Acute myocardial infarction. Aspirin and clopidogrel in patients with myocardial infarction undergoing reperfusion therapy Is aspirin given for acute infarction

A common question that is often asked with a heart attack is whether to chew and swallow aspirin as soon as 03 is called. But since a heart attack is dangerous, how useful is an aspirin tablet?

Heart attacks: why take aspirin while waiting for an ambulance?

A heart attack, also called myocardial infarction, is usually a form of acute coronary syndrome (ACS).

It is caused by a ruptured plaque in the coronary artery. This rupture leads to a thrombus (blood clot) in the artery and a blockage. Then, the part of the heart muscle supplied by the artery begins to die. The death of the heart muscle is what determines myocardial infarction.

This means that when you have a heart attack, most of problems are the growth of a blood clot in the affected artery. The formation of this blood clot is heavily dependent on platelets, which are tiny blood cells whose job it is to participate in blood clotting.

Why Aspirin?

It turns out that aspirin - even in small doses - can quickly and strongly inhibit platelet activity and therefore can inhibit the growth of a blood clot. Inhibiting blood clot growth is critical if you are having a heart attack, as keeping at least some blood flow through the coronary artery can lead to death of heart muscle cells.

Large randomized clinical trials have shown that if aspirin is used immediately with an acute heart attack, mortality after five weeks is reduced by 23%. This is why chewing and swallowing aspirin is usually one of the first things you are asked to do when you arrive at the department. emergency care with suspicion of MI.

But time has an essence - the number of minutes. Therefore, if you think you may be having a heart attack, most experts now advise patients not to wait until they receive medical assistance- Chew and swallow aspirin as soon as something bothers you to call paramedics.

Thus, you can start treatment immediately.

How many, what type?

The current recommendation for people who may be having a heart attack is to chew and swallow one adult uncoated dose of aspirin (325 mg) as soon as possible. Chewing or crushing aspirin enters your bloodstream faster - within four to five minutes - and the researchers measured a significant effect on platelets within that short period of time.

Swallowing whole aspirin with water as usual takes 10 to 12 minutes to achieve the same effect. This time difference may seem small, but again, every minute counts when your heart is at stake.

Acetylsalicylic acid belongs to non-steroidal anti-inflammatory drugs. It is used to lower body temperature, relieve pain. In cardiology, aspirin is prescribed to prevent blood clots from forming in blood vessels. The antiplatelet properties of the drug are considered the "gold standard" for the prevention of myocardial infarction and ischemic stroke.

Pharmacological action of aspirin

Despite the fact that the drug has been known for over 100 years, its mechanism of action has been studied quite recently. The main point of application is the irreversible suppression of the enzyme cyclooxygenase. The consequences of this are manifested in this way:

• the synthesis of prostaglandins is inhibited, while the vessels expand;
• the production of thromboxanes decreases - platelets do not stick together;
• the secretion of prostacyclins increases, which inhibit the fixation of platelets on the vessel wall and their connection into clots.

These actions are dose dependent. The antiplatelet properties of aspirin are most pronounced when taken in small amounts, then, as the dose is increased, antipyretic, anti-inflammatory, and then anesthetic effect is manifested first.

Large dosages have the opposite effect on the thrombus formation process, because the production of prostacyclins is inhibited.

An interesting feature of taking this medication to thin the blood is the preservation of the anti-thrombotic effect for a week. This is due to the lifespan of platelets. After the formation of new cells, the supply of cyclooxygenase is replenished.

And here is more about postinfarction cardiosclerosis.

How to take the drug

Depending on the purpose, aspirin can be prescribed in different regimens. General rule - reception after meals, washed down with milk or alkaline still water. It is not recommended to chew the tablet, but when prescribed in case of acute violation of coronary or cerebral circulation, such restrictions are not relevant. For a faster effect, aspirin is crushed or effervescent tablets are used, which are dissolved in water.

With a heart attack

If the patient develops severe attack angina pectoris, which is not relieved after taking one nitroglycerin tablet, as well as in any cases of intense pain in the heart with ischemic disease, you need to take 325-500 mg of acetylsalicylic acid as soon as possible. With prolonged pain syndrome, you can repeat the reception after 15 - 30 minutes.

Aspirin is most effective in the first hours of the development of a heart attack, its reception helps to localize the affected area and significantly reduce the risk of complications.

With angina

To improve the rheological properties of blood, coronary blood flow, special forms of Aspirin are used - Cardiomagnyl, Lospirin, Thrombo ACC, Asafen. These tablets are coated with an acid-resistant coating, due to this, the drug begins to be absorbed only in the intestinal lumen.

