Treatment of coronary heart disease symptoms. IBS symptoms and treatment. When we take risks

Ischemic heart disease is not in vain considered one of the most common and dangerous heart diseases. Unfortunately, it knows no boundaries, neither age, nor geographical, nor economic.

Ischemic heart disease can strike by surprise

Sometimes, instead of the term "coronary heart disease", the names "ischemia", "coronary disease" or "coronary sclerosis" are used, these terms were in the list of diseases of the WHO in the last century. But even now, in some sources, and in medical practice, these names of the disease are found, which have different stages, require different methods of treatment, and therefore bear different names.

signs

Most often, ischemia signals its presence with periodic bouts of burning pain in the chest. The pain is severe, its character is oppressive.

Sometimes signs of coronary heart disease are complaints of patients about a feeling of general weakness, nausea and an unpleasant feeling of lack of air. Pain in this case can be localized between the shoulder blades, felt behind the sternum, in the neck or left arm.

Painful sensations are the first signs of this disease. You should listen carefully to your own well-being, and as soon as the slightest suspicion of heart problems is felt, it is better to immediately contact a cardiologist.

If before such reactions of the body did not occur, this is the first sign of the need for a cardiological examination.

Discomfort in the chest is also an alarm signal of the body.

In some people suffering from this ailment, it is manifested by pain in the back, left arm, lower jaw. Also, symptoms of coronary heart disease are changes in heart rate, shortness of breath, heavy sweating, nausea.

If none of the listed signs of the disease is present, it is still sometimes important to be examined, albeit with a preventive purpose, because coronary heart disease in a third of patients does not manifest itself at all.

Causes

Clinically, coronary heart disease (CHD) characterizes a chronic pathological process caused by insufficient blood supply to the myocardium, or heart muscle.

Violation of the blood supply to the myocardium occurs due to damage to the coronary arteries, and can be absolute or relative.

The reason for the lack of oxygen in the myocardium is the blockage of the coronary arteries, which can be caused by a blood clot, a temporary spasm of the coronary artery, or atherosclerotic plaques accumulated in the vessel. Sometimes the reason lies in their fatal combination. Violation of normal blood flow in the coronary arteries and causes myocardial ischemia.

Throughout life, each person to some extent has deposits of cholesterol and calcium, in the walls of the coronary vessels there is an overgrowth of connective tissue, which leads to a thickening of their inner membrane and a narrowing of the total lumen of the vessel.

As you can see, the risk of the disease increases with age.

Narrowing of the coronary arteries, which leads to a partial limitation of the blood supply to the heart muscle, can cause angina attacks. These attacks most often occur with a sharp increase in the workload on the heart and its need for additional oxygen.

The occurrence of thrombosis of the coronary arteries is also caused by the narrowing of their lumen. The danger of coronary thrombosis is that it is the cause of myocardial infarction, leading to necrosis and further scarring of the affected area of ​​the heart tissue.

In addition, this also leads to dysrhythmia or heart block, in the worst case scenario of the progression of the disease.

Classification

In accordance with the clinical manifestations, causes of occurrence and degree of progression, IHD has several clinical forms that occur in patients individually or in combination: angina pectoris, myocardial infarction, cardiosclerosis.

Currently, physicians use the modern classification of coronary heart disease, adopted in 1984 by the WHO with amendments and additions by the VKSC.

According to this classification, all the various features of the clinical manifestations of cardiac ischemia, as well as the corresponding prognosis and treatment methods, can be combined into the following groups:

• sudden coronary death, or primary cardiac arrest - according to the results of treatment, two groups of primary cardiac arrest are distinguished - with the practice of successful resuscitation or with a fatal outcome;
• angina pectoris, which in turn is subdivided into angina pectoris, unstable and vasospastic angina pectoris;
• myocardial infarction;
• postinfarction cardiosclerosis;
• heart rhythm disturbances;
• heart failure.

In addition to this systematizing picture of various manifestations of coronary artery disease, until recently there was another classification recommended by WHO experts in 1979.

Death statistics

According to the then method of dividing coronary artery disease into classification groups, in the clinical form "angina pectoris" a subgroup "coronary syndrome X" was distinguished, unstable angina pectoris was considered in three different clinical manifestations. Also, such a picture of the disease as “painless form of coronary artery disease” was allocated to a separate diagnosed group.

Compliance with the classification of the disease when making a diagnosis is of paramount importance for the success of all further treatment of the patient.

It is unacceptable to formulate a diagnosis of coronary artery disease for a patient without subsequent decoding of the form, because in general terms such a diagnosis does not at all clarify the real information either about the nature of the disease or about the criteria for choosing the optimal method of treatment.

A correctly formulated diagnosis, in which the clinical form of the disease through the colon follows the general diagnosis of CAD, is the first step towards choosing a further course of treatment.

Acute and chronic forms

The course of cardiac ischemia is undulating, alternating periods of acute coronary insufficiency (coronary crises) that occur against the background of chronic, or relative, insufficiency of the coronary circulation. Accordingly, acute and chronic forms of coronary artery disease are distinguished.

The acute form of IHD is manifested by ischemic myocardial dystrophy and myocardial infarction. Often, ischemic myocardial dystrophy leads to acute heart failure, a complication that often becomes the direct cause of sudden death.

myocardial infarction

Myocardial infarction is the necrosis of the heart muscle caused by coronary artery disease. As a rule, this is an ischemic infarction with a hemorrhagic corolla.

In the systematization of IHD, the forms that characterize chronic coronary heart disease are diffuse small-focal cardiosclerosis or large-focal post-infarction. The latter in some cases is complicated by chronic aneurysm of the heart.

Both acute ischemic heart disease and the chronic form of this disease can cause irreparable damage to the health and life of the patient.

The impact of bad habits

According to WHO statistics, among the various causes of coronary artery disease and other cardiovascular diseases, there are those that most often lead to the development of cardiac pathologies.

Risk factors for CAD include:

• increased blood cholesterol, or hypercholesterolemia;
• carbohydrate metabolism disorders, especially diabetes mellitus;
• arterial hypertension;
• prolonged use of alcohol;
• smoking;
• obesity;
• physical inactivity against the background of stress instability;
• individual characteristics of behavior.

As can be seen from the listed reasons leading to the occurrence of IHD, this disease often has a number of causes, being complex. Therefore, measures for its prevention and treatment should also be comprehensive. Patients suffering from ischemia of the heart, you must first get rid of bad habits.

Smoking

One of the habits that most often lead to coronary atherosclerosis and myocardial infarction is smoking. Long-term smoking has a narrowing effect on the coronary vessels, and also leads to increased blood clotting and slowing of blood flow.

smoking is poison

Another reason for the harmful effects of nicotine on the heart is that nicotine causes an increased flow of adrenaline and norepinephrine into the blood, substances that are released in large quantities during emotional and physical overload, or stress.

Their excessive concentration leads to insufficiency of the coronary circulation due to an increase in the demand of the heart muscle for oxygen. Also, adrenaline and norepinephrine have a damaging effect on the inner surface of blood vessels.

The recently established similarity of the negative effects on the cardiovascular system of long-term negative emotions and nicotine proves how mistaken is the habit of many smokers to puff on the next cigarette to calm down.

Alcohol

This is the second most harmful habit for patients diagnosed with coronary artery disease. According to statistical medical data, among men, about a third of patients with myocardial infarction abuse alcohol. Drinking alcohol often causes an attack of angina pectoris.

A feature of coronary artery lesions in alcohol-dependent patients is a high degree of development of the disease process. Among non-alcoholic patients of the same age, this process is much less associated with pain.

The insidiousness of alcohol is that immediately after taking it, a slight narcotic effect occurs, pain disappears and a false impression arises about the vasodilating effect of alcohol on the heart. Very soon, however, there is a rapid vasospasm, an increase in blood viscosity leads to impaired blood flow.

Therefore, in the stage of intoxication of patients, there are so many heart and brain attacks that are very difficult to stop, especially if we take into account the incorrect action of cardiac glycosides against the background of the presence of alcohol in the blood.

Obesity

Obesity is another scourge that whips up the heart muscle. It has a negative effect on the cardiovascular system through a direct effect on the heart muscle (muscle obesity), as well as setting in motion a complex mechanism of nervous and hormonal effects.

Hypodynamia

Physical inactivity is now recognized as one of the most influential factors triggering the occurrence of coronary heart disease.

Passive lifestyle is the right way to CHD

A sedentary lifestyle is a serious reason for the development of atherosclerosis, thrombosis and other disorders of the normal functioning of the cardiovascular system.

A global problem

The dynamics of recovery of patients with IHD is largely determined by the timeliness and quality of diagnosis of the clinical form of the disease, the adequacy of the prescribed outpatient treatment, as well as the timeliness of urgent hospitalization and emergency cardiac surgery.

Sad European statistics claim that coronary artery disease, together with a stroke of the brain, make up a catastrophic majority, namely 90% of all diseases of the cardiovascular system.

This indicates that coronary heart disease is one of the most common diseases, as well as the most common causes of death in modern man.

It often leads to long-term and permanent disability of the active population, even in the most developed countries of the world. All this characterizes the task of finding more effective methods of treating IHD as one of the leading tasks among the first medical problems of the 21st century.

Signs of coronary heart disease

In this article, we will look at the main signs of coronary artery disease in adults.

Symptoms

The main clinical forms of ischemic heart disease include: angina pectoris (the most common initial form), acute myocardial infarction. cardiac arrhythmias, heart failure. as well as sudden coronary cardiac arrest. All of the above stages of coronary artery disease differ from each other in their severity and the presence of secondary complications.

The main signs of coronary artery disease, which should alert the patient and force him to consult a doctor for medical help, are: frequent shortness of breath, weakness, periodic pain in the chest, dizziness, sweating. These symptoms occur in more than 80% of all initial stages of coronary disease.

In most cases, patients note a significant deterioration in general well-being as a result of increased physical activity on the body, which aggravates the course of the disease.

As coronary heart disease progresses, there may be a significant aggravation of the resulting angina attacks, which indicates a fairly rapid deterioration of the underlying disease.

It should also be noted that recently there has been a fairly large number of cases of the development of painless forms of coronary artery disease, which are quite difficult to detect in the early stages of development, and which are much worse treatable. Therefore, it is very important at the slightest disturbance of the heart to consult a cardiologist in a timely manner to prevent the development of undesirable consequences.

angina pectoris is an early and initial sign of coronary artery disease, which is manifested by periodic pain in the region of the heart, chest, giving under the left arm, shoulder blade, in the jaw. The pain may be accompanied by tingling, squeezing, be quite pressing, and generally last no more than 10-15 minutes. then remissions are possible again.

Angina pectoris or, as the people say, "angina pectoris" can be of 2 types: tension and calm. The first occurs under the influence of physical stress on the body, it can develop as a result of stress or psycho-emotional disorders. Rest angina mostly occurs without cause, in some cases an attack can occur during sleep.

Both types of angina pectoris are very well removed by taking 1-2 tons of nitroglycerin under the tongue with a minimum interval between doses of at least 10 minutes.

Remember: this type of coronary artery disease requires a mandatory consultation with a cardiologist with a cardiogram of the heart and the appointment of an appropriate treatment so as not to provoke further progression of the disease and its possible transition to a more severe, life-threatening stage for the patient.

Advanced myocardial infarction is a very serious complication of coronary artery disease requiring emergency medical care. The main signs of a heart attack are severe, pressing and compressive pain in the region of the heart, which is not relieved by nitroglycerin preparations. In addition, a heart attack may be accompanied by shortness of breath, weakness, nausea, or vomiting, mostly yellowish in color.

The attack causes a feeling of fear, anxiety, general weakness, dizziness, in the area of ​​\u200b\u200bthe heart there may be a strong contraction, tingling.

