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Acute myocardial infarction, with code 10 according to the ICD (international classification of diseases), belongs to the block of ischemic heart pathologies and the class of circulatory diseases. A heart attack is an acute necrosis that occurs in the muscular wall of the heart due to a violation of tissue trophism. Clinically it can manifest itself in different ways - loss of consciousness, chest pain, pulmonary edema, in rare cases an asymptomatic form develops. Treatment and prognosis for recovery depend on the time when the pathology was diagnosed, as well as on the condition of the patient.

Myocardial infarction is a sudden cessation of blood flow in a certain area of ​​the muscle tissue of the heart, as a result, myocardiocytes (heart cells) are damaged and necrosis develops. The main reasons for this condition:

• complicated by thrombosis or hemorrhage into an atherosclerotic plaque;
• prolonged spasm of the coronary vessels (most often completely healthy), leading to ischemia;
• coronary artery embolism;
• violation of the drainage function of the lymphatic system;
• sharply increased need of the body for oxygen.

The most common cause of heart attack is atherosclerosis, so it is important to monitor the condition of blood vessels and prevent the formation of plaques.

Pathological anatomy of myocardial infarction

Pathologically, the site of necrosis is located in the center of the infarction, along its perimeter is the area of ​​damage, and then the ischemic zone. The lesion has an irregular shape and looks like a clay-colored spot on the red background of healthy tissue.

Depending on the size of the necrotic area, two forms of myocardial infarction are distinguished: finely focal And macrofocal. They, in turn, are divided into several types according to the degree of penetration of necrosis deep into the tissue.

• macrofocal:
  • transmural ;
  • intramural ;
• finely focal:
  • subepicardial ;
  • subendocardial .

Photo of a section of the left ventricle of the heart with the infarction zone

What is transmural myocardial infarction? This is the most severe variant of the development of pathology, in which necrosis passes through all the tissues of the heart. Unlike transmural, intramural infarction occurs only in the muscle layer and does not damage other tissues of the organ.

Subepicardial necrosis develops on the side of the muscular wall of the heart that is closer to the epicardium, and subendocardial - closer to the endocardium.

During the course of the disease, there are several periods during which major changes occur in the damaged organ:

• Most acute– the occurrence of ischemia of a certain area and the formation of necrosis, its duration ranges from 30 to 120 minutes.
• Spicy– completion of necrotic changes and softening of the damaged area – myomalacia. Lasts about 10 days.
• Subacute– formation of a scar at the site of necrosis. It begins after the end of myomalacia and lasts 4-8 weeks.
• Post-infarction– scar compaction and adaptation of the myocardium to new working conditions. It can last up to six months.

The most dangerous acute period, since it is here that complications of a heart attack develop, which lead to death.

Symptoms of myocardial infarction in women and men

Computer model of the view from the inside of a vessel: an atherosclerotic plaque is visible, narrowing the lumen

Symptoms and first signs of myocardial infarction in women begin to appear from the moment of spasm or blockage of blood vessels, which provoke tissue ischemia. Typical angiosis form Symptoms are characterized by pronounced pain, which is localized in the heart, the left half of the chest, and sometimes spreads to the entire chest. The nature of the pain syndrome is compressive, pressing. In some cases, pain first appears in the left arm, shoulder blade, and then gradually moves to the heart area.

A clear sign of myocardial infarction in men and women is pain, which does not go away with nitroglycerin, and its duration is more than half an hour. This feature helps to distinguish an acute heart attack from a regular attack of angina pectoris.

Patients in the acute period are excited, they may shout words, rush around the room, and experience a feeling of fear of death. On examination, marked pallor of the integument and mucous membranes, increased sweating, and blue discoloration of the skin under the nose (acrocyanosis) are noted. A third of patients experience irregularities in the heart rhythm - blockades, extrasystoles. Blood pressure decreases, but with severe pain it can be increased.

Atypical manifestations of a heart attack

In a small percentage of cases, the first signs of a heart attack in women or men are very different from typical symptoms. There are several non-standard flow options initial stage pathologies:

• cerebral– symptoms are associated with impaired blood circulation in the brain, as a result, a person loses consciousness and develops a stroke;
• asthmatic– symptoms of asthmatic myocardial infarction in men manifest themselves in the form of shortness of breath, complete inability to inhale air, and discharge of pink foam from the mouth;
• arrhythmic– pain is a secondary symptom; heart rhythm disturbance occurs at the very beginning;
• abdominal– the first sign of a heart attack in women with the abdominal type is a disorder of the gastrointestinal tract (vomiting, flatulence, heartburn). Then there is pain in the upper abdomen;
• asymptomatic– manifested by general weakness, decreased activity, malaise;
• atypical– characterized by unusual localization of pain.

