How can acute myocardial infarction be diagnosed?

Myocardial infarction is a clinical syndrome characterized by the development of a pathological process in the heart muscle, which has arisen due to a deviation between myocardial oxygen demand and the inability to transport it. In the early stages, the disease is difficult to confuse with other pathologies of the heart, except for angina pectoris. With myocardial infarction, the patient's condition noticeably worsens, there are prolonged attacks of pain, lack of air, and increased sweating. Mostly the disease is formed in people suffering from coronary heart disease and angina pectoris. However, MI can also occur in a healthy person. At the first manifestations of the disease, it is necessary to immediately call an ambulance and diagnose myocardial infarction.

Diagnosis of myocardial infarction at home

Most supporters of traditional medicine are interested in the question: how to independently diagnose myocardial infarction at home?

Without the help of a doctor, it is impossible to make a correct diagnosis. The patient requires urgent hospitalization and appropriate laboratory and instrumental examinations. Nevertheless, the patient has the opportunity to independently determine whether he had an attack, evaluating his well-being.

• Pain - as a rule, with MI, pain sensations occur on the left behind the chest and are acute and burning in nature, give to the arm and shoulder blade. The pain occurs abruptly, and with angina pectoris, the attack is characterized by a strong manifestation and is not suppressed with the help of painkillers. Sometimes painful sensations are characterized by medium intensity and affect the stomach (abdominal form of a heart attack), back, neck. MI in rare cases occurs painlessly, this occurs only with minimal damage to the heart muscle. A person with a painless form of a heart attack learns about the disease by chance during an electrocardiogram.
• A change in the psychological state - in most cases, with muscle ischemia, along with painful sensations, a feeling of fear of death arises, a person begins to behave inhibited.

• Feeling of uneven heartbeat - a symptom can occur by subjective signs - fading, noise, pulsation of the heart in the chest. Objective sensations are changes in the frequency, rhythm and nature of the pulse. To assess your own pulse, you should find the radial artery on the wrist or the carotid artery on the neck. When measuring the pulse, you need to attach two or three fingers to the artery for at least ten seconds and count the number of pulse waves. Multiplying the result by six, a person finds out the pulse rate per minute.
• Loss of consciousness - with acute pain or pronounced symptoms of arrhythmia, the patient may faint.

Myocardial infarction is a very serious pathology of the heart, in which the patient needs urgent medical attention. It is necessary to conduct a qualitative diagnosis using laboratory and instrumental examinations.

MI does not apply to those diseases that are treated using non-traditional methods, so supporters of traditional medicine should not try to help themselves or loved ones when using decoctions or mustard plasters at home.

• clinical diagnostics - an assessment of the patient's complaints, objective symptoms is carried out;
• laboratory diagnostics - a series of tests is prescribed to the patient;
• instrumental diagnostics - certain studies are required, primarily an electrocardiogram.

Each type of diagnostics has its own characteristics.

Clinical diagnostics

Clinical diagnosis is a general examination of the patient's condition, a study of the medical history and an assessment of the main complaints. The doctor measures the patient's blood pressure, which usually drops by 10-15 mm, and the pulse. In addition, by listening to heart sounds, he determines whether there is a violation of the basic functions of the myocardium and left ventricle.

Signs of pathology occur during or after emotional stress, exercise, or another factor that contributes to increased work of the heart, in which there is a sharp rhythm disturbance, an increase in blood pressure in the arteries. In this case, the patient's condition sharply worsens, pain appears. Usually it is localized behind the sternum or on the left side of the chest, pain affects the upper limbs on the left and the neck, in rare cases, other areas suffer.

Painful sensations are similar to the symptoms that occur during an attack of angina pectoris, but they are more severe and burning in nature. The pain does not let the patient go for half an hour, it cannot be eliminated with the help of nitrates, which have a strong effect in angina pectoris. In addition, the pain causes fear and excitement in the patient.

