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Overview Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease. When plaque builds up, they narrow your coronary arteries, decreasing blood flow to your heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack. Because coronary artery disease often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack. But there's plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact. Next Symptoms If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart — especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including: Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back. - Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion. Heart attack. A completely blocked coronary artery may cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms. When to see a doctor If you suspect you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort. If you have risk factors for coronary artery disease — such as high blood pressure, high cholesterol, tobacco use, diabetes, a strong family history of heart disease or obesity — talk to your doctor. He or she may want to test you for the condition, especially if you have signs or symptoms of narrowed arteries. PreviousNext Causes Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including: - Smoking - High blood pressure - High cholesterol - Diabetes or insulin resistance - Sedentary lifestyle Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack. PreviousNext Risk factors Risk factors for coronary artery disease include: - Age. Simply getting older increases your risk of damaged and narrowed arteries. - Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause. - Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65. - Smoking. People who smoke have a significantly increased risk of heart disease. Exposing others to your secondhand smoke also increases their risk of coronary artery disease. - High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow. - High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as the "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as the "good" cholesterol, can be a sign of atherosclerosis. - Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure. - Overweight or obesity. Excess weight typically worsens other risk factors. - Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well. - High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease. Risk factors often occur in clusters and may build on one another, such as obesity leading to type 2 diabetes and high blood pressure. When grouped together, certain risk factors put you at an even greater risk of coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist — increases the risk of coronary artery disease. Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including: PreviousNext - Sleep apnea. This disorder causes you to repeatedly stop and start breathing while you're sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system, possibly leading to coronary artery disease. - High sensitivity C-reactive protein. High sensitivity C-reactive protein (hs-CRP) is a normal protein that appears in higher amounts when there's inflammation somewhere in your body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, you'll have more hs-CRP in your blood. - High triglycerides. This is a type of fat (lipid) in your blood. High levels may raise the risk of coronary artery disease, especially for women. - Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase your risk of coronary artery disease. Complications Coronary artery disease can lead to: PreviousNext - Chest pain (angina). When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest — particularly during physical activity. This can cause chest pain (angina) or shortness of breath. - Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of your heart artery may trigger a heart attack. The lack of blood flow to your heart may damage your heart muscle. The amount of damage depends in part on how quickly you receive treatment. - Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if your heart has been damaged by a heart attack, your heart may become too weak to pump enough blood to meet your body's needs. This condition is known as heart failure. - Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms. Diagnosis The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including: PreviousNext Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart. Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions. Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise. Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram. Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. A tracer is injected into your bloodstream, and special cameras can detect areas in your heart that receive less blood flow. Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor may inject a special dye into your coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart. This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open. Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely. A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries. Treatment Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures. Lifestyle changes Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries: - Quit smoking. - Eat healthy foods. - Exercise regularly. - Lose excess weight. - Reduce stress. Drugs Various drugs can be used to treat coronary artery disease, including: - Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants. Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin. - Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks. - Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating your coronary arteries and reducing your heart's demand for blood. - Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. Procedures to restore and improve blood flow Sometimes more aggressive treatment is needed. Here are some options: PreviousNext Angioplasty and stent placement (percutaneous coronary revascularization). Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open. - Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries. Alternative medicine Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. However, recent studies have not shown them to be beneficial. More research is needed. - Fish and fish oil. Fish and fish oil are the most effective sources of omega-3 fatty acids. Fatty fish — such as salmon, herring and light canned tuna — contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. - Flax and flaxseed oil. Flax and flaxseed oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol. - Other dietary sources of omega-3 fatty acids. Other dietary sources of omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health isn't as strong. Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. These include: PreviousNext - Alpha-linolenic acid (ALA) - Artichoke - Barley - Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ) - Blond psyllium - Cocoa - Coenzyme Q10 - Garlic - Oat bran (found in oatmeal and whole oats) - Sitostanol (found in oral supplements and some margarines, such as Benecol) Preparing for an appointment Early-stage coronary artery disease often produces no symptoms, so you may not discover you're at risk of the condition until a routine checkup reveals you have high cholesterol or high blood pressure. So it's important to have regular checkups. If you know you have symptoms of or risk factors for coronary artery disease, you're likely to see your primary care doctor or a general practitioner. Eventually, however, you may be referred to a heart specialist (cardiologist). Here's some information to help you get ready for your appointment and to know what to expect from your doctor. What you can do - Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. For some tests, for example, you may need to fast for a time beforehand. - Write down any symptoms you're experiencing, including any that may seem unrelated to coronary artery disease. - Write down your key medical information, including other conditions with which you've been diagnosed, all medications and supplements you're taking, and family history of heart disease. - Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says. - Write down questions to ask your doctor. Questions to ask your doctor at your initial appointment include: - What are the possible causes for my signs and symptoms? - What tests do I need? - Should I see a specialist? - Should I follow any restrictions while I wait for my next appointment? - What emergency signs and symptoms should prompt a call to 911 or emergency medical help? Questions to ask if you are referred to a cardiologist include: - What is my diagnosis? - What is my risk of long-term complications from this condition? - What treatment do you recommend? - If you're recommending medications, what are the possible side effects? - Am I a candidate for surgery? Why or why not? - What diet and lifestyle changes should I make? - What restrictions do I need to follow, if any? - How frequently will you see me for follow-up visits? - I have these other health problems. How can I best manage these conditions together? Don't hesitate to ask additional questions about your condition. What to expect from your doctor A doctor or cardiologist who sees you for heart-related signs and symptoms may ask: - What are your symptoms? - When did you begin experiencing symptoms? - Have your symptoms gotten worse over time? - Do you have chest pain or difficulty breathing? - Does exercise or physical exertion make your symptoms worse? - Are you aware of heart problems in your family? - Have you been diagnosed with other health conditions? - What medications are you taking? - Have you ever been treated with radiation therapy? - How much do you exercise in a typical week? - What's your typical daily diet? - Do you or did you smoke? How much? If you quit, when? - Do you drink alcohol? How much? What you can do in the meantime It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against coronary artery disease and its complications, including heart attack and stroke. PreviousNext