Rise and fall of temperature in heart disease. Heart attack symptoms Does the temperature rise during a heart attack

The patient's body temperature on the 1st day of MI usually remains normal and rises on the 2nd, less often on the 3rd day. The temperature rises to 37 - 38 ° C and stays at this level for 3 - 7 days. In some cases of extensive damage to the heart, the duration of the temperature reaction can increase up to 10 days. A longer subfebrile condition indicates the addition of complications.

A high temperature (39 ° C or more) is rare and usually occurs when a complication is attached, such as pneumonia. In some cases, the temperature rises slowly, reaching a maximum after a few days, then gradually decreases and returns to normal. Less commonly, it immediately reaches a maximum value and then gradually decreases to normal.

The magnitude of the temperature rise and the duration of the fever to some extent depend on the extent of the MI, but the reactivity of the body also plays a significant role in this. In young people, the temperature reaction is more pronounced. In elderly and senile people, especially with small-focal MI, it may be insignificant or absent. In patients with MI complicated by cardiogenic shock, body temperature remains normal or even low.

The appearance of a temperature reaction after an anginal attack is an important diagnostic sign of MI and should always alert the doctor regarding the development of fresh focal changes in the myocardium. For MI, an increase in the number of leukocytes in the blood is very characteristic. It is observed within a few hours after the development of MI and persists for 3-7 days.

A longer leukocytosis indicates the presence of complications. There is usually a moderate increase in the number of leukocytes in the blood- up to (10 - 12) * 10 9 / l. Very high leukocytosis (over 20 * 10 9 / l) is considered an unfavorable prognostic sign.

According to some authors, the severity of leukocytosis to a certain extent depends on the extent of myocardial damage. In about 10% of cases, leukocytosis may be normal throughout the course of the illness. The number of leukocytes in the blood increases mainly due to neutrophils, while there is a shift of the leukocyte formula to the left. The first days of the disease are characterized by a decrease in the number of eosinophils in the blood, sometimes up to aneosinophilia. In the future, their number increases and comes to normal, and in some cases even exceeds normal values.

"Myocardial infarction", M.Ya. Ruda

Symptoms of myocardial infarction (presystolic rhythm)

myocardial infarction

Myocardial infarction is one of the clinical forms of coronary artery disease, which is accompanied by the development of ischemic myocardial necrosis due to impaired blood circulation in this area. According to statistics, this disease most often develops in males (women are twice as rare) in the age range from forty to sixty years. The risk of death in myocardial infarction is especially high during the first two hours from its onset.

Myocardial infarction - causes

In most cases, myocardial infarction affects people who lead an insufficiently active lifestyle against the background of psycho-emotional overload. However, a sedentary lifestyle is not a determining factor in the development of this disease, and a heart attack can suddenly strike even young people with good physical fitness. The main reasons contributing to the development of myocardial infarction include: bad habits (smoking, drinking alcohol), hypertension, lack of physical activity, an excess of animal fats in the food consumed, malnutrition, overeating, obesity. Physically active people are several times less likely to develop a heart attack than those leading a sedentary lifestyle due to certain reasons.

The heart is a muscular sac that works like a pump and pumps blood through it. The supply of oxygen to the heart muscle itself occurs through the blood vessels that come to it from the outside. For some reason, some of these vessels are clogged with atherosclerotic plaques, as a result of which they cannot pass the necessary volumes of blood. Ischemic heart disease (CHD) develops. Myocardial infarction develops as a result of a sudden complete cessation of the blood supply to part of the heart muscle due to the ongoing blockage of the coronary artery. Most often, a developed thrombus on an atherosclerotic plaque leads to this, much less often - a spasm of the coronary artery. The part of the heart muscle that is deprived of nutrition dies. infarction - dead tissue

Myocardial infarction - symptoms

The main typical symptom of this disease is intense pain in the region of the heart and behind the sternum. The pain occurs unexpectedly, in the shortest possible time reaching great severity and "giving" to the interscapular space, left shoulder blade, lower jaw and left arm. Unlike the pain observed in angina pectoris, pain in myocardial infarction is much more intense and does not go away after taking nitroglycerin (sometimes it is not eliminated even by injections of morphine). In such patients, it is necessary to take into account the presence of coronary artery disease during the course of the disease, as well as the shift of pain to the left arm, lower jaw and neck. In addition, in the elderly, this disease can manifest itself in the form of shortness of breath and loss of consciousness.

In 50% of patients, the harbingers of a heart attack are attacks of angina pectoris changed in intensity and frequency. They become more persistent, occur much more often even with slight physical exertion (sometimes they can occur even at rest), last longer, and in their intervals a feeling of pressure or dull pain remains in the region of the heart. Sometimes a heart attack may be preceded not by pain, but by dizziness and a manifestation of general weakness.

In 15% of patients, an attack of pain lasts no more than one hour, in 40% of patients from two to twelve hours, in 45% of patients - about one day.

In some patients, myocardial infarction is accompanied by suddenly developing shock and collapse. The patient turns pale, feels dizzy and severe weakness, covered with sweat, there may be a short-term loss of consciousness, nausea, vomiting, diarrhea (rarely). The patient is haunted by a feeling of intense thirst. The skin becomes moist, gradually taking on an ash-gray hue, and the tip of the nose and limbs are cold, blood pressure drops sharply (sometimes it may not be detected at all). The pulse on the radial artery is not palpable at all or very weak tension. During collapse, the number of heartbeats may be slightly reduced, slightly increased, or normal (tachycardia is more common), body temperature is slightly elevated. If collapse and shock continue for many hours and even days, the prognosis of a normal outcome is significantly worse. With myocardial infarction, serious disorders of the gastrointestinal tract can be observed - intestinal paresis, pain in the epigastric region, nausea and vomiting. No less serious disorders can be observed from the side of the central nervous system - fainting, short-term loss of consciousness, general weakness, difficult to eliminate persistent hiccups. With myocardial infarction, serious cerebrovascular accidents can develop, manifested by paresis, convulsions, coma, and speech impairment.

In addition to the specific symptoms described above, patients may experience general symptoms: the number of red blood cells increases in the blood and other biochemical changes are observed, fever appears, body temperature does not exceed the threshold of 38 * C

Clinical forms of myocardial infarction :

- Asthmatic form (the disease begins with an attack of cardiac asthma)

- Anginal form (a heart attack begins with painful attacks in the region of the heart and behind the sternum)

– Abdominal form (begins with dyspepsia and pain in the upper abdomen)

– Collaptoid form (the disease is preceded by collapse)

- Cerebral form (the disease begins with focal neurological symptoms)

- mixed form

– Painless form (the onset of myocardial infarction is hidden)

Atypical forms of myocardial infarction

In addition to the tearing sharp pain behind the sternum, which is characteristic of a heart attack, there are several forms of a heart attack that do not manifest themselves in any way, or masquerade as various other diseases of the internal organs.

Painless form of a heart attack. This form is manifested by a feeling of discomfort in the chest, severe sweating, deterioration of mood and sleep. This form of infarction is most often found in senile and old age, especially with concomitant diabetes mellitus.

Asthmatic form of myocardial infarction. This type of heart attack in its manifestations is very similar to an attack of bronchial asthma and is manifested by a feeling of congestion in the chest and a dry, hacking cough.

Gastritis form of myocardial infarction. In its symptoms, it is very similar to an exacerbation of gastritis and is characterized by severe pain in the epigastric region. On palpation, tension and soreness of the muscles of the anterior abdominal wall are noted. In the gastric variant, the lower sections of the left ventricular myocardium adjacent to the diaphragm are most often affected.

Diagnosis of myocardial infarction

The diagnosis is established based on a clinical assessment of the general condition of the patient and after differential diagnosis with such diseases as: acute pericarditis, dissecting aortic aneurysm, pulmonary embolism and spontaneous pneumothorax. One of the leading diagnostic methods is an electrocardiographic study (ECG), based on the data of which one can judge the localization and extent of myocardial damage and the duration of the developed process. For a heart attack, a change in laboratory blood parameters is characteristic: an increase in the level of cardiospecific markers - cardiomyocytes

Myocardial infarction - treatment

The main goal of treating a patient with acute myocardial infarction is to restore and further maintain blood circulation to the affected area of the heart muscle as quickly as possible. For this, the following drugs are used:

- Acetylsalicylic acid (aspirin) - due to inhibition of platelets, the formation of blood clots is prevented

- Prasugrel, Ticlopidin, Clopidogrel (Plavix) - also prevent the formation of a blood clot, but they are much more powerful than aspirin

- Bivalirudin, Fraxiparin, Lovenox, Heparin - anticoagulants that prevent the formation and spread of blood clots and act on blood clotting

- Reteplase, Alteplase, Streptokinase - powerful thrombolytic drugs that can dissolve an already formed blood clot

All of the above drugs are used in combination and are vital for the successful treatment of myocardial infarction.

