Acute myocardial infarction. Myocardial infarction with ST segment elevation, with Q wave (transmural). I22 Recurrent myocardial infarction

Acute myocardial infarction is the necrosis of cardiac muscle tissue in a certain area due to impaired blood circulation.

Acute myocardial infarction – ICD-10 code I21 – is one of the main causes of death in young and old people. Often the lesions presented lead to.

Causes

The work of the human heart is a constant contraction of the myocardium, which guarantees the normal delivery of oxygen and nutrients, so necessary for tissues vitally important body. Thanks to the presented work of the heart, important metabolic processes occur in cells in the human body.

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Through the presented significance, a person's heart should work smoothly. But often unpleasant moments arise in the form of oxygen starvation of the tissues of the heart muscle, which provokes the occurrence of a pathology characterized by irreversible changes occurring in the aorta and coronary arteries.

In the case when a lack of blood occurs, but it does not acquire critical levels, the sick person begins to develop reversible ischemia. Such phenomena are accompanied by angina pain, which is localized behind the sternum.

If a person has complete absence blood flow, then the accumulation of toxic metabolic products begins, which should not happen with normal blood circulation. In order not to stop work activity, the heart switches to an anaerobic mode of operation, where it begins to use its internal energy reserves.

Energy reserves run out after about 20 minutes, as a result of which the area of the heart muscle that is drained of blood due to impaired blood circulation dies. Such heart lesions are called myocardial infarction - tissue necrosis.

Tissue necrosis can be of different sizes, which depends on the level of vessel occlusion, the rate of ischemia, the age of the patient and other factors.

Also, the causes of tissue necrosis due to impaired blood circulation include:

In connection with the above facts, a person should be attentive to his health and begin immediate treatment if at least one factor is identified.

Kinds

Myocardial infarction is divided into several types, including:

Depending on the type of damage to the heart muscle, it may differ exactly further treatment the patient and his recovery.

Diagnosis of acute myocardial infarction

During the diagnosis, the doctor finds out from the patient all the prerequisites that could lead to such disturbances in the functioning of the heart.

Among other things, laboratory and instrumental studies, among which are:

Anamnesis	the presence of chest pain that the patient had previously experienced is clarified ( important factor to diagnose a heart attack is the presence pain syndrome behind the sternum for 20 minutes or more); the criteria for the existing pain syndrome are important here - duration, frequency of occurrence and other factors; During the examination, the patient may be diagnosed with excess body weight, beginning signs of blood pressure and other factors.
	Includes a blood clinic to look at increased white blood cell counts and increased ESR, and blood biochemistry, on the basis of which indicators are recorded increased activity enzymes, creatine kinases, myoglobin, electrolyte levels, iron and other enzymes.
Instrumental research methods	, EchoCG and coronary angiography. The presented research methods make it possible to identify the localization of the necrotic focus, impaired contractility of the affected ventricle, narrowing or blocking of blood vessels.

The presented examinations are carried out on the first day the patient visits the doctor. Here it is important to correctly “read” the results in order to determine the nature and extent of the damage.

Treatment

Emergency care for acute myocardial infarction is carried out in the following sequence:

the patient must be provided with complete rest;
the person needs to be given nitroglycerin and Corvalol orally under the tongue;
try to transport the patient to the cardiac intensive care unit as quickly as possible.

As a rule, the patient should be transported by an ambulance, which must be called as soon as the patient complains of chest pain.

Treatment in the hospital department is as follows:

To begin with, the patient's pain is relieved using strong narcotic analgesics and antipsychotics.
If the cause is blockage of a coronary vessel by a blood clot, treatment is used to dissolve it. Here special thrombolytic agents are administered. The presented method should be carried out within the first hour after the onset of the attack, since delay leads to damage to a larger area of the heart muscle.
Antiarrhythmic drugs are prescribed and administered to the patient.
Treatment should be aimed at improving metabolic processes in the heart muscle.
Treatment is aimed at reducing the volume of circulating blood, which significantly reduces the load on the heart.
If necessary, apply surgical methods treatments, which include balloon angioplasty of the coronary vessels, the introduction of a stent, coronary artery bypass grafting, which allows you to bypass the damaged vessel by creating a new blood flow path.
The patient is prescribed anticoagulants, which help reduce blood clotting and act as a.

All treatment is carried out only under the supervision of specialists who try in every way to prevent complications from occurring.

Complications

Myocardial infarction leads to complications, including:

	Here specialists can diagnose atrial fibrillation which can lead to sudden death of the patient.
	It is characterized by disturbances in the activity of the left ventricle, which are associated with blood pumping. This type of failure can lead to death due to a sharp drop in blood pressure.
Pulmonary embolism	It provokes the development of pneumonia or pulmonary infarction, often ending in the death of the patient.
Cardiac tamponade	Leads to the death of a person due to a rupture of the heart muscle at the site of the lesion and a breakthrough of blood into the pericardial cavity.
in an acute form of manifestation	Explains the dangerous bulging of the affected area of scar tissue that occurs with a large heart attack. The aneurysm subsequently leads to heart failure.
Thromboendocarditis	A complication that is diagnosed by the deposition of fibrin on the inner surface of the heart. The detached fibrin leads to stroke or mesenteric thrombosis, which subsequently leads to necrosis of the intestine or kidney damage.
Post-infarction syndrome	It is a generalized diagnosis of long-term complications.

