Clinical course of myocardial infarction often aggravated by various complications. Their development is determined not only by the size of the lesion, but also by a combination of reasons (primarily, the state of the myocardium against the background of atherosclerosis of the coronary arteries, previous myocardial diseases, the presence of electrolyte disturbances).
Complications of myocardial infarction can be divided into three main groups:
electric- rhythm and conduction disturbances (bradytachyarrhythmias, extrasystoles, intraventricular and AV blockades) - almost constant complications of large-focal MI. Often, arrhythmias are not life-threatening, but indicate serious disturbances (electrolyte, ongoing ischemia, vagal hyperactivity, etc.) that require correction;
hemodynamic due to disturbances in the pumping function of the heart (AFVN, ARVH and biventricular failure, CABG, ventricular aneurysm, infarction expansion); dysfunction of the papillary muscles; mechanical disorders (acute mitral regurgitation due to rupture of the papillary muscles, ruptures of the heart, free wall or interventricular septum, LV aneurysm, avulsions of the papillary muscles); electromechanical dissociation;
reactive and other complications- epistenocardial pericarditis, thromboembolism of vessels of the pulmonary and systemic circulation, early post-infarction angina, Dressler's syndrome.
By time occurrence of complications of myocardial infarction classified into:
for early complications- occur in the first hours (often during the stage of transporting the patient to the hospital) or in the most acute period (3-4 days):
1) rhythm and conduction disturbances (90%), up to VF and complete AV block (the most common complications and cause of mortality in the prehospital stage). In most patients, arrhythmias occur during their stay in the intensive care unit (ICU);
2) sudden cardiac arrest;
3) acute failure of the pumping function of the heart - ALV and CABG (up to 25%);
4) heart ruptures - external, internal; slow-flowing, instantaneous (1-3%);
5) acute dysfunction of the papillary muscles (mitral regurgitation);
6) early epistenocardial pericarditis;
for late complications(occur in the 2-3rd week, during the period of active expansion of the regime):
1) post-infarction Dressler syndrome (3%);
2) parietal thromboendocarditis (up to 20%);
3) CHF;
4) neurotrophic disorders (shoulder syndrome, anterior chest wall syndrome).
Classification of complications of myocardial infarction by severity L.N. Nikolaeva and D.M. Aronov
Both early and late stages of myocardial infarction acute pathology of the gastrointestinal tract (acute ulcers, gastrointestinal syndrome, bleeding, etc.), mental changes (depression, hysterical reactions, psychosis), cardiac aneurysms (in 3-20% of patients), thromboembolic complications - systemic (due to parietal thrombosis) may occur ) and pulmonary embolism (due to deep vein thrombosis of the legs). Thus, thromboembolism is clinically detected in 5-10% of patients (at autopsy - in 45%), often asymptomatic and is the cause of death in a number of hospitalized patients with MI (up to 20%).
Some older men with benign prostatic hypertrophy Acute atony of the bladder develops (its tone decreases, there is no urge to urinate) with an increase in bladder volume to 2 liters, urinary retention due to bed rest and treatment with narcotic drugs, atropine.
Heart pathologies that lead to a heart attack are difficult to cure completely. Even after surgery, early and late complications of myocardial infarction are observed.
People prone to heart attacks have features in the functioning of the body that require special attention throughout the rest of their lives, otherwise complications arise.
How to avoid consequences
A heart attack causes disturbances in the functioning of the body and requires the prohibition of certain types of activities and changes in lifestyle. In combination with pre-existing disturbances in the functioning of the heart and other diseases that often accompany a heart attack, complications lead to the need to streamline and.
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Immediately after an attack, the regime of activity and nutrition is radically revised, and permanent therapeutic measures are introduced to improve the health and control the condition of the body.
The following are excluded:
| Excessive exercise and physical activity |
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| Mental, emotional shocks and stress |
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| Bad habits | Smoking tobacco and drinking alcoholic beverages should definitely be excluded. |
| Sudden changes in climate | They create additional stress on the heart and should be avoided. |
An abrupt interruption of treatment or preventive measures can lead to a rapid deterioration in health, complications of acute myocardial infarction and other forms develop. Medicines are taken exactly according to the regimen prescribed by the doctor.
To improve the post-infarction state, it is necessary to immediately begin health measures.
Traditionally, the cardiologist prescribes the following measures:
Rehabilitation is effective if the body’s indicators meet the standards:
These factors indicate a reduction in the likelihood of a recurrent heart attack to a minimum. If at least one criterion falls outside the framework, additional treatment measures should be taken. If the condition worsens, the cardiologist adds drug therapy to prevention.
In the post-infarction period, immediately after it, to eliminate the possibility of complications, the following regimen is prescribed:
| 2 first days | Only bed rest, excluding stress that leads to a sharp disturbance in heart rhythm and pressure surges. These days, the necrosis begins to be overgrown with scar tissue. |
| 2–3 days | You can sit on the bed, in a soft chair near the bed. It becomes possible to eat while sitting. |
| 3–5 days | When the condition improves, they are allowed to leave the bed for a short time and walk around the room a little. They begin to visit the toilet on their own, but with the supervision of medical staff. |
| From 4 to 5 days | A short (10–20 min) walk is allowed along the corridor, room, clinic floors, on the street, but without climbing stairs. Walks are initially carried out under the supervision of specialists; they should not be tiring for the core. |
| A week later | If there are no complications, half an hour of walking and a shower with a water temperature that does not disturb the rhythms of breathing and heart and does not lead to excessive vasodilation are allowed. |
In the second week the patient is discharged from the hospital. During the last days of being there, they begin to do light exercises. This allows cardiologists to analyze the body’s reactions, how recovery is going, whether there is a threat of a recurrence of a heart attack or complications. An example of such an exercise: slowly climbing the stairs to the second floor.
Each case is considered individually, so the doctor can change the rhythm and mode of rehabilitation. If there are disturbances in the heart rhythm, heart failure, rehabilitation measures are carried out with less intensity.
Gradual, dosed methods of rehabilitation reduce the likelihood of complications, the connective tissue in the necrotic area is strengthened, the contraction of the heart muscles returns to normal.
Complications of myocardial infarction
Early and late complications of myocardial infarction are based on disturbances in the functioning of the heart muscles, abnormal blood pumping, and pathological activation of the blood clotting mechanism.
Each infarction period has complications with its own characteristics. They pose a danger to life in the acute and most acute stages of the disease. It is because of the consequences of the disease that a significant proportion of patients die.
Patients suffer from the following complications:
- phenomena of thromboembolic nature;
- Dressler's syndrome;
- rupture of heart tissue;
- functioning of the cardiac system.