The best current method for restoring blood flow in a coronary artery is immediate angioplasty of the coronary artery followed by placement of a coronary stent. If, for some reason, angioplasty cannot be performed during the first hour of a heart attack, the use of thrombolytic drugs is preferable.

In the event that all the above measures are impossible or do not help, the only means to restore blood circulation (save the myocardium) is an urgent coronary artery bypass grafting.

The most critical are the first days of the disease. Further prognosis directly depends on the degree of damage to the heart muscle, the timeliness of the measures taken and the presence of concomitant cardiovascular diseases.

Biblical Israel

How to save the heart from pain?

What role does heredity play in the development of myocardial infarction?

Research scientists have shown that if parents have had heart attacks before the age of 60, then children can inherit from them a predisposition to a heart attack. In this case, the risk of developing coronary heart disease is high already at a young age, even at 20-25 years old.

When to go to the doctor?

See a cardiologist if:

feel pain behind the sternum;
sometimes it is difficult to breathe;
having difficulty climbing stairs;
feel interruptions in the work of the heart;
do not even tolerate ordinary physical exertion? - this may be the result of angina pectoris and ischemia;
experience bouts of dizziness and weakness;
periodically there are fainting spells;
it seems that the heart is ready to jump out of the chest, is the first sign of arrhythmia.

How to determine if you have a pre-infarction condition?

Pre-infarction condition? is an exacerbation of coronary heart disease, lasting from several hours to 2-3 weeks. The patient's general health deteriorates sharply, angina pectoris attacks become more frequent, the pain in the heart intensifies, acquires a pulsating character, spreads not only to the chest, but also to the arm, neck, face. During an attack of angina pectoris, the patient is inhibited, and when a heart attack begins, he is excited and restless. If the pain is not relieved by nitroglycerin, it is already a heart attack.

If there is a stoppage of breathing and heartbeat, then what to do before the arrival of the ambulance?

For relatives:

1. Lay the person on their back on a flat surface and tilt their head back to ensure the airway is clear.

2. If the patient does not have spontaneous breathing, perform artificial ventilation of the lungs using the “mouth-to-mouth” method, while the victim’s nose should be clamped at the time of air blowing.

3. Feel the pulse on the carotid artery. If there is no pulsation, do an indirect heart massage: put your palms one on top of the other in the middle of your chest and rhythmically press down. Rhythm? - a little more than once per second (80 clicks per minute).

4. If resuscitation is carried out alone, every 15 compressions, two consecutive blows should be made into the patient's lungs (mouth to mouth).

5. If the patient's face turned pink, the pupils narrowed (that is, there was a reaction to light), he breathed on his own and a pulse appeared on the carotid artery, which means that you managed to save the person.

Do I need to stay in bed after a heart attack?

In severe cases, it is necessary, at least 5-7 days, since the damaged heart may not withstand even minimal stress. If this is a microinfarction, the doctor may allow you to get up already on the second or third day.

What are the benefits of beta-blockers for the heart?

Beta-blockers (Obzidan, Inderal, Metoprolol, Atenolol, Bisoprolol, Labetalol) are designed to reduce the load on the heart by reducing the heart rate. This makes it possible to reduce myocardial oxygen demand.

Can the temperature rise during myocardial infarction?

Unstable temperature signals an inflammatory process. Most often, inflammation develops in the myocardium on the 3-4th day after a heart attack. The temperature rises to 37.5-38°C. With intensive treatment, by the end of the first week, the condition returns to normal.

When is the patient discharged home?

It all depends on the severity of the heart attack. If shallow changes have occurred in the myocardium, after 2 weeks the patient is discharged from the intensive care unit. Rehabilitation is carried out at home, under the supervision of the attending physician. If the damage is extensive, but without complications, it will take a month to recover. In severe cases of a heart attack, inpatient treatment can last up to 2 months.

With a heart attack, hemosorption is used. What is the procedure?

This is a method of cleansing the blood of cholesterol and lipoproteins (the main culprits in the development of atherosclerosis). If atherosclerosis threatens to narrow the lumen of the coronary artery, hemosorption is performed to prevent recurrent infarction.

What research should be done in heart disease?

Blood pressure control measurements:

general blood analysis;
blood biochemistry (with the determination of cholesterol levels);
electrocardiography;
Holter monitoring (daily electrocardiography);
ultrasound examination of the heart.

How long should the attending cardiologist observe the patient?

It all depends on the condition of the patient after a heart attack. The recovery period, which requires medical supervision, usually lasts 2 years.

A. N. Novikov, doctor of the highest category

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education - Specialist

Additional education:

"Cardiology"

State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia

The main symptoms of myocardial infarction are more or less known to all people. Especially for those who experience pain in the heart area from time to time. But the fact that the symptoms can be disguised as a common cold and the temperature rises with myocardial infarction is far from being guessed by everyone.

Causes of temperature increase in the pre-infarction period

In a pre-infarction state, the blood supply is gradually disturbed, the body weakens and becomes vulnerable, easily perceiving infections. During this period, you can easily catch a cold. Difficult pulmonary ventilation also causes symptoms similar to the onset of a cold infectious viral disease. Slight sore throat, desire to clear your throat is very characteristic. That's when a slight rise in body temperature is initially observed, which usually passes quickly. However, the sluggish state before a heart attack often resembles a cold with temperature changes. It can last several months, which should already be alarming.

Temperature increase in the acute period

In the acute period of a heart attack, on average for a week, in addition to the main signs of heart failure with weakness and shortness of breath, there is a temperature of up to 38–39º. The inflammatory process in the infarct zone is aimed at isolating the dying tissues of the heart muscle from those areas that are not subject to destruction. This period is dangerous for a repeated heart attack or a transition to a complicated condition. Sometimes it resembles an acute course of a cold with dizziness and weakness.

Resorption, necrotic syndrome is required for the onset of a heart attack, it is he who distinguishes myocardial infarction from an attack of angina pectoris or asthma. The tissues of the affected areas of the heart muscle begin to disintegrate, and the decomposition products are actively absorbed by the body. This provokes a feverish state, an increase in the number of leukocytes. Among leukocytes, neutrophil cells (a type of leukocyte) predominate, which absorb tissue decomposition products, causing the body's response to inflammation. In laboratory diagnosis, a blood test confirms a shift in the peripheral blood to the left. The erythrocyte sedimentation rate accelerates, blood enzymes become active. Outwardly, this is expressed in an increase in the patient's body temperature, on average up to 38.5º.

Usually a feverish state is fixed in such cases on the second day of reactive changes. How much the temperature will rise, and how long it will remain, depends on many factors. For example, how large and deeply affected the dying area is, what is the reaction of the body to this process, etc.

Temperature reactions to inflammation due to myocardial infarction

As necrosis progresses, it engulfs the myocardium from within. The process reaches the inner shell of the heart - the endocardium, its inflammation develops. If further there is a deposition of blood clots - thrombi - on the walls of the heart cavities - this is parietal thromboendocarditis. It gives a prolonged increase in the patient's temperature.

The same temperature reaction is noted in fibrinous pericarditis as a complication of myocardial infarction. The temperature rises due to necrobiotic processes in the heart muscle. Initially, it is provoked by leukocytosis, and then often keeps parallel to it. Exudative (effusion) pericarditis in complicated myocardial infarction causes inflammation of the pericardial sheets. Therefore, the suction functions are disturbed, and a lot of inflammatory fluid accumulates in the pericardial cavity. This condition causes a high temperature for a month.

Causes of temperature changes in the body

When there is a sharp drop in heart tone, the mass of blood necessary for normal circulation is greatly reduced. Arterial and venous pressure falls because the flow of venous blood to the heart is reduced. Oxygen starvation of the brain sets in, which causes difficulties in the functioning of the whole organism. This is a collapse of the heart, in which the temperature is normal or even below normal.

In severe processes of the development of the disease, the production of leukocytes can slow down, up to leukopenia, when their number drops sharply or gradually. It is common in patients older than 60, more often in women than men. In this case, the effect of the so-called scissors occurs - the ESR indicators rise sharply, the body reacts with temperature with fever. Reasons for this:

Infection of the heart and valves.
Softening of the muscle tissue of the heart - myomalacia.
anemia.
Perifocal inflammation - within the circumference of the focal tissue lesion.
Destruction of tissue structures.

Symptoms of changes in body temperature in myocardial infarction

The temperature reaction to the inflammatory process is very individual, but there are common symptoms characteristic of it:

On the first day of myocardial infarction, the temperature rises rarely or towards the end of the day. However, there are some patients in whom this occurs immediately after a painful attack. Although the process of disintegration of myocardial fibers and the absorption of its toxic waste has not yet begun. According to doctors, this is due to the nervous reflex reaction of the body.
On the 2nd or 3rd day, 90% of patients have a temperature increase to 38º, although there are cases of low-grade fever - 37.1–37.9º.
The level of elevated temperature persists up to 6–10 days inclusive.
The process of myocardial inflammation is expressed by a slight (up to 38º) temperature increase on the 3rd day of a heart attack. The temperature returns to normal after 4 days.
Extensive damage to the tissues of the heart causes the manifestation of high temperature for two weeks.
If the fever persists for more than 14 days, then myocardial infarction has passed into a complicated form.

