Atypes of myocardial infarction and symptoms. Variants of the main atypical forms of myocardial infarction and myocardial infarction types and atypical variants

Classification of myocardial infarction according to ICD-10 in accordance with the state standard of illness code I21. In the group of glybin, there are 2 types of infarction - transmural and subendocardial. The stench, in its own accord, may be sub-code of the digital signified in the presence of the localization and the addition of hypertension. Recurrent coronary myocardial thrombosis maє code I22.

Shcho is an infarction of the heart

Myocardial infarction is a form of myocardial ischemia. Rizke change in the blood flow of the myocardium of the wicklica necrosis (death) of the disease. The morphology of the whole process is myomalacia (growth) of the individual zone and the firing of navkolishnіh fabrics.

At the heart of the reasons for these diagnoses is the ulceration of the coronary arteries by atherosclerotic plaques. At the time of the purchase of fatty tissue, a thrombus is set up, which causes the blood flow to occur in the myocardium. As a result, products entering the shelter in a drop in the size of the dough lead to hyperthermia. Chim is wider and more widespread than the area of ​​necrosis, and the temperature is more trivial.

Development of an infarction with a child with diabetes, abdominal obesity, Arterial hypertension, nervous way of life, nervous or physical stress. Provocative factor - kurnnya, implantation to alcohol.

Moving to an infarction behind the stages

Relocation of the guest ischemia to 5 types. For skin, they are characterized by changes in the electrocardiogram (EKG), dynamics of laboratory data. A clever picture is developed during the period or the stage of infarction for an hour:

1. The cobbled period is used for the frontal camp, which is usually 4-6 times. Characterized by attacks, squeezing pain in the area of ​​the heart with irradiation in my hand, Shoulder, teeth, shoulder blade. Already in the th stage, an arterial grip is developing, in some ailments there is an arrhythmia. How to squeeze more into breast cancer do not go through 30-40 minutes and do not know about nitroglycerin, do not talk about the threat, how to get sick of an infarction. Such patients will require basic diagnostics and medical assistance.
2. Another type of infarction - naygostrіsha stadіya - supravoduyu to unbearable pain in the sternum. At a certain period of time, there is a rupture of the myocardial zone, which is seen on the EKG by an arc-like ST segment. Naygostrish stage is triva up to 2-3 years old.
3. Gostriy period of infarction is usually from decilcoh years up to 14-16 dib and manifests itself in severe pain, enlarging the form of a zone of necrosis.
4. Subacute stage 4 of the type of infarction is characterized by substitutions of infarction with full tissue. The period is from 2-3 months to 1.5-2 months. The patient's camp is stable. More and tachycardia is not meant.
5. The scarring of the zone will be completed in 2 months after the diagnosis is made. The stage is diagnosed by drugs as postinfarction cardiosclerosis, which is a trifle of all life.

The most insecure period for the development of an infarction is the naygostrish stage, in which a typical classic picture appears. Pain syndrome is within reach of such intensity, so it is effective to know only drugs. The arterial grip adjustment is reduced to 80/30 mm. rt. Art.

Important! At this stage, cardiogenic shock, livoshlunochkov deficiency may develop.

For the adobe stage, a decrease pain syndrome, Polіpshennya zagalny camp. The temperature is normalized, tachycardia changes. Typical infarction for terms vary among children. Thromboembolic acceleration can also develop during the period of time.

The taste of myocardial infarction transferred to the heart of the heart. A wall of a lіvnogo dilyanka in the zone of a dead dіlyanka is to be pissed off. The tissue on the myocardium is healthy through the extended nasal hypertrophy. As a result of the deterioration of the pumping function, a heart failure often develops, an aneurysm of the body can be established.

Classification of myocardial infarction according to ICD

Predominations of coronary thrombosis are accompanied by signs of overturning of the state of affairs up to 4 years.

Ten re-glance of the international classification of ailments rozdilyaє gostry myocardial infarction (GIM) behind the stage of widening and localization of the head of the ear. The data are presented in the tables.

With the classification of victories, repeated or chronic coronary thrombosis, which is more than 28 days. Chi does not enter here also post-infarction camp.

Classification for Killip

Criteria of the Killip to be fixed for the purpose of the speedy function of the heart. The basis of the gravity classes cleverly show, Presented in tables.

Until speech! The classification of the Killipa is broken down for the assessment of the heart's activity on the myocardial infarction, but it is not stagnant in the case of those who are ill. Designed for viznachennya tactics lіkuvannya.

Clinical forms of infarction

rattle різні options severe myocardial thrombosis. The most common picture of hospitality is broadened to be manifested in a large form. At the її part of the attack ї 80% of cases of coronary ischemia. Characteristic signs:

• Strong unbearable to squeeze pain behind the sternum, liva shoulder, Vuho, crack, teeth. Irradiation expands to the area between the shoulder blades, not the hand, the knickers ring finger and music.
• Pain syndrome is triple from 30 hvili until decile years, do not know nitroglycerin, buy only narcotic analgesics.
• Shkіrnі pokrivi blіdі with acrocyanosis - bluish nasal tip, wuh.

Important! for state form characteristic profuse cold pit.

• Zadishka is swung, the weakness is growing.
• Feeling the fear of death, awakening, restless.

It is not so rare to develop an advanced type of infarction - an abdominal form. This means that the coronary ischemia is manifested by severe pain in the abdomen. Pechinnya zmushuє ailments unsuccessfully accept Renní, rozchin sodi. The people with ailments have nudota.
Bloating without lodging on aphids of non-fugitive pains in the epigastria with a stretch of 30 hilin is guilty of alerting a sick person, zmusiti yogo viclikati I will help the shvidka... In such cases, they categorically take painful medications to disguise the cause of the ailment.
In such a situation, it is necessary to rob the cardiogram. The abdominal form can be recognized by physical customization or re-transmission.

Likars of great help to develop in their practice with one obnoxious ailment - atypical pain syndrome in case of infarction. rapta sharp bile winikє in rutsi, nosi, vusi abo throats. Ailments take illnesses to the extent that they feel ill, and the cause of illness.

Uwaga! Even if the pain of localization was not strong enough for 30 minutes, a cardiogram is needed, as it is a characteristic sign of a severe coronary thrombosis - the ST segment in the viglyadi prapor.

In 25% of cases, a painless form of infarction is indicated, transferred to the legs. It will appear vypadkovo at the viglyadі of the scar of the heart meat with a prophylactic inspection, or even before the drive of the disease.

There is also an artistic option for infarction. The qia form is manifested in the absence of damage to the frequency of sertsebitia - paroxysmal tachycardia, blinking arrhythmia or extrasystole. Raptova's rapid pulse can be said about the development of the blockade of the heart. Signs cannot be lost without respect. It is necessary to turn up to the lykar. Cardiogram viyavlyak manifest host thrombosis of coronary sudins.

An asthmatic form of infarction is manifested by breathlessness, sluggishness, vision of a sputum sputum.

Uwaga! Vazhke critical camp without extra extra medical aid end with a lethal result. tse unsatisfactory mill called cardial asthma.

The reason for this is not a great one, because of the necrosis of the heart meat, which can lead to a rapid loss of the fast-feeling building of the heart. For the classification of myocardial infarction, the form is included in the group of "deyakykh ukladnen" under the code I23.

Hearts of the classifications of heart infarction behind the new algorithms. All the stench is used to improve diagnostics and selection of tactics for treatment. Russia has the ICD-10 criteria. For the significance of the severity of the ailment, the principle of Killip is also used. The period of diagnostics of the stench viznachayutsya behind the key signs.

Myocardial infarction— gostre zvoryuvannya heart meat, which is characterized by one or more decilcoma in the signs of death as a result of impaired blood circulation. Tse naivazhcha form ischemic ailments heart. Illness will require a post-regime. Diagnosis of priming on three key signs: characteristic severe anginous pain, which is usually 30 minutes long, not weak when taken nitroglycerin; EKH-danih (pathological Q wave or QS complex as a sign of necrosis, negative prong T); supplemented with the enzyme FK-MB in the blood.

Sponsor more often with people in 40-60 years. In cholovikiv myocardial infarction develops more often, less in women, especially in to a young person... From 41 to 50 years of travel, 5: 1, and in the period from 51 to 60 years - 2: 1. Vvazhaєtsya, that the townspeople suffer from myocardial infarction more often, not the civilians, but there is a role, mabut, not the same level of diagnostic capabilities. The maximum mortality rate is during the autumn-winter period. Name the myocardial infarction in the result of the lesion of the arteries of the heart in atherosclerosis, if there is an increase in education. It is not easy for the process to have a blockage of the judgment in the zone of its destruction, after which shelter I grow up, or sometimes it ceases to come to the occasion of the muzzle of the heart, and in it there is mid-life (not dead).

Rizik on myocardial infarction (for materials of the American Cardiological Association)

Rizik for myocardial infarction is low - 6 13 points, middle - 14-22 bali, high - 23 bali.