Thromboembolism
This group of pathologies (4–5% of complications) occurs due to the formation and separation of a blood clot. As it moves through the vessels, it blocks bottlenecks, causing blockage (occlusion) and problems with blood flow. Next, ischemia develops of the organ, the entire part of the body, which is supplied through a clogged vessel.
Frequent causes and places of blood clot formation: due to inflammation in the left ventricle, in the aneurysmal cavity, during congestion with concomitant heart failure, during rhythm disturbances, during the formation of atherosclerotic plaques, congestion in the legs (sometimes with the progression of thrombophlebitis).
Treatment is with thrombolytic therapy. It must be included in medication treatment.
Blood clots pose a danger by clogging the following vessels:
| Pulmonary artery | Problems with breathing, blood circulation. |
| Abdominal aorta | Impaired blood flow in the lower extremities, signs of shock in the clinical stage. |
| Arteries of the legs | The likelihood of necrosis and forced amputation of a limb with a blocked vessel. |
| Splenic artery | Severe pain in the left hypochondrium, with foci of necrosis there. |
| Arteries that deliver blood to tissues through intestinal loops | Pain in the abdomen, intoxication, impaired intestinal motility. |
| Arteries supplying the kidneys | Severe unilateral pain in the lumbar region decreases; the level of urine formation, blood pressure increases. |
| Arteries in the brain | . |
These types of thrombosis are characteristic of acute periods of left ventricular infarction. Thrombosis of the pulmonary arteries is observed with concomitant thrombophlebitis and rarely with right ventricular infarction.
Thrombolysis - resorption of blood clots - is carried out on an emergency basis before the tissues die, so in the post-infarction period the patient needs to stay in the clinic for some time.
Dressler syndrome
A rare (5% of all complications) post-infarction pathology of an autoimmune nature - Dressler's syndrome - complications of acute myocardial infarction, less common in its most acute period. Signs: damage to tissues not directly related to the myocardium.
Flow options:
| Pericarditis |
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| Pleurisy |
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| Pneumonitis |
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| Synovitis |
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| Atypical pathologies | Skin diseases (dermatitis, eczema), vascular pathologies (vasculitis), kidney diseases (glomerulonephritis), asthmatic symptoms. |
Dressler's syndrome is characterized by an autoimmune basis, that is, the immunity of the patient's body is responsible for its occurrence. One or a few of the listed organs are affected; damage to all is observed infrequently.
Mechanism of the syndrome: necrosis causes substances that are normally found only in cardiomyocytes to enter the blood. Some of them are safe, but some are regarded by the immune system as a threat and produce special antibodies. They are the cause of inflammation in tissues that are structurally similar to the formed substances.
With the syndrome, systemic changes often occur: increased temperature, increased levels of eosinophils, and signs of inflammatory processes increase.
Acute cardiac aneurysm
A cardiac aneurysm that occurs in the 2-week post-infarction period is considered acute. It usually affects the frontal left ventricular wall or its upper segment and is a limited protrusion of cardiac tissue; these are complications of acute myocardial infarction.
Pathology occurs due to a decrease in the strength and elasticity of myocardial tissue. Under pressure, this area stretches, creating a pathological area. Blood stagnation is created, since the heart in this segment does not contract.
Risks that aneurysms lead to: rupture with dangerous hemorrhage, disruption of normal heart contractions, the occurrence of heart failure, and blood clots being created in the aneurysmal cavity.
The complication is of increased danger because its symptoms do not appear clearly. It is detected during preventive studies - ECG, EchoCG, etc. It is treated, most often, with operative surgical methods - the weakened area is sutured and strengthened.
Heartbreak
The consequence is fatal. Almost always the result is the death of the patient. The incidence of ruptures in the first post-infarction week is 2.5% of all complications.
It occurs 2 times more often in females. Occurs, as a rule, with transmural heart attacks, when the connective tissues do not have time to strengthen to withstand intracardiac pressure.
Factors that increase the likelihood of rupture:
- in those who had a heart attack for the first time, with repeated attacks - less often;
- MB-fraction creatine phosphokinase increased degree;
- violations of the rehabilitation regime, excessive physical stress;
- late contact with doctors (more than 24 hours after the attack);
- use of medications with glucocorticoids, non-steroidal anti-inflammatory drugs; reducing scarring in the necrotic segment.
There is no treatment - the bleeding that opens is almost impossible to stop. All efforts are directed towards prevention and prevention of rupture (timely treatment measures, regimen).
Heart failure
Heart failure, as a post-infarction complication, manifests itself in two forms:,. These are early and late complications of myocardial infarction. The increased danger is precisely.
It occurs in the acute and acute infarction period and represents a critical disruption of the functionality of the elements of the heart responsible for pumping blood. A ventricle with damaged myocardium is not able to process the blood entering it.
Insufficiency occurs due to the following circumstances:
- significant necrotic area - 15–25% of the volume of the left ventricular myocardium;
- death of the papillary muscles responsible for the functioning of the mitral valve;
- significant rhythm disturbances;
- damage to the interventricular membrane;
- acute aneurysm.
The ventricle does not contract properly, stagnant processes form in it, there is no stretching of the walls, and blood does not flow into diastole. There is no normal blood supply to the aorta, which causes oxygen starvation of the tissues.
Fluid stagnates in the lungs, so when the left ventricle is functioning poorly, swelling occurs. From the capillaries, fluid flows into the alveoli, slowly filling them. Without immediate intervention, breathing stops
A chronic complication is detected months and years after a heart attack. Its nature is also associated with problems in the functions of the left ventricular myocardium and its pathologies. In this case, the complication is not particularly acute and does not pose an immediate threat to the patient’s life.
The chronic stage is manifested by the following symptoms: cough, shortness of breath, cardiac edema, weakness, dizziness. On the other hand, treatment of chronic deficiency is more complex. In the first stages of therapy, the left ventricle is supported with drug therapy. Disturbances in its functioning become more severe over time, and the disease often transforms from a chronic to an acute form.
Cardiogenic shock
Complications of acute myocardial infarction include cardiogenic shock. Because of the danger, it should be listed separately. Its cause is a sharp exacerbation of disturbances in the heart’s ability to pump blood (pumping function).
It is generally accepted that this disease is observed when about 40% or more of the left ventricular myocardium is affected by infarction. A large segment of its wall stops contracting, as a result of which a critically insufficient blood volume enters the aorta.
The heart cannot provide normal blood pressure, and the body cannot compensate for this in other ways (vasoconstriction), severe oxygen starvation of vital organs occurs.
With proper intervention, the incidence of pathology is 7%, without timely therapy – 20%. Coronary shock creates a number of interdependent consequences: there is no normal pressure in the aorta, less blood enters the arteries, which inhibits myocardial function. With concomitant diseases in other organs, this leads to the death of the patient.
