Myocardial infarction

Myocardial infarction is a necrosis of a part of the heart muscle caused by its ischemia, usually due to coronary artery disease. The cause may be atherosclerosis, i.e. a narrowing of the lumen of blood vessels due to the formation of clusters of blood platelets. Their formation is prevented by the use of cardiological doses of aspirin, the so-called aspirin for the heart.

8-10 percent people after a myocardial infarction will have another cardiovascular event within a year. Risk factors (accelerating and intensifying the pace of the development ofatherosclerosis ), not subject to human control, are: gender (men aged 35-45 are more likely to suffer from disease), environmental pollution, stress, age.
The second group of risk factors that can be influenced, thus reducing the risk of a heart attack, is: improper nutrition, obesity, diabetes, smoking, lack of exercise, hypertension, which occurs in 3% of people in Poland. population. Most often, because in 95 percent. cases, a heart attack affects men who meet at least two criteria from the so-called risk factor groups. Women are less prone toheart attack , because men usually have higher cholesterol than women, drink alcohol more often, smoke more and stronger cigarettes, love to eat a lot and eat fatty foods, they do not like keep moving and are often overweight. In short, men work more intensively than women during a heart attack.

Heart disease prevention

In he althy people, taking one dose of exercise every other day also significantly reduces the risk of stroke. In Poland, for example, due to diseases of the cardiovascular system, 91 thousand women die each year, which is approx. 55 percent. all deaths of that sex. You should definitely change the bad habits of everyday life, move more, eat he althily, eat more vegetables and fruits, less fat and red meat. It is recommended to limit alcohol and quit smoking. Proper pharmacological prophylaxis under the supervision of a doctor is also very important, in order to avoid complications, the most common of which is gastrointestinal bleeding. According to cardiologists, people at risk and patients after a myocardial infarction should use aspirin for the heart, in doses up to 100 mg / day

Symptoms of a heart attack

If your chest pains are accompanied by one or more of the following symptoms, pleaseimmediately call the ambulance:

• strong pressure in the chest or pains radiating towards the arms, abdomen or neck and neck
• sudden attack of breathlessness
• sweating and pale face
• panic attack.

Heart attack: diagnosis

First, the doctor will ask about diet, type of work, and how to rest. Measureblood pressurekiwi blood pressure. He should also check your weight and calculate your BMI and measure your waist circumference. Laboratory tests will tell the rest.
» Blood tests are the simplest but reliable. Morphology and biochemical determinations are performed. The level of potassium, sodium, creatinine, urea, triglycerides, sugar and cholesterol levels are important.
» A lipogram is a showcase of he alth and blood vessels, i.e. it is a measurement of total cholesterol level and its LDL and HDL fractions, as well as triglycerides. The test is performed on an empty stomach (after a 12-hour break in eating and drinking alcohol). Total cholesterol concentration should not exceed 190 mg / dl. The truth about the risk of atherosclerosis is shown by LDL (the so-called bad cholesterol), the level of which cannot be higher than 115 mg / dl, and the HDL fraction (so-called good cholesterol) should exceed 40 mg / dI in men, and 45 in women. The level of triglycerides is not may be greater than 150 mg / dL. It is also important to determine the percentage of LDL and HDL fractions to total cholesterol. Regular monitoring of cholesterol in kiwifruit should start after the age of 20.
» After testing the glucose you will find out if you are at risk of diabetes, which accelerates the development of atherosclerosis. Normal fasting levels should be less than 100 mg / dl. At a concentration of 100-125 mg / dl, it is necessary to perform the so-called sugar curve (the test consists of taking blood three times and measuring the glucose level in these samples). The first download is on an empty stomach. Then the glucose solution is drunk and blood is collected twice (one hour and two thereafter).
» Chest X-ray allows you to assess the figure, the size of the heart cavities and the overall cardiovascular capacity. The film also shows atherosclerotic plaques in the aortic wall or large arterial vessels and calcification of the heart valves.
» The resting ECG shows whether the heart is working at a physiological rhythm. The examination also reveals areas of ischemia. It consists in the fact that electrodes attached to the area of ​​the heart, wrists and ankles record the heart's work and transmit the record to the apparatus, which processes it and shows it on a special graph. A good EKG result does not always mean that the heart is functioningimpeccable.

When it turns out that the results are incorrect, the doctor will issue a referral to a cardiologist, because only this specialist can order further tests to assess the condition of the heart.
» The pressure recorder is a 24-hour measurement of blood pressure. Throughout the day, a cuff is worn on the arm (just above the elbow), which is connected by wires to the recording apparatus (not larger than a walkman). Blood pressure (systolic and diastolic) is automatically measured every 15 minutes during the day and night. During the entire examination, one should behave normally, perform everyday tasks, play, argue, etc. Only then, after computer analysis of the record, the specialist can determine what is happening with the heart. In case of treatment, e.g. for high blood pressure, your doctor may check you whether you are taking your medications regularly.
» The echo of the heart (ultrasound of the heart) allows you to assess the size of all parts of the heart, examine the contractility of individual walls of the heart muscle, the function of the valves and their structure, and determine the places of calcification caused by atherosclerotic plaques. The cardiologist may order the so-called echo through the esophagus. The effect of the examination is the same, but the doctor evaluates the heart by viewing it from the center of the chest.
» Gastroscope - a flexible tube with an ultrasound head is inserted through the esophagus.
» Coronography belongs to invasive diagnostic tests. But in difficult-to-assess situations, it is very useful because it shows the advancement of atherosclerosis, a narrowing that can lead to the complete closure of the lumen of the arteries, and thus to a heart attack. The test is performed in a hospital. Contrast is injected through a special catheter inserted into the femoral artery. On the monitor screen, the doctor checks how it spreads through the arteries and veins. After the examination, you must stay in the hospital and lie down for 12 hours.
» Exercise EKG. It is a test of how the heart works during exercise. It is much more accurate than regular EKG. They are performed in a similar way to the resting ECG. The difference, however, is that you walk on a treadmill or ride a stationary bike with the electrodes attached. We receive the test result in the form of a graph. It shows if and what changes have occurred in the heart as a result of hypertension or atherosclerosis.

