Extensive myocardial necrosis

Introduction Myocardial necrosis should be a medical myocardial infarction, which means that the blood supply to the coronary artery is drastically reduced or interrupted, causing local necrosis of the corresponding part of the myocardium due to severe persistent ischemia. Myocardial infarction refers to myocardial cell death caused by excessive ischemic time and is the result of imbalance of myocardial perfusion supply and demand. Myocardial ischemia can often be found in clinical patients through medical history, electrocardiogram and myocardial enzymology changes. Pain is the earliest and most prominent symptom, with a severe degree.

Cause

1, coronary artery blood supply is drastically reduced or interrupted, so that the corresponding part of the myocardium is severely persistent ischemia. Coronary atherosclerosis unstable atheroma rupture and erosion, followed by hemorrhage and intraluminal thrombosis caused partial or complete acute occlusion of the coronary vessels, while the collateral circulation is not fully established, the corresponding blood supply site of the coronary artery is severe and lasting Acute myocardial infarction can occur for more than 20-30 minutes. This is the most common cause of myocardial infarction, and about 70% of fatal events are caused by plaque rupture.

The incentives for plaque rupture and thrombosis are:

1 From 6 o'clock to 12 o'clock in the morning, the sympathetic activity increased, the body's stress response increased, myocardial contractility, heart rate, blood pressure increased, coronary artery tension increased;

2 After eating a large amount of fat, especially when eating a lot of fat, the blood fat is increased and the blood viscosity is increased;

3 When the physical activity, excessive emotional excitement, rapid rise in blood pressure or forced bowel movements, the left ventricular load is significantly aggravated;

4 shock, dehydration, hemorrhage, surgery or severe arrhythmia, causing a sudden drop in cardiac output, coronary artery perfusion decreased sharply.

2, non-coronary atherosclerosis:

Occasionally coronary artery embolism, inflammation, congenital malformation, paralysis and coronary artery obstruction.

an examination

Related inspection

Cardiovascular electrocardiogram selective angiography

1. Pain: It is the earliest and most prominent symptom. The site is the anterior region, the back of the sternum, the left shoulder, and even the teeth, the upper abdomen, the lower xiphoid, etc., and the degree is severe, lasting for hours or days, and there is no incentive. Rest and nitroglycerin can not alleviate. The patient has fear and a sense of death.

2. Arrhythmia: It occurs mostly within 1-2 weeks of onset, and is most common within 24 hours. It is most common with ventricular arrhythmia.

3. Hypotension and shock: When there is pain, there may be a drop in blood pressure. If there is irritability, paleness, cold skin, fine and fast pulse, sweating, decreased urine output, slow consciousness, and even fainting, it is cardiogenic. shock.

4. Heart failure.

5. Gastrointestinal symptoms: When the pain is severe, it is often accompanied by nausea, vomiting, upper abdominal pain and flatulence.

6. Other symptoms: may have fever, sweating, dizziness, fatigue and other performance.

Differential diagnosis

Myocardial hypoxia: The heart is deprived of oxygen due to insufficient blood supply. The main manifestations are: palpitations, heart discomfort, sometimes heart pain or appreciation of colic; shortness of breath, exercise, fullness or agitation is more serious, the body is weak; in severe cases, short-term shock.

Myocardial abscess: Myocardial edema is one of the main clinical symptoms of dilated cardiomyopathy.

Myocardium is gray and relaxed: it is a kind of myocardial damage, which may be related to immune myocardial damage after viral infection, and is generally seen in ultrasound examination of dilated cardiomyopathy. Can be used as a differential diagnosis with other cardiomyopathy.

Myocardial stunning, also known as myocardial dysfunction after ischemia, means that myocardial transient ischemia has not caused myocardial necrosis, but mechanical resilience after reperfusion returns to normal blood flow requires hours, days or weeks. The phenomenon of complete recovery.

Cardiac hypertrophy: This is a slower but more effective compensatory function, mainly in the case of long-term stress overload, increased myocardial volume, increased contractility, allowing the heart to maintain a normal blood circulation, and at the same time Reserve power. However, this compensatory function also has its disadvantages, mainly because of hypertrophic myocardial aerobic increase, and the coronary blood supply is often unable to be met, resulting in myocardial ischemia, which will eventually lead to a decline in myocardial contractility. Hypertrophic cardiomyopathy is characterized by cardiac hypertrophy. It is characterized by ventricular muscle hypertrophy, typically in the left ventricle, with interventricular septum, occasionally concentric hypertrophy.

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