Cardiovascular diseases for many years held the first place among all the human death reasons. Myocardial infarction is one of the most frequent. Every year it kills millions of lives.
Myocardial infarction is diagnosed in men more often than in women. The risk of disease increases with age. For example, at the age of 50-59 years the probability of cardiovascular pathologies is about 6 cases per 1,000 population, and from 60 to 64 years, this figure increases to 17 cases per 1,000 persons per year.
Mortality from myocardial infarction is very high. Even in developed countries, one third of patients die even before they get to the hospital. Another 15% of patients die within the first day, and 10% - over the next three months, after setting an appropriate diagnosis. Overall mortality from myocardial infarction is about 45% in developed countries, while in developing countries it exceeds 50-55% of all its cases.
Myocardial infarction is a death of the heart muscle area on the background of insufficient blood supply. The main reason (95%) of the cardiovascular diseases is coronary atherosclerosis. Coronary blood vessels are responsible for the delivery of arterial blood to the myocardium. As a result of the lumens overlap by the plaques of cholesterol, heart muscle no longer receives oxygen. The part affected by oxygen starvation, is killed.
The remaining causes of myocardial infarction, which cover about 5% of cases of this disease, are:
Besides direct causes there are also risk factors that increase the possibility of heart attack. The main ones are:
Some risk factors cannot be controlled. However, most of them can be eliminated, including body weight, high blood pressure and increased cholesterol level.
The clinical picture of myocardial infarction is highly variable. The most common symptom is the pain in the chest. It is observed in 70-90% of clinical cases according to different authors’ information.
Depending on the location of the pain several forms of myocardial infarction are distinguished:
According to another classification, the number of atypical forms of myocardial infarction includes:
Myocardial infarction often occurs as a result of physical activity. This factor contributes to the pain emergence or strengthening.
Additional symptoms that may accompany pain in different disease forms:
All of these symptoms are not pathognomonic. They can be found in other pathologies, therefore, to confirm the diagnosis the additional research is required: ECG, ultrasound and biochemical tests (blood tests for proteins cardiac proteins).
If someone in your family has symptoms of heart attack, the sequence of actions should be as follows:
1. Call an ambulance.
2. Seat the patient in the chair; take off his shirt, necktie and other items of clothing that may impede breathing.
3. Take all necessary measures to calm the person, because stress contributes to a spasm of the coronary vessels, which only exacerbates the situation.
4. Give a nitroglycerin pill.
5. Give 300-500 mg of acetylsalicylic acid. To accelerate the assimilation of the drug the patient should chew the pill.
Emergency myocardial infarction therapy should be started right after the arrival of an ambulance. It involves the use of drugs:
A person should be hospitalized to cardiology department. At the initial stage of therapy, the most important is the restoration of blood flow through the damaged vessel to stop the death of viable myocardium. Balloon angioplasty or pharmacological thrombolysis is often performed for this.
Coronary angioplasty and stenting. The balloon inserted into coronary vessel inflates with air and expands the artery. As a result, the blood supply to the heart is restored. An important addition to this method is stenting. Stent is a frame inserted into the coronary artery. It reduces the risk of restenosis (re-narrowing of the vessel lumen).
Coronary artery bypass grafting (CABG). This one is more efficient operation that helps to restore blood flow, even in cases where balloon angioplasty doesn’t work. Shunts are a circuitous path for the blood. A surgeon forms them using the fragments of arteries located in other areas of the patient's body. As a result, blood gets to the myocard through other vessels that are not blocked by atherosclerotic plaques.
ICD implantation. The operation is used for many heart diseases, including elimination of myocardial infarction effects. As a result of this illness the rhythm and conduction disturbances of the heart muscle often occur. It is associated with the heart areas necrosis. For this reason, the ejection fraction is lowered and indicates that the myocardium doesn’t fully perform its pumping function. The ICD implantation helps to normalize the rhythm, to improve the quality and duration of the patient’s life.
Cardiac Rehabilitation. The set of measures (medication, hygiene, health, cardiac) is required for restoring the quality of the patient’s life after myocardial infarction. Their amount depends on the particular clinical situation.
Stem Cell Therapy (SC). This myocardial infarction treatment method helps to avoid connective tissue scars on the heart surface. The scar is namely the one that stays the main cause of the myocardial conduction and contractility violations.
The reason for this method is based on injecting the patient’s own or donor stem cells, that are capable of transforming into the myocytes to replace necrotic portion, in the body. Chitosan hydrogel or another carrier, where the stem cells have already been placed, delivers the treatment to the affected area. Upon reaching the destination, this jelly-like mass "incises" into the affected area and forms a porous body, helping to stop the progression of necrosis.
The process of introducing the substance via a catheter, is minimally invasive. Stem cell therapy can simultaneously localize the zone of necrosis and start rebuilding muscle cells in this area over a short time.
Laser Revascularization. This process helps to quickly restore the coronary vessels patency to resume the normal blood circulation. It is performed with the help of laser system. The procedure involves a front or side chest wall incision with putting a special electrode to the heart. The electrode makes pinholes in the myocard that are supposed to become a place of new micro-vessels formation.
Thus, an artificial collaterals system is created, that takes charge of the blood supply of the affected heart area and provide normal metabolic processes in all of its departments. The result of this treatment results in a significant improvement of the patient’s life quality.
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