Symptoms:
- first signs: cloudiness of consciousness up to its loss, sensation of heartbeat, severe weakness;
- the skin is pale with a blue tint, so-called gray cyanosis;
- thready pulse or absence of it;
- pressure below 90 mm Hg. Art.;
- blood stagnation, pulmonary edema.
To save the patient in all of these cases, resuscitation measures are taken, however, they do not always guarantee the absence of death.
Heart rhythm disturbances
Early and late complications of myocardial infarction include widespread impairment, observed to varying degrees in 92–97%. Mechanism of occurrence: the resulting necrosis on the myocardium leads to disruption of the propagation of the bioelectrical (nerve) signal in it. The larger the lesion, the more obvious the rhythm pathologies.
There are many more specific descriptions of the mechanism; they are divided into three groups:
| Determining the forecast |
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| Worsening prognosis |
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| Life-threatening |
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Serious rhythmic pathologies are observed during acute and very acute periods immediately after a heart attack. Their severity depends on the pain syndrome, parameters and location of the necrotic area. As healing occurs and scar tissue forms, the rhythm usually returns to normal.
Often periodic attacks are observed for the rest of life, especially if a chronic aneurysm and other complications occur.
The heart is the most important vital organ of a person. Any problems that relate to the field of cardiology are considered the most threatening to human life. A person lives and works as long as the heart correctly and uninterruptedly copes with blood circulation throughout the body. entail problems of the most severe category, and stopping it means death.
The most dangerous pathology in cardiology is considered to be “myocardial infarction,” which is characterized by serious disturbances in the functioning of the heart, leading to irreversible consequences, the worst of which is death. Statistics show that mortality from heart attack occupies a leading position; sometimes even prompt assistance does not guarantee the absence of further complications. In this article we will tell you what kind of complications there are after myocardial infarction, what their classification is, periods of occurrence and features of the course.
A little about the disease
It often evolves as a result of cardiac ischemia, characterized by long-term pathologies of blood circulation in the muscles of a vital organ that precede the disease. The root cause of the progression of the disease is often the blockage of one or more coronary vessels by a blood clot, as a result of which the muscular tissues of the organ stop receiving the substances necessary for normal functioning, which causes death or necrosis of the epithelium of the heart. Due to the destruction of heart tissue, muscles lose their ability to contract, and a person’s blood circulation decreases.
The patient’s chances of recovery depend on the volume of the tissue segment that has undergone the pathological process. The most serious is considered to be abbreviated as AMI, which covers the entire volume of the heart. Often, with AMI, a person dies in the first hour after the incident; it is possible to save him in extremely rare cases, even with immediate assistance from doctors. In the case of local focal necrosis, the patient has a chance of recovery if he promptly goes to a medical center and in the absence of aggravating factors.
In case of myocardial infarction, the patient is subject to mandatory hospitalization with urgent placement in intensive care, where the first therapeutic measures are taken to stabilize the patient’s condition.
Classification of complications after a heart attack
Statistical data proves in numbers that most people with this disease die in the first hour after the incident if immediate assistance is not provided or it is impossible to stop the pathological process even with the help of medical resuscitation measures. However, even those people who survived a heart attack should not rejoice and relax, since rehabilitation is long and burdensome, and complications are very unpredictable.
The condition of a patient who has survived a myocardial infarction can become more complicated at any time after the illness. Acute and subacute time intervals after the precedent are considered the most unstable. The acute phase is characterized by a large percentage of deterioration in the patient’s health condition and lasts approximately ten days after the start of abnormal processes in the heart. The next most unreliable period is the subacute period, lasting up to a month. During this period, relapses of the disease with irreversible consequences are also possible.
After a month has passed after the onset of the disease, a period begins that medicine qualifies as post-infarction. Its duration reaches one year. During this period, the patient may become a victim of late exacerbations, which are no less life-threatening than early manifestations of the pathology.
The official classification of complications of myocardial infarction divides the consequences into two categories - early and late deterioration of the patient’s health.
Early complications of myocardial infarction:
Late complications of myocardial infarction:
- thromboembolism, namely obstruction of blood vessels in the heart and other organs;
- post-infarction syndrome;
- cardiac aneurysm;
- heart failure, which has degenerated into a chronic course of the disease.
In addition to classification into time intervals, there is a distribution of complications according to their types in medicine. Cardiology identifies the following categories of consequences of a heart attack:
Let us consider in detail the most common complications of myocardial infarction, which manifest themselves during different periods of the patient’s rehabilitation, their specificity and possible consequences.
Features of early complications of myocardial infarction
The most common complication of myocardial infarction in the first hours or days after its onset is acute heart failure, which often provokes the death of the patient. It manifests itself in the form of cardiac asthma, which makes itself felt to the patient with asphyxia, severe shortness of breath and an inexplicable feeling of fear. Helps eliminate the symptoms of cardiac asthma most often by taking Nitroglycerin tablets. However, the next step should be to urgently seek medical help, since asthma is most often followed by more serious complications that can be fatal for the patient and require serious therapy.
Pulmonary edema is considered a more widespread post-infarction pathology. It manifests itself as symptoms of loud breathing, often with bubbling in the throat, as well as incessant coughing attacks with pinkish sputum. Such a complication requires emergency medical intervention; it is impossible to eliminate such an abnormal process on your own at home. If the patient is not provided with immediate assistance, cardiac shock will further progress. The initial symptoms of cardiogenic shock are unexplained increased activity of the patient with clear indicators of shortness of breath and pain in the chest region. Additionally, the patient may complain of dizziness and body aches. Further, the person’s condition becomes more complicated, a decrease in blood pressure is added to the previous symptoms, the patient becomes apathetic and powerless, and before our eyes turns into a lifeless body.
External signs of cardiac shock:
- protruding cold sweat;
- change in body color to bluish;
- decreased response to external stimuli.
- a person’s limbs begin to get cold and lose sensitivity.
If the patient is not provided with urgent care in a hospital setting, the patient will fall into a coma and then die.
Experts in the field of cardiology call the consequence in the form of heart rhythm pathology a “companion” of a heart attack. The most dangerous violations of this plan are observed in the first five hours after the onset of the disease, mainly in men; the female body is less prone to such abnormal processes. It is treated directly in intensive care conditions with the help of medications and defibrillation of the ventricles of the heart. The chances of eliminating the arrhythmia and restoring the patient vary depending on the severity of the abnormal processes. Arrhythmia can also form in later post-infarction periods, however, in the future, most often it does not pose a threat to the patient’s life with appropriate treatment.
