Transmural infarction: causes and prognosis

Transmural infarction is a common and extremely dangerous disease, which is accompanied by necrosis of the heart muscle. It is worth noting that mortality in the case of development is similar to pathology is very high, especially if signs of heart failure were not noticed on time, and the patient did not receive the necessary medical care. That is why it is important to know how this form of infarct is manifested and what kind of help is required for a sick person.

Transmural myocardial infarction: what is it?

To begin with it is necessary to understand the meaning of the term. Surely many people know that the infarction states are accompanied by the withering away of the sites of the heart muscle. This is due to a sharp cessation of blood flow to the heart, as a result of which the tissues do not get the oxygen and nutrients necessary for life.

As you know, the heart wall consists of three layers - an epicardium (outer layer), a mural muscle layer and an endocardium (the inner part of the muscle). With the intramural form of the disease, necrosis affects only one layer. Acute transmural infarction is a pathology in which necrotic processes are observed in all layers of the heart. It is worth saying that this is the most dangerous form of such a disease.

In modern medicine, pathology is classified on the basis of localization of foci of necrosis. Most often there is a transmural myocardial infarction of the anterior wall, namely, the left ventricle. Only in one of five cases necrosis affects the wall of the right ventricle. Approximately a third of patients are involved in the process and the walls of the atria.

Causes of the disease

In almost every case, a transmural infarct is the result of ischemic heart disease. As already mentioned, with insufficient oxygen and nutrients, the muscle cells begin to die - this is how necrosis develops. According to statistical data, in 90% of cases the cause is atherosclerosis of the coronary vessels, which provide blood flow to the myocardium.

On the wall of the vessel formed the so-called atherosclerotic plaque. Under the influence of certain factors, part of the plaque is detached from the wall and blocks the lumen of the coronary artery. Acute transmural infarction, as a rule, rapidly progresses in those situations when the demand for myocardium in oxygen rises sharply - this can happen, for example, with strong physical activity, increased body temperature, strong emotional stress.

Acute transmural myocardial infarction: risk factors

As can be seen, necrotic lesions of the heart are not an independent pathology. In most cases, they develop against the background of already existing ischemia and atherosclerosis. Therefore, we can identify several risk factors:

• Genetic predisposition of the patient, which is associated with certain anatomical features and hereditary diseases.
• There is also the age factor. Transmural infarction is more often diagnosed in people older than 45 years, and men are more prone to this pathology.
• An increase in the level of cholesterol in the blood (it is because of this that plaques form on the walls of the vessels, which subsequently block the blood flow).
• Improper nutrition (eating fatty and fried foods increases the likelihood of developing atherosclerosis).
• Obesity (it is in most cases associated with malnutrition, and weight gain increases the burden on the heart).
• Hypodinamy (a sedentary lifestyle leads to a gradual weakening of the heart muscle, after which the myocardium is very difficult to cope with any physical stress).
• Constant stress, nervous exhaustion, emotional stress leads to a change in the hormonal background, which affects the work of the cardiovascular system.
• Smoking (according to statistics, in 35% of cases necrosis of the heart muscle is associated with this bad habit).

The main symptoms: how to identify a heart attack?

Symptoms of necrosis can be different - everything depends on the degree of damage, the age of the person, the presence of concomitant diseases, etc. There are cases of asymptomatic infarction. Nevertheless, some of the main symptoms can be identified:

• In most cases, a person complains of acute contracting pain behind the breastbone - she clearly gives into the left shoulder blade, arm, lower jaw, ear and even teeth.
• The pain is wavy and prolonged - seizures can be repeated for several hours or even days.
• Tachycardia develops, and the patient, as a rule, clearly feels frequent and even painful heart contractions.
• There is also a sense of short-term cardiac fading.
• There are also external signs of a heart attack - skin integuments and mucous membranes of a person sharply turn pale.
• Against the background of necrosis often develops cardiac asthma - the patient notes severe dyspnea, severe attacks of suffocation.