In some cases, a feeling of severe pain can cause a sudden loss of consciousness in the patient.

Therefore, in cases of acute myocardial infarction, the patient should be immediately hospitalized in order to avoid death and prevent the possible development of unwanted complications.

Chronic heart failure is one of the main signs of coronary heart disease, which is manifested by constant shortness of breath, the patient complains that he does not have enough air, he begins to periodically suffocate, the upper and lower tissue covers of the body become bluish in color, as a result of acute circulatory disorders, local blood stagnation occurs , the patient's chest becomes barrel-shaped.

With all the data, the above signs of coronary artery disease, it is necessary to go to the hospital as soon as possible to a cardiologist in order to timely diagnose the disease, since the development of coronary artery disease at its first stage can be at least slightly suspended in its further progression.

Sudden cardiac arrest(coronary death) is a formidable complication of acute myocardial infarction, as a result of untimely provision of emergency medical care for it. It is manifested by a sharp cessation of cardiac activity with a stop to the further functioning of all vital organs and systems.

If in the next 2-3 minutes. the patient will not be provided with urgent resuscitation, then after 4-6 minutes. irreversible processes occur in the cerebral cortex and central nervous system, which leads to complete biological death.

Attention: timely diagnosis of the disease at an early stage of its development will allow you to carry out a fairly effective treatment, as well as prevent the further development of unwanted complications.

Diagnostics

• examination of the patient by a doctor, patient complaints of pain in the chest area;
• obligatory electrocardiogram of the heart;
• coronary angiography (makes it possible to determine the state of the coronary arteries of the heart, as well as to identify the presence of pathological changes in them);
• computed tomography of the chest cavity;
• angiography of the main arteries of the heart.

In this article, we found out the main signs of coronary heart disease.

Manifestations of coronary heart disease

The word infarction means the necrosis of a part of the tissue of any organ due to a violation of the patency of the vessel that feeds this tissue. In addition to myocardial infarction (heart), there are infarctions of the lung, kidney, spleen and other organs. All of them occur in cases where one of the relatively large arteries supplying this organ with blood is clogged and a part of the tissue that received oxygen and all the substances necessary for its vital activity from this artery undergoes dystrophy and dies. Due to the morphological and functional features of the heart muscle and the arteries supplying it, the frequency of myocardial infarction is incomparably higher than the frequency of lesions of this kind of other organs. At the site of the formed myocardial infarction (Fig. 4), scar connective tissue gradually develops in the future, which is functionally unequal to the heart muscle. In this regard, if the myocardial infarction is large in area, heart weakness and other complications occur, leading to adverse consequences.

A person with a completely healthy heart can suffer from a myocardial infarction due to damage to one of the coronary arteries that feed the heart.

So, myocardial infarction is a catastrophe caused by complete or partial blockage of the coronary artery. When the lumen of the vessel is partially closed, the possibility of infarction will be determined by how large the discrepancy between the needs of the myocardium in

oxygen (which depends on the intensity of the work of the heart) and the actual supply of the heart muscle with arterial blood.

With complete blockage of the coronary artery, energy-rich phosphorus compounds - ATP and CF - are quickly consumed in the heart muscle. This leads to the fact that a part of the heart muscle, the supply of which has stopped due to a violation of the patency of the artery, stops contracting after a short time, and the muscle cells in this place do not recover ATP and CF

soon die. As a result of the cessation of contractions of a relatively large part of the left ventricle, cardiac weakness (failure) develops, which sharply aggravates the condition of a sick person.

In most cases, the lumen of the coronary artery narrows gradually as a result of the formation of one or more atherosclerotic plaques in one of the sections of the vessel, which we will discuss in more detail below. Sometimes the plaque itself is small, but a blood clot forms on its rough or ulcerated surface, which completely or partially closes the lumen of the artery. An increase in blood pressure contributes to an additional narrowing of the artery at the location of the atherosclerotic plaque. With excessive physical stress, even a small plaque can be an obstacle to a sharply increasing blood flow through the coronary arteries and cause the development of myocardial infarction. It is very likely that the episode known to us from the history of Ancient Greece with the messenger from Marathon, who ran 42 km to Athens and fell dead, is such an example.

Close to a heart attack is another manifestation of atherosclerosis of the coronary arteries - angina pectoris, characterized by pain in the region of the heart, behind the sternum, often radiating to the left arm or shoulder blade. Just like myocardial infarction, angina is the result of insufficient blood supply to the heart muscle (ischemia).

At the suggestion of the World Health Organization, the term "ischemic heart disease" has been established, which refers to all conditions accompanied by insufficient blood supply to the heart muscle.

Rice. 4. Myocardial infarction, which developed as a result of blockage of one of the branches of the left coronary artery (indicated by an arrow)

Thus, angina pectoris, myocardial infarction, very often various disturbances in the rhythmic work of the heart (arrhythmias), as well as cases of sudden death (see below) are manifestations of the same disease - coronary heart disease (CHD).

In coronary artery disease, the supply of oxygen to the heart muscle lags behind the actual need for oxygen, while normally, the supply of oxygen to the myocardium exceeds the need for it. As a result of myocardial ischemia, signs characteristic of IHD appear (Fig. 5).

Rice. 5. Scheme of the occurrence of myocardial ischemia and some of its manifestations

Of course, there are many different forms of myocardial infarction and angina pectoris. Sometimes it is difficult to draw a clear clinical line between a prolonged attack of angina pectoris and a non-severe myocardial infarction. Some patients suffer from angina pectoris for many years without causing serious consequences. However, more often angina pectoris serves as a prelude to myocardial infarction or eventually leads to cardiac weakness or irregular work of the heart.

There are many cases when a myocardial infarction is preceded by only a few attacks of angina pectoris, to which a person did not attach any importance and did not consider it necessary to consult a doctor.

In close connection with the problem of finding out the causes of myocardial infarction, there is the problem of studying the causes of the so-called sudden death that occurs a few hours after the first manifestations of the disease (in a practically healthy person). The basis of sudden death, as a rule, is a rapidly occurring coronary insufficiency due to a sharp and prolonged spasm of one of the coronary arteries or an acutely developed large-focal myocardial infarction. And the immediate cause of death is deep heart rhythm disturbances: instead of ordered effective contractions of the heart muscle, chaotic twitches of individual muscle bundles begin, the so-called ventricular fibrillation, or heart asystole, develops, and the effective work of the heart stops. Such a state, if it is delayed for several minutes, becomes incompatible with life.

In order to seek help in a timely manner and develop the correct line of one's behavior, it is important to know well how IHD manifests itself.

Signs of angina pectoris and myocardial infarction. For the first time, the classic description of an attack of "angina pectoris" (the so-called angina pectoris) was made by V. Heberden in 1768 at a lecture at the Royal College of Therapeutics in London.

During an attack of angina, a person has a feeling of pressure, heaviness, mixed with a feeling of dull pain in the central part of the chest, behind the sternum, sometimes somewhere deep in the throat. In some people, relatively severe pain is accompanied by fear, weakness, the appearance of cold sweat, but after 2-3 minutes the pain disappears and the person feels healthy again. In other people, this is not pain, but a kind of burning sensation, pressure behind the sternum or in the neck. (Fig. 6)

Usually, such short-term attacks occur in the morning when a person is in a hurry to work, especially in cold windy weather. This is a typical exertional angina.

Often, angina pectoris attacks develop after a hearty meal, during physical exertion, or shortly after great emotional stress, negative mental influences, or other unrest.

Fig 6. The area of ​​distribution of pain in angina pectoris

With rest angina, which often occurs at night or early in the morning, when the patient is at rest, a large role is played by the factor of vascular spasm (one of the sections of the coronary artery). As a rule, such spasms occur in patients with arterial hypertension or with coronary arteries affected by atherosclerosis.

In recent years, the term "unstable angina" has become widespread. It is opposed to the definition of "stable angina", which is understood as a condition characterized by the patient's habitual attacks of short-term retrosternal pain that occurs in certain situations (fast walking against the wind, especially after eating, during unrest, etc.). A patient with stable angina pectoris should be systematically treated. There are no indications for his urgent hospitalization. Another thing is if angina pectoris appeared for the first time in life or its attacks became more frequent, if, along with angina pectoris, angina pectoris appeared at rest, attacks began to be worse removed by nitroglycerin, became sharper or longer. This type of angina is called unstable. Patients with unstable angina pectoris should be taken under special supervision, sharply limit their physical and emotional stress, monitor their ECG, and strengthen treatment with vasodilators. In most cases, such patients need to be hospitalized for intensive monitoring and active treatment. Attacks of unstable angina are also harbingers of myocardial infarction.

As already noted, it is not always easy to define a clear line between angina pectoris and myocardial infarction. Sometimes patients endure non-severe myocardial infarction “on their feet”, without medical assistance. However, for myocardial infarction in the initial period, a more typically violent and severe course. Acute myocardial infarction most often occurs as an attack of sharp, piercing, lingering pains or as a very painful feeling of squeezing the chest, as if someone is squeezing it in a vise. The patient is frightened, restless, he has difficulty breathing, he rushes around the room, not finding a place for himself. Excitation is replaced by weakness, cold sweat, especially if the pain lasts more than 1-2 hours.

During such an attack, nitroglycerin, which previously relieved the condition, almost does not reduce pain or has only a short-term effect. In the midst of pain, the patient becomes pale, his pulse is weak and frequent, the rise in blood pressure is replaced by its fall. This is the most dangerous period of the disease. Immediate medical intervention is required. Only by administering special medicines, an ambulance or emergency doctor manages to cope with an attack, and sometimes the patient has to be urgently hospitalized.

If a person first has an attack of angina or develops an attack of chest pain, accompanied by weakness, cold sweat, nausea and vomiting, dizziness, or a brief loss of consciousness, it is extremely important to call a doctor right away. Only a doctor is able to assess the characteristics of certain manifestations of the disease and prescribe additional studies, the results of which can make an accurate diagnosis, decide on the need for hospitalization and recommend the correct treatment.

All patients who are suspected of having a myocardial infarction should be in a hospital where there is the possibility of careful examination, observation and intensive treatment. There are wards in specialized departments where especially seriously ill patients are sent in order to establish permanent electrocardiographic monitoring for them, enhanced monitoring of medical and paramedical personnel and, as a result, to promptly recognize and treat such complications of myocardial infarction, which 10-15 years ago were considered incompatible with life.

In some patients, myocardial infarction develops suddenly, almost without any precursors, in the midst of seeming complete health. However, if such “healthy” people are examined before myocardial infarction, then the vast majority of them can detect certain signs of atherosclerosis of the heart vessels or metabolic disorders that developed long before the heart attack.

Establishing a diagnosis of myocardial infarction is sometimes difficult. An electrocardiogram, the results of a study of the cellular and biochemical composition of the blood, and data from other auxiliary diagnostic methods help to recognize the disease.

In many countries of the world, a preventive examination of the population is being carried out to identify latent HBO and underlying atherosclerosis of the coronary arteries. But so far, such inspections are not widespread. To prove that active prevention of myocardial infarction is necessary, we will provide some information about the spread of coronary artery disease and some of its complications.

Prevalence of coronary heart disease

It cannot be assumed that atherosclerosis did not occur in ancient times. Thus, atherosclerotic vascular lesions were found in Egyptian mummies. In the surviving ancient manuscripts of the Egyptians, in the Bible, heart pains are described, similar to those of angina pectoris. Hippocrates mentioned cases of blockage of blood vessels. The descriptions of the narrowed, tortuous sections of the vessels that Leonardo da Vinci left are interesting. He also noted that such changes are most often manifested in the elderly and suggested that they adversely affect the nutrition of tissues.

