It should start with the fact that the occurrence of myocardial infarction( MI) in women younger than 50 years - an extremely rare phenomenon. This is due to the protective function of the natural hormonal background of a woman with a predominance of estrogen. The estrogen protects the vessels from the effects of pathogenic factors, counteracting the formation of vascular plaques.
It has been established that this kind of angioprotective effect is achieved by the action of estrogen on immune cells circulating in the blood.
Thus, while the level of production of female sex hormone is high enough, the risk of developing a heart attack is significantly reduced. With the onset of menopause, estrogen levels drop sharply, which causes an increase in the risk of development in women over 50 years old.
This factor has been confirmed instrumentally. Including, in one of the studies, the influence of the age factor and the onset of menopause was compared.
- Risk Factors
- Classical clinical picture of myocardial infarction
- Symptoms of myocardial infarction
- There are also atypical manifestations of myocardial infarction
- Features of the clinical picture of myocardial infarction in women
- Diagnosis of MI
- Treatment of MI
However,which can reduce the protective effect of natural hormonal background, greatly increasing the risk of myocardial infarction even in women younger than 50 let, i.e.before the onset of menopause.
Among them, it is possible to identify modifiable factors, that is, those for which a woman or her attending physician can exercise are able to influence and not modifiable, i.e.those that can not be influenced.
modifiable factors of heart attack in women risk
- life Consumption of foods rich in carbohydrates and fats
- Frequent stress
not modifiable factors:
- Heredity( burdened with familyanamnesis)
- Menopause, including early onset of menopause
With all this, it should be noted that according to many authors IM in womennot so much began to occur among women more often than in previous years, but also significantly "younger", i.e.now in clinical practice there are quite a lot of patients 40-45 years old with acute myocardial infarction. In addition, the manifestations of myocardial infarction, the frequency of development of its complications were heavier.
Classical clinical picture of manifestation of myocardial infarction
In order to understand the cause of the appearance of certain symptoms in myocardial infarction, it is first of all necessary to understand their pathogenesis, with the very essence of the disease.
An infarction is a necrosis( cell death) of a specific area of the heart, due to its ischemia.
Various factors can cause the development of ischemia, but in the vast majority of cases it is the occlusion of the coronary artery supplying the heart with blood, an atherosclerotic plaque. Another cause of ischemia is the spasm of one or more coronary arteries.
In both cases, there is a cessation or insufficient supply of blood to a certain area of the heart. With insufficient blood supply, cardiomyocytes do not receive enough oxygen and die.
It is natural that in connection with the death of cells and the continuing ischemia of one of the areas of the heart, his work as a whole is disrupted. This is explained by the appearance of symptoms characteristic of myocardial infarction.
Symptoms of myocardial infarction
The main symptom of myocardial infarction, regardless of whether a woman has it or a man, is an acute pain behind the sternum - anginal pain. She appears abruptly. Often patients describe it as oppressive, aching, compressive. The pain is growing. The patient takes a forced position, often tries to make as few movements as possible. Over time, other symptoms join in: dizziness, a sense of fear of death, a violation of breathing, a rapidly increasing weakness.
Often all this is accompanied by the appearance of profuse sweat.
The key symptom of anginal pain in myocardial infarction from normal anginal pain in angina is
- An episode of angina pain lasts more than 15 minutes
- Anginosis does not go away after taking nitroglycerin( pain in myocardial infarction is so strong that it can only be stopped with the use of narcotic analgesics)
There are also atypical manifestations of myocardial infarction:
Abdominal form. When the abdominal form of MI comes to the forefront symptoms of the gastrointestinal tract: pain in the epigastrium, nausea, vomiting;in such cases it is extremely difficult to suspect MI.The patient at the same time, as a rule, falls into the gastroenterology department with suspicion of acute intestinal infection, suspicion of exacerbation of chronic pancreatitis, etc.
Asthmatic form. This form is manifested by symptoms on the part of the respiratory system. These are symptoms such as: shortness of breath, cough, difficulty breathing. Such patients too often quite often fall into the wrong place, that is, not at the right place.completely to another specialist and only the experience of an emergency doctor, the presence of risk factors in the patient and additional symptoms indicating a pathology of the cardiovascular system, can tell the clinician that he is in front of a patient with MI.
The painless form of is one of the most insidious forms of MI flow, because it does not manifest itself clinically until the development of serious, life-threatening patient conditions. Often the absence of pain syndrome in ischemic myocardial damage can be a consequence of the pathology of the functioning of nerve endings, which is a common syndrome for polyneuropathy in diabetes mellitus. In connection with this, the painless form of MI is most often encountered in diabetics.
Cerebral form. With this form of myocardial infarction, the symptomatology is mainly represented by symptoms from the nervous system. The most common symptomatology in the cerebral form of myocardial infarction: dizziness, fainting, paresthesia and other neurological disorders.
Features of the clinical picture of myocardial infarction in women
Most often, MI develops in women who are overweight, smokers, those whose work is associated with persistent stress or in women over 50, i.е.menopause.
The most characteristic feature of the manifestation of MI in women is that, as a rule, it is accompanied by the appearance of various kinds of arrhythmias.
Extrasystoles often develop. The classical, abdominal and painless forms of MI prevail. Pain-free is more common in patients with diabetes mellitus.
As already mentioned above, a huge role in increasing the risk of developing MI in women is a change in the hormonal background, whatever factors it may be caused.
Most often, these changes are associated with the onset of menopause, but may be caused by other causes.
Diagnosis of MI regardless of the sex of the patient is carried out in a classical manner, according to the accepted worldwide algorithms for the care of patients with myocardial infarction. First of all, ECG diagnostics, Echocardiography, blood tests for enzymes that indicate cardiac muscle damage( MB-CKK, AsAT, LDH), MV-CKK, are a specific enzyme that appears in the blood only in necrosis of the cardiac muscle in ischemia. It is specific for the muscular tissue of the heart, and therefore plays a leading role in the diagnosis of myocardial infarction.
In complex or disputable cases, coronary angiography is performed. It should be recalled that this diagnostic method is invasive, therefore it is carried out purely for specific indications due to the risk of development due to its use of serious complications.
Treatment of myocardial infarction
Treatment of myocardial infarction in both men and women is carried out according to a similar scheme, in accordance with the standards of care for patients with MI.
The specificity of such care is not determined by sex, but by the severity of the patient's condition, the presence of concomitant diseases and complications.
The essence of therapy consists in the relief of pain syndrome, the appointment of thrombolytic therapy, anticoagulants, antiplatelet therapy. The patient also receives beta-blockers.
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