Signs of myocardial infarction in women or men with an atypical course mask the pathology as other diseases. Hidden infarction is detected only with the help of electrocardiography(ECG).

Diagnosis of myocardial infarction

Diagnosis of myocardial infarction is based on data ECG, laboratory test results ( troponin test), characteristic pain syndrome, as well as medical history.

ECG for myocardial infarction photo with interpretation

The picture of the electrocardiogram depends on the degree of damage to the heart tissue, as well as on the stage of the infarction.
The main ECG symptom of transmural large-focal infarction is a monophasic curve. During the acute stage of transmural infarction, the disappearance of the R wave is observed, instead of the normal QRS complex, a pathological QS complex is formed, and a coronary T wave appears.


With intramural localization, an abnormal Q wave appears, but the R wave remains, which reduces its amplitude.
ECG for lower myocardial infarction


The electrocardiographic sign of small focal infarctions is RS-T shift, as well as T-wave inversion.


Depending on the stage of development of ischemia or scar, the electrocardiographic picture changes:

Troponin test for myocardial infarction

Diagnosis of a heart attack using a troponin test is based on the concentration of a special protein in the blood - troponin, which is normally found in cardiomyocytes (heart cells). When ischemia develops, heart cells die and troponin is released and enters the bloodstream. Its amount in the blood directly depends on the extent of cardiac damage; the concentration exceeds the norm within 4-5 hours after the onset of ischemia.
The pathological content of troponin persists for 10-12 days, which makes it possible to diagnose an old heart attack. But the disease can only be confirmed using other research methods, since the amount of troponin can change in other diseases:

• myocarditis;
• drug intoxication;
• muscle fiber dystrophy;
• heart failure.

Treatment of myocardial infarction

Only a specialist can give recommendations for the treatment of myocardial infarction, since this is a dangerous disease that often leads to death. In the acute period, doctors have several main tasks when providing care:

• Elimination of pain syndrome - analgin, no-shpa, diphenhydramine are administered. If pain relief does not occur, resort to the use of narcotic analgesics - morphine, promedol;
• anticoagulant and fibrinolytic therapy - prevents the development of blood clots. Fibrinolysin with heparin and phenylin are used;
• prevention and treatment of rhythm disorders - isoptin, anaprilin. In case of a heart attack, it is not recommended to prescribe cardiac glycosides.

Ischemia, which leads to a heart attack, develops due to narrowing or blockage of the blood vessels supplying the heart. To stop oxygen starvation tissues, in modern medicine they resort to endovascular treatment methods - thromboaspiration, angioplasty And stenting or open intervention - bypass surgery.

Before surgery on the heart vessels, the patient is carefully examined. The main method that allows you to determine the volume and exact localization of surgical intervention is selective coronary angiography. This is administered under local anesthesia through a special catheter. A puncture is made in the femoral artery, then the guide is advanced through the aorta to the mouth of the coronary vessels. In some cases, the arteries of the forearm are used to insert the catheter.

After the contrast has spread through the network of vessels, a series of images is taken using a special device (angiograph). They show all the arteries, their narrowing or expansion.

Endovascular stenting of coronary arteries

– this is a prosthetics of blood vessels that allows you to expand their lumen. The entire operation is performed through a small puncture in the thigh, which gives access to the femoral artery. Through it, with the help of special conductors, a balloon is delivered to the place of narrowing, which is then expanded. Increasing in size, it expands the lumen of the vessel; this stage of the operation is called balloon angioplasty. Sometimes the intervention ends here and the stent is not inserted, but this treatment option is less popular because the vessels soon narrow again.

If it is carried out stenting, then the air is pumped out of the balloon and taken out, then the stent is inserted in the same way in a folded state. At the site of narrowing, it is straightened, it is fixed to the wall of the vessel and maintains the normal width of the artery.

The advantage of stenting is that the operation does not require opening the chest or making large incisions in other parts of the body. In addition, the intervention can be performed under local anesthesia.

X-ray surgical thrombosuction

If the cause of myocardial infarction is a blood clot, it can be removed using x-ray surgery thrombusspiration. Just as with angioplasty, a special flexible catheter is inserted through the femoral artery under local anesthesia. It is pushed towards the formed blood clot and the blood clot is removed piece by piece. Sometimes medications are injected directly into the clot through a catheter, which dissolves it, making aspiration easier - selective thrombolysis.