Lifestyle and home remedies Lifestyle changes can help you prevent or slow the progression of coronary artery disease. - Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack. - Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years starting at age 18. If you're age 40 or older, or you're age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is generally below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg). - Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and at least every five years after. If your test results aren't within desirable ranges, your doctor may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). - Keep diabetes under control. If you have diabetes, tight blood sugar management can help reduce the risk of heart disease. - Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor's OK, aim for about 30 to 60 minutes of moderate to physical activity most or all days of the week. - Eat healthy foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts — and is low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial. - Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease. - Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. PreviousNext Prevention The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing in the first place. Leading a healthy lifestyle can help keep your arteries strong and clear of plaques. To improve your heart health, you can: Previous - Quit smoking - Control conditions such as high blood pressure, high cholesterol and diabetes - Stay physically active - Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains - Maintain a healthy weight - Reduce and manage stress
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Infarkt miokarda : uzroci , simptomi , dijagnoza i liječenje Kardiovaskularne Bolesti / / August 12, 2017 srca - najteži radni organ ljudskog tijela.Kroz čovjeka kontinuirano pumpa krv kroz arterije mreže života, obogaćuje kisikom i vitalne hranjive tvari do svih tkiva u tijelu.Za izvođenje ovog zadatka napeta, sam srčani mišić treba obilje krvi bogate kisikom kroz koronarne mreže.Te arterije nose krv bogatu kisikom na zid srčanog mišića - miokard. Infarkt miokarda ili srčani udar nastaje kada je blokiran protok krvi u srčani mišić, dolazi nekroze (smrti) od tkiva od gubitka kisika i ozbiljno oštećeni dio srca. Koronarna bolest srca (KBS) uzrokuje gotovo sve srčani udar.KBS je krajnji rezultat složenog procesa koji se zove "ateroskleroza".To dovodi do začepljenja arterija (ishemije) i daje bogatu kisikom krv da stigne do srca. uzroci i faktori rizika za infarkt miokarda faktori rizika za infarkt miokarda - isti su kao faktora rizika od koronarne bolesti srca.To su: - doba. povećanje rizik od koronarnih arterija povećava s godinama.Oko 85% ljudi umre od bolesti srca u dobi od 65 godina.Za - Paul. Muškarci imaju veći rizik od bolesti koronarnih arterija, a više vjerojatno da će imati srčani udar u ranijoj dobi nego žene.Rizik od razvoja bolesti srca kod žena povećava nakon menopauze, a to je vjerojatno, angine pektoris; - genetski faktori i obiteljske povijesti. Neki genetski faktori povećavaju vjerojatnost razvoja značajnih čimbenika rizika - kao što su dijabetes, visoki kolesterol i visoki krvni tlak; - rasa i nacionalnosti. Afroamerikanci imaju najveći rizik od kardiovaskularnih bolesti, a osobito s obzirom na visoke stope visokog krvnog tlaka, kao i dijabetesa i pretilosti; - Pretilost i metabolički sindrom. višak masnog tkiva, osobito oko struka, može povećati rizik od razvoja bolesti srca.Pretilost povećava rizik od drugih stanja (npr visokog krvnog tlaka i dijabetesa), koji su povezani s bolesti srca.Pretilost je posebno opasno kad je dio metaboličkog sindroma - pre-dijabetičko stanje koje je jako povezano s bolestima srca.Ovaj sindrom dijagnosticira kada postoje: - abdominalnu pretilost; - nizak kolesterol (HDL); - visoke razine triglicerida; - visoki krvni tlak; - otpornosti na inzulin (dijabetes ili pre-dijabetes). životne navike - nedostatak fizičke aktivnosti. Vježbe pružaju brojne učinke koje koristi na srce i cirkulaciju.To je, uključujući i - poboljšanje zdravog kolesterola i krvnog tlaka i održavati normalnu težinu.Ljudi koji su se uglavnom sjedeći, gotovo dvostruko češće pate srčani udar od onih koji su redovito sudjelovali u tjelesnoj kulturi i sportu. - Pušenje. Pušenje je najvažniji faktor rizika za bolesti srca.Pušenje može uzrokovati visoki krvni tlak, lipide, te ga degradirati vrlo ljepljive čini trombocita, što povećava rizik od krvnih ugrušaka.Iako je teški pušači cigareta su na visokim rizikom, ljudi koji puše samo tri cigareta dnevno imaju veći rizik od krvnih žila abnormalnosti koje u velikoj mjeri ugrožava srce.I redovito izlaganje pušiti vani ( "pasivno pušenje" pušenje) također povećava rizik od kardiovaskularnih bolesti. - Alkohol. Umjereno konzumiranje alkohola u malim dozama, može povećati razinu HDL-a - "dobar" kolesterol.Alkohol u malim dozama može spriječiti stvaranje tromba i upale.Za razliku od toga, opijanje je vrlo štetna za srce.U stvari, bolesti srca je vodeći uzrok smrti u