Patients with angina pectoris are prescribed to reduce the risk of developing a heart attack in a stable and progressive form. The dosage ranges from 75 mg to 300 mg per day, it depends on the functional class of the disease.

All patients with manifestations of atherosclerosis should always have Nitroglycerin and Aspirin tablets with them, since taking them can save lives.

Angina pectoris

With hypertension

Taking Aspirin does not have a direct effect on blood pressure, but its preventive effect has been found. If you take 75 - 150 mg of the drug before going to bed, then the next day the hypertension becomes milder, controlled, and antihypertensive drugs are stronger.

The mechanism of this effect is considered to be a decrease in the activity of the production of vasoconstrictor hormones and enzymes by the kidneys. Enabling this drug in complex therapy arterial hypertension reduces the risk of ischemic stroke and transient disorders of cerebral blood flow.

After a heart attack

Continuous intake of aspirin is recommended for all patients who have suffered an acute disturbance of coronary blood flow. Its effect begins to manifest itself at a dose of 75 mg. The best option is the daily evening use of the drug. Thus, you can influence the morning increase in blood clotting. The minimum course of therapy is 30 days.

Watch the video about a heart attack:

For prevention

To prevent vascular catastrophes in those at risk, aspirin is used along with lifestyle modification. Taking the drug is shown in the presence of such conditions:

• diabetes mellitus or impaired carbohydrate tolerance,
• increased blood clotting,
• high concentration of cholesterol and triglycerides in the blood,
• obesity,
• the predominance of meat and fatty foods in the diet,
• age after 55 years,
• the presence of a hereditary predisposition to coronary or cerebral blood flow disorders,
• after vascular surgery,
• hypertonic disease,
• smoking,
• chronic alcoholism.

It is prescribed in a dose of 75 mg at night or 150 mg every other day.

Side effects of acetylsalicylic acid

The most common complication after prolonged use of the drug is abdominal pain and the occurrence of gastrointestinal bleeding with existing peptic ulcer... Therefore, for cardiac patients, special forms of aspirin are recommended, taken after meals or together with enveloping agents (Phosphalugel, Maalox). In addition, when using salicylates, there may be such side effects:

• inflammation of the mucous membranes of the stomach and intestines,
• nausea, diarrhea, heartburn,
• postoperative and internal bleeding,
• anemia and thrombocytopenia,
• asthmatic attacks,
• impaired renal and liver function,
• headache,
• hearing loss, tinnitus,
• attacks of gouty pain.

If any of these disorders appear, you should immediately stop taking aspirin and consult a doctor to change the drug.

Is an overdose possible

That is, for an adult, you need to take 7 g of the drug, which corresponds to 14 tablets of a standard or 93 tablets of a cardiac form. Such intoxication can be life threatening, so the drug should be kept in a hard-to-reach place for children and mentally unstable patients.

Chronic overdose has no special manifestations; headache, dizziness, tinnitus, nausea may appear. For treatment, the acceleration of excretion is used with the help of infusion therapy and diuretics.

And here is more about pain in myocardial infarction.

Acetylsalicylic acid belongs to medicines with proven effectiveness for primary and secondary prevention of coronary heart disease, progression of angina pectoris, prevention of stroke and heart attack. These actions fail due to the antiplatelet properties of this agent. The most effective use is in the very first hours of acute disturbance of coronary blood flow.

cardiobook.ru

Preventive treatment of myocardial infarction with aspirin

Low-dose aspirin treatment may be recommended for men aged 40 and over who are at increased risk of myocardial infarction and who have no contraindications to taking this medication.

Patients should be aware of the potential benefits and risks of aspirin treatment before starting treatment.

Coronary artery disease is the leading cause of death in the United States, causing about 1.5 million myocardial infarctions and more than 520,000 deaths annually. Every year about 400,000 Americans are victims of sudden death, primarily caused by latent atherosclerosis. Significant mortality, morbidity and disability have been associated with myocardial infarction. In 1986, the loss of production and treatment costs associated with cardiovascular disease amounted to nearly $ 80 billion in the United States.

Myocardial infarction and sudden death often occur without warning in people who have not had angina or other clinical symptoms... The main risk factors for coronary arterial disease are: smoking, hypertension, elevated level serum cholesterol and hereditary diseases.

