Heart attack on the legs: symptoms, diagnosis and prevention
Author Ольга Кияница
Myocardial infarction (MI) is a cardiovascular disease that most often occurs in old age. If a person works hard, poorly eats, has a variety of bad habits (smoking, drinking alcohol), then the risk of developing MI also increases.
Every year, millions of people around the world are experiencing attacks of myocardial infarction, which often result in the development of complications, and in severe cases - fatal.
Diagnosis of myocardial infarction is based on the use of electrocardiography, which by displaying the electrical conductivity of the heart reflects the place of damage to the heart muscle. In some cases, it is because of planned medical examinations that hidden forms of MI are identified, which, as they say, were carried on their feet.
Description of myocardial infarction
There are atypical forms of myocardial infarction, which differ from the clinical pattern of their clinical course. In particular, the following forms are distinguished: cerebral, abdominal, edematic, asthmatic, arrhythmic, peripheral, worn out, painless and combined.
A heart attack carried on the feet refers to a painless or erased form of the disease, since it is in these cases that there are no clear clinical manifestations associated with myocardial damage.
A silent myocardial infarction is a heart attack with no typical symptoms. The patient often does not know that he has developed a heart attack. Sometimes the disease is determined after several weeks or months after the attack.
Recent studies show that almost half of all myocardial infarctions are silent (hidden) heart attacks carried on their legs.
Symptoms of a heart attack on the legs
The asymptomatic course of a heart attack is not as serious as with a typical development of myocardial infarction.Basically, this condition is often mistaken for other pathologies. Some people do not complain at all. Still, you should pay attention when there are any signs from the following options:
- Discomfort in the chest. You can feel pain, but it will not be expressed, sharp or squeezed, as it happens in a typical heart attack. Most often, there is discomfort in the upper abdomen, in the back or in the lower jaw. Also, an unexpressed sip in the left hand can be noted. Some patients feel that their muscles have strained for no reason.
- Shortness of breath . If there is a lack of air, difficulty breathing or you need to take an extra breath, this can be a sign of a heart attack.
- Heartburn. A mild pain in the throat or chest can be mistaken for gastric reflux, dyspepsia, or heartburn.
- Fatigue. Physical discomfort or feeling tired can be signs of many diseases. When they occur against the background of MI, transferred to the legs, they are often mistaken for other pathological conditions. Often additionally, the patient becomes difficult to fall asleep or a restless condition arises, as if something bad happened.
- Feeling of easy hunger . It can also pierce cold sweat, there may be nausea or a desire to snatch, dizziness or a pre-stupor condition, frequent yawning.
If you have to experience one or more of these symptoms, you should immediately call your doctor or go to the emergency room. In extreme cases, call a medical team.
Causes of myocardial infarction
Heart attacks with asymptomatic course develop for the same reasons as typical myocardial infarctions. Most often MI is a consequence of an acute coronary syndrome, when a vessel supplying a part of the myocardium with blood is blocked by a sharply emerging spasm or an enlarged atherosclerotic plaque. As a result, part of the heart muscle is damaged and dies (necrosis), because the supply of enough oxygen and nutrients has been disrupted with blood.
The risk factors that contribute to vasospasm or the development of atherosclerosis are as follows:
- Elderly, with an increased risk for men over 45 years and for women over 55 years (or after menopause).
- High cholesterol.
- High blood pressure.
- Unfavorable family history of cardiovascular diseases.
- Race - African-Americans, Mexican Americans, Native Americans and local Hawaiians are at greater risk.
- Insufficient physical activity, contributing to poor heart contractility.
- Stress or chronic emotional stress.
- Sexual accessory. Women most often suffer from heart attacks than men.
Diagnosis of myocardial infarction transferred on legs
Most often, asymptomatic heart attacks are detected during a regular medical examination. If there are suspicions of the development of painless myocardial infarction, then the doctor can prescribe instrumental methods of research. They may include an electrocardiogram (ECG), echocardiography (echocardiography), and CT and MRI. These tests will help to see if the heart muscle was damaged. When determining the affected area, the diagnosis of a heart attack is confirmed. In some cases it is necessary to conduct blood tests, which determine the components that enter the blood with MI.
- Laboratory research
Laboratory tests used to diagnose MI include the following:
- Cardiac biomarkers / enzymes. The American College of Cardiology / American Heart Association (ACC / AHA) and the European Society of Cardiology (ESC) recommend that cardiac biomarkers be measured with the slightest suspicion of MI development and that the only biomarker that is recommended for diagnosis of acute MI is cardiac troponin from for his excellent sensitivity and accuracy.
- Troponin is a protein that is part of the striated muscles and which usually does not occur in the blood serum. It is released only when necrosis of the myocardium or other muscle tissue occurs.
- Complete analysis of blood cells.
- Complex study of metabolism.
- Lipid profile
ECG is the most important tool in the initial assessment of patients with the slightest suspicion of MI or other forms of acute coronary syndrome. Using this method, the diagnosis is confirmed in about 80% of cases.
- Coronary angiography
Patients with a very likely or confirmed acute MI may additionally be assigned coronary angiography, used for the final diagnosis or exclusion of coronary artery disease.
- Chest X-ray
Chest x-ray can be done to search for various data, including heart shape, aortic width and clarity of pulmonary fields.
If the heart attack has not been proven by the above research methods, further evaluation of the heart can be performed using stress tests or catheterization of the body cavities. The decision about which test or methods to use is taken individually, taking into account the characteristics of patients and their specific situations.