Heart attack: treatment

• Although statins have been known for twenty years, they are still an extremely valuable drug for heart patients. Their use extends life and improves its quality in people with coronary artery disease, atherosclerosis, as well as those with high risk factors for the development of heart diseases, including diabetes. Today, after many clinical trials, it is known that statinsprotect against heart attack, stroke, lower the level of bad LDL cholesterol. These drugs have a beneficial effect on thrombocytes, i.e. platelets responsible for its clotting. Statins prevent these plaques from sticking together, so they prevent the arteries from being blocked by a clot. Another advantage of these drugs is that they make the endothelial cells that line the blood vessels work better. As a result, the vessels are more flexible and can contract and relax more freely. Statins administered after cardiac surgery prevent the blood vessels from closing again and therefore make this therapy more effective. Taking them is of great importance for people with high levels of bad cholesterol, because it stops the progression of atherosclerosis.

Balloons. Advanced atherosclerosis cannot always be overcome with drugs. Then invasive cardiology comes to the rescue of our heart. Pushing the arteries, as this is what patients call angioplasty, is performed in the treatment of coronary artery disease, acute myocardial infarction or in the case of previously implanted by-passes. Through a small puncture of the artery in the groin (or, more rarely, on the forearm), the doctor inserts a special guidewire into the artery with a catheter ended with a balloon. When the balloon is in the place of the constriction of the coronary artery, it is inflated. By increasing its volume, it presses the plaque into the artery wall and restores its patency. With large atherosclerotic lesions, a balloon alone is not enough to open the artery. Then a special scaffolding is needed, i.e. a stent.

A stent is a very thin tube made of a thin mesh, which expands when introduced into the vessel and is a support for the vessel's weak walls. Stents are placed mainly because the walls of vessels cleared of cholesterol deposits are flaccid - they can collapse immediately or after some time and block the blood flow again. But there is another reason, after a while, cholesterol builds up on the walls again, and the stent can prevent this from happening. Arming the artery with stents takes place under the control of the X-ray machine so that they only go to the right place. The experience of medics shows that during ballooning of arteries, the plaque delamination or rupture occurs (approx. 20% of cases). This is conducive to restenosis, i.e. recurrent overgrowth of arteries. To prevent this, nowadays, stents coated with drugs that delay the growth of atherosclerotic plaque are more and more often inserted. The hit of recent years are scaffolding covered with goretex (we have jackets and shoes made of this fiber). They are usually used to treat aortic aneurysms to replace the damaged vessel wall.

By-passes, i.e. new onesbridges. If the arteries are completely overgrown, ballooning or stenting may not always restore them to working order. Then a decision is made to make new connections through which blood will flow. This is called Coronary bypass, or bypass. The procedure is performed under anesthesia. First, cardiologists take a he althy blood vessel (usually from a vein in the leg). Then, after opening the chest, the vein is implanted. One end of it is implanted above the obstruction of the coronary artery, and the other end below, i.e. between the aorta and the coronary vessel that distributes blood throughout the heart. In order for the operation to proceed smoothly, the patient is connected to a device called the heart-lung machine (the so-called extracorporeal circulation) for the duration of the procedure, and the work of the heart is stopped. After the procedure, blood may flow through a new, he althy vein or artery, bypassing the fragment damaged by atherosclerosis. It happens that several such bridges are made during one operation. New connections are just as vulnerable to atherosclerosis as others. Therefore, without supportive treatment, changes in nutrition and physical activity, the situation may repeat itself. It is also possible to bypass the arteries without opening the chest. During such an operation, the cardiac surgeon makes a small incision in the chest through which he can reach the front wall of the heart, which is constantly working.

Laser plaque removal is used very rarely. It is still an experimental method of getting rid of atherosclerotic deposits. During this angioplasty, the doctor inserts a special catheter into the femoral artery and then into the coronary artery. When it reaches the diseased area, it launches a laser beam from a special end of the catheter. More often, the laser is used to treat extreme heart failure - it is used to make the blood flow channels from the side of the heart ventricle.

Therapies of the future

Cardiologists are helpless when all vessels are damaged and no vein can be harvested from him for bypassing. Such situations prompted scientists to take a risky venture - to grow new vessels in the laboratory. They built a tube-shaped scaffold from flakes of self-decomposing polymer. They placed cells taken from the patient's vein on the surface and immersed them in a nutrient. After seven weeks, the cells had multiplied and the new vein was ready. Growing dishes is still an experiment, but it gives patients new hope. The fact that the vessels are made of cells taken from the patient suggests that they will not be rejected by the body. Work on this technique is ongoing, but we have to wait for putting it into practice.It is similar with plasmids injected into the heart by Polish scientists. They are tiny pieces of DNA in which memory is assigned the task of rebuilding the endothelium of intramuscular vessels. They were injected into the most ischemic part of the heart. A few days after the procedure, it turned out that the heart has much better blood supply
and works more efficiently.

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