Myocardial ischemia of the heart muscle. Changes in the myocardium on the ECG - what does it mean for the diagnosis Changes in the myocardium of the ventricles

Minor deviations from the norm in the structure of the heart can be detected in every second person. They are the result of various pathological processes, especially of an inflammatory nature. In a child, a similar problem often occurs during puberty, and in older people - due to age-related changes in the cardiovascular system. They are revealed mainly by accident during a routine examination. Knowingly worry about the presence of moderate changes in the myocardium, not knowing what it is, is not worth it. They usually do not affect the body in any way and do not manifest themselves, but a person will have to be fully examined to determine the causative factor and change their lifestyle.

Pathological abnormalities in the structure of the heart mainly occur in its lower part (in the left ventricle). If they are not particularly pronounced, are not a consequence of cardiological pathology and do not progress, then often the clinical picture is absent. On an ECG (electrocardiogram), such changes do not always appear. It is possible to identify them mainly with a more detailed examination.

More pronounced diffuse changes are manifested by characteristic cardiac symptoms. You can see their list below:

• pain in the chest (angina pectoris), provoked by ischemia of the heart;
• a feeling of shortness of breath and the appearance of edema - characteristic of cardiosclerosis;
• dizziness and signs of asthenia (weakness) occur with anemia.

Often, patients show symptoms of chronic heart failure after experiencing myocardial infarction. In more rare cases, the cause is dysfunction. thyroid gland... She begins to produce significantly more than the required amount of hormones, which leads to the following symptoms:

• tremors (tremors) of the limbs;
• weight loss;
• bulging (forward displacement) of the eyes, characteristic of exophthalmos.

The resulting symptoms gradually progress. The patient's quality of life will decrease until the appearance of shortness of breath after any physical activity, due to which the ability to work significantly decreases. If moderate changes in the left ventricular myocardium are manifested against the background of heart failure, then over time a person may lose the ability to independently perform daily activities. To prevent such complications, it is necessary to be fully examined in order to identify the cause of the pathological abnormalities in the structure of the heart. Treatment will be aimed at eliminating it and alleviating the general condition.

Varieties of pathological changes

Changes in the structure of the heart muscle are divided into several types, depending on the factor that influenced their development.

Genesis (cause of development) and localization of the listed types of deviations are different. By size, they are divided into diffuse and focal changes in the myocardium. The first type is diagnosed most often. It is characterized by the defeat of all parts of the heart. Focal deviations are isolated areas. In both cases, the changed locations are gradually replaced connective tissuethat does not transmit electrical impulses. It will no longer be possible to reverse the process at this stage.

Causes of abnormalities in the structure of the myocardium

In each case, there are reasons for the occurrence of deviations in the structure of the myocardium. They have a detrimental effect on the heart and blood vessels. Inflammatory changes appear in the patient due to myocarditis. The disease is of an infectious nature and aseptic, that is, caused without the help of microorganisms. Diffusely located lesions develop due to the influence of such factors:

• Rheumatism affecting connective tissues. The cause of the development of pathology is the ingestion of streptococcal infection. It occurs after tonsillitis, tonsillitis, scarlet fever and other similar diseases.
• Typhus, caused by the bacteria rickettsia. It is characterized by damage to the nervous and cardiovascular systems.
• Viral infections, which are characterized by complications of the heart muscle. Measles, rubella and influenza are especially common.
• Autoimmune disruptions caused by lupus erythematosus and rheumatoid arthritis, provoking complications in the heart muscle.

Cicatricial abnormalities in the structure of the myocardium are manifested mainly for the following reasons:

• The prolonged course of cardiac ischemia leads to an increase in the activity of fibroblastates. They provoke the proliferation of connective tissue.
• A heart attack appears as a scar. If its extensive form has been experienced, then necrosis affects the volumetric area of \u200b\u200bthe myocardium.
• Postponed operations on the heart muscle leave a trace in the form of a piece of connective tissue at the site of intervention.

Dystrophy of the tissues of the heart muscle is manifested mainly due to a malfunction metabolic processes in non-inflammatory cardiomyocytes. The changes are aggravated gradually against the background of the development of other pathologies.

Heart cells lack vital elements for normal functioning, due to which they are depleted and arrhythmias occur. In medicine, myocardial dystrophy is also called cardiac dystrophy. The most relevant list of reasons for its occurrence is as follows:

• Constant failures in the work of the liver and kidneys lead to the development of failure of these organs. Toxic substances begin to accumulate in the blood, due to which metabolic processes are disrupted throughout the body.
• Diseases of the endocrine organs (pancreas and thyroid glands, adrenal glands) provoke excessive production of hormones. They affect the entire body, especially the cardiovascular system.

• Anemia is manifested due to an acute deficiency of hemoglobin in the blood. Lack of this iron-containing protein often causes myocardial dystrophy.
• Various irritating factors (stress, overwork, overeating or dieting) gradually provoke depletion of the heart muscle.
• In childhood, the problem arises as a result of a combination of psycho-emotional overload and insufficient physical activity. In a child, these factors provoke the development of vegetative vascular dystonia, which disrupts the normal regulation of the heart due to failures in the autonomic part of the nervous system.
• Diseases caused by infections (tuberculosis, flu, malaria) can drain the body and adversely affect all its systems.
• Fever and its characteristic dehydration overload the heart and blood vessels and provoke degeneration due to a lack of nutrients.
• Acute intoxication caused by alcohol, medicines and chemicals, or chronic, caused by poor ecology or at work, lead to depletion of the body.

