Ischemic heart disease signs. Diagnosis and treatment of chronic coronary heart disease treatment. Blockades and arrhythmias of the heart

Scientific editor: Strokina O.A., practicing therapist, doctor of functional diagnostics. Work experience since 2015.
August, 2018.

Coronary artery disease (CHD) is a disease caused by a mismatch between the need of the heart muscle for oxygen and its delivery, leading to dysfunction of the heart. In Russia and many European countries, this pathology is one of the main causes of premature mortality, and this figure is growing from year to year.

Risk factors

• male gender (in young and middle age, men suffer from coronary artery disease more often, with age the incidence becomes the same)
• age over 65 years, although at the present time IHD is “getting younger”
• smoking
• alcohol abuse
• hypodynamia (low physical activity)
• heredity
• dyslipidemia - a violation of the lipid composition of the blood, in which the content of "bad" cholesterol - low-density lipoprotein (LDL) increases and the content of high-density lipoprotein (HDL) decreases
• diabetes
• arterial hypertension
• increased heart rate
• disorders in the blood clotting system, such as increased blood clots
• overweight (the most dangerous is the abdominal type of obesity, it may be indicated by a waist circumference > 88 cm in women and > 102 cm in men).
• severe or prolonged stress
• use of combined oral contraceptives

Causes

• atherosclerosis of the coronary arteries (up to 95% of cases)
• spasm of normal coronary arteries (rare)

Types of coronary heart disease

• Sudden coronary death (primary cardiac arrest)
• angina pectoris
  • exertional angina
  • spontaneous rest angina
• Painless myocardial ischemia
• Cardiac X syndrome
• Postinfarction cardiosclerosis

Angina with coronary artery disease and its symptoms

It is necessary to dwell in more detail on angina pectoris, tk. this is the most common manifestation of IHD.

Angina is manifested by the following symptoms:

• pain behind the sternum of a pressing or squeezing nature,
• pain may radiate to the left arm, shoulder, lower jaw,
• relieved at rest or with nitroglycerin.

Such a clinic may occur in response to the following factors:

• more common after exercise
• with an increase in blood pressure,
• in the cold
• after a heavy meal,
• with severe emotional stress.

The duration of the attack is usually a few minutes.

• With stable angina, pressing pain occurs with a certain physical activity (for example, the patient walks 200 m).
• Progressive angina is diagnosed when exercise tolerance decreases over time (i.e., the patient can tolerate less and less exercise without an attack). Progressive and first-time angina are unstable and require immediate medical attention, and sometimes hospitalization.
• With angina at rest, attacks often occur at night, in the early hours, may be accompanied by fear of death, a feeling of lack of air.

Diagnostics

For the diagnosis of coronary heart disease, first of all, the patient's complaints are important, since coronary artery disease is primarily a clinical diagnosis. To confirm it, laboratory and instrumental research methods are used.

Laboratory:

• complete blood count (possible leukocytosis; decrease in hemoglobin with non-vascular causes of pain)
• biochemical blood test (elevated cholesterol and LDL, low HDL, increased glucose levels).

Instrumental Methods

Invasive

• coronary angiography (X-ray examination of blood vessels using a contrast agent, often combined with a surgical method for the treatment of coronary artery disease - stenting),
• intravascular ultrasound (visualization of atherosclerotic plaques in coronary vessels, is used extremely rarely due to the low availability of technology),
• transesophageal electrical stimulation (for the diagnosis of latent coronary insufficiency when it is impossible to use non-invasive examination methods).

These procedures are carried out only in a hospital.

non-invasive

• ECG (ischemic changes)
• 24-hour Holter ECG monitoring
• ECG with exercise (bicycle ergometry or treadmill test on a treadmill)
• ECHO-KG (echocardiography) at rest
• ECHO-KG with pharmacological or physical stress
• radionuclide methods (the substance is distributed in the myocardial tissue and clearly visualizes areas with insufficient blood flow)
• MRI of the heart (for imaging problems with ECHO-KG).