People who have suffered a stroke, have ailments for diabet, Genetically sick to heart disease, risky development of myocardial infarction nabagato vishche.

Classification of myocardial infarction

1. For localization (right-wing lunochkova, livoshlunochkova, septum and in.);

2. For glybin necrosis of the myocardium (penetrating, non-penetrating, vognischevy, enlargement);

3. For the stages of myocardial infarction:

• naygostrishy;
• gostry;
• pidgostry;
• postinfarction.

4. For the appearance of acceleration:

• accelerations;
• confusion;

5. For glycemic damage: transmural myocardial infarction (the process of swallowing the entire heart muscle), intramural (from the localization of the dead in the heart), as well as subepal-subendocardial adenocardial

6. Three main zones of changes in the heart meat in case of infarction: in the presence of necrosis, the prenecrotic zone and in the distance from the necrosis zone. The result of the dead tissue is the establishment of a semi-tissue scar.

7. Clinical options for overcoming myocardial infarction: typical (abnormal) and atypical, including: asthmatic, abdominal, arithmic, cerebrovascularization and painless atypical (low-symptomatic), as well as local

Most often, an infarction develops in the anterior stage of a loner, in the basin of blood loss, the most often enmity with atherosclerosis of the anterior low-lying artery of the coronary artery. Another one in terms of frequency of loan is an infarction of the back wall of a lone dwarf. Distant traces of the interstitial septum and papillary mucosa.

1. Bolov form (typical version of development)

In a typical interruption of an important myocardial infarction, there are five periods: prodromal, naygostrish, gostry, pidgostria and pislyinfarction.

The prodromal period, or the so-called peredinfarction camp, is spared to grow more low in half of the ailments. Clinically, it is characterized by accidents and significant frequent and severe attacks of angina pectoris, as well as by the snares of angina pectoris (weakness, morbidity, low mood, anxiety, sleep disturbance). Diya of wicked zealous zasobіv in ailments, їх їх їх, become, as a rule, less effective

The most severe period (the hour from the diagnosis of myocardial ischemia to the first manifestations of myocardial necrosis).

Characteristics of a typical pain attack with myocardial infarction:

1. Characteristics of the pain: the raptus appears to be more intense behind the breastbone, fusion with irradiation in the left arm, left shoulder blade, live, back.

2. Triviality of pain: pain syndrome in the middle trivial more than 30 minutes, sometimes it takes 1-2 days.

3. Reactions to leaks: if not buyinitroglycerin but validol, you need some additional help for healthiness.

4. Reaction to physical stress: if you accept, the necessary post-treatment and change of any physical pressure.

5.Individual signs of pain: a painful attack can be superfluous for fear, for a weakness, for the suspicion of a lack of illusion, fear of death, for the occasion of profuse fatigue, a backlash in calmness, unhappiness of the lower Often, it is common for ailments in the camp of a strong psychomotional stress, alcoholic sp'yaninnya.

Myocardial infarction is in any hour dobi, especially often in nichni, peredrankovy years. Viklyuchno rіdko bіl vіdsutnіy.

When you look at a sick person, you start to see a bliss of a child and symptoms associated with intense pain (a painful viraz of exposure, a wrinkle of pain, or a cold, sticky pity). At the first time, the arterial grip of the arterial grip is growing, while it is progressively decreasing, as the manifestation of heart and reflexive hostility of judgment develops. rіzke reduction arterial vise wake up the dressing with the development of cardiogenic shock.

Gostry period is insisted without the middle period when the end of the period is close to 2 dib - until the residual period of necrosis (in the whole period one part of myocytes, developed in the first, in the middle of the day) In case of recurrent interruption of myocardial infarction, the triviality of the period can be up to 10 or more days.

At the first year of the hospitable period, there is an anginous bile. saving most of the views it is possible with the development of the pericardial infarction, as well as with prolonged or recurrent interruption of myocardial infarction. Sertseva's lack and arterial hypotensiveness, as a rule, become overwhelmed and can bring progress, and in some cases of stench, there is also a sign of the end of the guest period. Disruption to the rhythm and performance of the heart begins at a great deal.

Resorption syndrome, which develops during the period of myocardial infarction, is characterized by the appearance of a disease (at the same temperature, the temperature is only 38.5 ° C in small cases) and the development of SHOE.

The period, depending on the interval of the hour from the main period of the necrosis to the substitution of the lower tissue, is approximately 1 msec. Clinical symptoms Due to changes in the mass of the functional myocardium (heart failure) and its electrical instability (arrhythmias of the heart), in the whole period it manifests itself in a different way. Zagalne self-respecting ailments, as a rule, will turn. A restlessness, as well as auscultatory and radiological signs of blood stagnation in the lesions, change or know.

The soundness of the heart tones is gradually increasing, but it does not increase in the majority of the sick. Systolic AT in most ailments moves step by step, if they want and do not reach their magnitude. As soon as myocardial infarction has developed against the background of arterial hypertension, systolic AT is significantly lower, not until myocardial infarction, that is, as a diastolic hypertension.

It is necessary for the nobility to attack angina pectoris, but they can be seen; їх knowledge of a sick person, who suffered from angina pectoris to myocardial infarction, to indicate about another blockage of the artery, in the basin which to infarction periodically was diagnosed ischemia of the myocardium.

The period of infarction, the onset for the first time, completes the transition to myocardial infarction, and as a result of this period, residual formation is transferred to the zone of infarction of the cerebral scar. It is accepted that with a typical interruption of a large-focal myocardial infarction, the period of infarction will end in term, approximately 6 months from the moment of detection of necrosis. In the course of the period, compensatory hypertrophy of the spared myocardium develops in a step-by-step manner, such as deficiency of the heart, as well as in the early period of myocardial infarction, in some of the ailing there may be problems. However, at great sizes Myocardial damage is not expected to be compensated again, and signs of heart failure are likely to grow.

2. Asthmatic form

Of the atypical forms of myocardial infarction, the asthmatic variant is often developed, which is contrary to the type of heart asthma or a lot of legends. It is susceptible to a great loss of heart meat, with repeated infarctions, at the same time a lack of blood circulation, with the manifestation of cardiosclerosis. It affects 5-10% of people with ailments. In half of the breath, there is pain in the chest. The development of heart asthma can be improved by the development of an arterial vise.

The underlying syndrome lies extreme step left ventricular failure and congestion of blood in the lungs. Rapto is to be seen in the sight of a marriage because it grows into a breath, and the fear of death is bound to it. The ailment is even more restless, "I can't know my own miscy" dykhalny ruhu... The frequency of growth is up to 80-90 per quiline. The character of the dichanna changes: following a short breath, followed by podovzheniya vidikh. Viraz exposing a sick person to a little suffering, tortured, shkirnі pokrivi blіdі, ruin the cyanosis, in the form of a cold pit.

Dikhannya is becoming noisy, shrieking, wheezing in the hallway. There is a cough, it’s not a bar to start, the child’s sputum appears, and the sputum of the erysipelas color, or from the house’s blood.

3. Abdominal form

An abdominal variant of myocardial infarction is diagnosed in 2-3% of ailments, mainly in the case of either lower or lower posterior localization. Most of them are seen to be transformed into the epicheral dilyantsi. Ailments zbujeni, tossed around, to knock, shkirni curl at the moment the pain is overpowered, curl up a little. However, obmatsuvannya abdomen does not wickle pain, live to become myakim, symptoms of teasing of the queue are visible.

Before the pains in the epigastric period, you can come across a tediousness, blues, a big booze, a wild style. It can be used as a drive for grateful visitors about food poisoning or gastroenteritis.

4. Cerebral form

The cerebrovascular form can be counterproductive to insult. The impairment of cerebral blood circulation will give rise to a clock-like character. Z'yavlyayutsya signs of a judgment of the brain (brain damage, cerebral stroke). The order of cerebral strokes in the state period of myocardial infarction neurological damage: Negligence, loss of quality.

Brain stroke is often due to accelerated myocardial infarction. To clarify the situation with respect to the heart, record of the EHC, biochemical analysis of blood.

5. Artistic form

The arrhythmic option is to repair the rhythm of a rapid breakdown - attacks of instant arrhythmias, tachycardia, often extrasystoles. Bіl at all times of the day or there is a message of arrhythmia. HIM can be manifested by important tachyarrhythmias due to a decrease in the arterial vise, rapid clinny death in case of defibrillation of shlunochkiv (before asystole).

Diagnosis of myocardial infarction evidences with one-hour manifestation of an ailing clinical picture of an anginous attack, an increase in a number of enzymes (CPK, LDH, etc.) In the blood, characteristic changes on the EKG.

Deposition of myocardial infarction

1. Disruption to the rhythm of performance (arithmic shock).

In case of myocardial infarction, it is not only myocarditis that is affected - myazov cells, ale the guarding and the provid system. Have your heart in the mind of the robots, for the optimization you need a deyak perebudov. Ale for the whole time, it will take an hour. That heart will be drawn for the help of a large number of people, and will quickly deliver shelter to the organs of the people. Arrhythmias, which occur in case of myocardial infarction, can be both timid and persistent in nature. It is even more not safe so called blinking arrhythmias.