When the patient's body temperature rises to 39–40º, as a rule, some other serious illness is added to myocardial infarction, which complicates the situation. It could be pneumonia or pyelonephritis.

Sometimes the temperature increase progresses slowly. The maximum growth in these cases is observed only after a few days. Also, the process of its reduction and normalization is gradually going on.

The degree of temperature reaction is affected by the age of the patient. The young body reacts with greater force, so the temperature rises more strongly. In elderly and elderly patients, the temperature may not rise much, or even be completely normal. The temperature also shows that myocardial infarction is represented by a small focal type or is complicated by the insufficiency of the functioning of the left ventricle of the heart to an extreme degree. In cardiogenic shock, due to a decrease in myocardial contractility and a lack of blood supply, the temperature drops.

How temperature is related to the diagnosis of myocardial infarction

An increase in the patient's temperature as a reaction of the body to compressive (anginal) pain during an attack is an important symptomatic indicator of diagnosis for the doctor. This shows that new lesions of myocardial tissues develop in the patient's body. This is confirmed by an increase in the number of leukocytes. The more of them, the more unfavorable the prognosis of the course of the disease due to the extent of the lesion.

Also in the very first days, there is a strong decrease in one of the varieties of leukocytes - granular eosinophils, up to their complete absence - aneosinophilia. This is a reaction to the accumulation of decay products of toxins, which is also manifested by an increase in temperature. In process of recovery indicators of a leukocytic formula are restored and the temperature decreases. An increase in the erythrocyte sedimentation rate is diagnosed, as a rule, on the second or third day, reaches a maximum by an average of 10 days, then goes down and normalizes in a month.

With a complicated stage of the disease, this process is delayed. An increase in temperature and ESR is absent in angina pectoris, the symptoms of which are very similar to those of a heart attack. Therefore, these two signs are characteristic for its diagnosis. An increase in the functionality of the enzyme - myoglobin creatine phosphokinase in the heart muscle - manifests itself already 2-4 hours after the onset of the attack. Biochemical changes in the blood composition during myocardial infarction usually show an increase in its fermentation, because when the heart tissue dies, they actively enter the blood. Therefore, their presence in the analysis for the diagnosis of myocardial infarction is important.

The readings of the activity of transaminases (enzymes of liver cells) change, which remain at this level for up to a week. All this can be externally expressed by the temperature reaction of the patient's body. Observation of these processes allows us to draw conclusions about how the myocardium is restored.

Sometimes, especially in women and in diabetes mellitus, myocardial infarction can be asymptomatic. This is an atypical form. However, a symptom of transferring it becomes a temperature of up to 39º, which rises a day after a heart attack. This is again due to the intoxication of the body with tissue decomposition products. Therefore, the temperature gives reason to think that an atypical manifestation of a heart attack may have occurred. In order to avoid complications and death, do not neglect the temperature reaction. It is necessary to carefully check the temperature sign to confirm or eliminate concerns.

Temperature at other stages of the disease

In the subacute period, usually the patient's condition becomes much better, the pain goes away, the body temperature becomes normal.

The protracted course of a recurrent form of myocardial infarction is characterized by re-infection. It occurs due to the fact that the process of disintegration of muscle tissue is incomplete and the scar is formed slowly.

One option may be repeated arrhythmic or asthmatic infection. This causes a temperature reaction even two, two and a half months after the initial attack of a heart attack. This type of infarction is typical for elderly patients with severe coronary atherosclerosis. Necrosis in this case affects not only the areas that have undergone the first attack of a heart attack, but also healthy muscle fibers located in the infarcted area. This can be with a large-focal or small-focal form of a heart attack.

Here, attention is also drawn to the state of the collateral blood supply through the lateral vessels. With this form, patients complain of typical pain, fever, and blood tests show all the characteristic changes in leukocytes, enzymes and ESR.

Protracted forms of a heart attack can occur with a peripheral temperature increase (an increase in the temperature of skin receptors, subcutaneous adipose tissue, internal organs, the surface of skeletal muscles, etc.).

Recurrent myocardial infarction and temperature response

After 2 months, sometimes later, it also happens a few years after a heart attack, when even the scarring process has reached its full completion, a second heart attack occurs. Most often, in a one-year period after an attack, it develops in males of advanced age. Provoking factors are hypertension, especially crisis, chronic coronary heart disease. And also the influence is exerted by how long the period between the initial and repeated attack lasted, how much destruction of the myocardium.

Repeated heart attack sometimes develops atypically and is difficult to diagnose by electrocardiogram. However, the course of the disease is severe: with heart failure in acute and then chronic form, arrhythmias. High probability of death. Therefore, if the interpretation of the ECG and the comparison of the diagnosis of its previous version with the subsequent one did not bring results, then other indicators are analyzed. They include the dynamics of changes in the biochemical blood composition, the patient's temperature, etc. The patient's condition is monitored for a long time, at least a week. Often this condition turns into diffuse macrofocal cardiosclerosis.

Fever during thrombolytic therapy

The most common cause of a heart attack is a blockage or narrowing of blood vessels. They, affected by atherosclerotic plaques with thrombus formation, are not able to distill blood. Therefore, thrombolytic therapy is immediately used to treat myocardial infarction. Carried out in the first hour of the onset of the disease, the so-called golden hour, it helps to save most of the heart tissue from dying off. The blood flow is restored, the patient recovers faster.

However, drugs such as Fibrinolysin with Heparin, Plasmin - plasminogen activated by the enzyme - trypsin (a drug based on human plasma) are endogenous, have an external form of application. They improve the condition very slowly, while causing an increase in the temperature of the patient. Therefore, in order to eliminate side effects, they are used in conjunction with streptokinase-type activators injected directly into the coronary vessel. This occurs in stationary conditions of large medical centers during coronography. It is also possible to receive intravenous drip medication for an hour.

Temperature in acute myocardial infarction

If a heart muscle infarction passes with a complication in the form of pulmonary edema, then most often this is due to blockage of blood vessels and the formation of blood clots on the walls of the right ventricle of the heart. With insufficient function of the left ventricle, this can occur due to stagnation of blood in the pulmonary circulation, which caused thrombosis of the pulmonary vessels.

Diagnosis is carried out on the basis of examination of the patient and his description of his state of health. As a rule, these are chest pain, palpitations, shortness of breath, fever above 38º and bloody sputum when coughing.

An increase in temperature is possible during the rehabilitation period of scar formation with complications in the form of ischemic cardiopathy and pericarditis. Pain is similar to the acute course of a heart attack and is associated with the respiratory process. Often they depend on the position of the patient's body.

Postinfarction inflammation of the pericardium - the outer shell of the heart - causes leukocytosis and is manifested by an increase in body temperature.

Temperature response to Dressler's syndrome

Quite often, after an attack, an allergic post-infarction syndrome occurs, named after the doctor who described it. Dressler's syndrome is an inflammation of the tissues of the heart and lungs. It is manifested by pleurisy (lesion of the membrane covering the walls of the chest and lungs), pneumonia, pericardial inflammation, arthritis of the shoulder joints (mostly on the left). All these processes, as a rule, cause a temperature reaction of the body.

Such a reaction of the body is autoimmune, that is, immune cells perceive the tissues and organs of their own body as foreign and direct their forces to fight them.

This syndrome often occurs from the second to the sixth week after an attack of myocardial infarction. It can be expressed as one of the following complications, or in combination:

Inflammation of the heart membrane - the pericardium - in this case manifests itself in a mild form, nevertheless causing a subfebrile temperature within 38º. Pain and fever go away after a few days.
Pleurisy complements the picture of the disease with increasing pain during breathing, localized in the chest area, a slight increase in temperature.
Autoimmune pneumonia is expressed by shortness of breath and temperature reaction.
Damage to the internal (synovial) membranes of the joints is manifested by pain and subfebrile condition.

The combination complicates the course of myocardial infarction and gives a prolonged elevated temperature background.

There are asymptomatic forms of manifestation of Dressler's syndrome, which are diagnosed only by a change in the biochemical composition of the blood and an increase in temperature for a long time. They can be found in association with severe and persistent joint pain (arthralgia).

The cause of this condition in the syndrome is oxygen deficiency (hypoxia) of the muscles of the heart and other organs. Due to the fact that the cells of the muscular layer of the heart are damaged, antibodies are produced, on which the immune attack begins, which then passes to native cells, perceived as foreign. This situation often occurs with extensive myocardial infarction.

