Heartbreak

Heart rupture is a broken integrity of the heart walls. As a rule, a heart rupture occurs during the first week after the first arisen myocardial infarction. An infarction that happened repeatedly does not often end in a heart rupture. This is due to the fact that the scar formed from the previous infarction is resistant to an oxygen deficiency( ischemia, hypoxia).

Patients at a young age are less prone to heart rupture, in contrast to older people. Internal( at which the papillary muscle and interventricular septum break), external and external heart ruptures, which can be divided into 3 types:

- the first type is characterized by a gap in the form of a narrow slit, which has steep edges. It arises in the severe form of atherosclerosis of one coronary artery and acute ischemic disease.

- the second type is caused by rupture in lysis. In this case, a less or more prolonged interval between ischemic disease and cardiac tamponade can be observed.

- the third type is characterized by heart rupture in the center of acute aneurysm. Occurs in the early stage of ischemic disease.

It is also possible to single out one-time heart breaks and slow flowing, leading to gradual deterioration of the patient's condition.

Complete heart rupture is characterized by the fact that the damage extends to the full depth. An incomplete break is accompanied by damage to the heart muscle not to the full depth, with the further development of an aneurysm.

Aortic rupture of the heart is characterized by stratification of the aortic layers due to the fact that blood flows between the walls. Also, there is often a heart valve rupture due to some disease or injury.

Heart rupture causes

The cause of early heart rupture is myocardial infarction. Regardless of sex, a heart break can happen to everyone. However, it is known that women are more prone to heart rupture than men. Basically, there are heart ruptures in the case of a primary myocardial infarction. When repeated, it is rare. This is due to the fact that people who have previously suffered a heart attack, formed fibrotic changes in the myocardium and collateral circulation, preventing the rupture of the heart.

Deep and extensive lesions occur with transmural myocardial infarction. Quite often, extensive transmural lesions of the heart muscle lead to heart rupture.

The heart rupture that arises due to high blood pressure is controversial to date. There are specialists who deny this probability. However, some argue that patients who have hypertension, which does not decrease diastolic blood pressure( acute period of myocardial infarction) are prone to heart rupture.

There are data indicating that heart failure occurs in 58-100% of patients with high diastolic pressure. For this reason, with a heart attack, medications are needed that help reduce blood pressure, thereby relieving the myocardial load and accelerating the healing of the heart muscles( scars are formed).

In the case of mental and physical stress, violations of strict bed rest, especially during an acute period of myocardial infarction, a heart break is also possible. In the first week after a heart attack, when patients begin to walk, to overcome stairs, the load on the damaged heart begins to increase. It is proved that there are cases when there is a heart rupture during a conversation with relatives and even in a dream.

In the case of a late hospitalization with an infarction, from the beginning of which more than 24 hours have passed, can lead to heart rupture even when the patient is transported. Also, with a late intake of thrombolytic drugs that contribute to the dissolution of the thrombus, a heart rupture may occur. In the case of early intake of drugs, coronary blood flow is restored more quickly, so death from heart failure occurs in rare cases.

With the intake of anti-inflammatory and hormonal drugs, inhibition of the formation of the scar in the damaged part of the myocardium occurs, and the likelihood of a heart rupture is very high.

A heart rupture from fear can occur even in a completely healthy person. This is due to the fact that in an extreme situation, under the pressure of fear, the heart rate increases, and the blood flow in the muscles increases. A large amount of adrenaline is produced, and the resulting ventricular fibrillation does not allow them to pump blood, resulting in death.

A rupture of the aorta of the heart can occur only when the inner elastic membrane is thinned, thereby forming a lumen from which blood seeps. As a rule, the stratification of the walls leads to a lethal outcome.

A heart valve rupture can occur due to a chest injury or infective endocarditis. Rarely occurs in the case of acute heart failure.

Heart rash symptoms

In the pre-discontinuous period, intense pain in the heart region radiating between the scapula can be observed, which is not stopped by nitroglycerin and narcotic analgesics( Morphine).

A shock symptom caused by a cardiac tamponade will quickly build up( blood pressure drops, the consciousness is lost, the pulse is weak, a cold sticky sweat appears).On the electrocardiogram, the following can be recorded: the S-T interval rises and the pathological QS tooth rises in at least 2 leads. This indicates the expansion of the lesion of the site and the impending heart rupture.

Cardiac rupture is clinically accompanied by a sharp drop in blood pressure with a high venous, veins swelling. These changes indicate the development of nodal or sinus bradycardia.

