Angina (Lat.angina Pectoris, Sin. Breast toad) - the disease, the most characteristic manifestation of which is the attack of pain, mainly behind the sternum, less often in the field of the heart. The clinical picture of angina was first described by V.Geberend. They were noted the main features of pain in angina; pain appear suddenly when walking, especially after eating; They are short-term, stop when the patient stops. According to foreign data, the angina of men is observed 3-4 times more often than women.

Etiology and pathogenesis Currently, it can be considered established that angina region is due to the acute insufficiency of the coronary blood supply arising from the inconsistency between the inflow of blood to the heart and the need of it in the blood. The result of acute coronary insufficiency is ischemia of myocardium, causing a violation of oxidative processes in myocardium and excessive accumulation in it of poor exchange products (dairy, peyrograde, coal and phosphoric acids) and other metabolites.

Most frequent cause Stenicard development - atherosclerozorroconary arteries. Significantly rarely angina occurs in infectious and infectious allergic lesions.

We provoke the seizures of angina and the emotional and physical stress.

Clinical picture

Stenrope is accompanied by unpleasant sensations in the chest area, which occur when the bloodstream blood supply is reduced. Usually with angina person feels: heaviness, pressure or chest pain, especially behind the sternum. Often pain is transmitted in the neck, jaw, hands, back, or even teeth. It may also be observed indignant of the stomach, heartburn, weakness, high sweating, nausea, colicalilide.

Stenicard attacks usually occur during overvoltage, strong emotional excitation or after dense lunch. At these moments, the heart muscle requires more oxygen than it can get through narrowed coronary arteries.

Stenokard attack usually continues from 1 to 15 minutes, it can be loosen if calmed down, sit or lie down, put a nitroglycerin tablet under the tongue. NitroglycerinSews blood vessels and downtarterial pressure. Both reduces the need for the heart muscle in oxygen and removes the attack of angina.

Diagnostics Among the various methods of the study of angina (lipid metabolism, the activity of asatalt, creatine rises, lactate dehydrogenases of their isoenzymes, coagulograms, blood electrolyte, blood glucose) should be particularly noted the diagnostic value of new markers of damage to myocardine -troponin-iitroponin-t. These highly specific myocardial proteins, the definition of which can be used for the late diagnosis of myocardial, prediction with unstable angina, detecting minimal damage to myocardium (microfarct) and detecting among patients with increased risk. [Source not specified 361 days]

The "golden" standard of angina diagnosis (as one of the forms of IBS) is currently considered to be coronary art. Coronaryography is a pivotal procedure, which is essentially a diagnostic operation. [Source not specified 361 days]

Also, by the results of the ECG, the ischemic changes can be recorded.

Treatment.

Conservative angina therapy includes an appointment:

prolonged nitrates

combination of hypotensive preparations (β-blockers, angiotensin gloculating enzyme inhibitors, calcium channel blockers, diuretics)

antiagregants (preparations of acetylsalicylic acid), statins.

Surgical treatment implies the performance of the aorto-coronary shunting (AKSH) or bullon angioplasty systating of the coronary arteries.

Myocardial infarction - one of clinical shapes Ischemic heart disease flowing with the development of ischemic necrosis of a portion of myocardium, due to the absolute or relative insufficiency of its blood supply.

Classification

In development stages:

Ostive period

Acute period

Subighteous period

Observation period

By volume of lesion:

Large-Quality (Transmural), Q-Infarction

Small-scale, not Q-infarction

Localization of the focus of necrosis.

Myocardial infarction left ventricle (front, side, bottom, rear).

Heart top of myocardial heart attack isolated.

Miocardial infarction interventricular partition (septal).

Myocardial infarction right ventricle.

Combined localization: rear-bottom, front-side and dr.

Etiology

Myocardial infarction develops as a result of the obstruction of the lumen of the vessel of blood supplying myocardium (coronary artery). The reasons may be (in the frequency of occurrence):

Atherosclerosis of the coronary arteries (thrombosis, obturation of the plaque) 93-98%

Surgical Obbituration (Gleaning Artery or Dissection for Angioplasty)

Embolization of the coronary artery (thrombosis in coagulopathy, fat embolism, etc.)

Separately identify a heart attack at heart defects (abnormal debit of coronary arteries from the pulmonary trunk)

Pathogenesis

Distinguish the steps:

1. Damage (necrobiosis)

2. Scarring

Ischemia may be a predictor of a heart attack and lasts how long. When the compensatory mechanisms are exhausted, there is a damage when the metabolism and the function of the myocardium suffers, however, changes are reversible. The stage of damage lasts from 4 to 7 hours. Necrosis is characterized by irreversibility of damage. After 1-2 weeks after the heart attack, the necrotic section begins to be replaced by a scar cloth. The final formation of the scar occurs after 1-2 months.

Clinical manifestations

The main clinical sign is an intense pain for the sternum (anginal pain). However, pain may wear a variable character. The patient may complain about the feeling of discomfort in the chest, abdominal pain, throat, hand, shoulder blade, etc. It is often a disease. In 20-30% of cases in large-scale lesions, signs of heart failure are developing. Patients celebrate shortness, unproductive cough. Often there are arrhythmias. As a rule, these are various forms of extrasystole or atrial fibrillation.

Atypical Miocardial Infarction Forms

In some cases, the symptoms of myocardial infarction can be atypical. Such clinical picture It makes it difficult to diagnose myocardial infarction. The following atypical forms of myocardial infarction are distinguished:

Abdominal shape - symptoms of heart attack are represented by pains in the upper part of the abdomen, isota, bloating, nausea, vomiting. In this case, the symptoms of heart attack can resemble the symptoms of acute pancreatitis.

Astmatic form - symptoms of heart attack are represented by increasing shortness of breath. Infarct symptoms resemble symptoms of bronchial asthma attack.

Atypical pain syndrome with a heart attack can be represented by pains localized not in the chest, but in hand, shoulder, lower jaw, iliac yam.

A painless form of heart attack is rarely observed. Such development of a heart attack is most characteristic of diabetes patients, in which the sensitivity disturbance is one of the manifestations of the disease (diabetes).

Cerebral shape - symptoms of heart attack are represented by dizziness, disorders of consciousness, neurological symptoms.