alkoholičara. - Power. Dijeta igra važnu ulogu u zaštiti srca, posebno smanjivanjem prehrambenim izvorima trans masti, zasićene masti i "loš" kolesterol i ograničavanje unosa soli, koja pridonosi visokog krvnog tlaka. - NSAID i inhibitori COX-2 (ciklooksigenaza enzima tipa 2). Svi nesteroidni protuupalni lijekovi (NSAR), osim aspirina, nose rizik za srce.NSAID i inhibitori COX-2 može povećati rizik od smrti kod pacijenata koji su imali srčani udar.Najveći rizik - pri višim dozama, ali neke studije su pokazale da čak i niske doze NSAR su poduzete za kratko vrijeme, nisu sigurni nakon srčanog udara.NSAR su neprepisan lijekove, kao što su ibuprofen i lijekova na recept poput diklofenaka.Pacijenti koji su imali srčani udar trebali razgovarati sa svojim liječnicima prije uzimanja bilo kojeg od tih lijekova. Simptomi infarkta miokarda simptoma infarkta miokarda može biti vrlo različita.Oni se mogu pojaviti iznenada i snažno, ili može napredovati polako, u rasponu od blage boli.Simptomi mogu također razlikuju kod muškaraca i žena.Žene su manje vjerojatno da imaju klasični bol u prsima, ali oni su više vjerojatno da će doživjeti nedostatak daha, mučnina ili povraćanje, bol u čeljusti ili leđima. Najčešći znakovi i simptomi srčanog udara uključuju: - bol u grudima. Bol ili nelagoda u prsima (angina pektoris) glavni je znak srčanog udara.Može se osjećaju kao pritisak, stiskanje, proširenje srca ili bol u grudima centra.Pacijenti s bolesti koronarnih arterija koje imaju stabilne angine često doživljavaju bol u prsima koja traje nekoliko minuta, a zatim se ugasi.Kad je srčani udar bol obično traje duže od nekoliko minuta, a taj osjećaj može otići, ali onda se može vratiti; - nelagoda u gornjem dijelu tijela. Ljudi koji imaju srčani udar može osjećati nelagodu u rukama, vratu, leđima, čeljusti ili trbuhu; - Pomanjkanje daha. Kratkoća daha može dogoditi s boli u prsima ili bez nje; - Mučnina i povraćanje ; - hladan znoj ; - vrtoglavica ili nesvjestica. slijedeći simptomi mogu biti manje povezani s infarktom miokarda ili srčani udar: - akutne boli uzrokovane disanje ili kašalj; - pritisak u prsima; - bol koja se javlja uglavnom ili samo u sredini ili u donjem dijelu trbuha; - bol koja se može igrati pomicanjem prstiju na tijelo, a pritiskom na prsni koš ili ruku; - bol koja je stalna i traje nekoliko sati (u ovom slučaju, nitko ne mora čekati nekoliko sati, ako je osumnjičeni imao srčani udar); - oštra bol, koja je vrlo kratak, traje samo nekoliko sekundi; - bol koji se širi u noge. Međutim, nedostatak tih simptoma uvijek ne odbacuje mogućnost ozbiljne bolesti srca. Silent ishemije Neki ljudi s teškom bolesti koronarnih arterija i angine nemaju bolove.Ovo stanje je poznato kao "tihi ishemije".To je opasno stanje, jer je bol - pokazatelj bolesti, a ti pacijenti nisu primili od svojih tjelesnih uznemirujućih znakova upozorenja od srčanih bolesti.Neke studije pokazuju da ljudi s "tihe ishemije" imaju veći pobol i smrtnost od onih sa simptomima boli. Što ako je srčani udar ljudi koji pokazuju simptome koji su bili srčani udar simptomi, učinite sljedeće: - angina bolesnici trebaju uzeti jednu dozu nitroglicerina pod jezik (tablete) ili u obliku spreja upojava simptoma.Potrebno je uzeti drugu dozu svakih 5 minuta (do tri doze) ili do bol smanjena; - odmah treba nazvati broj lokalnih hitne medicinske pomoći.To bi trebao biti prvi radnja, ako angina pacijenti i dalje doživjeti bol u prsima nakon uzimanja tri doze nitroglicerina.Međutim, samo 20% od srčanog udara se javljaju u bolesnika s anginom pektoris ranije dijagnosticirati.Dakle, svatko tko razvije simptome srčanog udara, odmah treba nazvati "brzo"; - pacijent treba sažvakati i progutati aspirin za odrasle (325 mg) nije obložen, a liječnici kažu da oni nisu mu dati dodatnu dozu nitroglicerina; - bolesnika s boli u prsima ne treba se umoriti, oni bi trebali ići u bolnicu. Dijagnostika infarkt miokarda Kada pacijent dođe u bolnicu s bolovima u prsima, kroz obično uzimaju dijagnostičke mjere za utvrđivanje bilo kakvih problema sa srcem, ako su prisutne, a njihov stupanj ozbiljnosti.Pacijent mora obavijestiti liječnika o bilo kojem simptoma koji liječnici nisu mogli isključiti mogućnost srčane probleme i predložiti moguće druge uzroke teške bolesti. ispitne slike, uključujući ehokardiografija i perfuzijske scintigrafije, pomoći eliminirati srčanog udara, ako postoje bilo kakva pitanja i sumnje. - elektrokardiogram (EKG). EKG mjere i bilježi električnu aktivnost srca.Val mjeri na elektrokardiogram mjereno odgovara kontrakcije i opuštanja različitim dijelovima srca. Liječnici koriste pojmove «PQ» i «PR-interval" - to je vrijeme koje je potrebno da se presele električni impuls iz atrija do ventrikula. najvažnije valovi u dijagnostici i određivanje liječenja srčanog udara pod nazivom «S-t» i «P-val". - Povišena segmenti S-t: srčani udar. Povišene segmenti S-T su uvjerljivi dokazi od srčanog udara u pacijenata sa simptomima infarkta miokarda.Pretpostavlja se da je arterija dovodi do srca su blokirani i da ukupna debljina srčanog mišića je oštećen.Vrsta srčanog