Treatment of coronary heart disease

The main principle of therapy for coronary heart disease is the restoration of blood flow to damaged areas of the myocardium and the prevention of complications.

There are 2 main directions in the treatment of IHD:

1. Relief of an angina attack:

• need to stop physical activity,
• provide access to fresh air,
• take nitroglycerin under the tongue, or use nitrate spray.

2. Basic therapy.

Non-drug remedies

To give up smoking

Dieting.

• reducing the consumption of animal fats up to 30% of the total energy value of food,
• reducing saturated fat intake to 30% of total fat,
• cholesterol intake no more than 300 mg / day
• increased consumption of fresh fruits, plant foods, cereals,
• limiting total calorie intake when overweight,
• reducing salt and alcohol intake in high blood pressure.

• fast walk,
• jogging,
• swimming,
• cycling and skiing,
• tennis,
• volleyball,
• dancing with aerobic exercise.

In this case, the heart rate should be no more than 60-70% of the maximum for a given age.

The duration of physical exercises should be 30-40 minutes:

• 5-10 min warm-up,
• 20-30 min aerobic phase,
• 5-10 min final phase.

Regularity 4-5 r / week (with longer sessions - 2-3 r / week).

With a body mass index of more than 25 kg/m2, weight loss is required through diet and regular exercise. This leads to a decrease in blood pressure, a decrease in the concentration of cholesterol in the blood.

Medical therapy

With high blood pressure, antihypertensive therapy is prescribed in the absence of the effect of non-drug treatment (see arterial hypertension). The optimal blood pressure is considered to be less than 140/90 mm Hg.

The treatment of diabetes mellitus consists in the correct selection of hypoglycemic therapy and careful monitoring of blood glucose levels.

Treatment of atherosclerosis is an essential component in the treatment of coronary artery disease. The most common statins for this purpose are:

• rosuvastatin,
• atorvastatin,
• simvastatin

While taking these drugs, it is necessary to control the lipid spectrum and liver parameters (ALT, AST, CPK, LDH) once every 3 months.

Less common are fibrates, such as fenofibrate.

Antiplatelet therapy:

• acetylsalicylic acid (it is better to use not ordinary aspirin, but more modern drugs, such as Cardiomagnyl or Thrombo-Ass, since they are less aggressive on the gastric mucosa)
• in some cases, clopidogrel is indicated.

Beta-blockers reduce myocardial oxygen demand. Currently, it is preferable to use selective drugs:

• bisoprolol,
• metoprolol,
• nebivolol,
• carvedilol.

calcium antagonists:

• amlodipine,
• nitrendipine, etc.

Prolonged nitrates (it should be noted that when taking this group of drugs, headache is a common complication, and a pronounced decrease in blood pressure is also possible.)

• isosorbide dinitrate,
• isosorbide mononitrate.

Other anti-ischemic drugs:

• trimetazidine,
• ranolazine,
• ivabradine.

Surgery

Surgical treatment of coronary heart disease also plays a certain role today. For this, methods of revascularization (restoration of blood flow) of the myocardium are used. These include:

• coronary artery bypass grafting is a complex operation on the heart vessels to bypass the site of narrowing with the help of vascular prostheses.
• percutaneous intervention - stenting (restoration of the lumen of the vessel by placing a stent or frame inside the vessel).

Sources:

• Ischemic heart disease and atherosclerotic lesions of the carotid arteries. - National Clinical Guidelines, 2016
• Stable ischemic heart disease.
• Acute coronary syndrome without ST elevation of the electrocardiogram in adults. - National Clinical Guidelines, 2016.

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 condition of the coronary vessels, the 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.

Coronary artery disease (CHD) is a pathological process during which damage is caused to the myocardium due to impaired blood flow in the coronary arteries. That is why medical terminology suggests another name for the disease - coronary heart disease. At the first stage of formation, the disease develops asymptomatically, and only after the patient may experience an attack of angina pectoris. Treatment of pathology can be carried out with the help of medications or surgery. Everything here determines the degree of damage to the pathology.

