Myocardialinfarctionishigh,bewareofsevendistresssignals

Summer is the season for high incidence of myocardial infarction. In this issue of " Hundred Years Union Lecture Hall ", the Chief Physician of Fuwai Hospital of the Chinese Academy of Medical Sciences will invite Liang Yan, deputy director of the emergency department, to popularize science about acute myocardial infarction and solve you all at once. All questions and confusions.



7 "alarm signs" of myocardial infarction


Be aware of the signs of myocardial infarction! 55% of people will show clues 1-2 weeks before the onset of the disease. Many fatal diseases are hidden in some unremarkable symptoms. Learning to recognize the aura symptoms of myocardial infarction is an important step to save lives.


1. Increased severity of angina


People who have had coronary heart disease before the onset of myocardial infarction will increase the frequency of angina pectoris. The amount of activity that induces angina pectoris will lower the threshold, and even angina pectoris will appear at rest or at night. This indicates that the plaque is unstable. Be wary of myocardial infarction and go to the hospital as soon as possible. If the treatment is not done in time, it is possible to cause myocardial infarction at any time because the plaque ruptures and forms a thrombus. People who have never had coronary heart disease should pay special attention to the first episode of angina.

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2. Other pain


Some patients may present with atypical chest pain, which is mostly found in people with advanced age, diabetic patients, women, cognitive decline, etc., or shoulder pain, back pain, upper abdominal pain, toothache, etc., which need to be combined with the patient’s past Judging the condition of the disease and distinguishing it from angina.


(1) Stomach pain or upper abdominal pain


Patients who are obese, suffer from three highs and do not usually have upper abdominal discomfort, should be highly vigilant if they have stomach pain. Coronary heart disease, angina pectoris, or acute myocardial infarction sometimes manifests as a burning sensation in the stomach.


(2) Toothache


Usually about 3 minutes will pass, if it is periodontitis, it will not be so short. Toothache when tired, toothache when angry, or toothache worsens after fatigue or excitement, all may be a sign of myocardial infarction. May recur within 1 week. This kind of pain often involves multiple teeth, and can be accompanied by cold sweats, shoulder pain, etc. It is more common in women. Toothache, especially for high-risk groups, must first rule out myocardial ischemia.


3. Blackened or unable to open eyes

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Darkness in both eyes indicates that myocardial ischemia has worsened, which has affected the blood supply to the brain. If you suddenly lose sight of your eyes, or even open them, pay attention to your little heart.


4. Suddenly sweat a lot


Without exercise, the scalp, back of the neck, palms and soles of the feet sweat a lot. This symptom is a common sign before the onset of myocardial infarction.


5. Pain and chest tightness without warning


People who do not have heart disease suddenly experience chest tightness, palpitation, unexplained discomfort, and suffocation and difficulty breathing when inactive. If you have any of the above symptoms, you must doubt whether you may be myocardial ischemia, and go to the hospital for diagnosis and treatment in time to win the best treatment opportunity.


6. Weakness of left upper limb


This is not an isolated case. Many patients present with discomfort and swelling of the left scapula and left upper limb. Some of them are unable to exert strength. The examination found that it was myocardial ischemia. After improvement with medication or surgery, the symptoms disappear quickly.


7. Waking up painful and sweating profusely during sleep


If the patient wakes up suddenly during sleep, is accompanied by profuse sweating, or is near death, attention should also be paid. This is often due to the spasm of the coronary arteries that supply blood to the heart causing a sudden interruption of blood flow in part of the myocardium. If not relieved, it will progress to acute myocardial infarction.


When these "alarm signals" appear, one should be alert to the possibility of myocardial infarction in the near future, and it is best to go to the hospital for investigation in time. The time for these aura symptoms to appear is not long, 3-5 minutes have passed, but because the time is very short, you can't ignore it because you think it's all right. Discovery of aura and prompt hospitalization can help some patients avoid myocardial infarction. So if you have the above situation, especially if it has not happened before, you must go to the hospital to see it. There are studies in the United States that if such patients have been seen, the possibility of myocardial infarction and sudden death is reduced. If you don’t see it, there is a higher chance of sudden death.

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Self-judgment of symptoms of myocardial infarction, and seek medical treatment promptly when problems are found


The symptoms are closely related to the size, location, and collateral circulation of myocardial infarction area. The most critical step in the diagnosis and treatment of acute myocardial infarction is to see a doctor in time and perform revascularization as soon as possible. The decision to see a doctor in time depends on whether the public can recognize the symptoms of myocardial infarction. The more symptoms, the greater the possibility of myocardial infarction. Although self-judgment is not necessarily professional and accurate, in the face of life and death, it is better to "wrongly judge three thousand" than "miss one".


1. Chest pain


Chest pain is the most typical and common symptom of myocardial infarction, accounting for about 40% . Typical angina pectoris manifests as severe squeezing pain or tightness in the posterior or anterior heart region, which radiates to the left shoulder and left arm or radiates to the lower jaw, lasting for more than a few minutes, and may be accompanied by sweating. Some people compare the sensation of chest pain to "a mountain pressing on the chest", suggesting that this kind of chest pain is often accompanied by squeezing, heavy pressure or fullness. Generally, the area of ​​chest pain is the size of a slap, but some people may manifest as the entire chest. There is no special rule in the timing of chest pain. The onset is sudden and can occur at night or during the day, and it usually occurs in the early morning at night. Not all patients with myocardial infarction will have chest pain, and chest pain may not be a heart disease.