The cerebral myocardial infarction is an atypical form of this pathology. Features of the flow of disorders cause difficulties in diagnosis and require a differentiated approach. It is important to recognize the signs of pathology on time to provide first aid and appoint true treatment.

General characteristics, pathology stages

The origin of the cerebral myocardial infarction is associated with the insufficiency of cerebral circulation. There is an increase in such violations with age, so pathology is more common in the elderly.

The cerebral myocardial infarction is manifested in the same way as heart failure leads to neurological problems. In this case, the neurological signs of pathology are expressed by brighter typical symptoms of a heart attack.

There are three severity of pathology. Each is distinguished by certain features:

1. Easy degree. In this case, the patient may not notice the beginning of the disease. Usually, heaviness appears in the eye area, the acuity of sight is reduced, the pulsation in the temples is observed.
2. The average severity of the pathology accompany the difficulties of speech, the patient is difficult to move the tongue. This stage is characterized by a shameful gait, which is called drunk.
3. Violations of serious degree causes clouding consciousness, the patient is in prostration, looks at one place and does not notice anything around. Even at this stage in the region of the heart there is no painful sensations, because to suspect the heart attack difficult.

The heart attack is usually localized on the left-income type. In this case, the appearance of stagnant wheezing wet nature is possible in the lungs. They can cause chopping and subsequent swelling of the lungs.

If the blood circulation is broken by the right-hand type, then the heart expands to the right, the liver increases, swell lower limbs.

The cerebral form of myocardial infarction is diagnosed in 1-1.5% of cases.

The reasons

Cerebral infarction develops against the background of ischemic violations. They cause a decrease in the lumen of the arteries due to the spasmodic reaction of their smooth muscles. Provocates its impulse from catecholamines (mediators). The following factors can provoke their activation:

• depression;
• stress;
• insomnia;
• high exercise.

A frequent cause of cerebral infarct shape is atherosclerosis of the coronary arteries. Atherosclerotic plaques narrow the clearance of vessels, their walls lose elasticity. As a result, the blood supply to the heart and its muscles is broken. When the atherosclerotic plaque is broken, the vessel blocking is possible.

Atherosclerotic changes may be provoked by various factors. The risk of myocardial infarction increases in the following cases:

• high level cholesterol in blood;
• overweight;
• sedentary lifestyle;
• hobbating fatty food;
• smoking;
• diabetes;
• chronic stress;
• hereditary tendency to diseases of the cardiovascular system.

Statistics show that more often the pathology is diagnosed in men, the risk of its occurrence increases significantly after 40 years.

Signs of attack are similar to stroke. The main manifestations of such a state are:

• dizziness, darkening in the eyes, nausea;
• narrowing of pupils, pulsation;
• fainting;
• inside Speech, Musty Language, Potrested Face, Pallitude skin Pokrov;
• reduction of pressure to minimum indicators;
• violation of reflexes;
• cheyne-Stokes breathing (periodic): First, it is superficial and rare, then it becomes deeper and readily, after 5-7 breath, breathing again weakens, it becomes less often, after a pause, this algorithm is repeated.
• partial paralysis of the muscles of the limbs;
• there is no control of urination;
• heart rate violation;
• the symptom of Kerniga: if the patient in passive state bend the leg in the hip and knee joint at right angles, it is impossible to break it back; Such a phenomenon causes a reflex increase in muscle tone.

A distinctive feature of such a form of myocardial infarction is the absence of pain in the chest or their insignificant manifestation that does not allow the patient to suspect such pathology.

Diagnostics

Some symptoms for the diagnosis in the case of cerebral myocardial infarction is not enough. Mandatory performed an electrocardiogram. It will identify the changes that have occurred, even if the patient has no pain and he feels fine.

On the cardiogram under the cerebral form of myocardial infarction, a modified pattern is visible. Changes are manifested by a large number of teeth T, there is an element of the ST segment (more than 1 mm). It is important to take into account that changes to the ECG may appear later. clinical signs pathology.

Some laboratory studies may be included in the diagnostic complex. Information can be obtained by the following methods:

• General blood analysis. The infarction indicates an increased number of eosinophils and leukocytes. Indicators must come back within 3-4 days. If they have not normalized, this indicates the availability of complications or additional necrosited areas.
• According to the protein rate of the erythrocyte sedimentation rate, the severity of the heart attack is determined.
• Biomarkers. Creatine phosphocainase MV and Tropin allow you to identify even minor violations in the work of the heart. The level of tropine with a heart attack rises and keeps at such a level for about a week.
• Analysis of urine. It is necessary if the patient has kidney problems.

Under cerebral form of heart attack, ischemia is observed, therefore it is necessary to check the state of the patient's vessels.

During the patient's stay on inpatient treatment Be sure to control laboratory tests. Every day spend general analysis blood.

Due to the similarity of the signs of cerebral myocardial infarction with other pathologies, it is necessary to conduct differential diagnosis. To this end, the patient can be performed ultrasound scanning, cT scan, encephalography of the brain.

First aid

With cerebral myocardial infarction, emergency measures are needed. After 20 minutes after the development of the acute state, necrosis of tissues begins.

The victim should be convenient to arrange, laying under the neck twisted roller clothes. It is necessary to lower a person on the back carefully, without making sharp movements. He must be at rest before the arrival of the doctors.

A to avoid a sharp decline in pressure will help the tablet. For blood liquefaction is necessary. Pre-tablet must be folded.

For calm nervous system Use Corvalol or Valokardin. Dosage must be more norm - 60 drops.

With the deterioration of the condition and termination of breathing, heart massage and artificial respiration are necessary.

Treatment

For cessation of thrombosis and its prevention, heparin is used. For the first time it is introduced intravenously or intramuscularly in the amount of 10,000 units. Then execute intramuscular injections. Such therapy requires control of blood coagulation after each injection. It should take a maximum of 20 minutes.

On the third day, anticoagulants are usually prescribed indirect action - Phenylin or Neodyacumarine. At the same time, the prothrombin index (analysis of blood coagulation) is either investigated by urine on microhematuria (the presence of blood, an invisible eye).

