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Трансмуральный инфаркт миокарда прогноз

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17 августа 2019

Инфаркт миокарда — необратимый некроз (отмирание) сердечной мышцы, возникающий вследствие длительной ишемии (недостаток кровоснабжения).

Если некроз затрагивает сразу все слои сердечной мышцы, то такой инфаркт называется обширным или трансмуральным. Существуют и другие термины обозначающие это же заболевание — проникающий инфаркт, инфаркт с ST элевацией или Q-позитивный.

Что вызывает обширный инфаркт?

Причиной развития такого типа инфаркта являются тромбы, образующиеся на поверхности поврежденных атеросклеротических бляшек.

Следующие факторы содействуют возникновению атеросклероза, который может привести к обширному инфаркту:

  • Возраст — молодые люди меньше подвержены риску развития атеросклероза и инфаркта миокарда.
  • Пол — атеросклероз встречается у мужчин в четыре раза чаще, чем у женщин.
  • Наследственность.

Это факторы на которые мы не способны повлиять. Далее рассмотрим причины которые мы способны контролировать:

  • Курение (и любое другое употребление табака);
  • Сахарный диабет.
  • Высокие артериальное давление и уровень холестерина.
  • Ожирение, сидячий образ жизни, недостаток физических упражнений.
  • Стресс.

Под влиянием вышеперечисленных факторов развивается атеросклероз. Атеросклеротическая бляшка способна оторваться от стенки сосуда и закупорить собой коронарные сосуды, что приведёт к обширному инфаркту миокарда.

Симптомы

Трансмуральный инфаркт миокарда, в сравнении с непроникающим, характеризуется более тяжелым состоянием больного.

Боль. В качестве основных клинических симптомов острейшего периода трансмурального инфаркта миокарда выступают сильнейшие боли колющего или сжимающего характера. Боль может ощущаться в руках, челюсти, ухе и зубах.

Интенсивность боли напрямую зависит от объёма некроза. Боли волнообразный (то набирают обороты, то ослабевают), продолжаются до нескольких часов (больше двадцати-тридцати минут) и даже нескольких суток, не помогает устранить боль нитроглицерин. Боли сопровождается чувством ужаса и возбуждением.

Побледнение/посинение кожи. Боль может и отсутствовать. При внешнем осмотре – у пациента бледная кожа, бледные видимые слизистые оболочки, акроцианоз.

Аритмия. Измеряя пульс, врач может выявить брадикардию, которая способно самопроизвольно проходить или даже наоборот переходить в тахикардию. Ритм неравномерен и может сбиваться.

В острый период очень быстро образуется некроз. Когда мышечная ткань отмирает пациент теряет способность чувствовать её – так исчезает боль. Если боль сохраняется, то это связывают или с выраженной ишемией в периинфарктной зоне, или с сопутствующим перикардитом.

Проявлением подострого периода является отсутствие болевого синдрома. Острая сердечная недостаточность уменьшаются в проявлениях, однако у некоторых пациентов она может перейти в хроническую форму. Исчезновение тахикардии и систолического шума, если его возникновение связывают с недостаточностью миокарда, также является симптомом подострого периода.

В постинфарктном периоде, если он протекает благоприятно, особые клинические проявления не наблюдаются. Лабораторные показатели в норме.

Лечение

Первая помощь, при подозрении на обширный инфаркт миокарда, такая же как и при стенокардическом приступе.

Атеросклеротический тромб, нарушивший нормальное кровоснабжение сердца, можно растворить. Больной, у которого с момента возникновения инфаркта прошло не более 2 часов, имеет отличные шансы на благоприятный исход заболевания.

Как отличить стенокардию от инфаркта? Первая помощь при инфаркте.

Обширный инфаркт миокарда — смертельно опасное заболевание. Необходимую медицинскую помощь можно получить только в стационарных условиях в больнице.

Диета

Выше мы уже говорили о том, что инфаркт является следствием поражения сосудов атеросклерозом. В лечении атеросклероза, а значит и профилактики и реабилитации после инфаркта, первостепенное значение имеет правильное питание.

Не следует нагружать ослабленный организм чрезмерными объемами пищи. Лучше есть маленькие порции, можно делать это чаще — до шести раз в день. Основное ограничение накладывается на жареную и жирную пищу. Следует потреблять достаточное количество клетчатки. Ознакомьтесь с нашими рекомендациями касательно диеты при атеросклерозе.