2. Pain in other parts


Myocardial infarction is not necessarily chest pain. It can radiate to other parts and cause pain in other parts of the chest. It most often occurs in the left forearm, left shoulder blade, upper abdomen and gums, followed by the throat, jaw, fingers or wrist, neck, and again in the left armpit pain, migraine, cheek pain, facial pain, ear pain Head pain, umbilical pain, low back pain and "distant" lower limb pain. On the surface, these pains have nothing to do with the heart, but they are actually closely related. Ectopic pain is often ignored and misdiagnosed because it is far away from the heart. No matter where the pain occurs, as long as it is sudden and severe, it must be considered whether it is related to the heart.


3. Accompanying symptoms


Accompanying symptoms can not only provide more clues and evidence for our diagnosis, but also help judge the severity of the disease.

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(1) Systemic symptoms:


Fever, profuse sweating (virtual sweat, cold sweat), fatigue, weakness, tight chest and back, etc. A small number of patients may have fever 1 to 2 days after the onset of illness. The body temperature is generally around 37-38°C, rarely exceeding 39°C, and lasts for several days. At this time, the fever is caused by the absorption of myocardial necrotic substances.


(2) Digestive tract symptoms:


About 30% of patients with acute myocardial infarction have gastrointestinal symptoms, which are often accompanied by severe pain and nausea, vomiting, loss of appetite, upper abdominal pain, burning sensation, hiccups, hematemesis, diarrhea, melena and even incontinence, etc. Wait. It is often considered to be more common in patients with dyspepsia, acute gastroenteritis, and inferior myocardial infarction.


(3) Arrhythmia:


It occurs in 75% to 95% of patients. It usually occurs 1 to 2 days after the onset of the disease. It is most common within 24 hours. Ventricular arrhythmia, especially ventricular premature contraction, is the most common. Anterior myocardial infarction is prone to ventricular arrhythmia, and inferior myocardial infarction is prone to slow heart rate and atrioventricular block. Those with amaurosis and loss of consciousness should consider malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation, as well as whether there is a new conduction block. Patients with palpitations should be alert to rapid arrhythmias such as atrial fibrillation and ventricular tachycardia.


(4) Hypotension and shock:


Seen in about 20% of patients, it usually occurs within a few hours to 1 week after onset. Acute myocardial infarction can cause hypotension due to severe pain, nausea, vomiting, sweating, hypovolemia, arrhythmia, etc., and large-area myocardial infarction (infarct area>40%). The cardiac output decreases sharply, which can cause heart source Sexual shock, systolic blood pressure <80mmHg, restlessness or indifference, pale complexion, clammy skin, rapid pulse, rapid heart rate, unconsciousness or even fainting, decreased urine output <20ml/h.


(5) Heart failure and edema:


The incidence is about 32% to 48%, mainly acute left heart failure, which can occur within the first few hours to a few days after the onset of the disease, or in the stage of pain and shock improvement. There may be fluid retention, leading to limb edema and sudden weight gain. In severe cases, pulmonary edema may occur. Manifestations of dyspnea, cough, hemoptysis, wheezing, cyanosis, irritability, loss of appetite, edema of the feet, ankles, lower extremities, or abdomen.


(6) Respiratory symptoms:


It is manifested as coughing, wheezing, neck tightening, throat discomfort, and some only feeling chest tightness, suffocation, and shortness of breath. If the patient has chronic bronchitis, it is easy to be misdiagnosed as pulmonary heart disease. The mechanism of symptoms is that during acute myocardial infarction, myocardial contractility decreases and cardiac output decreases, causing pulmonary congestion and prone to complicated bronchial infection.


4. Typical myocardial infarction


The typical symptoms of myocardial infarction include chest tightness and chest pain in the left precordial area, accompanied by palpitations, shortness of breath, profuse sweating, nausea, and vomiting. In men with acute myocardial infarction, persistent chest pain and profuse sweating are more common; women with myocardial infarction have less chest pain, profuse sweating and other symptoms than men, but nausea, vomiting, shortness of breath, fatigue, pain in other parts, and big and urinating Incontinence is more common.


5. "Not painful" myocardial infarction


It is more common in the elderly and diabetic patients, because diabetes can cause painful nerve insufficiency. When the heart is ischemic, there may be no warning of chest pain. It often manifests as mild chest tightness, suffocation, upper abdominal discomfort, nausea, palpitations, hypotension, shock, etc. This type of myocardial infarction often damages the myocardium more thoroughly.






6, silent myocardial infarction


That is, completely asymptomatic myocardial infarction, without chest pain or other symptoms, which is more common in diabetic patients. Such patients have no symptoms from beginning to end, only the ECG reveals suspicious myocardial infarction patterns, which are more common in focal or old myocardial infarction. It should be noted that a myocardial infarction with no symptoms or mild symptoms is also fatal. The patient may have sudden arrhythmias (such as ventricular fibrillation), cardiogenic shock or sudden death, and should not be taken lightly.


7. Complications of myocardial infarction


In addition to heart failure, there are many complications of myocardial infarction, such as severe arrhythmia, ischemic mitral regurgitation, ventricular aneurysm, ventricular septal perforation, acute myocardial infarction pericarditis and so on.

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