In severe pains, painful agents are used. If they do not bring effect, they are resorted to narcotic drugs. At the same time, neuroleptics are usually prescribed, for example, aminazine.

If the bleeding is enhanced, the patient prescribe viscasol and intravenous infusion of calcium chloride solution (10%).

The patient is shown a strict bed mode. It is necessary to observe it at least 3 weeks, and with a large-scale defeat - more than a month.

The therapeutic complex necessarily includes special nutrition. The first 2 days the patient is allowed only to drink. Therapeutic table number 10 is then prescribed, based on dairy and vegetable food.

The treatment of cerebral form of myocardial infarction is carried out under hospital. In exceptional cases, therapy is carried out at home, but requires constant good care and qualified help of physicians.

Forecast

Due to the atypical nature of cerebral myocardial infarction, the forecast is less favorable. To confirm the diagnosis, it is necessary to conduct instrumental and laboratory diagnostics. Due to the imperfection of medicine, this process is delayed, therefore treatment begins.

Another problem is the similarity of the signs of different pathologies. If the diagnosis is not to check, then you can assign incorrect treatment.

Cerebral myocardial infarction, as well as other forms, can cause many complications. The most severe consequences include swelling or ,.

There is a risk of recurrence of pathology. Typically, the intervals between heart attacks make up several months. There is also a pathology transition to a protracted form.

The cerebral form of myocardial infarction is dangerous by its atypical manifestations. At the very first signs of pathology it is necessary to call ambulanceEven if they appear in a light form. The forecast of the disease depends on the timeliness and correctness of the diagnosis and treatment of treatment.

Is an attack of severe pain in the area behind the sternum. In such cases, the diagnosis of the disease is carried out practically unmistakably, which makes it possible to immediately begin the therapy of the pathological condition. It happens that myocardial infarction manifests itself absolutely atypically for the illness and in patients there are a number of symptoms, which sometimes resemble signs of visceral organs. So, what are the atypical forms of myocardial infarction and how to determine them?

Factors contributing to the development of atypical forms

The atypical forms of the flow of myocardial infarction arise mainly in the elderly people with genetic predisposition to the atherosclerotic damage to the coronary vessels. The development of an abnormal disease clinic contributes to a number of factors, including:

• pronounced cardiosclerosis;
• insufficiency of coronary blood circulation;
• diabetes;
• atherosclerosis of vessels;
• arterial hypertension;
• aged heart attacks in the past or a history of the patient.

Overview options

According to statistical studies, the myocardial infarction, the development of which differs from the classical version of the course of the disease, occurs in each tenth patient with diagnosed focal necrosis of the heart muscle. As a rule, such a notch at the very beginning of its development is masked for diseases of visceral organs or proceeds almost asymptomatic, without a clearly pronounced pain syndrome.

The atypical forms of myocardial infarction include:

• abdominal;
• arrhythmic;
• asthmatic;
• collaptoid or nonsense;
• asymptomatic;
• peripheral;
• edema;
• cerebral;
• combined.

1. The abdominal form of myocardial infarction is characteristic of patients who have necrosis adjacent to the diaphragm, which provokes the development of symptoms similar to the manifestations of violations by digestive tract. For this embodiment, the following symptoms are characteristic:

• abdominal pain, mainly in the epigastric region or under the right edge arc in the area of \u200b\u200bthe projection of the liver and biliary tract;
• pronounced nausea, vomiting;
• intestinal meteorism;
• sharply pronounced bloating;
• constipation or broach.

The most often abdominal infarction flows under the mask of acute pancreatitis. I can identify focal myocardial necrosis using an ECG study, as well as during a medical examination, when the tone of the front muscles is diagnosed abdominal wall and violations in the work of the heart in the form of a decline arterial pressure and arrhythmias.

1. The arrival of the disease is characterized by minimal manifestations of pain syndrome during the development or impairment of the conductivity of the heart. In patients to the forefront, there are signs of paroxysmal tachycardia, an atrio-ventricular blockade and other pathological conditions. Such symptoms should be treated very seriously and not forget to differentiate them with the arrhythmic form.

1. The asthmatic form of myocardial infarction meets mainly in the elderly people, regardless of their gender. Often this version of the disease is a recurrence of the necrosis of the heart muscle, so in this case it is impossible to lose a single minute. In patients, the disease begins with an attack of shortness of breath, which arises in exhalation and very much resembles bronchial asthma. Dyspnea is often accompanied by a cough with the experience of pink foamy sputum.

1. Cheering ischemia or collaptoid myocardial infarction is an atypical form of a disease, for which violations are characteristic of the functioning of the central nervous system, which are expressed in dizziness, conmature states and vision disorders. Brave myocardial infarction flows absolutely painless against the background of a sharp decline in blood pressure, which makes it possible to suspect myocardial infarction.

Brave version of myocardial necrosis is rare. In most clinical cases, they suffer from patients of old age, suffering from diabetes. As you know in older people and diabetics pain threshold significantly reduced due to the intake of receptors. It is with this pathological phenomenon that the occurrence of the insolent form of myocardial infarction and the development of collaptic states is associated.

1. Asymptomatic or erased form of the disease is the most cunning version of the illness, which is diagnosed in a timely manner, is very difficult, which leads to the occurrence of severe complications of the pathological condition and significantly undermines the health of the patient person. For asymptomatic form, it is characteristic of the mains of the main symptoms. The patient just feels a slight malaise or decline, whereas a real catastrophe is happening in his heart.

The disease in most cases is regarded as a manifestation of a banal cold or overwork at work. Patients very rarely betray the importance of such a deterioration in their health. Therefore, do not consider the need to apply for qualified medical care.

1. The peripherals are characterized by the appearance of an atypical disease for the disease, which occurs in the places of possible irradiation without the focus of primary pain. For example, in many patients affected by the peripheral form of myocardial necrosis, the algae syndrome is manifested in the throat and resembles an angina. Also, pain can be determined only in the Mizinza Mizinz or under the blade, without its feeling in the field of the heart.

1. Myocardial infarction shape is developing in patients with signs of heart failure. In such patients, against the background of relative well-being, swelling occurs sharply, first local, and then extensive. Massive swelling is accompanied by an increasing breath, an increase in the size of the liver and the accumulation of fluid in abdominal cavity.

