MINISTRY OF EDUCATION AND SCIENCE OF RUSSIAN FEDERATION

⇐ ПредыдущаяСтр 3 из 3

MINISTRY OF EDUCATION AND SCIENCE OF RUSSIAN FEDERATION

Federal State Autonomous Educational Institution of Higher Education

«V. I. VERNADSKY CRIMEAN FEDERAL UNIVERSITY»

Medical Academy named after S. I. Georgievsky (structural subdivision).

ABSTRACT : MYOCARDIAL INFARCTION

SUBJECT:________INTERNAL MEDICINE 2 ________________________________________________________

STUDENT ____________CHARLES JEFFERY ________________________________________________

(full name.)

Faculty ____International medical faculty____________________________ course __4________ group __LA1-co-174(2)________

NAME OF PRACTICE:___________Inpatient doctor’s assistant _______________________________

SPECIALIZED ORGANIZATION___________Republican _Clinical hospital named after N.A.Semashko________________________________

CITY (urban village):_________________Simferopol______________________________________

· DURATION OF PRACTICE: from______02-07___________till __19-07_________20_21__

Simferopol, 2021

Introduction:What is acute myocardial infarction? Acute myocardial infarction is the medical name for a heart attack. A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries. A blockage can develop due to a buildup of plaque, a substance mostly made of fat, cholesterol, and cellular waste products.Call ambulance right away if you think that you or someone you know may be having a heart attack. A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle.The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw.Often it occurs in the center or left side of the chest and lasts for more than a few minutes.The discomfort may occasionally feel like heartburn.Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat or feeling tired.About 30% of people have atypical symptoms.Women more often present without chest pain and instead have neck pain, arm pain or feel tired.Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.

Classification:

Type 1 (spontaneous MI): Related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with intraluminal thrombus in one or more of the coronary arteries, leading to decreased myocardial blood flow or distal platelet emboli and thereby resulting in myocyte necrosis. The patient may or may not have underlying obstructive coronary artery disease (CAD).

Type 2 (MI secondary to an ischemic imbalance):MI consequent to increased oxygen demand or a decreased supply (eg, coronary endothelial dysfunction, coronary artery spasm, coronary artery embolus, tachyarryhthmias/bradyarrhythmias, anemia, respiratory failure, hypertension, or hypotension).

Type 3 (MI resulting in death when biomarker values are unavailable):Sudden, unexpected cardiac death before blood samples for biomarkers could be drawnorbefore their appearance in the circulation.

Type 4a (MI related to percutaneous coronary intervention [PCI]):Elevation of biomarker values (cTn is preferred) to more than 5 times the 99 th percentile of the URL in patients with normal baseline values (<99<sup>th</sup> percentile URL) or a rise of values over 20% if the baseline values are elevated but stable or falling. In addition, any of the following are required: (1) symptoms suggestive of myocardial ischemia; (2) new ischemic ECG changes or new BBB; (3) angiographic loss of patency of a major coronary artery or a side branch or persistent slow flow or no flow or embolization; or (4) demonstration of the new loss of viable myocardium or new regional wall motion abnormality by cardiac imaging.

Type 4b (MI related to stent thrombosis): MI associated with stent thrombosis as detected by coronary angiography or autopsy in the setting of myocardial ischemia in combination with a rise and/or fall of cardiac biomarkers with at least one value above the 99 th percentile URL.

Type 5 (MI related to coronary artery bypass grafting [CABG]): Elevation of cardiac biomarker values more than 10 times the 99 th percentile URL in patients with normal baseline cTn values. In addition, either (1) new pathologic Q waves or new BBB, (2) angiographic-documented new graft or native coronary artery occlusion, or (3) evidence of new loss of viable myocardium or new regional wall motion abnormality by cardiac imaging is required.

Causes:

Your heart is the main organ in your cardiovascular system, which also includes different types of blood vessels. Some of the most important vessels are the arteries. They take oxygen-rich blood to your body and all of your organs. The coronary arteries take oxygen rich blood specifically to your heart muscle. When these arteries become blocked or narrowed due to a buildup of plaque, the blood flow to your heart can decrease significantly or stop completely. This can cause a heart attack. Several factors may lead to a blockage in the coronary arteries.

Bad cholesterol

Bad cholesterol, also called low-density lipoprotein (LDL), is one of the leading causes of a blockage in the arteries. Cholesterol is a colorless substance that’s found in the food you eat. Your body also makes it naturally. Not all cholesterol is bad, but LDL cholesterol can stick to the walls of your arteries and produce plaque. Plaque is a hard substance that blocks blood flow in the arteries. Blood platelets, which help the blood to clot, may stick to the plaque and build up over time.

