Rupture or apoplexy of the ovary is a pathological violation of the integrity of the ovary and its vessels, in which bleeding inside is formed. abdominal cavity and there is pain in the abdomen. During ovulation, the ovary ruptures in the area of ​​the follicle, this physiological phenomenon, it is not accompanied by pain and bleeding. As a result pathological changes the body develops apoplexy.

Causes

The exact reasons why an ovarian rupture occurs have not yet been established. Most often, apoplexy is observed between the ages of 20 and 35 years.

The main theory of the formation of ovarian rupture is considered to be neuro-endocrine shifts in the processes of regulation of ovulation. Due to the cyclic release of hormones, the filling of the ovarian region with blood and the process of follicle exit are regulated. If this process fails, pathological ruptures with vascular damage and bleeding can occur.

Value is attached inflammatory processes in the pelvic area, anomalies in the development of the ovaries, tumor processes. Influence and external influences- lifting weights or injuries to the lower abdomen, violent sex.

For the most part, ovarian rupture occurs at the stage of ovulation or later, in the second phase of the cycle. Much more often, apoplexy occurs in the area of ​​​​the right ovary due to the anatomical features of its blood supply.

Symptoms of ovarian rupture

Signs of a ruptured ovary may simulate an ectopic pregnancy. Usually, apoplexy occurs abruptly, against the background of a completely normal state of health, more often in the evening or at night.

When an ovary ruptures, sharp paroxysmal pains in the abdomen are characteristic, localized on the right, less often on the left. Occasionally, an attack can be preceded by tingling pains in the groin on the right or left.

Pain may be:

• paroxysmal all the time
• may begin with an attack in the side, move to the lower back, perineum and then become blurred over this abdomen.

As blood accumulates in the abdominal cavity, symptoms of peritoneal irritation are revealed:

• pain when feeling the abdomen,
• small bloody discharge from the vagina,
• voltage abdominal wall closer to the affected area
• pallor develops,
• increased heart rate,
• decrease in pressure, presyncope,
• tinnitus, nausea, dizziness.
• occasional fever.

It is necessary to distinguish ovarian rupture from appendicitis and ectopic pregnancy, but often the final verdict is made already during the operation.

Treatment

Tactics of treatment of ovarian ruptures depends on the degree of blood loss and the intensity of bleeding. At mild degree severity, many doctors choose conservative tactics for managing patients - strict bed rest, cold on the stomach and complete rest with control of hemoglobin, hematocrit and general condition are recommended.

Operation at breaks

At moderate and severe ruptures, an operation is performed with simultaneous infusion of blood-substituting solutions and plasma. During the operation, they try to minimize the amount of intervention - a resection of the ovary with damaged vessels is performed. If possible, laparoscopic surgery is performed without incisions, through punctures of the abdominal cavity.

If extensive intervention and removal of blood from the abdominal cavity is necessary, a lower-median laparotomy is performed with careful examination pelvic and abdominal organs. During the operation, surgeons are guided by the situation - if the gap is formed on a healthy ovary, they coagulate the bleeding vessel and apply special sutures. If cysts are found on the ovary, the scope of the operation expands.

Consequences

The prognosis for ovarian ruptures is favorable, however, after discharge from the hospital, a detailed examination is necessary.

Rupture of the heart, myocardium: background, forms, signs, help, prognosis

Without exaggeration, the heart is considered the main organ in the circulatory system, without which blood delivery to the internal organs. If it is damaged, hemodynamics is disturbed, and heart rupture (PC) makes the movement of blood impossible, and the patient dies from shock.

Rupture of the heart muscle - myocardium is a violation of its integrity, which most often occurs due to a heart attack. Contrary to popular belief, a rupture cannot occur on its own from fear or intense fear, because the heart is a powerful muscular organ, and prerequisites in the form of changes in the myocardium are necessary for its damage.

Elderly people, especially women, as well as patients suffering from diabetes, hypertension, are more susceptible to heart rupture. Taking certain medications, late initiation of treatment for a heart attack may be accompanied by a slowdown in scar formation, which creates the preconditions for a rupture. The rupture of the heart vessels, the initial section of the aorta is provoked by a deep atherosclerotic process, vasculitis.

Causes and types of heart failure

Causes of heart failure include:

• Organ injuries chest;
• congenital;
• exchange violations.

The causes of heart wall rupture lie in structural changes, because A healthy myocardium is quite strong and, at the same time, elastic, so it cannot burst.