It is precisely because possible complications the patient must remain in hospital until liquidation acute period myocardial infarction.

Stages of rehabilitation

Rehabilitation of the patient occurs in three stages, which include:

The time for treatment and recovery depends on the nature and extent of the lesion. Thus, patients are divided into class I-III - patients with uncomplicated myocardial infarction and class IV - patients with complications, which, in turn, are divided into three groups - mild disorders, moderate and severe.

At the inpatient stage, in addition to the administration of medications, the patient undergoes a course of exercise therapy, which is based on achieving such goals as improving mental state patient, breathing, cellular nutrition and blood circulation of the heart, prevention of work disorders internal organs, elimination of muscle tension and subsequent and gradual increase in exercise tolerance.

Physical activity is compiled based on the patient’s functional class, where 4 steps are distinguished, which include:

First stage	This implies the patient’s ability to turn on his side, independently use a bedside table and a bedpan, eat in a sitting position and sit on the bed with his legs down for several minutes.
Second stage	Includes the patient's ability to sit up on a bed for 20 minutes and independently transfer to a chair.
Third stage	Characterized by the ability to independently walk around the ward while eating and sitting on the bed for a long time or without any restrictions. Exits to the stairs with independent walking up one flight of stairs are also possible.
Fourth stage	The patient’s ability to walk along the corridor without restrictions, climb one floor and complete self-care is noted.

During post-inpatient rehabilitation, the patient faces slightly different tasks, which include:

it is important to try to restore the previous functions of the heart;
preventive actions for coronary heart disease are used;
are used various methods to increase stress tolerance;
methods are used for social and everyday adaptation;
rehabilitation actions are aimed at improving the quality of life;
careful reduction of doses of medications used is practiced.

When rehabilitating a patient in sanatoriums and special rehabilitation centers, regular group classes are used, which include a set of exercises to restore and strengthen all muscles, and exercises for attention and coordination of movements are used.

Exercises, as far as possible, are carried out sitting or standing; in the future, weights weighing up to 5 kg are used.

Danger of relapse

Myocardial infarction is dangerous because it occurs within the first three days to two months after the damage to the heart muscle has occurred. The cause of relapse is repeated disruption of blood flow to the affected area.

To prevent this from happening, the patient must adhere to the following rules:

We will talk about the chances of survival and the consequences of an extensive myocardial infarction in.

We will tell you what placental infarction is and why it is dangerous for a pregnant woman.

Timely consultation with a doctor, accurate and correct diagnosis, compliance with all the instructions of specialists and careful attention to one’s health will help a person recover from heart damage and return to his previous life of work.

Limit physical activity	Compliance with the doctor’s recommendations must be carried out unconditionally. That is why, at first, the patient is under the supervision of a specialist in a hospital, where he is provided with complete peace.
Stick to proper nutrition	You should stop eating fatty foods and give preference to more plant-based foods. It is important to reduce the consumption of foods high in cholesterol, since such a diet will again lead to the formation of a blood clot and re-injury.

in accordance with ICD-10, it identifies the following:

121 - Acute myocardial infarction, specified as acute or established

lasting 4 weeks (28 days) or less after acute onset:

121.0 - Acute transmural infarction of the anterior myocardial wall.

121.1 - Acute transmural infarction of the lower myocardial wall.

121.2- Acute transmural myocardial infarction of other specified localizations.

121.3 - Acute transmural myocardial infarction of unspecified localization.

121.4 - Acute subendocardial myocardial infarction.

121.9 - Acute myocardial infarction, unspecified.

122 - Repeated myocardial infarction (including recurrent myocardial infarction):

122.0 - Repeated infarction of the anterior myocardial wall.

122.1 - Repeated infarction of the lower myocardial wall.

122.8 - Repeated myocardial infarction of another specified location.

122.9 - Repeated myocardial infarction of unspecified localization.

Section 123 includes complications of myocardial infarction.

Since the specified nomenclature does not fully satisfy clinical requirements, then

Currently, the classification of myocardial infarction based on the international

classification of ischemic heart disease. It is based on taking into account several characteristics. First of all, it's size and depth

necrosis. In accordance with these, all heart attacks are divided into Q heart attacks (large focal) and heart attacks

myocardium without Q wave (small focal). In addition, transmural infarction,

subendo- and subepicardial infarctions. The presence of these options is determined by the depth and localization

zones of necrosis.

