Myocardial infarction, the irreversibleperishCardiac muscle, can be due to many pathophysiological mechanisms. Today we will talk about different onestypes of heart attackand its symptoms.
Myocardial distress is manifested by an increase in cardiac troponin I or T. These are essential proteins of the contractile system of cardiomyocytes. The increase in its blood level specifically reflects cell necrosis. And perhaps inconsistently accompanied by clinical symptoms. They can make the condition worse - in the case of an initial surge followed by a drop in troponin. Or chronic, this marker remains stable, as in severe chronic renal failure or structural heart disease. However, myocardial stress is always a sign of severity. Regardless of the etiology, this does not necessarily indicate myocardial infarction (MI).
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IDM is when the condition is ischemic in origin. That is, associated with a mismatch between myocardial oxygen demand. And thebloodSupply by coronary arteries. Classic manifestation, regardless of underlying cause, chest pain is retrosternal (burning, heaviness, or tightness), bar. Radiating to one or both arms or the lower angles of the jaw. The ECG can then show ST segment changes, elevation or depression, flattening. Or even T-wave trading. Sometimes it's normal.
5 types of heart attack
In collaboration with the WHO, the European and North American Cardiovascular Societies distinguish 5 types of stroke. Each is associated with a specific mechanism.
IDM Type 1: Classic!
It has been associated with the occurrence of coronary thrombus due to rupture or cracking of an atherosclerotic plaque.
Complete obstruction induces an acute coronary syndrome (ACS) with ST segment elevation (ST+). 2 This therapeutic emergency requires immediate transfer to a facility. A technical platform for coronary angiography for angioplasty revascularization (or fibrinolysis in the absence of readily available imaging). It would be helpful if you also urgently administer an anticoagulant (enoxaparin or unfractionated heparin). And 2 antiplatelet agents (aspirin and P2Y12 receptor inhibitor, prasugrel or ticagrelor) promote coronary patency.
A thrombus that partially obstructs or causes distal coronary embolism causes non-ST elevation (ST-) but troponin-elevating ACS. Coronary angiography required within 24 hours. Or even immediately for chest pains that do not respond to the administration of a nitro derivative. Monotherapy with anticoagulants and platelet aggregation inhibitors is urgently required. However, it is recommended to delay anti-P2Y12 administration until angioplasty to reduce the risk of bleeding. 3, 4
In most cases, so-called active stents are implanted, ie covered with an agent that prevents coronary restenosis. The risk of thrombosis from this device has decreased significantly with the advent of active stents and is 2 to 3 times lower than the rate of recurrence (plaque rupture) elsewhere. Bare stents are no longer recommended due to the high likelihood of restenosis and serious cardiovascular events.
You must continue dual antiplatelet therapy for at least 1 year. If the risk of bleeding is low (young patient, without oral anticoagulant). And a significant ischemic risk (recurrent coronary artery disease, diabetes, multiple stents) can prolong it beyond 1 year. For patients on anticoagulants, particularly direct oral anticoagulants ([DOA], for AF, mechanical valve, MTEV), it is now possible to discontinue aspirin after a short time, typically < 15 days, and maintain anti-P2Y12 on top of DOA. 5
IDM Typ 2: ohne Thrombus
Decreased coronary perfusion is due to a local (spasms, spontaneous dissection, or coronary embolism) or systemic cause (hypotension or shock, severe bradycardia, respiratory arrest, or severe anemia), or to increased oxygen demand (persistent arrhythmia or severe hypertension). We speak of the "functional" heart attack, which occurs more frequently with an underlying atheromatous coronary disease. This infarction can be accompanied by clinical and electrical manifestations of ACS, including ST (+) ACS. Depending on the context, a more or less urgent coronary angiography may be necessary to remove an acute thrombus or to check a coronary arteryAtheromdisclosed on this occasion. Urgency: Identify and treat the cause of the mismatch between O 2 demand and supply (correction of hypotension or hypertension, hypoxia, anemia, etc.).
In the cardiac intensive care unit (ICU) assessment of coronary blood flow (coronary angiography). And the extent of muscle damage (cardiac ultrasound and MRI). In type 2 IDM, correcting the cause of the ischemic stress (hypoxia, anemia, etc.) is crucial. For type 1: urgent reperfusion in conjunction with the above antithrombotics. In addition, you need aggressive secondary prevention because of the underlying atherothrombosis. It includes a high-dose statin (atorvastatin 80 mg/day with an LDL target of 0.55 g/L or even 0.4 at relapse) with Ezetrol from the start of hospital treatment. The severity and extent of the atheroma can motivate the cardiologist to prescribe an anti-PCSK9: alirocumab, available after ACS depending on residual LDL and severity of coronary artery damage (Multitronic patients) and other locations (particularly AOMI).