Cardiovascular bypass surgery

TO bypass surgery are used in cases where stent placement is impossible or impractical, for example, a large number of narrow areas in the coronary arteries. This operation is much more dangerous and complicated than stenting. It requires direct access to the vascular system of the heart, so a thoracotomy is performed - opening the chest.

The purpose of the operation is to create a bypass for the blood so that it can reach areas further than the impassable areas. To do this, a vessel is cut out from the patient (most often the great saphenous vein or radial artery) and one end is sutured to the aorta, and the other below the affected area. Thus, the sewn vessel will play the role of a shunt, delivering oxygen and nutrients bypassing the narrow arteries.

Rehabilitation after myocardial infarction and stenting

Immediately after the acute phase of the pathology, the time for rehabilitation begins, the success of which affects the further quality of life. Its duration and specificity depend on the degree of myocardial damage and the general condition of the patient. Conventionally, several rehabilitation stages are distinguished.

One of the main aspects of rehabilitation is dietary nutrition. At the beginning of the disease, the patient is allowed only pureed vegetable soups, which should be eaten in small portions. It is forbidden to use salt and spices. During the formation of the rumen, nutrition should gradually become habitual, but fatty, fried foods and sweets should be excluded. It is important to maintain a drinking regime - you can drink up to one and a half liters of liquid per day.

• quitting smoking;
• limiting alcoholic beverages;
• healthy sleep at least 8 hours per day;
• avoiding stress;
• performing physical therapy exercises with a feasible load;
• taking medications correctly and visiting your doctor.

Disability after a heart attack

Whether or not a person is disabled after a myocardial infarction depends on the severity of the damage to the heart, its ability to continue to function, and the patient’s state of health. Assigned disability can be of three groups:

• assigned to patients who have persistent signs of heart failure. As a result, they partially or completely lose the ability to perform any work.
• Average severity of disability is given to people whose working capacity has decreased, but has not been completely lost. They are characterized by functional disruptions in the functioning of the myocardium.

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– the death of certain areas of the heart muscle, provoked by circulatory disorders, when a critically reduced amount of blood begins to flow into the organ through the coronary vessels.

Pathology can cause not only serious consequences, but also death. That is why, when the first signs appear, you need to seek help from specialists.

Pathology is often diagnosed in older people. Patients who lead a sedentary lifestyle or are obese are also at risk.

In addition, the cause of myocardial infarction can be:

• Psycho-emotional overload, frequent stress, nervous strain.
• Overeating.
• Hypertensive diseases.
• Sedentary lifestyle.
• Lack of animal fats in the diet.
• Bad habits, such as drinking alcohol or smoking.
• High cholesterol. When keeping large quantity substances on the walls of blood vessels begin to form blood clots.
• Diabetes mellitus.

It is diagnosed mainly in people who lead a predominantly sedentary lifestyle. In women, circulatory disorders occur at the age of 40 years, and in men - after 30 years.

First symptoms

The first obvious manifestation of myocardial infarction is severe chest pain. It manifests itself in the form of burning and squeezing and can radiate to the neck, shoulder, arm, jaw, or back.

Painful sensations also appear during the rest period. Also, the most pronounced symptom of myocardial infarction is the lack of relief after taking three tablets of the drug to normalize the functioning of blood vessels.

Other signs include:

• Difficulty breathing.
• Paleness of the skin.
• Sudden appearance of cold sweat.
• Nausea accompanied by vomiting.
• Abdominal pain.
• Feeling of fear.
• Headache and dizziness.
• Heart rhythm disturbance.

In some cases, loss of consciousness is observed. If these symptoms appear, you should consult a doctor. Timely assistance will help not only avoid serious consequences, but also save life.

Why is a heart attack dangerous?

Lack of therapy or delayed assistance can lead to various complications. Among them:

• Atrial fibrillation.
• Cardiogenic shock.
• Pulmonary artery thrombosis.
• Rupture of the spleen, which provokes strokes, pneumonia, and intestinal necrosis.
• Cardiac tamponade. The complication is fatal.
• Pericarditis, inflammation of the pleura, joint pain.

The occurrence of complications after a myocardial infarction significantly affects the patient’s life prognosis. Based on many years of research, it was found that mortality reaches about a third of all cases.

Diagnostics

First, the doctor assesses the patient's condition and conducts a survey to determine the presence of symptoms. The specialist also examines the medical history, which often helps determine the cause of the heart attack.