In its development, myocardial infarction passes through a number of periods. This is the most acute stage, acute

period, subacute period and scarring stage.

The most acute stage includes the period from the onset of pain to the appearance of the first signs of necrosis

myocardium. It ranges from 30 minutes to 2 hours. The acute period lasts from 2 to 14 days and is

the time during which the final development of necrosis and myomalacia occurs. In subacute

period, which lasts 4-8 weeks, the zone of necrosis is delimited by inflammatory

leukocyte shaft and the processes of resorption and replacement of necrotic tissue begin.

Finally, the scarring stage can occur for the remainder of the time required for formation.

connective tissue scar. The total duration of all stages can be up to 2 months.

As already noted, the total time required for the pathomorphosis of a heart attack is about 4-

8 weeks depending on the size of necrosis and depth of the lesion. In accordance with this, when

The occurrence of a new heart attack within 2 months of the first is usually referred to as a relapse. If

More than two months have passed, then this is a repeat heart attack.

Typical clinical picture myocardial infarction (anginal variant) occurs in 60-70%

all cases. The development of a heart attack is sometimes preceded by intense physical activity, stressful

situation at home or at work, symptoms may appear against the background of a sharp increase in blood pressure

pressure. In a number of patients, a heart attack is preceded by an episode of progression of angina pectoris. However, often

Myocardial infarction develops against a background of complete well-being, sometimes at night.

The patient complains of unbearable pain in the chest or in the heart area,

pressing, tearing or burning character with irradiation into left hand from shoulder and/or to tips

fingers. Sometimes pain can radiate to the neck, under the left shoulder blade, lower jaw and left half

faces. The patient is agitated, restless, and cannot find a place for himself. Nitroglycerin, which previously helped well,

does not bring any effect or only slightly reduces the intensity of pain.

Upon objective examination, the patient is pale, covered with sticky cold sweat, forced

the provisions do not bring relief. Tachycardia is noted, and extrasystole may occur.

Arterial pressure ranges from hypotension to moderate hypertension. Heart sounds are muffled

perhaps the appearance of functional muscle systolic murmur at the apex and Botkin's point.

Moderate shortness of breath is recorded.

A similar clinic characterizes the classic anginal variant. In addition, the debut

myocardial infarction can occur through asthmatic, gastralgic (abdominal),

arrhythmic, cardio-cerebral and painless options.

How is arterial hypertension classified according to ICD 10?

Arterial hypertension according to ICD 10 is defined as a group of conditions that are characterized by a pathological increase in blood pressure in the arteries. ICD 10 revision is used by doctors all over the world. The purpose of its application is to systematize and analyze clinical course diseases. Rubrication of diseases involves letter and numerical designation. Hypotension is coded using the same principles.

Arterial hypertension in ICD-10 is represented by a detailed list of pathologies that cause it. The classification structure depends on the lesion system, severity pathological process, presence of complications, age of the patient.

Classification

In order to determine the form of the disease, monitor its course and the effectiveness of the treatment, an international classification is used depending on the values determined using the Korotkov technique.

Division of blood pressure (BP) in mm Hg. Art. can be displayed in table form:

In addition to subdivision by blood pressure level, hypotension and hypertension are classified into stages according to the involvement of target organs: heart, kidneys, retina, brain.

Hypertension according to ICD 10, taking into account the effect on target organs, is divided into the following stages:

No damage.
One or more targets are affected.
The presence of pathologies such as ischemic heart disease, nephropathy, hypertensive encephalopathy, myocardial infarction, retinopathy, aortic aneurysm.

It is important to determine the general risk of hypertension, which determines the prognosis of the course of the disease and life in a patient with arterial hypertension.

Groups of diseases with increased blood pressure

According to ICD 10, arterial hypertension(AH) is divided into types such as hypertension with damage to the heart, symptomatic, with the involvement of cerebral vessels, and the heart.

Essential hypertension

Hypertension, ICD code 10 - I10, is defined as essential or primary. She suffers a large number of of people. In older women, hypertension is slightly more common than in men. Statistical indicators are compared after 60 years, then there are no gender differences.

The true causes of the primary form of the disease have not yet been established, but there is a direct connection between high blood pressure in this disease and genetic predisposition, excess weight, stress and excess salt in the diet.

The main symptoms of hypertension that occur with increased blood pressure:

intense squeezing pain in the head;
combination of cephalalgia and pain eyeballs, flickering “flies”;
nosebleeds associated with increased blood pressure;
difficulty falling asleep, insomnia;
excessive excitability and emotional lability;
acoustic phenomena (ringing, squeaking in the ears);
tachycardia;
dizziness.

The course of the disease can be benign and malignant. In the first option, episodes of high blood pressure occur rarely, damage to associated organs does not occur for a long time, and remission can be achieved with the help of non-drug treatment.

If hypertension is malignant, then in this case there is poor control over the disease, high blood pressure (not lower than 230/130 mm Hg), constant hypertensive crises and rapid development of complications.