Aspirin's ability to inhibit platelet adhesion prevents arterial clots or atherosclerotic plaques from forming. Several secondary preventive studies have shown that daily aspirin ingestion can reduce the risk of non-fatal myocardial infarction (MI) attacks in people at high risk for atherosclerosis and thrombogenesis (people with unstable angina, transient ischemic attack, after coronary artery bypass graft surgery, and thrombolysis). In some studies, however, the efficacy of aspirin treatment is seen as the primary prophylactic measure in asymptomatic people without considering cases that thus become less prone to myocardial infarction. The use of aspirin to prevent seizures in people who do not have neurological symptoms is recommended for people at increased risk of thromboembolic manifestations (for example, those who have a murmur over carotid artery, cardiovascular diseases, atrial fibrillation), however, even for this contingent there is not enough convincing information to confirm the effectiveness of treatment in this way. Two recent randomized controlled studies in the United States and the United Kingdom have shown the efficacy of aspirin in preventing myocardial infarction in healthy individuals. In a US study, more than 2,200 asymptomatic male doctors received 325 mg of either aspirin or a substitute each day. The study was completed ahead of schedule 4.5 years later, when a statistically significant 47% reduction in the incidence of fatal and non-fatal myocardial infarction was noted in the aspirin-treated group. In a British study where there were fewer test subjects (5139 male doctors) and a higher dose (500 mg daily), there was no significant reduction in MI. While the lack of measurable reductions in myocardial infarction may have been due to lack of efficacy, the UK study may not have shown measurable impact on MI due to inadequate numbers of study participants and differences in other parameters (eg, higher dosage and no substitutes). None of the studies provide sufficient statistical volume to demonstrate a reduction in overall mortality from cardiovascular disease. In both studies, there was an increase in the incidence of seizures in people taking aspirin, however, in neither study was this difference statistically significant. According to preliminary data from an American study among men, taking their aspirin, there was a statistically significant increase in the incidence of average and severe attacks with hemorrhage. In more recent analyzes of the final data, the researchers nevertheless found that the difference was not statistically significant. It is necessary to consider other side effects in aspirin treatment to assess the safety of long-term drug use. Aspirin can cause unpleasant gastrointestinal symptoms such as abdominal pain, heartburn, nausea, and constipation, as well as latent blood loss in the gastrointestinal tract, bloody vomiting, and melena. The likelihood of such side effects among quite healthy people, it is in direct proportion to the dose of the medicine. According to a British study in which the dose was 500 mg per day, 20% of doctors taking aspirin were forced to stop taking the drug due to dyspepsia and constipation, 3.6% had bleeding or bruising and 2.2% had gastrointestinal intestinal blood loss. According to an American study in which the dose was 325 mg every other day, the difference in gastrointestinal complaints between the groups taking aspirin and placebo was less than 1%. In 4.5 years of research, only 1 death was reported due to gastrointestinal bleeding.

Similarly, a large secondary preventive study reported little difference in cases of epigastric malaise, decreased hemoglobin concentration, or occult stool blood in patients who received 325 mg per day.

In addition to reducing the risk of side effects, low-dose treatment has been shown to have a comparable, if not greater, platelet-aggregation-inhibiting effect than higher doses. A review of 254 secondary preventive studies involving a total of 29,000 patients found little difference in outcomes between 300 and 1200 mg per day. In one study, a dose of as little as 60 mg per day was effective in reducing the incidence of hypertension during pregnancy. It is possible that treatment with higher doses may be less effective in stopping platelet aggregation due to the inhibition of prostacyclin synthesis by the vascular walls simultaneously with the production of tromboxane A2 platelets. Doses as low as 30-40 mg per day may be needed to achieve optimal balance.

The likelihood of side effects at such low doses is likely to be small, but further studies of aspirin treatment are needed to provide conclusive evidence regarding both the clinical efficacy of the low dose regimen and the safety of long-term drug administration.

There is little information about whether asymptomatic patients will follow a doctor's advice for long-term aspirin use. Aspirin is the most commonly used drug in the United States, with an annual consumption of approximately 20-30 billion tablets. However, many of these consumers suffer from pain, fever, or other forms of discomfort while taking this medication. It is not known whether they can or will want to healthy people bind yourself to a lifelong regimen of daily (or every other day) medication, especially if it causes unpleasant side effects.

As noted above, over the 6-year course, 20% of the doctors in the British study had to stop taking 500 mg of aspirin daily due to dyspepsia and constipation.

The American Heart Association recently recommended that physicians monitor a patient before starting lifelong aspirin treatment: efforts must first be made to modify the primary risk factors for heart disease and stroke, weigh possible contraindications to aspirin use, and advise patients on possible side effects and symptoms that require attention of doctors.

Researchers in the American and British studies recommended that physicians first consider the patient's propensity for cardiovascular disease risk and weigh the known harmful qualities of aspirin (eg, gastrointestinal malaise and bleeding, cerebral hemorrhage) and the benefits before prescribing aspirin to asymptomatic people. which it can bring to reduce the risk of a first myocardial infarction.