Early complications of a heart attack also include cardiac rupture or partial mechanical deformation. The complication is accompanied by pain in the chest region; often even narcotic painkillers cannot eliminate it. This pathology can be observed in the first few days after the development of the disease and often leads to the instant death of the patient. If ruptures have formed in the internal parts of the heart, without compromising the external integrity of the organ, most often the patient can be saved through surgical intervention.
Thromboembolism is a dangerous post-infarction pathology in the body that can occur at any stage of the patient’s rehabilitation. Blood clots that form in the chambers of the heart during a heart attack do not always have time to dissolve under the influence of antithrombotic drugs, and over time enter the vessels and spread throughout the body. Accordingly, after some time, blockage of a vessel can occur in any part of the patient’s body, which causes serious pathologies and consequences, the treatment of which depends on the location of the problem.
Pericarditis is an inflammation of the inner lining of the heart. Occurs in most people who have had a heart attack. The first signs of complications begin mainly a few days after the incident and are characterized by dull pain in the sternum and a slight increase in body temperature. With timely initiation of treatment, which consists of taking anti-inflammatory drugs, pericarditis does not pose a threat to the patient’s life.
Characteristics of late complications after a heart attack
The most common late complication is heart failure, which progresses and develops over time into a chronic form. The reasons for its evolution may be unfavorable circumstances, non-compliance with doctors' advice on rehabilitation. Most often, this phenomenon is observed in men who smoke or abuse alcohol, as well as in patients who overwork themselves with physical activity after discharge from the hospital.
The complication is signaled by frequent shortness of breath, heaviness of breathing, and regular swelling of the limbs. From a medical point of view, such a deterioration in the patient’s health belongs to a complex category, since it arises due to the insufficient strength of the heart to pump blood through the human body in a sufficient volume, thereby not supplying oxygen and useful substances necessary for normal functioning to vital organs. In such a situation, patients are prescribed medications from the category of beta blockers, which reduce the need of the heart muscle for oxygen, as well as drugs that help restore blood circulation in the body. Giving up bad habits and maintaining a healthy lifestyle helps reduce the occurrence of complications.
Post-infarction syndrome is often characterized by an autoimmune continuation of a heart attack, which is expressed by inflammatory processes in the body at different locations. This can be inflammation of the pleura, lungs, pericardium, joints and blood vessels. This reaction of the body is explained by its weakening after illness and the inability to fight various autoimmune diseases. The risk group for this complication includes people who have autoimmune problems in their pathogenesis. As in the previous case, most often such a complication is observed in men leading an inferior lifestyle.
Thromboembolism in the late period after a heart attack most often occurs due to the patient’s poor nutrition and irregular intake of prophylactic medications. A tendency to such a complication occurs in people suffering from diabetes mellitus and elevated blood cholesterol levels. The risk group also includes people who, before a heart attack, had serious problems with the vascular system of the body.
Cardiac aneurysm, as a consequence of the disease, progresses most often two months after a heart attack, when scarring of the damaged cardiac epithelium ends. Often, the resulting scar prevents the full functionality of the organ, thereby causing the progression of heart failure. The presence of such a defect in the organ is determined using special medical computer examinations, and treatment often involves surgical intervention.
Prospects for recovery
A heart attack is considered a very serious cardiac disease, the prospects for recovery after which are not always comforting for the patient and his relatives. With a large heart attack, the patient’s chances of recovery are negligible, even with prompt assistance to the patient. If the heart attack is of a small localization, with concomitant favorable indicators, the patient can get back on his feet and continue to live a normal life for several more decades.
The patient’s chances of recovery are influenced by indicators of the person’s overall health status and his age, and the timeliness of providing qualified assistance. Increases prospects for proper and effective rehabilitation, which includes following doctors’ orders, taking preventive medications and ensuring a correct lifestyle.
The risk of developing a second heart attack, which is more life-threatening than the primary one, is high in men who are prone to obesity, the use of harmful drugs, narcotic substances, and alcohol. Incorrect nutrition also causes aggravation of the disease, development of concomitant pathologies, as well as relapse of the disease.
A patient who has suffered a heart attack, while still in the hospital, needs to prepare himself mentally for long-term rehabilitation and restoration of basic body functions.
The patient’s recovery should include the following stages:
- Inpatient treatment until the patient’s health is completely stabilized.
- Rehabilitation in special centers that specialize in the recovery of post-infarction patients.
- Home therapy under the strict supervision of cardiologists.
The period after a heart attack requires the patient to be very careful about his health. Proper nutrition is one of the areas of a healthy lifestyle that helps restore the patient’s strength after illness. The patient's diet should be as balanced as possible in terms of the amount of proteins, fats and carbohydrates; meals should consist only of healthy ingredients.
Rejection of bad habits– the second mandatory rule for a person who has had a heart attack. Alcohol and nicotine, even in small quantities, can provoke an exacerbation of the disease with a fatal outcome, and also reduce the effectiveness of preventive drug therapy.
Physical activity is an integral part of stabilizing blood circulation and tone of blood vessels. Upon discharge, doctors recommend individual physical exercises, which are allowed for the patient and will accompany recovery. In addition, it is useful to take walks in the fresh air, which not only promote the restoration of the musculoskeletal system, but also improve the state of the body's respiratory functions and stimulate blood circulation.
Restoring the nervous system includes providing comfortable conditions for the patient, eliminating a variety of stressful situations and experiences. Moral support from family and friends helps to cope with post-infarction depression.
In the post-infarction period, it is important to undergo regular examinations in medical institutions, take all necessary tests in a timely manner and undergo additional prescribed procedures.
Let's sum it up
The post-infarction period is difficult not only for the patient’s relatives and friends, but also for the patient himself. During this period, it is too early to rejoice at the fact that you managed to survive after a complex illness; you must try to do everything to avoid relapses and complications after the illness. Rehabilitation after an illness is characterized by the versatility of therapeutic measures and has many pitfalls in the form of unforeseen complications.
Complications of varying severity can manifest themselves throughout the year after the illness and are classified by varying degrees of severity and risk to life. It is up to the person himself and those around him to reduce risk factors for life; sometimes it is enough to maintain a healthy lifestyle, and for relatives to simply provide moral support to the patient.
General information
– a focus of ischemic necrosis of the heart muscle, developing as a result of an acute violation of the coronary circulation. Clinically manifested by burning, pressing or squeezing pain behind the sternum, radiating to the left arm, collarbone, scapula, jaw, shortness of breath, a feeling of fear, cold sweat. Developed myocardial infarction is an indication for emergency hospitalization in the cardiac intensive care unit. Failure to provide timely assistance can result in death.
