Transmural infarction is common andan extremely dangerous disease, which is accompanied by necrosis of the heart muscle. It is worth noting that mortality in the case of development is similar to pathology is very high, especially if signs of heart failure were not noticed on time, and the patient did not receive the necessary medical care. That is why it is important to know how this form of infarct manifests and what kind of help is required for a sick person.
Transmural myocardial infarction: what is it?
To begin with it is necessary to understand the meaning of the term.Surely many people know that the infarction states are accompanied by the withering away of the sites of the heart muscle. This is due to a sharp cessation of blood flow to the heart, as a result of which tissues do not receive oxygen and nutrients necessary for life.
As you know, the heart wall consists of three layers- this is the epicardium (outer layer), the mural muscle layer and the endocardium (the inner part of the muscle). With the intramural form of the disease, necrosis affects only one layer. Acute transmural infarction is a pathology in which necrotic processes are observed in all layers of the heart. It is worth saying that this is the most dangerous form of such a disease.
In modern medicine, pathology is classifiedbased on the localization of foci of necrosis. Most often there is a transmural myocardial infarction of the anterior wall, namely the left ventricle. Only in one of five cases necrosis affects the wall of the right ventricle. About a third of patients in the process are also involved in the walls of the atria.
Causes of the disease
In almost every case, transmuralHeart attack is the result of ischemic heart disease. As already mentioned, with insufficient oxygen and nutrients, muscle cells begin to die - this is how necrosis develops. According to statistical data, in 90% of cases the cause is atherosclerosis of the coronary vessels, which provide blood flow to the myocardium.
On the wall of the vessel, the so-calledatherosclerotic plaque. Under the influence of certain factors, part of the plaque tears off from the wall and blocks the lumen of the coronary artery. Acute transmural infarction, as a rule, rapidly progresses in those situations when the demand for myocardium in oxygen sharply rises - this can happen, for example, with strong physical activity, increased body temperature, strong emotional stress.
Acute transmural myocardial infarction: risk factors
As can be seen, necrotic lesions of the heartare not an independent pathology. In most cases, they develop against the background of already existing ischemia and atherosclerosis. Therefore, we can identify several risk factors:
- Genetic predisposition of the patient, which is associated with certain anatomical features and hereditary diseases.
- There is also the age factor. Transmural infarction is more often diagnosed in people older than 45 years, and men are more prone to this pathology.
- Increased blood cholesterol (precisely because of this, plaques form on the walls of blood vessels, which subsequently block the blood flow).
- Improper diet (eating fatty and fried foods increases the likelihood of atherosclerosis).
- Obesity (in most cases it is associated with malnutrition, and an increase in body weight increases the load on the heart).
- Hypodynamia (sedentary lifestyle leads to a gradual weakening of the heart muscle, after which the myocardium is very difficult to cope with any physical exertion).
- Constant stress, nervous exhaustion, emotional stress leads to changes in hormonal levels, which affects the work of the cardiovascular system.
- Smoking (according to statistics, in 35% of cases the necrosis of the heart muscle is associated with this harmful habit).
Main symptoms: how to determine a heart attack?
Signs of necrosis can be different - here everything isdepends on the degree of damage, the age of the person, the presence of concomitant diseases, etc. There are cases of asymptomatic infarction. Nevertheless, some of the main symptoms can be identified:
- In most cases, a person complains of acute compressive pain behind the sternum - it clearly gives into the left shoulder blade, arm, lower jaw, ear, and even teeth.
- The pain is undulating and prolonged - the seizures can be repeated for several hours or even days.
- Tachycardia develops, and the patient, as a rule, clearly feels frequent and even painful heartbeats.
- There is also a sensation of short-term fading of the heart.
- There are also external signs of a heart attack - the skin and mucous membranes of a person abruptly turn pale.
- Against the background of necrosis, cardiac asthma often develops - the patient notes severe shortness of breath, sharp attacks of suffocation.