1. The cerebral version of the disease proceeds like the insufficiency of cerebral circulation. The sick person arises strong dizzinesswhich can lead to a fainted state. Sometimes patients diagnose speech disorders and weakness in the limbs. Often there are such symptoms as nausea, vomiting, the appearance of dark circle in front of the eyes.

The cerebral form of myocardial infarction resembles a collaptic version of the disease, and may also be mistakenly regarded as a brain stroke.

In contrast to ischemia, the site of the central nervous system under cerebral infarction does not occur functional and organic disorders from the brain side.

1. Combined focal necrosis of the muscular fabric of the heart is found in clinical practice infrequently. In this case, the development of the disease in the patient there is a manifestation of several atypical forms of pathological state at once, which further complicates its diagnosis. The most common is the combined infarction, when the patient complains of pain in the abdomen (symptom of abdominal form) and strong dizziness with clouding of consciousness (characteristic of the cerebral variant of the disease).

Unfortunately, sometimes even the most experienced doctors are not able to determine the combined form of an atypical infarction. That is why there is a delay in the appointment of adequate treatment and the risks of the development of cordial complications increase.

Diagnostic features

Atypical variants of myocardial infarction are quite complex in the diagnosis, which is explained by the clinical picture at the beginning of the development of the disease. That is why all patients with suspected violations in the work of the cardiovascular system need to be recorded an electrocardiogram, which will determine the presence of zones of ischemia of the heart muscle.

ECG with small-scale myocardial infarction in the top of the top and the front-winding wall of the left ventricle

The most complex in terms of diagnosis is the arrhythmic form of myocardial focal necrosis, What is explained by registration to ECG arrhythmia, which successfully masks signs of heart attack. In this regard, for any type of arrhythmic disorders, the specialists first remove the attack of the rhythm impairment, and then write a repeated electrocardiogram of the heart to determine the true state of affairs.

Since the atypical forms of myocardial infarction imitate different diseases internal organsPatients except ECG follow a number of studies that make it possible to eliminate or confirm the alleged diagnosis:

• ultrasound examination of the abdominal organs;
• computer tomographic study of the body;
• cerebro or electroencephalography;

By virtue of circumstances, timely diagnose atypical infarction sometimes not at least an experienced cardiologist. Therefore, it is not always possible to start an anti-chemical treatment on time, which allows you to limit the necrosis zone.

What should be done when typical symptoms appear?

With the appearance of symptoms that remind the clinic of atypical variants of the flow of myocardial infarction should not be engaged in self-diagnosis and even more so self-medication.

Even with the slightest suspicions on the occurrence of signs of necrosis of the hearth muscles, it is necessary to immediately seek qualified help and cause an urgent.

As a rule, after a medical examination, an ECG examination is assigned to a patient with a suspicion of impaired heart functioning, which allows you to determine the myocardial infarction and hospitalize a person in the intensive therapy separation.

The asthmatic version of myocardial infarction (5-10%), flowing along the type of cardiac asthma or edema of the lungs, is more often found in the elderly or senile age Against the background of expressed myocardial changes due to hypertensive diseaseCardiosclerosis is often with extensive transmural myocardial infarction.

The asthmatic form of myocardial infarction proceeds very unfavorable and often ends with a fatal outcome.

Differential diagnostic signs of myocardial infarction

… the problem of heart attack is not fully solved, mortality from it continues to increase.

Myocardial infarction, allergic and infectious-toxic shock. Strong stubborn pain, shortness of breath, drop in blood pressure - symptoms arising from anaphylactic and infectious-toxic shock. Anaphylactic shock may occur with any medicinal intolerance. The beginning of the disease is sharp, it is clearly dedicated to the causal factor (injection of the antibiotic, the vaccination in order to prevent the infectious disease, the introduction of anti-trust serum, etc.). Sometimes the disease begins in 5-8 days from the moment of non-herogenous intervention, it develops by the type of phenomenon of Artus, in which the heart acts as a shock organ. Infectious and toxic shock with a lesion of myocardium may occur in any severe infectious disease (pneumonia, angina, etc.).

The clinically disease is very similar to the myocardial infarction, differing from it in the etiological factors given above. Differentiation is all the more difficult that with allergic and infectious allergic shock may occur non-corona necrosis of myocardium with rough changes in ECG, leukocytosis, increasing ESP, hyperfermenia asat, LDH, GDD, KFK, and even MV KFK. Unlike a typical myocardial infarction, in such patients on the ECG there is no deep teeth q and even more so the QS complex, the discordance of changes in the final part.

Myocardial infarction and pericarditis (myopericidal). Etiological factors pericarditis - rheumatism, tuberculosis, viral infection (more often coxaki- or echo virus), diffuse diseases connective tissue. Pericarditis often occurs in patients with terminal chronic renal failure. In acute pericardia, subepicardial myocardial layers are often involved in the process.

In a typical version, during dry pericardia, stupid, gullives arise, less often sharp pains in the precodal area without irradiation in the back, under the blade, in the left hand, characteristic of myocardial infarction. The jokes of fridge friction are registered on the same days as the increase in body temperature, leukocytosis, an increase in ESR. It is resistant, listened to within a few days, weeks. With myocardial infarction, pericardia friction noise short-term, in the clock, precedes a fever, an increase in ESR. If cardiac insufficiency appears in patients with pericarditis, then it is justifying or biventricular. For myocardial infarction, left ventricular heart failure. The differential diagnostic value of enzymological tests is small. Due to the lesion of subepicarordial myocardial layers, Hyperfermenia AsaT, LDH, LDH1, GDD, KFK, and Even Isaenzyme MV KFK can be registered in patients with pericarditis.

Help the diagnostics ECG data. PI Pericardius There are symptoms of subepicardial damage in the form of elevation of ST interval in all 12 generally accepted leads (no discordance characteristic of myocardial infarction). Culk Q with pericade, unlike myocardial infarction, is not detected. Teeth T with pericade may be negative, it becomes positive after 2-3 weeks from the beginning of the disease. With the appearance of pericardial exudate, a sprouting picture becomes very characteristic.