Since the 18th century, Italian anatomists began to describe cases of myocardial rupture in the dead, who during their lifetime suffered from pain in the heart. Correspondence of English scientists V. Heberden and E. Jenner (70s of the XVIII century) is known, in which E. Jenner gave examples of blockage of the coronary arteries in patients who died from an attack of angina pectoris (angina pectoris).

Russian doctors V. P. Obraztsov and N. D. Strazhesko in 1909 created a modern understanding of the clinical picture and the nature of acute coronary heart disease. The doctrine of coronary disease began to develop especially rapidly with the introduction of the method of electrocardiography (ECG) into clinical studies. In 1920, X. Purdy demonstrated ECG changes characteristic of myocardial infarction. Since 1928, the ECG method has been widely used in advanced cardiology clinics around the world. In our time, an electrocardiological study in 12-15 leads has become an integral method for diagnosing heart disease, not only in stationary, but also outpatient conditions. According to the results of an ECG examination of people during physical exertion, it is often possible to reveal hidden coronary disorders. Other subtle methods for diagnosing myocardial infarction are being improved by determining the activity of certain blood serum enzymes, for example, creatine phosphokinase, etc.

Thus, it is safe to say that myocardial infarction did not appear in the 20th century. Nevertheless, there is a complex of reasons that led to the widespread occurrence of this disease in our time.

Many do not imagine the whole danger of a sharp increase in cases of myocardial infarction and angina pectoris, since human psychology is being rebuilt gradually. Meanwhile, there are indisputable statistics showing that myocardial infarction and other "coronary catastrophes" have become the main cause of death in most of the most economically developed countries.

Experts from the World Health Organization have concluded that in the 1970s, mortality from cardiovascular diseases among men over 35 worldwide increased by 60%. At an international symposium in Vienna in 1979, it was reported that. Of the 2 million deaths recorded annually in the United States, more than half are due to cardiovascular disease, including more than a third accounted for by coronary artery disease. In the US, about 650,000 people die from coronary artery disease every year.

The mortality rates of the population from cardiovascular diseases, including coronary artery disease, for a number of countries are shown in Fig. 7.

In general, in highly developed countries, out of ten people over 40 years old, five die from cardiovascular diseases. In Germany, about 250 thousand cases of myocardial infarction are registered annually, and the number of deaths from this disease from 1952 to 1974 increased by 5 times. In the Soviet Union, 514.4 thousand people died from atherosclerotic heart disease in 1976, in 1977 - 529.9 thousand people. According to the Central Statistical Bureau of the USSR for 1981, mortality from cardiovascular diseases in the country has stabilized, and in some Union republics there has been a tendency to reduce it.

Rice. 7. Mortality of men aged 35-74 from various diseases per 100 thousand inhabitants in different countries

A population survey of large groups of residents of the largest cities of our country - Moscow, Leningrad and Kyiv - was carried out in order to identify the prevalence of coronary artery disease among them and the factors contributing to its development. As expected, there was a regular increase in the prevalence of coronary artery disease with an increase in the age of the examined. So, among men of the city of Leningrad at the age of 20-29 years, the prevalence of coronary artery disease is less than 1%, 30-39 years old - 5%, 40-49 years old - 9%, 50-59 years old - 18% and at the age of 60-69 years old - 28 %. In general, it can be said that every sixth man aged 50-59 and every fourth man aged 60-69 are mountains. Leningrad suffer from coronary artery disease. Among women, the prevalence of coronary artery disease was approximately the same as among men, but severe forms of coronary artery disease were less common. According to medical statistics in many countries, women in the premenopausal period get myocardial infarction much less often than men. Therefore, the main attention was paid to the prevention of this disease among the male part of the population, although, as the results of population studies conducted during the Soviet era, it is necessary to carry out appropriate preventive measures among women.

It has already been noted above that coronary artery disease and myocardial infarction arise on the basis of atherosclerotic lesions of the coronary arteries of the heart. Modern medical literature is full of descriptions of the so-called CHD risk factors that contribute to the onset and progression of this disease. But first of all, we will try to tell you what atherosclerosis is and what its essence is.

Ischemia, the symptoms of which are manifested not only by pain in the chest, is a disorder of the coronary circulation, which leads to insufficient blood supply to the myocardium, metabolic disorders and inadequate supply of oxygen to the heart muscle. Recently, a fairly common disease of the cardiovascular system, which leads to severe irreparable deterioration in health and even death. The risk group includes mainly men, women during the period, as well as after menopause, which, with a change in hormonal levels, brings with it a weakening of the body and provokes many diseases.

There are several forms of cardiac ischemia:

• The initial one is painless. There is a decrease in blood pressure, discomfort in the chest, shortness of breath.
• Primary arrest - characterized by cardiac arrest. In this case, without immediate professional help, it leads to death.
• Angina. There is a blockage of the coronary arteries with plaques that cause pain in the chest, arm, neck, and facial part.
• Heart attack. Termination of the full flow of blood to the heart.
• Heart failure or cardiosclerosis. Scarring of areas of the heart, violation of the shape of the valves.

If you do not seek medical help in a timely manner, serious complications are possible. At the first sign, you should immediately consult a doctor. The cardiovascular system is involved in the process of blood circulation of the whole organism, and the heart, as its independent organ, also needs blood supply. Coronary vessels or arteries feed the myocardium and heart muscle.

But there are reasons that lead to disruption of this process and the development of coronary disease:

• Atherosclerosis. The formation of cholesterol on the walls of blood vessels.
• Arterial hypertension. Due to the constant increase in blood pressure, there is an increase in the left ventricle and a violation of the full blood supply.
• Diabetes. It leads to the formation of cholesterol plaques, which impede blood circulation.
• Thrombosis. The mechanism of rapid blood clotting makes it impossible for it to enter the organs through the vessels.

These diseases often not only provoke ischemia, but are subsequently concomitant diseases. Much complicate the treatment and recovery of patients.

Provoke violations and improper functioning of the organs of the cardiovascular system can not only diseases, but also the characteristics of the body and the life of the person himself:

• Stress, nervous strain. They lead to constant arrhythmia, disruption of the supply of nutrients and oxygen to the organs.
• genetic predisposition. It is inherited along with the genetic code.
• Gender identity. In men, ischemia is more common.
• Excess weight. Exceeding normal body weight leads to an increase in the volume of blood that the heart must push out in one contraction. The tone of the walls gradually worsens, the load on the vessels increases.
• Having bad habits. Smoking provokes an excessive amount of carbon monoxide and a lack of oxygen in the blood.

Gradually and with age, the vessels lose their elasticity, so after 45-50 years there is a high probability that ischemia will appear. Symptoms in the stronger sex are more pronounced, as they are more vulnerable to ischemia. This is due not only to physiological characteristics. The reasons are difficult working conditions, bad habits and stressful situations.

Untimely visit to the doctor, when there are complaints of coronary artery disease, leads to coronary heart disease, which manifests itself in men with characteristic symptoms:

• severe pain in the chest;
• lack of air, shortness of breath;
• fainting, darkening in the eyes;
• dizziness and migraine;
• bouts of nausea;
• increased sweating;
• arrhythmias.

The prerequisites for the appearance of cardiac ischemia in this case are atherosclerosis, the formation of blood clots in the vessels, elevated cholesterol levels and spasms of the coronary vessels. All this contributes to a lack of nutrients in the body and disruption of the full process of blood circulation.

Signs of ischemia of the heart in women and children

Signs of cardiac ischemia in women are not as bright as in men, since for a long time only men were susceptible to cardiac ischemia. In women, this disease was observed quite rarely. Now it is considered age-related and manifests itself during menopause. Changes occurring in the body, lack of estrogen affects the work of the cardiovascular system in 20% of women.

Women still have individual signs of cardiac ischemia:

• bouts of acute sharp pain in the back;
• short angina - lasts no more than 15 minutes;
• dyspnea;
• indigestion;
• swelling of the extremities may appear in the evening;
• loss of consciousness or frequent dizziness.

In women, the cause for ischemia of the heart can be stress, hard mental work, age from 55 years. Then, as in men, the disease begins by the age of 40.

Diseases of the cardiovascular system affect even young children. There are several reasons for their occurrence. These include heredity, overwork during the educational process, congenital pathologies.

In a child, ischemia shows its characteristic symptoms:

• Pain, feeling of constriction of the chest. The duration reaches 30 minutes.
• Numbness and sharp pain in the left side of the face, arm and forearm.
• Lack of oxygen, shortness of breath, signs of suffocation.

In most cases, even the drug "Nitroglycerin" is not able to alleviate the condition. In childhood, mortality from coronary disease is much higher. Therefore, at the first even the slightest suspicion of a violation of the heart, it is urgently required to call an ambulance.

An ischemic attack usually begins after heavy physical exertion or a strong emotional shock. A person feels squeezing pain in the chest, there is profuse sweating.

In such cases, it is necessary to know exactly the rules of how to provide first aid for angina pectoris:

• immediately call an ambulance;
• it is convenient to put the patient on the bed, raising his head and loosening the belt and collar of the clothes;
• try to calm and distract;
• open windows, turn on a fan or air conditioner in the summer;
• pour warm water into a heating pad and place it at the feet of the patient.

You can also give the drug "Nitroglycerin", depending on the severity, you can give from 1 to 4 tablets. A person should put them under the tongue and dissolve.

It is impossible for angina pectoris to cause excitement, give unfamiliar drugs and force a person to move. Until the ambulance arrives, it is better to keep quiet and, in case of severe anxiety, apply valerian tincture.

The best way to avoid ischemia is to constantly monitor your health and undergo a medical examination. In the case when symptoms suddenly appear in the chest or left side of the body, contact a specialist.

The main measures for the prevention of coronary disease are simple daily rules that must be observed:

• Stick to a healthy nutritious diet. Control weight, avoid obesity.
• Move more and accustom the body to walks in the fresh air.
• Don't forget about physical activity.
• Get rid of bad habits.
• With a hereditary predisposition, spend more time visiting doctors.
• Take, on the advice of a specialist, drugs that strengthen the heart and blood vessels, for example, Entresto (you can read about the drug) or Kordanum medicine.

Many diseases are the result of the wrong way of life of the person himself. It is necessary to take into account environmental problems, which also play a large role in the deterioration of health. In every possible way avoid stressful situations and excessive loads.

Cardiovascular diseases are the leading cause of death and disability worldwide. According to researchers, in the Russian Federation, mortality from cardiovascular diseases is 8 times higher than in France, and accounts for approximately 58% of the total mortality structure. Every year more than 1.2 million people die from cardiovascular diseases in our country, while in Europe a little more than 300 thousand. The leading role in the structure of mortality from cardiovascular diseases belongs to coronary heart disease (CHD) - 35%. If this continues further, then the population of Russia by 2030 will be approximately 85 million. These are frightening numbers. But the situation can and should be changed if each of us is aware of it. "You know - armed" - said the ancients.

The structure and function of the heart, coronary arteries

To understand CHD, let's first look at what affects CHD - our heart.

The heart is a hollow muscular organ consisting of four chambers: 2 atria and 2 ventricles. In size, it is equal to a clenched fist and is located in the chest just behind the sternum. The mass of the heart is approximately equal to 1/175 -1/200 of body weight and ranges from 200 to 400 grams.

It is conditionally possible to divide the heart into two halves: left and right. In the left half (this is the left atrium and left ventricle), arterial blood, rich in oxygen, flows from the lungs to all organs and tissues of the body. Myocardium, i.e. the muscle of the heart, the left ventricle is very powerful and able to withstand high loads. Between the left atrium and the left ventricle is the mitral valve, which consists of 2 cusps. The left ventricle opens into the aorta through the aortic (it has 3 cusps) valve. At the base of the aortic valve on the side of the aorta are the orifices of the coronary or coronary arteries of the heart.

