The temperature has fluctuated significantly recently, and the emergency department of the Oriental Hospital Affiliated to Tongji University is busier than before. Just around 9 pm a few days ago, an 89-year-old man suddenly sweated profusely after dinner. Since his children were all abroad, the man immediately contacted his nephew. The nephew was very experienced and immediately called 120 and was transferred to the emergency department of Oriental Hospital within 30 minutes.
The emergency department doctor learned that this old man had had a myocardial infarction for more than 10 years and had implanted multiple stents. Coronary CT was just checked for a second time, but I have had a slight chest pain recently and has not been taken seriously. The emergency doctor immediately improved the electrocardiogram and made it clear that the old man had " acute myocardial infarction " and his condition was extremely critical. In the more than ten minutes in the emergency room, the patient had another attack of acute heart failure.
Gao Liming, deputy chief physician of the Department of Cardiology, and the team from the Chest Pain Center started the catheter room together to improve emergency coronary angiography for this old man who is nearly 90 years old. imaging found that two stents 10 years ago were completely blocked, and the only remaining blood vessel also had more than 90% acute thrombosis, almost lingering in life. After implanting the balloon counterpulsation device through femoral artery , the only remaining blood vessel in the patient was opened. Once opened, the patient's symptoms improved significantly, but for such a dangerous situation, he only passed the first level. Next, there are two completely obstructed blood vessels that need to be processed after the patient is stable. This is indeed a difficult level for an elderly patient. However, the successful rescue of his last "lifeline" blood vessel within 90 minutes of the emergency room was of great significance.
Acute myocardial infarction is a difficult task for both the general public and cardiovascular doctors. Like the old man mentioned above, he is old and has a history of coronary artery disease. The recent recurring symptoms and sudden aggravation are even more predictable that he is a hard bone that is more difficult to crack than ordinary myocardial infarction. At this time, in the heart of the cardiovascular intervention doctor, it is really a matter of time. In the words doctors often say, time is the myocardium. Therefore, the attention of the general public to symptoms and seek medical treatment in a timely manner is often the first important part of saving the myocardium.
So, what symptoms need to be taken seriously? In other words, acute myocardial infarction is so dangerous, is there any sign that people can pay attention to it once they are discovered? Dr. Gao Liming gave a detailed introduction to this: Most patients have prodromal symptoms such as fatigue, chest discomfort, fatigue during activity, palpitations and irritability a few days before the onset of the disease. These are actually atypical signs. But not all signs of symptoms occur. For people who originally had no symptoms of angina, it is difficult to pay attention to it early or reflect the danger of their own symptoms. When there is a situation where chest tightness and discomfort are significantly worse for several days, you must pay attention to it. The increase in the number of angina symptoms, the prolonged attack time, and the occurrence of cold sweating, fatigue and even a sense of near-death are all very important signs of pre-onset myocardial infarction. The earlier the patient recognizes these symptoms, the more likely he is to save more myocardium. Some patients also cause angina pectoris even if they perform mild activities in their daily lives, and even attacks when they sleep, which may be difficult to judge. For difficult-to-judge situations, it is recommended to seek medical treatment as soon as possible to prevent delayed diagnosis and treatment.
There are indeed some people who do not have any signs of "angina pectoris", but various types of general discomforts cannot be ruled out. For example, gastrointestinal symptoms, about 1/3 of some patients with myocardial infarction have early symptoms of nausea, vomiting and abdominal distension. flatulence is also uncommon. These conditions often lead to the treatment of the gastroenterology department due to the initial symptoms or mistakenly thinking that gallbladder disease and delay diagnosis and treatment. Some patients also have symptoms of shortness of breath, or even coughing, foaming and sputum. If you have no previous history of respiratory diseases, you need to be vigilant. This may be an acute myocardial infarction in the form of heart failure , which may indicate a more difficult treatment process than direct chest pain .
Some patients also have arrhythmia . Acute arrhythmia is usually a serious manifestation of basal lesions, such as persistent myocardial ischemia , pump failure or electrolyte disorder , autonomic nervous system dysfunction hypoxemia or acid-base balance disorder. In our cognition, some myocardial infarctions are prone to rapid arrhythmia, and patients experience obvious palpitations, while some myocardial infarctions show chronic arrhythmia, which is often manifested as dizziness, blackness, or even fainting. It may also be asymptomatic, and when measuring blood pressure, it is found that the heart rate is too slow and it attracts attention.
Of course, the attacks of various types of arrhythmia do not all indicate a bad prognosis of myocardial infarction. On the contrary, some myocardial infarctions will cause blood vessels and re-union, and the arrhythmia at this time suggests that the prognosis is often better.
In short, the occurrence of various symptoms requires more examinations to further clarify the final prognosis. The most serious way of onset of myocardial infarction is shock and hypotension . The prognosis of myocardial infarction in this way is often very poor. The more dangerous the situation is, the more it is necessary to race against time to open the blood vessels and fight for every possible second to save the myocardium.
How to save yourself if an emergency occurs, Dr. Gao Liming also gave a specific introduction. Self-rescue of myocardial infarction is definitely not about not going to the hospital, but about what we can do before 120 arrives to buy time for doctors and 120 transshipment. Currently, video 120 has been opened in some countries and regions, so that families can be taught to save themselves on-site. However, based on the current situation in China, especially during the epidemic, we should learn to keep calm, let the patient lie flat on the spot, raise his feet slightly, and try not to move the patient to avoid increasing his tension and heart burden, endangering his life; at the same time, call 120 as soon as possible and contact the hospital emergency center as soon as possible. If you have spare medicine at home, you can immediately take nitroglycerin or relieve heartache to help patients relieve symptoms. If you have the conditions at home, you can also inhale oxygen. Once acute myocardial infarction occurs, myocardial necrosis begins within about 20 minutes, and most of the myocardial will be necrotic in about 6-8 hours. Therefore, if family members or friends are found to have acute myocardial infarction, they should maintain sedation and first aid. The earlier the blocked blood vessels are opened during the onset, the greater the chance of treatment. If the patient suddenly stops beating, he or she needs to undergo CPR immediately, that is, continue chest compressions until the doctor arrives.
Author: Zhao Lirong
Editor: Wang Boling
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