At the age of 40-60 years, myocardial infarction is 3-5 times more common in men due to the earlier (10 years earlier than in women) development of atherosclerosis. After 55-60 years, the incidence among people of both sexes is approximately the same. The mortality rate for myocardial infarction is 30-35%. Statistically, 15-20% of sudden deaths are caused by myocardial infarction.
Disruption of the blood supply to the myocardium for 15-20 minutes or more leads to the development of irreversible changes in the heart muscle and cardiac dysfunction. Acute ischemia causes the death of some functional muscle cells (necrosis) and their subsequent replacement with connective tissue fibers, i.e., the formation of a post-infarction scar.
In the clinical course of myocardial infarction, five periods are distinguished:
- 1 period– pre-infarction (prodromal): increased frequency and intensification of angina attacks, which can last several hours, days, weeks;
- 2nd period– acute: from the development of ischemia to the appearance of myocardial necrosis, lasts from 20 minutes to 2 hours;
- 3rd period– acute: from the formation of necrosis to myomalacia (enzymatic melting of necrotic muscle tissue), duration from 2 to 14 days;
- 4th period– subacute: initial processes of scar organization, development of granulation tissue in place of necrotic tissue, duration 4-8 weeks;
- 5th period– post-infarction: scar maturation, adaptation of the myocardium to new operating conditions.
Causes of myocardial infarction
Myocardial infarction is an acute form of coronary artery disease. In 97-98% of cases, the basis for the development of myocardial infarction is atherosclerotic damage to the coronary arteries, causing a narrowing of their lumen. Often, atherosclerosis of the arteries is accompanied by acute thrombosis of the affected area of the vessel, causing a complete or partial cessation of blood supply to the corresponding area of the heart muscle. Thrombosis is promoted by increased blood viscosity observed in patients with coronary artery disease. In some cases, myocardial infarction occurs against the background of spasm of the branches of the coronary arteries.
The development of myocardial infarction is promoted by diabetes mellitus, hypertension, obesity, mental stress, addiction to alcohol, and smoking. Sharp physical or emotional stress against the background of coronary artery disease and angina pectoris can provoke the development of myocardial infarction. Myocardial infarction of the left ventricle develops more often.
Classification of myocardial infarction
According to sizes focal damage to the heart muscle is classified as myocardial infarction:
- macrofocal
- finely focal
Small-focal myocardial infarctions account for about 20% of clinical cases, but often small foci of necrosis in the heart muscle can transform into large-focal myocardial infarction (in 30% of patients). Unlike large-focal infarctions, small-focal infarctions do not cause aneurysm or cardiac rupture; the course of the latter is less often complicated by heart failure, ventricular fibrillation, and thromboembolism.
Depending on the depth of the necrotic lesion myocardial infarction is distinguished from the heart muscle:
- transmural - with necrosis of the entire thickness of the muscular wall of the heart (usually large-focal)
- intramural – with necrosis in the thickness of the myocardium
- subendocardial – with myocardial necrosis in the area adjacent to the endocardium
- subepicardial - with myocardial necrosis in the area adjacent to the epicardium
According to changes recorded on the ECG, distinguish:
- “Q-infarction” - with the formation of a pathological Q wave, sometimes a ventricular QS complex (usually large-focal transmural myocardial infarction)
- “non-Q-infarction” – not accompanied by the appearance of a Q wave, manifested by negative T-waves (usually small-focal myocardial infarction)
By topography and depending on the damage to certain branches of the coronary arteries, myocardial infarction is divided into:
- right ventricular
- left ventricular: anterior, lateral and posterior walls, interventricular septum
By frequency of occurrence myocardial infarction is distinguished:
- primary
- recurrent (develops within 8 weeks after the initial one)
- repeated (develops 8 weeks after the previous one)
According to the development of complications Myocardial infarction is divided into:
- complicated
- uncomplicated
According to the presence and localization of pain syndrome The following forms of myocardial infarction are distinguished:
- typical – with pain localized behind the sternum or in the precordial region
- atypical - with atypical pain manifestations:
- peripheral: left scapular, left-handed, laryngopharyngeal, mandibular, upper vertebral, gastralgic (abdominal)
- painless: collaptoid, asthmatic, edematous, arrhythmic, cerebral
- low-symptomatic (erased)
- combined
According to period and dynamics development of myocardial infarction are distinguished:
- stage of ischemia (acute period)
- stage of necrosis (acute period)
- stage of organization (subacute period)
- stage of scarring (post-infarction period)
Symptoms of myocardial infarction
Pre-infarction (prodromal) period
About 43% of patients note the sudden development of myocardial infarction, while the majority of patients experience a period of unstable progressive angina of varying duration.
The most acute period
Typical cases of myocardial infarction are characterized by extremely intense pain with pain localized in the chest and radiating to the left shoulder, neck, teeth, ear, collarbone, lower jaw, and interscapular area. The nature of the pain can be squeezing, bursting, burning, pressing, sharp (“dagger-like”). The larger the area of myocardial damage, the more severe the pain.
A painful attack occurs in waves (either intensifying or weakening), lasting from 30 minutes to several hours, and sometimes even a day, and is not relieved by repeated administration of nitroglycerin. The pain is associated with severe weakness, agitation, a feeling of fear, and shortness of breath.
An atypical course of the acute period of myocardial infarction is possible.
Patients experience severe pallor of the skin, sticky cold sweat, acrocyanosis, and anxiety. Blood pressure is increased during an attack, then moderately or sharply decreases compared to the initial level (systolic< 80 рт. ст., пульсовое < 30 мм мм рт. ст.), отмечается тахикардия , аритмия .
During this period, acute left ventricular failure (cardiac asthma, pulmonary edema) may develop.
Acute period
In the acute period of myocardial infarction, pain syndrome usually disappears. The persistence of pain is caused by a pronounced degree of ischemia of the peri-infarction zone or the addition of pericarditis.
As a result of the processes of necrosis, myomalacia and perifocal inflammation, fever develops (from 3-5 to 10 or more days). The duration and height of the temperature rise during fever depend on the area of necrosis. Arterial hypotension and signs of heart failure persist and increase.
Subacute period
There is no pain, the patient’s condition improves, and body temperature normalizes. Symptoms of acute heart failure become less pronounced. Tachycardia and systolic murmur disappear.
Post-infarction period
In the post-infarction period, there are no clinical manifestations, laboratory and physical data are practically without deviations.
Atypical forms of myocardial infarction
Sometimes there is an atypical course of myocardial infarction with localization of pain in atypical places (in the throat, fingers of the left hand, in the area of the left scapula or cervicothoracic spine, in the epigastrium, in the lower jaw) or painless forms, the leading symptoms of which may be cough and severe suffocation, collapse, edema, arrhythmias, dizziness and confusion.