Infarction (necrosis) of the heart muscle is considered the most common cause of heart rupture.. With this disease, a rupture occurs in about 3% of cases, and in about half of patients it occurs on the first day from the onset of necrosis. Over the next two weeks, the likelihood of a rupture increases significantly.

rupture of the heart as a result of a heart attack (arrows indicate areas of necrosis)

With myocardial infarction, a rupture of the left ventricle of the heart usually occurs, since it is this department that experiences the greatest load during the work of the organ, and it is in it that necrosis usually appears. Up to 3% of cases may be accompanied by a violation of the integrity of the septum between the ventricles. The precursor to the rupture is a massive infarction that affects a significant amount of the heart muscle, and the risk of damage is maximum in the first two weeks. The right departments and auricles are broken exceptionally seldom.

Endocarditis (inflammation of the inner layer of the heart), tumors, metabolic disorders (amyloidosis) lead to a change in the state of the heart muscle, which becomes very susceptible to stress and may break. With endocarditis involving the valvular apparatus, rupture of the heart valve is likely, which is fraught with acute heart failure.

Among other causes of rupture of the wall of the heart indicate trauma. For example, in an accident, a stab wound, a strong blow to certain types sport or fight.

Many people think that there is a rupture of the heart from fear, and this is evidenced by cases sudden death with a strong emotional shock. Indeed, with a post-mortem examination of the heart, it is possible to diagnose it from a rupture, but the cause of a defect in the myocardium is more often a heart attack, which, among other things, can be triggered by stress, fear, and strong excitement.

on the left - postinfarction rupture of the myocardium (heart muscle), on the right - external rupture of the heart with hemotamponade

In addition to the immediate causes, there are also predisposing factors:

1. Old age - after 50 years, regeneration processes slow down, and most people of this age already have certain signs or wear of the heart muscle;
2. , creating an additional load on the myocardium;
3. Delayed treatment of acute myocardial infarction;
4. Early activation of the patient with extensive heart attacks - even walking on the street or walking around the ward requires an increase in myocardial work, therefore motor mode usually limited;
5. exhaustion low weight the patient's body contributes to a slower formation of a scar in the necrosis zone, which is fraught with a rupture in the acute period of a heart attack;
6. Taking drugs containing hormones, as well as non-steroidal anti-inflammatory drugs, slows down the formation of connective tissue in the heart attack.

Depending on the area that has undergone a rupture, the time of manifestation of the pathology is isolated various options heart break. According to the localization of the damage zone, the following are possible:

different kinds heart breaks

• External ruptures, when a through defect is formed in the wall of the heart, through which blood enters the heart sac.
• Internal ruptures, when the structures of the organ located inside it are damaged: rupture of the papillary muscles, the formation of a defect in the septum.

The blood inside the heart moves under great pressure, and when defects appear in the myocardium, it instantly rushes into the cavity of the heart shirt, limited by the pericardium. The rapid filling of the pericardial cavity with fluid disrupts the contraction of the heart, its tamponade occurs and stops. There is a shortage of blood flow in the organs, and the patient dies from shock.

Internal ruptures can flow more easily than external ones. So, with a partial rupture of the papillary muscle, the patient can live up to two weeks, but this condition somehow requires urgent surgical treatment. Incorrect movement of the valve leaflets when papillary muscles or chords are damaged causes acute heart failure and is deadly. Septal ruptures are accompanied by the movement of blood through the defect from the left half of the heart to the right and can also lead to the death of the patient.

If the rupture occurred within up to three days from the moment of necrosis or injury, then it will be called early. After 72 hours, when the recovery processes have already begun, but the scar is very tender, the rupture is provoked by excessive physical activity and is called late.

With extensive infarcts, it is possible simultaneous gap, and then death comes suddenly. If the defect does not extend to the entire depth of the myocardium or is relatively small, then instantaneous death does not occur, blood circulation progressively worsens, and the damage is called slowly flowing.

How does MS manifest itself?

Symptoms of heart rupture depend on the area of ​​the lesion in the myocardium, the presence of hemopericardium, and the degree of hemodynamic disturbance. With a relatively small defect, when blood does not enter the cavity of the heart shirt or its amount is insignificant there, the signs of the disease increase over several hours, ten minutes, while the patient is concerned about:

1. Sharp, very intense pain behind the sternum, in the heart;
2. Severe anxiety, possibly psychomotor agitation;
3. Dyspnea;
4. Blueness of the skin;
5. Puffiness.

With the progression of symptoms of acute heart failure, the pulse becomes thready, falls arterial pressure, perhaps a change in consciousness or even its loss. There is pain in the right hypochondrium, associated with an increase in the liver with stagnation of venous blood, swelling increases.