Also, the syndrome has an inflammatory-allergic nature of occurrence, which can sometimes manifest as isolated polyarthritis.

In the treatment to relieve inflammation and normalize the temperature, amidopyrine, aspirin (acetylsalicylic acid), in severe cases - prednisolone, cortisone (corticosteroid hormones) are used.

Temperature in chronic heart attack

The chronic form of a heart attack is manifested by periodic pressing pains and shortness of breath, very similar to those that occur at the very beginning of an attack of the disease. Such symptoms may occur for a week or more (up to 21 days). As soon as the pain begins, the temperature rises. The patient has a fever for several days, then the temperature drops, but soon a new surge occurs.

It happens that the temperature manifests itself subfebrile and remains at this level even when pain attacks pass. But on the other hand, if the pain returns, it leads to a temperature surge for at least 3 days. This undulating fever is very similar to the manifestations of septic, rheumatic endocarditis and may be due to a similar complication. Then, when listening to heart sounds, the doctor detects a characteristic systolic murmur - muscular or functional.

Myocardial infarction in any form, except for the stage of remission, proceeds as an inflammation, which is confirmed by biochemical changes in the composition of the blood. Therefore, the reaction of the body to this is so universal - a change in body temperature. This implies a unified approach in prescribing drug treatment, aimed not only at eliminating the consequences of a heart muscle infarction, but also at relieving the inflammatory process as a whole.

A longer leukocytosis indicates the presence of complications. Usually there is a moderate increase in the number of leukocytes in the blood - up to (10 - 12) * 10 9 / l. Very high leukocytosis (over 20 * 10 9 / l) is considered an unfavorable prognostic sign.

"Myocardial infarction", M.Ya. Ruda

Symptoms of myocardial infarction (presystolic rhythm)

myocardial infarction

Myocardial infarction - causes

Myocardial infarction - symptoms

In 15% of patients, an attack of pain lasts no more than one hour, in 40% of patients from two to twelve hours, in 45% of patients - about one day.

Clinical forms of myocardial infarction:

Asthmatic form (the disease begins with an attack of cardiac asthma)

Anginal form (a heart attack begins with pain attacks in the region of the heart and behind the sternum)

Abdominal form (begins with dyspepsia and pain in the upper abdomen)

Collaptoid form (disease preceded by collapse)

Cerebral form (the disease begins with focal neurological symptoms)

mixed form

Painless form (the onset of myocardial infarction is latent)

Atypical forms of myocardial infarction

Diagnosis of myocardial infarction

Myocardial infarction - treatment

Acetylsalicylic acid (aspirin) - due to inhibition of platelets, the formation of blood clots is prevented

Prasugrel, Ticlopidin, Clopidogrel (Plavix) - also prevent the formation of a blood clot, but they are much more powerful than aspirin

Bivalirudin, Fraxiparin, Lovenox, Heparin - anticoagulants that prevent the formation and spread of blood clots and act on blood clotting

Reteplase, Alteplase, Streptokinase are powerful thrombolytic drugs that can dissolve an already formed blood clot

All of the above drugs are used in combination and are vital for the successful treatment of myocardial infarction.

In the event that all the above measures are impossible or do not help, the only means to restore blood circulation (save the myocardium) is an urgent coronary artery bypass grafting.

Biblical Israel

How to save the heart from pain?

What role does heredity play in the development of myocardial infarction?

When to go to the doctor?

See a cardiologist if:

feel pain behind the sternum;
sometimes it is difficult to breathe;
having difficulty climbing stairs;
feel interruptions in the work of the heart;
do not even tolerate ordinary physical exertion? - this may be the result of angina pectoris and ischemia;
experience bouts of dizziness and weakness;
periodically there are fainting spells;
it seems that the heart is ready to jump out of the chest, is the first sign of arrhythmia.

How to determine if you have a pre-infarction condition?

If there is a stoppage of breathing and heartbeat, then what to do before the arrival of the ambulance?

For relatives:

1. Lay the person on their back on a flat surface and tilt their head back to ensure the airway is clear.

4. If resuscitation is carried out alone, every 15 compressions, two consecutive blows should be made into the patient's lungs (mouth to mouth).

5. If the patient's face turned pink, the pupils narrowed (that is, there was a reaction to light), he breathed on his own and a pulse appeared on the carotid artery, which means you managed to save the person.

Do I need to stay in bed after a heart attack?

What are the benefits of beta-blockers for the heart?

Can the temperature rise during myocardial infarction?

When is the patient discharged home?

With a heart attack, hemosorption is used. What is the procedure?

What research should be done in heart disease?

Blood pressure control measurements:

general blood analysis;
blood biochemistry (with the determination of cholesterol levels);
electrocardiography;
Holter monitoring (daily electrocardiography);
ultrasound examination of the heart.

How long should the attending cardiologist observe the patient?

It all depends on the condition of the patient after a heart attack. The recovery period, which requires medical supervision, usually lasts 2 years.

A. N. Novikov, doctor of the highest category

heal-cardio.com

temperature during a heart attack

Life in a civilized society has deprived most people of the need for intense physical activity, which served as a rapid increase in cardiovascular pathologies.

Myocardial infarction is one of the leading causes of cardiac death today. That is why every adult should know how this disease manifests itself in the initial stages and how our body reacts to it.

Causes of a heart attack

Myocardial infarction is the outcome of an irreversible violation of blood flow in the area of the heart muscle. Violation of blood supply in the myocardium is almost always associated with thrombosis of the coronary arteries against the background of atherosclerosis.

Such thrombi undergo spontaneous lysis due to the “emergency” increase in the work of the hypocoagulable blood systems, however, any ischemia lasting more than 1 hour leads to the death of cardiomyocytes from hypoxia. 15 hours after thrombosis, the area of necrosis in the affected area of the heart can already be seen with the naked eye.

Thus, the atherosclerotic process can be considered the fundamental cause of a heart attack. This is due to the fact that a thrombus can form only on the damaged part of the vessel, and the eroded surface of the cholesterol plaque is ideal for this. Factors in the formation of lipid layers on the walls of blood vessels are:

chronic intoxication;
bad habits (especially smoking, which triggers the processes of free radical damage to the endothelium);
prolonged use of combined oral contraceptives;
excessive insolation;
abuse of fatty foods;
excess weight;
endocrine diseases;
inflammatory processes in the vascular wall and more.

Stressful situations can also be attributed to risk factors, since against the background of emotional stress, the tone of the coronary vessels that feed the heart muscle changes. If the vessels have a narrowed lumen, then any nervous shock or fright can cause a severe spasm, which will finally disrupt blood circulation in the myocardium.

People who have a history of more than two of the above factors are at risk for a heart attack and should pay more attention to the state of their cardiovascular system.

Signs of a heart attack

The first signal that the heart muscle is experiencing oxygen starvation is pain. The number of cases of painless forms of myocardial infarction is very small, and even in these cases, the patient feels discomfort in the region of the heart, therefore it is quite rational to focus on pain. The nature of such pain can be pressing, burning or tearing.

Often the pain radiates to the left shoulder girdle, the left half of the neck and the shoulder blade on the same side. Taking painkillers and drugs from the nitroglycerin group has no effect, unlike an angina attack. The pain does not stop within half an hour and can only be stopped with morphine preparations.

Almost always, there is a decrease in blood pressure and various autonomic disorders in the form of cold extremities, sweating, etc. If a large vessel is blocked and a large area of the myocardium suffers, cardiogenic shock may develop with loss of consciousness, a sharp decrease in diastolic pressure to 40 mm Hg. and less.

There are options for the atypical course of myocardial infarction, in addition to painless ones, which can confuse even an experienced specialist. Among the atypical forms are:

Abdominal form. Characterized by pain in the upper abdomen, which is accompanied by hiccups, bloating, nausea and vomiting. May be confused with acute pancreatitis.
Asthmatic. It resembles an attack of bronchial asthma due to increasing shortness of breath.
Cerebral. It is distinguished by a change in the patient's behavior, complaints of dizziness or complete loss of consciousness. There may be focal neurological symptoms.
Collaptoid. It begins with a collapse (a sharp decrease in blood pressure, loss of consciousness, autonomic dysfunction). The condition is associated with cardiogenic shock against the background of damage to the heart wall.
Arrhythmic. With this form, the attack begins with severe arrhythmia, which can smoothly develop into a classic clinical picture or cardiogenic shock.
Edema. Differs in edematous phenomena from the lower extremities and the lower half of the abdomen, which is associated with insufficiency of the right ventricle.
Peripheral. With this type of heart attack, the pain is localized outside the area of the projection of the heart. Patients complain of pain in the throat, fingertips of the left hand, cervical spine.

There are also mixed forms, which suggest the presence of several complaints characteristic of various types of heart attacks. In any case, a patient with suspected myocardial infarction should be hospitalized for additional diagnosis and appropriate treatment.