Diagnostic measures

When the first violations occur, it is necessary to immediately deliver the sick person to the hospital department, where appropriate diagnostics and treatment will be carried out. The main diagnostic method for myocardial necrosis is electrocardiography, because with this procedure it is possible to fix electrical potentials in different parts of the heart.

Correctly conducted and deciphered electrocardiogram allows the doctor to determine the localization of necrosis (for example, the lower transmural infarction), the extent of the pathological process and the depth of the lesion, the prescription of the disease.

In addition, a blood test is needed. With an infarct, there is an increase in the rate of erythrocyte sedimentation, an increase in the number of leukocytes, the appearance in the blood of specific enzymes and compounds that normally are inside the cells of the myocardium.

First Aid Rules

Acute transmural myocardial infarction of the anterior wall is a pathology that develops very quickly. Symptoms of it can appear almost at any moment, so it is worth familiarizing yourself with the rules of rendering help to the patient. Naturally, first of all you need to call an ambulance.

Waiting for the doctors, the person needs to lie down. An exception is the situation in which there is severe shortness of breath and distinct wheezing when breathing - in this case, the patient should be seated better by placing a pillow or roller under his back. It is recommended to take an aspirin tablet. You also need to give the person nitroglycerin - first one pill, and if the pain does not go away, then after five minutes one more (but not more than three).

Treatment regimen for infarction

Depending on the results obtained during diagnosis, the doctor prescribes treatment. Initial therapy, as a rule, consists of three main parts:

• Taking painkillers in order to relieve the patient's condition. Quite often soreness can only be stopped with the help of strong drugs, including Promedol and Morphine. The appearance of symptoms and the diagnosis of "myocardial infarction" are stress for a person, and excitement and fear only increase the burden on the heart - the patient is prescribed sedatives.
• The therapy scheme includes the use of nitrates and beta-blockers, which helps to eliminate arrhythmia and restore the heart rhythm.
• With transmural infarction, there is a high probability of blood clots, which is fraught with necrosis of other organs and the spread of the process to neighboring parts of the myocardium, damage to the nervous system and even death. Therefore, the fight with thrombosis should begin already in the first hours after the onset of symptoms. For this purpose, diluting drugs are used that contain heparin and fibrinolysin. Naturally, when taking such drugs, there is a possibility of a massive hemorrhage, because the blood ceases to curl, so it is important to carefully monitor the patient's condition.

Treatment is always carried out in a hospital - the patient has to be under the supervision of a doctor around the clock.

Consequences and complications of the disease

Transmural infarction is the most complex and dangerous form of myocardial necrosis, especially when it comes to large focal necrosis. The disease is fraught with consequences - the development of pulmonary edema, paralysis of limbs, speech disorders. Sometimes infarction entails and further pathologies of the vascular system, in particular stroke.

The consequences of this pathology also include thromboembolism, ventricular fibrillation, cessation of work of different organs and even their systems. Such cases often end in death, even if the patient was provided with medical assistance. Another fatally dangerous complication is a heart rupture. With a strong contraction of the myocardium and increased pressure inside the ventricles and atria, there is a risk of damage to the integrity of the muscle in the necrosis area.

Rehabilitation and prognosis

Unfortunately, the predictions for such a disease are not very favorable - in about 50% of cases, patients (especially when it comes to elderly people) die. If, however, it was possible to restore normal blood circulation, there is still a risk of complications in the future, as there have been changes in the tissues of the myocardium.

That is why the period of rehabilitation is so important. Patients are advised to eat simple, light and high-calorie food. It is also important to gradually restore the motor activity, since lack of mobility is fraught with muscle atrophy and congestion in the lungs. Of course, all activities associated with physical exertion must be strictly controlled by a specialist.

Supportive therapy and constant monitoring by a doctor are necessary until the end of life. Of course, patients need to monitor food, avoid stress and intense physical exertion, do not allow a strong increase in blood pressure and quit smoking.