Реабилитация при обширном инфаркте

Реабилитация направлена на скорейшее восстановление работоспособности пациента, что благоприятно скажется на восстановлении после перенесённого инфаркта. Двигательная активность направлена на устранение застойных явлений в организме. Правильно дозированная физическая активность снижает вероятность возникновения осложнений, однако важно не допускать перенапряжения.

Прогноз и последствия

Прогноз условно неблагоприятный. После любого инфаркта в миокарде развиваются необратимые изменения, что служит причиной развития осложнений. Чем скорее будет оказана качественная медицинская помощь, тем больше шанс на благоприятный исход незначительно снижающий качество жизни пациента.

Инвалидность

Затрагивая сразу все слои мышечной ткани сердца, трансмуральный инфаркт миокарда часто приводит к инвалидности. Даже при благоприятном исходе трудоспособность сохраняется только для пациентов чей труд не связан с сильными физическими и эмоциональными нагрузками.

Профилактика

Под профилактикой обширного инфаркта миокарда следует понимать мероприятия направленные на замедление развития атеросклероза коронарных сосудов:

  • Правильное питание с достаточным количеством овощей и фруктов, ограничением соли, сладкого и жирного.
  • Умеренная физическая активность — минимум два раза в неделю в течении часа.
  • Снижение потребления табака, чая и кофе, алкоголя.
  • Следите за уровнями артериального давления, сахара и холестерина в крови.
  • Применение медикаментозных препаратов снижающих вязкость крови.

После инфаркта миокарда мой лечащий врач сразу предупредил, что теперь мне нужна обязательно систематическая профилактика, чтобы не повторилось. Также очень опасен тромбоз, без профилактики нельзя. Соблюдать тело в нормальном весе и хорошо питаться. Потому, дети меня отправили в санаторий «Русь» Ессентуки, там практикуется реабилитационная программа как раз для людей с такими проблеа. А также для себя я поняла, что профилактические процедуры это очень хорошо, но без лекарственной терапии тоже никак нельзя. Не дай Бога, как говорится…

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Саратовский государственный медицинский университет им. В.И. Разумовского (СГМУ, СМИ)

Уровень образования — Специалист

1990 — Рязанский медицинский институт имени академика И.П. Павлова

Острый трансмуральный инфаркт миокарда – одна из тяжелейших форм патологии. На остром этапе пораженный участок сердца отмирает, боль обычно проходит. Если оставить это состояние без внимания, патология будет прогрессировать. Крупные кровеносные сосуды и сердечная мышца подвергнутся значительным некротическим поражениям. Около 10% больных даже при своевременно оказанной медицинской помощи умирает после трансмурального инфаркта в течение года. Иногда смертельные случаи фиксируются в лечебных учреждениях – из-за быстрого прогрессирования серьезных осложнений.

Трансмуральный инфаркт миокарда

Трансмуральный инфаркт – что это такое? «Транс» – значит «сквозь», «через». При этой форме инфаркта очаг поражения пронизывает ткани сердечной стенки насквозь, включая наружную (эпикард) и внутреннюю (эндокард) оболочки. Прочие разновидности инфаркта не задевают эпикард и эндокард, поражая лишь средние ткани сердечной мышцы.

Трансмуральные (проникающие) некрозы могут быть мелко- и крупноочаговыми. Чаще они локализуются в области передней стенки миокарда, в левом желудочке. Проникающие некрозы правого желудочка регистрируются в 1 /5 случаев, у трети больных процесс затрагивает предсердие. Выделяют несколько фаз трансмурального инфаркта:

  1. Острейшая – до двух часов;
  2. Острая – до 10 суток;
  3. Подострая – 10-56 дней;
  4. Рубцевания – от 56 дней до шести месяцев.

Прогнозы при мелкоочаговых трансмуральных поражениях сердечной мышцы обычно благоприятные. Но каждый рецидив подобного инфаркта масштабнее предыдущего, а восстановление более продолжительно и менее эффективно. Большую опасность здоровью и жизни представляет крупноочаговый некроз тканей, когда поражение распространяется не только на всю глубину сердечных оболочек, но и по значительной площади тканей.

Инфаркт передней стенки миокарда сопровождается выраженными болями в груди даже в состоянии покоя.

Причины возникновения патологии и факторы риска

Проникающий инфаркт миокарда развивается, как и остальные формы патологии. Проход венечной артерии перекрывает холестериновая бляшка. Сердечная мышца испытывает недостаток кислорода и жизненно необходимых веществ, но в обычном состоянии большой опасности это не представляет.