Although data from a large study indicate that low-dose aspirin treatment may reduce the risk of myocardial infarction in asymptomatic men, it seems premature to recommend widespread use of aspirin for this purpose at a general level. This positive impact was noted in a sampled population: male doctors aged 40-84 with exceptionally good health, who were also selected to exclude those who are intolerant to aspirin. In addition, the study was terminated early, so it cannot be said with certainty that the long-term complications of aspirin treatment will ultimately outweigh its benefits. Some patients may feel that the reduced risk of myocardial infarction cannot justify the unpleasant side effects or the increased risk of gastrointestinal bleeding. Moreover, in both the American and British studies, emergencies were more common among patients taking aspirin. Although the difference was not significant, the findings indicate that further research is needed on the relationship between aspirin treatment and cerebral haemorrhage.

Hypertensive patients, a contingent with an increased risk of developing both coronary arterial and cardiovascular diseases, may be more susceptible to hemorrhagic attacks when taking medication.

Low-dose aspirin treatment (325 mg / every other day) can be given as an initial warning to men aged 40 and over who have risk factors for myocardial infarction (eg, hypercholesterolemia, smoking, diabetes mellitus, early family history of coronary artery disease) disease) and those who did not have uncontrolled hypertension, kidney and liver disease, stomach ulcers, gastrointestinal bleeding, or other risk factors for bleeding or cerebral hemorrhage. Patients should be aware of the potential benefits and risks of aspirin prior to treatment and should be encouraged to focus on modifying primary risk factors such as smoking, high cholesterol and hypertension. Gaev G.I., Levandovsky I.V., Spirin A.I.

medbe.ru

Aspirin for a heart attack will save lives

A common question that is often asked with a heart attack is whether to chew and swallow aspirin as soon as 03 is called. But since a heart attack is dangerous, how useful is an aspirin tablet?

Heart attacks: why take aspirin while waiting for an ambulance?

A heart attack, also called myocardial infarction, is usually a form of acute coronary syndrome (ACS).

It is caused by a ruptured plaque in the coronary artery. This rupture leads to a thrombus (blood clot) in the artery and a blockage. Then, the part of the heart muscle supplied by the artery begins to die. The death of the heart muscle is what determines myocardial infarction.

This means that when you have a heart attack, most of the problem is the growth of a blood clot in the affected artery. The formation of this blood clot is heavily dependent on platelets, which are tiny blood cells whose job it is to participate in blood clotting.

Why Aspirin?

It turns out that aspirin - even in small doses - can quickly and strongly inhibit platelet activity and therefore can inhibit the growth of a blood clot. Inhibiting blood clot growth is critical if you are having a heart attack, as keeping at least some blood flow through the coronary artery can lead to death of heart muscle cells.

Large randomized clinical trials have shown that if aspirin is used immediately with an acute heart attack, mortality after five weeks is reduced by 23%. This is why chewing and swallowing aspirin is usually one of the first things you are asked to do when you arrive at the emergency room with a suspected MI.

But time has an essence - the number of minutes. So if you think you might be having a heart attack, most experts now advise patients not to wait until they receive medical attention - chew and swallow aspirin as soon as something bothers you to call paramedics.

Thus, you can start treatment immediately.

How many, what type?

The current recommendation for people who may be having a heart attack is to chew and swallow one adult uncoated dose of aspirin (325 mg) as soon as possible. Chewing or crushing aspirin enters your bloodstream faster - within four to five minutes - and the researchers measured a significant effect on platelets within that short period of time.

Swallowing whole aspirin with water as usual takes 10 to 12 minutes to achieve the same effect. This time difference may seem small, but again, every minute counts when your heart is at stake.

medictionary.ru

Q myocardial infarction

According to the conditions and tasks of physical rehabilitation at different times from the onset of I. m., Three phases can be distinguished, of which phase I corresponds to the stationary stage, phase II - to the post-hospital stage before the patient returns to work, phase III - to the period of dispensary observation of the patient who underwent I. m. And renewed labor activity.

At the inpatient (hospital) stage of rehabilitation (phase I), the criteria for prescribing exercise therapy are improvement general condition the patient, the cessation of pain in the heart and suffocation, stabilization of blood pressure and the absence of prognostically unfavorable disturbances in the rhythm and conduction of the heart, as well as signs of continued I. m. Abstain from exercise therapy with increasing cardiovascular failure, thromboembolic complications, severe cardiac arrhythmias, rest angina, fever, although in these cases, a positive psychological effect for the patient can be obtained from carrying out several practical non-load exercises with the help of a methodologist (squeeze and unclench hands, slightly straighten and bend the feet, etc.).