• dyspnea;
• rapid pulse;
• heavy sweating;
• weakness;
• nausea;
• lowering blood pressure.

Other signs of pathology may appear, which are usually not typical for myocardial infarction. Some patients claimed that a heart attack was similar to a prolonged attack of angina pectoris, the symptoms of which did not differ in anything unusual. Another part of the people says that the pain was not localized in the chest, but in other places that usually do not suffer from MI. For example, there is a case where a woman made an appointment with a dentist because she suffered from acute pain in her jaw. During the examination, the doctor found that the pain was a symptom of a heart attack.

As previously noted, sometimes there is a painless form of a heart attack. This form of the disease is mainly faced by people with diabetes for a long time.

In this case, the following symptoms indicate a myocardial infarction:

• suffocation;
• violation of the rhythm of the heartbeat;
• edema.

Other symptoms of myocardial dysfunction may also appear.

The causes of a heart attack are varied. The disease can be triggered by severe stress, excessive physical exertion, hypertensive crisis. Sometimes the symptoms of myocardial infarction appear suddenly without any reason. For example, a disease can overtake a person early in the morning, when he is still sleeping in his bed.

Atypical forms of heart attack are rare. However, if a person suffering from coronary heart disease feels unusual sensations, he should immediately seek help from a doctor. During the clinical diagnosis, the doctor will take into account all the main symptoms that will determine further examination methods.

Laboratory diagnostics

• general clinical examination of blood and urine;
• tests for markers of myocardial injury.

With a heart attack, the process of inflammation begins in the human body, which serves as a response to the cessation of tissue vital activity in the myocardium. A general blood test is prescribed to identify this process: with inflammation in a patient, the number of leukocytes and the erythrocyte sedimentation rate (ESR) increase.

Within three hours after the onset of a heart attack, the number of leukocytes in the patient's blood begins to increase. 2-4 days their number increases, and after a week it returns to normal. 4-5 days after the onset of the disease, the patient has an increase in the erythrocyte sedimentation rate. ESR returns to normal in 2-3 weeks.

More difficult is the analysis of enzymes. In the blood, the presence of a small amount of intracellular enzymes or their complete absence is considered the norm. With myocardial infarction, a certain area of ​​\u200b\u200btissue is destroyed, which causes the release of enzymes into the blood. The study of blood allows them to be identified, however, such tests are not always reliable, since they depend on the duration of the disease.

Many patients with signs of myocardial infarction undergo a study of the level of the MB-fraction of creatine phosphokinase (CPK-MB). At the beginning of the pain syndrome, its level rises within 3-4 hours. In a normal state, he comes after 3-6 days after the onset of a heart attack.

Myocardial infarction is diagnosed if the EFV-MB increases two or more times. In this case, there is no doubt about the correctness of the diagnosis. If necessary, the procedure is carried out several times.

After 2-3 hours from the onset of the disease, a myoglobin test, which is considered quite effective in this disease, helps to establish the correct diagnosis. The doctor draws attention to the level of myoglobin, which during a heart attack rises 10 times higher than normal. The test should be carried out on the same day that the symptoms appeared, because then the enzyme will disappear from the blood, and there will be no point in the tests.

Another effective diagnostic method is the analysis of troponins. An increase in the level of troponins in the blood begins 3-4 hours after the onset of signs of myocardial damage. In addition, enzymes remain in the blood for 14 days, after which their level begins to decline. During the diagnosis, the doctor pays attention not to the increase in the level of the enzyme, but to the characteristic dynamics of its content in the patient's blood. When a specific change in the content of enzymes in the blood is detected, the doctor can accurately diagnose "myocardial infarction".

Instrumental diagnostics

An important role in the examination of the patient is played by instrumental diagnostics, which is based on the use of special equipment to study the affected area. The main method of examination is electrocardiography (ECG).