The right half, also consisting of the atrium and ventricle, pumps venous blood, poor in oxygen and rich in carbon dioxide, from all organs and tissues of the body to the lungs. Between the right atrium and the ventricle is the tricuspid, i.e. the tricuspid valve, and the ventricle is separated from the pulmonary artery by a valve of the same name, the pulmonic valve.

The heart is located in the heart bag, which performs a shock-absorbing function. The heart sac contains a fluid that lubricates the heart and prevents friction. Its volume can normally reach 50 ml.

The heart works according to the one and only law “All or nothing”. His work is done cyclically. Before the contraction begins, the heart is in a relaxed state and passively fills with blood. Then the atria contract and send an additional portion of blood into the ventricles. After this, the atria relax.

Then comes the systole phase, i.e. ventricular contractions and blood is ejected into the aorta to the organs and into the pulmonary artery to the lungs. After a powerful contraction, the ventricles relax and the diastole phase begins.

The heart contracts due to one unique property. It is called automatism, i.e. This is the ability to independently create nerve impulses and contract under their influence. There is no such feature in any organ. These impulses are generated by a special part of the heart located in the right atrium, the so-called pacemaker. From it, impulses go through a complex conducting system to the myocardium.

As we said above, the heart is supplied with blood by the coronary arteries, left and right, which are filled with blood only in the diastolic phase. The coronary arteries play a crucial role in the life of the heart muscle. The blood flowing through them brings oxygen and nutrients to all the cells of the heart. When the coronary arteries are patent, the heart works adequately and does not get tired. If the arteries are affected by atherosclerosis and are narrow because of this, then the myocardium cannot work at full capacity, it lacks oxygen, and because of this, biochemical changes begin, and then tissue changes develop. ischemic heart disease.

What do coronary arteries look like?

The coronary arteries consist of three membranes, with different structures (figure).

Two large coronary arteries depart from the aorta - the right and the left. The left main coronary artery has two major branches:

• The anterior descending artery, which delivers blood to the anterior and anterior-lateral wall of the left ventricle (figure) and to most of the wall that separates the two ventricles from the inside (the intraventricular septum is not shown in the figure);
• The circumflex artery that runs between the left atrium and ventricle and delivers blood to the lateral wall of the left ventricle. Less commonly, the circumflex artery supplies blood to the superior and posterior portion of the left ventricle.

The right coronary artery delivers blood to the right ventricle, to the inferior and posterior wall of the left ventricle.

What are collaterals?

The main coronary arteries branch into smaller blood vessels that form a network throughout the myocardium. These small blood vessels are called collaterals. If the heart is healthy, the role of collateral arteries in supplying the myocardium with blood is not significant. When coronary blood flow is impaired due to an obstruction in the lumen of the coronary artery, collaterals help increase blood flow to the myocardium. It is thanks to these small "reserve" vessels that the size of myocardial damage in case of cessation of coronary blood flow in any main coronary artery is smaller than it could be.

This is myocardial damage caused by impaired blood flow in the coronary arteries. That is why the term is often used in medical practice. coronary heart disease.

What are the symptoms of coronary heart disease?

Typically, people with coronary artery disease show symptoms after the age of 50. They only occur during exercise. Typical manifestations of the disease are:

• pain in the middle of the chest (angina);
• feeling short of breath and difficulty breathing;
• circulatory arrest due to too frequent contractions of the heart (300 or more per minute). This is often the first and last manifestation of the disease.

Some patients suffering from coronary heart disease do not experience any pain and feeling of lack of air even during myocardial infarction.

In order to find out the probability of developing a myocardial infarction in the next 10 years, use a special tool: "Know your risk"

How do you know if you have coronary heart disease?

Seek help from a cardiologist. Your doctor will ask you questions to help identify symptoms and risk factors for the disease. The more risk factors a person has, the more likely it is to have the disease. The influence of most risk factors can be reduced, thereby preventing the development of the disease and the occurrence of its complications. These risk factors include smoking, high cholesterol and blood pressure, and diabetes.

In addition, the doctor will examine you and prescribe special examination methods that will help confirm or deny that you have an illness. These methods include: registration of an electrocardiogram at rest and with a stepwise increase in physical activity (stress test), chest x-ray, biochemical blood test (with determination of cholesterol and blood glucose levels). If your doctor, based on the results of the conversation, examination, tests received and instrumental methods of examination, suspects a severe lesion of the coronary arteries requiring surgery, you will be prescribed coronary angiography. Depending on the condition of your coronary arteries and the number of affected vessels, in addition to drugs, you will be offered either angioplasty or coronary artery bypass grafting. If you turned to the doctor on time, you will be prescribed medications that help reduce the impact of risk factors, improve quality of life and prevent the development of myocardial infarction and other complications:

• statins to lower cholesterol;
• beta-blockers and angiotensin-converting enzyme inhibitors to lower blood pressure;
• aspirin to prevent blood clots;
• nitrates to help stop pain in an angina attack

Remember that the success of treatment depends largely on your lifestyle:

• do not smoke. It's the most important. Non-smokers have a significantly lower risk of myocardial infarction and death than smokers;
• eat foods low in cholesterol;
• regularly, every day for 30 minutes, exercise (walking at an average pace);
• reduce your stress levels.

What else needs to be done?

• see your cardiologist regularly. The doctor will monitor your risk factors, treatment, and make adjustments as needed;
• take your prescribed medications regularly at the doses prescribed by your doctor. Do not change your treatment without consulting your doctor;
• if your doctor has prescribed you nitroglycerin to relieve angina pain, always carry it with you;
• tell your doctor about all episodes of chest pain if they occur again;
• change your lifestyle according to these recommendations.

Coronary arteries and atherosclerosis

In people with a predisposition, cholesterol and other fats accumulate in the walls of the coronary arteries, which form an atherosclerotic plaque (figure).

Why is atherosclerosis a problem in the coronary arteries?

A healthy coronary artery is like a rubber tube. It is smooth and flexible and the blood flows through it freely. If the body needs more oxygen, such as during exercise, the healthy coronary artery will stretch and more blood will flow to the heart. If the coronary artery is affected by atherosclerosis, it becomes like a clogged pipe. Atherosclerotic plaque narrows the artery and makes it stiff. This leads to a restriction of blood flow to the myocardium. When the heart begins to work harder, such an artery cannot relax and deliver more blood and oxygen to the myocardium. If the atherosclerotic plaque is so large that it completely blocks the lumen of the artery or this plaque ruptures and a blood clot is formed that blocks the lumen of the artery, then blood does not flow to the myocardium and its area dies.

Ischemic heart disease in women

In women, the risk of developing coronary heart disease increases 2–3 times after menopause. During this period, cholesterol levels increase and blood pressure rises. The reasons for this phenomenon are not entirely clear. In women with coronary heart disease, the manifestations of the disease sometimes differ from the symptoms of the disease in men. So in addition to typical pain, women may experience shortness of breath, heartburn, nausea, or weakness. In women, myocardial infarction often develops during mental stress or intense fear, during sleep, while "male" myocardial infarction often occurs during exercise.

How can a woman prevent the development of coronary heart disease?

See a cardiologist. The doctor will give you recommendations on lifestyle changes, prescribe medications. In addition, consult a gynecologist to determine the need for hormone replacement therapy after menopause.

How should you change your lifestyle?

• stop smoking and avoid places where other people smoke;
• daily for 30 minutes walk at an average pace;
• limit saturated fat to 10% of the diet, cholesterol to 300 mg/day;
• maintain a body mass index within 18.5–24.9 kg/m 2 and a waist circumference within 88 cm;
• if you already have coronary heart disease, watch for signs of depression
• consume moderate amounts of alcohol, if you do not drink alcohol, do not start;
• follow a special diet to lower your blood pressure levels
• if, despite a change in lifestyle, the blood pressure level is above 139/89 mm Hg. Art. - see a cardiologist.

What medications should be taken?

Do not take any action without consulting your doctor!

• at intermediate and high risk of coronary heart disease, you need to follow a diet and take statins to lower cholesterol;
• if you have diabetes, check your glycated hemoglobin every 2 to 3 months. It must be less than 7%;
• if you are at high risk of developing coronary heart disease, take a daily aspirin in low doses;
• if you have had a heart attack or have angina, take beta-blockers;
• if you are at high risk for a heart attack, have diabetes, or have heart failure, take an angiotensin-converting enzyme inhibitor. This drug lowers blood pressure and reduces the workload on your heart;
• If you cannot tolerate angiotensin-converting enzyme inhibitors, this drug can be changed to an angiotensin II blocker.

Hormone replacement therapy and coronary heart disease

A combination of estrogens and progestins or estrogen alone is not recommended for the prevention of coronary heart disease in menopausal women. Although hormone replacement therapy does not prevent the development of coronary heart disease after menopause, some women take these drugs to reduce menopausal symptoms. Most doctors recommend weighing the pros and cons of taking these drugs. Before taking hormonal drugs, consult a gynecologist.

Symptoms of coronary heart disease

IHD is the most extensive pathology of the heart and has many forms.

Let's start in order.

1. sudden cardiacor coronary death is the heaviest of all forms ischemic heart disease. It is characterized by high mortality. Death occurs almost instantly or within the next 6 hours from the onset of an attack of severe chest pain, but usually within an hour. The causes of such a cardiac catastrophe are various kinds of arrhythmias, complete blockage of the coronary arteries, severe electrical instability of the myocardium. The causative factor is alcohol intake. As a rule, patients are not even aware that they have ischemic heart disease but have many risk factors.
2. Myocardial infarction. Terrible and often disabling form ischemic heart disease. With myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the sternum, extending to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin, it does not completely disappear and only briefly decreases. There is a feeling of lack of air, cold sweat, severe weakness, lowering blood pressure, nausea, vomiting, a feeling of fear may appear. Reception of nitropreparations does not help or assist. The part of the heart muscle deprived of nutrition becomes dead, loses its strength, elasticity and ability to contract. And the healthy part of the heart continues to work with maximum tension and, contracting, can break the dead area. It is no coincidence that a heart attack is colloquially referred to as a heart rupture! It is only in this state that a person has to make even the slightest physical effort, as he is on the verge of death. Thus, the meaning of the treatment is that the place of the rupture is healed and the heart is able to work normally further. This is achieved both with the help of medications and with the help of specially selected physical exercises.
3. Angina. The patient develops pain or discomfort behind the sternum, in the left half of the chest, heaviness and a feeling of pressure in the region of the heart - as if something heavy had been placed on the chest. In the old days they said that a person has "angina pectoris". The pain can be different in nature: pressing, squeezing, stabbing. It can give (radiate) to the left arm, under the left shoulder blade, lower jaw, stomach area and be accompanied by the appearance of severe weakness, cold sweat, a sense of fear of death. Sometimes, during exercise, it is not pain that occurs, but a feeling of lack of air, passing at rest. The duration of an angina attack is usually a few minutes. Since pain in the region of the heart often occurs when moving, a person is forced to stop. In this regard, angina pectoris is figuratively called "the disease of shop window observers" - after a few minutes of rest, the pain, as a rule, disappears.
4. Cardiac arrhythmias and conduction disorders. Another form ischemic heart disease. It has a large number of different types. They are based on a violation of the conduction of an impulse along the conduction system of the heart. It is manifested by sensations of interruptions in the work of the heart, a feeling of "fading", "gurgling" in the chest. Heart rhythm and conduction disturbances can occur under the influence of endocrine, metabolic disorders, intoxication and drug exposure. In some cases, arrhythmias can occur with structural changes in the conduction system of the heart and myocardial diseases.
5. Heart failure. Heart failure is manifested by the inability of the heart to provide sufficient blood flow to the organs by reducing contractile activity. The basis of heart failure is a violation of the contractile function of the myocardium, both due to its death during a heart attack, and in violation of the rhythm and conduction of the heart. In any case, the heart contracts inadequately and its function is unsatisfactory. Heart failure is manifested by shortness of breath, weakness during exertion and at rest, swelling of the legs, enlargement of the liver and swelling of the jugular veins. The doctor may hear wheezing in the lungs.

