First aid for myocardial infarction

Author Ольга Кияница

2018-05-18

According to the World Health Organization, many patients die from an attack of a heart attack even at the pre-hospital stage. Observations show that men die more often than women, and the cause of death is usually sudden death. The frequency of such sad outcomes is not related to the month of the year, but depends on other factors: the time of day (often in the early night or morning hours), the day of the week (usually on weekends).

According to some statistics, about half of men and 1/3 of women who died due to myocardial infarction did not know that they had some kind of pathology of the heart and blood vessels. And the main factor predisposing to the development of this acute condition and the subsequent death after it, the factor becomes hypertension.

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Cardiologists say that the patient's life depends on the quality and timeliness of pre-medical and emergency care for myocardial infarction. And this means that everyone, especially patients with ischemic heart disease, should know the first signs of this acute heart pathology and the correct algorithm of actions before the arrival of an ambulance.

The first signs of myocardial infarction

About the onset of an attack of myocardial infarction the following symptoms are signaled:

  • sudden or paroxysmal pain behind the sternum, lasting more than half an hour (up to 2 hours);
  • painful feelings are burning, tearing, dagger character, usually occur after physical exertion (sometimes immediately after sleep) and do not become less pronounced even after resting;
  • pain is not eliminated (as with angina pectoris) by taking Nitroglycerin and after taking the pill (and even a second dose), a person can feel only a slight decrease in pain;
  • pronounced weakness (up to pre- or fainting);
  • nausea;
  • painful sensations are given to the left (sometimes to the right) arm, neck area, interscapular zone, teeth, scapula, lower jaw;
  • sharp pallor;
  • the appearance on the skin of cold and sticky sweat;
  • expressed concern and fear of death.

Approximately half of patients with myocardial infarction have signs of heart failure: difficulty breathing, shortness of breath, unproductive cough, arrhythmic pulse, atrial fibrillation, sudden short-term cardiac arrest.

Video: What are the symptoms of myocardial infarction?

In some patients, the infarction occurs in atypical forms. The following symptoms may indicate the onset of such an attack:

  • pain in left arm or little finger of left hand, in cervico-thoracic spine, lower neck or lower jaw, scapula;
  • pain with abdominal localization and dyspepsia;
  • suffocation and shortness of breath;
  • shortness of breath with severe weakness and rapid build-up of edema;
  • dizziness with nausea, darkening in the eyes and a sharp drop in blood pressure;
  • dizziness with confusion, speech disorders, nausea, vomiting and paresis of hands and feet;
  • discomfort in the chest (without pain) with increased sweating and severe weakness.

In a number of clinical cases, an attack of a heart attack is represented by a combination of symptoms of several atypical forms (for example, cerebral and arrhythmic). Such manifestations of this life-threatening condition make it very difficult to detect necrosis of the myocardium and aggravate the prognosis of the outcome of the urgent state under consideration in this article.

Emergency before arrival. What to do?

For any suspected myocardial infarction, call an ambulance immediately and inform the dispatcher of the following:

  • about a suspected attack of myocardial infarction;
  • describe the symptoms observed in the affected person;
  • ask for the arrival of a team of cardiologists and resuscitators.

Prior to the arrival of specialists, it is necessary to begin immediately to carry out activities to provide emergency care:

  1. Help the patient to take a comfortable position: lay on his back and put under the nape of the cushion or give a semi-sitting position, placing under his back a pillow or folded clothes, a blanket, etc.
  2. Unbutton and remove clothing or accessories (scarf, belt, tie, etc.) that interfere with free breathing, and provide the most comfortable temperature regime (for example, open the window in hot weather or cover with a blanket in the cold season).
  3. Explain to the victim that he must remain immobile and remain emotionally calm. Talk with a person in a state of attack of myocardial infarction in an even, firm and calm tone, while not doing sharp movements that could scare him. If the patient has signs of motor excitement, then give him a sedative (tincture of valerian, motherwort, Valocardinum, etc.).
  4. Measure blood pressure: if its values are not higher than 130 mm Hg. , then give the patient under the tongue a tablet of Nitroglycerin or another available product, an active component of which is organic nitrates (for example, Isoket, Nitrocore, Nitrogranulong, Izodinit in the form of sublingual tablets or spray). Before the arrival of medics, repeated Nitroglycerin should be taken 1-2 more times (that is, you can give 2-3 tablets). If after receiving the first dose of this drug, the patient has a severe headache of a pulsating nature, then the subsequent dose should be halved. And if after a reception of Nitroglycerin there was a sharp decrease in blood pressure indicators, then the repeated intake of this nitrate-containing drug should be canceled. When using analogues of Nitroglycerin (for example, drugs in the form of Isoket Spray), each dose should be 0, 4 mg. Before the injection of the drug, the first dose should be released into the air, since it may be incomplete. After this, the patient should take a deep breath and hold his breath, then the injection is performed, the mouth closes, and breathing for 30 seconds should only be done through the nose.
  5. To prevent thrombosis, dilute blood and reduce the load on the heart muscle, give the patient up to 300 mg of chopped Aspirin.
  6. On the area of pain localization it is possible to put a mustard plaster. Constantly monitor it so that the skin does not burn.
  7. To count the patient's pulse, and if he does not have a history of bronchial asthma, and the heart rate does not exceed 70 beats per minute, then give him 25-50 mg of Anetolol or a dose of any other beta-blocker (for example, Bisopropol, Propranolol, Nebivolol and etc.). This measure will reduce the risk of arrhythmia and sudden death, limit the necrosis zone of the tissues of the heart muscle, protect the myocardium from toxic effects and increase its tolerance to stress.