Without treatment, with incorrectly selected therapy, against the background of irregular medication use, damage occurs to the arteries and parenchyma of the kidneys, the heart and the vessels that feed it, capillaries, and the brain.

Arterial hypertension with heart damage

When cardiac pathology is combined with heart failure, the ICD code is I11.0, and without heart failure, the code is I11.9.

Hypertension with cardiac damage in most cases occurs after 40 years of age; this pathology is associated with an increase in intravascular tension due to arteriolar spasm. This increases the strength of the heartbeat and stroke volume.

At constant high levels Due to intense work, the cardiac muscle increases in size, the cavities expand - hypertrophy (increase in size) of the left ventricle develops. In this case, the entire body suffers due to lack of oxygen supply.

Signs of primary hypertension with cardiac symptoms are the following conditions:

paroxysmal pain behind the sternum of a compressive nature;
expiratory shortness of breath;
angina attacks;
a feeling of interruptions in the work of the heart.

Depending on the degree of heart damage, the following stages of hypertension are distinguished.

No damage.
Left ventricular hypertrophy.
Heart failure of various degrees.

With a long course of the disease, myocardial infarction develops as a result of decompensation. In case of survival, post-infarction cardiosclerosis remains, which aggravates the person’s condition.

Hypertension with kidney damage

This form of hypertension is coded I12. Kidney disease can occur as hypertensive failure (I12.0) and without the development of failure (I12.9).

The pathogenesis of damage to the renal parenchyma is based on the fact that a systematic increase in blood pressure ultimately leads to remodeling (restructuring) of small arterioles. Such damage is most often observed in the malignant course of headache.

In this case, the kidneys undergo the following pathomorphological stages of damage.

Primary nephrosclerosis (replacement of normal connective tissue).
Fibrosis (scar degeneration).
Compaction of capillary walls.
Atrophy of glomeruli and tubules.

Hypertensive nephropathy with the development of insufficiency is characterized by the appearance of the following symptoms:

drowsiness, increased fatigue;
anemia;
gout;
itchy skin;
frequent and night urination;
bleeding of any location;
nausea, vomiting, diarrhea.

Chronic renal failure causes a decrease in immunity, which leads to frequent bacterial and viral infections, which sharply worsen kidney function.

Hypertension with heart and kidney damage

In this case, the following states are separately encrypted:

hypertension with heart and kidney damage with heart failure (I13.0);
HD with a predominance of nephropathy (I13.1);
hypertension with heart and kidney failure (I13.2);
Hypertension involving the kidneys and heart, unspecified (I13.9).

This form of headache occurs with a combination of symptoms of pathologies of both organs. It is also possible that there is a failure of the functional or organic nature of only the heart or kidneys, as well as their simultaneous damage. The patient's condition is serious and requires constant therapy and medical supervision.

Symptomatic hypertension

Secondary or symptomatic hypertension, code in the ICD - I15, is only one of the manifestations of the underlying disease. The incidence of such pathology is low.

This form of the disease includes increased blood pressure due to the following reasons:

renovascular (associated with narrowing of the arteries of the kidneys) - I15.0;
other kidney diseases - I15.1;
endocrine pathologies - I15.2;
other reasons - I15.8;
unspecified etiology - I15.9.

Secondary hypertension is characterized by the following manifestations:

absence or insignificance of effect from drug therapy;
the need to prescribe 2 or more drugs;
deterioration of condition despite treatment;
malignant course;
lack of hereditary predisposition;
damage to young people.

The main diseases that cause the development of secondary hypertension:

glomerulonephritis and others inflammatory processes in the kidneys;
polycystic disease;
connective tissue pathologies of the kidneys;
nephrolithiasis (urolithiasis);
endocrine disorders (Cushing's syndrome, pheochromocytoma, thyrotoxicosis);
disruption of the adrenal glands;
aortic pathology (atherosclerosis, inflammation, aneurysm);
traumatic or inflammatory disease brain.

Vascular pathology of the brain and hypertension

Hypertensive encephalopathy and other brain pathologies associated with hypertension are coded I60-I69. This subgroup includes diseases for which hypertension is mentioned.

High blood pressure has an adverse effect on the walls of blood vessels in the brain. If the patient does not receive treatment or the doses of medications are inadequately selected, irreversible damage occurs. In this case, constant narrowing and sclerosis of the vascular wall occurs, as a result, brain tissue is constantly exposed to oxygen starvation and hypertensive encephalopathy develops.

In addition, pressure surges are a direct provoking factor in the onset of critical ischemia due to arterial spasm, which is the main cause of stroke.

According to ICD 10, arterial hypertension has different codings and reflects variants of the course of the pathology. Rubrication, according to the international classification, makes it possible to statistically register the incidence of hypertension of various origins.

