The pain in the chest ISCHEMIC HEART DISEASE

"The pain in the chest. ISCHEMIC HEART DISEASE: myocardial infarction. Diagnosis, differential diagnosis and emergency treatment. Lecturer: Prof. M. Rustamova

Myocardial infarction-acute disease caused by the development of one or more lesions of ischemic necrosis in cardiac muscle, various cardiac disorders and clinical syndromes, as determined by the nature of Reflex reactions related to acute ischemia and myocardial necrosis.

ECG – SIGNS CHARACTERISTIC OF MYOCARDIAL INFARCTION. • Transmural myocardial infarction (within the first few hours): • enhancement (dome-shaped) ST segment on izolin high, positive as well as pointed tooth of t in some areas; • reduction of ST segment contours below in other areas;

ECG – SIGNS CHARACTERISTIC OF MYOCARDIAL INFARCTION. • Diskordant ST-segment change in various areas; • reduced amplitude R, deformation of micro; • the appearance of pathological zubza Q > 0. 04 with wide and depth > 1/4 R;

ECG – SIGNS CHARACTERISTIC OF MYOCARDIAL INFARCTION. • within 2 -3 days of gradual emergence zubza QS; • ST segment change and the appearance of deep negative prongs t.

Subèndokardial myocardial infarction: • reduction of ST segment contours below; • the appearance of deep negative prongs t; • There may be all kinds of arrhythmias and blockades.

. AMI 2 x a week ago. Heart of the 76 -year-old man. Clearly visible demarcation line Reproduced by kind permission of Drs Mc. Lay & Johnson - Tulane School of Medicine

Массивное поражение септы, давность ОИМ 1 неделя. Reproduced by kind permission of Drs Mc. Lay & Johnson -Tulane School of Medicine

Nekrotič-rezorbtive syndrome: • increased Myoglobin in the first 2 -3 hours and up to 1 -2 h; • improvement of MW-FSC in the first 4 -8 hours and up to 2 -3 days; • enhancing the overall CPK in the first 4 -8 hours and up to 3 -4 days; • increase LDH and LDG 1 in the first 8 -12 hours and up to 8 -14 d;

Nekrotič-rezorbtive syndrome: • increased AST in the first 8 -12 hours and up to 3 -4 days; • increase in body temperature during the first 12 h; • Leukocytosis within the first 2 -6 hours and up to 2 -3 days; • acceleration of SEDIMENTATION RATE via 2 -3 day with normalization depending on the clinical course of the disease.

CLINICAL VARIANTS OF MYOCARDIAL INFARCTION Pain (status anginozus) is the most common and characteristic version. The pain is localized to the breast bone, heart, right from the belly, on the entire surface of the thorax. Usually pain oppressive, compact nature, rarer – pulse, burning, cutting or undefined. The pain continues for more than 20 -30 min, often several hours and often 1 -2 m, can be recurrent. It is administered by nitroglycerin or Department include dinitrate, analgesics.

Asthmatic. The clinical picture is shortness of breath, a feeling of lack of air, choking. After cupping levojeludockova failure patient tells that the disease started with pain behind the breastbone or in the heart, but very quickly became short of breath. Most often occurs when the heart muscle papillary ones.

• Abdominal (gastral′gičeskij). Pain manifests itself under mečevidnym or in the process of the upper divisions of diarrhoeal disorders èpigastriâ (nausea, belching, hiccups, vomiting).

Aritmic. Starts with the attack of ventricular tachycardia, supraventricular, AV blockade II extent or dire the blockade of atrioventricular-ventricular feet beam (beam Guisa).

• Cerebral infarction. Is rare (in 0. 8% of patients). The clinical picture is dominated by symptoms of cerebral circulation: fainting, dizziness, nausea, vomiting, focal neurologic symptoms. Chest pain is poorly expressed or even absent.

• asymptomatic myocardial infarction manifesting bouts have pains, transient bouts of shortness of breath and other short-lived changes in health. ECG is crucial-a study in Dynamics.

COMPLICATIONS OF MYOCARDIAL INFARCTION • Cardiac arihythmia; • acute circulatory failure (pulmonary edema, cardiogen shock); • tears of the heart; • acute cardiac aneurysm; • Èpistenokardičesk pericarditis; • tromboèndokardit; • thromboembolism;

COMPLICATIONS OF MYOCARDIAL INFARCTION • violations of the gastrointestinal tract (stomach, bowel paresis, acute ulcers, erosion of the stomach and intestines, sometimes with the development of acute bleeding); • urinary system disorders (retention);

• postinfarction autoimmune syndrome Dresslera; • syndrome of the anterior wall of the thorax, shoulder syndrome; • personality disorders (varying degrees of symptoms, bleeding episodes sputannogo of consciousness, hallucinations, delusional disorders, konfabulâtorno-neurotic reactions, fears and phobias, hypochondriacal reaction reactive depression).

TREATMENT OF MYOCARDIAL INFARCTION Main tasks of the doctor are: • mild pain attack; • attempting to restore coronary blood flow occlusion on the spot; • warning of life-threatening arrhythmias; • restriction zone infarction; • treatment of complications; • psychological and physical rehabilitation

TREATMENT OF MYOCARDIAL INFARCTION • THROMBOLYTIC • ANTICOAGULANT • AND ANTIAGREGANT THERAPY

TREATMENT OF MYOCARDIAL INFARCTION • Lysis therapy is carried out in the first 12 (but more effectively it in the first 0. 5 seconds from start anginal′nogo -2 status) using performance (intravenous) and vnutrikoronarnogo of trombolitika. Thrombolysis is not shown if the elevation is missing and the ECG ST segment changes represented only ST depression or missing altogether.