Diagnostic measures
When the first violations appear,Immediately deliver the sick person to the hospital ward, where appropriate diagnosis and treatment will be carried out. The main diagnostic method for necrosis of the myocardium is electrocardiography, because with this procedure it is possible to fix the electrical potentials in different parts of the heart.
Competently conducted and decodedan electrocardiogram allows the doctor to determine the localization of necrosis (for example, lower transmural infarction), the extent of the pathological process and the depth of the lesion, the duration of the disease.
In addition, a blood test is needed.With a heart attack, there is an increase in the erythrocyte sedimentation rate, an increase in the number of leukocytes, the appearance of specific enzymes and compounds in the blood, which are normally found inside myocardial cells.
First Aid Rules
Acute transmural infarction of the anterior wallmyocardium is a pathology that develops very quickly. Symptoms may appear at almost any time, so you should familiarize yourself with the rules of patient care. Naturally, first of all you need to call the ambulance brigade.
Waiting for doctors, a person needs to lie down.An exception is a situation in which there is a strong shortness of breath and distinct wheezing when breathing - in this case, the patient is better to sit down, putting a pillow or a roller under his back. It is recommended to take an aspirin pill. You also need to give a person nitroglycerin - first one pill, and if the pain does not go away, then after five minutes another one (but not more than three).
Treatment for myocardial infarction
Depending on the results obtained during the diagnosis, the doctor prescribes treatment. Initial therapy usually consists of three main parts:
- Taking painkillers torelieve the patient's condition. Quite often, the pain can be stopped only with the help of strong drugs, including Promedol and Morphine. The onset of symptoms and the diagnosis of myocardial infarction are stressful for a person, and anxiety and fear only increase the load on the heart - the patient is given sedative medications.
- The treatment regimen includes taking nitrates and beta-blockers, which helps to eliminate arrhythmia and restore heart rhythm.
- When transmural heart attack is highthe formation of blood clots, which is fraught with necrosis of other organs and the spread of the process to neighboring areas of the myocardium, damage to the nervous system and even death. Therefore, the fight against thrombosis should begin in the first hours after the onset of symptoms. For this purpose, diluting agents are used, which contain heparin and fibrinolysin. Naturally, when taking these drugs, there is a chance of massive hemorrhage, because the blood stops rolling, so it is important to carefully monitor the patient's condition.
Treatment is necessarily carried out in a hospital - the patient should be under the supervision of a doctor around the clock.
Consequences and complications of the disease
Transmural heart attack is the most difficult and dangerousform of myocardial necrosis, especially when it comes to large-focal necrosis. The disease is fraught with consequences - the development of pulmonary edema, paralysis of limbs, speech disorders. Sometimes a heart attack entails further pathologies of the vascular system, in particular stroke.
The consequences of this pathology also includethromboembolism, ventricular fibrillation, termination of the work of various organs and even their systems. Such cases often end in death, even if the patient has been provided with medical care. Another deadly complication is heart failure. With a strong contraction of the myocardium and an increase in pressure inside the ventricles and atria, there is a risk of impaired muscle integrity in the area of necrosis.
Rehabilitation and prognosis
К сожалению, прогнозы при подобном заболевании не too favorable - in about 50% of cases, patients (especially when it comes to older people) die. If, nevertheless, it was possible to restore normal blood circulation, there is still a risk of developing complications in the future, as myocardial tissue changes have occurred.
That is why the period is so important.rehabilitation. Patients are recommended to eat simple, light and high-calorie food. It is also important to gradually return the locomotor activity, since the low mobility is fraught with muscle atrophy and congestion in the lungs. Of course, all activities related to physical activity should be strictly controlled by a specialist.
Поддерживающая терапия и постоянное наблюдение у a doctor is needed until the end of life. Of course, patients need to monitor nutrition, avoid stress and intense physical exertion, prevent a high increase in blood pressure and quit smoking.