Myocardial infarction and left-sided pneumonia. In pneumonia, pain in the left half can appear chest, sometimes intense. However, in contrast to precordial pains with myocardial infarction, they are clearly connected with breathing and cough, are not typical of the myocardial myocardial infarction. Productive cough is characteristic of pneumonia. The beginning of the disease (chills, temperature rise, fighting in the side, the noise of friction of the pleura) is absolutely not typical for myocardial infarction. Physical and radiographic changes in the lungs help diagnose pneumonia. ECG at pneumonia may vary (low tooth ta, tachycardia), but never changes that resembles such a myocardial infarction. As with the myocardial infarction, with pneumonia, leukocytosis can be detected, an increase in ESR, hyperfermenia asata, LDH, but only when myocardial lesions increases the activity of the GBD, LDH1, MV KFK.

Myocardial infarction and spontaneous pneumothorax. With a pneumothorax, there is a strong pain in the side, shortness of breath, tachycardia. In contrast to myocardial infarction, the spontaneous pneumothorax is accompanied by a tympanic performer tone on the side of the lesion, the weakening of breathing, radiographic changes (gas bubble, the collapse of the lung, the displacement of the heart and mediastum in a healthy side). ECG indicators with spontaneous pneumothorax or normal, or a transient decrease in T. leukocytosis, an increase in the EMP at pneumothorax does not happen. The activity of serum enzymes is normal.

Myocardial infarction and chest injury. With this and other disease occur strong pain In the chest, shock is possible. The concussion and injury injury leads to damage to the myocardium, which is accompanied by the element or depression of the ST interval, the negativeness of the teeth T, and in severe cases, even the appearance of the pathological teeth Q. In the formulation of the correct diagnosis, the history of the right diagnosis is played by an decisive role. Clinical Evaluation Breastfeeding with ECG changes should be quite serious, since these changes are based on non-corona necrosis of myocardium.

Myocardial infarction and osteochondrosis of the thoracic spine with the root compression. With osteochondrosis with root sinphs in the chest, the left can be very strong, unbearable. But, in contrast to pain from myocardial infarction, they disappear when the patient "freezes" in a forced position, and sharply enhanced at the corners of the body and breathing. Nitroglycerin, osteochondrosis nitrates are completely not effective. Effect of analgesic. With a breast "Radiculit", a clear local pain in the paravertebral points is determined, less often in the course of the intercreation. The number of leukocytes, ESO, enzymological indicators, ECG within the normal range.

Myocardial infarction and lisha. The clinic of the shelter linging is very reminded described above (see the description of the symptoms of the root syndrome during the osteochondrosis of the spine in breast Department). In some patients, fever can register in combination with moderate leukocytosis, an increase in ESP. ECG, enzyme tests, as a rule, often help to exclude myocardial infarction. The diagnosis of "Lishey" becomes reliable from 2-4 days of the disease, when characteristic bubble (vesicular) rash appears in the course of the intercreation).

Lead Symptom - Cardiac Astha

The asthmatic version of the myocardial infarction in pure form is rare, more often choking is combined with pain in the atrial region, arrhythmia, shock symptoms. Outragia left-delicate insufficiency complicates the course of many diseases of the heart, including cardiomyopathy, valve and congenital villocks Hearts, myocarditis, etc.

In order to correctly diagnose myocardial infarction (asthmatic option), you must be able to take into account many signs of this disease in various clinical situations. (1) when the syndrome of acute left left ventricular failure hypertensive crisis; (2) when it occurs in persons who have previously suffered a myocardial infarction suffering from angina; (3) in the occurrence of suffocation in patients with any violation of the rhythm, especially with unreserved tachiisistol; (4) With for the first time or re-developed attack of cardiac asthma in a person of medium, elderly or older; (5) When the symptoms of the "mixed" asthma appear in a patient of an elderly, for a number of years suffering from a bronchopile disease with the episodes of bronchial obstruction.

Leading symptom - acute abdominal pain, drop in blood pressure

Myocardial infarction and acute cholecittsopancatitis. In acute cholecystopancatite, as in the gastralgic version of myocardial infarction, severe pains occur in the epigastric region, accompanied by weakness, sweating, hypotension. However, pain in acute cholecystopancreatite is localized not only in epigastrics, but also in the right hypochondrium, irradiate up and right, in the back, sometimes can be encircling. Their combination with nausea, vomiting, and the venge of bile is determined in the vomit masses. Palparato is determined by the pain at the point of the gallbladder, the pancreas projections, the positive symptoms of Crara, Ortner, Mussy, which is not typical of myocardial infarction. Scotching, local voltage in the right upper quadrant is not typical for myocardial infarction.

Leukocytosis, an increase in ESO, Hyperfermenia AsaT, LDHs may appear in both diseases. In cholecystopancathite, an increase in the activity of alpha-amylase serum and urine, LDH 3-5 is noted. With myocardial infarction, the KFK enzyme activity, MV of the KFK, GDD, should be focused on the myocardial infarction.

ECG in acute cholecystopancathite can change. This is a decrease in ST interval in a number of declarations, a weakly negative or two-phase teeth T. N.K. Permics described in the morphological material the large-scale damage to myocardium in patients with acute cholecystopnatitis, more often in cases of heavy pancreatic. During life, these patients complained about intense abdominal pains, dyspeptic disorders, collapse. ECG changes were infarct-like. The activity of serum enzymes increased dramatically, including KFK, MV KFK. This data is confirmed by V.P. Polyakov, B.L. Movshovich, G.G. Saveliev when observing patients with acute pancreatitis, cholecystitis in combination with diabetes mellitus. These data were determined as non-cultural, metabolic, due to direct toxic effect on myocardials of proteolytic enzymes, an imbalance of a kinin-kallyrein system, electrolyte disorders. The large-scale metabolic damage to myocardials significantly worsens pancreatitis forecast, is often the leading factor in the fatal outcome.

Myocardial infarction and pellar soda. Sharp epigastric pain is characteristic of both diseases. However, with the probationary ulcer of the stomach pain in the epigastrics, nonsenter, "dignged". The maximum of their severity is at the time of the run, then the pain is spontaneously decreased in the intensity, their epicenter is shifted somewhat to the right and down. Pi gastralgic variance of myocardial infarction pain in epigastrics can be intense, but they are not characterized by such an acute, instantaneous beginning with a subsequent decline, as with a soda ulcer of the stomach.