In addition, the ICD makes it possible to monitor complications of the disease: hypertensive encephalopathy, angina pectoris, renal failure, heart attack and stroke.

At what blood pressure can Amlodipine be taken?

Pressure surges are one of the most common problems of modern people. Therefore, every person is looking for the most effective and safe medicine, intended to normalize blood pressure. One of the most common modern 3rd generation drugs is Amlodipine, the instructions for use of which should be studied in detail, and also find out at what pressure it is used.

Composition of the drug
Instructions for use
Reception features
How to use
Side effects
Contraindications for use
Norvasc or Amlodipine - which is better?
Analogues of the drug

Composition of the drug

The drug is available in the form of tablets that contain the main active substance – amlodipine besylate. In addition to it, the medicine also contains auxiliary components:

lactose;
calcium stearate;
croscarmellose sodium.

White tablets, coated with a colorless film, are sold in sheets packaged in a large cardboard pack. You can buy Amlodipine at any pharmacy. For Russia the price is approximately 40 rubles. As for Ukraine, this drug can be purchased at average price 15 UAH

Instructions for use

Most often, Amlodipine is used to normalize blood pressure. It is taken by people suffering from hypertension. The drug is also prescribed for the following diseases and ailments:

treatment of hypertension initial stage development;
with irregular, single surges in blood pressure;
with stable angina;
with spasms of blood vessels.

Amlodipine helps lower high blood pressure and also improves functioning of cardio-vascular system. Therefore, if a patient experiences a rapid heartbeat along with high blood pressure, then the drug will bring the body back to normal.

Reception features

This medicinal product contains potent substances. Therefore, during treatment with Amlodipine, you must adhere to the following rules:

During the appointment, you should monitor your weight and also see a dentist. The medicine may cause excess weight or severe bleeding gums.
Do not stop taking the drug abruptly. This may trigger renewed attacks of high blood pressure, and a high pulse may also be observed.
During the treatment period, it is better for people whose professional activities involve increased care and responsibility to take a vacation. This drug causes constant drowsiness or dizziness.
Patients with liver failure The use of Amlodipine should be carried out under regular specialist supervision.

The relatively low cost of the drug allows it to be used by all segments of the population. However, you should consult your doctor before use.

How to use

Depending on the problems with blood pressure, the dosage is prescribed differently:

Infrequent increases in blood pressure. This indicator can be reduced by taking 1 tablet once a day. It is better to take the tablet in the morning, as it begins to act after a couple of hours. If there is no improvement in the condition, you need to increase the dosage to 2 tablets per day, taking them once. With long-term use of the drug, the dose should be reduced to 0.5 tablets per day. The course of treatment is 1 week. An increase in duration can only be prescribed by a specialist.
Arterial hypertension. People suffering from this disease need to take Amlodipine 0.5 tablets per day. This treatment has a supporting effect on the body. You should take the drug in this mode constantly.
Impaired functioning of the cardiovascular system. For heart disease, experts recommend taking 1 tablet once a day. If improvement is not observed for a long period of time, then you can increase the dose to 2 tablets for a while. How long should I take this drug? Most often, doctors recommend using it on an ongoing basis for heart problems.

Side effects

If you take this drug excessively, a person may experience the following ailments:

From the cardiovascular system: swelling of the upper and lower limbs, painful sensations in the heart area, shortness of breath with minor exertion, increased or decreased heartbeat.
From the central side nervous system: rapid fatigue, dizziness with loss of consciousness, sleep disturbances, causeless irritability, anxiety, apathy.
From the outside gastrointestinal tract: nausea with vomiting, pain in the lower part abdominal cavity, constipation or diarrhea, constant thirst, exacerbation of gastritis.

The patient may also experience problems in intimate life, painful urination, allergic rashes on the skin, and increased body temperature.

Contraindications for use

This drug is strictly contraindicated in the following cases:

during pregnancy - the active component of Amlodipine negatively affects the development of the fetus;
breastfeeding period;
for diabetes mellitus;
with low blood pressure;
persons under 18 years of age;
for lactose intolerance, as well as hypersensitivity to other components of the drug.

Also, if the patient has strong allergic reactions after using Amlodipine, such treatment should be stopped and consult a specialist about the use of similar drugs.

Norvasc or Amlodipine - which is better?

Norvasc is a drug whose active substance is amlodipine. If you compare this imported medicine with Amlodipine, there is no significant difference in the effect on the body. Norvask is several times more expensive than its domestic analogue, but in terms of purification and concentration active substance foreign drug has an advantage.

A package of Norvasc costs on average 400 rubles in Russia. In Ukraine it can be purchased for approximately 130 UAH. Therefore, many people suffering from regular increases in blood pressure cannot afford such treatment and choose Amlodipine.