При возникновении эмоционального или физического перенапряжения скорость кровотока возрастает, около бляшки образуется «завихрение». Оно поражает стенку сосуда и приводит к образованию тромба, еще более осложняющего кровоснабжение сердечной мышцы. На перерастание ишемической болезни в инфаркт влияют определенные факторы:

  • пожилой возраст (старше 45 лет);
  • генетическая расположенность;
  • некоторые хронические заболевания (атеросклероз, стенокардия);
  • высокий уровень холестерина;
  • излишний вес;
  • табакокурение;
  • малоподвижный образ жизни;
  • частый стресс;
  • неправильное питание.

Иногда заживший рубец, оставшийся после переднего проникающего инфаркта, мешает работе сердца. Подобное обстоятельство может спровоцировать образование некротического очага на задней стенке сердечной мышцы.

Симптомы острого трансмурального инфаркта

При остром проникающем некрозе проявляются типичные признаки патологии, но в более выраженной форме. Это объясняется резкой остановкой кровоснабжения, затрагивающей значительную площадь сердца. Признаки заболевания могут различаться, но есть общие симптомы, присущие патологии:

  • учащенное сердцебиение;
  • перебои в деятельности сердца;
  • резкие боли, иррадиирующие в левую часть тела: челюсть, руку, лопатку;
  • бледность;
  • удушье.

Проявления острого проникающего инфаркта зависят от масштабности некроза и его локализации. В соответствии с основными симптомами выделяют несколько разновидностей патологии:

  1. Ангинозная – выраженные «рвущие» боли возникают за грудиной и разливаются по обеим сторонам в руки. Продолжаются от 30 минут до суток. Плохое кровообращение в церебральных сосудах вызывает головокружения и мышечную слабость;
  2. Гастралгическая – боли проявляются в подложечной зоне и перемещаются за грудину. Симптоматикой схожа с признаками язвенных болезней ЖКТ, нередко сочетается со рвотой. Больных с подобными болями могут госпитализировать в стационар с подозрением на желудочно-кишечную патологию;
  3. Астматическая – удушье, провоцирующее отек легких. Не всегда сопровождается болями;
  4. Церебральная – симптоматика инсульта и вариант без боли.

На второй день развития острого трансмурального инфаркта начинается лихорадка, температура тела поднимается до 38,5 градуса, держится она около недели. Проявления кардиогенного шока наличествуют при остром проникающем некрозе практически постоянно. Симптомы дополняются цианозом кожи, слабым сердцебиением, понижением кровяного давления. Болевой синдром продолжается дольше 10 минут, нитроглицерином не купируется.

Последствия проникающего некроза

Инфаркт не исчезает без следа. Даже своевременно оказанная помощь не всегда предотвращает негативные последствия. Их тяжесть определяют:

  • величина некроза;
  • адекватность и своевременность оказания медицинской помощи;
  • место расположения очага поражения.

Последствиями проникающего некроза могут быть:

  • недостаточность сердечной мышцы;
  • аритмия;
  • гипотензия;
  • повреждение желудочков и перегородки между ними;
  • дилатация аорты;
  • воспаление перикарда;
  • воспаление плевральных листков;
  • поражения легких;
  • легочная эмболия.

Недостаточность сердечной мышцы обычно сопровождается хрипами, кашлем и способна вызвать крайнюю степень левожелудочковой недостаточности и смерть пациента. Аритмия (экстрасистолия, мерцание желудочков и предсердий) возникает в первые дни развития некроза. Мерцание желудочков провоцирует их фибрилляцию и остановку сердца. Реже наблюдается развитие тампонады, возникающей из-за разрыва тканей мышц.

Первая помощь при проникающем инфаркте

Острый трансмуральный инфаркт – состояние серьезное, грозящее неожиданной смертью. Оказание помощи следует начинать до врачебных манипуляций. Необходимо:

  • вызвать скорую помощь;
  • поместить пациента на ровную жесткую поверхность;
  • дать нитроглицерин. При сохранении болей через пять минут еще дать таблетку препарата (но не больше трех);
  • дать больному аспирин;
  • при хрипах в легких и затрудненном дыхании больного усадить, подложив под спину подушку.

