Atypical forms of myocardial infarction: a general characteristic

Author Ольга Кияница

2018-09-18

Myocardial infarction can manifest itself in different ways, and its atypical forms represent the greatest difficulty in diagnosing the disease. In such cases, both patients and doctors may not pay attention to uncharacteristic symptoms in time, which threatens the development of various complications.

Myocardial infarction is a heart attack that develops against a background of long-term ischemia of the heart muscle.Despite a significant reduction in mortality due to cardiovascular disease for several decades, coronary heart disease (CHD) remains the leading cause of disability and mortality worldwide.

More than 370 000 Americans die from CHD every year, and about 47% have at least three key risk factors for IHD: high blood pressure, hyperlipidemia and smoking.

Myocardial infarction (MI) remains the most common complication of ischemic heart disease. An estimated 735,000 Americans experience MI every year. This disease can occur in a typical and atypical form. The second option is less favorable, as it can lead to a greater number and severity of complications.

Video: Acute myocardial infarction Classification and Diagnosis

Description of myocardial infarction

A heart attack causes atherosclerosis, which affects the arteries in various parts of the body. When the coronary heart network is affected, the heart muscle is said to be coronary heart disease caused by the formation of atheroma. Its growth narrows the lumen of the artery and limits blood flow. This process can lead to angina and necrosis of the myocardium

A heart attack (also known as myocardial infarction or MI) occurs when the blood supply of the heart is completely blocked by either a blood clot or a torn piece of atheroma. Cessation of blood flow in the coronary artery can lead to damage to the part of the heart muscle, which was previously blood-supplying this coronary artery.

Facts about myocardial infarction

  • Most people experience heart attacks and are almost completely restored.
  • The heart is one of the most important muscles in the human body, so it is extremely important to carry out its timely treatment.
  • It is normal to feel fatigue, weakness and excessive emotionality after a heart attack - it will pass.
  • Many of the causes of myocardial infarction depend on the patient's lifestyle - it's never too late to reduce the risk of developing a repeated heart attack.

Typical and atypical symptoms of myocardial infarction

More often than not, the most debilitating symptom of myocardial infarction is chest pain, which doctors know as angina.It is also often felt nausea and vomiting, severe sweating, pain in the left hand. All this is more typical for a typical course of a heart attack.

Typical symptoms of myocardial infarction:

  • chest pain or chest discomfort;
  • nausea;
  • fatigue;
  • inconsistent breathing;
  • sweating;
  • dizziness;
  • fear of death.

But, especially in women, atypical cardiac manifestations can be documented. For example:

  • a sharp change in the sensations of one's body;
  • pain in the chest, which can be central or felt in the axillary region, at least 10% of women;
  • unusual pain, discomfort, pressure, heaviness, burning or raspiranie left or right hand, upper back, shoulder, neck, throat, lower jaw or abdomen;
  • weakness, syncope or extreme / unusual fatigue;
  • Shortness of breath and / or shortness of breath;
  • anxiety, insomnia, or panic attack;
  • bluish complexion or numbness in the lips, hands or feet;
  • nausea or vomiting;
  • sticky sweat (or sweating, which does not correspond to the environment or the degree of stress);
  • persistent dry, barking cough.

A heart attack can also cause a sensation of pain or discomfort along the movement of nerve fibers from the heart to the spinal cord, where many nerves merge into a single one that goes to the central part of the brain. For example, the hand may be in perfect order, but the brain thinks that the pain is concentrated in the hand (or in the jaw, shoulder, elbow, neck or upper back).

Not all these symptoms occur during each heart attack. Some patients (especially women) after MI report that they suddenly felt some unusual condition or premonition.

Sometimes the most extreme symptoms do not always mean massive damage to the heart muscle. Also, the symptoms may disappear, and then return with time.

Stable signs of the disease usually worsen during physical stress, but go away at rest. If the manifestation occurs when the patient is in a calm state, then they are considered unstable - and this can mean a serious adverse course of the disease, which requires immediate medical attention.

Description of atypical forms of myocardial infarction

The clinical picture of myocardial infarction can be very diverse and in recent years doctors have increasingly noted the increased occurrence of atypical forms of this disease. There are 9 variants of the course of a heart attack, which differ markedly from their typical form by their developmental mechanisms and clinical manifestations.

  1. Cerebral form
  2. Asthmatic form
  3. Arrhythmic form
  4. Abdominal form
  5. Peripheral shape
  6. Pain-free form
  7. Edema form
  8. Shabby form
  9. Combined
  • Cerebral form

In Latin, the brain is referred to as "cerebrum", so when the cerebral form of MI occurs those symptoms that are more characteristic of neurological diseases:

  • flickering of dots or flies before the eyes;
  • severe dizziness;
  • fainting or fainting;
  • twilight consciousness.