The main goal of exercise therapy at the stationary stage of rehabilitation of patients with I. m is a gradual expansion of the patient's physical activity, training of orthostatic stability of hemodynamics, adaptation of the patient to basic self-care and performance of such loads as walking and climbing stairs. This is achieved by gradually expanding the patient's motor activity mode from passive movements and turns to active turns in bed, then sitting, getting up, walking, i.e. the gradual development of modes 0, I, II, III, IV of motor activity, provided for by the programs of physical rehabilitation of patients with I. m. proposed by WHO (1960). Two rehabilitation programs are recommended, differing in the timing of the appointment of exercise therapy and the rate of increase in the modes of motor activity, depending on the severity of I. m. Largely determined by its vastness and depth (Table 2). For patients with small focal uncomplicated I. m. The program of physical rehabilitation is designed for 3 weeks. for patients with large focal and complicated I. m - on average for 5 weeks. but these programs are amended taking into account the functional class of severity of I. m. in the acute period of the disease, for example, according to L.F. Nikolaeva and D.M. Aronov (1988), distinguishing 4 such classes (depending on the size of the heart attack, the presence and severity of complications, the degree of coronary insufficiency).

Remedial gymnastics they begin carefully, without disturbing the patient's bed rest, in the lying position and controlling the patient's load tolerance. The change in the modes of motor activity is carried out, gradually moving from performing exercises lying down to performing them lying and sitting, then sitting, then sitting and standing, and finally standing.

Table 2.

The timing of the start of the use of individual modes of motor activity at the hospital stage of rehabilitation in patients with small focal and large focal myocardial infarction

Movement mode

Myocardial fibrosis and arrhythmias: predicting the effect of catheter ablation

Conceptually, any structural myocardial pathology, accompanied by the development of necrosis / fibrosis, can create conditions for the development of VA by the re-entry mechanism (Marchlinski F. 2008). The more fibro-cicatricial changes in the myocardium of the left / right ventricles, the higher the probability of VA by the re-entry mechanism and, accordingly, the worse the prognosis.

Today, much attention of pathophysiologists and clinicians is attracted primarily by the quantitative and qualitative assessment of fibrosis / scar of the left ventricular muscle - LV (Zipes D. Camm A. 2012). Consolidated scar / fibrosis is not capable of conducting impulses and cannot be a direct source of VA.

Etiology of myocardial fibrosis / scarring

A large number of diseases leads to the formation of diffuse and local large and small focal fibrosis, which cause a delay in the contrast medium in the myocardium. The main ones include: ischemic heart disease, myocardial infarction, hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, myocarditis, sarcoidosis, amyloidosis, malignant tumors myocardium (primary and secondary). In Latin America, this list also includes Chagas disease (Zipes D. Camm A. Borggrefe M. 2006).

Of the listed nosologies, ischemic heart disease, which is accompanied by the formation of fibrosis / scar, has the greatest practical significance.

Methods for determining scar / myocardial fibrosis

Duration of taking aspirin for myocardial infarction. Clopidogrel for myocardial infarction

To patients. those who have had myocardial infarction are recommended to take aspirin daily for life. As noted by American experts (T. J. Ryan et al. 1996), aspirin has a pronounced antiplatelet effect at a dose of 75 mg to 1.2 g per day (it is possible that even taking 30 mg per day is quite effective). Long-term aspirin is usually prescribed at a dose of 81 mg per day (after meals).

Is it better to take 81-162.5 mg aspirin every day or 325 mg every day or every other day? What is the optimal dose of aspirin for both primary and secondary prevention of coronary artery disease - science has not yet been established. Recall that the lower the dose of aspirin, the less likely it is to irritate the gastric mucosa. Many doctors recommend taking aspirin after dinner.

The logic is to influence the morning (circadian rhythms!) Increase in blood clotting. After all, these unfavorable shifts, as we have already said, to a certain extent explain the relative increase in the incidence of myocardial infarction in the morning hours.

The Coumadin Aspirin Reinfarction Study (CARS) evaluated the feasibility of combining low-dose aspirin with the indirect anticoagulant coumadine versus taking aspirin alone for the secondary prevention of coronary artery disease. It was performed on 8803 patients with myocardial infarction.

The combination of aspirin at a dose of 80 mg per day with coumadin, both at a dose of 1 mg per day and 3 mg per day, with observation for an average of 14 months, did not reduce the total clinical value of aspirin alone at a dose of 165 mg per day. indicator - the incidence of repeated non-fatal heart attacks, ischemic strokes, or mortality from cardiovascular pathology.

If a patient with myocardial infarction is allergic to aspirin, American experts recommend using dipyridamole, ticlopidine (ticlid) or clopidogrel (T. J. Ryan et al. 1999). Unfortunately, in an acute situation, these drugs "lose" to aspirin, since their antiplatelet effect develops only 24-48 hours after the start of administration. Ticlopidine is prescribed 250 mg 2 times a day. This drug often causes side effect, in particular from the gastrointestinal tract.