Factors in the development of coronary heart disease

Risk factors are features that contribute to the development, progression and manifestation of the disease.

Many risk factors play a role in the development of coronary artery disease. Some of them can be influenced, others cannot. Those factors that we can influence are called removable or modifiable, those that we cannot influence are called irremovable or non-modifiable.

1. Non-modifiable. Fatal risk factors are age, gender, race and heredity. Thus, men are more prone to developing coronary artery disease than women. This trend persists until approximately 50–55 years, that is, until the onset of menopause in women, when the production of female sex hormones (estrogens), which have a pronounced “protective” effect on the heart and coronary arteries, is significantly reduced. After 55 years, the incidence of coronary artery disease in men and women is approximately the same. Nothing can be done about such a clear trend as the increase and aggravation of diseases of the heart and blood vessels with age. In addition, as already noted, race affects the incidence: residents of Europe, or rather those living in the Scandinavian countries, suffer from coronary artery disease and arterial hypertension several times more often than people of the Negroid race. Early development of coronary artery disease often occurs when the patient's direct male relatives had a myocardial infarction or died of sudden cardiac disease before age 55, and direct female relatives had a myocardial infarction or sudden cardiac death before age 65.
2. Modifiable. Despite the impossibility of changing either one's age or one's gender, a person is able to influence his condition in the future by eliminating avoidable risk factors. Many of the avoidable risk factors are interrelated, so eliminating or reducing one of them can eliminate the other. So, reducing the fat content in food leads not only to a decrease in blood cholesterol levels, but also to a decrease in body weight, which, in turn, leads to a decrease in blood pressure. Together, this helps to reduce the risk of coronary artery disease. And so we list them.

• Obesity is an excess accumulation of adipose tissue in the body. More than half of the world's people over the age of 45 are overweight. What are the reasons for being overweight? In the vast majority of cases, obesity is of alimentary origin. This means that the causes of overweight are overeating with excessive consumption of high-calorie, primarily fatty foods. The second leading cause of obesity is lack of physical activity.
• ischemic heart disease. Smoking is highly likely to contribute to the development ischemic heart disease, especially if combined with an increase in total cholesterol levels. On average, smoking shortens life by 7 years. Smokers also have increased levels of carbon monoxide in the blood, which reduces the amount of oxygen that can reach the body's cells. In addition, the nicotine contained in tobacco smoke leads to spasm of the arteries, thereby leading to an increase in blood pressure.
• An important risk factor ischemic heart disease is diabetes mellitus. If you have diabetes, the risk ischemic heart disease more than doubles on average. Patients with diabetes often suffer from coronary disease and have a worse prognosis, especially with the development of myocardial infarction. It is believed that with a duration of overt diabetes mellitus of 10 years or more, regardless of its type, all patients have a fairly pronounced atherosclerosis. Myocardial infarction is the most common cause of death in patients with diabetes.
• Emotional stress may play a role in development ischemic heart disease, myocardial infarction or lead to sudden death. With chronic stress, the heart begins to work with increased load, blood pressure rises, and the delivery of oxygen and nutrients to organs worsens. To reduce the risk of cardiovascular disease from stress, it is necessary to identify the causes of its occurrence and try to reduce its impact.
• Hypodynamia or lack of physical activity is rightly called a disease of the twentieth, and now the twenty-first, century. It is another avoidable risk factor for cardiovascular disease, so being physically active is essential to maintaining and improving your health. In our time, in many areas of life, the need for physical labor has disappeared. It is known that coronary artery disease is 4-5 times more common in men under the age of 40-50 who were engaged in light work (compared to those performing heavy physical work); in athletes, a low risk of coronary artery disease persists only if they remain physically active after leaving the big sport.
• Arterial hypertension is well known as a risk factor for CHD. Hypertrophy (increase in size) of the left ventricle as a consequence of arterial hypertension is an independent strong predictor of mortality from coronary disease.
• Increased blood clotting. Coronary artery thrombosis is the most important mechanism for the formation of myocardial infarction and circulatory failure. It also promotes the growth of atherosclerotic plaques in the coronary arteries. Disorders that predispose to increased thrombus formation are risk factors for the development of complications of coronary artery disease.
• metabolic syndrome.
• Stress.

metabolic syndrome

Metabolic syndrome is a pathological process that contributes to an increase in the incidence of diabetes mellitus and diseases based on atherosclerosis - coronary heart disease, myocardial infarction, stroke.

A mandatory sign of the metabolic syndrome is the presence of abdominal obesity (waist circumference of more than 94 cm for men and more than 80 cm for women) in combination with at least two of the following indicators:

• increase in the level of blood triglycerides more than 1.7 mmol / l;
• a decrease in high-density lipoprotein less than 1.03 mmol / l in men and less than 1.29 mmol / l in women;
• increased blood pressure: systolic more than 130 mm Hg. or diastolic more than 85 mm Hg;
• an increase in fasting blood glucose in the venous plasma of more than 5.6 mmol / l or previously diagnosed type II diabetes mellitus.

Prevention of coronary heart disease

All prevention of coronary heart disease comes down to a simple rule "I.B.S.".

I. Get rid of smoking.
B. Move more.
C. Watch your weight.

I. Getting rid of smoking
Smoking is one of the most important development factors ischemic heart disease especially if it is combined with an increase in total cholesterol levels. On average, smoking shortens life by 7 years.

The changes are to reduce the time of blood clotting and increase its density, increase the ability of platelets to stick together and reduce their viability. Smokers increase the level of carbon monoxide in the blood, which leads to a decrease in the amount of oxygen that can enter the cells of the body. In addition, the nicotine contained in tobacco smoke leads to spasm of the arteries, thereby contributing to an increase in blood pressure.
Smokers have a 2 times higher risk of myocardial infarction and 4 times the risk of sudden death than non-smokers. When smoking a pack of cigarettes per day, mortality increases by 100%, compared with non-smokers of the same age, and mortality from coronary artery disease - by 200%.
The association between smoking and heart disease is dose-dependent, meaning the more cigarettes you smoke, the higher your risk. ischemic heart disease.
Smoking cigarettes with low tar and nicotine levels or pipe smoking does not reduce the risk of cardiovascular disease. Passive smoking (when people smoke near you) also increases the risk of death from ischemic heart disease. It has been found that passive smoking increases the incidence of coronary disease by 25% among individuals working in a team of smokers.

B. Move more.
Hypodynamia or lack of physical activity is rightly called the disease of the XXI century. It is another avoidable risk factor for cardiovascular disease, so being physically active is essential to maintaining and improving your health. In our time, in many areas of life, the need for physical labor has disappeared.
It is known that ischemic heart disease 4-5 times more common in men under the age of 40-50 who were engaged in light labor (compared to those performing heavy physical work); athletes are at low risk ischemic heart disease persists only if they remain physically active after leaving the big sport. It is useful to exercise for 30-45 minutes at least three times a week. Physical activity should be increased gradually.

C. Watch your weight.
Obesity is an excess accumulation of adipose tissue in the body. More than half of the world's people over the age of 45 are overweight. In a person with normal weight, up to 50% of fat reserves lie directly under the skin. An important criterion for health is the ratio of adipose tissue and muscle mass. In muscles devoid of fat, the metabolic process proceeds 17-25 times more actively than in body fat.
The location of fat deposits is largely determined by the sex of a person: in women, fat is deposited mainly on the hips and buttocks, and in men - around the waist in the abdomen: such an abdomen is also called a “lump of nerves”.
Obesity is one of the risk factors ischemic heart disease. When you are overweight, your resting heart rate increases, which increases your heart's need for oxygen and nutrients. In addition, obese individuals tend to have a metabolic disorder of fats: high levels of cholesterol and other lipids. Among overweight people, arterial hypertension and diabetes mellitus are much more common, which, in turn, are also risk factors. ischemic heart disease.

What are the reasons for being overweight?

1. In the vast majority of cases, obesity is of alimentary origin. This means that the causes of overweight are overeating with excessive consumption of high-calorie, primarily fatty foods.
2. The second leading cause of obesity is lack of physical activity.

The most unfavorable is the abdominal type, in which fatty tissue accumulates mainly in the abdomen. This type of obesity can be recognized by waist circumference (>94 cm in men and >80 cm in women).

What to do when identifying overweight? An effective weight loss program is based on improving nutrition and increasing physical activity. More effective and physiological are dynamic loads, such as walking. The diet should be based on foods low in fat and carbohydrates, rich in vegetable proteins, microelements, and fiber. In addition, it is necessary to reduce the amount of food consumed.

Small fluctuations in weight during the week are completely natural. For example, women during menstruation can gain up to two kilograms in weight due to the accumulation of water in the tissues.

Complications of ischemic heart disease

Complications of coronary artery disease are subject to the following mnemonic rule "I.B.S.".

I. Myocardial infarction.
B. Blockade and arrhythmia of the heart.
C. Heart failure.

myocardial infarction

So, about a heart attack. Myocardial infarction is one of the complications of coronary artery disease. Most often, a heart attack affects people suffering from a lack of physical activity against the background of psycho-emotional overload. But the "scourge of the twentieth century" can also strike people with good physical fitness, even young ones.
The heart is a muscular sac that pumps blood through itself like a pump. But the heart muscle itself is supplied with oxygen through the blood vessels that come to it from the outside. And now, as a result of various reasons, some part of these vessels is affected by atherosclerosis and can no longer pass enough blood. Ischemic heart disease occurs. In myocardial infarction, the blood supply to part of the heart muscle stops suddenly and completely due to a complete blockage of the coronary artery. This usually leads to the development of a thrombus on an atherosclerotic plaque, less often - a spasm of the coronary artery. The section of the heart muscle deprived of nutrition dies. In Latin, dead tissue is a heart attack.

What are the signs of myocardial infarction?
With myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the sternum, extending to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin, it does not completely disappear and only briefly decreases. There is a feeling of lack of air, cold sweat, severe weakness, lowering blood pressure, nausea, vomiting, a feeling of fear may appear.
Prolonged pain in the region of the heart, which lasts more than 20-30 minutes and does not go away after taking nitroglycerin, may be a sign of myocardial infarction. Please refer to "03".
Myocardial infarction is a very life-threatening condition. Myocardial infarction should only be treated in a hospital. Hospitalization of the patient should be carried out only by the ambulance team.

Blockades and arrhythmias of the heart

Our heart works according to one single law: "All or nothing." It should work at a frequency of 60 to 90 beats per minute. If it is below 60, then this is bradycardia, if the heart rate exceeds 90, then they speak of tachycardia. And of course, our well-being depends on how it works. Violation of the heart is manifested in the form of blockades and arrhythmias. Their main mechanism is the electrical instability of cardiac muscle cells.

Blockades are based on the principle of disconnection, it's like a telephone line: if the wire is not damaged, then the connection will be, if there is a break, then it will not be possible to talk. But the heart is a very successful "communicator", and in the event of a break in communication, it finds workarounds for signaling thanks to a developed conduction system. And as a result, the heart muscle continues to contract even with “a break in some transmission lines,” and doctors, taking an electrocardiogram, register a blockade.
Arrhythmias are a little different. There is also a “break in the line”, but the signal is reflected from the “break point” and begins to circulate continuously. This causes chaotic contractions of the heart muscle, which affects its overall work, causing hemodynamic disturbances (blood pressure drops, dizziness and other symptoms occur). That is why arrhythmias are more dangerous than blockades.