A patient with slowly progressive MS is restless, tries to relieve pain with the usual nitroglycerin, but does not get any effect, the pain may decrease somewhat, but then reappears. Characterized by cold clammy sweat, palpitations and hypotension. The condition is aggravated by the fact that the arteries of the organ do not receive the blood they need, the myocardium experiences severe hypoxia, and its failure is inevitable.

Acute rupture of the heart big size inevitably leads to the outflow of blood into the heart sac (hemopericardium), the systemic blood flow is sharply disturbed, and the death of the patient occurs. In more than 90% of cases, doctors are faced with just such sudden and large myocardial ruptures. Often, the called ambulance simply does not have time to provide first aid and is only forced to state the sudden death of the patient.

Harbingers of a broken heart there may be intense pain that is not relieved by nitroglycerin and even narcotic analgesics, blood pressure drops sharply, the pulse becomes thready, palpable with great difficulty, the patient turns pale, cyanosis of the skin increases, consciousness becomes confused.

Symptoms of external rupture are reduced to signs of pericardial hemotamponade and acute heart failure:

• The patient loses consciousness;
• The cervical veins swell, swelling increases;
• Severe cyanosis appears;
• Severe shortness of breath is replaced by respiratory arrest;
• It is impossible to feel the pulse, hypotension is replaced by shock with no pressure.

Hemotamponade of the pericardium is possible not only with ruptures against the background of a heart attack, but also with traumatic injuries of the heart, rupture of the aorta in its initial section. Sudden pain and signs of cardiogenic shock are the main manifestations of hemotamponade. Both aortic rupture and myocardial infarction may have common mechanisms of development, therefore all patients with coronary arteries and aorta are at risk.

hemotamponade in postinfarction heart rupture

Such symptoms increase within a few minutes, after which death occurs from a heart rupture - the pupils do not react to light, breathing and heartbeat are not detected, consciousness is absent. The ECG at this moment will show an isoline, that is, a complete absence of cardiac activity.

Myocardial damage does not occur imperceptibly, and the risk of dying from a heart rupture increases significantly if a large-focal transmural infarction is diagnosed, especially against the background of arterial hypertension, in the elderly patient.

Internal ruptures are no less dangerous than external ones. So, violation of the integrity of the papillary muscles of the left ventricle is fraught with the rapid development of pulmonary edema - the main complication in violation of blood flow in the left half of the heart. Significant ventricular septal defects are manifested by symptoms of increasing. There is practically no chance to save the patient in these cases.

Heart rupture treatment

Treatment of patients with cardiac rupture involves emergency cardiac surgery and intensive care. It is far from always possible to provide all the necessary measures in time, because death occurs suddenly and very rapidly. In addition, the patient may be far from the cardiac surgery hospital, and the time for preparation and transportation is extremely limited.

Surgical operations that can be performed for heart ruptures:

• Sewing up the defect and installing special “patches”;
• Coronary artery bypass grafting;
• Valve prosthetics;
• Donor organ transplant.

Surgical treatment consists in suturing the myocardial defect during open surgery, possibly strengthening the injury site with a special “patch” made of synthetic materials. In case of ruptures of the interventricular wall, their correction by endovascular intervention is applicable, without open access to the heart, but even in this case, a “patch” is installed in the damage zone. Fluid from the pericardial cavity is removed by puncture.

With a deep atherosclerotic lesion of the coronary vessels, plastic surgery on the heart can be supplemented, aimed at restoring blood flow and, thus, accelerating the formation of a scar at the site of ischemia and rupture.

If the pathology is accompanied by damage to the papillary muscles, chords, and other elements of the valvular apparatus of the heart, then the method of choice may be the operation to install an artificial valve ().

Large gaps against the background of extensive heart attacks are extremely difficult to “correct” due to severe ischemia in the focus of necrosis, where the tissues are poorly connected to each other, regeneration slows down, and a significant area of ​​​​the heart muscle may be subject to removal. In these cases, the patient is able to save, but serious difficulties with its implementation are due to the limited time and lack of a suitable donor.

Drug therapy is aimed at maintaining acceptable blood pressure figures and the function of vital organs. The appointment of diuretics, peripheral vasodilators, analgesics, cardiac glycosides is shown. Infusion therapy consists in the introduction of fresh frozen plasma, saline solutions.

Rupture of the heart is a pathology that requires emergency medical care, so patients suffering from or who have had a myocardial infarction should not only carefully observe the cardiologist’s regimen and prescriptions, but also take seriously every attack of retrosternal pain, and if it lasts more than five minutes, then apply for medical care should be immediate.