Clopidogrel is a relative of ticlopidine, which is administered orally at a dose of 75 mg once a day (J. M. Herbert et al. 1993). Clopidogrel irreversibly inhibits ADP-activated platelet aggregation. Therapeutic action the drug develops only on the second day from the start of taking the drug. We note the data of the CAPRIE study (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events Study, CAPRIE Steering Committee, 1996), conducted on 1918 patients with clinically pronounced atherosclerotic vascular lesions - ischemic stroke, myocardial infarction, history of lower limb vascular pathology. The higher therapeutic efficacy of clopidogrel compared to aspirin in the prevention of cardiovascular morbidity and mortality in this cohort of patients was convincingly shown.

The pharmaceutical market is now being actively conquered by "superaspirins", in particular, oral forms of drugs that block platelet IIb / IIIa receptors. The increased risk of bleeding is a major problem that manufacturers face before they launch these new drugs on the market. Patients will have to solve the "financial side" of the issue. It is not difficult to predict future disputes between the supporters of the use of the usual antiplatelet regimens (combinations of aspirin with ticlide or with its new "relative" - \u200b\u200bclopidogrel) and adherents of "superaspirins" - oral inhibitors of IIb / IIIa receptors of platelets. In other words, new clinical trials are coming.

For many years, people have been using Aspirin (acetylsalicylic acid) as a pain reliever and anti-inflammatory agent. But several decades ago, doctors began to argue that the drug can also be used for heart attacks, and for prophylactic purposes. After all, he is able to quickly inhibit the activity of platelets, respectively, preventing the growth of a blood clot.

Effects of acetylsalicylic acid on the heart

Studies have been carried out by scientists who have proven that this medication helps with cardiovascular diseases. But progress does not stand in one place, and quite recently experts have invented other drugs that are not inferior in effectiveness to the Soviet "Aspirin".

Heart attack, also known as heart attack, is acute form coronary syndrome caused by rupture of a memorial plaque in an artery. After that, the part of the heart muscle that is supplied with the coronary artery begins to gradually die. It is muscle death that determines myocardial infarction.

"Aspirin" (acetylsalicylic acid) effectively fights cardiovascular diseases of the heart, which makes it healthy and blood vessels strong. That is, if a heart attack has already struck the heart, then acetylsalicylic acid will heal and strengthen it. If the illness has already been experienced, then taking the medication daily will reduce the risk of a second attack by about 20%.

The drug reduces the likelihood of platelets sticking to each other, for this reason a blood clot when taking acetylsalicylic acid is much easier to break down. The pill will certainly not cure a person, but it will support the heart and the body as a whole.

Method of application for heart attack

Since "Aspirin" can provoke cerebral and gastric hemorrhage, a particularly important question becomes, in what dosage to take the medicine for a heart attack. There are data on the comparative safety and effectiveness of two doses of Aspirin: 162 and 325 mg - in the acute stage of myocardial infarction. Although treatment with Aspirin reduces the development of complications and death in myocardial infarction, the optimal dosage has not been clarified.

As soon as the diagnosis of "heart attack" is made, the patient will be offered to chew one 325 mg tablet of "Aspirin", or two 162 mg. If the pain syndrome does not subside, it is allowed to take another same dose after 20 minutes.

It is necessary to chew, and not swallow whole, because in this way the active substances will begin to act much faster. Then you should drink half a glass of water so that the rest of the tablet gets into the body. With this method, the medicine will take effect in 5 minutes, and if swallowed, in 13 minutes.

The most effective is "Aspirin" in the first hours of a heart attack, the main substance immediately localizes the affected area, thereby reducing the risk of complications.

In the event that the patient has contraindications for oral use (gastrointestinal pathology,), he is prescribed rectal suppositories with acetylsalicylic acid.

"Aspirin" as a prevention of heart attack

"Aspirin" is a drug that prevents blood cells from sticking together, thereby preventing blockage of blood vessels. Since taking Aspirin can cause internal bleeding, it is prescribed if the chances of preventing a heart attack are higher than the risk of bleeding that may occur while taking it.

People who have previously suffered a heart attack or stroke are subject to re-development of the disease, therefore, they are shown to use 75 mg of the medicine every evening. The same applies to people with diabetes mellitus, they have an increased risk of developing a heart attack, since the blood vessels are already blocked. Such persons should take one tablet of "Aspirin" daily, if there are no contraindications to this.

