Infarction

Infarction is called necrosis (death of a tissue) due to alteration of the blood flow (usually the arterial supply) of an organ or a part of it, by:

Arterial obstruction, the most common case, either by:

• Elements within the lumen of the vessel, for example atheroma plaques (the most common cause, either by thrombosis or embolism).
• External elements (tumors that compress the vessel, torsion of an organ, etc.).
• Arterial rupture (trauma).
• Arterial vasoconstriction (for example: cocaine use ).
• Venous obstruction.
• Hematological neoplasms. Thrombocythemia and polycythemia vera cause heart attacks, often of the myocardium, as they favor the formation of thrombi.

The most frequent infarction localization occur in the:

• Heart (acute myocardial infarction or heart attack),
• Brain (cerebrovascular accident),
• Intestine or bowel (intestinal infarction, usually caused by occlusion or reduction of the lumen of the mesenteric vessels),
• Lung
• Splen
• Limb
• Bone
• Testicle
• Eye
• but they can occur in any organ.

Infarcts, in the same organ, can present different locations and morphological patterns, depending on its structural conformation, its anatomical relationships and the causal mechanism. For example, splenic infarctions can show very different characteristics in case of torsion of the hilum and loss of vascular function, endocarditis or sickle cell anemia.

Some processes in particular, such as the paraneoplastic syndrome or the antiphospholipid syndrome cause multiple infarcts in multiple organs. Thrombophilia is one of the causes of kidney and myocardial infarctions in young people.

Heart Infarction (Myocardial infarction or heart attack)

The most well-known infarction is myocardial infarction, namely the heart muscle (heart).

Early detection and health care as quickly as possible determine the evolution of the patient affected by a myocardial infarction, recovery will depend on the amount of cardiac tissue that has been injured.

Myocardial infarction occurs when a plaque breaks off, then moves and becomes immobilized in a coronary artery. A blood clot forms around the plaque and cuts off the blood supply, depriving the heart of oxygen. This leads to the destruction of a more or less extensive part of the heart muscle.

Cerebral infarction

Cerebral infarction of the brain is a type of cerebrovascular accident.

Myocardial infarction or myocardial infarction , often abbreviated as AMI (or acute myocardial infarction ), colloquially known as heart attack , heart attack or infarction , refers to insufficient blood supply, due to necrosis of the myocardium , produced by an obstruction in one of the coronary arteries , usually as a result of thrombosis of one of them, sclerosed.

Early detection and health care as quickly as possible determine the evolution of the patient affected by a myocardial infarction, recovery will depend on the amount of cardiac tissue that has been injured.

A myocardial infarction is a medical emergency by definition and immediate medical attention should be sought. Delays are a serious mistake that claims thousands of lives every year.

The vital prognosis of a patient with a heart attack depends on:

• the extension of this, that is to say the amount of heart muscle lost as a result of the lack of blood irrigation;
• the speed of attention received.

Risk factors

The risk factors in the occurrence of a myocardial infarction are based on the risk factors of arteriosclerosis, and include, among others:

• Arterial hypertension.
• Oldness.
• Male sex
• Smoking
• Hypercholesterolemia , more specifically hyperlipoproteinemia, in particular high levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL).
• Diabetes mellitus, with or without insulin resistance.
• Obesity, defined as a body mass index greater than 30 kg/m², the abdominal circumference or the waist / hip index.
• Stress.
• Hyperhomocysteinemia, a blood elevation of homocysteine, a toxic amino acid that rises with low or insufficient intake of vitamin B2, B6, B12 and folic acid.

Infarction of the intestine

Myocardial infarction or stroke, we all know and we know that we must act quickly. Very quickly. But digestive infarction (or mesenteric ischemia, in scientific terms), their cousin, is almost unknown to the general public.

In the event of an intestinal infarction, the patient has a 100% chance of dying if he is not treated. They must feed by central infusion. We asked how to avoid getting there?

How to recognize it

Digestive infarction, intestinal infarction or mesenteric ischemia is a vascular accident of the intestine, just as stroke is in the brain or myocardial infarction is in the heart. It is due to a total or partial obstruction of the artery that irrigates the intestine. Part or all of the intestine may be affected.

What symptoms?