Main symptoms:

1. Feeling of palpitations and interruptions in the chest;
2. very fast heartbeat or slow heartbeat;
3. Sometimes chest pains;
4. Dyspnea;
5. Dizziness;
6. Loss of consciousness or feeling close to it;

Therapy of blockades and arrhythmias includes surgical and therapeutic methods. Surgical is the installation of artificial pacemakers or pacemakers. Therapeutic: with the help of various groups of drugs called antiarrhythmics, and electrical impulse therapy. Indications and contraindications in all cases are determined only by the doctor.

Heart failure

Heart failure is a condition in which the ability of the heart to supply blood to organs and tissues in accordance with their needs is impaired, which, most often, is a consequence of ischemic heart disease. As a result of damage, the heart muscle weakens and cannot satisfactorily perform its pumping function, resulting in a decrease in the blood supply to the body.

Heart failure is often characterized according to the severity of clinical symptoms. In recent years, the New York Heart Association's classification for severity of heart failure has gained international recognition. Mild, moderate, severe heart failure is distinguished depending on the severity of symptoms, primarily shortness of breath:

• I functional class: only sufficiently strong loads provoke the onset of weakness, palpitations, shortness of breath;
• II functional class: moderate limitation of physical activity; performing normal physical activity causes weakness, palpitations, shortness of breath, angina attacks;
• III functional class: pronounced limitation of physical activity; comfortable only at rest; with minimal physical exertion - weakness, shortness of breath, palpitations, pain behind the sternum;
• IV functional class: inability to perform any load without discomfort; symptoms of heart failure appear at rest.

Non-drug therapy is aimed at reducing the severity of symptoms and thereby improving the quality of life of patients with moderate or severe heart failure. The main measures include the normalization of body weight, the treatment of hypertension, diabetes mellitus, the cessation of alcohol intake, the restriction of salt and fluid intake, and the fight against hyperlipidemia.
Scientific studies of recent decades have shown that moderate physical training in patients with chronic heart failure reduces the severity of symptoms of heart failure, but physical activity must be dosed and carried out under the supervision and supervision of a physician.
But, despite the progress in the medical therapy of heart failure, at present the problem of treating this serious condition, unfortunately, is far from being resolved. Over the past 15 years, there have been significant changes in the evaluation of the effectiveness of drugs used in heart failure.
If earlier the leading drugs were cardiac glycosides and diuretics, then at present the most promising are ACE inhibitors, which improve symptoms, increase physical performance and increase the survival of patients with heart failure, so their appointment is considered mandatory in all cases of heart failure, regardless of age sick.
And finally: it is currently believed that the most important factor determining the survival of patients with chronic heart failure, in addition to adequate medical treatment, is the tactics of patient management, which provides for regular and continuous (without interruption) long-term therapy under strict medical supervision.

How to detect angina pectoris without additional examinations

It is necessary to assess the clinical manifestations of the disease (complaints). Pain in angina pectoris has the following features:

• the nature of pain sensations: a feeling of compression, heaviness, bursting, burning behind the sternum;
• their localization and irradiation: pain is concentrated in the sternum, often the pain radiates along the inner surface of the left arm, to the left shoulder, shoulder blade, neck. Less often, pains "give" to the lower jaw, the right half of the chest, the right arm, to the upper abdomen;
• duration of pain: a painful attack with angina pectoris lasts more than one, but less than 15 minutes;
• conditions for the occurrence of a pain attack: the onset of pain is sudden, directly at the height of physical activity. Most often, such a load is walking, especially against the cold wind, after a heavy meal, when climbing stairs;
• factors that alleviate and / or stop pain: a decrease or disappearance of pain occurs almost immediately after a decrease or complete cessation of physical activity or 2-3 minutes after taking nitroglycerin under the tongue.

Typical angina:

Chest pain or discomfort of characteristic quality and duration
Occurs with physical exertion or emotional stress
Passes at rest or after taking nitroglycerin.

Atypical angina:

Two of the above signs.

Non-cardiac pain:

One or none of the above symptoms.

Laboratory studies in coronary heart disease

The minimum list of biochemical parameters for suspected coronary heart disease and angina pectoris includes the determination of the content in the blood:

• total cholesterol;
• high density lipoprotein cholesterol;
• low density lipoprotein cholesterol;
• triglycerides;
• hemoglobin;
• glucose;
• AST and ALT.

Diagnosis of coronary heart disease

The main instrumental methods for diagnosing stable angina pectoris include the following studies:

• exercise test (veloergometry, treadmill),
• echocardiography,
• coronary angiography.

Note. If it is impossible to conduct a test with physical activity, as well as to identify the so-called bosebolic ischemia and variant angina pectoris, daily (Holter) ECG monitoring is indicated.

Coronary angiography

Coronary angiography (or coronary angiography) is a method for diagnosing the state of the coronary bed. It allows you to determine the localization and degree of narrowing of the coronary arteries.

The degree of narrowing of the vessel is determined by a decrease in the diameter of its lumen compared to the proper one and is expressed in%. Until now, visual assessment has been used with the following characteristics: normal coronary artery, altered artery contour without determining the degree of stenosis, narrowing< 50%, сужение на 51-75%, 76-95%, 95-99% (субтотальное), 100% (окклюзия). Существенным рассматривают сужение артерии >fifty%. Hemodynamically insignificant is the narrowing of the lumen of the vessel< 50%.

In addition to the location of the lesion and its extent, coronary angiography may reveal other characteristics of arterial involvement, such as the presence of a thrombus, tear (dissection), spasm, or myocardial bridge.

There are currently no absolute contraindications for coronary angiography.

The main tasks of coronary angiography:

• clarification of the diagnosis in cases of insufficient information content of the results of non-invasive examination methods (electrocardiography, daily ECG monitoring, exercise tests, and others);
• determination of the possibility of restoring adequate blood supply (revascularization) of the myocardium and the nature of the intervention - coronary artery bypass grafting or angioplasty with stenting of the coronary vessels.

Coronary angiography is performed to resolve the issue of the possibility of myocardial revascularization in the following cases:

• severe angina pectoris III-IV functional class, which persists with optimal therapy;
• signs of severe myocardial ischemia based on the results of non-invasive methods (electrocardiography, daily ECG monitoring, bicycle ergometry, and others);
• the patient has a history of episodes of sudden cardiac death or dangerous ventricular arrhythmias;
• progression of the disease (according to the dynamics of non-invasive tests);
• questionable results of non-invasive tests in people with socially significant professions (public transport drivers, pilots, etc.).

Acute coronary heart disease is a group of heart diseases that are caused by circulatory disorders, that is, a complete or partial cessation of blood flow to the heart. This includes focal dystrophy, coronary death. We will discuss this in more detail below.

What it is?

Acute coronary heart disease (CHD) is a pathological condition that occurs due to insufficient blood supply to the myocardium. Due to the fact that blood flow is disturbed in the coronary arteries, the heart does not receive oxygen and nutrients in the right amount. And this leads to ischemia of the cells of the organ, which in the future is dangerous for the development of a heart attack, and death.

Men over 50 years of age are more susceptible to this disease, but its occurrence in women is also not excluded. To date, the disease has rejuvenated and is often found in young people.

Causes and risk factors

The main cause of acute ischemic disease is the narrowing of the coronary vessels responsible for the nutrition of the heart. Vascular stenosis is caused by the formation of atherosclerotic plaques on the walls of the arteries, as well as by blockage of the lumen by a thrombus. When the amount of lipoproteins in the blood increases, the risk of developing coronary heart disease increases 5 times.

The presence of certain diseases can become a predisposition to the occurrence of coronary heart disease:

• diabetes;
• heart diseases (malformations, tumors, endocarditis);
• kidney failure;
• chest trauma;
• oncological diseases;
• vascular pathologies;
• aggravated lung disease.

The likelihood of developing acute coronary heart disease increases with the presence of certain factors. These include:

• heredity;
• elderly age;
• overweight, improper diet;
• addictions (smoking, alcohol abuse, drug addiction);
• constant presence in stressful conditions;
• the use of oral contraceptives by women;
• sedentary lifestyle;
• helminthic invasions;
• cardiac operations.

Classification

The disease has several types of course. It is important to identify them in order to choose the right treatment. There are the following types of cardiac ischemia:

1. myocardial infarction is an acute condition that is necrosis of the heart muscle. It proceeds in 2 stages - 18-20 hours after the onset of acute ischemia, the death of muscle cells develops, and then the affected tissue is scarred. Often the cause of a heart attack is the detachment of a cholesterol plaque or blood clot, which disrupts the supply of oxygen to the heart. A heart attack can leave behind consequences such as aneurysm, cardiac failure, ventricular fibrillation, and this is dangerously fatal.
2. Sudden coronary death- occurs within 6 hours after the onset of acute ischemia. It occurs as a result of prolonged spasm and narrowing of the coronary vessels. As a result, the ventricles begin to function uncoordinated, the blood supply worsens, and then stops altogether. Causes that can provoke coronary death:

• ischemic process in the heart;
• thrombosis of the pulmonary artery;
• congenital defects;
• chest trauma;
• hypertrophy (enlargement) of the heart muscle;
• accumulation of fluid in the pericardial region;
• vascular diseases;
• severe intoxication;
• tumor, infiltrative processes.

Death occurs suddenly for no apparent reason within an hour after the onset of complaints.

1. Focal myocardial dystrophy- is not an independent disease, but is manifested by pronounced cardiac signs along with other diseases (, tonsillitis, anemia)

All of these forms are a serious danger to the health and life of the patient. The lesion extends to the brain, kidneys and limbs. If timely medical assistance is not provided, the outcome can be disastrous.

Clinical picture (symptoms)

The main complaints in coronary heart disease will be the appearance of severe pain in the sternum and shortness of breath. Sometimes an attack of acute ischemia of the heart begins abruptly, that is, sudden death against the background of complete health. But in many cases, the state of health worsens with the appearance of some symptoms:

• dizziness;
• nervousness, anxiety;
• cough;
• discomfort in the chest area;
• severe sweating;
• , increase or decrease in blood pressure;
• nausea;
• difficulty inhaling or exhaling;
• prostration;
• fainting;
• cold extremities.

Violation of the blood flow of the coronary vessels, which enrich the heart with oxygen, leads to myocardial dysfunction. Within half an hour, the cells are still viable, and then they begin to die.

Necrosis of all cells of the heart muscle lasts from 3 to 6 hours.

Diagnostics

If the patient is concerned about any complaints for a certain time, you should consult a doctor for advice. Perhaps these are alarming bells of coronary heart disease.

Based on the accompanying complaints, examination and additional examination, the doctor makes a diagnosis and selects the appropriate treatment. On examination, the cardiologist should pay attention to the presence of edema in the patient, coughing or wheezing, and also measure blood pressure. The next step should be the referral to laboratory and instrumental methods of examination. These include:

1. Electrocardiogram - the precursors of acute ischemia or infarction in the course are evidenced by pathological teeth in the results of the study. Also, using an ECG, a specialist can determine the time of onset of the pathological process, the volume of damage to the heart muscle, and the localization of the focus.
2. Ultrasound examination of the heart - allows you to identify changes in the body, the structure of the chambers, the presence of scars and defects.
3. Coronary angiography - makes it possible to assess the state of the coronary vessels, localization and degree of their narrowing, as well as to determine the presence of blood clots, atherosclerotic plaques in them.
4. Computed tomography - reveals all of the above changes in the body, but more reliably and quickly.
5. Blood test for cholesterol, sugar, protein enzymes.

Complications

The likelihood of complications depends on the extent of myocardial damage, the type of damaged vessel, and the time of emergency care.

In acute ischemia, the most common complication is myocardial infarction.

Also, the consequences of coronary disease include:

• cardiosclerosis;
• violations in the work of the myocardium (conductivity, excitability, automatism);
• dysfunction of contraction and relaxation of the chambers of the heart.

And the most dangerous and irreversible complication of this disease is acute heart failure, which can lead to death. About 75% of patients die from this complication of coronary artery disease.