Treatment of a heart attack transferred to the legs
Usually, heart attacks that do not appear clinically are found after a long time after their development. Treatment of such pathological conditions will be based on the admission of cardiac medicines. With the help of medications prescribed by the doctor, the blood flow in the heart muscle improves, the blood clotting level is normalized and the risk of a repeated heart attack is reduced.
The treatment of any heart attack, including that carried on the legs, is to use the following drugs:
- An ACE inhibitor.
- Fish oil.
The doctor prescribes therapy according to the individual characteristics of the patient. If a patient has had a heart attack before, the doctor can recommend a lifestyle change. To take advantage of such advice is necessary for the sake of prevention of repeated MI.
Emergency medical care for myocardial infarction
Hospitals have a treatment plan that minimizes the time for diagnosis and therapy of people with a heart attack. The generally accepted recommendations show that electrocardiography should be performed within 10 minutes after the patient's arrival in the emergency department.
Much will happen simultaneously with the completion of the ECG. The doctor will examine the medical history and perform a physical examination, while the nurses begin intravenous administration of the drugs, connect the cardiac monitor to the chest and inject oxygen.
Medications are used to try to restore the blood supply to the heart muscle. If this was not carried out prior to arrival at the office, the following can be used:
- Aspirin for the control of platelet aggregation.
- Nitroglycerin for the expansion of blood vessels.
- Heparin or enoxaparin (Lovenox) - for the dilution of blood.
- Morphine for the elimination of severe pain, but with a transferred heart attack on the legs, it is irrelevant.
Antiplatelet drugs, such as clopidogrel (Plavix) or prasugrel (Effient), may also be recommended.
There are two strategies for managing patients with MI (depending on the capabilities of the hospital itself):
- Cardiac catheterization.
The implementation of these procedures depends on whether the ECG shows an acute heart attack and the presence / absence of contraindications.
- Cardiac catheterization
The preferred method of treatment is cardiac catheterization. The tubes are passed through the femoral artery to the groin or through the brachial artery in the elbow joint. They are brought to the coronary arteries, after which the area of myocardial blockage or lesion is revealed.
- Vascular surgery (angioplasty)
Angioplasty (angio = artery + plastic = repair) is considered when it is possible. During its execution, the balloon in the deflated form is placed in the blocking position and, when it opens, the plaque is compressed in the wall of the blood vessel. Then the stent is placed through an angioplasty incision in the affected vessel, so that it is not closed again.
The recommendations indicate that less than 90 minutes should pass from the moment the patient enters the hospital and before the opening of the blood vessel.
Not all hospitals have the opportunity to perform cardiac catheterization 24 hours a day, so they can transport a patient with an acute heart attack to a hospital with appropriate equipment. If the transfer time will delay the treatment with angioplasty for more than 90 minutes, then drugs are used to dissolve blood clots that interfere with the blood flow through the coronary artery. The tissue plasminogen activator (TPA or TNC) can be used intravenously. After the medication is poured, the patient can still be catheterized with further monitoring.
If the ECG is normal, but there has previously been a heart attack or angina in the history of the disease, the evaluation of the condition is usually continued through blood tests as described above. In this case, the victim is likely to be treated as if it happened MI.
Complications of myocardial infarction
When a heart attack occurs, some of the heart muscle dies and is eventually replaced by scar tissue. This makes the heart weaker and less able to meet the needs of the body. This leads to irritability, including early fatigue or dyspnoea with exertion. The degree of disability depends on the percentage of lost function of the congested heart muscle.
The myocardium, which normally does not supply blood, becomes electrically irritable. This can cause a short circuit in the electrical conductivity of the heart, resulting in ventricular fibrillation (the ventricles contract not coordinated).
Sudden death is a serious complication that can develop against the background of MI, unstable angina and ventricular fibrillation.
If a cardiac arrest occurred in a hospital, a defibrillator can be used quickly. Under the influence of electric current, the heart rate is restored.
Prevention of myocardial infarction
A healthy lifestyle can help prevent any heart attack, including its asymptomatic form. For its organization, first of all it will be required:
- Quit smoking, if there is such a bad habit, it is also necessary to avoid passive smoking.
- Adhere to the rules of healthy eating with low fat and cholesterol-like substances.
- Regularly exercise and perform physical exercise.
- Minimize the impact of stressful situations.
- Control of blood pressure.
- Management of blood sugar, if there is diabetes.
- Regularly undergo examinations with your doctor.
Life after a heart attack
After a myocardial infarction occurred on the legs, the risk of a re-attack increases. Most often, after concealed MI, the classical form of damage to the heart muscle develops with a characteristic clinic. To reduce the risks, the doctor will advise to make changes in the usual way of life. These include:
- Healthy food for the heart.
- Maintain weight within acceptable limits.
- Control of psychoemotional state.
- Maintain acceptable physical activity.
- Abandonment of bad habits (smoking, drinking alcohol and drugs).
Symptoms during the second heart attack may be different from the first. If you have any new signs of myocardial infarction or any doubts, you do not need to postpone calling an ambulance. Early treatment is the key to surviving a heart attack.
Questions to ask your doctor:
- If there is discomfort in the chest, can myocardial infarction occur on the legs?
- How much chance of survival and recovery with myocardial infarction?
- How serious is the condition after a heart attack?
- What is happening now?
- Will I need to take medicine for the rest of my life?
- What are the risks of developing a repeat heart attack?
- Will it be more dangerous than the first?
- What lifestyle changes need to be done to prevent the recurrence of myocardial infarction?
It is important to understand that myocardial infarction is a dangerous disease, so the sooner it is identified and the faster the medical help, the less chance of complications with all the ensuing consequences.
Video: Consequences of myocardial infarction (latent infarction)