They are manifested by stomach aches. Either “sudden abdominal pain so intense that it requires going to the emergency room” or chronic abdominal pain (or intestinal angina) occurring after meals which cause the patient to lose the desire to eat and lead to a loss of weight.

Lung infarction

A pulmonary infarction occurs when there is an abrupt cessation of blood flow, due to the obstruction of an artery that supplies the lung parenchyma. The obstruction causes an ischemic – type necrosis of the tissue.

The lung, being a tissue with extensive vascularization, is rarely infarcted in normal people.
Pulmonary infarction is usually preceded by a pulmonary thromboembolism , although there are other causes such as: post-surgical patients (mainly those who suffered hip fracture), patients with heart disease, patients with respiratory disease, cancer patients, long-term bedridden patients. dates and infections.

Symptoms

There are no specific symptoms for pulmonary infarction. If there are symptoms that guide the diagnosis:

Dyspnea , which is usually abrupt and abrupt in onset, usually does not improve without supplemental oxygen.
Pleuritic-type pain, the patient reports that he cannot take a deep breath.
Hemoptysis.
Febrile syndrome, which, associated with dyspnea and pleuritic pain, could confuse us with pneumonia .
Symptoms can develop in a matter of hours and even days, depending on the extent of the infarction.

Treatment

When a diagnosis is already made, therapy with common heparin or low molecular weight heparin (LMWH) should be started. The latter is preferred due to its lower recurrence of PTE, lower risk of bleeding and lower mortality. Currently, thrombolytics are no longer used due to their side effects that could put the patient’s life at risk.

Clinical course

The symptoms can persist for several days, after several days they begin to diminish gradually, they can go to the resolution or leave sequels depending on the extension of the infarction and the possible complications.

Splenic infarction

Is understood to be the destruction of spleen tissue due to an occlusion of the splenic artery or its branches.

Clinical picture

The rare acute, complete occlusion of the splenic artery leads to the clinical picture of an acute abdomen with symptoms in the left upper abdomen. The color-coded duplex sonography can lead to the preoperative diagnosis (perfusion of the splenic artery interrupted). In the case of a smaller infarct, there is a hypoechoic area below the splenic capsule. In computed tomography , the splenic infarction is hypodense.

In the differential diagnosis , an abscess of the spleen must also be considered in an acute abdomen with symptoms predominantly in the left upper abdomen .

Intraoperatively, the spleen is discolored grey-black, flaccid and mostly already necrotic . If a bacterial infection is added at this stage, acute upper abdominal peritonitis with the associated septic complications can develop. The incomplete occlusion of the splenic artery often remains asymptomatic or leads to uncharacteristic upper abdominal symptoms.

Pathogenesis

Acute embolic occlusion due to absolute arrhythmia or endocarditis is extremely rare. The vessels are more frequently blocked by tumor cells, for example in the case of myeloid leukemia . An occlusion of the arteria splenica, more frequently a splenic vein thrombosis , can occur in the course of an acute, necrotizing pancreatitis and are often not noticed in the context of this highly acute clinical picture. The thrombosis leads to a hemorrhagic splenic infarction.

Therapy

The partial (partial) splenic infarction can heal without treatment, leaving a corresponding scar. Splenectomy (removal of the spleen) is the only possible therapy for a complete infarction.

Limb infarction

A limb infarction is an area of tissue death of an arm or leg. It may cause skeletal muscle infarction, avascular necrosis of bones, or necrosis of a part of or an entire limb.

Acute arterial limb occlusion is a vascular disease in which blood clots (thrombi) obstruct arteries in the extremities. It is a form of arterial thromboembolism and most commonly occurs in the lower extremities. Heart diseases, increased blood clotting and atherosclerosis are the most common underlying diseases. In contrast to chronic peripheral arterial occlusive disease , the disease occurs suddenly (acutely).

The affected limb is painful, pale or cyanotic , and cold. Doppler sonography and angiography are used for diagnosis . In the acute phase, treatment is with heparin , the extremities are positioned low, and painkillers can be administered. The clot is then surgically or interventionally removed at a specialized facility; thus revascularization can be achieved. If the extremity is severely damaged, amputation may be necessary.

Sources: PinterPandai, NHS UK, RxList, OpenMD