We focus on the clinical manifestations of acute myocardial infarction.
First of all, pain, persistent and aggravating symptoms of "angina".
★ It is said that it is angina, but in fact, when acute myocardial infarction is not considered to be angina. Because angina generally does not last long, no more than 10 or 20 minutes. When myocardial infarction occurs, it is already a persistent chest pain.
Myocardial ischemia necrosis, the production of inflammatory substances and other substances will stimulate the nerves, causing the symptoms of "angina". When myocardial infarction dies, the pain will be more severe and persistent than usual angina and cannot be relieved, nor can it be relieved with nitroglycerin.
★ The site of pain in myocardial infarction, with typical chest pain and atypical pain in other parts. However, chest pain is the most common.
Chest pain, the most typical is retrosternal pain, the anterior chest is in the middle, from the throat, that is, the "throat eye" to the "heart and mouth socket" under the sword process.
★ It is said that it is pain, nor is it the pain of knife cutting and needle pricking, but the feeling of suffocation, squeezing, and tightening, dull pain; some patients are just indescribable discomfort, discomfort, and not necessarily pain.
However, patients with myocardial infarction will generally be in poor condition. The patient may appear weak, sweaty, irritable, but not want to talk much. In short, it is an adducted, introverted pain.
★ Acute myocardial infarction, chest pain with heavy sweating is common.
Patients can also be accompanied by other symptoms, such as nausea, vomiting, defecation, diarrhea, dizziness, and even syncope.
★ Nausea and vomiting alone are of no particular significance for acute myocardial infarction, but if chest pain is accompanied by nausea and vomiting, the likelihood of acute myocardial infarction is greatly increased.
Therefore, if someone has the above performance, it is necessary to be vigilant about whether an acute myocardial infarction has occurred. Chest pain of unknown cause is treated as coronary heart disease first, because the risk is high.
In addition to chest pain, patients with acute myocardial infarction can present with a variety of manifestations.
★ Various arrhythmias.
Myocardial ischemia necrosis will affect the pacing conduction of the heart, so there will be a variety of arrhythmias, rapid, slow, all kinds of premature beats, tachycardia, atrial fibrillation, bradycardia, conduction block, bundle branch block and so on. These are also related to the site of myocardial infarction. In general, myocardial infarction of the anterior wall of the heart is often characterized by rapid arrhythmias; inferior myocardial infarction is more often associated with bradyarrhythmias.
There is also a case where a complete left bundle branch block is newly present on the ECG, and it is also necessary to be vigilant.
If there is a serious malignant arrhythmia, it can cause sudden cardiac death.
★ Manifestations of shock, cardiogenic shock.
This is because the area of cardiac infarction is large, and the heart's blood-shooting ability is seriously insufficient, resulting in a significant decrease in cardiac function and affecting blood circulation. The patient's limbs and hands are cold, cold sweat, irritability, and blood pressure will be lowered. If the shock is severe and persistent, then the systemic organ function is not good.
It should be reminded here that patients whose blood pressure has always been relatively high should also be vigilant if their blood pressure suddenly drops to a normal or low level.
★ Heart failure, pump failure.
Myocardial infarction can affect the systolic function of the heart and can cause heart failure. When the left heart fails, the blood is stalted in the lungs, affecting oxygen exchange, and the plasma will also seep into the alveoli, resulting in pulmonary edema. The patient will have a rapid heartbeat, wheezing, unable to lie flat, and sit upright and breathe. Foamy sputum, severe will be pink foam sputum; when the right heart failure, the blood of the whole body can not return to the heart, the heart does not have enough blood to pump out, can not maintain circulation, will be shock.
★ Manifestations of heart rupture and perforation.
After the myocardial necrosis is not rescued in time, the necrotic myocardium will undergo myolysis, just like the meat rot, not strong. When the heart contractile pressure is high, it will rupture and perforate, and if the ventricular papillary muscles that pull the heart valve are broken, the valve will not be closed. Patients can suddenly develop severe heart failure, pericardial tamponade, and even death.
★ Cardiac arrest.
Myocardial infarction, severe malignant arrhythmias can cause ventricular fibrillation or cardiac arrest, the patient is manifested as a sudden loss of consciousness, touching the carotid artery or the root of the thigh femoral artery pulsation disappears, which indicates that the heartbeat has stopped and urgent CPR is needed.
The above manifestations do not necessarily appear in every patient, nor are they necessarily so obvious, especially in the elderly, usually weak patients, or patients who have had a stroke, feel less sensitive, and have expression disorders. Patients like diabetes and smokers are less sensitive to pain and less typical chest pain. However, if such patients suddenly have changes in their condition, such as irritability, palpitation, chest tightness, wheezing, abdominal pain, sweating, psychiatric symptoms or decreased blood pressure, and even convulsions, syncope, etc., they should be vigilant against acute myocardial infarction.
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