Diseases for which you need to take "Aspirin" in preventive measures:

• high cholesterol;
• obesity;
• age group after 50 years;
• postoperative period;
• smoking;
• alcoholism;
• suffered a heart attack or stroke;
• violation of blood circulation in the brain;
• circulatory disorders in lower limbs;
• violation of blood flow in the carotid arteries;

For long-term use of the medicine, preference should be given:

• enteric forms of the drug;
• soluble Aspirin, with the addition of alkali;
• medicine in the form of intramuscular or intravenous injection;
• an aspirin patch.

As a preventive measure, Aspirin should be consumed at the same time, preferably in the morning after a meal. It is recommended to drink a tablet with milk or alkaline mineral water. You must stop taking the drug 5 days before the planned operation.

How to replace Aspirin?

If Aspirin is not at hand at the right time, you can replace it with other drugs, in which the active substance is:

1. Clopidogrel.(Plavix, Zylt, Lopirel, Plagril and others).
2. Prasugrel.(Effient, Prasugrel, Eptifibatid).
3. Dipyridamole.

Among the natural blood thinners are:

• fish fat;
• garlic;
• ginger root;
• vitamin E

Aspirin - best drug, which protects against dangerous heart diseases, which must be consumed daily for preventive purposes, and in the first hours after a heart attack. Before using it, you should make sure that there is no individual intolerance to the active ingredient and contraindications for use.

Myocardial infarction is an emergency condition that occurs due to an acute violation of the blood supply to the heart muscle. This condition is directly life threatening, and therefore requires the adoption of urgent measures of assistance in the acute period, as well as adequate treatment after its transfer.

The mechanism of formation of a heart attack

Most often, a heart attack occurs in elderly patients suffering from ischemic disease heart due to atherosclerosis of the coronary vessels. Translated from medical terminology, this means that the vessels supplying blood to the heart, due to the fact that their lumen is significantly narrowed (as a result of atherosclerosis), do not cope with their duties and do not deliver a sufficient amount of blood to the area of \u200b\u200bthe heart muscle they feed. This condition is called ischemic heart disease (“ischemia” in Latin means a lack of blood). When the lumen of the vessel is completely blocked, and blood generally ceases to flow through it, a heart attack occurs. With a heart attack, the area fed by the damaged vessel dies after 30-45 minutes, so it is important that first aid is provided during this time.

The extent of the infarction is determined by the size of the affected area of \u200b\u200bthe heart muscle. A heart attack can be so extensive and located in such a way that the heart can no longer perform its functions, and the person dies. On the contrary, there are cases of a microinfarction - when a small vessel is damaged, so small that a person does not even notice the moment when a heart attack occurs, but it is discovered only by chance, during examination for another reason.

Nevertheless, without exception, all cases of acute disturbance of the blood supply to the heart muscle pose a serious danger that cannot be underestimated. The fact is that after a heart attack, the affected area of \u200b\u200bthe myocardium is no longer restored, a scar of fibrous tissue forms in its place. The contractile ability of the heart muscle deteriorates, which means that the function of the heart as a whole is irreversibly deteriorated.

Signs of a heart attack

As mentioned above, heart attacks are more common in older people who already have heart disease. However, there are often cases when a person does not even realize that his heart is working with disorders, a heart attack can occur even in young people. Therefore, it is important to know the signs of a heart attack and be able to provide first aid, even if there are no people at risk in your environment.

So, the main signs of a heart attack:

1. Heart pain of high intensity and duration - from a quarter of an hour to several hours. The pain is localized behind the sternum, but can be given to the arm, shoulder blade, shoulder, neck. It differs from an attack of angina pectoris in that taking nitroglycerin does not help to stop the pain syndrome;
2. Fear of death. Often, after suffering a heart attack, patients note that this fear is irrational;
3. Deterioration of the general condition: pallor of the skin or vice versa, unhealthy redness, cold sweat, shortness of breath.

In addition to the "classic" signs of a heart attack, there are also atypical ones, in which only a specialist can recognize a heart attack. Nevertheless, they are also worth knowing in order not to miss the danger.

Abdominal infarction (from the Latin "abdomen" - stomach) - a heart attack masquerading as an intestinal disorder. Its symptoms are nausea, vomiting, stool disturbance, against which background palpitations, shortness of breath and weakness often go unnoticed.

Asthmatic infarction - resembles an asthma attack, with no or minor pain in the heart. The patient is gasping for breath, but medications that usually relieve an asthma attack do not help him.

Cerebral (cerebral) infarction - the condition proceeds like a stroke. It manifests itself as a violation of speech, coordination of movements, and the appearance of an acute headache (as in a stroke) is possible.

Silent heart attack - according to the general opinion of cardiologists, this is the most dangerous form of heart attack, which does not draw attention to itself for a long time, since there are practically no signs of an acute condition. The patient notes only a slight deterioration in the general condition, he has shortness of breath and weakness, especially when moving, but at the same time he, as a rule, continues to lead a normal life. The dumb option is dangerous in that neither first aid nor specialized cardiac care is provided in a timely manner, meanwhile, the functioning of the heart deteriorates.

