What's going on
An atherosclerotic plaque forms in the wall of the coronary artery over the years. At some point, its tire is torn, a blood clot forms at the site of the rupture, and the lumen of the artery is blocked. The area of the heart muscle that it nourished remains without oxygen and begins to die within 20–30 minutes.
The dead muscle is not restored - a scar is formed in its place, which does not contract. Hence the direct connection: the more time passes before blood flow is restored, the larger the scar and the higher the risk of heart failure in the future.
How to recognize
- Pain behind the sternum: pressing, squeezing, burning, “as if an elephant had stepped on”; intensity can be moderate
- Duration more than 20 minutes, does not go away with rest and after nitroglycerin
- Irradiation: left arm, both shoulders, neck, lower jaw, between the shoulder blades, upper abdomen
- Associated: cold sticky sweat, nausea, vomiting, severe weakness, feeling of fear
- Shortness of breath, sometimes the only symptom
How is it different from other chest pains?
- Heart attack: pressing pain behind the sternum >20 minutes, does not go away with rest, there is sweat and weakness
- Angina: the same pain, but for 3–15 minutes, occurs during exercise and goes away with rest or with nitroglycerin
- Intercostal neuralgia and osteochondrosis: point pain, intensifies with inhalation, turning, pressing on the point - in case of a heart attack, pressing does not change the pain
- Heartburn and reflux: burning behind the sternum is associated with eating and lying down, antacids help
- Panic attack: palpitations, shortness of breath and fear, but without pressing pain; passes in 10–20 minutes
Rule of thumb: When in doubt, call an ambulance. An ECG and troponin test are done in minutes and cost incomparably less than the lost time.
What to do before the ambulance arrives
- Вызвать скорую, чётко сказав: «боль в груди, подозрение на инфаркт».
- Прекратить любую нагрузку, сесть или полулечь с приподнятой головой, расстегнуть тесную одежду, открыть окно.
- Принять нитроглицерин под язык, если он назначен и давление не низкое; при сохранении боли повторить через 5 минут, максимум 3 раза.
- Разжевать таблетку ацетилсалициловой кислоты (около 250–325 мг), если нет аллергии и противопоказаний, — именно разжевать, а не глотать.
- Не оставаться в одиночестве, открыть входную дверь заранее.
- Не садиться за руль и не ехать в больницу самостоятельно.
Treatment and recovery
The main task in the hospital is to restore blood flow as quickly as possible. The optimal method is emergency stenting of the coronary artery; if it is not available in the required time frame, drugs that dissolve the blood clot are used.
- Coronary angiography and stenting of the affected artery
- Thrombolytic therapy if rapid stenting is not possible
- Dual antiplatelet therapy is long-term and cannot be discontinued on its own
- High dose statins, beta blockers, ACE inhibitors as indicated
- Cardiac rehabilitation: dosed exercises under control, training, work with risk factors
After a heart attack, secondary prevention is lifelong. Quitting smoking reduces the risk of a recurrence of the event more than any drug. Control of blood pressure, cholesterol and sugar, regular activity and adherence to therapy determine whether there will be a second heart attack.