2.Very cardiogenic shock- the most important is the acceleration of myocardial infarction, as it often ends in death. The reason for the shock buvaє shvidko viniklo і great deadening meaz of the liv myazovoi masi), Yake supravodzhutsya rіznіzhennya obsyagu vikidaєtsya krovі. With a lot of ailments, do not collapse, there is a lot of weakening, you can’t lean on the pain, you’ll see a lot of power on the power supply, often falling into a fatal camp, maybe a waste of svidomostі. Expose the bleed, with the bluish lips and mucous membranes, the cold cuts, the scruffy curls, the "marmur" babies, curl up with bright cold, sticky sweat.

One of the main signs of cardiogenic shock is the catastrophic fall of the arterial vise - below 80 mm Hg. Often the systolic grip does not appear. Pulse of weak napovnennya, parts, more than 100-120 strokes in khilina. With a reduced arterial vise lower than 60/40 mm Hg. the pulse becomes threadlike, with a greater low grip the pulse does not quilt. Dikhannya often and superficial (25-35 per chilin). In the lungs, a stiff manifestation grows on the tlі of the arterial vise, right up to the embryo. There is a decrease in the appearance, right up to the rest of the day.

3. Gostra sertseva lack. The weakness of a lingering duck is not expected to manifest itself in the form of heart asthma and a lot of legends. In bagatokh ailments livoshlunochkova lack of a more peaceful character. The sickness is not very bad, the heart rate is accelerated (more than 100 hits in the sickness), the cyanosis is ruined. The arterial grip grows on a normal or slightly reduced level. In the posterior-lower portions of the lungs, there is often a small number of eccentric wheezing. Extreme forms of left ventricular failure є heart asthma.

4. Rose heart. Rise of the heart meat is seen in ailments with the primary transmural myocardial infarction. Repeated infarctions can quickly become slower. Lethality is in the middle of the arch of the temple. There are more wineries in the first three days, often on the first day. Development of new and internal development of the heart, new development is more frequent. Razriv vidbuvatsya ring along the front line of the lynx, nearer to the top. There are a lot of ailments in myocardium on the first day.

5. Aneurysm of the heart. The process of accelerating the widened transmural myocardial infarction є diffuse vibuhne or saccular emptying, invoke revenge on the prismatic thrombus. Most often aneurysm grows in the area of ​​the upper part of the louse, or close to it. Aneurysm is established in 10-15% of ailments in persistent myocardial infarction. Chronic aneurysm is the result of cicatrization of stynok aneurysms.

Heart aneurysm can be accelerated by cutting in the first 3 types of ear and myocardial infarction. Closely 70% of ailments with chronic postinfarction aneurysm should be moved for 3-5 times due to heart failure, arrhythmia or repeated myocardial infarction.

One of the lower criteria is sufficient for the diagnosis of myocardial infarction.

Type of adjustment i demeanor(Heart troponin) or a greater increase in the increase and decrease (MB CPK) of biochemical markers in myocardial necrosis in the presence of one of these signs:

a) the key picture of the ACS;

b) the appearance of pathological Q waves on the EKG;

c) changes in the EKG, which can lead to the appearance of myocardial ischemia: diagnosis due to ST segment depression, blockade of LNBH;

d) the appearance of a sign of the loss of a vital myocardium, or a breakdown of local rapidity during vicious methods, which allows visualization of the heart.

diagnostics

The main clinical and laboratory signs of myocardial infarction є:

1. Adjusted temperature (in subfebrile digits up to 38.5-39 ° C).

2. Leukocytosis, which I don’t change?

3. aneosinophilia.

4. A small butchery zsuv blood formula.

5. Збільшення ШОЕ.

Enzyme diagnostics. By the level of activity of enzymes, one can judge the severity of myocardial infarction. So, for example, the activity of the MB-fraction to the CPK (creatine phosphokinase) enzyme starts to move in 8-10 years from the ear to myocardial infarction and turn back to normal in 48 years. The purpose of the activity is to carry out the skin for 6-8 years; for viklyuchennya myocardial infarction, three negative results are required. Likuvannya to fix, not check to adjust the activity of KFK. New ways of determining CPK isozymes can speed up the diagnosis, however, they did not reject the stench wide sucking... The activity of the 1st LDH isoenzyme (LDH;) level, the lower activity of LDH 2 for the 3-5th stage of myocardial infarction. The activity of LDH appears to start every day for 3 dB, when ailments occur after 24 years, if symptoms appear in myocardial infarction. If the activity of LDH is within the reach of near-border values, if there are ailments that occur after 3 additions or more symptoms appear, scintigraphy of the myocardium with 99m Tc-pyrophosphate is shown.

Electrocardiographic dosage. According to Bayley, the impairment of the coronary blood circulation in myocardial infarction is reduced to the formation of three zones pathological changes: Around the time of necrosis, the zones of ischemic disease and ischemia will grow. In the case of introductions, an active electrode of a quick straightening over the area IM, the skin of the cich zones takes care of the fate of the onset of the EKG-changes.

1. The zone of necrosis is a pathological Q wave (trivial more than 30 ms) and a decrease in the amplitude of the R wave or the QS complex.

2. Zone of ischemic ear - replacement of the RS-T segment (with transmural IM) or lower izolinia (with subendocardial lesion of the heart).

3. Zone of ischemia - "coronary" (equilateral and gostrian) tooth T (high positive with subendocardial IM and negative - with transmural IM).

Echocardiography is carried out up to the number of general viscous methods beforehand, which can be used for diagnostics of state-of-the-art and assessment of hemodynamic and structural breakdowns in case of a wide range of diseases.

Stagnation of myocardial scintigraphy technique with technetium is shown for verifying myocardial infarction, which is important in quiet cases, since it is very difficult in the interpretation of EKG changes, due to the blockage of the heart

If you know about the ischemic ailment of the heart, you need a mother on the next step:

1. Atherosclerosis of the coronary arteries is an anatomical understanding, as it affects the possibility of polymorphic ulceration of the coronary arteries.

2.Ismic ailment of the heart appears as such a camp of the coronary arteries, if morphological (structural) or functional breakdown to produce up to їх disadvantages. Stenosis of the coronary arteries is indicated as a result of concentric abnormal eccentric atheromatous changes in the diagnosis of vasospastic ailments of the coronary arteries, which do not show structural, but functional changes) (angiospasm). Possibly showing the transitional forms: secondary stenosis and vasospastic ailments of the coronary arteries.

3. Coronary deficiency is the main pathological mechanism, which is a superficial disease of the coronary arteries.

Vinikak yak naslidok:

1) rupture of іvnovagi mіzh by the need for myocardium in stenosis and delivery with stenosis of the coronary arteries;

2) a change in coronary blood flow in the case of vasospasm of the coronary arteries, which is carried out by the method of talin-201 or radionuclide ventriculography for an hour of spontaneous attack or viklicana ergonovin

3) porus in small (intramural) blood-bearing myocardial vessels. Ostann is characteristic of syndrome X (coronary heart disease without the resulting disease of the coronary arteries).

In such a rank, є the area of ​​myocardial ischemia, which can get sick through the coronary arteries, stenosis or cause vasospasm. The ischemia region is a heterogeneous zone, as it is in the blood from the other coronary arteries, and in addition to the non-ischemic fibers.

4. coronary disease heart - key syndrome, Yakiy manifest symptoms and signs of myocardial ischemia. The stage of the coronary artery and the functional significance of the coronary artery, brought by the methods of arteriography, can be used for additional electronic-digital technology.

Every hour before the test on the bike ergometer at 120-150 W of 14 minutes at the end of the test, the test on the test on the bicycle does not appear (as well as the equivalent symptoms and specific EKG signs of the onset of stenosis), then there may be some In vipadkas, if you think you get lost, you need to go to the coronary angiography. Negative coronary angiography results in angina pectoris.

On the basis of all types of pain in the chest wall, angina pectoris as a characteristic pain syndrome arises at the presentation of a detailed introduction of sub-active symptoms of ailments (the nature of an anginal pain), such as For angina pectoris, it is obvious that it should be given a dose of nitroglycerin (give it a stretch of 1 min). However, it is necessary for mothers in uvaz, so that the angina bile is manifested atypically.

Before atypical manifestations of angina pectoris, perspiration is considered for all atypical irradiation of angina pains: right shoulder, slit, nose tip, tongue tip, hard palate and throat, eyebrows, muscles.

Likewise, it’s a memory, which is equivalent to a typical anginous pain, but it can be a slow turn of the disease.

When carrying out differential diagnostics, they especially add: detailed nutrition, positive dynamics of specific EKG changes (ischemia), positive test for nitroglycerin (with one-hour clinical warning and regimen).