Risk factors

Like all internal organs, the heart cannot function without a blood supply. Two coronary arteries are responsible for delivering the required amount of blood to the myocardium. They arise from the aorta in the form of a crown, and then divide into small vessels. Those, in turn, are responsible for delivering blood to specific areas of the heart muscle.

There is no other way of blood supply to the myocardium, therefore, with thromboembolism of any small vessel, oxygen starvation of the heart occurs, and this already leads to the formation of coronary heart disease.

Coronary artery disease is considered to be the underlying cause of coronary heart disease. It is characterized by overlapping cholesterol plaques or narrowing of the heart arteries. Therefore, the heart does not receive the necessary amount of blood for its normal functioning.

Symptoms

Symptoms of coronary heart disease begin to make themselves felt gradually. The first signs of a lack of oxygen to the myocardium can be recognized while running or walking fast. Violation of myocardial metabolism can be detected by such manifestations as chest pain when a person is at rest. The frequency of angina attacks depends on how much the lumen in the coronary artery has become smaller.

Together with angina pectoris, a person can attend in a chronic form. It is characterized by shortness of breath and increased swelling.

The lumen of the artery is completely closed when the plaque ruptures. These events can cause a heart attack or cardiac arrest. Here, the determining factor is the section of the heart muscle that has been affected. If a large artery is completely closed, then the patient will face serious consequences, even death.

The symptoms of coronary heart disease are very diverse and can manifest themselves in the clinical form that they accompany. Most often, the patient is visited by the following signs of coronary heart disease:

• chest pain affecting the left arm or shoulder;
• heaviness behind the sternum;
• apathy and shortness of breath.

If a person has been visited by the symptoms presented or there is at least one risk factor, then the doctor is obliged to ask him about the features of the pain syndrome and about the conditions that could provoke it.

As a rule, patients are aware of their illness and can accurately describe all the causes, the frequency of seizures, the intensity of pain, their duration and nature, taking into account physical activity or taking specific medications.

Varieties of coronary heart disease

Ischemic heart disease can be represented by various types. The classification of the disease is relevant and is used today by all doctors, despite the fact that it was developed in 1979. It presents individual forms of coronary heart disease, which are characterized by their symptoms, prognosis and therapy. Today, IHD has the following clinical forms:

1. Rapid coronary death.
2. Seizure.
3. Myocardial infarction.
4. Postinfarction cardiosclerosis.
5. Insufficient circulation.
6. Violation of the rhythm of the body.
7. Painless myocardial ischemia.
8. Microvascular ischemic heart disease.
9. New syndromes of ischemia.

Of all the described forms, most often patients are diagnosed with myocardial infarction, angina pectoris and rapid coronary death. Therefore, we will consider them in more detail.

angina pectoris

This disease is considered the most common symptom of coronary heart disease. Its development is associated with atherosclerotic damage to the vessels of the heart, resulting in blood clots and blockage of the lumen of the artery. Damaged vessels are not able to fulfill their direct duties of carrying blood, even if a person performs minor physical exertion. The result of this process is a disturbed metabolism, which is manifested by pain.

Signs of coronary heart disease in this case are as follows:

1. Pain in the chest, which has a paroxysmal character. They affect the left arm, shoulder, in some cases, the back, shoulder blade.
2. Violation of the rhythm of the heart.
3. Increase in blood pressure.
4. The occurrence of shortness of breath, feelings of anxiety, pallor of the skin.

Depending on what causes provoked angina pectoris, the following variants of its course are distinguished. She may be:

1. Tense, if it arose against the background of some kind of load. If you take nitroglycerin, then all the pain disappears.
2. Spontaneous angina pectoris is a form of coronary heart disease, which is characterized by the presence of pain without justified reasons and the absence of physical exertion.
3. Unstable angina is a form of coronary heart disease that is characterized by the progression of the disease. Here there is an increase in pain and an increased risk of acute myocardial infarction and death. The patient is increasingly using medication, as his condition has deteriorated significantly. With this form of the disease, immediate diagnosis and urgent therapy are required.

myocardial infarction

Ischemic heart disease often manifests itself in the form of myocardial infarction. Here, the necrosis of the muscle of the organ occurs due to the sudden cessation of blood supply to it. Most often, the disease affects men than women, and for the following reasons:

1. Atherosclerosis develops later in the female half of the population due to hormonal status. After the onset of menopause, there is a greater percentage of the likelihood of myocardial infarction. Already by the age of 70, the disease can affect both men and women equally.
2. Men drink more alcohol and smoke.