Saturated fats

Saturated fats may also contribute to the buildup of plaque in the coronary arteries. Saturated fats are found mostly in meat and dairy products, including beef, butter, and cheese. These fats may lead to an arterial blockage by increasing the amount of bad cholesterol in your blood system and reducing the amount of good cholesterol.

Trans fat

Another type of fat that contributes to clogged arteries is trans fat, or hydrogenated fat. Trans fat is usually artificially produced and can be found in a variety of processed foods. Trans fat is typically listed on food labels as hydrogenated oil or partially hydrogenated oil.

Symptoms:

What are the symptoms of acute myocardial infarction?

While the classic symptoms of a heart attack are chest pain and shortness of breath, the symptoms can be quite varied. The most common symptoms of a heart attack include:

Pressure or tightness in the chest

Pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back

Shortness of breath

Sweating

Nausea

Vomiting

Anxiety

A cough

Dizziness

A fast heart rate

It’s important to note that not all people who have heart attacks experience the same symptoms or the same severity of symptoms. Chest pain is the most commonly reported symptom among both women and men. However, women are more likely than men to have:

Shortness of breath

Jaw pain

Upper back pain

Lightheadedness

Nausea

Vomiting

In fact, some women who have had a heart attack report that their symptoms felt like the symptoms of the flu.

Risk factors:

Certain factors may increase your risk of having a heart attack.

High blood pressure

You’re at greater risk for heart attack if you have high blood pressure. Normal blood pressure is below 120/80 mm Hg (millimeters of mercury) depending on your age. As the numbers increase, so does your risk of developing heart problems. Having high blood pressure damages your arteries and accelerates the buildup of plaque.

High cholesterol levels

Having high levels of cholesterol in your blood puts you at risk for acute myocardial infarction. You may be able to lower your cholesterol by making changes to your diet or by taking certain medications called statins.

High triglyceride levels

High triglyceride levels also increase your risk for having a heart attack. Triglycerides are a type of fat that clog up your arteries. Triglycerides from the food you eat travel through your blood until they’re stored in your body, typically in your fat cells. However, some triglycerides may remain in your arteries and contribute to the buildup of plaque.

Diabetes and high blood sugar levels

Diabetes is a condition that causes blood sugar, or glucose, levels to rise. High blood sugar levels can damage blood vessels and eventually lead to coronary artery disease. This is a serious health condition that can trigger heart attacks in some people.

Obesity

Your chances of having a heart attack are higher if you’re very overweight. Obesity is associated with various conditions that increase the risk of heart attack, including:

Diabetes

High blood pressure

High cholesterol levels

High triglyceride levels

Smoking

Smoking tobacco products increases your risk for heart attack. It may also lead to other cardiovascular conditions and diseases.

Age

The risk of having a heart attack increases with age. Men are at a higher risk of a heart attack after age 45, and women are at a higher risk of a heart attack after age 55.

Family history

You’re more likely to have a heart attack if you have a family history of early heart disease. Your risk is especially high if you have male family members who developed heart disease before age 55 or if you have female family members who developed heart disease before age 65.

Other factors that can increase your risk for heart attack include:

Stress

Lack of exercise

The use of certain illegal drugs, including cocaine and amphetamines

A history of preeclampsia, or high blood pressure during pregnancy

Diagnosis:

To determine whether you’ve had a heart attack, your doctor will listen to your heart to check for irregularities in your heartbeat. They may measure your blood pressure as well. Your doctor will also run a number of different tests if they suspect that you’ve had a heart attack. An electrocardiogram (EKG) may be done to measure your heart’s electrical activity. Blood tests can also be used to check for proteins that are associated with heart damage, such as troponin.

Other diagnostic tests include:

A stress test to see how your heart responds to certain situations, such as exercise

An angiogram with coronary catheterization to look for areas of blockage in your arteries

An echocardiogram to help identify areas of your heart that aren’t working properly

ECG:

The primary purpose of the electrocardiogram is to detect ischemia or acute coronary injury in broad, symptomatic emergency department populations. A serial ECG may be used to follow rapid changes in time. The standard 12 lead ECG does not directly examine the right ventricle, and is relatively poor at examining the posterior basal and lateral walls of the left ventricle. In particular, acute myocardial infarction in the distribution of the circumflex artery is likely to produce a nondiagnostic ECG. The use of additional ECG leads like right-sided leads V3R and V4R and posterior leads V7, V8, and V9 may improve sensitivity for right ventricular and posterior myocardial infarction.[citation needed]

The 12 lead ECG is used to classify patients into one of three groups:

1)Those with ST segment elevation or new bundle branch block (suspicious for acute injury and a possible candidate for acute reperfusion therapy with thrombolytics or primary PCI),

2) with ST segment depression or T wave inversion (suspicious for ischemia), and

3)Those with a so-called non-diagnostic or normal ECG.