With a broken heart, many scare themselves and those around them, saying that out of fear or severe stress something like this can easily happen. But, if you think about it, in order for a heart rupture to occur, an injury must occur - a knife wound, a blow, because strong muscle tissues cannot tear on their own. Unfortunately not only mechanical damage the main "engine" in the body can lead to a serious illness. A complication of some diseases of the cardiovascular system can also be a tear of the heart muscle, which in the vast majority of cases leads to the death of the patient.

Causes of the disease

A very severe, almost always fatal consequence of myocardial infarction, which occurs in 2-8% of patients, is a heart rupture. It is a violation of the integrity of the organ wall, or, in other words, the formation of a through defect on the heart wall in transmural myocardial infarction.

Rupture of the heart muscle occurs, as a rule, 5-7 days after the onset of myocardial infarction. It is the third most common cause of death in patients, second only to pulmonary edema and cardiogenic shock, which, however, can develop against the background of partial myocardial rupture. It is believed that the greatest danger regarding the rupture of the heart is the first heart attack. After it, if the patient managed to survive, scar tissue resistant to hypoxia is formed, so repeated heart attacks are much less likely to lead to heart rupture.

According to statistics, 80% of all ruptures are damage to the free wall of the heart, 15% - damage to the interventricular septum, 5% - the chord of the heart valve and papillary muscles, resulting in acute mitral regurgitation. As the body ages, the likelihood of a heart rupture after a heart attack increases greatly. So, if up to 50 years it is 4%, then after 60 years it rises already in excess of 30%, while becoming especially significant in anterior extensive transmural infarction with a 20% left ventricular lesion.

More often, fiber tear is observed during a heart attack in women, the elderly due to slow scarring of the myocardium, in people with low body weight, with exhaustion. There are other risk factors that are recognized as seriously increasing the risk of acute myocardial pathology:

• arterial hypertension;
• diabetes;
• preservation motor activity during the acute phase of a heart attack, or within a week from the moment of its development;
• late hospitalization and untimely initiation of treatment for a heart attack;
• lack of use of thrombolytic drugs in the most early dates after thrombosis of coronary vessels;
• the first heart attack that ended in a heart attack, with previously absent coronary artery disease, angina pectoris, vascular disease;
• the presence of early postinfarction angina pectoris;
• taking NSAIDs, hormones that prevent the formation of scar tissue quickly.

Other possible reasons myocardial rupture, which are much less common, can be:

• traumatic injury to the heart;
• tumors of the heart muscle;
• endocarditis;
• infiltrative damage to the organ during sarcoidosis, amyloidosis, hemochromatosis;
• anomalies in the structure of the heart of a congenital type.

Rupture of the heart, despite the achievements of modern medicine, is a poorly understood pathology. Many experts consider it a hopeless condition, the only chance to survive in which is an emergency and successfully performed surgery. Unfortunately, the speed with which the disease develops leaves little room for organizing surgical intervention, especially when the person is not in a specialized cardiac surgery department. That is why experts emphasize the importance preventive measures and identification of risk factors, which will prevent such a formidable complication of myocardial infarction.

Varieties of heart rupture

According to the localization of damage, it can be internal, external. Internal ruptures include ventricular septum, which separates the left and right ventricles. This leads to a rapid disruption of blood flow, a drop in pressure and death. Also, the group of internal ruptures includes damage to the papillary muscles of the heart, which move the valves. Death in this case develops due to pulmonary edema against the background of congestion. It is these patients who can be saved by emergency surgical treatment, as they are able to live several days before death. External tears cause blood to leak into the pericardium (the pericardial sac), which puts the heart under compression and stops working.

According to the timing of the appearance of the pathology is as follows:

1. early rupture - occurs within 72 hours after a heart attack or other disease;
2. late rupture - observed after 72 hours and later after a heart attack.

The duration of the pathology may be different. Instantaneous ruptures lead to instant death due to cardiac tamponade, slowly flowing for several hours, days cause circulatory disorders and death of a person. A complete rupture damages the muscle to its full depth, an incomplete one partially damages it, followed by the formation of a bulging (aneurysm) of the heart.

Signs of manifestation

Most often, a formidable complication occurs 1-4 days after the occurrence of myocardial infarction. Sometimes the danger persists until the end of the 3rd week after a heart attack. Symptoms of the disease are acute, sudden, but sometimes there is a so-called pre-rupture period, which also has its own clinical signs:

• severe pain in the region of the heart, which radiates to the area between the shoulder blades and is not confused by taking medications;
• drop in blood pressure;
• fainting;
• dizziness;
• weakness of the pulse;
• cold, clammy sweat;
• enlargement of the liver.