Diagnosis of a heart attack

It is possible to diagnose a heart attack with accuracy only after electrocardiography, which in our country is available only in a hospital setting. On the ECG, after a few hours, signs of ischemia appear, which are manifested by the rise or depression of the S-T segments. In this case, the changes will be in those leads, the projection of which corresponds to the site of the infarction. During the period of necrobiosis (the second stage of myocardial infarction), an abnormal Q wave may appear in one or more leads of the cardiogram, which directly indicates in favor of transmural damage to the wall.

In the first hours after a heart attack, ECG changes may not be observed, in such cases, the patient is shown laboratory tests for markers of myocardial damage (creatine kinase (CPK-MB), lactate dehydrogenase (LDH-1), aspartate aminotransferase (AST) or troponin). All of them are substances released during cytolysis (cell destruction) and, even with a small amount of damage, appear in the blood serum.

In case of controversial cases, the department performs echocardiography, which fully reflects the function of various parts of the heart muscle. If the hospital has the ability to perform coronary artery bypass grafting or stent placement, then coronary angiography (contrast radiography of the coronary arteries) is also indicated.

Thanks to the procedure, it is possible to visualize the level of thrombus localization and assess the amount of ischemic damage. After the elimination of the acute condition, in the delayed period, myocardial scintigraphy can be performed if necessary.

Differential diagnosis is usually carried out with an attack of unstable angina and pulmonary embolism.

Temperature response to heart attack

Damage to a vital organ cannot but be accompanied by systemic changes in the body. The death of cardiomyocytes leads to the release into the blood of a mass of substances that signal a “breakdown” to systems that can restore the defect. Some of them also have pyrogenic properties, that is, the ability to cause fever. Therefore, to the question - "Can there be a fever after a heart attack?" - there is a definite positive answer.

The mechanism of temperature reaction is quite complex and has a deep physiological meaning. Primary pyrogens, released from destroyed myocardial cells, provoke the synthesis of interleukin by surrounding tissues. Interleukin, after entering the bloodstream, affects leukocytes, which intensively begin to produce prostaglandins and other compounds that affect the thermoregulatory centers in the hypothalamus. A change in the sensitivity of cold and heat receptors, at the same time, causes a decrease in heat transfer and an increase in heat production, due to which the temperature rises.

This pathogenetic chain makes sense to increase the reactivity of the diseased organism. An increase in temperature triggers a whole cascade of chemical reactions in our body, which prevents the infection from joining, and also stimulates regeneration processes for the speedy scarring of the focus.

The temperature during a heart attack appears on the 2nd or 3rd day and can reach 37.5 - 38 ° C. The height of the temperature correlates with the volume of the lesion, that is, the larger the focus of ischemia, the more intense and longer the fever can be. The patient stays in this state for about 7-10 days, which should not cause concern, because this can be considered an adequate reaction of the body.

Some time ago, there were suggestions about the relationship between post-infarction fever and a decrease in systolic function of the left ventricle, however, they were all refuted experimentally.

Fever for more than 10 days after a heart attack or an increase in temperature above 39 ° C can indicate the attachment of an infectious process in the heart muscle or lungs. In parallel with this, the general condition of the patient will also worsen, therefore such changes are unlikely to be accidentally overlooked.

Along with a change in body temperature in the blood, the number of leukocytes will increase, which can also be considered normal for a person who has had a heart attack. Leukocytosis of more than 20 thousand should alert, as well as deterioration against the background of both febrile temperature and hypothermia (below 35 ° C), which may be a signal of septic complications.

A fever that occurs weeks after an attack also indicates a pathological process that can be both infectious and autoimmune in nature (postinfarction Dressler's syndrome).

How to deal with a fever in a heart attack

An increase in body temperature is always associated with discomfort. Headache, ache in the joints, chilliness and sweating cannot but disturb the state of health, therefore patients often want to bring down the fever as soon as possible. However, if the temperature does not exceed 38 ° C, then this is not recommended.

The reasons lie in the same significance of this reaction for the body. Yes, and there will be no long-term effect from such treatment, it will take only a few hours and the fever will return to its original position. Under the condition of subfebrile condition, the fight against it can be set aside, as this will only increase the list of prescriptions, which is already loaded with a significant amount of drugs.

If the thermometer on the thermometer reaches more than 38 ° C, then it is recommended to take some kind of antipyretic, since such a thermal load begins to affect the state of the cardiovascular system. To reduce the temperature, Paracetamol, Ibuprofen, Nimesulide, or any other non-steroidal anti-inflammatory drug that suits the patient is perfect.

You should not try to lower the temperature on your own without first consulting with your doctor. Any changes in the condition must be reported to the staff of the department in which the patient is located. By hiding the fever from the doctor, you can miss the moment of infection, which will greatly complicate the recovery process and threaten with serious complications.

Treatment of the consequences of a heart attack is a long process of interaction between a doctor and a patient, therefore it is very important to reach a consensus between these two main links in the treatment process. Only by following the recommendations exactly, the patient will be able to quickly get back on his feet and prevent a recurrence of a heart attack.

wmedik.ru

Temperature in myocardial infarction: how to normalize after an attack

Causes of temperature increase in the pre-infarction period

Temperature increase in the acute period

Temperature reactions to inflammation due to myocardial infarction

Causes of temperature changes in the body

Infection of the heart and valves.
Softening of the muscle tissue of the heart - myomalacia.
anemia.
Perifocal inflammation - within the circumference of the focal tissue lesion.
Destruction of tissue structures.

Symptoms of changes in body temperature in myocardial infarction

The temperature reaction to the inflammatory process is very individual, but there are common symptoms characteristic of it:

On the first day of myocardial infarction, the temperature rises rarely or towards the end of the day. However, there are some patients in whom this occurs immediately after a painful attack. Although the process of disintegration of myocardial fibers and the absorption of its toxic waste has not yet begun. According to doctors, this is due to the nervous reflex reaction of the body.
On the 2nd or 3rd day, 90% of patients have a temperature increase to 38º, although there are cases of low-grade fever - 37.1–37.9º.
The level of elevated temperature persists up to 6–10 days inclusive.
The process of myocardial inflammation is expressed by a slight (up to 38º) temperature increase on the 3rd day of a heart attack. The temperature returns to normal after 4 days.
Extensive damage to the tissues of the heart causes the manifestation of high temperature for two weeks.
If the fever persists for more than 14 days, then myocardial infarction has passed into a complicated form.

Sometimes the temperature increase progresses slowly. The maximum growth in these cases is observed only after a few days. Also, the process of its reduction and normalization is gradually going on.

How temperature is related to the diagnosis of myocardial infarction

Temperature at other stages of the disease

In the subacute period, usually the patient's condition becomes much better, the pain goes away, the body temperature becomes normal.

Recurrent myocardial infarction and temperature response

Fever during thrombolytic therapy

Temperature in acute myocardial infarction

Postinfarction inflammation of the pericardium - the outer shell of the heart - causes leukocytosis and is manifested by an increase in body temperature.

Temperature response to Dressler's syndrome

Such a reaction of the body is autoimmune, that is, immune cells perceive the tissues and organs of their own body as foreign and direct their forces to fight them.

This syndrome often occurs from the second to the sixth week after an attack of myocardial infarction. It can be expressed as one of the following complications, or in combination:

Inflammation of the heart membrane - the pericardium - in this case manifests itself in a mild form, nevertheless causing a subfebrile temperature within 38º. Pain and fever go away after a few days.
Pleurisy complements the picture of the disease with increasing pain during breathing, localized in the chest area, a slight increase in temperature.
Autoimmune pneumonia is expressed by shortness of breath and temperature reaction.
Damage to the internal (synovial) membranes of the joints is manifested by pain and subfebrile condition.

The combination complicates the course of myocardial infarction and gives a prolonged elevated temperature background.

Also, the syndrome has an inflammatory-allergic nature of occurrence, which can sometimes manifest as isolated polyarthritis.

In the treatment to relieve inflammation and normalize the temperature, amidopyrine, aspirin (acetylsalicylic acid), in severe cases - prednisolone, cortisone (corticosteroid hormones) are used.

Temperature in chronic heart attack

cardioplanet.com

Temperature in myocardial infarction

A heart attack is the most severe heart disease: where pain occurs, how it manifests itself, whether there is a temperature during a heart attack - this is worth knowing for every adult. Doctors often face the presence of various pains in the heart in patients. It is important to recognize myocardial infarction in time in order to immediately help the injured person. A heart attack can happen to anyone and at any age. There are many reasons for this disease. Most deaths from myocardial infarction occur within the first hour of onset. But in most cases, a person's life can be saved. Calmness, knowledge of a clear algorithm of actions in such a situation and confidence are the factors that determine whether the patient can survive.