Диагностика трансмурального инфаркта

При проявлении признаков проникающего некроза необходимо срочно установить диагноз, ведь здоровье больного находится в прямой зависимости от своевременной терапии. При диагностировании проводят:

  • сбор анамнеза;
  • физикальный осмотр – оцениваются хрипы в легких и шумы в сердце, показатели давления и пульса;
  • общий анализ крови и мочи – позволяют выявить воспалительные процессы;
  • биохимический анализ крови – выявляет высокую концентрацию сахара, холестерола;
  • коагулограмму – способствует выбору дозировки лекарственных средств;
  • ЭКГ – выявляет инфаркт, отражает данные о времени его развития, выраженности, локализации;
  • ЭхоКГ – оценивает поражения сосудов;
  • рентген грудной клетки – выявляет поражения аорты;
  • коронарографию – определяет локализацию и размеры суженности сосудов.
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Для уточнения диагноза могут назначаться дополнительные методики обследования и консультации врачей узких специализаций.

Острый трансмуральный инфаркт нижней стенки миокарда диагностировать сложнее. Нередко вскрытие выявляет рубцы, в то время как на ЭКГ подобной патологии не наблюдалось.

Терапия острого проникающего инфаркта

Трансмуральный инфаркт, уточненный как острый, лечат в стационаре: сначала в реанимационном (до 12 дней), позже – в кардиологическом отделении. Главные цели терапии:

  • сократить ишемическую зону;
  • добиться рубцевания очага поражения;
  • предупредить возникновение осложнений;
  • мобилизовать кровообращение.

Пациенту обеспечивают постельный режим и щадящую диету. Если он в тяжелом состоянии, через маску подается кислород. Внутривенно вводят сильнодействующие обезболивающие средства. Срочная терапия предусматривает прием:

  • психолептиков (успокоительные);
  • анальгетиков (обезболивающие);
  • β-адреноблокаторов (сосудорасширяющие);
  • блокаторов кальциевых каналов м нитратов (антиангинальные).

Вторичная терапия призвана стабилизировать состояние больного. Для этого применяют:

  • антикоагулянты (противосвертывающие);
  • дезагреганты (антитромбоцитарные);
  • тромболитики (тромборастворяющие);
  • β-блокаторы (сосудорасширяющие) или ангиотензинпревращающие ферменты (если имеются противопоказания к приему -блокаторов).

По показаниям врач может назначить прием дополнительных лекарственных средств: понижающих давление, мочегонных. Нередко инфаркт вызывает настолько серьезные поражения сердца, что требуется хирургическое вмешательство. Основные методики проведения оперативных вмешательств:

  • коронарная ангиопластика – восстановление суженного просвета артерии;
  • коронарное шунтирование – восстановление тока крови путем создания при помощи шунтов обхода суженного места. Назначается, если консервативное лечение не принесло ожидаемого эффекта.

Реабилитация после инфаркта

В восстановительный период необходимо организовать сбалансированное питание. Легкоперевариваемую пищу следует употреблять небольшими порциями пять-шесть раз в день. Поначалу в рацион включают соки, кефир, сухофрукты, каши. Необходимы продукты со слабительным эффектом (свекла, курага).

Физическая реабилитация призвана вернуть больному возможность активно двигаться. На начальных этапах нужно устранить застойные легочные явления, мышечную атрофию и другие последствия постельного режима. Постепенно больной вовлекается в занятия лечебной физкультурой. Показано восстановление в условиях санатория. Продолжительность реабилитации зависит от выраженности некроза и от определения возникших последствий.

Профилактика трансмуральных инфарктов

Профилактические меры направлены на ликвидацию факторов риска. Для избежания проникающих некрозов необходимо:

  • исключить курение;
  • ограничить употребление алкоголя;
  • придерживаться диеты;
  • ограничить потребление соли;
  • нормализовать вес тела;
  • держать под контролем давление;
  • избегать стрессовых ситуаций;
  • заниматься физкультурой;
  • дозировать физические нагрузки.

Важно следить за здоровьем сердца, раз в полгода посещая врача.

Прогноз при остром трансмуральном инфаркте условно неблагоприятный. Некрозы, возникшие при патологии, необратимы. Стопроцентно восстановить сердечную деятельность после обширного трансмурального инфаркта невозможно. Тем не менее, при своевременно оказанной квалифицированной помощи можно обрести все шансы на своевременное восстановление коронарного кровотока и уменьшение объемов некротического поражения тканей.

Трансмуральный инфаркт — распространенное и крайне опасное заболевание, которое сопровождается некрозом сердечной мышцы. Стоит отметить, что смертность в случае развития подобно патологии очень высока, особенно если признаки поражения сердца не были замечены вовремя, и пациент не получил необходимую медицинскую помощь. Именно поэтому важно знать о том, как проявляется данная форма инфаркта и какая помощь требуется больному человеку.