With the trimming ulcer of the stomach in 2-4 hours from the moment of speaking the symptoms varies. In patients with trimming gastroduodenal ulcers, symptoms of intoxication appear; The language becomes dry, the expression of the face changes, its features are sharpened. The stomach becomes drawn, tense, the symptoms of irritation are positive, the "disappearance" of hepatic stupidity is performed, radiologically detected air under the right dome of the diaphragm. The body temperature may be subfebrile with both diseases, as well as moderate leukocytosis during the first day. An increase in the activity of serum enzymes (LDH, KFK, MV KFK) is characteristic of myocardial infarction. ECG during the sample ulcer of the stomach during the first day, as a rule, does not change. The next day, changes in the final part are possible due to electrolyte violations.

Myocardial Infarction and Cancer Cardial Stomach Department. In case of cardia cancer, intensive occurs often pour pain in epigastria and under mesia-shaped processcombined with transient hypotension. To eliminate the gastralgic variant of myocardial infarction in such cases, an ECG study is carried out. The ECG reveals changes in the interval ST (more often depression) and the T (isoelectric or weakly negative) in III, AVF leads, which serves as a reason for the diagnosis of small-scale myocardial infarction.

Unlike myocardial infarction with cardia cancer, epigastric pains are naturally repeated daily, they are associated with food intake. ESP increases with both diseases, but the dynamics of the activity of KFK enzymes, MV KFK, LDH, GDD is characteristic only for myocardial infarction. When Cardi cancer ECG "frozen", it fails to determine the speakers characteristic of myocardial infarction. The diagnosis of cancer is specified. first of all FGDS, x-ray research The stomach in various positions of the body under study, including in the antiodetasis position.

Myocardial infarction and edible toxicoinfection. In both diseases, epigastria pain appear, blood pressure drops. However, pain in epigastrics with nausea. vomiting, hypothermia is more characteristic of food toxicoinfection. The diarrhea is not always found in food toxicoinfection, but it never happens when myocardial infarction. ECG in food toxicoinfection either does not change, or during the study, "electrolyte disorders" are determined in the form of a trough-shaped offset of the ST interval, a weakly negative or isoelectric teeth T. Laboratory studies in food toxicoinfection show moderate leukocytosis, red blood cell (blood thickening), a small increase in the activity of Alat , Asat, LDH without significant changes in the activity of KFK, MV KFK, GDD characteristic of myocardial infarction.

Myocardial infarction and acute disruption of mesenter. Epigaste pain, the drop in blood pressure occurs in both diseases. The difficulties of differential diagnosis are exacerbated by the fact that the thrombosis of mesenteral vessels, as well as a myocardial infarction, is striking, as a rule, elderly people with various clinical manifestations of IBS, with arterial hypertension. If the blood circulation is violated in the system of mesenteral vessels, pain is localized not only in the epigastria, but also throughout the abdomen. The abdomen will be moderately, auscultative does not reveal the sounds of intestines peristals, it is possible to detect the symptoms of the annoyance of the peritoneum. To clarify the diagnosis, the abdominal cavity radiography should be carried out and determine the presence or absence of intestinal peristals and gas accumulation in intestinal hinges. The disorder of the mesenterological circulation is not accompanied by changes in the ECG and enzyme indicators characteristic of myocardial infarction. With difficulty in the diagnosis of thrombosis of mesenteral vessels, pathognomonic changes can be detected at laparoscopy and angiography.

Myocardial infarction and aggidominal aortic aneurysm. With abdominal form, the aortic aortic aneurysm unlike the gastralgic version of myocardial infarction is characterized by the following signs (Zenin V.I.): the beginning of the disease with chest pain; The wave-like character of pain syndrome with irradiation into the lower back in the course of the spine; The appearance of tumor-like formation of elastic consistency, pulsating synchronously with a heart, the appearance of systolic noise over this tumor formation; Angle anemia.

When interpretation symptom " acute pain In epigastrics "in combination with hypotension when conducting a differential diagnosis with myocardial infarction, more rare diseases should be borne. acute adrenal insufficiency; gap of liver, spleen or hollow organ during injury; Syphilic spinal cord dry shot with tabetic gastric crises (anisocorium, ptosis, reflex immobility eye apples, atrophy spectator nerve, ataxia, lack of knee reflexes); Abdominal crises in hyperglycemia, ketoacidosis in patients with diabetes mellitus.

Lead Symptom - "Infared-like" Electrocardiogram

Non-monogenous myocardial necrosis These may occur with thyrotoxicosis, leukose and anemia, systemic vasculitis, hypo- and hyperglycemic states. In the pathogenesis of neuronogenic necrosis, myocardium lies an imbalance between the need of myocardium in oxygen and its delivery through the system of coronary arteries. With thyrotoxicosis, a metabolic request is sharply increasing without adequate to ensure it. With anemia, leukemia, sugar diabetes (comatous states) Rough metabolic disorders arise in cardiomyocyte. Systemic vasculites lead to a rough impaired microcirculation in myocardium. With acute poisoning, direct toxic damage to myocardial cells occurs. The morphological essence of the myocardial damage is similar in all cases: these are multiple finelyocopy necrosis of cardiomyocytes.

Clinically against the background of symptoms of the main disease, pain in the heart are noted, sometimes strong, shortness of breath. Data laboratory studies There are non-informative in differentiation of non-corona necrosis with the myocardial infarction of atherosclerotic genesis. Hyperfermenia LDH, LDH1, GDD, KFK, MV KFK are caused by myocardial necrosis as such without reference to their etiology. On the ECG in the necroragenic necrosis, changes in the final part - depression or less frequent, elevation of ST interval, negative teeth, followed by a dynamics corresponding to a non-transmural myocardial infarction. The exact diagnosis is established on the basis of all symptoms of diseases. Only such an approach makes it possible to methodically correctly evaluate the heart pathology properly.