In addition to the risk factors presented, the following causes can contribute to the occurrence of myocardial infarction:

• violation of the coagulation and anticoagulation systems;
• insufficient development of "bypass" ways of blood circulation;
• violation of metabolism and immunity in combination with damage to the heart muscle.

This form of coronary artery disease is characterized by the death of the patient, which most often occurs in the presence of witnesses. It occurs instantly or within 6 hours from the time the heart attack occurred.

Coronary heart disease in this form is manifested by loss of consciousness, respiratory and cardiac arrest, dilated pupils. In this state of affairs, it is urgent to take therapeutic measures. If you immediately provide medical assistance to the victim, then he has a chance for life.

But, as practice shows, even timely resuscitation does not reduce the risk of death. In 80% of cases, the patient dies. This form of ischemia can affect young and old people. The reason is a sudden spasm of the coronary arteries.

Consequences of the disease

Ischemic heart disease due to untimely treatment can provoke many complications:

1. Postinfarction cardiosclerosis.
2. Chronic heart failure.
3. Acute heart failure.
4. Cardiogenic shock.

Therapeutic activities

How to treat coronary heart disease? Therapy of the disease implies a set of measures, thanks to which it is possible to normalize the delivery of the required amount of blood to the myocardium to eliminate the consequences. Therefore, the treatment of coronary heart disease involves drugs whose action is aimed at regenerating this balance.

Surgical treatment

When drug therapy has not given its positive result, the patient is prescribed surgical treatment for coronary heart disease. During the operation, the surgeon cleans the arteries from cholesterol.

There are situations when coronary heart disease occurs due to a slight hardening of platelets. Therefore, it is not possible to cite procedures such as stenting or angioplasty. If such a pathology occurs, you can try to remove a blood clot using a special medical device that looks like a drill. The effectiveness of such treatment of coronary heart disease is achieved when the vessel is affected in a separate area of ​​the artery.

Brachytherapy

Ischemic heart disease is a pathology that is actively treated today with the help of radiation. This technique is used in the case when secondary damage to the vessels of the organ occurred after angioplasty. Such treatment is prescribed when diagnosing a severe form of coronary artery disease.

The presented type of surgical therapy includes standard measures. It is advisable to carry it out when the causes of the disease are numerous blockages of the artery. The operation takes place using the blood capillaries of the internal mammary artery.

The essence of the operation is that the patient is connected to the device, thanks to which artificial blood circulation is carried out. It functions instead of the heart muscle at the time of surgery. The organ itself is forcibly stopped for a while. Such therapy is in great demand, since after it there are practically no complications. It is possible to reduce the number of side effects during open heart surgery, but it is not always possible to use such manipulation.

Minimally invasive coronary surgery

It is advisable to carry it out if the causes of IHD are blockage of the first and anterior coronary arteries. In this situation, the surgeon, instead of the damaged vessel, installs the artery that was taken from the victim from the chest. Such treatment does not involve a complete opening of the sternum.

The method of indirect myocardial revascularization with a laser

Such therapy is prescribed when surgery and angioplasty are not possible. During the operation, the heart muscle is pierced in several places using a laser. New blood vessels form at the punctured sites. The operation can be performed as a separate therapy and as a systemic approach.

Ischemic heart disease is a very serious and dangerous disease that contributes to the formation of a large number of complications, one of which is death. The success of treatment depends on the form and severity of the disease. In this case, it is very important to determine the causes of the disease and its manifestations in time.