Recently, low-dose colchicine has attracted interest: in synergy with lipid-lowering drugs, it stabilizes plaques and reduces recurrence. Finally, to prevent complications (heart failure with significant sequelae), the drugs inhibit the renin-angiotensin system (IEC, ARB2, and anti-aldosterone), which fights fibrosis and heart remodeling.
Arrhythmias are prevented by a beta-blocker, the usefulness of which is still relevant in thehospitalInitial phase and at least during the first 6 months.
Furthermore, in the absence of recurrences, significant sequelae of cardiac insufficiency are questionable. It evaluates the ABYSS study conducted by our ACTION heart group with the support of a national PHRC.
Other infarcts: interested in comparing curative strategies.
Type 3MIincludes deaths that appear to be of coronary origin without the ability to measure troponin or perform an ECG prior to death.
called Type 4Infarcts after percutaneous coronary intervention (4a within 48 hours after the intervention; 4b and 4c in the case of thrombosis or stent restenosis, regardless of the delay).
Enter 5 MDIdefines myocardial ischemic stress occurring within 48 hours after coronary artery bypass graft surgery.
People who have had a myocardial infarction (MI, or "heart attack") need urgent medical attention. Once the heart attack is treated, patients receive long-term care to prevent another heart attack and prevent cardiovascular complications after a heart attack. This post-infarction care is based on multiple therapeutic modalities: drugs, cardiovascular rehabilitation, lifestyle interventions, and sometimes surgery.
What are myocardial infarctions and their types?
During a myocardial infarction, or heart attack, part of the heart muscle is destroyed when oxygen is no longer supplied. What happens when a supplying artery becomes blocked or suddenly narrowed in diameter? This happens, for example, when a piece of fatty plaque detaches itself from the inner wall of a blood vessel and blocks an artery in the heart. A blood clot then forms, choking off part of the heart.
Heart muscle cells die when there is a lack of oxygen, and the affected area can no longer properly contract to a greater or lesser extent. Because muscle cell death occurs approximately four hours after the onset of the infarction, a myocardial infarction is a medical emergency and ALWAYS call 911 or 911.
What are the symptoms of a myocardial infarction?
The symptoms of a heart attack are chest pain that lasts more than 20 to 30 minutes. It radiates from behind the sternum into the back, shoulders, jaw and left arm. Other symptoms are possible: for example anxiety, sweating, dizziness, shortness of breath. This pain can be localized in the stomach or abdomen in women, which is less common in men. They may be accompanied by sudden nausea, vomiting or severe tiredness.
Certain infarctions often go unnoticed and are discovered during an electrocardiogram performed during aHealthcheck over.
FAQ on types of myocardial infarction
Am I having a new heart attack?
If you have a second heart attack, the symptoms may be different. Therefore, you must be aware of what you are feeling and react as quickly as possible, regardless of the intensity and duration of the pain. The patient or their companion should never hesitate to call Samu (15 or 112). You should try to remain calm, not drive and, if possible, take aspirin and your vasodilator medicine if your doctor has told you to.
What is the prognosis of a heart attack?
About 100,000 people in the US suffer a myocardial infarction each year. It's a potentially serious disease, but great strides have been made in the treatment of heart attacks: today, 96% of people who suffer a heart attack survive more than a month and 89% survive more than a year.
Depending on their age, not all patients have the same prognosis after a heart attack,Sex, the presence of cardiovascular risk factors (such as tobacco, excess cholesterol or diabetes) and of course depending on the severity of the infarction.
What are the complications of myocardial infarction?
The consequences of a heart attack are more or less pronounced depending on the extent of the heart muscle area affected and the speed of emergency treatment. The severity of heart muscle damage is assessed by severalPhysicianExaminations: for example electrocardiogram, heart ultrasound, coronagraphy, scintigraphy (see box below). It is also possible to measure certain cardiac enzymes in the blood that are released when cells are destroyed.
What is cardiac arrhythmia in a heart attack?
The risk of sleeping in an IM's suites is much greater than those present: heart rate or reps > 75 bpm. Elevated heart rate when exerting <89 bpm. A decrease in heart rate <25 bpm 1 minute after an exercise test.
Conclusion on the types of myocardial infarction
A heart attack occurs when a second heart attack is announced a few days or hours beforehand: discomfort, tiredness, nausea, digestive problems, for example. In this case, it is important to see your doctor quickly.
The complications of myocardial infarction are varied: stroke, chronic heart failure (70% of chronic heart failure is due to an infarction), recurrence (repeated heart attacks), and obliterating arteriopathies of the lower extremities (closure of leg arteries). . Follow-up care consists of taking measures to prevent these complications in the long term.