Actually, the gap period in 90% of cases proceeds abruptly, suddenly, and only in 10% of cases develops slowly. As a rule, cardiac tamponade occurs, blood circulation stops. The patient loses consciousness, his skin becomes gray-bluish, which is especially noticeable on the face and the entire upper body. A person's neck swells and grows in size due to overfilling of the neck veins with blood. First, pressure and pulse disappear, then breathing stops, the pupils dilate.

Slow ruptures can last several hours or days, as they are characteristic of a small amount of myocardial damage. There is also a relatively favorable course of the disease, when slowly flowing blood becomes a blood clot that clogs the hole that has appeared. Symptoms of pathology are as follows:

• pain in the heart that is difficult to reduce with drugs, periodically increasing and weakening;
• arrhythmia;
• weakness of systolic pressure, while diastolic pressure may generally tend to zero (during thrombosis, pressure returns to normal);
• tenderness of the liver on palpation;
• swelling of the legs, feet.

The prognosis for a heart rupture depends on the size of the organ lesion, on the severity of shock events, and on the speed of surgical treatment. Particularly successful is the operation performed within 48 hours with partial tears of the heart.

Complications of pathology

The disease itself is so severe that it almost always leads to death. Any patient who has not received surgical treatment dies. Even with a small gap when closing the last thrombus, death occurs no later than 2 months without heart surgery. With high-quality treatment, up to 50% of patients die during the operation, since the sutures in the rupture area can erupt.

Carrying out diagnostics

Usually a patient with myocardial infarction is already in the hospital for treatment, so that an experienced doctor will immediately determine the signs of a developing complication even according to a physical examination. The presence of edema of the extremities, grayness of the skin, a drop in pressure and pulse, as well as others characteristic symptoms suggest that a break is imminent. When listening to heart sounds, a coarse systolic murmur is determined, which appears suddenly during systole and is located at the apex of the heart, behind the sternum, between the shoulder blades.

An ECG is performed on a patient with suspected cardiac rupture. If the study was done in the prerupture period, an increase in the S-T interval, the appearance of a pathological QS wave in several leads are recorded. This means an expansion of the infarct zone and subsequent rupture. With a rupture that has already occurred, an irregular heart rhythm is first noted, and then its stop is asystole. If it is possible to perform an ECHO-KG, then the place of the rupture or tear, the size of the lesion, the presence of blood in the pericardium, and the disruption of the valves are revealed.

Treatment Methods

Treatment can only be surgical, no conservative measures can save a person. Much more successful are those operations that are performed outside the acute phase, but with this pathology, the patient does not have time for such an expectation. Sometimes, before preparing a person for a long and serious operation, a minimally invasive intervention is performed to stabilize hemodynamics - intra-aortic balloon counterpulsation. Also, the patient may be shown pericardiocentesis - pumping fluid from the pericardium and stopping cardiac tamponade. Additionally, to maintain vital functions, nitrate preparations are administered to reduce vascular resistance.

Among the methods of surgical intervention can bring positive results open suturing of the rupture site or the placement of a prosthesis (patch) at the site of myocardial or valve damage, intravascular operations that are effective for rupture of the interventricular septum. If a tear with a thrombus is located at the apex of the heart, its partial amputation can be done. In the presence of a donor heart, an organ transplant is performed.

Preventive measures

It is possible to prevent such a disease by preventing myocardial infarction. To this end, you must follow these tips:

• stop eating fatty foods, normalize cholesterol levels;
• normalize your weight;
• eliminate bad habits;
• observe feasible activity;
• timely treat hypertension, coronary artery disease and atherosclerosis;
• Seek immediate medical attention if you suspect unusual heart pain or other abnormal symptoms.
• in case of a heart attack - do not move, immediately go to the intensive care unit.

The closer to birth, the future mom thinking about them more and more. Who are looking forward, who are happy - everyone has their own experiences, but at the same time they have a lot common features. And there is certainly fear, it can be insignificant, but still: every woman worries about the baby, and for herself.

As a rule, such fear is strong in women who have not yet given birth - because of the unknown. They know only theoretically about what they will have to go through, and practice and theory often do not coincide. Of course, for each of the women in labor, childbirth takes place in its own way, individually. But after all, he is 100% aware - which means he is well armed. As a result, knowing a lot of "before" can be helpful and even decisive.