During the procedure, special sensors-electrodes are attached to the chest and other limbs of the patient to record the potentials of the heart on a special tape. The records themselves are curved lines, according to the appearance of which the doctor evaluates changes in different parts of the heart. Usually electrocardiography looks like a series of teeth, intervals and segments. When diagnosing certain parts of the heart, the ECG looks a little different.

With myocardial infarction, specific changes develop in certain leads of electrocardiography (depending on which area of ​​the myocardium began to die off), namely:

• pathological Q wave, which indicates a serious damage to the myocardium;
• decrease in height or complete disappearance of the R wave;
• increase in the ST segment;
• increase and sharpening of the T wave;
• ST segment depression.

With myocardial infarction, other changes that indicate heart disease may also be reflected on the electrocardiogram. In some cases, a heart attack develops against the background of a heart rhythm disorder, which complicates the diagnosis. In addition, the result of the ECG is largely determined by the statute of limitations of the disease.

Only a qualified specialist should evaluate the results of ECG diagnostics. However, sometimes even an experienced doctor is not able to say for sure whether the symptoms were caused by a myocardial infarction or not. This is especially common in patients with coronary heart disease, angina pectoris, or arrhythmias. The fact is that due to pathologies of the heart, their electrocardiogram always looks unhealthy, which is why the doctor cannot immediately notice a heart attack.

In addition to electrocardiography, other types of instrumental diagnostics are also prescribed. So, echocardiography allows you to detect areas of hypokinesia and akinesia, which are characterized by a decrease or complete disappearance of the narrowing of the myocardial walls. This diagnostic method allows you to determine the location and size of the heart lesion.

Myocardial scintigraphy consists in the introduction of special radionuclides into the patient's body, then the doctor registers their accumulation in the heart tissues using a scintillator. In the event that the process of cell death has begun in the heart, radionuclides will not accumulate. Recently, when diagnosing a heart attack, doctors use an ultrasound examination of the heart. Ultrasound can reveal areas of damage to the heart muscle, but this diagnostic method does not allow you to establish the exact date when they arose.

Differential Diagnosis

A heart attack should be distinguished from a number of other diseases. First of all, it should be differentiated from pathologies of organs and structures of the cardiovascular system, since they predominantly have similar symptoms.

Many heart diseases occur with painful sensations of the same nature. An ECG will allow you to accurately determine which disease worsened the patient's condition.

Differential diagnosis is also carried out with nervous diseases, namely with neuralgia of the intercostal nerves. A significant difference is the nature of the onset of pain, so, with MI, symptoms occur mainly after physical exertion, while with neuralgia, a person becomes ill when changing body position.

• severe pain in the chest area;
• violation of blood flow;
• loss of consciousness.

It is necessary to conduct a differential diagnosis of MI in cases of suspected development of osteochondrosis of the thoracic spine. This disease is characterized by prolonged pain and the absence of pathologies in the bloodstream and myocardium.

Recommendations for patients with myocardial infarction

The patient does not need to know how the doctor determines the presence of a heart attack according to tests or ECG and ECHO CG, since this information will only confuse him. And in case of a heart attack, the patient will not be able to understand the information received at all, the decoding should be entrusted to a qualified specialist, who will then notify the patient of the results.

1. In the presence of any pathology of the heart, it is imperative to make an electrocardiogram, even if there are no obvious symptoms. This is to ensure that the patient always has normal results of his own ECG with him. If there is a suspicion of myocardial infarction, doctors will first of all direct the patient to do electrocardiography. It will be easier and faster to make an accurate diagnosis if the doctor has the opportunity to compare the obtained data with past ECG results.
2. To avoid a heart attack, you should maintain a healthy lifestyle and follow the doctor's recommendations. People with coronary heart disease need to undergo a course of cardiorehabilitation in a sanatorium to reduce the risk of complications.
3. If a heart attack did occur and the patient managed to cure him, after being discharged from the hospital, he should also visit cardiorehabilitation, since the body needs recovery after an illness, which takes a long time without the help of doctors.