General clinical picture of a heart attack

In fact, myocardial infarction is necrosis of the heart muscle. This is a signal from the heart that it is not receiving enough blood, which means oxygen and nutrients. As a result of a violation or complete cessation of blood circulation, a certain area of \u200b\u200bthe heart muscle dies.

People over 40 suffer from myocardial infarction most often. This happens less often in young people. Not only doctors should be able to recognize a heart attack by common signs.

The main symptom of myocardial infarction is severe pain in the left side of the chest, and taking conventional medicines almost does not bring relief to the victim. Irradiation of pain also occurs in the left arm, shoulder, shoulder blade, abdomen. The pain can feel completely different, but always very strong. Blood pressure may drop sharply, cold sweat may come out. The patient may feel dizzy, have nausea, vomiting, and sometimes even diarrhea. The patient's skin color becomes pale gray, all limbs become cold.

The pulse can be felt very weakly or not at all. The victim may have tachycardia, blood pressure drops sharply. A person may be scared, he has heavy breathing. Serious disturbances in the functioning of the nervous system can occur: fainting or loss of consciousness, hiccups, weakness.

The causes of a heart attack can be the following factors:

stressful situations;

mental strain;

excessive consumption of alcohol and food;

a sharp change in weather conditions;

lack of sleep;

high blood cholesterol;

diabetes;

sedentary lifestyle.

With myocardial infarction, there is very little time - an hour and a half. You have only 90 minutes from the onset of the first symptoms of the disease to the moment when the victim is in the hospital and receives qualified medical care.

This is the time you need to do:

Perform a first aid.
Call an ambulance.
Get to a specialized hospital.
Do coronary angiography.
To diagnose.
Restore blood flow to the heart muscle.

Predisposition to such cardiovascular pathologies can be inherited.

What does the temperature say

Can there be a temperature during a heart attack? Undoubtedly. Its increase is one of the important signs by which the onset of this terrible disease is determined. This is due to the fact that there are sharp reactive changes in the body of the victim. Temperature in myocardial infarction on the first day is present in 90 percent of cases. As a rule, it can appear immediately during an attack or by the end of the first day, and it happens that on the second or even on the third day. A significant increase in body temperature (up to 40 degrees) is quite rare and, as a rule, is a sign of any accompanying disease (pneumonia, kidney inflammation). The degree of increase in body temperature of the patient also depends on the extent of damage to the heart muscle.

Often in older people, the temperature during a heart attack remains normal. If cardiogenic shock has occurred, the temperature may even decrease. In young people, this reaction of the body is much more pronounced, so they often experience an increase in body temperature. The occurrence of such a reaction should prompt the doctor that there are new lesions in the myocardium. The temperature can rise slowly, reaching a very high point, then dropping down to a normal 36.6. Sometimes there are cases of a heart attack, in which there is immediately a sharp increase followed by a decrease. Usually the temperature in the range of 37-38 degrees lasts up to five to seven days. If it continues to hold on longer than this period, then this should especially alert the doctor, since it means that there are complications in the patient's body.

In medicine, there are cases when a heart attack turned into a protracted form with a peripheral change in body temperature. After a short time (2-3 weeks), the patient may develop signs of pleurisy, arthritis, pneumonia with fever.

What to do immediately

If there is a suspicion of a heart attack, you need to urgently take the necessary measures:

Ensure the patient is in a sitting position.
Give a pain reliever. It is imperative to find out if the victim has an allergy to medications, since intolerance to drugs with an acute development of allergic reactions is possible, otherwise the drug will not help the person, but will only lead to complications.
Immediately call an ambulance and take the person to the hospital.

It is necessary to wait for the arrival of the doctors and transfer the patient under their supervision. Only in this case will he have a chance for salvation.

A person who has had an attack of a heart attack should be treated only in a hospital and under the full supervision of doctors. The further condition of the victim depends not only on drug treatment. After a heart attack, it is very important to consolidate the result, adhering to the doctor's recommendations.

The following factors matter:

compliance with the daily routine;
lack of mental and physical stress;
lack of bad habits;
diet compliance. You need to drink enough water, eat regularly (every three to four hours). Sugar and foods that contribute to the accumulation of fat should be excluded.

On average, the organization of a heart attack can be within three to four months, with a large focal heart attack - up to six months.

At the end of treatment, the patient will need to undergo a course of rehabilitation measures. After a heart attack, overload is contraindicated for the next few years.

To avoid a heart attack, you should lead an active lifestyle, monitor your weight, say goodbye to smoking, harmful foods, alcohol, and the habit of eating late at night. If necessary, you need to visit a doctor and take tests. To lower cholesterol, which provokes diseases such as a heart attack, take statins as recommended by your doctor. In your daily diet, you need to include foods that help cleanse blood vessels (garlic, ginger, vegetables). After a heart attack, you should be especially careful about your own health.

Remember - trouble can happen to anyone. Do not pass by if the person next to you becomes ill. Someday you may find yourself in this situation.

Diagnosis of acute myocardial infarction is based on the assessment of the pain syndrome (according to the story of the patient or his relatives), the results of the examination of the patient, ECG changes and some laboratory parameters. Under typical conditions (on average in 90% of patients), myocardial infarction begins with an attack of angina pectoris pain felt behind the sternum or to the left of it: pressing, squeezing, burning, boring, occasionally stabbing ("weight on the heart", "stab in the chest", "hot dagger in the heart", etc.). Often the pain reaches its maximum intensity in a short time. Sometimes they grow gradually or acquire a wave-like character (weaken and quickly increase again). Nitroglycerin rarely brings relief. Pain radiates primarily to the left half of the chest, under the left shoulder blade, along the left arm to the fifth finger, and also to the right side of the anterior surface of the chest, to the neck, jaw. Some patients feel a sharp burning sensation only in the left arm (shoulder, wrist). At the same time, the sick are seized by a sense of anxiety, fear of approaching death; they groan, change position of the body in search of relief from pain. Sweating increases, weakness may appear.

The duration of such an angina attack usually exceeds 30 minutes, often it drags on for many hours and days. It happens that the first attack of retrosternal pain is shorter than half an hour, but then after a period free from pain, a second, protracted pain attack follows. It should be mentioned that people with reduced sensitivity to visceral pain, including alcoholics, can perceive angina pain only as discomfort in the chest, mild tightness in the chest.

Acute myocardial infarction occurs at any time of the day, especially often at night, early morning hours. Attacks are provoked by various reasons: excessive physical effort, intense mental work, conflict situations, experiences, unrest, rich food, alcohol, sudden changes in the weather.

If the patient does not experience circulatory disorders, does not significantly decrease blood pressure and does not disturb the rhythm of the heart, then the onset of acute myocardial infarction is regarded as uncomplicated. Of course, even in such patients, the ambulance doctor can detect a number of objective signs: pallor, moisturizing of the skin of the face, blurred cyanosis of the lips. slowing of the pulse, followed by its increase or from the very beginning sinus tachycardia (up to 100 beats / min), rare extrasystoles, weakening of the first tone at the apex of the heart.

Arterial pressure on the 1st day of the disease either corresponds to the age norm, or decreases slightly. There are, however, patients whose blood pressure rises above 150/90 mm Hg. Art., which, among other things, is associated with a feeling of severe retrosternal pain.

Auscultation of the heart does not give clear criteria about the nature of the lesion. It is necessary to mention only the sign of large-focal end-to-end myocardial infarction - eisthenocardiac pericarditis. Its main manifestation is a gentle pericardial friction rub, which can be heard on the 2-4th day of the disease, in approximately 10% of patients, more often with anterior localization of the infarction. Noise is determined within a few hours in the area of absolute dullness of the heart and along its left border. A coarser and more persistent pericardial friction rub can be heard in the first days of the disease and outside the zone of necrosis. Such diffuse enistenocardic pericarditis is a consequence of the spread of inflammation that began in the necrotic zone. This process may be accompanied by constant pain in the region of the heart, aggravated by deep inspiration, coughing, changing body position, which is not always correctly interpreted by doctors ("acute pneumonia", "intercostal neuralgia", etc.).

An increase in body temperature that occurs in 80 - 90% of patients should be expected by the end of the 1st day or on the 2nd, less often - the 3rd day of illness. The body temperature is about 37 ... 38.5 CC is maintained for 3 - 7 days. The lengthening of the period of fever is associated with the addition of pneumonia, exacerbation of pyelonephritis, etc.

An increase in the number of leukocytes in the blood (neutrophilic leukocytosis) is observed in 80% of patients by the end of the 1st day and on the 2nd day of acute myocardial infarction. ESR rises on the 2-3rd day. An increase in CPK activity and CPK MB is recorded after 4/2 hours from the onset of a pain attack, AST activity - after 4-6 hours, myoglobinemia develops after 1 - 1.5 hours.