As there is no positive dynamics of the EKG, the more protracted character in the left half of the breast cell is indicated, either about the importance of the IXC (IM) form, or about the visibility of the ix connection from the IXC.

For angina pectoris, induce positive EKG data in the presence of depression (or even lower) of the ST segment more than 2 mm lower or less than the isoelectric line. It’s a lot of authors to see the thoughts, when a negative tine appears T before an hour of new tests can be analogous.

A test with physical navantages should not be carried out in the case of positive EHC donations in a calm state, but after receiving nitroglycerin, repeat the nasal test.

The death of the sub-active camp of the sick and the dynamism of the EKG changes, how to turn on the ischemia of an important step, to signal about the sharpening of angina pectoris, how to take special visits to your room. At this point, it is necessary to prescribe an adequate therapy and a post-bed regimen in order to overcome the development of unstable angina pectoris or myocardial infarction.

Unstable angina pectoris - transitional to the clinical form of mіzh stable angina and myocardial infarction.

Myocardial infarction- the most important form IXC. In the classic classical paintings of the middle characteristic signs of the house of the Gostr an anginozny bil, which is trivial 15 mins, or a protracted angina camp, which is trivial in years and days, like bathing only in narcotic lykarskiy zasobami... Characterized by the classic EKG changes, which develop according to the morphological changes (ischemia, malignancy, necrosis), and laboratory data (accelerated SHOE, hyperglycemia, malignant leukocytosis Appointed biochemistry and ECG are indicative of myocardial necrosis in patients with myocardial infarction.

Differential diagnosis of anginous pain and diagnosis clinical formІХС for angina pectoris, to reduce the risk of an angina pectoris, shortness, low temperature in case of myocardial infarction, clinical analysis, tachycardia, hips, hypertension, biochymic disorders, specific

Prothylenically on ІМ, navit at the outset of anginous pain, cause an unsupported belly (for no apparent reason) heart failure and collapse. However, a more detailed history of treatment is allowed to allow the patient to have an illness of ІХС. In the establishment of residual diagnosis, which is designated as IM, additional EKG specific changes and indications of biochemical data are added.

Anginous attack can be provocations (except for those who are already out of touch), as with ІХС, as well as with atherosclerosis of coronary arteries: tachycardia (be the cause), especially atherosclerotic high temperature debility, impaired metabolism (especially with thyrotoxicosis, anemia of an important stage and hypooglycemia), intoxication with nikotin, a sharp change of climatic minds (cold, hot alcoholic in high-class areas)

Decrease in perfusion coronary blood flow due to supportive syndrome of coronary insufficiency to change and shock the heart, which is especially affected: bradycardia, arterial hypotension, heart failure are swollen.

Differential diagnostics between angina pectoris and those with heart-vascular disease is carried out in the first place with these diseases, in case of which there is a coronary deficiency.

To them are admitted:

- congenital anomalies of the coronary arteries;

- congenital coronary arterial venous fistula;

- embolism of the coronary artery (fat, povitryana, chubby cells and in.);

- idiopathic arm dilatation legendary artery s legenevoy hypertension;

- stenosis of the legacy artery for any combination with Fallot's notebook;

- vrodzheni wadi sertsya with left-right shunts;

- timchasoviy prolapse of the mitral valve;

- urazhennya girl of the aorta (aortic stenosis, aortic insufficiency);

- mitral stenosis (important form);

- hypertrophic obstructive myocarditis and idiopathic hypertrophic subaortic stenosis;

- aneurysm of the heart;

- aortitis (including syphilic aorta);

- rheumatic heart disease and especially accelerated endocarditis;

- Gostry and chronic pericarditis;

- collapse of the heart rhythm, perspiration for all paroxysmal supraventricular tachycardia;

- first and second Legendary hypertension;

- ignition-allergic coronary;

- panarteritis of the aorta (Takayashi's ailment);

- regional thromboarthritis (Burger's ailment);

- higher education institution;

- mayzhe all systemic discomfort with the resulting fabric and collagenosis).

When carrying out differential diagnostics, it is important to remember that there is a great therapeutic potential for correcting coronary insufficiency in case of the named ailments, the first step is to treat the main ailment.

In the midst of vodzhenny and nabutih vad the heart is especially significant in the differential diagnostics may be such a discomfiture:

1. Congenital anomalies of the coronary arteries, in the first place, the abnormalities of the coronary arteries from the legacy arteries, even in the early childhood lead to coronary insufficiency. Deyakі authorize vvazayut, how unsupported "ailing screams" children lead to some kind of vice.

2. Congenital coronary arterial venous fistula can be the cause of anginous pain. Differential diagnostics have additional help in detecting coarse random noise in the precordial area. Prompt correction (dressing) of the fistuli to produce coronary symptoms.

3. Adding vices of the heart with the appearance coronary syndrome... On the thought of Bagatyokh authors, in particular in the stage of heart failure, there may be superficial angina pain, and in children it is the main sub-active manifestation of sickness.

4. The prolapse of the mitral valve may alternate with coronary insufficiency as a result of spasm of the coronary arteries. Speak to the corysty of all і before І. K. Shkhvatsabaia (1982), which means that the hour of coronary angiography and ventriculography as a result of a catheter tip until the coronary artery throat leads to spasm, which means that the papillary muscularischemia and the lack of a valve.

In ailments with intermittent prolapse of the mitral valve, anginous pains spontaneously occur in calmness, often supravodzhuyutsya zamorochennya, zadishkoy and EKG snaps, which cause ischemia and breakdown of the rhythm.

One of the many advances, including in Yugoslavia, is a hospitable therapeutic effect in the case of illicit illnesses to reach beyond the additional antagonism of calcium.

In addition, congenital heart defects, most often lead to an increase in the coronary blood flow, as well as to a significant (secondary) coronary insufficiency, such as:

- mitral stenosis,

- stenosis of the leg artery,

- heart defects with left-right shunts,

- hypertrophic obstructive myocarditis and idiopathic hypertrophic subaortic stenosis,

- first and second Legendary hypertension.

In the case of small types of swelling, the heart is more anginous in nature, it is developed with a growing frequency.

- aortic and aortic-metral defects - 40%,

- mitral stenosis, especially in children, 6.4%.

The greater the severity of the heart failure, the more often the more severe anginous bile.

On the thought of I. K. Shkhvatsabaia (1982), the method of coronary angiography is effective when stenosing atherosclerosis of the coronary arteries can be detected in case of severe heart disease. In such a way, the bulo was established, that there is the same idea of ​​aortic (17%) and mental (20%) heart defects in ailments. General information І. K. Shkhvatsabaia will explain that the main role in the pathogenesis of coronary syndrome in cases of heart disease is hemodynamic deficiency, and not the steps of atherosclerotic symptoms of coronary artery disease.

In case of aortic insufficiency, the appearance of anginous pain in the thoracic clitus with a low grip of diastoli and "wet" action on the coronary artery of the vortex blood flow in the hypertrophic myocardium of the lavage of the heart.

In case of aortic stenosis, including subaortic stenosis, the anginal bee is more pronounced as a result of a decrease in systolic and hemorrhagic blood loss in the minds of an abnormal consumption of a hypertrophic myocardium of a blood clotted lymph node.

In case of mental porosity of anginous pain, there is a stasis of blood in the coronary sinus as a result of an increased grip in the right atrium, as well as a decrease in shock volume and inadequate improvement in case of physical replacement.

Pericarditis (chronic and chronic) can be superficially painful in half of the breast, as a simulated angina pectoris.

Q large ear and progressively intense atypical localization in the thoracic clitus in case of severe pericarditis may simulate angina pectoris;

Differential diagnostics are difficult to present not only with pain syndrome, ale and accelerated SHOE, an increase in the number of leukocytes, as powerfully and important forms of ischemic ailments of the heart, myocardial infarction and pericardial infarction. However, it is less important for pericarditis, it is the first for all types of angiographic data (the heart is shown in the trapezium) and the significance of the EKG family, as they see the dynamics of the state, in addition to the differentiation

Chronic pericarditis;

- Pain in the half of the breast, as it appears in the viglyadi of tricky squeezing or pokryuvannya, і get stoked when the situation changes, for the change of weather minds;

- change the EKG, which is a difficult one (a steeply negative wave of T, "correct" to a positive one when it is added and immediately afterwards, to turn to the output level).

In case of differential diagnostics of the order with pointing signs of cinnamon pericarditis of a certain type, it is possible to indicate and predict the results of angiography (the manifestation of adhesion and the appearance of the vapna).

Embolism of the coronary arteries (fatty tissue, puffiness, puffin clumps) can lead to coronary insufficiency. In addition, in the case of differential diagnostics, it is necessary to remember about ethological factors, such as to produce a similar embolism of the coronary arteries.

lykuvannya

The system for the treatment of ailments for myocardial infarction was formed in Danish hour, including:

• specialty cardiological brigade of "shvidkoy auxiliary help" (pre-hospital stage);
• specialization of infarction with the block of intensive therapy for the indication of cardiooreanimation (hospital stage);
• special rehabilitation centers (for medical purposes and cardiological sanatoriums);
• cardiological consultative and diagnostic centers and cardiological cabinets of polyclinics (dispensary examination of ailments who have undergone IM).