In addition, the following instrumental diagnostic methods are prescribed:

1. . The electrocardiogram reveals various changes characteristic only of a heart attack. The localization of the necrosis focus and period are also established.
2. . Helps restore vascular patency and establish the exact location of the lesion. It is carried out using x-ray radiation and a contrast agent, which is injected through a special probe.
3. Computer coronary angiography. Used in the diagnosis of coronary disease to determine the degree of narrowing of the main arteries. The method allows you to determine the degree of development of a heart attack. This method is used in rare cases, since not all clinics have the equipment and specialists.

In addition, laboratory diagnostics are carried out, since as a heart attack develops, a change in blood composition is observed. Biochemical composition indicators are also monitored during therapy.

Treatment methods

The main goal of therapy is to restore blood circulation to the injured area and maintain it at the proper level. This is done using medications, and in severe cases, surgical treatment may be required. Patients also need to follow a specially designed diet.

Drug therapy

With a purpose quick recovery blood circulation, various drugs are used, which are prescribed depending on the degree of damage, the patient’s condition and individual characteristics.

These include:

• "Aspirin". Helps thin the blood and prevent the formation of blood clots on the walls of blood vessels.
• "Plavix", "Triclopidine". They have the same effect as the previous drug, but have a stronger effect.
• "Lovenox", "Fraxiparin". They are anticoagulants that act on coagulation and inhibit factors that influence the appearance of blood clots.
• "Streptokinase", "Reteplase", "Alteplase". They are thrombolytic agents that have the ability to dissolve a blood clot already formed in the vessels.

For the treatment of myocardial infarction, the use of a combination of several groups of drugs is indicated.

In the first hour of acute development of the disorder, the use of thrombolytic agents is required. In case there are no results drug treatment, surgical intervention is prescribed. This may also be the only way to restore impaired blood circulation.

Surgical treatment

After the patient’s stable condition has been achieved with the help of medications and the heart rate has returned to normal, surgery is prescribed.

Today, modern medicine can offer several methods:

• Stenting. The procedure is performed using a special stand, which is inserted into the narrowed areas of the coronary vessel through the femoral artery. The operation is performed under the control of an x-ray machine.
• Coronary artery bypass surgery. The procedure is performed on an open heart after opening the chest. The essence of the method is to create additional blood supply to the injured area of ​​the heart muscle. The operation is performed by transplanting the patient's veins. This creates additional blood flow paths.

From the video you can learn the main symptoms of myocardial infarction:

The choice of method for restoring blood circulation in the coronary vessels depends on the following indicators:

1. Presence or absence of post-infarction aneurysm.
2. Damage to more than two arteries or more than 50% narrowing.

During the recovery period after surgery great value has physical activity patient. During the first week, strict adherence to bed rest is required, and it is necessary to perform passive movements without getting out of bed. It could be breathing exercises under the supervision of specialists.

As your general condition improves, you should gradually increase the load.

At the same time, you should also not get out of bed. After one week after the procedure, patients are allowed to eat and wash themselves.

In the second postoperative period, the patient is allowed to get up and walk around the bed. Over time, walks can be taken along the hospital corridor, gradually increasing the load. Patients switch to complete self-care.In the third period, a free mode is provided, which then turns into a training mode.

Diet

The diet is developed for each patient individually. First of all they evaluate general condition, measure blood cholesterol levels and body weight. 4-5 meals a day are recommended.

In cases of excess cholesterol levels, patients should limit their intake. egg yolk, caviar and liver. Moreover, one third of all consumed fats should be of plant origin. To reduce cholesterol, it is recommended to include apples and bananas in your diet.

In addition, the content of dietary fiber in foods is of great importance. They slow down the absorption of cholesterol into the intestines and maintain normal levels of cholesterol in bile.The patient is discharged from the hospital if there are no symptoms of the disease, a sufficient level of self-care and resistance to physical activity.

Prognosis and prevention

Myocardial infarction is a serious disease characterized by serious complications. A significant proportion of deaths occur in the first day after the attack. In cases where more than half of the myocardium is damaged, the heart muscle cannot function, which provokes death.

But even with smaller lesions, the heart cannot always cope with the load. As a result, heart failure develops. When the acute period is stopped, the prognosis is favorable.

In order to protect your body and prevent a heart attack, doctors recommend keeping healthy image life, stop drinking alcohol and smoking, eat right, eliminate psycho-emotional stress, control blood pressure and cholesterol levels in the blood.

It is considered the most dangerous disease, which is characterized by impaired performance of the heart muscle as a result of tissue necrosis.