For example, breaks in childbirth, which all women fear and fear, can be avoided in many situations. After all, it all depends on your behavior during childbirth and careful preparation to them during pregnancy.

Causes of ruptures during labor

There are many conducive to this unpleasant factor. But do not rush, everything is in order.

You can start anatomical structure perineum and pelvic muscles - this is very interesting, because this complex of muscles is very important for every person.

During gestation, the shape, location, elasticity of many vaginal and abdominal muscles change slightly. The female body is always preparing for the passage of the baby through birth canal, making it easy to move forward as soon as possible. In addition, the muscles involved in this complex process are slightly weakened and, as it were, diverge into different sides, clearing the way for the fetus.

Also, in order to control the passage of the baby along the birth “roads” and help correct childbirth, firstly, the woman in labor must be able to manage her delicate muscles, and, secondly, the muscles themselves must be as elastic as possible. In many cases, the latter property is genetically incorporated: an excellent ability to stretch and completely return to the previous good condition muscles are usually hereditary. But, and also it can be trained - with the help of training. Then the chances of a "seamless" birth increase. However, in any situation, under certain circumstances, the gaps still cannot go through, because the muscles have a tension limit.

Also, gaps in childbirth depend on many other factors:

• anatomical features women: "high perineum", when the distance between the vagina and the rear opening is about 8 cm in a woman in labor;
• : if a woman in labor for the first time became pregnant after 35 years, the risk of ruptures in childbirth increases very much;
• "sports perineum": in professional athletes, the muscles of the pelvis and perineum are very pumped. It makes it hard birth process, which leads to breaks;
• scarring from stitches: if a woman has stitches from previous births, it is more likely that a tear will occur in the same place;
• wrong action of doctors: if the obstetrician made a mistake when removing the shoulders and head of the baby from the vagina, this can become main reason gap;
• swelling of the perineum during labor activity if the birth proceeds sluggishly or is very delayed in time;
• rapid labor: as a rule, the baby should come out slowly and smoothly: this is good for both the woman and the baby, as well as to prevent tears. However, there are many cases where the delivery is very fast. Then they are artificially slowed down, and the woman is given strict instructions regarding behavior, especially relaxation at this time as well. If the phasing of labor activity is not controlled, then severe gaps may occur;
• wrong action of a woman: you need to know how to breathe and act correctly. Listen carefully to what the obstetrician says, and do everything calmly and responsibly. Premature attempts are very often the main cause of ruptures: there is a moment in childbirth when you need to “breathe”, avoiding straining.
• infection and inflammation of the urinary and genital female tract, chronic diseases: thrush, vulvovaginitis, colpitis increase the likelihood of breaks in childbirth.

Which is better, tear or cut?

Usually, experts try to avoid gaps, because torn edges it is very difficult to compare tissues with each other for connection. First of all, this can be the cause of suppuration in the seams, their poor fastening. Some complications may also develop, such as uterine prolapse. Therefore, if a critical moment is observed and the specialist sees that breaks cannot be dispensed with, he makes a small incision. As a result, you can avoid undesirable consequences, and such wounds heal better and faster: it is much easier to connect the edges of cut tissues.

Always after the completion of labor, specialists carefully examine the female genital organs in cases of cuts and ruptures, assess the level of their severity and apply special sutures in layers. Depending on the level of damage, anesthesia may be used.

It should be noted that ruptures are external and internal, and that in addition to ruptures of the perineum, there may be ruptures of the cervix and some. The latter are a very serious complication, due to which there is a strong bleeding and maybe death. But by following the doctor's instructions, the risks can usually be avoided.

How can you prevent breaks in labor activity?

You need to think about this even before giving birth. It is difficult to say that gaps can be completely avoided, but it is possible to minimize the risks of their occurrence. You just need your awareness of normal childbirth, and your willingness to obediently and calmly follow all the instructions of an experienced obstetrician. You need to breathe first. Only in this way will you help the child and yourself to survive this difficult process with little damage and prevent surgical intervention.

It is very useful to do gymnastics vaginal muscles. Famous exercises Kegels are generally ideal for women and are able to perfectly prepare the pelvis and muscles for childbirth, as well as improve sexual life.

It is very practical that strengthening the crotch with this in a simple way can be done anywhere. But, in some cases, during gestation, such exercises are contraindicated: for example, with the threat of miscarriage. Therefore, before exercising, you should consult your doctor.

Because among the risks are inflammatory and infectious diseases sexual and urinary tract, after 35 weeks of pregnancy, some tests are given for reinsurance. If there are doubts, you need to treat and retake all the tests. You should not worry about this, because the specialist will prescribe good drugs for this period.