The basic therapy, as it appears in all ailments on the IM with the Q wave, directly as a result of the presence of a quiet day, including come in:

• pain relief (analgesia);
• thrombolytic therapy (for individual indications and prototypes);
• antithrombotic and antiplatelet therapy;
• oxygen therapy;
• zasosuvannya anti-ischemic lykarsky zasobiv;
• sucking іngіbіtorіv APF and antagonists of receptors to angiotensin II.

Asthmatic variant of myocardial infarction (5-10%), which is against the type of heart asthma or a bunch of legends, often develop in individuals of a kidnapped or an old person at the same swelling of the myocardium. hypertensive ailments, Cardiosclerosis is not often at great transmural myocardial infarctions.

The asthmatic form of myocardial infarction is unpleasant and often ends with a lethal result.

Differential and diagnostic signs of myocardial infarction

… the problem of infarction before the end is not violated, the mortality rate of a new prodigal is.

Myocardial infarction, allergic and infectious toxic shock... Strong retrosternal bile, backwardness, depression of the arterial vise are symptoms that occur with anaphylactic and infectious-toxic shots. anaphylactic shock can be diagnosed with any kind of intolerance. An ear of ailment gostry, clearly confined to the causal factor (ін'єкція antibiotics, splintering with the prevention of infectious diseases, the introduction of antipravian syrovatka and іn.). Some ailments will be repaired in 5-8 days at the moment of iatrogenic involvement, develop like the Artyus phenomenon, in a certain heart, in the role of a shock organ. Infectious-toxic shock with lesions of the myocardium can be diagnosed with any important infectious diseases(Pneumonia, angina, etc.).

Klіnіchno zvoryuvannya duzhe nagadu myocardial infarction, as a result of ethiological factors, we will guide the eye. Differentiation of this type is important, in case of allergic and infectious and allergic diseases, there may be no coronary necrosis of the myocardium with coarse symptoms of EKG, leukocytosis, hypertension of hypertension, hypertension On the basis of a typical myocardial infarction, in such ailments on the EKG there is not a large Q wave and a larger QS complex, discordance of the bone part.

Myocardial infarction and pericarditis (myopericarditis). ethiological officials pericarditis - rheumatism, tuberculosis, viral infection(Partly Koksaki-abo Echo-virus), diffuse ailments from the resulting fabric. Pericarditis is not very common in ailments with chronic chronic nirk deficiency... In case of pericarditis, the process often involves subepicardial myocardial balls.

In a typical option, with dry pericarditis, there is dullness, it squeezes, more pain in the precordial area without radiating to the back, to the scapula, to the left hand, to myocardial infarction. Shui, rubbing the pericardium, is restructuring in the same days, when the temperature is increased, leukocytosis, and the increase in SHOE. It is strong, it is easy to hang out with a stretch of decilkoh days, tizhniv. In case of myocardial infarction, the murmur of rubbing the pericardium is short-term, in the year-round, overdue, feverish, abnormal SHOE. If a person with pericarditis has a heart failure, then there is a right-sided lunochkova or biventricular. For myocardial infarction, livoshlunochkova heart failure is characteristic. Differential and diagnostic value of enzyme tests is not great. In addition, the reduction of subepicardial myocardial spheres in patients with pericarditis may be restructuring hyperenzymemia of AsAT, LDH, LDH1, HBB, CPK and nav izoenzyma MV CPK.

Additional diagnostics of the EKG data. Pericarditis є symptoms of subepicardial auricularity in the presence of an elevated ST interval in 12 hypothetical cases (mute discordance, powerful myocardial infarction). The Q wave with pericarditis, on the view of the myocardial infarction, does not appear. The T wave with pericarditis can be negative, but it becomes positive after 2-3 times from the ear of the ailment. With the appearance of pericardial exudate, the characteristic old-fashioned picture is even more characteristic.

Myocardial infarction and lateral pneumonia... With pneumonia, there may be pain in the left half of the breast tissue, in one of the intensive cases. However, on the basis of precordial pain in case of myocardial infarction, the stench is clearly associated with symptoms and cough, not typical for myocardial infarction. Productive cough is characteristic of pneumonia. A cob of ailments (chills, fever, fever, bots, noise rubbing pleurisy) is absolutely not typical for myocardial infarction. Physical and radiological changes in the legends add to the diagnosis of pneumonia. EKG in case of pneumonia can change (low T wave, tachycardia), ale nicoli doesn’t get worse, but it’s like that in case of myocardial infarction. In case of myocardial infarction, in case of pneumonia, leukocytosis, an increase in SHEE, hyperenzymemia AsAT, LDH, and ale only in case of myocardial infarction may occur, the activity of HBD, LDH1, MVP1.

Myocardial infarction and spontaneous pneumothorax... With pneumothorax, there is a strong bile in botsi, bad-headedness, tachycardia. On the basis of myocardial infarction, spontaneous pneumothorax is superimposed with a tympanic percussion tone on the sides of the shock, weakening of dysfunction, radiological changes (gas microscopy, collapse of the legacy, changing the middle of the heart). EKG indices in spontaneous pneumothorax are abnormally normal, abnormally, there is a decrease in T wave leukocytosis, an increase in SHOE with pneumothorax is not bovine. The activity of syrovatkovykh enzymes is normal.

Myocardial infarction and slaughter of the breast... At the same time, I get severe pains in the breasts, a strong shock. The strus and slaughter of the breast cancer should be produced until the myocardium is lost, so that it is supervised against the ST interval, the negative T wave, and in important cases, the emergence of a pathological Q wave. CLINIC ASSESSMENT The hammering of the breast cancer due to the EKG's changes is guilty, but it is a serious problem, because of the lack of coronary necrosis of the myocardium.

Myocardial infarction and osteochondrosis of the thoracic ridge with compression... With osteochondrosis with korintsevym syndrome, pain in the chest cavity can be even stronger, unbearable. Ale, at the sight of pain from myocardial infarction, it stinks, if ailments are "stuck" in the affected position, and quickly adapt when turning the tulub and dichanna. Nitroglycerin, nitrate for osteochondrosis is not effective. flammable effect of analgesics. With chest "radiculitis", there is a local soreness in the paravertebral points, moving along the middle space. Number of leukocytes, SHOE, enzymological indicators, EKG in between the norms.

Myocardial infarction and operative lichen... Klinika operіzuvalnogo lichen velmi nagaduє described a vische (div. Description of symptoms of cortical syndrome in osteochondrosis of the ridge in the thoracic ridge). In some ailments, a fever may be restructed in the presence of a low leukocytosis, a decrease in SHOE. EKG, enzyme tests, as a rule, often add to the diagnosis of myocardial infarction. The diagnosis of "operative lichen" becomes reliable from 2-4 days of ailment, if in the course of the intercostal spaces there is a characteristic bulbashkov (vesicular) visip.

LEADING SYMPTOM - CARDIAC ASTHMA

Asthmatic variant of myocardial infarction in a clear view is very rare, often breathless with pain in the atrial region, arrhythmia, symptoms of shock. Gostra livoshlunochkova lack of accelerated heart ailments, including cardiomyopathy, valvular and congenital heart defects, myocarditis, etc.

In order to correctly diagnose myocardial infarction (asthmatic variant), the need for vrahovuvati is often a sign of sickness in other clinical situations. (1) in case of diagnosed syndrome of a gross livoshlunochkovo deficiency in case of a hypertensive crisis; (2) when they are diagnosed in individuals, who have suffered earlier myocardial infarction and suffer from angina pectoris; (3) in case of a discernible scent of ailments with any disturbance to the rhythm, especially with no reason for a tachysystole; (4) in the case of a previously repeated attack of heart asthma in an average person, kidnapped or an older person; (5) with the appearance of symptoms of "malignant" asthma in a patient with a kidney disease, a number of years of suffering from bronchogenic disease with bronchial obstruction episodes.

THE LEADING SYMPTOM - GOSTRA BELL in the stomach, FADINNYA ARTERIAL VISKU

Myocardial infarction and gostry cholecytesopancreatitis... With gross cholecystopancreatitis, as with gastralgic variation of myocardial infarction, there are strong pains in epigastric dileants, which are superficially weak, puffy, hypotensive. However, the pain in the presence of a gostromy cholecystopancreatitis is not localized only in the epigastria, but in the right side, up to the right, in the back, sometimes it can be operated. It is natural that there is a lot of nudota, blues, and moreover, there is a house of zhovchi in the bloody masses. On palpation, there is a soreness in the point of the cheek bone, the projection of the papillary zone, the positive symptoms of Kera, Ortner, Musset, but it is not typical for myocardial infarction. Abdominal pain, locally stress in the right upper quadrant is not typical for myocardial infarction.

