Major Heart Attack - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Extensive heart attack

What is a massive heart attack?

Extensive myocardial infarction is ischemia and tissue necrosis that covers large areas of the heart muscle. A massive heart attack is a very serious pathology, in which about 40% of patients die without waiting for medical help. Most often, an extensive infarction is transmural, when all layers of the myocardium are exposed to necrosis.

Extensive infarction is included in the classification of myocardial infarction, and in terms of prevalence it ranks third after small-focal and large-focal lesions. Extensive heart attacks provoke intoxication of the body with products of tissue decay, and necrotic masses in the center of the focus can persist for not only weeks, but even months.

Content:

• Symptoms of a massive heart attack
• Causes of extensive heart attack
• Stages of extensive infarction
• The consequences of a massive heart attack
• What are the odds of surviving a massive heart attack?
• How long do you live after a massive heart attack?
• Treatment and rehabilitation after a massive heart attack

Symptoms of a massive heart attack

The symptoms of a massive heart attack are almost indistinguishable from those of a small focal heart attack. In the same way, it is impossible to determine the affected area with 100% accuracy only by clinical signs.

Nevertheless, for an extensive heart attack, more pronounced symptoms of the ongoing pathological process are most often characteristic, among them:

• Severe pain that comes on suddenly. They are localized behind the sternum, can have a different character (burning, cutting, pressing, bursting);
• The pain is prolonged, it is not possible to eliminate them by taking Nitroglycerin;
• The pain can be given to the shoulder blades, to the neck, to the right shoulder;
• Profuse perspiration with the appearance of clammy cold sweat;
• For extensive damage to the heart muscle, severe general weakness is characteristic;
• A person has a fear of death, anxiety increases.

The symptoms described are found in 75-90% of patients and characterize the typical form of a heart attack.

If we consider atypical options for the course of an extensive heart attack, then the symptoms will be slightly different:

• Asthmatic infarction is characterized by the appearance of breathlessness and shortness of breath, palpitations and orthopnea. Pains are mild or absent at all;
• The gastralgic variant of an extensive heart attack manifests itself in pain that is localized in the upper abdomen. In parallel, dyspeptic disorders occur;
• In the case of an arrhythmic variant of the course of an extensive heart attack, an increased heartbeat, disturbances in the work of the heart, and its "fading" come to the fore;
• With the cerebrovascular form of myocardial infarction, symptoms such as dizziness, loss of consciousness, nausea and vomiting are observed.

The malosymptomatic form of the course of the disease with extensive heart attack practically does not occur.

Causes of extensive heart attack

The cause of extensive infarction in 98% of cases is an acute manifestation of ischemic heart disease, in which the coronary arteries undergo atherosclerotic changes. Thrombosis of the coronary arteries in the last century was considered the only cause of a massive heart attack.

At the moment, there are several more reasons why this cardiac pathology can develop:

• Congenital malformations of the coronary arteries;
• Blockage of large arteries with parts of the tumor, vegetation;
• Inflammatory processes affecting the coronary arteries of the heart;
• Formation of a hematoma near the mouth of the coronary artery as a result of dissection of the ascending aorta;
• Coronary artery thrombosis due to disseminated intravascular coagulation;
• Oncological formations of the heart. In this case, a massive infarction can happen due to tumor necrosis, due to the blockage of the coronary artery by it.
• Extracardiac oncological formations, germinating and metastatic to the coronary artery;
• The use of drugs that provoke spasm of the coronary arteries (amphetamine, cocaine);
• Mechanical injuries, as well as electric shock;
• Iatrogenism due to surgical interventions on the heart and on the coronary artery.

An extensive infarction differs from small-focal myocardial damage in that an obstacle that interferes with blood flow occurs in a larger artery. The main trunk of the left coronary artery is usually occluded.

The size of a heart attack is determined by the following factors:

• The degree of coronary artery stenosis;
• The degree of collateral circulation disorder;
• Trunk arterial occlusion (embolism or thrombosis);
• The functionality of the myocardium.

The higher the degree of disturbance, the more extensive the area of heart damage will be.

Stages of extensive infarction

Considering the stages of an extensive heart attack, five consecutive periods can be distinguished:

• Prodromal stage, during which angina attacks intensify. The duration of this stage is from several hours to several weeks;
• The most acute stage, during which ischemia manifests with the subsequent appearance of a site of myocardial necrosis. The duration of this stage is from 20 minutes to 2 hours;
• Acute stage, during which myocardial necrosis continues, followed by enzymatic fusion of the damaged muscle tissue of the heart (tissue myomalacia). The duration of this stage is from two days to two weeks;
• The subacute stage, during which the processes of tissue scarring are triggered, and the areas that have undergone necrosis are replaced by granulation tissue. This stage lasts 1-2 months;
• Postinfarction stage, during which the scar continues to form, and the myocardium adapts to the new conditions in which it has to function.