Трансмуральный инфаркт миокарда: что это такое?

Для начала стоит разобраться со значением термина. Наверняка многие знают о том, что инфарктные состояния сопровождаются отмиранием участков сердечной мышцы. Происходит это из-за резкого прекращения притока крови к сердцу, в результате чего ткани не получают необходимый для жизнедеятельности кислород и питательные вещества.

Как известно, стенка сердца состоит из трех слоев — это эпикард (наружный слой), муральный мышечный слой и эндокард (внутренняя часть мышцы). При интрамуральной форме заболевания некроз поражает только один слой. Острый трансмуральный инфаркт — патология, при которой некротические процессы наблюдаются во всех слоях сердца. Стоит сказать, что это самая опасная форма подобного недуга.

В современной медицине патологию классифицируют исходя из локализации очагов некроза. Наиболее часто наблюдается трансмуральный инфаркт передней стенки миокарда, а именно левого желудочка. Лишь в одном из пяти случаев некроз поражает и стенку правого желудочка. Примерно у трети пациентов в процесс вовлечены и стенки предсердий.

Причины развития заболевания

Практически в каждом случае трансмуральный инфаркт является результатом ишемической болезни сердца. Как уже упоминалось, при недостаточном количестве кислорода и питательных веществ мышечные клетки начинают отмирать — так развивается некроз. Согласно статистическим данным, в 90% случаев причиной является атеросклероз коронарных сосудов, которые и обеспечивают ток крови к миокарду.

На стенке сосуда формируется так называемая атеросклеротическая бляшка. Под воздействием определенных факторов часть бляшки отрывается от стенки и перекрывает просвет коронарной артерии. Острый трансмуральный инфаркт, как правило, быстро прогрессирует в тех ситуациях, когда потребность миокарда в кислороде резко повышается — это может случиться, например, при сильной физической нагрузке, повышении температуры тела, сильном эмоциональном стрессе.

Острый трансмуральный инфаркт миокарда: факторы риска

Как можно увидеть, некротические поражения сердца не являются самостоятельной патологией. В большинстве случаев они развиваются на фоне уже имеющейся ишемии и атеросклероза. Поэтому можно выделить и несколько факторов риска:

  • Генетическая предрасположенность пациента, что связана с определенными анатомическими особенностями и наследственными заболеваниями.
  • Имеет место и фактор возраста. Трансмуральный инфаркт чаще диагностируется у людей старше 45 лет, причем мужчины более склонны к данной патологии.
  • Повышение уровня холестерина в крови (именно из-за этого формируются бляшки на стенках сосудов, которые впоследствии и перекрывают кровоток).
  • Неправильное питание (употребление в пищу жирных и жареных блюд повышает вероятность развития атеросклероза).
  • Ожирение (оно в большинстве случаев связано с неправильным питанием, а увеличение массы тела повышает нагрузки на сердце).
  • Гиподинамия (малоподвижный образ жизни ведет к постепенному ослаблению сердечной мышцы, после чего миокарду очень трудно справляться с любыми физическими нагрузками).
  • Постоянные стрессы, нервное истощение, эмоциональное напряжение ведет к изменению гормонального фона, что сказывается на работе сердечно-сосудистой системы.
  • Курение (согласно статистике, в 35% случаях некрозы сердечной мышцы связаны именно с этой вредной привычкой).
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Основные симптомы: как определить инфаркт?

Признаки некроза могут быть разными — здесь все зависит от степени поражения, возраста человека, наличия сопутствующих заболеваний и т. д. Известны случаи бессимптомного протекания инфаркта. Тем не менее некоторые основные симптомы можно выделить:

  • В большинстве случаев человек жалуется на острую сжимающую боль за грудиной — она отчетливо отдает в левую лопатку, руку, нижнюю челюсть, ухо и даже зубы.
  • Боль волнообразная и продолжительная — приступы могут повторяться в течение нескольких часов или даже дней.
  • Развивается тахикардия, причем пациент, как правило, отчетливо чувствует частые и даже болезненные сердечные сокращения.
  • Наблюдается также ощущения кратковременного замирания сердца.
  • Есть и внешние признаки инфаркта — кожные покровы и слизистые оболочки человека резко бледнеют.
  • На фоне некроза часто развивается сердечная астма — больной отмечает сильную одышку, резкие приступы удушья.