Sometimes during a heart attack infarction a patient faints. Help him in such situations can the following measures:

  • lay the patient on his back and put a roller under his shoulders;
  • To take out tooth structures from the oral cavity (if they are present);
  • tilt the victim's head or turn it to the side if the patient has started vomiting;
  • Ensure the prevention of aspiration of vomit.

Remember! If a patient with signs of myocardial infarction stopped his heart and breathing, or breathing movements became intermittent (agonal), then immediately begin performing activities for cardiopulmonary resuscitation - indirect heart massage and artificial respiration.

Before the beginning of resuscitation, a precardial stroke is performed - 2 strong and short strokes are applied from the height of 20 to 30 cm to the sternum (at the border of the middle and lower third of it). Immediately after they are performed, a pulse is felt. If he did not appear, then cardiopulmonary resuscitation is carried out (indirect heart massage and artificial respiration):

  • pressure on the heart area with a frequency of 75 - 80 per minute;
  • 2 breaths into the mouth of the patient after every 15 to 20 strokes on the chest.

The duration of such actions should be at least 10 minutes.

First aid for myocardial infarction. Algorithm of actions

Emergency care for a patient after an ambulance arrives in the following sequence:

  1. Coping of acute pain with non-narcotic and narcotic analgesics (solutions of Analgin, Morphine hydrochloride, Omnepona, Promedol) in combination with the solution of Atropine sulfate. Drugs are administered intravenously for faster anesthesia.
  2. Conduction of ECG.
  3. If the patient's delivery to the intensive care unit is possible within the next 30 minutes, the victim is immediately taken to hospital.
  4. If such a rapid transportation of the patient is difficult, then the introduction of drugs for the restoration of coronary circulation (Tenteplase, Alteplase, etc.) is performed on the spot.
  5. The patient is transferred to the ambulance as sparingly as possible - a stretcher is used for this. During transportation, humidified oxygen is inhaled.

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After delivery of the patient to the intensive care unit, neuroleptanalgesia is performed, which provides complete relief of the pain syndrome. To do this, use drugs such as talamonal or a combination of droperidol and fentanyl. If the desired analgesic effect is not achieved, the patient is injected into the inhalation anesthesia, which is provided by a mixture of oxygen and nitrous oxide.

Further for the first aid the patient is prescribed the following drugs:

  • organic nitrates: sodium isosorbide, nitroglycerin, isoket or other;
  • anticoagulants: Heparin and others;
  • antiplatelet agents: Acetylsalicylic acid, Cardiomagnet, etc .;
  • beta-blockers: Propranolol, Inderal, Obsidan, Anaprilin;
  • ACE inhibitors: Enalapril, Ramipril, etc .;
  • hypnotics and sedatives: Temazepam, Diazepam, Triazolam, etc .;
  • antiarrhythmic drugs: Lidocaine, Amiadron, Novokainamid and others.

The treatment plan is made individually for each patient. If necessary, other medicines may be added to it.

To restore the coronary circulation to the patient with severe forms of a heart attack, the following surgical operations can be performed:

  • balloon angioplasty;
  • aortocoronary shunting.

Actions of the patient with a heart attack

Patients with IHD who have a risk of developing a heart attack should know not only the first signs of this dangerous condition, but also the algorithm of action at the beginning of such an attack:

  • keep calm and take the position of "reclining" or "sitting";
  • report on the onset of an attack and the need to take medicines to others;
  • if possible, call an ambulance yourself, informing the dispatcher about the development of a heart attack;
  • try to move as little as possible;
  • in the presence of drugs take 2-3 crushed tablets Aspirin, Valocardin and Nitroglycerin;
  • describe the symptoms of emergency workers.

Video: First aid to oneself with a heart attack

After admission to the intensive care unit, the patient must follow all the doctor's recommendations regarding medication, gradual expansion of the motor regimen and diet.

How important is first aid for an infarction?

All cardiologists are unanimous in the opinion that it is timely and quality first aid in case of an attack of a heart attack that largely predetermines the patient's chances of survival and reduces the risk of complications and irreversible changes in the cardiovascular system. The first steps to rescue such patients should begin within the first 30 minutes after the onset of the first symptoms, and the emergency team should be called out for any suspicion of such an attack.