Leukocytosis, malignant SHOE, hyperenzymemia AsAT, LDH may occur with both illnesses. With cholecystopancreatitis, an increase in the activity of alpha-amylase of blood and blood, LDH 3-5 is indicated. In case of myocardial infarction, it is necessary to focus on high indicators of enzyme activity of CPK, MV CPK, HBD.

EKG in case of gostromy cholecystopancreatitis can change. The price of a decrease in the ST interval in the row of a lead, a weakly negative or two-phase tooth T. N.K. Permyakov described on morphological material large-focal myocardial disease in patients with cholecystopencreatitis, often in cases of important pancreatic necrosis. For the life of the ailment, they were suffering from intense pain in the abdomen, dyspepsia, collapse. Zmini EKG buli infarction-like. The activity of syrovatous enzymes, including CPK, MV CPK, increased rapidly. Tsі danі pіdtverdzhenі V.P. Polyakovim, B.L. Movshovich, G.G. Savel'evim in case of spared ailments with gosstrim pancreatitis, cholecystitis in the presence of congestive diabetes. This gave rise to a non-coronary, metabolic, direct toxic effect on the myocardium of proteolytic enzymes, an imbalance of the kinin-callicrein system, and electrolytic damage. Large-focal metabolic rate of the myocardium is often the prognosis of pancreatitis, which is not often a leading factor in lethal outcomes.

Infarction of myocardium... Hospitality in the epigastria is typical for both illnesses. However, during the incision of the slunk, the pain in the epigastriya is unbearable, "dinghal". The maximum turn is - at the moment of a breakthrough, at the same time it spontaneously changes in intensity, the center moves to the right and down. The gastralgic variant of myocardial infarction pain in the epigastrium can be intense, but they are not characterized by a sting of gostre, there is a bit of a cob with a further decline, as when the puff of the slunk is broken.

When the cut through the slunk, after 2-4 years, at the moment when I break through, the symptoms change. In ailments with prorivnoy gastroduodenal virazkoy symptoms of intoxication; mova stak dry, zmіnyuєtsya viraz denouncing, yogo rice zagstryuyutsya. The old one lives absorbed, strained, the symptoms of teasing are positive, percussion appears to be "known" of the liver dullness, radiologically appears to appear as we rule the dome of diaphragms. The temperature may be subfebrile with both illnesses, as it is itself and a small amount of leukocytosis with a stretch of the first dobi. Increased activity of syrovatkovyh enzymes (LDH, CPK, MV CPK) is typical for myocardial infarction. EKG, when probitty to the twisting ailment of the shlunka, by extending the first doby, as a rule, do not change. On the coming day, there may be a change in the end of the day for the rakhunok of the electrolyte debris.

Myocardial infarction and cardiac cancer... In case of cardiac cancer, it is not easy to detect intensively to squeeze pains in the epigastriya and the past sword-like, Scho get along with the transitory hypotonia. For viklyuchennya gastralgic options for myocardial infarction in such cases, an EKG-dosage is carried out. On the EKG, there are changes in the ST interval (often depression) and T wave (Isoelectricity or weakly negative) in III, avF introduced, which is a drive for diagnostics of small-focal posterior myocardial infarction.

On the basis of myocardial infarction with cancer of the cardiac epigastric pain, it is regularly repeated every day, the stench is associated with the reception of the patient. SHOE to improve with both diseases, protein dynamics of the activity of enzymes CPK, MV CPK, LDH, HBD is characteristic only for myocardial infarction. In case of cancer, the EKG cardia "caught", it does not go through the dynamism characteristic of myocardial infarction. The diagnosis of cancer is to be clarified. in the first place of the FGDS, the radiological preliminaries of the shlunny in the lower positions of the pre-juvenile, including the antiorthostasis.

Myocardial infarction and kharchova toxicoinfection... When both are ill, there are pains in the epigastria, an arterial grip falls. However, there was b_l in the epigastria with nudota. bloody, hypothermic more typical for grub toxicoinfections. Diarrhea is not expected to develop in case of gross toxicoinfections, but not in case of myocardial infarction. EKG in case of gross toxicoinfections, for no change, for an hour until the end of the day. " electrical damage"Y viglyadі koritopodіbnogo zmіschennya down іntervalu ST, slabkonegativnim abo іzoelektrichnogo T wave Laboratornі doslіdzhennya at harchovoї toksikoіnfektsії pokazuyut pomіrny leukocytosis, eritrotsitoz (zguschennya krovі), small pіdvischennya aktivnostі ALT, AST, LDH without іstotnih Change log aktivnostі CPK, CPK MB, HBB vlastivih myocardial infarction.

Infarction of myocardium and gostre damage to mesenteric blood circulation... Bil epigastriya, the fall of the arterial vise is recognized with both illnesses. Difficult differential diagnosis is accepted by those who thrombosis of mesenteric vessels, such as myocardial infarction, the enemy, as a rule, people who have been kidnapped with different clinical manifestations ІХС, s arterial hypertension... With impaired blood circulation in the system of mesenteric vessels, the pain is localized not only in the epigastrium, but in the whole stomach. Lives well, no sounds of intestinal peristalsis appear on auscultation, more symptoms can appear in a tease. To clarify the diagnosis, then to carry out an oglyadovy radiography black emptyі visibility of visibility or visibility of intestinal peristalsis і gas collection in intestinal loops. The impairment of mesenteric blood circulation is not supervised by the changes of the EKG and enzyme indicators, characteristic of myocardial infarction. When twisting in the diagnosis of thrombosis of mesenteric vessels, pathognomonic changes can be detected during laparoscopy and angiography.

Myocardial infarction and cranial aortic aneurysm... In case of abdominal dissecting aortic aneurysm, gastralgic variance of myocardial infarction appears in the form of dissecting aortic aneurysm, characteristic signs (Zenin V.I.): an ear of ailment with pain in the breasts; sickly nature of pain syndrome with irradiation across the ridge; the appearance of a plump-like illumination of elastic consistency, pulsing in sync with the heart, the appearance of a systolic noise over the cym, a plump-like illumination; growth of anemia.

When the symptom is interpreted “ gostry bil in the epigastriya "in the case of hypotensive diagnostics during the differential diagnosis of myocardial infarction of the mother's need for high and high incidence of ailments. GOSTR adrenal insufficiency; opening the liver, spleen or hollow organ in case of injury; syphilitic tabes of the spinal cord with tabetic shlunkovy crises (anisocoria, ptosis, reflex numbness real apples, Atrophy of the healthy nerve, ataxia, visibility of colonic reflexes); abdominal crises with hyperglycemia, ketoacidosis in ailments with diabetics.

LEADING SYMPTOM - "infarction-like" electrocardiograms

Non-coronary necrosis of the myocardium It can be diagnosed with thyrotoxicosis, leukemia and anemia, systemic vasculitis, hypotharyngeal hypertension. In the pathogenesis of non-coronary necrosis of the myocardium, there is an imbalance between the need for myocardium in oxygen and its delivery through the system of coronary arteries. In case of thyrotoxicosis, metabolic nutrition increases rapidly without adequate disease. In case of anemia, leukemia, diabetes mellitus (coma), gross metabolic damage occurs in cardiomyocytes. Systemic vasculature can lead to gross destruction of microcirculation in the myocardium. at gostrich otruєnnyah vinikaє straight toxic lesion myocardial cells. The morphological day of the myocardial damage is similar in all types of diseases: there are many different types of necrosis of cardiomyocytes.

Clinically, on the basis of the symptomatology of the main ailment, there is pain in the heart, an hour is strong, bad. tribute laboratory dosages they are not very informative in differentiation of non-coronary necrosis from myocardial infarction of atherosclerotic genesis. Hyperenzymemia LDH, LDH1, HBB, CPK, MV CPK amazed with myocardial necrosis with such unacceptable etiology. On the EKG with non-coronary necrosis of the myocardium, there are changes in the endocytic part - depression abo, more, elevation to the ST interval, negative T waves, with a further dynamism, as a result of a non-transmural An accurate diagnosis is established on the basis of all symptoms of illness. Only this kind of thinking gives you the ability to methodically correctly assess vlast heart pathology.

Myocardial infarction and swelling of the heart (primary and metastatic)... With swelling of the heart, there may be more intense pain in the precordial area, resistant to nitrates, heart failure, arrhythmias. On the EKG - pathological Q wave, eleviation to the ST interval, negative T wave. Sertseva lack, refractory arrhythmias to lіkuvannya. Diagnosis will be clarified with a retinal analysis of clinical, radiological and echocardiographic data.