IN preventive purposes massage the vagina to strengthen the walls of the uterus, increase muscle elasticity pelvic floor. But it should be noted that when making such a massage, one should very strictly adhere to the technique and create conditions of sterility, which is absolutely impossible. Therefore, some experts oppose such a massage.

rehabilitation period

If it didn’t work out to avoid the gaps, then you will have to carefully look after the seams and follow some rules in behavior until they are completely healed. rehabilitation period, first of all, includes the usual disinfection of the joints, which is carried out every day, as well as their washing - every time after visiting the toilet. At this point, it is important to wash properly - from the pubis to the rear hole. And you need to dry the seams well. It is recommended to lie down after washing without underwear let everything dry out on its own. And change the pads every day to keep the wound dry.

The first days it is advisable not to go to the toilet for a long time (after all, there is a high probability that the seam may open). Therefore, it is worth sticking to a diet and eliminating fiber from food. If you feel the urge to defecate - ask the obstetrician to bring you a glycerin rectal suppository specifically to soften the stool.

Also, for about 4 weeks, a “tailored” woman is forbidden to sit down, so the baby will only have to be fed while standing or lying down.

Note!

The risk of developing or contracting postpartum complications with incisions and tears remains high throughout long period. Also, you should always adhere to feminine hygiene and follow the rules mentioned above, control your well-being and the condition of the seams. With minimal suppuration, increasing pain, a feeling of discomfort, you should go to an experienced gynecologist.

In general, you should understand well that childbirth is a normal process. All pregnant women go through this difficult path, and you will definitely succeed. You just need to be prepared and not panic.

Heartbreak- this is a broken integrity of the heart walls. As a rule, heart rupture occurs during the first week after the first myocardial infarction. A heart attack that happened again rarely ends with a heart rupture. This is due to the fact that the scar formed from a previous heart attack is resistant to oxygen deficiency (ischemia, hypoxia).

Patients in young age are less prone to heart failure than the elderly. It is possible to distinguish internal (in which there is a rupture of the papillary muscles and interventricular septum), external and external ruptures of the heart, which can be divided into 3 types:

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

- the second type is caused by a rupture during lysis. In this case, a shorter or longer interval between ischemic disease and cardiac tamponade can be observed.

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

It is also possible to single out instantaneous ruptures of the heart and slowly flowing ones, leading to a gradual deterioration in the patient's condition.

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

Rupture of the aorta of the heart is characterized by dissection of the layers of the aorta due to the fact that blood flows between the walls. It is also not uncommon for a heart valve to rupture due to some disease or injury.

Rupture heart causes

Cause early break heart is . Regardless of gender, heart failure can happen to anyone. However, women are known to be more prone to heart failure than men. Cardiac ruptures are mainly observed in the primary incident myocardial infarction. When repeated occur quite rarely. This is due to the fact that in persons who had previously suffered a heart attack, fibrous changes in the myocardium and collateral circulation formed, preventing heart rupture.

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

Rupture of the heart that occurs due to high blood pressure is controversial today. There are experts who deny this possibility. However, some argue that patients who have, in which diastolic blood pressure (acute period of myocardial infarction) does not decrease, are prone to heart rupture.

There are data indicating that rupture of the heart occurs in 58-100% of patients with high diastolic pressure. For this reason, in case of a heart attack, medications, which help to lower blood pressure, due to this, the load on the myocardium is reduced and the healing of the heart muscles is accelerated (scarring is formed).

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

When late deadline hospitalization for a heart attack, from the beginning of which more than 24 hours have passed, can lead to a rupture of the heart, even when transporting the patient. Also at late reception thrombolytic drugs that help dissolve a blood clot, a heart rupture may occur. When early admission drugs, coronary blood flow is restored faster, due to which death from heart failure occurs in rare cases.

When taking anti-inflammatory and hormonal drugs there is an inhibition of scar formation in the damaged part of the myocardium, as a result of which the probability of heart rupture is very high.

Heartbreak from fear can occur even in completely healthy person. This is due to the fact that in extreme situation under the pressure of fear, the heart rate increases and the blood flow in the muscles increases. Produced a large number of adrenaline, and the arisen does not allow them to pump blood, resulting in death.

Rupture of the aorta of the heart can occur only when the internal elastic membrane has become thinner, as a result of which a lumen is formed from which blood seeps out. As a rule, the separation of the walls leads to death.

Rupture of the heart valve can occur due to chest trauma or infection. Quite rarely occurs in the case.