Analogues of the drug

In addition to Norvasc, modern pharmacology offers many more drugs similar in composition and effect on the body:

Duactin. This medicine is available in capsules. Prescribed for hypertension, as well as for chronic palpitations. The advantage is the minimum number of contraindications for use.
Tenox. Used when severe forms hypertension and chronic angina. The drug is not suitable for persons suffering from acute heart failure.
Normodipin. In a short time it normalizes high blood pressure and improves the functioning of the cardiovascular system. Contraindicated in people who have suffered acute myocardial infarction.
Emlodin. A fairly inexpensive analogue of Amlodipine. It is strictly forbidden to use in severe hypotension, as well as in cases of impaired functioning of the left ventricle.

Regardless of the choice of a particular medicinal product at high blood pressure, you need to agree on its dosage and advisability of use with a specialist.

About 43% of patients note the sudden development of myocardial infarction, while the majority of patients experience a period of unstable progressive angina of varying duration. The most acute period.
Typical cases of myocardial infarction are characterized by extremely intense pain syndrome with pain localized in chest and irradiation in left shoulder, neck, teeth, ear, collarbone, lower jaw, interscapular area. The nature of the pain can be squeezing, bursting, burning, pressing, sharp (“dagger-like”). How larger zone myocardial damage, the more pronounced the pain.
A painful attack occurs in waves (either intensifying or weakening), lasting from 30 minutes to several hours, and sometimes even a day, and is not relieved by repeated administration of nitroglycerin. The pain is associated with severe weakness, agitation, a feeling of fear, and shortness of breath.
An atypical course of the acute period of myocardial infarction is possible.
Patients experience severe pallor of the skin, sticky cold sweat, acrocyanosis, and anxiety. Blood pressure is increased during the attack, then moderately or sharply decreases compared to the initial level (systolic tachycardia, arrhythmia.
During this period, acute left ventricular failure (cardiac asthma, pulmonary edema) may develop. Acute period.
In the acute period of myocardial infarction, pain syndrome usually disappears. The persistence of pain is caused by a pronounced degree of ischemia of the peri-infarction zone or the addition of pericarditis.
As a result of the processes of necrosis, myomalacia and perifocal inflammation, fever develops (from 3-5 to 10 or more days). The duration and height of the temperature rise during fever depend on the area of necrosis. Arterial hypotension and signs of heart failure persist and increase. Subacute period.
Painful sensations are absent, the patient’s condition improves, body temperature normalizes. Symptoms of acute heart failure become less pronounced. Tachycardia and systolic murmur disappear. Post-infarction period.
In the post-infarction period clinical manifestations absent, laboratory and physical data are practically without deviations. Atypical forms of myocardial infarction.
Sometimes there is an atypical course of myocardial infarction with localization of pain in atypical places (in the throat, fingers of the left hand, in the area of the left scapula or cervicothoracic spine, in the epigastrium, in the lower jaw) or painless forms, the leading symptoms of which may be cough and severe suffocation, collapse, edema, arrhythmias, dizziness and confusion.
Atypical forms myocardial infarction are more common in elderly patients with severe signs of cardiosclerosis, circulatory failure, against the background of repeated myocardial infarction.
However, only the most acute period usually proceeds atypically; further development of myocardial infarction becomes typical.

ON APPROVAL OF THE STANDARD OF MEDICAL CARE

PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

In accordance with paragraphs. 5.2.11. Regulations on the Ministry of Health and social development Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collection of Legislation of the Russian Federation, 2004, N 28, Art. 2898), Art. 38 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993 N 5487-1 (Gazette of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Art. 1318; Collection of Legislation of the Russian Federation, 2004, N 35 , Art. 3607) I order:

International Classification of Diseases, 10th Revision (ICD-10). Aneurysm of the interatrial septum ICD 10

I20-I25 Coronary heart disease

I20 Angina [angina pectoris]

I20.0 Unstable angina
I20.00 Unstable angina with hypertension
I20.1 Angina with documented spasm
I20.10 Angina pectoris with documented spasm with hypertension
I20.8 Other forms of angina
I20.80 Other forms of angina with hypertension
I20.9 Angina pectoris, unspecified
I20.90 Angina pectoris, unspecified with hypertension

I21 Acute myocardial infarction

I21.0 Acute transmural infarction of the anterior myocardial wall
I21.00 Acute transmural infarction of the anterior myocardial wall with hypertension
I21.1 Acute transmural infarction of the inferior wall of the myocardium
I21.10 Acute transmural infarction of the inferior myocardial wall with hypertension
I21.2 Acute transmural myocardial infarction of other specified locations
I21.20 Acute transmural myocardial infarction of other specified locations with hypertension
I21.3 Acute transmural myocardial infarction of unspecified localization
I21.30 Acute transmural myocardial infarction of unspecified localization with hypertension
I21.4 Acute subendocardial myocardial infarction
I21.40 Acute subendocardial myocardial infarction with hypertension
I21.9 Acute myocardial infarction, unspecified
I21.90 Acute myocardial infarction, unspecified with hypertension