Myocardial infarction and heart tumors (primary and metastatic). In the tumors of the heart, persistent intensive pains in the precodal region, resistant to nitrates, heart failure, arrhythmias can appear. On the ECG - Pathological Teeth Q, the element of the ST interval, the negative teeth of T. Unlike the myocardial infarction with a heart tumor, there is no typical ECG evolution, it is unmaniform. Heart failure, arrhythmia refractors for treatment. The diagnosis is specified with a thorough analysis of clinical and radiographic and echocardiographic data.

Myocardial infarction and post-fatachardial syndrome. Postatahcardial syndrome is called an ECG phenomenon, expressed in the transient myocardial ischemia (depression of the ST interval, negative TC) after the relief of tachyarhythmia. This symptom complex must be assessed very carefully. Firstly, Tahiaritimia may be the beginning of myocardial infarction, and the ECG after her relief often only identifies infarctional changes. Secondly, the attack of tachiarhythmias of such an extent violates hemodynamics and coronary blood flow, which can lead to the development of myocardial necrosis, especially with initially defective coronary blood circulation in patients with sampling coronary atherosclerosis. Consequently, the diagnosis of post-thagidial syndrome is reliable after careful observation of the patient, taking into account the dynamics of clinical, echocardiographic, laboratory data.

Myocardial infarction and premature repolarization syndrome. The premature repolarization syndrome is expressed in the elevation of the ST interval in Wilson leads beginning with the point J (junction - compound) located on the downlink knee of the R. This syndrome is registered with healthy people, athletes, patients with neurocirculatory dystonia. For the setting of the correct diagnosis, it is necessary to know about the existence of an ECG phenomenon - premature repolarization syndrome. In this case, the syndrome does not have a myocardial infarction clinic, does not have an ECG speaker characteristic.

Myocardial infarction - almost the most common cause of the death of people of the middle and older age group.

The high mortality of this disease is due to the fact that it occurs most often suddenly, and its irreversible consequences Develop lightning. Plus, the clinical picture does not always correspond to the "classic scenario".

There are a large number of variations of atypical forms of myocardial infarction: Consider all the symptoms and signs, diagnosis and distinctive features Such options like abdominal (gastralgic), arrhythmic, peripheral, cololtoid, edema, erased, cerebral and combined.

Development mechanism and statistics data

The atponality of the heart attack is manifested only at the time of the chisosis itself. The development of non-classical forms of pathology occurs due to an overly sharp blockage of one or another vessel leading to the heart, together with concomitant diseases progressive against the background of a infarction crisis.

Thus, from the asymptomatic and arrhythmic nature of the disease, diabetics or persons with already existing violations of the heart rhythm suffer more often. Painfulness, Pneumonia and other symptoms do not occur due to the reduced susceptibility of the nervous system. The manifestations of the ailment are noticeable only on the ECG.

Cerebral species develops in people with a violation of cerebral circulation. The symptoms resembles the beginning of ischemic stroke, but after replacing more characteristic. Arises due to the blockage of the artery thrombus close to the brain.

Abdominal shape is caused by pain in the abdomen, nausea and vomiting. This is due to the fact that part of the nerve endings of the chest are on the territory of the abdominal cavity. Pathological processes hurt them, which provokes such manifestations.

What do figures say:

• 0.5% of men and 0.1% of women annually transfer heart attack. Of these, every fifth - in an atypical form.
• Each second patient dies even before providing him in ambulance - at a pre-hospital stage. Among patients with an atypical form of illness, this figure is significantly higher.
• Approximately 3% of all those who died over the year in Russia died as a result of a sharp infarction.
• Most often, the ailment is developing in the morning clock (between 4 and 8 am), in the fall or spring (in November or March). About 25% of all registered heart attacks account for this time.
• Women suffer from infarction less often, but the fatal outcome as a result of them happens more often - 53% of the ladies die with this ailment. In men, this figure is lower by 10%.

What is dangerous sinus tachycardia of the heart and how to treat it? You can read comprehensive information.

Options, symptoms and differences, diagnostic measures

The atypical forms of myocardial infarction include the following varieties:

• abdominal - With this form, the symptoms resemble acute pancreatitis, pains are localized in the upper part of the abdomen and are accompanied by nausea, bloating, and sometimes with vomiting;
• astmatic - This form resembles ostrieving stages bronchial asthma, shortness of breath appears, the severity of the symptom increases;
• atypical pain syndrome - Man complains of pain in lower jaw, iliac yam, in hand, shoulder;
• asymptomatic - This form is rarely observed, and they suffer mainly diabetics, which, as a result of the peculiarities of chronic disease, the sensitivity is reduced;
• cerebral - neurological symptoms arise, consonants for dizziness, disturbances of consciousness.

Peripheral

Peripheral infarction with atypical politicization of pain. Symptoms:

• weakness;
• sweating at rest;
• drop pressure;
• heart rhythm disorders;
• fingering fingers and lips.

The pain is concentrated in the left hand (throughout the limb or only in the fingers), the left blade (roller), the lower jaw on the left (whit), in the neck (in the upper part of the spine sharp pain), in the area of \u200b\u200bthe throat and esophagus. At the same time, the classic pain in the heart is much weaker or not at all.

Diagnostics: ECG in dynamics, continuous monitoring.

Abdominal (gastralgic)

Abdominal form of myocardial infarction. Symptoms:

• nausea;
• vomiting;
• meteorism and diarrhea;
• ikota;
• arrhythmia;
• pressure drop.

The pain sharp and strong in the area of \u200b\u200bthe stomach and liver is the top of the abdomen, under the ribs on the right. Reminds the attack of pancreatitis.

Noticeable signs of the gastralgic form of myocardial infarction: the front wall of the abdomen is strong tense, the heart rhythm is changed. ECG required in dynamics. Consultation of the gastroenterologist. It often happens in people with atherosclerosis and digestive problems.

Asthmatic

Astmatic shape and its symptoms:

• shortness of breath at rest;
• attack of suffocation;
• foam cough with abundant moocrost;
• drop pressure;
• severe heartbeat;
• fear of death.

The heart does not hurt or hurts not much. It occurs in patients with cardiosclerosis or severe hypertension. It is more likely to have women of pre-age and older men. ECG is needed.