Back in 1909, V.P. Obraztsov and N.D. Strazhesko reported three initial clinical variants of acute thrombosis of the coronary arteries of the heart: status stenocardicus, status asthmaticus, status gastralgicus. Subsequently, it was shown that myocardial infarction can debut with cerebral and arrhythmic disorders.

In extensive clinical observations by I. E. Ganelina (1977), primary large-focal myocardial infarction began with chest pain in 95% of patients, repeated myocardial infarction - in 76% of patients. The frequency of the anginal variant decreased somewhat in people over 60 years of age. The description of status stenocardicus has been given above.

Asthmatic onset of acute widespread myocardial infarction occurs in 5-10% of patients. In half of the cases, suffocation is combined with retrosternal pain. More often this happens in the elderly or with a second heart attack against the background of an already existing expansion (hypertrophy) of the left ventricle, postinfarction cardiosclerosis, chronic heart aneurysm, and obesity. An acute increase in blood pressure can contribute to the development of cardiac asthma.

This syndrome is based on an extreme degree of left ventricular failure and retrograde congestion in the lungs. The feeling of lack of air, developing into suffocation, and the fear of death associated with it appear suddenly. The patient becomes very restless, "cannot find a place for himself", takes a forced sitting position, leaning his hands on the bed to increase the respiratory movements. The respiratory rate increases to 40 - 50 per 1 min; the nature of breathing changes: a short inhalation is followed by an extended exhalation. The expression of the patient's face is suffering, exhausted, the skin is pale, the lips are cyanotic, cold sweat appears. Signs of acute swelling and incipient stagnation in the lungs are determined: percussion sound with a tympanic tinge, hard breathing, persistent moist fine bubbling rales in the posterior or middle paravertebral sections, as well as wheezing due to bronchospasm and swelling of the mucous membrane of small bronchi.

If the patient does not receive the necessary assistance, then pulmonary congestion steadily progresses: cardiac asthma turns into pulmonary edema. Breathing becomes noisy, bubbling, wheezing is heard in the distance. A cough appears, and soon a liquid, foamy sputum of a pinkish color or with an admixture of blood begins to separate. The amount of sputum is increasing. The pulse noticeably quickens, its filling is lowered. Blood pressure varies in different patients from low to high (secondary hypoxic arterial hypertension) The melody of the heart is difficult to listen to. In the intervals between breaths, it is possible to catch a deaf I tone at the top, the summation rhythm of the "gallop"; on the pulmonary artery - an accent of the II tone. When percussion of the lungs, dull tympanitis is determined both in the lower sections and above the tops. Respiratory noise is not heard due to an abundance of different-sized sonorous wet rales, their front moves from the bottom up, covering the entire surface of the lungs.

Far advanced status asthmaticus (pulmonary edema) is an obstacle to transporting patients to a specialized infarction department. The role of the emergency physician in the prompt elimination of pulmonary edema is extremely high.

The gastralgic variant of the onset of acute myocardial infarction is observed in 2-3% of patients, mainly with its lower or lower-posterior localization. V. P. Obraztsov and N. D. Strazhesko described this condition as a feeling by patients of painful strong pressure in the epigastric region and "support" under the heart. "Reflex", "reflected" pain in the upper abdomen can be cramping.

Patients at this time are excited, rush about, groan; their skin at the time of intensification of pain becomes covered with sweat. However, palpation of the abdomen does not eliminate significant pain, the abdomen remains soft, and there are no symptoms of peritoneal irritation. Such a clear discrepancy between subjective and objective symptoms is of diagnostic value.

Nausea, vomiting, excruciating hiccups, loose stools may soon join the pain. This has repeatedly served as a pretext for erroneous medical conclusions about food intoxication or gastroenteritis. This impression is reinforced if the patient informs the doctor about the use of poor-quality food by him shortly before the disease. In such a situation, gastric lavage (bezzondovoe or with the help of a probe), a cleansing enema were sometimes prescribed. These measures provide only temporary relief; after 1-11/2 hours, pain, as a rule, resumes with renewed vigor, the patient's condition progressively worsens with fatal consequences.

An observant doctor will pay attention to such signs that are not characteristic of a gastrointestinal disease, such as cyanosis, increased dyspnea during movements, deafness of the first tone at the apex of the heart against the background of sinus tachycardia. It has also been noted that under the influence of analgesics, a false abdominal syndrome often turns into an almost typical anginal status.

Diagnostic difficulties increase if status gastralgicus associated with myocardial infarction develops against the background of acute pathology of the abdominal organs. In the literature, one can find descriptions of acute myocardial infarction, which in the very first hours was complicated by hemorrhagic pancreatitis, perforation of a stomach ulcer or gastric bleeding. Obviously, in such complex diagnostic cases, the emergency physician must immediately hospitalize the patient.

The cerebral variant of the onset of myocardial infarction is not always interpreted in the same way by clinicians. Strictly speaking, it should be identified only with the apoplexy form of acute myocardial infarction described by N. K. Bogolepov (1949). True, ischemic stroke here is a complication of myocardial infarction, and it is in this sequence that these 2 diseases develop - the heart and the brain. Meanwhile, "heart" symptoms are initially masked by more obvious signs of vascular damage to the brain (hemiparesis, speech impairment, etc.). A careful examination of the heart and an ECG recording clarify the situation.

Along with cerebral strokes in the acute period of myocardial infarction, other neurological disorders are not so rare. Fainting, loss of consciousness at the onset of the disease occur in 3-4% of patients. More often they are associated with severe angina pectoris and reflex hypotension-bradycardia, causing transient cerebral ischemia. After the pain is relieved and the blood pressure rises, consciousness quickly returns to the patients.

Another cause of temporary loss of consciousness with epileptiform seizures are cardiac arrhythmias: from ventricular tachycardia and ventricular fibrillation to complete or subtotal AV blockade (tachycardic and bradycardic types of Adams-Stokes-Morgagni syndrome). These changes can be clarified during an ECG study.

ECG diagnostics of acute myocardial infarction. ECG registration is a necessary and often decisive element in recognizing acute myocardial infarction, as well as in determining its stage, localization, extent and depth. At the same time, the absence of an ECG confirmation of the diagnosis of myocardial infarction cannot serve as a basis for the emergency doctor to refuse urgent hospitalization of the patient if there are corresponding clinical manifestations of the disease. It is appropriate to recall here that, according to various authors, with a single ECG recording, the diagnosis of acute myocardial infarction is established only in 51 - 65% of cases. The number of positive diagnoses increased to 83% if the ECG was recorded repeatedly over time.

Naturally, in the diagnosis of recurrent and repeated myocardial infarctions, particular importance is attached to the clinical picture, laboratory data and any ECG changes that appear after a pain attack.

An ambulance doctor with suspicion of "repeated myocardial infarction" is obliged to deliver the patient to the infarction department.

Ed. V. Mikhailovich

"How myocardial infarction begins" and other articles from the section

General clinical picture of a heart attack

People over 40 suffer from myocardial infarction most often. This happens less often in young people. Not only doctors should be able to recognize a heart attack by common signs.

The causes of a heart attack can be the following factors:

stressful situations;

mental strain;

excessive consumption of alcohol and food;

a sharp change in weather conditions;

lack of sleep;

high blood cholesterol;

diabetes;

sedentary lifestyle.

This is the time you need to do:

Perform a first aid.
Call an ambulance.
Get to a specialized hospital.
Do coronary angiography.
To diagnose.
Restore blood flow to the heart muscle.

Predisposition to such cardiovascular pathologies can be inherited.

What does the temperature say

Often in older people, the temperature during a heart attack remains normal. If cardiogenic shock has occurred, the temperature may even decrease.

young people, this reaction of the body is much more pronounced, so they often have an increase in body temperature. The occurrence of such a reaction should prompt the doctor that there are new lesions in the myocardium. The temperature can rise slowly, reaching a very high point, then dropping down to a normal 36.6. Sometimes there are cases of a heart attack, in which there is immediately a sharp increase followed by a decrease. Usually the temperature in the range of 37-38 degrees lasts up to five to seven days. If it continues to hold on longer than this period, then this should especially alert the doctor, since it means that there are complications in the patient's body.

www.boleznikrovi.com

My mother is 77 years old. She already had a stroke about 10 years ago. Before that, she had a myocardial infarction. She recovered relatively. She did not do hard housework - only cooking. Speech is slightly slow, sometimes she could not find the right words - but these are all trifles. At intervals crises occurred at about 2 years old - she was in hospitals, periodically underwent prophylaxis in a day hospital at the district clinic and regularly took pills - enalapril, bisoprolol, amlodipine, periodically took medicines for the kidneys and herbal decoctions. Until recently, the condition was stable. .