Heart rupture symptoms

In the pre-rupture period, one can observe intense pain in the region of the heart, radiating between the shoulder blades, which is not stopped by Nitroglycerin and narcotic analgesics (Morphine).

The symptom of shock caused by cardiac tamponade will increase rapidly (blood pressure drops, consciousness is lost, pulse is weak, cold clammy sweat appears). The following can be recorded on an electrocardiogram: S-T interval the pathological QS wave rises and deepens in at least 2 leads. This indicates the expansion of the lesion of the site and the upcoming rupture of the heart.

Rupture of the heart is clinically accompanied by a sharp decrease in blood pressure with high venous pressure, the veins swell. These changes indicate the development of nodular or.

The rupture of the heart can occur slowly, or maybe suddenly. As a rule, it most often occurs suddenly due to the fact that it happens quickly, blood circulation stops. The patient suddenly loses consciousness, pronounced - the skin is painted in a gray-blue color in upper half torso and face. The neck veins swell, the neck thickens significantly. Weakly heard heart sounds. Blood pressure and pulse disappear. After 1 minute, breathing stops. On the electrocardiogram, an irregular rhythm will be registered, which goes into ( full stop hearts).

Slow rupture can occur over several days or hours. This is due to the size of the gap through which blood will flow into the pericardium. In this case, intense pain occurs, which is not stopped by narcotic analgesics and Nitroglycerin. Pain sensation, as a rule, will periodically weaken and intensify on their own, then weaken again, and so on.

The skin becomes gray shade and the patient breaks out in a clammy cold sweat. There is a weak pulse and arrhythmia. Also, the lower (diastolic) pressure can reach zero, the upper (arterial) will be quite low. If the rupture stops (blood clots form), then, consequently, the symptoms begin to decrease, blood pressure stabilizes. On the cardiogram, you can register identical changes with a sudden rupture of the heart.

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

With a rupture of the interventricular septum of the myocardium, intractable pain suddenly appears. Begins to develop, in which blood pressure drops sharply, sticky cold sweat appears, skin covering acquires a bluish tint, consciousness is lost.

In the event of a rupture of the septum between the ventricles, the jugular veins swell, the liver will increase in size, when pressed on it, pain occurs, followed by swelling of the feet and lower legs. Usually ends in death.

When the papillary muscle ruptures, it rapidly forms. In this case, it is almost impossible to save the patient and there are the following symptoms:

- Sharply resumed intractable pain in the myocardium;

- Shock develops rapidly (blood pressure drops sharply, consciousness is lost, the pulse is weak at first, after which it completely disappears);

- Shortness of breath is severe, which will gradually turn into an asthma attack;

- Cough with sputum (frothy), pink.

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

- With damage to the aorta, pain occurs behind the sternum or in the intercellular region. If an intimal rupture occurs, then the pain is boring, sharp, unbearable;

- With a rupture of the abdominal aorta, pain occurs in the abdomen, and can also radiate to groin, back;

- If an intimal rupture has occurred, then it is possible that there is an increase in pressure (arterial), which normalizes without taking any drugs.

Common symptoms are: absence of pulse in lower limbs, vomiting, hiccups, nausea, sudden weakness.

Rupture of the heart treatment

In order to develop effective measures prevention of heart rupture, 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 intraventricular pressure in the presence of hypertension. Also, accurate and timely diagnosis allows for successful surgical treatment. In such cases, pericardiocentesis is performed and a catheter is inserted intravenously. Surgical intervention should lead to the restoration of blood flow, eliminating the gap.

If necessary, coronography can be performed not only in a special laboratory, but also in the operating room. Mechanical circulatory support is used to restore left ventricular function. Also, accumulated fluid is removed from the pericardial sac with a needle (pericardiocentesis).

In some cases, successful surgery is performed for internal rupture of the heart. Closure of a ventricular septal defect or prosthesis 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 point, and for this reason, different combinations of non-drug and drug agents are individually assigned to each.

An open heart surgery is also performed - the gap is sutured on a special lining. When a transaction is closed, a patch is set. The mitral valve is also prosthetized, coronary artery bypass grafting is performed, the aneurysm area is removed, upper part heart with a rupture site, and in some cases, transplantation is performed.

With moderately severe decompensation, cardiac glycosides and diuretics are prescribed for treatment. But this is not enough for severe left-to-right blood shunting or significant mitral regurgitation.

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

In the event that severe hypertension occurs with a complication, then peripheral vasodilators are combined with a strong inotropic agent. However, if ineffective this therapy, then they resort to counterpulsation (assisted blood circulation).

Treatment of an external rupture of the heart has virtually no effect.