Collaptoid

Collaptic option of the attack, symptoms:

• sudden pressure drop;
• dizziness;
• abundant sweat;
• in front of the eyes darkens;
• pallor and cooling of the skin;
• loss of consciousness;
• state of prostration;
• become invisible veins on the limbs.

Pain is absent. In the risk group, older diabetics. It takes very hard. Emergency assistance is required. Diagnosed with ECG.

Hydropic

The myocardial female infarction is accompanied by the following signs:

• dyspnea;
• weakness;
• swelling of the limbs;
• the liver increases sharply and ascites occurs - the liquid in the abdomen accumulates.

Pain is absent. It takes very hard. Emergency assistance is required. Diagnosed with ECG.

Arrhythmic

The arrhythmic form has such symptoms:

• attack of pathological heartbeat (sharp increase in or demolition of heart abbreviations);
• fainting;
• arrhythmic shock (drop pressure, irrepressible pulse).

With the arrhythmic form of myocardial infarction, pain in the heart area is weak or not at all. It is more likely to have patients with the already existing heart rhythm problems. Emergency ECG is needed.

Cerebral

Cerebral infarction is characterized by the following signs:

• sharp pressure drop;
• faint;
• confusion and loss of consciousness (pseudoinsult) - from light inhibition to coma;
• may be nausea and vomiting;
• violations of speech;
• pares muscles.

There are no pain in the heart. More often the elderly people with brain circulation disorders. Consultation of a neuropathologist, ECG and EEG is needed.

Erased (low-power)

The mysterious form of the InInifarka can manifest themselves as follows:

• unmotivated weakness;
• sweating;
• insomnia;
• discomfort for sternum.

There are no sharp pain in the heart. Atypical shabby forms of heart attack are often found in diabetics or alcoholics.

Combined

When combined form combined various symptoms Atypical forms of heart attack. The pain in the heart is insignificant and the patient does not pay attention to it. A thorough multilateral diagnosis is required in dynamics with the invitation of other specializations.

What does the diagnosis of the "TachiSistolic form of atrial fibrillation", what is he dangerous and what to treat him? All details - .

Risk factors

Basic features that increase the chance of developing atypical forms of infarction are:

• elderly age;
• previously suffered infarction;
• excessive use of alcohol and nicotine.

Specific factors are previously transferred or progressive diseases:

• diabetes;
• cardiosclerosis;
• heavy forms of hypertension;
• atherosclerosis;
• pathology of the gastrointestinal tract;
• brain circulation disorders;
• ailments provoking cardiac rhythm failures.

Treatment technique

Algorithm for assistance in any form of atypical infarction:



• Urgent hospitalization is necessary.
• Bed regime and full of peace in the first day. In the future, moderate motor activity is necessary.
• Diet with the restriction of salt and animal fats.
• It is necessary to eliminate pain if it is presented, since the cells and fabrics are obtained as a result of pain discomfort, there is less oxygen, therefore the hearth leaning the heart muscle increases in size. Before the arrival of doctors in the patient every 5 minutes give nitroglycerin subwaged. In the hospital apply morphines and beta-adrenoblastors intravenously.
• The use of oxygen mask or oxygen therapy is necessary for all infarction plates in the first few hours after an exacerbation of the ailment.
• Stabilization of cardiac rhythm with amiodarone or atropine.
• Antiagregative therapy or the use of roofing drugs. In the absence of contraindications before the arrival of the ambulance doctors can be given acetylsalicylic acid - 1 tablet chew and swallow, drinking water. Plavix, Ticlopidine, Heparin, Bivalirudine have an even more powerful antithrombotic effect. In the hospital, such patients in order to dissolve the already formed thrombus are carried out thrombolytic therapy using streptocinase, urchinase, alteplosis.

Surgery Conducted strictly according to the testimony by the methods of coronary shunting, endovascular angioplasty. Studies show that angioplasty is most effective if it was carried out in the first few hours after a heart attack.

If the time is omitted - preferably conservative medicia treatment With thrombolitics. If it does not help - the only thing that can save the heart muscle is aorto-coronary shunting.


Possible coming and remote complications

Acute period

It begins the day after the attack and continues up to two weeks. It is the most dangerous time, since the organism is as weakened as much as possible and susceptible to all kinds of concomitant diseases. Among them:

• acute left-oscillatory failure, leading to cardiac asthma or lung swelling;
• pathology of atrioventricular conductivity;
• all types of cardiogenic shock;
• pares of the gastrointestinal tract.

Subighteous period

It lasts starting from the second week after the crisis and continues up to the month. Diseases that manifest themselves during this period are less common, but it is difficult to heal. May develop:

• internal and external myocardial breaks;
• cloth thrombendocarditis;
• pericarditis.

Observation period

Lasts up to two months. It is dangerous in that complications expressed before that acquire chronic incurable in nature and are complemented by more gravitative symptoms. During the formation of the scar can manifest themselves:

• heart aneurysms;
• post-infarction autoimmune Dressler syndrome;
• ventricular fibrillation;
• thrombosndocarditis;
• thromboembolic complications.

Post-infarction cardiosclerosis

It comes after the second month from the moment of heart attack and continues until complete adaptation of the body to the consequences of the disease. Manifests itself in:

• loss of the reduction of the contractile function of the heart;
• conductivity violation;
• heart rhythm failures.

Forecast, rehabilitation and prevention measures

Mortality for atypical infarction exceeds mortality rates in the usual form of the disease precisely because non-classical infarction difficult to immediately diagnose and recognize. About half of all patients dying before applying to the doctor or before the emergence of ambulance. Decisive are the first day - if the patient will survive the first 24 hours, that is, 70-80% of the probability that it will survive in the future.

Postinfarclical rehabilitation includes a set of measures medication and physiotherapeutic treatment. Such patients recommended sanatorium rehabilitation.

In order to prevent recurrence and prevention of complications, it is necessary to accept therapeutic doses Antiagregants (aspirin) and beta-adrenbocators, comply with diet and reasonable motor activity.


With the slightest suspicion of a heart attack, a person must be immediately hospitalized- This is the only way to prevent a deadly outcome. Self-treatment or ignoring symptoms of the disease in this case is not allowed. Especially attentive should be those who fall into the "infarction" risk group: elderly people, diabetics, patients with cardiovascular and endocrine illnesses.