Myocardial infarction and posttachycardiac syndrome... The posttachycardial syndrome is an EKG-phenomenon, which rotates in the immediate ischemia of the myocardium (depression to the ST interval, negative T wave) to suppress tachyarrhythmias. Denmark symptom complex needs to be assessed more carefully. In a word, tachyarrhythmia can be a cob of myocardial infarction, and the EKG is often deprived of symptoms of infarction. On the other hand, an attack of tachyarrhythmia of such a world will destroy hemodynamics and coronary blood flow, but it can lead to the development of myocardial necrosis, especially when there is a combination of defective coronary blood circulation in patients with stenotic coronary atherosclerosis. Otzhe, the diagnosis of posttachycardial syndrome is reliable for the diagnosis of illness from the dynamics of clinical, echocardiographic, laboratory data.

Myocardial infarction and early repolarization syndrome... The syndrome of early repolarization of small chicks rotates in the ST interval in the Wilson introductions, which should be repaired from the J point (junction), which is rocked in the lower number of striations of the R wave. healthy people, Athletes, ill with neurocirculatory dystonia. To establish the correct diagnosis, the nobility needs to know about the EKG phenomenon - the syndrome of early repolarization of shlunochki. With a wide syndrome of myocardial infarction, the dynamics of the EKG does not occur.

Do you see myocardial infarction - what kind of ailment is it laid down in the basis of the classification of ailments? An infarction is called the development of tissue due to necrosis, i.e.

characteristic signs Typical form of myocardial infarction є Intensive swelling of the retrosternal bladder (medically viznachennya - anginous), yak irradiation between the shoulder blades, in the arm, ribs or slit and do not know about analgesic drugs.

Infarction can occur in other internal organs, but most often it is myocardial infarction. Well, why should I see? Through the functional significance of the heart and the great consumption of heart meat in sour, myocardial infarction develops even more quickly and is superfluous with non-vascular inheritance. A spike of different types of myocardial infarction, skin diseases in the clinic has been created.

5 types of infarction for the classification of the All-Russian Cardiological Federation

The main classification of myocardial infarction in Danish hour is prepared sleeping group of the All-Russian Cardiological Federation of Classification, de the principle of a comprehensive approach to the cause, pathogenesis and clinical manifestations of pathology is laid down in the basis. In such a rank, myocardial infarction is divided into 5 types:

• type 1- spontaneous myocardial infarction, the cause of which is the primary deterioration of the coronary blood circulation, for example, the destruction of the coronary artery, the erosion of atherosclerotic plaque in the education, the development of the lack of judgment, i.e.
• type 2- Secondary myocardial infarction, which is due to lack of blood circulation in cases of coronary spasm or thromboembolism of the coronary artery. Besides, possible reasons to another type - anemia, impairment of adequate perfusion (pumping) of blood, impaired arterial grip, arrhythmia;
• type 3, Abo Raptova coronary death, wiclicana gostra ishemia in some cases, the system of the heart is carried out with damage - blockade of the left lower part of the Gis bundle with characteristic signs on the EKG;
• type 4 last for 4a - accelerated coronary engagement (balloon angioplasty, stenting) and 4b - accelerated coronary engagement, associated with stent thrombosis;
• type 5- myocardial infarction, dressings with coronary artery bypass surgery. It may be as early as the hour of the operation, as well as at the sight of a slower pace.

4 and 5 types are responsible for iatrogenic, i.e., provoking by the actions of the lycaria the damage to the heart blood circulation.

Arbitration methods for diagnostics of ECG (electrocardiography), echocardiography (ultrasound of the heart), as well as the identification of specific markers in the blood.

Classification of myocardial infarction by stages of development

A great part of all organic changes in the heart in case of infarction occurs in the first few years when the ear is attacked. In the protested infarction of the heart mellitus, there is a sprinkle of periods.

1. most recent period- the first few years from the ear will attack. At the end of the hour, the maximum ischemia is determined, the bend of the cells is repaired, the compensatory mechanisms are activated. An important moment in the treatment of infarction є additional help itself in the whole period - by expanding the judges and giving the myocardium more sourness, it is possible to help the masovan bend the clitin.
2. gostry period- repaired through six years to attack and three times to two times. At the end of the period, it is necessary to be more careful with the living indicators of the sick, so as a high risk of repeated infarction. In addition, during the therapy with fibrinolytics, it is possible to develop rather accelerated - reperfusion syndrome. Wines are characterized by even greater heart disease and necrosis due to rapid renewal of blood circulation in the region. In addition, the blood flow is reduced by and large, and the tissue is eliminated by the radicals from the blood.
3. pidgostry period- from two days to two months. In a whole hour, a heart deficiency is formed, since the pumping function is greatly reduced through the development of a robotic area of ​​necrosis. In 35% of patients in the whole period, Dressler's syndrome develops - an autoimmune reaction of the body to necrotic tissue, which leads to the death of the patient. Such a stan- dard can be bought with drugs that will bring specific antibodies to myocardium.
4. period of scarring- to repair from the end of the period until the scar is formed on the site of necrosis. The power of cicatricial tissue is not similar to the power of the heart meat, it is no longer possible to determine its function in the general public of the heart - as long as it will form a strong heart inadequacy, as it is to be saved every day. Є Imovіrnіst of stinking of the heart in the area of ​​scar, tearing of the heart with significant physical changes.

There is a great part of all organic changes in the heart when an infarction occurs in the first few years when the ear is attacked.

Anginal and atypical form and myocardial infarction

Rozpodil on the form is seen according to the main symptoms of illness. The characteristic signs of a typical form of myocardial infarction are intense heaving of the retrosternal beads (medical viznachennya - anginosal), yak irradiation between the shoulder blades, in the hand, ribs or slit and do not know about analgesic drugs. Tsey stan supervises arrhythmia, weakness, tachycardia, tediousness, pidvishheno pitlivistyu. Infarction, which can manifest such types, is called an anginal form - after the name of the pain syndrome.

Інші forms, with any kind of clinical manifestation, you do not lose sight of the classic bookish picture of becoming ill. To them are admitted:

• abdominal form of myocardial infarction- symptom complex nagaduє gostry pancreatitis. Patient skarzhitsya for pain in the stomach, zduttya, nudota, booze, blues. Strong beating at the same time, like at typical infarction, Do not know antispasmodics and analgesics;
• asthmatic- through rapidly progressing heart failure, symptoms develop, similar to bronchial asthma, mainly because of the bad;
• the painless form is typical for people with diabetes- through a high blood glucose indicator, pain sensitivity is muffled. There is one of the best forms of insecurity, since there is little symptomlessness when there is a loss of malignancy for medical assistance;
• cerebral, abo mozkov form- for non-typical waste of svidomosty, zamorochennya, cognitive problems, problems with spirits. In general, myocardial infarction can be easily mistaken for a stroke;
• kolaptoidny form- as the inheritance of cardiogenic shock i razkogo fadinnya arterial grip of vinikє collapse, ailments vidchuv zapamorochennya, darkening in the eyes, strong weakness, can reduce the evidence;
• peripheral- characterized by a special irradiation pain in the throat area, knots or fingers, the ridge, with a lot of pain in the heart, it is weakly rotated, or in the middle of the day;
• arrhythmic- the main symptom is arrhythmia;
• bulged- a quick development of the heart failure before the appearance of extra-cardiac manifestations: bumps on the legs and arms, backside, ascites (ridina in the empty stomach).

Atypes can form one by one, as well as anginal infarction.

For the data of the EKG, it is possible to notice the steps of myocardial necrosis, to make a defect, to assess the conductivity, wakefulness and power of the heart meat.

anatomical classifications

So, as soon as the heart grows, it’s growing in blood, and it’s possible to develop a forecast. For the anatomy of the battle, see the onset of the infarction:

• transmural- the whole tovshchina of the heart meat is entangled with necrosis;
• intramural- the mid-point of retouching in comrade walls, most often of a lynch, with a whole endocard and epicard, does not shrink;
• subendocardial- in the presence of necrosis of rosetting with a vuzkoy brute for endocarditis, often on the anterior stage of the louse;
• subepicardial- do not pour the heart onto the glib balls, develop immediately before the last shell - epicard.

Vyhodyach from the anatomical growth and the size of the necrosis, to see the myocardial infarction, which is transmural, as well as Q-infarction. Name to resemble due to specific EHC sign this type of myocardial infarction - with a new saving Q wave.

There are three options for reshta before the debris strike, not with the Q wave on the cardiogram, which may be called non-Q-infarctions.

There is one more classification in the localization of necrosis in the anatomical views of the heart:

• myocardial infarction- be the most frequent. Falsely from the uzhenoi stinka razryznyayut more front, bichne, bottom and rear rasstashuvannya;
• Isolation of upper heart infarction;
• septal infarction- the area of ​​urazhennya є mіzhshlunochkovo ї partitions;
• myocardial infarction of the right shlunochka- to develop in the edge of the heart, as well as striking the back of the heart.

You can change localization.

diagnostics of illness

Arbitration methods for diagnostics of ECG (electrocardiography), echocardiography (ultrasound of the heart), as well as the identification of specific markers in the blood.