Treatment

If the patient or you are suddenly disturbed by pain in the heart, it is necessary to call an emergency medical service and provide first aid before the arrival of doctors. The outcome of the attack depends on how quickly it is provided.

The patient must be laid on a horizontal surface and provided with a flow of fresh air. You can also put a Nitroglycerin tablet or Corvalol drops under his tongue.

Drug therapy for acute ischemic disease consists of the following drugs:

1. Drugs that dilate the coronary vessels - Papaverine, Validol.
2. Anti-ischemic drugs - Corinfar, Verapamil, Sustak.
3. Drugs that have an effect on atherosclerosis - Probucol, Crestor, Cholestyramine.
4. Antiplatelet agents - Curantyl, Aspirin, Thrombopol, Trental.
5. Statins - Lovastatin, Atorvastatin.
6. Antiarrhythmic drugs - Cordarone, Amirodarone, Difenin.
7. ATP inhibitors - Captopril, Enalapril, Kapoten.
8. Diuretics - Furosemide, Mannitol, Lasix.
9. Anticoagulants - Heparin, Phenylin, Warfarin.
10. Preparations for hypoxia - Mildronate, Cytochrome.

When there is no improvement from drug treatment, they resort to surgical interventions. There are 2 types of surgical treatment of acute ischemia of the heart:

• Angioplasty - by this procedure, the narrowed coronary vessel is expanded and a stent is inserted there, which will continue to maintain a normal lumen.
• Coronary artery bypass grafting - an anastomosis is applied between the aorta and the coronary vessel to provide full blood supply to the damaged artery by bypassing the damaged area.

At home, along with medicines, with the permission of the attending physician, traditional medicine methods can be used. They are aimed at stabilizing blood pressure and improving metabolism. The following compositions are recommended:

1. Garlic tincture. Take 50 grams of garlic, grate and pour 150 grams of vodka. Leave to thaw in a dark cool place for three days. Ready infusion take 8 drops 3 times a day for a week.
2. Herbal complex from ischemic heart disease. It is necessary to mix in equal proportions the grass of motherwort, hawthorn and chamomile. To prepare a decoction, pour 1 teaspoon of dry extract into 150 ml of boiling water and leave to infuse for about 20 minutes. Then strain and drink the entire volume on an empty stomach. Take this composition until the condition improves.

During the treatment of an acute period of coronary heart disease, as well as for the rest of his life, the patient must adhere to a healthy lifestyle. This refers to the observance of a balanced diet. That is, this is a limitation of the intake of daily amount of liquid and salt, the exclusion of fast carbohydrates and animal fats. And also you need to minimize physical activity, as they create an additional burden on the work of the myocardium.

Forecast

In most cases, the acute course of coronary artery disease ends in serious consequences and even death. An unfavorable prognosis awaits the patient if the disease developed due to arterial hypertension, diabetes mellitus and impaired fat metabolism. It should be remembered that it is in the power of doctors to slow down the progression of the disease, but not to cure it.

Prevention

In order to prevent coronary heart disease, both in healthy people and in people at risk, you need to follow simple but effective recommendations:

• to eradicate such addictions as smoking, love of alcoholic beverages;
• alternate work with leisure;
• introduce more vitamins, dairy products into the diet and exclude harmful foods;
• with a sedentary lifestyle, add physical activity;
• maintain normal body weight;
• control blood sugar and cholesterol levels;
• periodically undergo preventive examinations and take an ECG.

Compliance with these simple points prevents the likelihood of developing acute coronary disease and improving the lives of any category of people. For people who have suffered a myocardial infarction, prevention measures should become a way of life. Only in this case, you can live many more healthy years.

Ischemic heart disease is one of the most common diseases today. Ischemia combines angina, heart attack and atherosclerotic cardiosclerosis.

Medicines in the question of how to treat cardiac ischemia, unfortunately, are not always effective.

Cardiologists are increasingly inclined towards complex treatment of this disease.

Causes

Cardiac ischemia develops due to insufficient supply of the coronary arteries, which occurs due to the narrowing of their lumen. Why does such a phenomenon occur? With age, cholesterol deposits accumulate in the inner lining of the coronary arteries. This is due, first of all, to human nutrition: the more fatty and fried foods he consumes, the faster “bad” cholesterol accumulates in the blood. Gradually, atherosclerotic plaques grow, obscuring the arterial lumen and impeding blood flow leading to the heart.

Due to insufficient blood flow to the heart muscle, chest pains occur - angina pectoris. If you do not pay attention to this symptom in time and do not learn how to treat cardiac ischemia, there is a risk of myocardial infarction. What factors provoke the development of coronary heart disease? Physicians divide them into two groups - external and internal. The presence of at least one of the following factors significantly increases the risk of developing cardiac ischemia and other disorders of the cardiovascular system:

External

• Unbalanced nutrition. Overeating, the predominance of animal fats and easily digestible carbohydrates in the diet predisposes to the deposition of cholesterol;
• Sedentary lifestyle. Regular exercise strengthens the heart muscle and significantly reduces the risk of ischemia and other heart diseases;
• Psycho-emotional overstrain (stress, depression);
• Smoking and alcohol. Bad habits have a detrimental effect on the cardiovascular system, not only increasing the risk of ischemia, but also myocardial infarction;
• Long-term use of hormonal contraceptives.

Internal

• Hypertension. High blood pressure increases the risk of developing coronary disease by 2-6 times;
• High blood cholesterol. Promotes the growth of cholesterol plaques and, as a result, the narrowing of the lumen;
• Obesity;
• Violation of water and electrolyte metabolism. Long-term intake of water, devoid of salts of magnesium, potassium, chromium and other minerals, creates the prerequisites for the development of ischemia;
• Decreased thyroid function;
• Cholelithiasis;
• Violation of the body's ability to absorb glucose.

Symptoms

Depending on the form of coronary heart disease can proceed in different ways. However, cardiologists identify a list of characteristic symptoms for this disease:

• Arrhythmia (decrease or increase in heart rate);
• physical weakness;
• Shortness of breath after low-intensity exercise;
• Feeling of tightness in the region of the heart;
• Nausea;
• Cold clammy sweat.

Mental manifestations are also characteristic of coronary heart disease: groundless feeling of anxiety, dreary mood and apathy, severe suffocation.

Treatment

In many countries of the world, cardiac ischemia is the most common cause of morbidity and mortality in the population. How to treat ischemia of the heart in modern conditions? With serious complications of the disease, when it comes to severe vasoconstriction, surgical methods are used. In other cases, cardiologists resort to an integrated approach, including taking medications and changing the patient's lifestyle.

Preparations

Drug therapy is aimed at restoring the blood supply to the heart, as well as preventing complications of coronary heart disease. How do doctors suggest treating ischemia of the heart? The following groups of drugs are widely used:

• Beta blockers. Reduce the heart rate, lower blood pressure. Help prevent heart attack
• Nitroglycerine. The action of this drug is aimed at reducing chest pain and reducing the heart's need for oxygen. With angina attacks, nitroglycerin acts instantly, maintaining a therapeutic effect for several hours;
• Statins. Reduce cholesterol in the blood, resulting in changes in the walls of blood vessels. Statin drugs slow down the course of ischemia, preventing repeated heart attacks.

How to treat coronary heart disease?

In this article, we will look at how to properly treat coronary heart disease in adults.

Medical treatment

Drug treatment of coronary artery disease consists in taking drugs that improve blood circulation in the heart, and exhibit vasodilating, diuretic, and blood-thinning effects. The main groups of these drugs are nitrates, antiplatelet agents, B - blockers, diuretics, cardiac, calcium channel blockers.

Nitrate preparations(nitroglycerin, nitrogranulong) have a rapid vasodilating effect, allowing you to stop (remove) an angina attack for 3-5 minutes. after their sublingual (under the tongue) intake.

The permissible single dose of nitroglycerin should be no more than 3 tablets every 10 minutes. If after 3 times taking this drug, the effect does not occur (an attack of pain or compression behind the sternum has not been removed), then in this case it can be regarded as an acute myocardial infarction. in which you need to immediately call an ambulance and hospitalize the patient in the hospital.

Also, it should be remembered that nitroglycerin has a fairly strong hypotensive effect (lowers blood pressure), therefore, it should not be taken by patients whose blood pressure is less than 100/60 mmHg.

In addition, after taking nitroglycerin, headaches are possible as a result of a sharp effect on the vessels of the brain, so it is recommended to take it together with a validol tablet under the tongue at the same time as nitroglycerin.

Nitrate preparations are quite strong heart remedies, so they are recommended to be taken only in cases of emergency.

There are drugs similar to nitroglycerin containing its main composition of the therapeutic substance, but in a smaller amount, for example, corvalment or its analogue corvaltab.

Corvalment, like nitroglycerin, is a very good remedy for relieving such angina attacks, but unlike it, it has a rather beneficial effect on the body. It should be taken 1 capsule under the tongue until completely absorbed with a feeling of discomfort or pain in the heart area.

B - blockers in the complex treatment of coronary artery disease are indispensable components.

Their main therapeutic effect is aimed at improving the normal supply of oxygen to the muscles of the heart, namely to the myocardium.

This group includes bisoprolol, as well as metoprolol, etc. These drugs should be taken on an ongoing basis for 1 t. 2 r. for a day. The course of treatment is prescribed by the attending physician, since there are a fairly large number of various contraindications for taking these drugs, such as the presence of chronic bronchial asthma in a patient. or various infectious diseases of the lung cavity.

Taking antiplatelet agents(aspirin, cardiomagnyl) can significantly improve blood circulation in the cardiovascular system and prevent the formation of blood clots, by "thinning" the blood. Daily intake of aspirin avoids the development of serious complications of coronary disease, such as acute coronary insufficiency or myocardial infarction.

Cardiomagnyl is a combined preparation containing aspirin in its composition, as well as asparkam, which is needed to improve the functioning of the heart (contains potassium and magnesium, the main substances for normalizing the functioning of the heart).

Cardiomagnyl is recommended to take 1 tablet after meals, mostly at bedtime. The main course of treatment is prescribed by a cardiologist, on average it is 1-2 months with intervals of 1-1.5 weeks. After this period, the treatment course can be repeated.

Heart remedies prescribed in the complex treatment of the disease. They significantly improve the functioning of the heart and the cardiovascular system. The main drugs are digoxin, asparkam, verapamil. Asparkam preparations improve the functioning of the heart very well, due to the presence in their composition of trace elements of potassium and magnesium, which are necessary for the full functioning of the myocardial heart muscle.

Basically, they should be taken in 1 t. 2 - 3 r. per day for 1 - 2 months, then the treatment course can be repeated in consultation with your doctor - a cardiologist.

Diuretics (diuretics) drugs play an important role in the treatment of coronary artery disease. This group of drugs includes: furosemide, hypotazid, dibazol, veroshpiron, etc.

Taking these drugs can significantly improve the excretion of excess fluid from the body, which speeds up the overall period of rehabilitation (recovery).

Basically, furosemide is prescribed 1 tablet every other day along with asparkam, since it flushes out the potassium and calcium needed by the body, and asparkam restores it. The course of treatment with furosemide is generally 1-2 months. 1 ton every other day.

vitamins It is recommended to take to significantly improve the work of the cardiovascular system and strengthen the immune defenses of the body. The most effective cardiac vitamins are undevit, cardiofit, dekamevit, etc., which should be taken in 1 t. 2 r. per day for 1 month.

Attention: do not self-medicate coronary artery disease, as this can only aggravate the general course of the disease and provoke the development of undesirable complications, be sure to consult your cardiologist about treatment!

Surgery

• coronary bypass grafting (surgical intervention connects the coronary vessels of the heart);
• balloon angiography;
• coronary artery bypass grafting (connection of the aorta to the coronary arteries of the heart).