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Answer only if you have proven medical knowledge

The heart is not in vain compared to the engine of the human body. And if this engine malfunctions, it can disable the entire body. The heart, as a mechanism, is characterized by high reliability, however, it can also be susceptible to various diseases. The most dangerous of them is ischemic disease. What are the manifestations of this disease, and what does it threaten a person with?

Description of the disease

Everyone knows that the purpose of the heart muscle (myocardium) is to supply the body with oxygenated blood. However, the heart itself needs blood circulation. The arteries that deliver oxygen to the heart are called coronary arteries. There are two such arteries in total, they depart from the aorta. Inside the heart, they branch into many smaller ones.

However, the heart does not just need oxygen, it needs a lot of oxygen, much more than other organs. This situation is explained simply - because the heart works constantly and with a huge load. And if a person may not particularly feel the manifestations of a lack of oxygen in other organs, then a lack of oxygen in the heart muscle immediately leads to negative consequences.

Circulatory failure in the heart can occur for only one reason - if the coronary arteries pass little blood. This condition is called coronary heart disease (CHD).

In the vast majority of cases, the narrowing of the vessels of the heart occurs due to the fact that they are clogged. Vasospasm, increased blood viscosity and a tendency to form blood clots also play a role. However, the main cause of CAD is atherosclerosis of the coronary vessels.

Atherosclerosis used to be considered a disease of the elderly. However, this is far from the case now. Now atherosclerosis of the heart vessels can also manifest itself in middle-aged people, mainly in men. With this disease, the vessels are clogged with deposits of fatty acids, forming the so-called atherosclerotic plaques. They are located on the walls of blood vessels and, narrowing their lumen, impede blood flow. If this situation occurs in the coronary arteries, then the result is an insufficient supply of oxygen to the heart muscle. Heart disease can develop imperceptibly for many years, not particularly manifesting itself, and without causing much concern to a person, except in some cases. However, when the lumen of the most important arteries of the heart is 70% blocked, the symptoms become apparent. And if this figure reaches 90%, then this situation begins to threaten life.

Varieties of coronary heart disease

In clinical practice, several types of coronary heart disease are distinguished. In most cases, coronary artery disease manifests itself in the form of angina pectoris. Angina pectoris is an external manifestation of coronary heart disease, accompanied by severe pain in the chest. However, there is also a painless form of angina pectoris. With it, the only manifestation is fatigue and shortness of breath even after minor physical exercises (walking / climbing stairs several floors).

If attacks of pain appear during physical exertion, then this indicates the development of angina pectoris. However, in some people with coronary artery disease, chest pains appear spontaneously, without any connection with physical activity.

Also, the nature of changes in angina symptoms may indicate whether coronary disease develops or not. If the coronary artery disease does not progress, then this condition is called stable angina. A person with stable angina, with proper behavior and appropriate supportive care, can live for several decades.

It is quite another thing when angina pectoris becomes more and more severe over time, and the pain is caused by less and less physical activity. Such angina is called unstable. This condition is a reason to sound the alarm, because unstable angina inevitably ends in myocardial infarction, and even death.

In a certain group, vasospastic angina or Prinzmetal's angina are also distinguished. This angina is caused by spasm of the coronary arteries of the heart. Often spastic angina occurs in patients suffering from atherosclerosis of the coronary vessels. However, this kind of angina may not be combined with such a symptom.

Depending on the severity, angina pectoris is divided into functional classes.

Signs of coronary heart disease

Many people do not pay attention to the signs of coronary heart disease, although they are quite obvious. For example, it is fatigue, shortness of breath, after physical activity, pain and tingling in the heart area. Some patients believe that “it should be so, because I am no longer young / not young.” However, this is an erroneous point of view. Angina pectoris and shortness of breath on exertion are not normal. This is evidence of a serious heart disease and a reason to take action as soon as possible and see a doctor.

In addition, IHD can also manifest itself with other unpleasant symptoms, such as arrhythmias, dizziness attacks, nausea, and fatigue. Heartburn and abdominal cramps may occur.