Atypical forms of myocardial infarction are more common in elderly patients with severe signs of cardiosclerosis, circulatory failure, and secondary myocardial infarction.
However, only the most acute period usually proceeds atypically; further development of myocardial infarction becomes typical.
The erased course of myocardial infarction is painless and is accidentally detected on an ECG.
Complications of myocardial infarction
Often complications arise already in the first hours and days of myocardial infarction, complicating its course. In most patients, in the first three days, various types of arrhythmias are observed: extrasystole, sinus or paroxysmal tachycardia, atrial fibrillation, complete intraventricular block. The most dangerous is ventricular fibrillation, which can turn into fibrillation and lead to the death of the patient.
Left ventricular heart failure is characterized by congestive wheezing, symptoms of cardiac asthma, pulmonary edema and often develops during the acute period of myocardial infarction. An extremely severe degree of left ventricular failure is cardiogenic shock, which develops with a large heart attack and usually leads to death. Signs of cardiogenic shock are a drop in systolic blood pressure below 80 mmHg. Art., impaired consciousness, tachycardia, cyanosis, decreased diuresis.
Rupture of muscle fibers in the necrosis zone can cause cardiac tamponade - hemorrhage into the pericardial cavity. In 2-3% of patients, myocardial infarction is complicated by thromboembolism of the pulmonary artery system (which can cause pulmonary infarction or sudden death) or systemic circulation.
Patients with extensive transmural myocardial infarction in the first 10 days may die from ventricular rupture due to acute cessation of blood circulation. With extensive myocardial infarction, failure of scar tissue may occur, its bulging with the development of acute cardiac aneurysm. An acute aneurysm can transform into a chronic one, leading to heart failure.
The deposition of fibrin on the walls of the endocardium leads to the development of parietal thromboendocarditis, which is dangerous due to the possibility of embolism of the vessels of the lungs, brain, and kidneys from detached thrombotic masses. In a later period, post-infarction syndrome may develop, manifested by pericarditis, pleurisy, arthralgia, and eosinophilia.
Diagnosis of myocardial infarction
Among the diagnostic criteria for myocardial infarction, the most important are the medical history, characteristic changes on the ECG, and indicators of serum enzyme activity. The patient's complaints during myocardial infarction depend on the form (typical or atypical) of the disease and the extent of damage to the heart muscle. Myocardial infarction should be suspected in the event of a severe and prolonged (longer than 30-60 minutes) attack of chest pain, disturbances in cardiac conduction and rhythm, and acute heart failure.
Characteristic ECG changes include the formation of a negative T wave (with small-focal subendocardial or intramural myocardial infarction), a pathological QRS complex or Q wave (with large-focal transmural myocardial infarction). EchoCG reveals a violation of local contractility of the ventricle and thinning of its wall.
In the first 4-6 hours after a painful attack, an increase in myoglobin, a protein that transports oxygen into cells, is detected in the blood. An increase in the activity of creatine phosphokinase (CPK) in the blood by more than 50% is observed 8-10 hours after the development of myocardial infarction and decreases to normal in two days. CPK levels are determined every 6-8 hours. Myocardial infarction is excluded with three negative results.
To diagnose myocardial infarction at a later stage, they resort to determining the enzyme lactate dehydrogenase (LDH), the activity of which increases later than CPK - 1-2 days after the formation of necrosis and returns to normal values after 7-14 days. Highly specific for myocardial infarction is an increase in the isoforms of the myocardial contractile protein troponin - troponin-T and troponin-1, which also increase in unstable angina. An increase in ESR, leukocytes, activity of aspartate aminotransferase (AsAt) and alanine aminotransferase (AlAt) is detected in the blood.
Coronary angiography (coronary angiography) makes it possible to establish thrombotic occlusion of the coronary artery and decreased ventricular contractility, as well as to evaluate the possibilities of coronary artery bypass grafting or angioplasty - operations that help restore blood flow in the heart.
Treatment of myocardial infarction
In case of myocardial infarction, emergency hospitalization in a cardiac intensive care unit is indicated. In the acute period, the patient is prescribed bed rest and mental rest, fractional meals limited in volume and calorie content. In the subacute period, the patient is transferred from intensive care to the cardiology department, where treatment of myocardial infarction continues and the regimen is gradually expanded.
Relief of pain is carried out by a combination of narcotic analgesics (fentanyl) with antipsychotics (droperidol), intravenous administration of nitroglycerin.
Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, and cardiogenic shock. Antiarrhythmic drugs (lidocaine), ß-blockers (atenolol), thrombolytics (heparin, acetylsalicylic acid), calcium antagonists (verapamil), magnesia, nitrates, antispasmodics, etc. are prescribed.
In the first 24 hours after the onset of myocardial infarction, perfusion can be restored by thrombolysis or emergency balloon coronary angioplasty.
Prognosis for myocardial infarction
Myocardial infarction is a serious disease associated with dangerous complications. Most deaths develop in the first days after myocardial infarction. The pumping ability of the heart is related to the location and volume of the infarct area. If more than 50% of the myocardium is damaged, as a rule, the heart cannot function, which causes cardiogenic shock and death of the patient. Even with less extensive damage, the heart does not always cope with the load, resulting in heart failure.
After the acute period, the prognosis for recovery is good. Unfavorable prospects for patients with complicated myocardial infarction.
Prevention of myocardial infarction
Necessary conditions for the prevention of myocardial infarction are maintaining a healthy and active lifestyle, giving up alcohol and smoking, a balanced diet, avoiding physical and nervous stress, controlling blood pressure and blood cholesterol levels.
Myocardial infarction is a very serious attack. It is a consequence of coronary artery disease. The death of a certain area of the heart muscle is observed due to disruption of its blood supply. This means that part of the myocardium completely dies and ceases to function. It is already possible to roughly imagine what the complications of a myocardial infarction will be, because in this case the heart will not be able to perform its previous functions in full.
Myocardial infarction on ECG
Classification and features of complications
All complications can be divided into several groups:
- mechanical – represent ruptures;
- electrical – manifested in heart failure and disruption of its conductivity;
- embolic – formation of blood clots;
- ischemic – expansion of the dead area of the myocardium;
- inflammatory in nature.
Complications are also divided into two groups, depending on the time of their occurrence: early and late.
Early complications of myocardial infarction
They occur during the first hours or days after the onset of the attack. They develop during the acute period of a heart attack. The most dangerous complication is acute heart failure. AHF usually appears quite often; the severity of the condition directly depends on the size of the affected muscle area. No less serious is cardiogenic shock.