PROGRAM STATUS ANGINAL′NOGO EDEMA • pain medicine administered subcutaneously or intravenously, • especially people aged patients, low supply. • The introduction sequence is listed below. • Each subsequent introduction means inefficiency.

Baral′gin 5 ml or 50% анальгин of Analgin 2 2 мл, Баральгин 5 мл или solution 50% раствор ml of 1% solution, diphenhydramine 1 -2 в/в in/in димедрол 1% раствор 1 -2 мл ml Promedol 1 -2% solution 11 ml in/in Промедол 1 -2% раствор мл в/в Papaveretum 1 -2% solution Омнопон 1 ml in/in 1 -2% раствор 1 мл в/в Morphine 1% solution 1 ml in/in Морфин 1% раствор 1 мл в/в

For system and fibrinolysis intralumincoronari apply the following preparations: • streptokinase-1000000 -1500000 IU dissolved in 100 -150 ml of isotonic sodium chloride solution and give/drip 250000 IU within 30 min, followed by maintenance dose. • To prevent possible allergic reactions previously injected 30 mg prednisolone/in or

• streptodekaza-300 000 FE (fibrinoliticakih units) in 20 -30 ml izotoniceski solution of sodium chloride in/on for 10 -15 min (diagnostic test). If the behavior does not occur within an hour, impose adverse reactions/2700000 speeds-600000 300000 FE/min, or

• After fibrinolytic and anticoagulant therapy is prescribed antiplatelet agents that patients myocardial infarction are long-term, for 1 year or more: • acetil′salicilovuû acid – 125 – 300 mg inwards 1 time per day (inogd day) and dipyridamole on 50 -75 mg 3 x/day inwards (medication often prescribed in combination with acetilsaliciovoj acid to strengthen antiagregantnogo effect), or • tiklopedin on 125 -250 mg 1 -2 times a day and sometimes every other day.

• urokinazu-4400 u/kg/in for 10 min, and then at the dose of 4400 u/kg every hour it was answered 10 -12 h and 72 h, or rarely • fibrinolizin – 80000 -100000 IU/in the dissolved in izotonicescom solution of sodium chloride at the rate of 100 – 160 UNITS in 1 ml, the initial speed of 10 -12 drops per 1 minute (the drug significantly favour the first three), or tissue plasminogen activator (actilyse, al′teplaza).

Rehabilitation • In determining the pace of rehabilitation include the following symptoms: • -prevalence of myocardial infarction: • finely-, krupnoočagovyj, subèndokardial′nyj, circular; • -the gravity of complications: • arrhythmias, circulatory insufficiency, etc. ; • -age; • -presence of heavy pathologies of internal organs: • HYPERTENSION, diabetes, heart diseases, etc.

The stages of rehabilitation • Phase I Begins after cupping anginoznogo status and severe complications. The patient performs statistical breathing exercises, and exercises for small medium -sized muscular arms, legs. Includes massage of the legs, the elements of autogenic training.

The stages of rehabilitation • Phase II. Mode of bed rest, but with the increasing volume of exercise. Complex medical gymnastics is usually included with the 2 -day phase.

The stages of rehabilitation • Stage III. Polupostel′nyj mode. Permitted to sit on the bed with downy sometimes feet on day 3, use the bedside Chair on the 4 th day. Complex medical gymnastics continues.

The stages of rehabilitation • Stage IV. Treatment Chamber. First movement is permitted near the bed to the 7 th day, and then by the House. Walking in the House, staying in the self-servicing Chair. On 8 -9 th day out into the corridor, into the toilet.

The stages of rehabilitation • Phase v. development of a common regime in the Department. Dosed walking into Office, food service, lifting on 6 -12 -speed ladders, morning physical exercises. The samples measured physical activity on 11 -21 -day myocardial infarction in the absence of the following contraindications: • -heart failure; • -heart rhythm disorders; • -other serious complications.

Prevention of CHD and AMI. • Control of hyperlipidaemia is one of the areas of the prevention of CHD; It begins long before the appearance of clinical symptoms of this pathology. Treatment and prevention of Hyperlipidemia have given the patient's age, cholesterol and other factors.

• Phase VI. The increase in household loads. Development of routes on flat and rough ground. Continuation training on the stairs (2 -6 bays), workout at the gym (subporogovyj), the complex of physiotherapy exercises. Translation in cardiological sanatorium

Hypo lipidic diet and prevention of risk factors for CHD. • Nežirne meats (beef, poultry, lean pork is rare); • Fish (sel′d, sardine, cod, Pollock, icy, Pike, salmon, tuna, rare CARP); • Fresh vegetables and fruits are apples, citrus fruits, carrots, beetroot, lettuces, herbs (cilantro, dill, parsley, etc. ), cucumbers, dried fruit as additives to tea and coffee; • All varieties of vegetable oil, soft margarine varieties, occasionally a small amount of butter; • A small number of eggs (preferably white); • Occasionally (during holidays) a small amount of sweet and baked meals, including ice cream.

• Thank you for your attention