Pain in ischemic heart disease

The cause of pain is irritation of the nerve receptors of the heart by toxins formed in the heart muscle as a result of its hypoxia.

Pain in coronary heart disease is usually concentrated in the region of the heart. As mentioned above, pain in most cases occurs during physical exertion, severe stress. If pain in the heart begins at rest, then with physical exertion, they usually increase.

Pain is usually observed in the retrosternal region. It can radiate to the left shoulder blade, shoulder, neck. The intensity of pain is individual for each patient. The duration of the attack is also individual and ranges from half a minute to 10 minutes. Taking nitroglycerin usually helps relieve pain.

In men, pain in the abdomen is often observed, which is why angina pectoris can be mistaken for some kind of gastrointestinal disease. Also, pain in angina pectoris most often occurs in the morning.

Causes of coronary artery disease

Coronary heart disease is often considered inevitable for people who have reached a certain age. Indeed, the highest frequency of diseases is observed in people over 50 years of age. However, not all people fall ill with coronary artery disease at the same time, for some it occurs earlier, for others later, and someone lives to an advanced age without encountering this problem. Therefore, the development of IHD is influenced by many factors. And in fact, there is no single cause of coronary heart disease. Many factors have an impact:

• bad habits (smoking, alcoholism);
• overweight, obesity;
• insufficient physical activity;
• wrong diet;
• genetic predisposition;
• some concomitant diseases, for example, diabetes mellitus, hypertension.

All of these causes may play a role, but the immediate precursor to coronary atherosclerosis is an imbalance in the various types of cholesterol in the blood and an extremely high concentration of so-called bad cholesterol (or low-density lipoprotein). When the value of this concentration is above a certain limit, a person with a high degree of probability develops atherosclerosis of the vessels, and as a result, coronary heart disease. That is why it is important to monitor blood cholesterol levels. This is especially true for people who are overweight, hypertensive, sedentary and have bad habits, as well as those who among their relatives had many deaths from cardiovascular diseases.

A certain negative factor is the male gender. Statistics show that coronary heart disease is much more common in men than in women. This is due to the fact that women in the body produce female hormones that protect blood vessels and prevent the deposition of cholesterol in them. However, after the onset of the female menopause, the amount of estrogens produced by the female body falls, and therefore the number of women suffering from coronary artery disease rises sharply, almost comparing with the number of men suffering from this disease.

Separately, one should dwell on such a prerequisite for the disease as an improper diet. As you know, the highest percentage of the incidence of coronary artery disease - in developed countries. Experts mainly attribute this fact to the fact that in Europe and America people consume more animal fats and simple, easily digestible carbohydrates. And this, together with a sedentary lifestyle, leads to obesity, to an excess of cholesterol in the blood.

Doctors knowingly warn about foods containing bad cholesterol. These products include fatty meats, butter, cheese, eggs, caviar. The amount of these products in the diet of each person should be limited, they should not be consumed every day, or in small quantities. Although, on the other hand, only a small proportion of harmful cholesterol enters the body from the outside, and the rest is produced in the liver. So the significance of this factor should not be exaggerated, not to mention the fact that bad cholesterol can be called very conditionally, since it takes part in many metabolic processes.

Why is IBS dangerous?

Many people suffering from coronary artery disease get used to their illness and do not perceive it as a threat. But this is a frivolous approach, because the disease is extremely dangerous and without proper treatment can lead to serious consequences.

The most insidious complication of coronary heart disease is what doctors call sudden coronary death. In other words, this is a cardiac arrest caused by electrical instability of the myocardium, which, in turn, develops against the background of coronary artery disease. Very often, sudden coronary death occurs in patients with a latent form of coronary artery disease. In such patients, symptoms are often either absent or not taken seriously.

Another way of developing coronary heart disease is myocardial infarction. With this disease, the blood supply to a certain area of ​​\u200b\u200bthe heart deteriorates so much that its necrosis occurs. The muscle tissue of the affected area of ​​the heart dies, and scar tissue appears in its place. This happens, of course, only if the heart attack does not lead to death.