Диагностические мероприятия

При появлении первых же нарушений стоит немедленно доставить больного человека в больничное отделение, где и будет проведена соответствующая диагностика и лечение. Основным диагностическим методом при некрозе миокарда является электрокардиография, ведь при подобной процедуре можно зафиксировать электрические потенциалы в разных участках сердца.

Грамотно проведенная и расшифрованная электрокардиограмма позволяет врачу определить локализацию некроза (например, нижний трансмуральный инфаркт), степень распространения патологического процесса и глубину поражения, давность заболевания.

Кроме того, необходим анализ крови. При инфаркте наблюдается повышение скорости оседания эритроцитов, увеличение количества лейкоцитов, появление в крови специфических ферментов и соединений, которые в норме находятся внутри клеток миокарда.

Правила первой помощи

Острый трансмуральный инфаркт передней стенки миокарда — патология, которая развивается очень быстро. Симптомы ее могут появиться практически в любой момент, поэтому стоит ознакомиться с правилами оказания помощи больному. Естественно, в первую очередь нужно вызывать бригаду скорой помощи.

Дожидаясь медиков, человеку нужно прилечь. Исключением является ситуация, при которой наблюдается сильная одышка и отчетливые хрипы при дыхании – в таком случае пациента лучше усадить, подложив под спину подушку или валик. Рекомендуется принять таблетку аспирина. Также нужно дать человеку нитроглицерин — сначала одну таблетку, а если боль не уходит, то спустя пять минут еще одну (но не более трех).

Схема лечения при инфаркте

В зависимости от полученных во время диагностики результатов врач назначает лечение. Первоначальная терапия, как правило, состоит из трех основных частей:

  • Прием болеутоляющих средств для того, чтобы облегчить состояние больного. Довольно часто болезненность можно купировать только с помощью сильных препаратов, включая "Промедол" и "Морфин". Появление симптомов и диагноз "инфаркт миокарда" являются стрессом для человека, а волнение и страх лишь увеличивают нагрузку на сердце — пациенту назначают успокоительные лекарства.
  • В схему терапии включают прием нитратов и бета-блокаторов, что помогает устранить аритмию и восстановить сердечный ритм.
  • При трансмуральном инфаркте высока вероятность образования тромбов, что чревато некрозом других органов и распространением процесса на соседние участки миокарда, поражением нервной системы и даже смертью. Поэтому борьбу с тромбозом нужно начинать уже в первые часы после появления симптомов. С этой целью используются разжижающие препараты, которые содержат гепарин и фибринолизин. Естественно, при приеме подобных лекарств существует вероятность массивного кровоизлияния, ведь кровь перестает сворачиваться, поэтому важно тщательно следить за состоянием пациента.

Лечение обязательно проводится в стационарных условиях — пациент круглосуточно должен находиться под присмотром врача.

Последствия и осложнения заболевания

Трансмуральный инфаркт — самая сложная и опасная форма некроза миокарда, особенно если речь идет о крупноочаговом некрозе. Недуг чреват последствиями — развитием отека легких, параличом конечностей, нарушениями речи. Иногда инфаркт влечет за собой и дальнейшие патологии сосудистой системы, в частности инсульт.

К последствиям данной патологии также относят тромбоэмболию, мерцание желудочков, прекращение работы разных органов и даже их систем. Такие случаи нередко заканчиваются смертью, даже если пациенту была предоставлена медицинская помощь. Еще одно смертельно опасное осложнение — разрыв сердца. При сильном сокращении миокарда и повышении давления внутри желудочков и предсердий существует риск нарушения целостности мышцы в области некроза.

Реабилитация и прогнозы

К сожалению, прогнозы при подобном заболевании не слишком благоприятные — примерно в 50 % случаев пациенты (особенно если речь идет о пожилых людях) погибают. Если же все-таки удалось восстановить нормальное кровообращение, все равно существует риск развития осложнений в будущем, так как произошли изменения тканей миокарда.

Именно поэтому столь важным является период реабилитации. Пациентам рекомендуют есть простую, легкую и высококалорийную пищу. Также важно постепенно возвратить двигательную активность, так как малоподвижность чревата атрофией мышц и застойными явлениями в легких. Разумеется, все мероприятия, связанные с физическими нагрузками, должны строго контролироваться специалистом.

Поддерживающая терапия и постоянное наблюдение у врача необходимы до конца жизни. Разумеется, пациентам нужно следить за питанием, избегать стрессов и интенсивных физических нагрузок, не допускать сильного повышения артериального давления и отказаться от курения.

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