Cardiogenic shock is characterized by a significant decrease in the contractile function of the heart. It is caused by the death of a large part of the myocardium. Usually it reaches 50%. Most often it is observed in women. Develops in people suffering from diabetes. Can be observed with anterior wall infarction. Treatment in this case consists of taking nitroglycerin. The patient is also prescribed cardiac glycosides and ACE inhibitors. Diuretics, vasopressors, and beta-agonists should be taken in combination. In severe forms, surgery may be necessary.
Rupture of the interventricular septum. It usually occurs in the first few hours after the onset of myocardial infarction. Such complications of acute heart attack are often observed in women. Diagnosed in older people. Hypertension and tachycardia are factors predisposing to rupture. Drug treatment involves the use of vasodilators, but only surgical intervention is indicated to completely eliminate the ruptures.
Thromboembolism. It is considered an equally dangerous complication. It develops in the acute period of MI. To combat it, intravenous heparin is administered in the first 24 hours. This is followed by treatment with warfarin.
Early pericarditis. Most often, this complication is observed after a transmural infarction, characterized by damage to all layers of the heart muscle. It develops 1-4 days after the onset of the attack. The basis of treatment is the use of acetylsalicylic acid, a blood thinner.
Arrhythmia on ECG
Arrhythmia. It is observed immediately after the onset of a heart attack and poses a particular threat to life, because most often we are talking about ventricular fibrillation. In this case, the activity of the heart begins to stop, followed by cardiac arrest. Then there is a need for electrical defibrillation of the heart. In connection with such a danger, arrhythmia requires increased attention and an urgent start to fight.
Pulmonary edema. Most often it becomes a complication of transmural myocardial infarction, but can also be diagnosed with minor muscle lesions. Caused by acute heart failure. Determined in the first 7 days after the onset of an attack. In this case, treatment should begin immediately. The patient is given diuretics. Glycosides are prescribed. They help relieve the condition.
If we consider late complications, they develop several weeks after the attack, sometimes a month later. The most common are: arrhythmia and chronic heart failure, but in fact there are many more complications.
Post-infarction syndrome. This is a whole set of consequences, such as pericarditis, pleurisy and pneumonitis. Even if one ailment is diagnosed at first, over time the others listed will join it. In this case, the patient is prescribed hormonal treatment. Late pericarditis can also occur, which is usually diagnosed after 6-8 weeks. It is treated with aspirin and glucocorticoids.
ECG for heart failure
Chronic heart failure. It manifests itself as constant shortness of breath. Often accompanied by a lack of oxygen and the formation of edema. This is due to the fact that the heart is not able to pump the required volumes of blood and, accordingly, cannot provide the tissues with oxygen in the required quantity. Doctors recommend a healthy lifestyle. It is mandatory to give up bad habits. Beta blockers are prescribed. They help reduce the heart's need for oxygen.
Post-infarction cardiosclerosis. It begins with the fact that dead areas of the myocardium are replaced by connective tissue. This disrupts the contractile function of the heart and causes interruptions in its functioning. Heart failure develops. The patient must constantly monitor his emotional and physical state and take medications.
Regardless of whether we are talking about complications of myocardial infarction - early or late, we will highlight several basic recommendations that will help reduce the likelihood of their occurrence:
- Having determined the onset of myocardial infarction, begin providing first aid as soon as possible;
- Reassure the patient as much as possible, because stress and nervous tension only aggravate the situation.
Note! If a person does not give in to persuasion, give him a sedative to drink. For example, an infusion of valerian or motherwort.
Valerian tincture
Another important recommendation is that when you call an ambulance, immediately order a cardiology team that has experience in such cases, all the medications and equipment that may be needed to provide emergency care.
Complications of myocardial infarction
Acute myocardial infarction (AMI) is dangerous in itself. But, in addition, its numerous complications pose an additional danger, which sometimes become an immediate threat to human life.
Early and late complications of heart attack
- repeated heart attack;
- unstable angina (called early post-infarction);
- acute heart failure;
- arrhythmias and heart block;
- acute cerebrovascular accident caused by ischemia of a region of the brain;
- thromboembolism;
- heartbreak;
- acute cardiac aneurysm;
- acute ulcers or erosions of the stomach and intestines.
Late complications of myocardial infarction usually occur 10 or more days after the cardiovascular accident.
- post-infarction syndrome;
- thromboendocarditis;
- formation of a blood clot in the left ventricle and others.
Characteristics of early complications of acute myocardial infarction
Repeated heart attack
It is no secret that patients who have already had one heart attack have a fairly high chance of having it happen again. Repeated heart attacks are more dangerous than the first ones. This is explained by the fact that even after the first event, scarring of the heart muscle occurred, and the body’s compensatory capabilities became less. In addition, after a primary heart attack, the death of a large number of pain receptors in the heart often occurs, and pain sensitivity decreases due to atherosclerosis of cerebral vessels. These changes lead to the fact that a person remains “on his feet” during a state that brings him closer to a new heart attack - he simply does not understand that something bad is happening to him. He continues to receive physical activity and experience emotional stress, and the latter can most likely lead to a recurrence of the disease, an increase in the infarction area, the development of heart rhythm disturbances and other complications, sometimes incompatible with life.
Acute heart failure
Acute heart failure (AHF) is the most common cause of death in patients with heart attacks. It can occur in several ways:
- Cardiac asthma. With it, a person suddenly feels shortness of breath, suffocation, and experiences fear. Hands and feet may turn blue and become cold. In cardiac asthma, relief often occurs by taking several nitroglycerin tablets.
- Pulmonary edema. With pulmonary edema, noisy, rapid, perhaps even bubbling breathing will appear, and a cough with foamy pink sputum will occur. A favorable outcome is possible only in case of emergency assistance.
- Cardiogenic shock. In the first minutes, a person is often excited, complaining of chest pain, weakness, dizziness or shortness of breath - it all depends on the severity of certain manifestations of a heart attack. After some time, blood pressure drops sharply, and the patient becomes lethargic, almost unresponsive to what is happening around him. He breaks out in a cold sweat, his legs and arms become cold and take on a bluish tint. If emergency medical assistance is not provided, the person falls into a coma and dies.
Rhythm and conduction disturbances as complications of myocardial infarction
Within 2-6 hours after the onset of a heart attack, almost all patients develop arrhythmias. Ventricular fibrillation, asystole, and complete atrioventricular block can cause death in patients. Most often, such arrhythmias occur in the first 6 hours from the onset of the disease.
Other rhythm disturbances are less dangerous, although some of them (for example, “jogs” of ventricular tachycardia or progressive intraventricular block) can later develop into more severe forms and ultimately cause death.
