological rehabilitation directed to increase of tolerance to exercise and psychoemotional stresses is carried out.