Symptoms are always pronounced, and lack of treatment leads to many serious consequences. That is why, when the first signs of a heart attack appear, you should call an ambulance. Only timely medical assistance will help avoid death.

Myocardial infarction (MI) as a severe manifestation of coronary heart disease (CHD) is one of the leading causes of mortality worldwide. In 2017, about half of all people who died in the Russian Federation had diseases of the cardiovascular system.

Myocardial infarction– this is the death (necrosis) of cardiac muscle cells, which is associated with a sharp restriction or cessation of blood supply to a certain area of ​​the myocardium. This condition most often occurs due to a sudden blockage of a coronary artery by a blood clot. Also, the cause of MI can be a significant increase in myocardial oxygen demand during psychoemotional and/or physical stress or vasospasm.

Brief classification of myocardial infarction

To prescribe the most optimal therapy for MI and determine the prognosis of the disease, the doctor must make an accurate diagnosis. In addition to patient complaints, electrocardiography is an important diagnostic method. Based on the results of the electrocardiogram (ECG), the following types of MI are distinguished:

1. According to the depth of myocardial damage:

• macrofocal,
• transmural – necrosis penetrates the entire myocardial wall,
• small-focal – limited necrosis that does not penetrate the entire myocardial wall.

2. By localization of the lesion - depends on which artery is affected:

• in the left ventricle: anterior, posterior (lower), septal, apical, lateral wall;
• in the right ventricle - this location is much less common.

3. According to the presence of complications:

• complicated,
• uncomplicated

Reasons for the development of MI

Most often, the cause of blockage of blood vessels is atherosclerotic plaques, which, as atherosclerosis progresses, gradually reduce their lumen. The greatest danger is represented by plaques, which can ulcerate, collapse and become the site of blood clot formation (atherothrombosis). It is because of atherothrombosis that MI develops in 75% of cases. The cause of plaque destruction may be a sudden increase in blood pressure or heart rate (tachycardia), vasospasm (often in morning hours) when the sympathetic nervous system is activated.

Biologically active substances that stimulate the inflammatory process, as well as platelets that form a blood clot, rush to the site of plaque destruction.

When a large artery is blocked, myocardial cells (cardiomyocytes) begin to die within 15-30 minutes, and after 1 hour only about 50% of functional cells remain. Without appropriate treatment and restoration of blood flow, necrosis may be irreversible after 6 hours. These figures make it clear how quickly professional help should be in case of myocardial infarction.

The most critical thing for the heart muscle is a lack of oxygen (ischemia). Even in the period when there is no necrosis yet, and MI is just developing, myocardial functions are already suffering. Contractility and the ability to conduct an electrical impulse through the conduction system of the heart are impaired.

The sooner the patient receives specialized care in a cardiology hospital and restores blood flow, the greater the chance that it will be possible to restore the functioning of the damaged heart muscle and avoid serious complications.

In only 5% of cases of MI, no signs of atherosclerosis are found in the vessels. Then the cause of MI is considered to be vasospasm. The triggering factor for this mechanism can be significant psycho-emotional stress or excessive physical activity.

Considering that atherosclerosis is the leading cause of myocardial infarction, the same factors that lead to atherosclerotic vascular damage contribute to the development of myocardial infarction. Among them are called modifiable and non-modifiable.

Modifiable risk factors (MRFs)

RFs that can be influenced:

• smoking,
• arterial hypertension,
• elevated cholesterol levels - hypercholesterolemia,
• diabetes mellitus, impaired glucose tolerance,
• overweight, obesity (calculation test),
• chronic stress (anxiety, depression),
• physical inactivity

Unmodifiable FRs (not changeable):

• age,
• hereditary predisposition.

It is impossible to influence them, so they are called unmodifiable.

Modifiable risk factors are those that can be eliminated or whose impact can be reduced. Special significance have concomitant diseases such as diabetes mellitus, hypertension, obesity, as well as lifestyle characteristics (alcohol abuse, poor diet, chronic stress, physical inactivity, unfavorable environmental conditions, and others).

An increase in cholesterol levels, especially low-density lipoprotein cholesterol, is considered a serious risk factor.

In the presence of several factors simultaneously, the risk of developing cardiovascular pathology and myocardial infarction increases several times. The SCORE scale is used to assess the risk of cardiovascular events and death over the next 10 years.

Clinical picture of MI

Symptoms of myocardial infarction depend on how extensive the damage to the heart muscle is, where the lesion is located, as well as on the individual characteristics of the patient and concomitant diseases.