In addition, patients can note a frustration of understanding of what is happening around. Sometimes the clinic is supplemented with nausea and vomiting.

  • Asthmatic form

From Latin, the term "asthma" is translated as "frequent breathing, shortness of breath". Such a course of the disease is mainly found in the elderly, and there is no definite connection with gender.

When developing the asthmatic form of a person's IM, it is not uncommon to initially worry about shortness of breath, which in severe cases goes into choking, as happens in bronchial asthma. That is why a similar form of the disease is called asthmatic.

If there is a shortness of breath on exhalation, this further worsens the diagnosis, since such a symptom is most often observed with bronchial asthma.

Clinic of the disease may be accompanied by the release of foamy sputum pink color, which will indicate the complexity of the course of the disease.

  • Arrhythmic form

With this form of myocardial infarction, the feeling of pain is poorly expressed, whereas the patient is more concerned with arrhythmias. Violation of the rhythm can occur by the type of atrioventricular block or simply supraventricular tachycardia. In any case, if a patient has previously had heart attacks, then the first thing to be done is research on the function of the myocardium.

  • Abdominal form

A similar course of myocardial infarction is typical for those situations when the posterior wall of the myocardium is affected. Due to its proximity to the diaphragm, the nerve impulses are more extended to the abdominal cavity.

For abdominal MI is typical:

  • sensation of severe pain in the upper abdomen;
  • strong feeling of nausea;
  • frequent desire to snatch.

The last sign can particularly annoy the patient, since even on an empty stomach, vomitive reflexes arise. In addition, there may be either a strong relaxation of the stomach, or vice versa in the type of the intestinal paresis, when the peristalsis is practically absent and because of the non-occurrence of the gases the stomach becomes swollen.

  • Peripheral shape

In this clinical variant of myocardial infarction, painful sensations are localized in a variety of places, even very far from the region of the heart. Depending on the place of definition of pain, they distinguish:

  • Lethopelagic pain - the pain in the left scapula is determined; by nature, they can be sharp, even intolerant, sometimes by the type of lumbago.
  • Left hand pains - there is an irradiation of unpleasant sensations on the left hand, which can "pull", "twist", "pull".There were cases when the pain was felt only in the left little finger and other signs of a heart attack were practically absent.
  • Upper invertebral pain - with this variant of IM, patients often think that they have an exacerbation of osteochondrosis, while in the study other signs of myocardial damage are determined.
  • Gorsky-pharyngeal pain - it is determined by severe discomfort or sore throat. In this case, there are cases when patients came to see an otolaryngologist with similar complaints, as a result of which it became clear that a myocardial infarction occurred.
  • Mandibular pains - a patient can apply to the dentist with complaints of severe pain in the entire lower jaw or only in its left half, whereas in fact there is MI.

If a person has ECG signs of myocardial infarction, but he does not make any complaints, then this is the next variant of the course of the disease.

  • Pain-free form

It is also known as collaptoid, because when it develops, the patient can not point out any signs that bother him. This does not mean that myocardial damage is insignificant, although this form is often equated with a microinfarction.

The patient can still show fatigue, weakness, poor health, but most often these symptoms are associated with increased physical exertion. Also, the cause of the disease can serve as a long period of non-release periods at work, sometimes perceived as a manifestation of laziness. But such excuses do not allow timely diagnosis of the disease and conduct treatment. Therefore, in order to prevent progression of the insidious form of myocardial infarction, it is necessary at the appearance of minimal signs similar to MI, and even in elderly people to immediately consult a doctor.

  • Edema form

The patient is primarily concerned about swelling, which often initially develops as peripheral, that is, on the feet, ankles, legs. In critical cases, fluid accumulates in the abdominal cavity and then speak of ascites. If you do not provide medical help in such cases, the patient may develop pulmonary edema and death.

  • Shabby form

This form is still known as asymptomatic, because the patient does not clearly notice any signs, although it can complain about increased sweating, fear of death. In such cases, attention to detail can help especially, so if there are risk factors for the development of MI, you need to carefully monitor your health.

  • Combined

With the development of this form of IM, the signs of several forms of the disease are simultaneously determined. For example, swelling may occur and at the same time there are severe pain in the scapula, in the left arm or in the throat.Such an unusual combination of symptoms should first of all lead to the thought of a heart attack.

Video: Myocardial infarction: from pathomorphology to the clinic


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