A normal ECG does not rule out acute myocardial infarction. Mistakes in interpretation are relatively common, and the failure to identify high risk features has a negative effect on the quality of patient care.It should be determined if a person is at high risk for myocardial infarction before conducting imaging tests to make a diagnosis. People who have a normal ECG and who are able to exercise, for example, do not merit routine imaging.Imaging tests such as stress radionuclide myocardial perfusion imaging or stress echocardiography can confirm a diagnosis when a person’s history, physical exam, ECG and cardiac biomarkers suggest the likelihood of a problem.

Atypical forms:

Atypical myocardial infarction often occurs in older patients with a pronounced cardiosclerosis, circulatory failure, and often with people who have a history of heart attacks.The symptoms may confuse you, or make you think that they are not associated with the heart.Usually, atypical manifestations develop only in the initial stages of myocardial infarction. As symptoms develop, the clinical features become obvious, when the condition aggravates. The peripheral form of myocardial infarction with atypical localization of the pain, which occurs not in the retrosternal or precordial region behind the chest bone, but:

In the throat (laryngeal-pharyngeal form)

In the left-hand end of the left little finger (left-hand form)

Left shoulder blade (left shoulder blade form)

In the cervical-thoracic spine (upper vertebral)

Lower jaw (mandibular form)

The intensity of pain varies. Sometimes it is enhanced, and not relieved by nitroglycerin. The rest of the symptoms are characterized by weakness, sweating, blood pressure drop, Croc’s disease, palpitations, arrhythmias.

The abdominal form is usually found in posterior diaphragmatic myocardial infarction (the back of the heart). There is an intense pain in the epigastric or right upper quadrant of the stomach, the right half of the abdomen. Also. The pain is accompanied with nausea, vomiting, abdominal distention (upset stomach), paresis of the stomach and intestines, diarrhea.On the palpation, the muscles of the anterior (front) abdominal wall are stretched. The cardiovascular system reaction includes the drop in blood pressure, voiceless heart tones, and a variety of arrhythmias.

An arrhythmic formof myocardial infarction is characterized by the appearance of different rhythm disturbances (arrhythmias, atrial fibrillation, paroxysmal tachycardia), as well as different types of atrioventricular block (when there is an insufficient conduction of the electrical impulse through the heart wall, the pulse does not go through from the atrium to the ventriculus)

Asthmatic formof myocardial infarction is characterized by the development of cardiac asthma and pulmonary edema (severe dyspnea, cough with frothy sputum) in the absence or weak expression of pain in the heart. A significant drop in the blood pressure, the cantering rhythm (galop) may occur as well, various arrhythmias are a weighing factor of this form of MI. This form is typical for a heart attack in the presence of severe cardiosclerosis, hypertension, and almost always develops into papillary muscles myocardial infarction.

Collapse formof myocardial infarction differs completely from the other forms of MI by the absence of pain. However, the clinical picture shows domination of the sharp sudden hypotension, dizziness, cold sweat, darkening of the vision. This condition is regarded to a manifestation of cardiogenic shock a severe life-threatening condition.

Cerebral infarction form appears as the development of a classical clinic of cerebral circulatory disorders. The distinguishing features of this condition are a headache, dizziness, nausea, vomiting, less often motor and sensory disorders. The insufficiency of cerebral blood supply occurs against a background of atherosclerotic lesions of cerebral arteries due to a decrease in cardiac output ( the heart does not pump enough blood to feed the brain, which leads to the oxygen starvation of the head), which is typical for acute myocardial infarction.

Edematous form of myocardial infarction, it is when the patient has shortness of breath, weakness, swelling, even an ascites. The development of the symptoms occurs relatively quickly. Also, an enlarged liver might be found while examinations as well. An acute right ventricular failure develops while this form of MI leading to the fluid effusion in the abdominal cavity (ascites).

Subclinical formof myocardial infarction is characterized by weakness, sweating, chest pain of uncertain nature. In general, these symptoms are difficult to interpret, as they might be found in numerous conditions.

Combination formof myocardial infarction includes several different manifestations of atypical forms.

For the diagnosis of atypical forms of myocardial infarction, all clinical symptoms should be carefully assessed, such as dynamic ECG changes and resorption necrotic syndrome.Special features found in the biochemical blood test, echocardiography data have to be encountered.If you feel that there is something wrong in your chest, and you are from the risk group according to the age and health condition, do not hesitate to call an ambulance.