I22 Recurrent myocardial infarction

I22.0 Repeated infarction of the anterior myocardial wall
I22.00 Repeated infarction of the anterior myocardial wall with hypertension
I22.1 Repeated infarction of the inferior myocardial wall
I22.10 Repeated infarction of the inferior myocardial wall with hypertension
I22.8 Repeated myocardial infarction of another specified location
I22.80 Repeated myocardial infarction of another specified location with hypertension
I22.9 Repeated myocardial infarction of unspecified localization
I22.90 Repeated myocardial infarction of unspecified localization with hypertension

I23 Some current complications of acute myocardial infarction

I23.0 Hemopericardium as an immediate complication of acute myocardial infarction
I23.00 Hemopericardium as an immediate complication of acute myocardial infarction with hypertension
I23.1 Atrial septal defect as a current complication of acute myocardial infarction
I23.10 Atrial septal defect as a current complication of acute myocardial infarction with hypertension
I23.2 Ventricular septal defect as a current complication of acute myocardial infarction
I23.20 Ventricular septal defect as a current complication of acute myocardial infarction with hypertension
I23.3 Rupture of the heart wall without hemopericardium as a current complication of acute myocardial infarction
I23.30 Rupture of the cardiac wall without hemopericardium as a current complication of acute myocardial infarction with hypertension
I23.4 Rupture of the chordae tendineus as a current complication of acute myocardial infarction
I23.40 Chordae tendinus rupture as a current complication of acute myocardial infarction with hypertension
I23.5 Papillary muscle rupture as a current complication of acute myocardial infarction
I23.50 Papillary muscle rupture as a current complication of acute myocardial infarction with hypertension
I23.6 Thrombosis of the atrium, atrial appendage and ventricle of the heart as a current complication of acute myocardial infarction
I23.60 Atrial thrombosis of the atrial appendage and ventricle of the heart as a current complication of acute myocardial infarction with hypertension
I23.8 Other current complications of acute myocardial infarction
I23.80 Other current complications of acute myocardial infarction with hypertension

I24 Other forms of acute coronary heart disease

I24.0 Coronary thrombosis not leading to myocardial infarction
I24.00 Coronary thrombosis not leading to myocardial infarction with hypertension
I24.1 Dressler syndrome
I24.10 Dressler's syndrome with hypertension
I24.8 Other forms of acute coronary heart disease
I24.80 Other forms of acute coronary heart disease with hypertension
I24.9
I24.90 Acute coronary heart disease, unspecified

I25 Chronic ischemic heart disease

I25.0 Atherosclerotic cardiovascular disease, as described
I25.00 Atherosclerotic cardiovascular disease as described with hypertension
I25.1 Atherosclerotic heart disease
I25.10 Atherosclerotic heart disease with hypertension
I25.2 Previous myocardial infarction
I25.20 Previous myocardial infarction with hypertension
I25.3 Heart aneurysm
I25.30 Cardiac aneurysm with hypertension
I25.4 Aneurysm coronary artery
I25.40 Coronary artery aneurysm with hypertension
I25.5 Ischemic cardiomyopathy
I25.50 Ischemic cardiomyopathy with hypertension
I25.6 Asymptomatic myocardial ischemia
I25.60 Asymptomatic myocardial ischemia with hypertension
I25.8 Other forms of chronic coronary heart disease
I25.80 Other forms of chronic ischemic heart disease with hypertension
I25.9 Chronic ischemic heart disease, unspecified
I25.90 Chronic ischemic heart disease, unspecified, with hypertension

Acute myocardial infarction

Acute myocardial infarction

Acute myocardial infarction is the death of a section of the heart muscle caused by a circulatory disorder. Heart attack is one of the main causes of disability and mortality among adults.

Causes

Myocardial infarction is acute form IHD. In 97-98% of cases, the basis for the development of myocardial infarction is atherosclerotic lesion coronary arteries, causing narrowing of their lumen. Often, atherosclerosis of the arteries is accompanied by acute thrombosis of the affected area of the vessel, causing a complete or partial cessation of blood supply to the corresponding area of the heart muscle. Thrombosis is promoted by increased blood viscosity observed in patients with coronary artery disease. In some cases, myocardial infarction occurs against the background of spasm of the branches of the coronary arteries.

The development of myocardial infarction is promoted by diabetes mellitus, hypertension, obesity, neuropsychic stress, addiction to alcohol, and smoking. Sharp physical or emotional stress against the background of coronary artery disease and angina pectoris can provoke the development of myocardial infarction. Myocardial infarction of the left ventricle develops more often.

Symptoms

About 43% of patients note the sudden development of myocardial infarction, while the majority of patients experience a period of unstable progressive angina of varying duration.

Typical cases of myocardial infarction are characterized by extremely intense pain with pain localized in the chest and radiating to the left shoulder, neck, teeth, ear, collarbone, lower jaw, and interscapular area. The nature of the pain can be squeezing, bursting, burning, pressing, sharp (“dagger-like”). The larger the area of myocardial damage, the more severe the pain.