The consequences of a massive heart attack

The severity of organic heart disease causes serious consequences of a massive heart attack, including:

• Rupture of the heart muscle, which is most often observed in patients who have had a transmural infarction for the first time. Lethal outcome in this case always occurs. Heart rupture usually occurs on the first day after the manifestation of an extensive infarction, mainly the anterior wall of the left ventricle is damaged;
• Cardiogenic shock, which is most often formed with extensive anterior infarction against the background of coronary artery disease and with necrosis of more than 40% of the mass of the left ventricular myocardium. If a patient has a true cardiogenic shock, then the mortality rate reaches 90%. It is expressed in tachycardia, lethargy and weakness. The skin becomes very pale, their moisture rises, blood pressure drops sharply;
• Pulmonary edema. First, the patient develops interstitial pulmonary edema, which, in the absence of adequate assistance, turns into alveolar edema with shortness of breath, weakening of breathing, moist wheezing, coughing with foamy pink sputum. Mortality in myocardial infarction complicated by pulmonary edema reaches 25%.

In addition, the consequences of a massive heart attack are mitral valve insufficiency (25-50% of patients), left ventricular aneurysm (7-15% of patients), postinfarction syndrome (4-10% of patients), thromboembolism (10-15% of patients), disorders heart rhythm, atrial fibrillation, ventricular arrhythmias, sinus tachycardia and bradycardia.

What are the odds of surviving a massive heart attack?

Statistics indicate that after a massive heart attack, about 40% of patients die at the pre-hospital stage. No specialist will unequivocally answer the question about the chances of surviving after a massive heart attack.

However, the risk of death can be calculated using the GRACE rating scale. It should be noted that a large area of myocardial damage is considered an unfavorable prognostic factor, as well as the patient's advanced age, high blood pressure, signs of congestive heart failure, etc. Criteria are evaluated in points, the points are summed up, after which the risk of death of the patient is calculated (low, medium, tall).

How long do you live after a massive heart attack?

Life expectancy after a massive heart attack is influenced by many factors. If in the early period it is the presence of complications, the vastness of the lesion, the age of the patient, then in the later period it is the observance of the doctor's recommendations and the maintenance of a healthy lifestyle. To prolong life, it is necessary to take medications, not to violate the treatment regimen, give up bad habits, and reduce excess body weight.

It is worth considering that if after a small-focal heart attack it may take about 8 weeks to recover, then after a massive heart attack, often half a year is not enough.

If we turn to the statistics, then it indicates that 19% of patients do not cross the five-year survival threshold and die either due to a recurrence of a heart attack or due to its complications.

Treatment and rehabilitation after a massive heart attack

Treatment and rehabilitation of a patient with an extensive heart attack should be carried out under the strict supervision of a physician in a hospital setting. Each person with suspected myocardial infarction is urgently admitted to the intensive care unit.

• Elimination of pain syndrome. Before the arrival of emergency doctors, patients most often take Nitroglycerin 0.5 mg under the tongue, which helps to reduce pain. The drug intake can be repeated. When relief does not come, then the doctors who came to the call as soon as possible inject the patient with narcotic analgesics. If this is not done, then the risk of expansion of the zone of necrosis increases significantly, which is due to the activation of the sympathetic nervous system against the background of a painful attack. For this purpose, intravenous morphine sulfate is used. If the patient vomits or is severely nauseous, then he is injected up to 20 mg of metoclopramide.
• Oxygen therapy. Oxygen is prescribed to all patients with myocardial infarction due to heart failure, cardiogenic shock, and respiratory disorders.
• Antiplatelet therapy. All patients are prescribed Aspirin, regardless of how long ago the disease arose.
• Blood clot destruction. The thrombus is eliminated using thrombolytic therapy (Streptokinase, Anistreplase, Alteplase, Urokinase) or it is destroyed mechanically. If both of these methods do not lead to normalization of blood flow, then coronary artery bypass grafting is possible.

As for the rehabilitation of patients with extensive heart attack, it boils down to the following activities:

• Performing medical gymnastics. Physical activity should be dosed, initially exercises must be performed under strict medical supervision. A well-built scheme allows patients to recover faster after prolonged immobilization;
• Compliance with a strict diet. Emphasis should be placed on food of plant origin, meat should be chosen from dietary varieties (poultry, lean fish). Fermented milk drinks should be present on the table every day. It is important to limit your consumption of table salt. Products should not increase the level of cholesterol in the blood, which means that it is necessary to give up the use of egg yolk, liver, caviar, fried and fatty foods;
• Medication correction of arrhythmia, blood pressure, cardiovascular failure. Patients are prescribed lipid-lowering drugs (Atorvastatin, Pravastatin, Simvastatin), antiplatelet agents (Aspirin, Ticlopidin, Clopidogrel), ACE inhibitors, beta-blockers (Timolol, Metoprolol, Carvedilol, etc.);
• Psychological rehabilitation. Patients after suffering a heart attack continue to fear a second attack, are in confusion about the prospects for further personal and social life. In order for all these worries not to turn into neuroses and not aggravate the course of the disease, it is necessary to provide the patient with competent psychological assistance;
• Sanatorium treatment at specialized resorts;
• Rejection of bad habits.

Correctly structured rehabilitation can significantly prolong the life of patients after suffering an extensive myocardial infarction.

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The author of the article: Molchanov Sergey Nikolaevich | Cardiologist

Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".