A heart rupture can occur slowly, or maybe suddenly. As a rule, it most often occurs suddenly because the cardiac tamponade occurs quickly, the blood circulation stops. The patient suddenly loses consciousness, cyanosis is pronounced - the skin is painted in a gray-blue color in the upper half of the trunk and on the face. Cervical veins swell, neck considerably thickens. Heart notes are poorly listened. Blood pressure and pulse disappear. After 1 minute, breathing stops. An electrocardiogram will record a wrong rhythm that goes into asystole( complete cardiac arrest).

A slow gap can occur over several days or hours. This is due to the size of the rupture through which blood will flow into the pericardium. This causes intense pain, which is not stopped by narcotic analgesics and nitroglycerin. Painful sensations, as a rule, will periodically weaken and grow on their own, then weaken again, and so on.

Skin becomes gray, and the patient is covered with a sticky cold sweat. There is a weak pulse and arrhythmia. Also, the lower( diastolic) pressure can reach zero, the upper( arterial) pressure will be quite low. In case the rupture stops( blood clots form), then, consequently, the symptoms begin to decrease, blood pressure stabilizes. On a cardiogram, changes can be registered that are identical with sudden heart rupture.

Despite the slow development of a heart rupture, death often occurs. But in the case of a pericardial puncture and urgent surgical intervention, patients can survive.

When the interventricular septum of the myocardium ruptures, uncontrollable pain suddenly appears. Cardiogenic shock begins to develop, at which arterial pressure drops sharply, a sticky cold sweat appears, the skin becomes bluish, consciousness is lost.

In case of a rupture of the septum between the ventricles, the cervical veins will swell, the liver will increase in size, when pressed, pain occurs, then the swelling of the feet and lower leg is formed. As a rule, it ends with a lethal outcome.

When the papillary muscle ruptures, swelling of the lungs is rapidly forming. In this case, it is almost impossible to save the patient and the following symptoms appear:

- Unrestrained pain in the myocardium is sharply renewed;

- Rapidly developing shock( blood pressure drops sharply, consciousness is lost, pulse is weak at first, then completely disappears);

- Dyspnoea strong, which will gradually pass into a fit of suffocation;

- Cough with phlegm( frothy), pink.

With aortic aortic rupture, the following symptoms can be observed, depending on the location and type of rupture:

- In case of aortic lesion, pain occurs behind the sternum or in the intercellular region. If there was a break in the intima, the pain is boring, sharp, unbearable;

- When the abdominal aorta ruptures, pain occurs in the abdomen, and can also irradiate to the groin, back;

- If there was a break in the intima, it is possible, an increase in pressure( arterial), which is normalized without taking any medications.

Common symptoms are: lack of pulse in the lower extremities, vomiting, hiccups, nausea, dizziness, sharply arisen weakness.

Cardiac rupture treatment

In order to develop effective measures to prevent heart failure, a differential approach to the treatment of heart attacks at each stage of the disease is needed. The main role in the treatment is played by accurate and early diagnosis, timely elimination of manifestations of coronary insufficiency.

The patient should be protected from conditions that increase the intraventricular pressure in the presence of hypertensive disease. Also, accurate and timely diagnosis allows for successful surgical treatment. In such cases, a pericardiocentesis is performed and an intravenous catheter is inserted. Surgical intervention should lead to the restoration of blood flow, eliminating the rupture.

If necessary, coronography can be carried out not only in a special laboratory, but also in the operating room. In order to restore the function of the left ventricle, the mechanical maintenance of blood circulation is used. The stored fluid( pericardiocentesis) is also removed from the pericardium by means of a needle.

In some cases, a successful surgical procedure is performed with internal heart rupture. Close the defect of the interventricular septum or prosthetic mitral valve. Surgical intervention allows to achieve a more favorable result, especially when carried out a month after the acute period. However, not all patients can survive to this moment and for this reason each combination of non-medicamentous and medicamental drugs is individually prescribed.

They also perform an open heart surgery - they close the gap on a special lining. When the operation is closed, a patch is installed. The mitral valve is also prosthetized, aortocoronary bypass is performed, the aneurysm zone is removed, the upper part of the heart is removed from the site of the rupture, and in some cases, a transplant is performed.

With moderate decompensation, cardiac glycosides and diuretics are prescribed for treatment. But this is not enough when shunting of blood or significant mitral regurgitation is expressed from left to right.

For the control of this phenomenon, vasodilating peripheral agents are used. Thus, ejection resistance decreases and regurgitation of blood decreases, increasing cardiac output. For a greater effect, it is necessary to select drugs that affect mainly the arterial part of the vascular bed( sodium nitroprusside, Fentolamine).

In case the expressed hypertension occurs with complication, the peripheral vasodilators combine with a strong inotropic agent. However, if this therapy is ineffective, then they resort to the control of pulsation( ancillary circulation).

Treatment of external heart rupture does not actually have an effect.