The main clinical manifestation of myocardial infarction is pain. It has certain signs by which it can be distinguished from other types of pain syndrome.

Pain during MI, the so-called anginal pain, usually occurs suddenly. It begins with a feeling of discomfort behind the sternum, gradually increases and becomes very strong. It can be squeezing, pressing, sometimes cutting and even tearing. In addition to the retrosternal localization, it can spread to the left half of the chest with transition to left shoulder, shoulder blade, hand, grab the upper abdomen. Sometimes it radiates to the lower jaw, reminiscent of a toothache. Its intensity does not depend on body position, posture, or is not relieved by taking nitroglycerin.

The pain can last from 20-30 minutes to a day or more. Often accompanied by sudden excitement, sometimes panic, a feeling of lack of air, fear of death, “cold sweat”.

MI may be the first manifestation of coronary heart disease (CHD). Also, symptoms of myocardial infarction can develop against the background of chronic ischemic heart disease, when angina attacks are already well known to the patient. Then one of the main differences between the pain is the fact that it is not relieved by the usual intake of nitroglycerin, lasts more than 20 minutes, and appears at rest or at night.

You should also be alert to the appearance of additional symptoms that were not there before: interruptions in heart function, suffocation, other localization of pain, increased frequency of angina attacks, deterioration of tolerability of normal physical activity.

What symptoms should you look out for to prevent myocardial infarction?

Even if an MI occurs without previous angina, with detailed questioning the doctor can identify signs of a pre-infarction condition that were simply not paid attention to. This

Such symptoms cannot be ignored. If they appear, you should consult a doctor and undergo a minimal examination (ECG, ECHO-CG).

According to the clinical signs of myocardial infarction, it is divided into 6 options:

Atypical forms of myocardial infarction

In addition to the main clinical variant of myocardial infarction, there are others. They differ in symptoms; it is more difficult to make a correct diagnosis, since they can masquerade as other diseases.

1. Asthmatic. The pain is not so pronounced, and sometimes is completely absent. Symptoms of suffocation or shortness of breath come to the fore, which are sometimes accompanied by a cough, which can be mistaken for an attack of bronchial asthma or an exacerbation of other chronic diseases lungs.

2. Abdominal. Occurs rarely - in approximately 3% of patients. Characterized by abdominal pain and symptoms that can be associated with indigestion (nausea, vomiting, bloating, stool disorders). The abdominal muscles may be tense. Such patients often end up in the surgical department with suspected acute appendicitis. This option can develop when the source of myocardial infarction is localized in lower parts left ventricle of the heart

3. Arrhythmic . Typical pain is absent or mild. In this case, various heart rhythm disturbances and conduction disturbances are recorded. This type of MI may be accompanied by a sharp decrease in blood pressure and heart failure.

4. Cerebrovascular. There is practically no pain in the heart area. The main signs are symptoms from the nervous system, which indicate a violation of cerebral circulation. It is more often observed with severe cerebral atherosclerosis in elderly patients.

General cerebral symptoms may be observed: nausea, vomiting, dizziness, fainting; mental disorders: apathy, disorientation in time and space, psychosis.

5. MI with atypical pain syndrome. Pain can be noted in the thoracic spine, left shoulder blade, shoulder, hand, lower jaw, and right half of the chest. The character makes you think about osteochondrosis and other diseases of the musculoskeletal system. The diagnosis of a heart attack can be confirmed using an ECG, ECHO-CG (ultrasound of the heart) and troponin tests (blood test).

6. Painless or low-symptomatic option. Such heart attacks are discovered by chance during an examination for another reason. They are observed mainly in older people with various concomitant diseases, such as diabetes.

When to urgently call a doctor

If intense pain appears behind the sternum or in the chest, which radiates to the arm, shoulder blade, shoulder, lasts more than 20 minutes, is not relieved by nitroglycerin and is accompanied by weakness, cold sweat, agitation, you need to call ambulance or a doctor. When calling an ambulance, indicate the nature of the pain so that a specialized cardiology team can arrive. Early diagnosis and adequate therapy to restore blood flow can save lives.

Before the ambulance arrives, you can take nitroglycerin in the form of a sublingual tablet or spray (up to three times with an interval of 5 minutes). It must be borne in mind that the drug can cause a sharp decrease in blood pressure, even to the point of fainting, so it is important not to exceed the dosage.

In the absence of contraindications, you should take acetylsalicylic acid in a dose of 150-300 mg, after crushing or chewing it. In the hospital, treatment will be aimed at