Often, arrhythmia seriously aggravates the course of myocardial infarction. But there are also rhythm disturbances that cardiologists call “companions of a heart attack”: they often accompany it, but do not pose a serious threat to life. These include increased sinus rhythm, atrioventricular block I-II degree (Mobitz 1), supraventricular extrasystoles (extraordinary contractions of the heart), as well as rare ventricular extrasystoles.
Heartbreak
This complication usually occurs in the first few days after a heart attack, and is very rare if more than 5 days have passed since its moment.
In most cases, instant death occurs; less often, a heart rupture develops gradually, manifesting itself as very intense pain in the chest, from which even narcotic analgesics do not help. Along with the pain, the phenomena of cardiogenic shock increase.
Sometimes an internal rupture of the heart occurs, in which the outer walls of the organ remain intact. With an internal rupture of the heart, the papillary muscles that hold the valves in the correct position may be torn off, or the interventricular septum may rupture. Such events dramatically complicate the course of a heart attack, but, unlike external cardiac rupture, the patient can almost always be saved. Treatment in such cases is only surgical.
Pericarditis
On the second to fourth days after a heart attack, the patient may experience pericarditis - inflammation of the connective tissue of the heart. With pericarditis, pain in the chest area reappears, which the patient describes as constant, dull, aching. The pain intensifies if the person coughs or takes a deep breath. Often with pericarditis, body temperature rises to 37-38°C.
As a rule, it is enough to take aspirin or other drugs from the group of non-steroidal anti-inflammatory drugs so that all the phenomena subside over time.
Thromboembolism
Heart rhythm disturbances (atrial fibrillation, etc.) lead to the appearance of blood clots in the heart chambers. Subsequently, these blood clots are very often washed into the blood and travel with its current to various organs, leading to thromboembolism.
Thromboembolism of cerebral vessels leads to stroke. When the blood vessels of the intestinal mesentery are blocked by a blood clot, severe abdominal pain and symptoms of intestinal obstruction develop. Thromboembolism of the vessels of the extremities causes gangrene.
The probability of developing thromboembolism during a heart attack is 5-10%. Most often, blood clots go to the vessels of the lungs, which is very dangerous.
Post-infarction syndrome (Dressler syndrome)
The appearance of aching chest pain, weakness and elevated temperature to 37-38°C 2-6 weeks after a heart attack indicates the development of Dressler's syndrome. With this complication, the pain subsides on its own after a few days, and the temperature also gradually normalizes. Aspirin, other NSAIDs, and glucocorticosteroid hormones can help the patient recover.
Mental disorders
Transient mental disturbances during a heart attack are not uncommon, especially when it comes to the first two weeks after it and in patients over 60 years of age.
Patients may behave inappropriately: episodes of depression are replaced by euphoria, during which the person is excited, talks a lot, tries to get up and walk around the ward. Sometimes a seemingly mild mental disorder can turn into delirium with clouding of consciousness and the appearance of hallucinations. If a person is not helped during this period, in the future he may develop phobias, neuroses and sleep disorders.
Erosion and ulcers of the stomach and intestines
In the first 10 days after the development of myocardial infarction, abdominal pain of varying intensity may appear, accompanied by loose stools, and less often by vomiting coffee grounds or tarry black liquid feces. In this situation, you need to look for ulcerative lesions of the digestive tract and prescribe antiulcer therapy.
Late complications of myocardial infarction
Chronic heart failure (CHF)
The death of part of the heart muscle can lead to the development of CHF - a condition in which the beating heart cannot provide adequate blood circulation and blood supply to organs and tissues.
Classic signs of heart failure are palpitations and shortness of breath on exertion, and swelling in the legs. With the help of pharmaceuticals it is usually possible to reduce the manifestations of CHF. Physical therapy can also have a beneficial effect.
Left ventricular aneurysm
An aneurysm is an abnormal sac-like bulge in the wall of the heart. It usually occurs in the infarct zone in patients with extensive damage to the heart muscle.
An aneurysm manifests itself as symptoms of heart failure. It can lead to life-threatening arrhythmias, the development of blood clots in the heart and further thromboembolism. Many patients with left ventricular aneurysm require surgical treatment.
Rhythm and conduction disorders
Myocardial infarction can lead to various arrhythmias and conduction disturbances, from harmless to fatal.
If there is a possibility that an arrhythmia will lead to death, the patient may be fitted with a pacemaker-defibrillator, which responds to a sudden rhythm disturbance and restores normal heart function. In other cases (atrial fibrillation), the patient's own sinus rhythm is restored or the optimal heart rate is maintained.
Intracardiac blocks are also very diverse. Some require the installation of an artificial pacemaker - a special device that sets the heart to the correct rhythm of contractions, while for others, drug therapy is sufficient to treat.
Sleep disorders and complications after myocardial infarction
Sleep disorders always negatively affect the quality of our life: with vigor, we lose vitality and strength. In addition, sleep disturbances can become a serious threat to human health and even life, especially for those of us who have suffered an acute myocardial infarction.
Such a seemingly harmless phenomenon as snoring occurs in at least 30% of people suffering from coronary heart disease, and is a symptom of a terrible disease - sleep apnea syndrome. With this syndrome, respiratory arrest at night, when a person is sleeping, leads to acute oxygen starvation of the heart muscle and provokes the development of a heart attack - both the first and repeated ones. The likelihood of a recurrence of a cardiovascular accident in people with sleep apnea syndrome increases fivefold! But this is only if the sleep apnea syndrome remains untreated. 
Therapy for this disease has long been developed, it is effective from the first days and completely eliminates breathing pauses in a sleeping person. If you snore, and especially if you have had a heart attack, you should be diagnosed at a sleep center and receive qualified help. You can do this by contacting the sleep medicine department of the Barvikha sanatorium. The doctor will select an effective treatment regimen for sleep apnea syndrome and help eliminate any other sleep disorders, if any. At the same time, the probability of both the first and repeated myocardial infarction will decrease many times.
It’s no secret that patients who have already had one heart attack have a fairly high chance of having it happen again. Repeated heart attacks are more dangerous than the first ones. This is explained by the fact that even after the first event, scarring of the heart muscle occurred, and the body’s compensatory capabilities became less. In addition, after a primary heart attack, the death of a large number of pain receptors in the heart often occurs, and pain sensitivity decreases due to atherosclerosis of cerebral vessels. These changes lead to the fact that a person remains “on his feet” during a state that brings him closer to a new heart attack - he simply does not understand that something bad is happening to him. He continues to receive physical activity and experience emotional stress, and the latter can most likely lead to a recurrence of the disease, an increase in the infarction area, the development of heart rhythm disturbances and other complications, sometimes incompatible with life.
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Complications of myocardial infarction
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Acute heart failure;
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