I couldn’t move at all, I was sluggish. I immediately called an AMBULANCE - but EMERGENCY ASSISTANCE arrived. They gave injections against high blood pressure, because it increased from 16080 to 200100 and left with assurances that she would soon get better, although last time they immediately took her to hospital. But it didn’t get better and I called the ambulance again, the dispatcher still had to prove that it was the cardiological team that was needed. In the hospital they immediately put me in intensive care. 2 days later, the weather changed (mother had reacted negatively to weather fluctuations before) and she became worse. Gradually, her condition improved, but did not reach the level as after the transfer from intensive care, although I bought all the prescribed medicines. Treatment: MgSO4, digoxin, L - lysine escinat, corvitin, pharmadepin, mucolvan, hepacef, gliatilin, ceraxon, cibor, latium, moxogam, vazar-n, enap. After a two-week stay in the hospital (1 week in intensive care and 1 week in the island
the right hand began to act, but until the weather changed from “bad” to “good.” I took the tablets regularly with my help: Vazar-N 320 mg 1 t a day, amlodipine 10 mg 1 t a day, cardiomagnyl 1 t a day, toris 20 mg 1 t a day, levofloxacin 500 mg 1 t each 10 days, Neuromedin 1t 2p a day, Nicerium 1t 2p a day, Biolact 1 package a day. by 12060, and my mother was “sluggish” - all the time half asleep. Three days ago she became worse again, although her pressure, pulse, temperature were normal. although I grind all the food on a blender - with every spoonful of food, my mother has to stir up so that she does not fall asleep while eating and remind-beg that what is in her mouth needs to be swallowed, she does not want to drink water either. One meal takes about 1 hour, although earlier the problem .
to take - to call an ambulance (Will it come?) or a local therapist or someone else? Thank you in advance for any advice!

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Diagnosis of acute myocardial infarction is based on the assessment of the pain syndrome (according to the story of the patient or his relatives), the results of the examination of the patient, ECG changes and some laboratory parameters. Under typical conditions (on average in 90% of patients), myocardial infarction begins with an attack of angina pectoris pain felt behind the sternum or to the left of it: pressing, squeezing, burning, drilling, occasionally stabbing (“weight on the heart”, “prick in the chest”, "hot dagger in the heart", etc.). Often the pain reaches its maximum intensity in a short time. Sometimes they grow gradually or acquire a wave-like character (weaken and quickly increase again). Nitroglycerin rarely brings relief. Pain radiates primarily to the left half of the chest, under the left shoulder blade, along the left arm to the fifth finger, and also to the right side of the anterior surface of the chest, to the neck, jaw. Some patients feel a sharp burning sensation only in the left arm (shoulder, wrist). At the same time, the sick are seized by a sense of anxiety, fear of approaching death; they groan, change position of the body in search of relief from pain. Sweating increases, weakness may appear.

An increase in body temperature that occurs in 80 - 90% of patients should be expected by the end of the 1st day or on the 2nd, less often - the 3rd day of illness. Body temperature of the order of 37 ... 38.5 CC is maintained for 3 - 7 days. The lengthening of the period of fever is associated with the addition of pneumonia, exacerbation of pyelonephritis, etc.

This syndrome is based on an extreme degree of left ventricular failure and retrograde congestion in the lungs. The feeling of lack of air, developing into suffocation, and the fear of death associated with it appear suddenly. The patient becomes very restless, "cannot find a place for himself", takes a forced sitting position, leaning his hands on the bed to increase the respiratory movements. The respiratory rate increases to 40 - 50 in 1 min; the nature of breathing changes: a short inhalation is followed by an extended exhalation. The expression of the patient's face is suffering, exhausted, the skin is pale, the lips are cyanotic, cold sweat appears. Signs of acute swelling and incipient stagnation in the lungs are determined: percussion sound with a tympanic tinge, hard breathing, persistent moist fine bubbling rales in the posterior or middle paravertebral sections, as well as wheezing due to bronchospasm and swelling of the mucous membrane of small bronchi.

If the patient does not receive the necessary assistance, then pulmonary congestion steadily progresses: cardiac asthma turns into pulmonary edema. Breathing becomes noisy, bubbling, wheezing is heard in the distance. A cough appears, and soon a liquid, foamy sputum of a pinkish color or with an admixture of blood begins to separate. The amount of sputum is increasing. The pulse noticeably quickens, its filling is lowered. Blood pressure varies in different patients from low to high (secondary hypoxic arterial hypertension) The melody of the heart is difficult to listen to. In the intervals between breaths, it is possible to catch a deaf I tone at the top, the summation rhythm of the gallop; on the pulmonary artery - accent II tone. With percussion of the lungs, blunted tympanitis is determined both in the lower sections and above the tops. Respiratory noise is not heard due to the abundance of different-sized sonorous wet rales, their front moves from bottom to top, covering the entire surface of the lungs.

The gastralgic variant of the onset of acute myocardial infarction is observed in 2-3% of patients, mainly with its lower or lower-posterior localization. V. P. Obraztsov and N. D. Strazhesko described this condition as a feeling of painful strong pressure in the epigastric region and “support” under the heart. "Reflex", "reflected" pain in the upper abdomen can be cramping.

The cerebral variant of the onset of myocardial infarction is not always interpreted in the same way by clinicians. Strictly speaking, it should be identified only with the apoplexy form of acute myocardial infarction described by N. K. Bogolepov (1949). True, ischemic stroke here is a complication of myocardial infarction, and it is in this sequence that these 2 diseases develop - heart and brain. Meanwhile, "heart" symptoms are initially masked by more obvious signs of vascular damage to the brain (hemiparesis, speech impairment, etc.). A careful examination of the heart and an ECG recording clarify the situation.

ECG diagnostics of acute myocardial infarction. ECG registration is a necessary and often decisive element in recognizing acute myocardial infarction, as well as in determining its stage, localization, extent and depth. At the same time, the absence of an ECG confirmation of the diagnosis of myocardial infarction cannot serve as a basis for the emergency doctor to refuse urgent hospitalization of the patient if there are corresponding clinical manifestations of the disease. Here it is appropriate to recall that, according to various authors, with a single ECG recording, the diagnosis of acute myocardial infarction is established only in 51 - 65% of cases. The number of positive diagnoses increased to 83% if the ECG was recorded repeatedly over time.

An ambulance doctor with suspicion of "repeated myocardial infarction" is obliged to deliver the patient to the infarction department.

Ed. V. Mikhailovich

"How myocardial infarction begins" and other articles from the section Emergency care in cardiology

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Causes of a heart attack

chronic intoxication;
bad habits (especially smoking, which triggers the processes of free radical damage to the endothelium);
prolonged use of combined oral contraceptives;
excessive insolation;
abuse of fatty foods;
excess weight;
endocrine diseases;
inflammatory processes in the vascular wall and more.

People who have a history of more than two of the above factors are at risk for a heart attack and should pay more attention to the state of their cardiovascular system.

Signs of a heart attack

There are options for the atypical course of myocardial infarction, in addition to painless ones, which can confuse even an experienced specialist. Among the atypical forms are:

Abdominal form. Characterized by pain in the upper abdomen, which is accompanied by hiccups, bloating, nausea and vomiting. May be confused with acute pancreatitis.
Asthmatic. It resembles an attack of bronchial asthma due to increasing shortness of breath.
Cerebral. It is distinguished by a change in the patient's behavior, complaints of dizziness or complete loss of consciousness. There may be focal neurological symptoms.
Collaptoid. It begins with a collapse (a sharp decrease in blood pressure, loss of consciousness, autonomic dysfunction). The condition is associated with cardiogenic shock against the background of damage to the heart wall.
Arrhythmic. With this form, the attack begins with severe arrhythmia, which can smoothly develop into a classic clinical picture or cardiogenic shock.
Edema. Differs in edematous phenomena from the lower extremities and the lower half of the abdomen, which is associated with insufficiency of the right ventricle.
Peripheral. With this type of heart attack, the pain is localized outside the area of the projection of the heart. Patients complain of pain in the throat, fingertips of the left hand, cervical spine.

There are also mixed forms, which suggest the presence of several complaints characteristic of various types of heart attacks. In any case, a patient with suspected myocardial infarction should be hospitalized for additional diagnosis and appropriate treatment.

Diagnosis of a heart attack

Thanks to the procedure, it is possible to visualize the level of thrombus localization and assess the amount of ischemic damage. After the elimination of the acute condition, in the delayed period, myocardial scintigraphy can be performed if necessary.

Differential diagnosis is usually carried out with an attack of unstable angina and pulmonary embolism.

Temperature response to heart attack

Some time ago, there were suggestions about the relationship between post-infarction fever and a decrease in systolic function of the left ventricle, however, they were all refuted experimentally.

A fever that occurs weeks after an attack also indicates a pathological process that can be both infectious and autoimmune in nature (postinfarction Dressler's syndrome).

How to deal with a fever in a heart attack

The first signs of a heart attack Moderate changes in the myocardium

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