Heart attack and coronary artery disease in itself can lead to another complication, namely, to chronic heart failure. This is the name of a condition in which the heart does not adequately perform its functions of pumping blood. And this, in turn, leads to diseases of other organs and violations of their work.

How is IHD manifested?

Above, we indicated what symptoms accompany coronary heart disease. Here we will address the question of how to determine whether a person has atherosclerotic changes in the vessels in the early stages, even at a time when obvious evidence of coronary artery disease is not always observed. In addition, such a symptom as pain in the heart is not always indicative of coronary heart disease. Often it is caused by other causes, for example, diseases associated with the nervous system, spine, and various infections.

Examination of a patient complaining of negative phenomena typical of coronary heart disease begins with listening to his heart sounds. Sometimes the disease is accompanied by noises typical of IHD. However, often this method fails to detect any pathology.

The most common method of instrumental study of the activity of the heart is a cardiogram. With its help, you can track the spread of nerve signals through the heart muscle and how its sections are reduced. Very often, the presence of coronary artery disease is reflected in the form of changes on the ECG. However, this is not always the case, especially in the early stages of the disease. Therefore, a cardiogram with a stress test is much more informative. It is carried out in such a way that during the removal of the cardiogram, the patient is engaged in some kind of physical exercise. In this state, all pathological abnormalities in the work of the heart muscle become visible. Indeed, during physical exertion, the heart muscle begins to lack oxygen, and it begins to work intermittently.

Sometimes the method of daily Holter monitoring is used. With it, the cardiogram is taken over a long period of time, usually within a day. This allows you to notice individual deviations in the work of the heart, which may not be present on a conventional cardiogram. Holter monitoring is carried out using a special portable cardiograph, which a person constantly carries in a special bag. At the same time, the doctor attaches electrodes to the human chest, exactly the same as with a conventional cardiogram.

Also very informative is the echocardiogram method - ultrasound of the heart muscle. With the help of an echocardiogram, the doctor can assess the performance of the heart muscle, the size of its departments, and blood flow parameters.

In addition, informative in the diagnosis of coronary artery disease are:

• general blood analysis,
• blood chemistry,
• blood glucose test,
• blood pressure measurement,
• selective coronography with contrast agent,
• CT scan,
• radiography.

Many of these methods make it possible to identify not only the ischemic heart disease itself, but also its concomitant diseases that aggravate the course of the disease, such as diabetes mellitus, hypertension, blood and kidney diseases.

IHD treatment

Treatment of coronary artery disease is a long and complex process, in which sometimes the leading role is played not so much by the skill and knowledge of the attending physician as by the desire of the patient himself to cope with the disease. At the same time, it is necessary to be prepared for the fact that a complete cure for IHD is usually impossible, since the processes in the vessels of the heart are in most cases irreversible. However, modern methods make it possible to extend the life of a person suffering from a disease for many decades and prevent his premature death. And not just to prolong life, but to make it full, not much different from the life of healthy people.

Treatment in the first stage of the disease usually includes only conservative methods. They are divided into drug and non-drug. Currently, in medicine, the most modern is the treatment regimen for the disease, called A-B-C. It includes three main components:

• antiplatelet agents and anticoagulants,
• beta blockers,
• statins.

What are these drug classes for? Antiplatelet agents prevent platelet aggregation, thereby reducing the likelihood of intravascular thrombus formation. The most effective antiplatelet agent with the largest evidence base is acetylsalicylic acid. This is the same Aspirin that our grandparents used to treat colds and flu. However, conventional Aspirin tablets as a regular medication are not suitable in case of coronary heart disease. The thing is that taking acetylsalicylic acid carries the risk of stomach irritation, peptic ulcer and intragastric bleeding. Therefore, acetylsalicylic acid tablets for cores are usually covered with a special enteric coating. Or acetylsalicylic acid is mixed with other components that prevent its contact with the gastric mucosa, as, for example, in Cardiomagnyl.

Anticoagulants also prevent the formation of blood clots, but have a very different mechanism of action than antiplatelet agents. The most common drug of this type is heparin.

