Department faculty and hospital therapy of medical faculty and department internal diseases of medical prophylactic faculty. MYOCARDIAL INFARCTION Prof. Rizamuhamedova M.Z.

MYOCARDIAL INFARCTION Acute focal necrosis of heart muscle due to absolute or relative failure coronary blood flow. Acute focal necrosis of heart muscle due to absolute or relative failure coronary blood flow.

AETIOLOGY 1. Coronary artery thrombosis in an atherosclerotic plaque 2. Spasm of the coronary arteries of different etiologies 3. Vasculitis affecting medium-sized vessels - rheumatic fever, periarteritis nodosa, rheumatoid arthritis 4. Coronary embolism in infective endocarditis, diseases of the blood Anemia, which developed against the background of coronary atherosclerosis

RISK FACTORS 1. Hypercholesterolemia 2. Heredity 3. Smoking 4. Diabetes mellitus 5. Arterial hypertension 6. Gout 7. Hypertriglyceridemia 8. Early gerontoxon 9. The diagonal earlobe crease

PATHOGENESIS 1. Rupture of an atherosclerotic plaque 2. Platelet activation 3. Acute coronary artery occlusion 4. The development of necrosis, arrhythmias 5. Dimensions foci of necrosis depends on the level of occlusion of a coronary artery

Period of myocardial infarction 1. Prodrome - 30 min. Up to 30 days. (Unstable angina) 2. The Island - from the attack of angina before the appearance of signs of necrosis of cardiac muscle. Duration hours 3. Acute - is characterized by resorption of necrotic masses, the beginning of the formation of scar around - 10 days 4. Subacute - reduced symptoms of heart failure, resorption necrotic syndrome. 3 to 8 weeks 5. Postinfarction –is not observed with a favorable course of clinical manifestations

CLASSIFICATION OF MYOCARDIAL INFARCTION BY ECG CHARACTERS 1. On pathological tooth Q - stable occlusive thrombus caused a coronary artery, an effective thrombolytic therapy 2. Equivalents wave Q - R wave amplitude changes 3. Any other changes in the QRS complex 4. Without pathological Q wave

5. Myocardial infarction with isolated T- wave changes - (small focal)- has a favorable course 6. Elevation myocardial infarction segment S-T (mural) - proceeds favorably, but with a high probability of recurrence, thrombolytic therapy 7. Myocardial infarction with S-segment depression T (subendocardial) has a severe course, predictive adverse

CLINICAL FORMS OF MYOCARDIAL INFARCTION 1. ANGINAL FORM 2. ATYPICAL FORMS OF MYOCARDIAL INFARCTION Gastroalgic form (2-3%) Asthmatic form (5-10%) Cerebral form (3-5%) Painless form (arrhythmic) edematous form

STUDIES IN MYOCARDIAL INFARCTION 1. ECG (awareness - 85%) 2. Echocardiography 3. Chest X-ray 4. Angiography (to assess the degree of recovery of myocardial perfusion) 5. Enzymatic diagnosis 6. ESR is increased after 12 hours of myocardial infarction 7. Leucocytosis - a few hours, peak 2-4 days a week - the normalization value

COMPLICATIONS OF MYOCARDIAL INFARCTION 1. Heart failure 2. Pulmonary edema 3. Cardiogenic shock 4. Myocardial rupture 5. Left ventricular aneurysm

6. Thromboembolism (including pulmonary embolism) 7. Pericarditis 8. Dysrhythmia 9. Dressler's syndrome 10. Cardiac arrest

Modern principles of treatment of acute myocardial infarction Aspirin Aspirin Oxygen Oxygen Treatment of anginal pain Treatment of anginal pain Reperfusion therapy (pharmacological, mechanical) Reperfusion therapy (pharmacological, mechanical) Beta-blockers Beta-blockers

Intravenous infusion of nitroglycerin Intravenous infusion of nitroglycerin Early use of ACE inhibitors Early use of ACE inhibitors Anticoagulants Anticoagulants Lipid-lowering drugs Lipid-lowering drugs Metabolic therapy Metabolic therapy