Possible complications of myocardial infarction

Experts share the complications of the infarction in the early and late:

Type of complications of myocardial infarction

When arise

Types of complications

Early

In the first hours or days (in the first 3-4 days) after an acute attack

  • disturbances in rhythm and conductivity (90%), up to ventricular fibrillation and complete AV blockade;
  • sudden cardiac arrest;
  • internal, external, one-stage or slow-flowing heart breaks;
  • mitral regurgitation;
  • acute failure of the pumping function of the organ;
  • early episthenicardic pericarditis.

Late

Occur against the background of an expansion of the patient's motor activity 14 to 21 days after an acute attack

  • Post-infarction syndrome Dressler;
  • chronic heart failure;
  • parietal thromboendocarditis;
  • a syndrome of anterior thoracic wall or a shoulder syndrome.

Depending on the nature of the damage and violations of complications, infarction is classified as follows:

Type of complications

Nature of damage and violations

Mechanical

  • rupture of the interventricular septum;
  • rupture of the free wall of the left ventricle;
  • rupture of papillary muscle;
  • left ventricular failure;
  • dynamic obstruction of the outflow tract of the left ventricle;
  • a large aneurysm of the left ventricle;
  • right ventricular failure;
  • cardiogenic shock.

Electrical (or arrhythmic)

occur in almost 90% of patients and manifest different types of arrhythmias.

Ischemic

  • an increase in the infarction zone;
  • postinfarction angina pectoris;
  • repeated infarction.

Thromboembolic

  • thromboembolism of blood vessels;
  • parietal thrombosis of the left ventricle.

Inflammatory

  • epistenocarditis (early) pericarditis;
  • Dressler's syndrome.

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The most severe complications of myocardial infarction include:

  • recurrent or prolonged course;
  • pulmonary edema;
  • areactive or true cardiogenic shock;
  • clinical death;
  • acute right ventricular failure;
  • atrioventricular blockade with any localization of the necrosis zone;
  • acute aneurysm of the heart;
  • thrombosis and thromboembolism in different organs;
  • circulatory failure II B and III degree;
  • ventricular paroxysmal tachycardia;
  • gastrointestinal bleeding;
  • combination of two or more complications.

Potential risks

With myocardial infarction, the specialists outline the following potential risks:

Primary

Secondary

  • pulmonary edema;
  • pericarditis;
  • ruptures of the heart muscle;
  • shock;
  • hypotension of different genesis.
  • thromboembolism;
  • aneurysms of the heart;
  • chronic heart failure;
  • Dressler's syndrome.

Prevention of myocardial infarction

According to observations of cardiologists, the first heart attack occurs unexpectedly! That is why the prevention of this dangerous for health and life condition should be directed at preventing the occurrence of heart and vascular diseases and repeated angina attacks.

The main reasons for the development of myocardial necrosis are the following:

  • arterial hypertension;
  • blood thickening;
  • atherosclerosis;
  • violations of carbohydrate metabolism.

In connection with the above-mentioned risk factors, the prevention of myocardial infarction consists in the appointment of a comprehensive drug therapy and diet aimed at preventing atherosclerotic deposits in the arterial lumen and reducing blood pressure.

The choice of drugs in such cases, their dosing and duration of admission is always determined only by a doctor who is guided by laboratory and instrumental research data!

Usually the following means are included in the plan of preventive medicamentous therapy:

  • antiaggregants and anticoagulants;
  • statins;
  • beta-blockers;
  • Supplements based on Omega-3 and vitamins;
  • nonfractional heparin;
  • ACE inhibitors.

Diet with a high risk of myocardial infarction should provide for a reduction in the amount of salt consumed, foods with high cholesterol, dairy and animal fats. All those in the risk group are recommended to stop smoking, drinking alcoholic beverages (by agreement with a doctor, we can only take a glass of red wine), fight against predisposition to stress and emotional stress.

An important role in the prevention of heart attack is also the compliance with the recommendations of the doctor on motor activity. Such patients are shown:

  • prescribing exercise therapy;
  • moderate loads (for example, dancing, walking, cycling, etc.).

The desire to engage in some kind of sport should always be discussed with the attending physician. The volume of physical activities is determined only individually!

Cardiovascular diseases have been a strong leader in the list of deadly ailments for several decades, and myocardial infarction is one of the most frequent causes of death. Specialists note a significant increase in the number of young patients with this dangerous disease. In this regard, each of us should know about how to properly render the first medical aid in such a dangerous state for health and life. Strong and prolonged pains in the region of the heart, which are not eliminated by taking Nitroglycerin, pallor, cold sweat, fear of death - all these manifestations should become the reason for calling the ambulance brigade and initiating decisive and correct actions aimed at saving the patient.

 


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