As a rule, in these cases, a heart attack is detected during an electrocardiogram, therefore, it is prescribed almost always when a patient goes to a doctor with serious discomfort.

First aid for heart attack

If you suspect a heart attack, you should immediately call an ambulance, and it is important to indicate to the operator that it is cardiac care that is required - in this case, a specialized team will be sent with the necessary equipment at its disposal.

Further measures for first aid for a heart attack are as follows:

1. Lay the patient to bed, provide fresh air: open a window or window, loosen tight clothing;
2. Give a nitroglycerin tablet under the tongue. Despite the fact that with a heart attack, nitroglycerin is not able to remove pain attack, nevertheless, the drug has curative action. Attention! - pending the arrival of an ambulance, you can give no more than three tablets of nitroglycerin;
3. Give the victim a tablet or two aspirins (also known as acetylsalicylic acid). Aspirin promotes blood thinning, thereby improving the blood supply to the heart in ischemic conditions, in addition, it has an analgesic effect. The tablet must be chewed - so the effect of the drug will appear faster.

If the patient has lost consciousness, and the pulse cannot be felt or has become threadlike, it is necessary to immediately start resuscitation:

1. Apply a short, strong punch to the sternum, the so-called. precordial stroke. In the absence of special tools, it can act as a defibrillator and restart the stopped heart. The blow should be delivered once;
2. If the precordial stroke did not have the desired effect, immediately begin to do chest compressions, while artificially ventilating the lungs using one of the methods - mouth-to-nose, mouth-to-mouth. This must be done before the arrival of an ambulance.

With myocardial infarction aspirin is prescribed on the first day at a dose of 160-325 mg. As soon as myocardial infarction is diagnosed, the patient is recommended to chew 1.5-1-2 aspirin tablets (depending on their dosage). In cases where the drug cannot be administered orally to the patient due to the pathology of the upper gastrointestinal tract, as well as nausea (vomiting), candles with acetylsalicylic acid (325 mg) are used.

For our doctors famous also the drug acelysin (aspisol), which, if myocardial infarction is suspected, is better administered intravenously than intramuscularly. The initial dose of the drug is usually 0.5-1 ml once a day (M.D. Mashkovsky, 1994).

Study ISIS-2 showed that the use of aspirin (162.5 mg per day) for myocardial infarction can significantly reduce mortality within 35 days (by 23%) without hemorrhagic complications observed with the use of thrombolytics.

it randomized the study was conducted on 17,187 patients with myocardial infarction. With the appointment of aspirin, the incidence of nonfatal myocardial infarction decreased over the same period by 49%, and the incidence of nonfatal strokes by 46%. Against the background of combined treatment with streptokinase and aspirin, mortality decreased by 42%, with the appointment of streptokinase alone - by 25%. At the same time, the cost of acetylsalicylic acid preparations is very low and cannot be compared with the astronomical prices for many thrombolytics.

Dr. Charles H. Hennekens (1996) solved an interesting arithmetic problem considering that an aspirin tablet in the United States costs about a cent on average (a monthly intake is 30 cents), and a thrombolytic "dose" is $ 300, $ 1700 and $ 2200, respectively, for streptokinase, complex of streptokinase with tissue plasminogen activator (APSAC) and tissue plasminogen activator (t - PA). Taking aspirin can reduce mortality by 23%, and thrombolytic therapy by an average of 25%. Let us assume that the lethality in myocardial infarction is about 10%. This means that the use of aspirin will save 23 lives if 1000 patients are "treated". Thus, the "cost of one life saved" in the treatment of patients with myocardial infarction with aspirin will be $ 13 (30 cents x 1000 patients: 23 lives saved \u003d $ 13). For streptokinase, APSAC, and tissue plasminogen activator the figures are $ 2,000, $ 68,000 and $ 88,000, respectively. This is the arithmetic. The need to prescribe aspirin for myocardial infarction is obvious.

First - aspirin (160-325 mg), and only then a thrombolytic agent, if indicated, and the hospital (patient) can afford it. Those who suffer from ischemic heart disease, as well as all conscientious citizens over 40 years old, should be explained that an aspirin tablet should always be with you. It is advisable to carry aspirin in your pocket in the same tube as nitroglycerin. If chest pain appears that does not go away at rest or after taking nitroglycerin under the tongue, aspirin must be chewed and swallowed. In 1997, the American Heart Association issued a special "information letter" on the therapeutic value of aspirin in cardiology (SN Hennekens et al., 1997).