Beta-blockers prevent the action of adrenaline on special receptors located in the heart - adrenaline receptors of the beta type. As a result, the patient's heart rate decreases, the load on the heart muscle, and as a result, its need for oxygen. Examples of modern beta-blockers are metoprolol, propranolol. However, this type of drug is not always prescribed for IHD, as it has a number of contraindications, for example, some types of arrhythmias, bradycardia, hypotension.

The third class of first-line drugs for the treatment of coronary artery disease are drugs to lower bad cholesterol in the blood (statins). Atorvastatin is the most effective statin. For six months of therapy with this drug, atherosclerotic plaques in patients are reduced by an average of 12%. However, other types of statins, such as lovastatin, simvastatin, and rosuvastatin, may be prescribed by your doctor.

Fibrate class drugs are also designed to reduce bad glycerol. However, the mechanism of their action is not direct, but indirect - thanks to them, the ability of high-density lipoproteins to process “bad” cholesterol increases. Both types of drugs - fibrates and statins can be prescribed together.

Also, with IHD, other drugs can be used:

• antihypertensive drugs (if coronary heart disease is accompanied by hypertension),
• diuretics (with poor kidney function),
• hypoglycemic drugs (with concomitant diabetes mellitus),
• metabolic agents (improving metabolic processes in the heart, for example, mildronate),
• sedatives and tranquilizers (to reduce the amount of stress and relieve anxiety).

However, nitrates are the most commonly used type of medication, taken right at the time of the angina attack itself. They have a pronounced vasodilating effect, help relieve pain and prevent such a formidable consequence of coronary artery disease as myocardial infarction. The most famous drug of this type, used since the last century, is nitroglycerin. However, it is worth remembering that nitroglycerin and other nitrates are symptomatic drugs for a single dose. Their continuous use does not improve the prognosis of coronary heart disease.

The second group of non-drug methods of dealing with coronary artery disease is physical exercise. Of course, during the period of exacerbation of the disease, with unstable angina, any serious exercise is prohibited, since they can be fatal. However, during the rehabilitation period, patients are shown therapeutic exercises and various physical exercises, as prescribed by the doctor. Such a dosed load trains the heart, makes it more resistant to lack of oxygen, and also helps to control body weight.

In the event that the use of medications and other types of conservative therapy do not lead to improvement, then more radical methods are used, including surgical ones. The most modern method of treating coronary heart disease is balloon angioplasty, often combined with subsequent stenting. The essence of this method lies in the fact that a miniature balloon is inserted into the lumen of the narrowed vessel, which is then inflated with air and then blown off. As a result, the lumen of the vessel expands significantly. However, after some time, the lumen may narrow again. To prevent this from happening from the inside, the walls of the artery are strengthened with a special frame. This operation is called stenting.

However, in some cases angioplasty is powerless to help the patient. Then the only way out is the operation of coronary artery bypass grafting. The essence of the operation is to bypass the affected area of ​​the vessel and connect two segments of the artery in which atherosclerosis is not observed. For this purpose, a small piece of a vein is taken from the patient from another part of the body and transplanted in place of the damaged part of the artery. Thanks to this operation, the blood gets the opportunity to get to the necessary parts of the heart muscle.

Prevention

It is well known that it is always more difficult to be treated than to avoid the disease. This is especially true for such a severe and sometimes incurable disease as coronary artery disease. Millions of people around the world and in our country suffer from this heart disease. But in most cases, it is not an unfavorable combination of circumstances, hereditary or external factors that is to blame for the occurrence of the disease, but the person himself, his wrong way of life and behavior.

Recall once again the factors that often lead to early incidence of coronary artery disease:

• sedentary lifestyle;
• a diet high in bad cholesterol and simple carbohydrates;
• constant stress and fatigue;
• uncontrolled hypertension and;
• alcoholism;
• smoking.

To change something on this list, making it so that this problem would go out of our lives and we would not have to be treated for coronary artery disease, is within the power of most of us.

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, and also 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.

An untimely visit to a 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 subject 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.