Treatment:

Heart attacks require immediate treatment, so most treatments begin in the emergency room. A minimally invasive procedure called angioplasty may be used to unblock the arteries that supply blood to the heart. During an angioplasty, your surgeon will insert a long, thin tube called a catheter through your artery to reach the blockage. They will then inflate a small balloon attached to the catheter in order to reopen the artery, allowing blood flow to resume. Your surgeon may also place a small, mesh tube called a stent at the site of the blockage. The stent can prevent the artery from closing again.Your doctor may also want to perform a coronary artery bypass graft (CABG) in some cases. In this procedure, your surgeon will reroute your veins and arteries so the blood can flow around the blockage. A CABG is sometimes done immediately after a heart attack. In most cases, however, it’s performed several days after the incident so your heart has time to heal.A number of different medications can also be used to treat a heart attack:

Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries.

Thrombolytics are often used to dissolve clots.

Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots from forming and existing clots from growing.

Nitroglycerin can be used to widen your blood vessels.

Beta-blockers lower your blood pressure and relax your heart muscle. This can help limit the severity of damage to your heart.

ACE inhibitors can also be used to lower blood pressure and decrease stress on the heart.

Pain relievers may be used to reduce any discomfort you may feel.

Prevention:There are many steps you can take to prevent a heart attack, even if you’ve had one before.There are many steps you can take to prevent a heart attack, even if you’ve had one before.One way to lower your risk is to eat a heart-healthy diet. This diet should largely consist of:whole grains, vegetables fruits lean protein You should also reduce the amount of the following in your diet: sugar saturated fat trans fat cholesterol This is especially important for people with diabetes, high blood pressure, and high cholesterol.Exercising several times a week will also improve your cardiovascular health. If you’ve had a heart attack recently, you should speak with your doctor before starting a new exercise plan. It’s also important to stop smoking if you smoke. Quitting smoking will significantly lower your risk of a heart attack and improve both your heart and lung health. You should also avoid being around secondhand smokOne way to lower your risk is to eat a heart-healthy diet. This diet should largely consist of: whole grains vegetables fruits lean protein You should also reduce the amount of the following in your diet: sugar saturated fat trans fat cholesterol This is especially important for people with diabetes, high blood pressure, and high cholesterol. Exercising several times a week will also improve your cardiovascular health. If you’ve had a heart attack recently, you should speak with your doctor before starting a new exercise plan. It’s also important to stop smoking if you smoke. Quitting smoking will significantly lower your risk of a heart attack and improve both your heart and lung health. You should also avoid being around secondhand smoke.

Outcomes: Chances of recovering from a heart attack depend on how much damage there is to your heart and how quickly you receive emergency care. The sooner you receive treatment, the more likely you are to survive. However, if there’s substantial damage to your heart muscle, your heart may be unable to pump an adequate amount of blood throughout your body. This can lead to heart failure. Heart damage also increases your risk of developing abnormal heart rhythms, or arrhythmias. Your risk of having another heart attack will be higher as well. Many people who’ve had heart attacks experience anxiety and depression. It’s important to speak with your doctor about your concerns during recovery. It may also be beneficial to join a support group or to speak with a counselor about what you’re going through. Most people are able to resume their normal activities after a heart attack. However, you’ll need to ease back into any intense physical activity. Your doctor will help you develop a specific plan for recovery. You may be required to take medications or undergo a cardiac rehabilitation program. This type of program can help you slowly regain your strength, teach you about healthy lifestyle changes, and guide you through treatment.

Conclusion:If you ask about the symptoms of a heart attack, most people think of chest pain. Over the last couple of decades, however, scientists have learned that heart attack symptoms aren’t always so clear-cut.If you ask about the symptoms of a heart attack, most people think of chest pain. Over the last couple of decades, however, scientists have learned that heart attack symptoms aren’t always so clear-cut.Symptoms may show up in different ways and can depend on a number of factors, such as whether you’re a man or a woman, what type of heart disease you have, and how old you are.It’s important to dig a little deeper to understand the variety of symptoms that may indicate a heart attack. Uncovering more information can help you learn when to help yourself and your loved oneSymptoms may show up in different ways and can depend on a number of factors, such as whether you’re a man or a woman, what type of heart disease you have, and how old you are.It’s important to dig a little deeper to understand the variety of symptoms that may indicate a heart attack. Uncovering more information can help you learn when to help yourself and your loved ones.

References:

https://www.findatopdoc.com/Healthy-Living/Atypical-Forms-of-Myocardial-Infarction

https://en.m.wikipedia.org/wiki/Myocardial_infarction_diagnosis#:~:text=The%20diagnosis%20of%20myocardial%20infarction,over%20a%2024-hour%20period.

https://www.healthline.com/health/heart-disease/heart-attack-symptoms

https://emedicine.medscape.com/article/155919-overview

https://www.webmd.com/heart-disease/understanding-heart-attack-basics

https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106

https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction

https://www.health.harvard.edu/a_to_z/heart-attack-myocardial-infarction-a-to-z

⇐ Предыдущая 1 23