Prevention

• complete rejection of bad habits (alcoholism, smoking);
• complete, balanced diet (fruits, vegetables);
• physical therapy and sports;
• constant stabbing of your body (taking baths with cool water, etc.);
• timely treatment of chronic diseases of the body that contribute to the development of ischemic heart disease.

In this article, we found out how to treat coronary heart disease.

Treatment of the heart (angina pectoris, ischemia, heart pain) with folk remedies.

Angina pectoris or "angina pectoris" is one of the stages in the development of coronary heart disease. These are periodic contractions (spasms) of blood vessels and disturbances in the blood supply to the heart. Most often, angina pectoris develops in old age, and in men 3-5 times more often. This is explained by the fact that estrogens (female hormones) before the onset of menopause protect the body from cholesterol deposits on the walls of blood vessels. Ischemic heart disease (CHD) is a pathological condition characterized by an absolute or relative impairment of myocardial blood supply due to damage to the coronary arteries of the heart.

Treatment of angina pectoris, coronary artery disease, folk remedies:

Adonis from tachycardia. from pain in the heart. Prevention of heart disease.

Pour one quarter liter of water into a saucepan, boil water. As soon as the water boils, reduce the fire. While the boil is small (just a little near the edges of the saucepan), pour in 4-5 g (tablespoon) of Adonis spring grass (Adonis). Boil over low heat for no more than 3 minutes. Then cover the pan and put in a warm place for 20 minutes to infuse the broth. Strain and discard the herb. Drink 3 times a day, 1 tablespoon. The abnormal beating of the heart stops after taking this remedy.

You can take a course of prevention of heart disease adonis. 1 tbsp adonis pour 1 tablespoon of boiling water, boil for 5 minutes over low heat. Insist 5 hours. Strain. Drink 1 tsp. in the morning on an empty stomach before breakfast for 10-12 days. This remedy can be used as first aid for heart pain. Treatment should be carried out only in courses, strictly observing the dosage.

Relieve sudden heart pain.

• In half a glass of warm boiled water, stir 0.5 teaspoon of baking soda and drink.
• Put 10-12 drops of fir oil on the palm of your hand and rub into the heart area for 1-2 minutes.
• Massage your little fingers.
• Grasp the wrist of the left hand with the right hand, find the pulse on the left hand with the thumb and press it 10-12 times, give a push to the heart. Then, with the thumb and forefinger, rub the little finger of the left hand up and down, also 10-12 times. Sit quietly, and after 5 minutes the heart will calm down.

Ivan tea is harvested and dried from July to September. In winter, brew: 2 tbsp. spoons for 1 cup of boiling water. A pleasant and healthy tea for heart health.

Help the heart.

The infusion is prepared from hawthorn berries. 25 g of fruits should be poured into a thermos and pour 200 ml of boiling water. Infused for 4 hours. Then the infusion must be filtered. This is the daily dose. It should be drunk - in 4 doses of 50 ml before meals. The recipe is simple, but the effect is great. Sleep will improve, weakness will disappear, and consequently blood pressure will also normalize.

A prescription for atherosclerosis, angina pectoris, hypertension, ischemia and other heart diseases.

Two compositions are prepared separately. The first composition: natural honey - 500g. vodka 40% - 500g. Mix both components, heat over moderate heat until foam forms on the surface. Then remove from heat, let stand. Second composition: motherwort . cottonweed marshmallow, valerian root, knotweed . chamomile. Take a pinch of each herb, brew a liter of boiling water, leave to stand for 1-2 hours, then strain through cheesecloth. Mix the first composition with the second, then put the medicine in a dark place for three days. Take the first week on a teaspoon 2 times a day. Starting from the second week, take a tablespoon 2 times a day until used up. Keep refrigerated. After a 7-10 day break, prepare the elixir again and continue treatment, the full course is 1 year.

Rosehip and hawthorn for heart health.

In a 2-liter saucepan, put 7 tbsp. (with top) hawthorn berries and wild rose. pour water, boil over low heat for 15 minutes and wrap it warmly, insist for a day. Strain and refrigerate. Drink 0.5 - 1 glass 3 times a day after meals instead of tea.

Astragalus for angina attacks and chest pain.

10-15 gr. astragalus brew a glass of boiling water, leave for 1 hour. Take 1-2 tbsp. 3-4 times a day. This infusion will relieve venous pressure, increase blood flow, remove tachycardia, relieve swelling, and normalize blood pressure. After its regular intake, angina attacks and chest pains will pass. This infusion treats the kidneys.

Help the heart, blood vessels, nervous system.

To help the heart, blood vessels, nervous system, take fresh juice from leaves and roots from May to October dandelion. Pass the plant through a meat grinder, squeeze out the juice. Drink 30 drops 4 times a day. The walls of blood vessels are strengthened, memory improves, irritability decreases, and insomnia disappears.

Heart tincture.

Prepare like this. Buy in a pharmacy for 100 ml of tinctures peony evasive, valerian, hawthorn, motherwort and add 50 ml of tincture to them eucalyptus and 25 ml of tincture mint. Mix everything in a half-liter bottle and add 10 cloves (spice).

Put the bottle with the "cocktail" in a dark place for two weeks, shake occasionally. Take the medicine 3 times a day for 15-20 minutes. before meals, 20-25 drops, diluting with a small amount of water or dripping on sugar. The course of treatment is a month. After a short break, you can repeat.

The spectrum of action of such treatment is very extensive: it lowers intracranial pressure and normalizes arterial pressure, has an antispasmodic and anticonvulsant effect, helps with varicose veins, improves cerebral circulation, prevents the formation of blood clots, and stimulates hematopoiesis.

Remedy for heart disease.

Buy a glass of seeds carrots. Pour them with 70% alcohol and a glass of freshly squeezed carrot juice. Then pour everything into a bottle and put in a dark place for a week. Drink 3 times a day for 1 tbsp. 15-20 minutes before meals. Drink one bottle - a break for a week (during this time you will make a new tincture) and again take a course. Spend several courses and your doctor will like your cardiogram.

Kalina from heart failure.

People suffering from heart failure should have 3-4 courses of viburnum treatment per year for a month. There is viburnum both fresh and frozen, but this does not make it worse. You can prepare a healing infusion like this. 1 tablespoon berries viburnum mash a little to bring out the juice. Add a tablespoon of honey to this mass, mix and pour a glass of boiling water. Leave for 1 hour to infuse. Drink this infusion 2 times a day for half a glass. The course of treatment lasts a month. If you don't like this method, you can use any other. Kalina benefits the heart in any form.

Murraya for arrhythmia, tingling and pain in the heart.

For those with heart problems, grow a houseplant at home - murraya. Five ripe berries, cut in half, five crushed leaves and fallen flower petals, pour vodka in a 100-gram bottle and insist in a dark place for two weeks. Take 18-20 drops in 20 minutes. before meals. The condition will improve quickly. Pain, tingling in the heart disappear, arrhythmia disappears.

Tea that strengthens the heart.

First, such a mixture is prepared: 1 part of rose hips and squeezed berries sea ​​buckthorn(pulp without juice), 1/2 part hawthorn fruit. Then pour 2 teaspoons of the mixture with a glass of boiling water, leave for 2 hours and add honey to taste. To strengthen the heart, such tea should be drunk for at least a month, and better - constantly with breaks of two or three weeks. And in the fall, be sure to drink such tea. Since sea buckthorn should be fresh, you can mix rose hips and hawthorn in the required proportion, and already separately squeezed sea buckthorn with honey (store in the refrigerator).

Jaundice will relieve heart disease.

jaundice- a find and salvation for a sick tired heart. He can overcome "angina pectoris" (angina pectoris), he restores the heart muscle affected by a heart attack, is necessary for heart defects, myocarditis, acute and chronic heart failure, calms the central nervous system, improves mood, brings a good, restful sleep. Jaundice stops hypertensive crises, stabilizes blood pressure, eliminates arrhythmia, tachycardia, shortness of breath. raises people after heart attacks, strokes. And in addition, the work of the pancreas is normalized. For a month, 2-3 kg of excess weight are dumped. Jaundice is also needed for varicose veins, thrombophlebitis. Drink jaundice to prevent a heart attack. There are many species of jaundice, but gray and levkoy are the most healing (they have similar properties). You can grind the herb and take a dry powder of 0.1 g (at the tip of a teaspoon) 3 times a day 10-15 minutes before meals. The course of treatment is 2 months, a break of 3 weeks. Drink several courses. You can take kvass from jaundice

Herbal collection for angina pectoris, heart failure, rhythm disturbances.

From many problems with the heart, herbal collection will help. It contains herbs that dilate blood vessels, relieve heart pain, normalize heart rate and blood pressure: odorous rue . spring book(rank), gray jaundice, arnica mountain and zyuznik European. All components are taken in equal parts in a dry crushed form. 2 tsp with the top of the collection pour 2 tbsp. boiling water, leave for an hour, strain. Drink 3 times a day for 0.5 tbsp. adding 0.5 tsp. honey. The treatment cycle is a month. Break 8-10 days and repeat 1-2 cycles again. It is desirable to conduct at least two courses of treatment per year.

Sochevichnik spring regulates cardiac activity and relieves heart pain. Jaundice gray reduces blood pressure, increases the rate of coronary blood flow, is the best remedy for dropsy.

Arnica mountain improves heart function in angina pectoris, myocarditis and cardiosclerosis. It is very effective in hypertension.

Zyuznik European normalizes the heart rate during tachycardia, has a strong calming effect, relieves the feeling of causeless fear and insomnia.

Rue is an excellent antidepressant. It relieves spasms of blood vessels, improves blood supply to internal organs. It is used for angina pectoris, hypertension, atherosclerosis and nervous excitability.

Together with the herbal collection, drink mummy. Shilajit is necessary for heart diseases, atherosclerosis and hypertension. It perfectly relieves spasms of the heart vessels in coronary disease and dilates the vessels of the retina.

You need to take mummy 0.2 g each (if it is a pharmacy drug, then one tablet each), put under the tongue and dissolve with a small amount of honey. The pain in the heart immediately passes, it brightens in the eyes. The effect is much more effective than from validol. Therefore, it is useful for all cores to have this natural product in the home medicine cabinet. But mummy should be treated regularly, in cycles, take the remedy in the morning on an empty stomach and in the evening before going to bed. Ten days to drink, five days - a break. And so - three cycles.

Collection from heart failure.

Take 2 tablespoons of rose hips, dry leaves raspberries . currants black and cranberries. Grind everything well and brew 750 ml of boiling water. Put on fire and simmer on low heat for 10-15 minutes. After this, the broth must be insisted for another 4 hours. Then strain through 2 layers of gauze. It is necessary to take a decoction in half a glass 3 times a day. It is advisable to add 3 tbsp to each dose of decoction right before use. light low-alcohol beer. It, together with a healing decoction, has a very good effect on the cardiovascular system. The course of treatment is 4 weeks. After that, you need to take a break for a month or two and repeat if necessary. Carry out such treatment every year. Very good result.

Collection for the health of the cardiovascular system.

The herb cudweed marsh is mixed with lemon balm. valerian root, buds hops. flowers lindens. grass oregano. motherwort and seed coriander. All herbs are taken in equal proportions - 1 tbsp. l. Then you need to brew the collection in a thermos at the rate of 1 tbsp. l. (with top) collection of 0.5 liters of boiling water. Insist night. You need to drink this portion per day in 2-3 doses as desired. In addition to strengthening the immune system, this collection relieves arrhythmia, improves the state of the cardiovascular system. Drink this tea 3 times a week constantly if you have heart problems.

If you have verified folk recipes for the treatment of heart failure, angina pectoris, coronary artery disease and other heart diseases, write. Thanks in advance.

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