A painful attack occurs in waves (either intensifying or weakening), lasting from 30 minutes to several hours, and sometimes even a day, and is not relieved by repeated administration of nitroglycerin. The pain is associated with severe weakness, agitation, a feeling of fear, and shortness of breath.

An atypical course of the acute period of myocardial infarction is possible.

Patients experience severe pallor of the skin, sticky cold sweat, acrocyanosis, and anxiety. Blood pressure is increased during an attack, then moderately or sharply decreases compared to the initial level (systolic< 80 рт. ст. пульсовое < 30 мм мм рт. ст.), отмечается тахикардия, аритмия.

During this period, acute left ventricular failure (cardiac asthma, pulmonary edema) may develop.

Acute period

In the acute period of myocardial infarction, pain syndrome usually disappears. The persistence of pain is caused by a pronounced degree of ischemia of the peri-infarction zone or the addition of pericarditis.

As a result of the processes of necrosis, myomalacia and perifocal inflammation, fever develops (from 3-5 to 10 or more days). The duration and height of the temperature rise during fever depend on the area of necrosis. Arterial hypotension and signs of heart failure persist and increase.

Subacute period

There is no pain, the patient’s condition improves, and body temperature normalizes. Symptoms of acute heart failure become less pronounced. Tachycardia and systolic murmur disappear.

Post-infarction period

In the post-infarction period, there are no clinical manifestations, laboratory and physical data are practically without deviations.

Diagnostics

Types of disease

Among diagnostic criteria In case of myocardial infarction, the most important factors are the medical history, characteristic changes on the ECG, and indicators of serum enzyme activity.

The patient's complaints during myocardial infarction depend on the form (typical or atypical) of the disease and the extent of damage to the heart muscle. Myocardial infarction should be suspected in the event of a severe and prolonged (longer than 30-60 minutes) attack of chest pain, disturbances in cardiac conduction and rhythm, and acute heart failure.

Characteristic ECG changes include the formation of a negative T wave (with small focal subendocardial or intramural myocardial infarction), a pathological QRS complex or Q wave (with large focal transmural infarction myocardium).

In the first 4-6 hours after a painful attack, an increase in myoglobin, a protein that transports oxygen into cells, is detected in the blood.

An increase in the activity of creatine phosphokinase (CPK) in the blood by more than 50% is observed 8-10 hours after the development of myocardial infarction and decreases to normal after two days. CPK levels are determined every 6-8 hours. Myocardial infarction is excluded with three negative results.

To diagnose myocardial infarction at a later stage, they resort to determining the enzyme lactate dehydrogenase (LDH), the activity of which increases later than CPK - 1-2 days after the formation of necrosis and returns to normal values after 7-14 days.

Highly specific for myocardial infarction is an increase in the isoforms of the myocardial contractile protein troponin - troponin-T and troponin-1, which also increase in unstable angina.

An increase in ESR, leukocytes, activity of aspartate aminotransferase (AsAt) and alanine aminotransferase (AlAt) is detected in the blood.

EchoCG reveals a violation of local contractility of the ventricle and thinning of its wall.

Coronary angiography (coronary angiography) makes it possible to establish thrombotic occlusion of the coronary artery and decreased ventricular contractility, as well as to evaluate the possibilities of coronary artery bypass grafting or angioplasty - operations that help restore blood flow in the heart.

Patient Actions

If pain in the heart area occurs for more than 15 minutes, you should immediately call an ambulance.

Treatment

In case of myocardial infarction, emergency hospitalization in a cardiac intensive care unit is indicated. In the acute period, the patient is prescribed bed rest and mental rest, fractional meals limited in volume and calorie content. In the subacute period, the patient is transferred from intensive care to the cardiology department, where treatment of myocardial infarction continues and the regimen is gradually expanded.

Relief of pain syndrome is carried out by a combination of narcotic analgesics (fentanyl) with antipsychotics (droperidol), intravenous administration nitroglycerin.

Therapy for myocardial infarction is aimed at preventing and eliminating arrhythmias, heart failure, and cardiogenic shock. Antiarrhythmic drugs (lidocaine), ß-blockers (atenolol), thrombolytics (heparin, aspirin), calcium antagonists (verapamil), magnesia, nitrates, antispasmodics, etc. are prescribed.

In the first 24 hours after the onset of myocardial infarction, perfusion can be restored by thrombolysis or emergency balloon coronary angioplasty.

Complications

After the acute period, the prognosis for recovery is good. Unfavorable prospects for patients with complicated myocardial infarction.

Prevention

Necessary conditions for the prevention of myocardial infarction are maintaining a healthy and active lifestyle, giving up alcohol and smoking, a balanced diet, avoiding physical and nervous overstrain, control blood pressure and blood cholesterol levels.