udara povezanog s tim nalazima, pod nazivom «Q-infarkt miokarda (IM)" ili "s usponom IM S-t» (povišenje S-t-segment infarkt miokarda).Međutim, povećanje S-t segment ne znači nužno da pacijent ima srčani udar.Na primjer, upala u vreći oko srca (perikarditis) je još jedan razlog visina S-t-segment. - Stabilna angina (kad su rezultati ispitivanja krvi ili drugih testova ne ukazuju na ozbiljan problem i ne otklanja bol u prsima).Između 25-50% ljudi koji imaju angina ili tihi ishemije, normalan EKG čitanja. - Akutni koronarni sindrom (AKS) - uključuje iznenadnu i tešku bolest srca koja zahtijeva ozbiljno liječenje, ali bolest koja još nije postala full-puhano srčani udar. - echocardiogram - neinvazivni test koji koristi ultrazvučne slike srca.Liječnik je važno znati da li je dio srčanog mišića je oštećen.Ehokardiografija također može koristiti kao dio testa opterećenja otkriti lokaciju i opseg oštećenja srčanog mišića u vrijeme otpusta ili ubrzo nakon otpuštanja iz bolnice nakon srčanog udara. - radionuklida slike (talij stres test). radionuklid postupci koji koriste imaging tehnike i računalnu analizu za izgradnju i otkriti prolaz radioaktivnih izotopa kroz srce.Takovi elementi su obično daju intravenozno.Radionuklida slike koristiti za dijagnosticiranje i: - težini nestabilne angine, kada jeftiniji dijagnostički pristupi su nedostupni ili nepouzdani; - ozbiljnost kronične bolesti ishemijska srca; - uspjeh operacije u ishemijskom bolesti srca; - ako ste imali srčani udar; - položaj i opseg oštećenja srčanog mišića u vrijeme otpusta ili kratko nakon otpuštanja iz bolnice nakon srčanog udara. Postupak je neinvazivan (bez intervencije u tijelo).Ako postoji oštećenje srčanog udara, radioaktivni izotop (tehnecij ili talijev) uvedena u pacijenta venu.Radioaktivni izotop prolazi kroz krv koja cirkulira u srcu.Izotopa mogu se pratiti kroz srce pomoću posebnih kamera ili skenera.Slike mogu biti u kombinaciji s elektrokardiogram.Pacijent je testiran tijekom blagdana, a zatim ponovno ispitivanje prolazi vrijeme testa opterećenja.Šteta zbog srčanog udara prošle bit će spremljene kada se ponavlja skeniranje srce.Trauma uzrokovana anginom, međutim, pojavit će vrijeme. - angiografija. angiografija je invazivni test.To se koristi za pacijente koji pokazuju jake dokaze o teškom opstrukcijom (prepreka normalnom radu) zbog stresa i drugih ispitivanja, kao i za pacijente s akutnim koronarnim sindromom. Postupak: uska cijev se umeće u arteriju - obično u nogu ili ruku, a zatim s navojem se pokretnom tijelu da koronarnih arterija.Boja se ubrizgava u cijevi, a Rendgenski zapisi boje kroz arterije.Ovaj proces omogućuje kartu koronarnu cirkulaciju, otkrivajući blokiranog područja. - Biološki biljezi.Kad srčane stanice su oštećeni, oni oslobađaju razne enzima i drugih tvari u krvotok.Povišene razine tih markera srčanog oštećenja u krvi i urinu može pomoći u predviđanju srčanih udara kod bolesnika s teškim bolovima u prsima, te određivanje metode liječenja.Testovi za tih markera često izvode u stroj "hitne" ili u bolnici, kada se sumnja na srčani udar.Neki markeri su troponini;miokarda kreatin kinaze (CK-MB), itdOpcije infarkt miokarda Liječenje liječenja uključuju infarkt miokarda: - terapija kisikom; - Nitroglicerin ili morfij - za ublažavanje boli i nemir; - kontrolu bilo aritmije (smetnje srčanog ritma); - blokira daljnje zgrušavanje krvi (ako je moguće); - otvaranje blokirane arterije što je prije moguće - obavljanjem angioplastika ili lijekove koji tanka krvnih ugrušaka; - beta blokatori, blokatori kalcijevih kanala ili ACE inhibitori - za pomoć mišiće srca i arterija rade bolje. prvo pomoći pacijentu s infarktom infarkom U ranim postupcima za podršku su slični za pacijente koji su pretrpjeli infarkt miokarda.Potrebno, osobito kisik, aspirin, nitroglicerin, morfij, otvaranje arterija kroz hitne angioplastike ili tromboliticima. Standardna opće medicinske i kirurške skrbi za otvaranje arterija: - angioplastike (perkutane koronarne intervencije - PCI) - postupak željeni hitnu za otvaranje arterije; - trombolitici (lijekovi) - standardni lijekovi koji se koriste za otvaranje arterija.Trombolitik lijek treba dati u roku od 3 sata nakon početka simptoma; - CABG - ponekad koristi kao alternativa angioplastike. - tromboliticima. tromboliticima - lijekovi koji se preporučuju kao alternativa angioplastike.Ovi lijekovi otopiti ugrušak krvi blokira arterije i vodi srce mišićno tkivo umrijeti. tromboliza smatra dobar izbor za pacijente sa srčanim napadima, u kojima simptomi su manje od 3 sata.U idealnom slučaju, ti lijekovi moraju se dati u roku od 30 minuta nakon dolaska u bolnicu, kada je angioplastika nije izvediva opcija. druga situacija gdje možete koristiti droge: - kontinuirani transport pacijenta; - predugo čekaju kateterizacije; - ako se postupak koronarne premosnice nije bio uspješan, ili ako anatomski previše komplicirano. trombolitici treba izbjegavati ili koristiti s oprezom u sljedećim skupinama bolesnika nakon srčanog udara: - više od 75 godina; - one čiji simptomi potraju duže od 12 sati; - trudnice;Art.