During anatomical growth and the size of necrosis, they see myocardial infarction, which is transmural, as well as changes in Q-infarction. The name resembled because of the specific EKG sign of this type of myocardial infarction - with a new wave of savings Q wave.

For the data of the EKG, it is possible to notice the steps of myocardial necrosis, to make a defect, to assess the conductivity, wakefulness and power of the heart meat.

Echocardiography s'єдnu classic EKG s ultrasound diagnostics the heart and the stasis of the Doppler effect for the visualization of the blood streams in the middle of the heart. Such a regimen permits treatment is necessary for assessing the inheritance of hemodynamic infarction, valvular insufficiency, and regurgitation of blood mass. EchoKG also allows the exact localization of necrosis in the field of necrosis.

Biochemical analysis of blood to serve as residual confirmation of diagnosis. For the ruining of myocardial cells, proteins and enzymes are seen (troponin, CPK-MV, etc.). The stench is indicative of the specificity of necrosis, that is, roztashuvanny vognischa itself in the myocardium.

All re-insurance of the classifications will help to accurately determine the type of myocardial infarction, virobite the principle of approaching the skin from them, assess the necessary treatment and further rehabilitation, as well as the most frequent prognosis.

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Є an attack of severe pain in the area behind the sternum. In such cases, the diagnosis of malaise is carried out in a practical and uncomplicated manner, so that the therapy of the pathological camp can be safely started. To eat, myocardial infarction manifests itself absolutely atypical for an ailment and in patients with a disease there are a number of symptoms, as an hour the signs of illness of visceral organs can be detected. Also, how are there any atypical forms of myocardial infarction and how much?

A factor to take advantage of the development of atypical forms of IM

Atypes of the form of myocardial infarction occur more importantly in people with a kidney disease from genetic schism to atherosclerotic lesions of vintsevian vascular disease. The development of an anomalous clientele is a number of factors, the middle:

• bends of cardiosclerosis;
• lack of coronary blood circulation;
• Diabetes mellitus;
• atherosclerosis sudin;
• arterial hypertension;
• experienced heart attack in the past or a history of the patient.

Options for overcoming ailments

It is well known that statistically diagnosed myocardial infarction, the development of what appears to be a classic variant of ailments, is diagnosed in the tenth patient's skin with a diagnosis of cervical necrosis. As a rule, an illness on the very cob of its development is disguised as a disease of visceral organs, otherwise it is practically asymptomatic, without a clearly pronounced pain syndrome.

Before atypical forms of myocardial infarction, it is possible to carry out:

• abdominal;
• arrhythmic;
• asthmatic;
• kolaptoїdny abo painless;
• asymptomatic;
• peripheral;
• bulged;
• cerebral;
• combined.

1. The abdominal form of myocardial infarction is characteristic of patients, in some wineries, necrosis, lying down to diaphragms, and provoking the development of symptoms similar to the manifestations of lesions on the side herbal tract... For a given option, ailments are characteristic є such symptoms:

• I have a pain in the abdomen, especially in the epigastric period or along the right costal arch in the zone of the projection of the liver and cheeks;
• nudota, blues are swirled;
• intestinal flatulence;
• sharp swelling of the abdomen;
• constipation or carrying.

Naybіlsh often abdominal infarction against the mask of hostile pancreatitis. Viscitic necrosis of the myocardium is possible behind the help of the EKG-dosage, as well as for an hour to look around, if the muscle tone of the anterior cervical syndrome is diagnosed and the damage in the robot heart is in the middle of the depression.

1. The arrhythmic variant of becoming ill is caused by minimal manifestations of pain syndrome during development of abnormal heart wire. Patients on the first plan will have signs of paroxysmal tachycardia, atrio-ventricular blockade and other pathological stances. To further symptoms, it should be set even more seriously and do not forget to differentiate from the arrhythmic form of IM.

1. The asthmatic form of myocardial infarction is very important in people with kidney disease, it is not overwhelming in all statuses. Often this variant of illness is a relapse of the necrosis of the heart meat, so in this case it is not possible to draw in any sickness. Patients with ailment have to repent for an attack of a zadishka, yak vinykє to vidikha and duzhe nagadu bronchial asthma... Zadishka often coughs due to erysipelas sputum.

1. Bezbolova ischemia or colapsed myocardial infarction is an atypical form of overcoming ailments, for which the central function of the central nervous system, Ikі turn around in zapamorochennі, before fainting camps and rozladami zoru. Pain-free myocardial infarction is absolutely painless on a small blood pressure, allowing the suspicion of myocardial infarction.

The painless options for myocardial necrosis are rare. Most of the classmates have a sick child who is sick with diabetes. Yak vіdomo in lіtnіh people and diabetics big porig There are a few reductions in the number of receptors. The very same pathological manifestation is associated with a painless form of myocardial infarction and development of a colaptoid stance.

1. Symptomless or erased the form of ailment - the most advanced version of the development of ailments, which diagnoses quite quickly, even more easily, to bring to the conclusion of important morbid morbidity and sutta the health of ailing people. For asymptomatic form, the main symptoms are dominant. The ailment simply sees a slight lack of strength or a lack of strength, so that a disaster will happen in your heart.

Being caught up in a large number of vypadkіv roztsіnuєtsya as a manifestation of a banal cold or even on robots. Patients will be able to brighten up the meaning of such destruction, and I will become healthy. They do not care about the need to commit themselves to quality medical aid.

1. Peripheral IM is characterized by the appearance of an atypical pain for an affliction, as a result of a disease in the places of a possible irradiation without the presence of the primary pain. For example, in Bagatikh patients, who suffered from peripheral necrosis of the myocardium, the algic syndrome manifests itself in the throat and nagadu angina. Likewise, it is possible to start depriving it in the urine of a little piece or a spatula, without seeing it in the area of ​​the heart.

1. The form of myocardial infarction develops in patients with signs of heart failure. In such ailments, on a small scale, there is a lot of swelling, a few local ones, and sometimes it is great. Massive build-ups are supercharged with a growing backwardness, growth in the size of the stove and purchased goods in black empty spaces.

1. The cerebral variant of ailment is similar to the lack of cerebral blood circulation. In a sick people, vinikє is more soiled, as you can lead to an uncomfortable body. In some cases, the children diagnose the deterioration of the movement and weakness in the children. Frequently, these symptoms are detected, such as nudota, bloating, and the appearance of a dark stake in front of the ochima.

The cerebral form of myocardial infarction is nagadu kolaptoidny variant of discomfort, as well as can be pomilkovo roztsinena, like a cerebral stroke.

On the basis of the ischemia of the central nervous system in cerebral infarction, there are no functional and organ damage from the side of the brain.

1. Combinations in cognitive necrosis m'yazovoy fabric The heart is not often in the classroom practice. With a wide range of options for the development of sickness, the patient is diagnosed with atypical atypical forms of the pathological camp, which is even more advanced in diagnostics. We will broaden the expansion of the combination of infarction, if the ailment lays on pain in the abdominal area (a symptom of abdominal form) and more severe congestion due to cloudy symptoms (typical for the cerebral version of the ailment).

It’s a pity, it’s an hour to find a doctor who didn’t need a combined form of atopic infarction. The very fact is a response to the signs of an adequate treatment and an increase in the development of the development of a slower heart beat.

specialties of diagnostics

Atypes of options for myocardial infarction to complete the fold in diagnostics, which is explained by a hackneyed or disguised pathological setting, is a key picture on the cob of development of an affliction. The very fact that all patients who are undergoing a breakdown in the robotic heart-vascular system need to record an electrocardiogram, in order to allow the appearance of zones of ischemia of the heart muscle.

EKG in case of small focal myocardial infarction in the upper and anterior wall of the lynx

Most folding in the plan of diagnostics є arrhythmic form of myocardial necrosis, to explain the restoration of the arrhythmia on the EKG, yak gave the mask a sign of an infarction. At the connection with the cym in case of any kind of arrhythmic disturbances, there is a chance to know the attack of the broken rhythm, and then to write down the repeated electrocardiogram of the heart for the correct setting of the true stand.

Oscillations of atypical forms of myocardial infarction occur when internal organs are affected, patients of the EKG crim must go through a number of times before they allow them to fail and confirm the diagnosis:

• ultrasound detection of organs in the black empty;
• computer tomography dosage to organism;
• cerebro abo electroencephalography;

By virtue of the circumstances, it is often impossible to diagnose atopic infarction for an hour. That does not expect to be thrown into an hour for the opposite reason, as it will allow the zone of necrosis to be enclosed.

What should be done with the appearance of typical symptoms?

When symptoms appear, such as a type of atypical options for overcoming myocardial infarction, it is not possible to engage in self-diagnosis and more self-diagnosis.

To navigate at the highest dosages for a diagnosis is a sign of necrosis in the heart of the heart;

As a rule, when I look around, a patient with an adolescent for a broken function of the heart is assigned an EKG, as it allows the importance of myocardial infarction and hospital therapy to seize people at an intensive pace.