The most commonplace and common cause of heart dystrophy is a lack of nutrients in the body due to an improperly composed diet. Sometimes it is provoked by the following diseases:

• atherosclerosis;
• ischemia;
• hypertonic disease;
• arrhythmia;
• myocardial hypertrophy.

Metabolic abnormalities are triggered by malfunctions at the cellular level. They are manifested by impaired exchange of potassium and sodium in cardiomyocytes, as a result of which the heart does not receive the required energy for full contraction and relaxation. If the changes that have arisen are not serious and arise due to overwork, obesity, stress and hormonal surges (during pregnancy, during puberty), then we are talking about a nonspecific lesion. They are also provoked by malfunctions in the metabolism of cardiomyocytes. Severe metabolic disorders in heart cells are manifested due to the influence of the following factors:

• hypertension;
• cardiomyopathy;
• acute rheumatic fever;
• cardiosclerosis;
• angina pectoris.

It is considered a completely natural phenomenon if the left ventricle of the heart is slightly altered in children or elderly people. In the first case, the problem lies in the restructuring of the body associated with active growth and an imperfect metabolic process. In aged patients, deviations in the structure of the myocardium are permissible due to aging and wear and tear of all tissues.

Diagnostic and treatment methods

Treatment by a cardiologist is made only on the basis of the results of the examination. If the patient does not have a dangerous cardiac pathology, then the doctor may advise taking vitamin complexes, especially in autumn and winter, to control the pressure level and correct the lifestyle. If there is suspicion of the secondary nature of myocardial changes, that is, development under the influence of other diseases, the following diagnostic methods will be assigned:

• Blood donation to determine the amount of hemoglobin, check the level of leukocytes and erythrocyte sedimentation rate.
• Study of the composition of urine to assess the condition of the kidneys.
• Performing a biochemical blood test to determine the level of protein, sugar and cholesterol.
• Daily ECG monitoring with and without exercise to assess the condition of the heart.
• Ultrasound examination (ultrasound) internal organs for the presence of deviations in their structure.
• Examination of the heart muscle using an echocardiograph to visualize its sections and determine the cause of myocardial changes.
• Using electrocardiography (ECG) to detect any abnormalities in the heart rhythm, as well as in its conduction and structure.

Having received all the necessary data, the doctor will assess the patient's condition. If the reason is not only in the heart, then he will advise you to consult with other specialists (endocrinologist, gastroenterologist, hematologist) to draw up complex treatment... An important advantage of a timely started course of therapy is a high chance of eliminating pathological changes. In fact, in 90% of cases, myocardial cells are able to recover completely.

Even if modern methods diagnostics could not help identify the cause of the problem, then treatment is aimed at achieving the following goals:

• stop clinical picture heart failure;
• to secure cardiomyocytes and restore their functions;
• normalize metabolic processes in the heart.

The following groups of drugs are commonly used in the treatment of heart failure:

• Cardiac glycosides ("Strofantin", "Digitoxin") increase vascular tone, eliminate arrhythmias, shorten the contraction phase of the heart muscle and improve its nutrition.

• Antiarrhythmic drugs ("Amiodarone", "Dofetilide") block beta and alpha-adrenergic receptors, improve myocardial nutrition and have a coronary dilating effect.
• Diuretics (Lasix, Britomar) reduce venous return to the heart and remove excess moisture from the body, lowering blood pressure.

To stimulate metabolic processes, doctors prescribe the following drugs based on nutrients:

• "Cocarboxylase" (coenzyme);
• Doppelgerts Active, Asparkam (magnesium, potassium);
• "B-Complex", "Neurobion" (vitamins of group B);
• Preductal, Mexidol (antioxidants);
• "Riboxin" (metabolic agent).

As an addition to the main treatment regimen, the following drugs may be required:

• hypotensive;
• sedatives;
• hormonal (with endocrine disruptions);
• antiallergic;
• antibacterial.

Folk remedies are often introduced into the treatment regimen for myocardial changes, as they saturate the body essential substances and soothe nervous system... The most relevant decoctions are the following herbs:

• hawthorn;
• melissa;
• motherwort;
• peppermint;
• cranberry;
• pion;
• rosehip.

Compliance with a healthy lifestyle

Comprehensive treatment of any pathology consists not only in taking medications, but also in a properly selected diet. In the presence of moderate changes in the myocardium, it is recommended to adhere to the following rules:

• overeating or starving is not recommended;
• the daily amount of salt consumed should not exceed 5 g;
• it is imperative to add vegetables and fruits to your diet;
• the daily menu should contain only low-fat varieties of fish and meat;
• you need to eat 4-5 times a day, and take the last meal 3-4 hours before bedtime;
• it is advisable to completely abandon fatty foods;
• it is recommended to cook steamed or by boiling.

The rules will help normalize metabolic processes in cardiomyocytes healthy way lives, which are given below:

• sleep at least 6-8 hours a day;
• to refuse from bad habits;
• try to avoid stressful situations;
• exercise at a moderate pace without overload.

Forecast

Moderate changes in the structure of the heart muscle are not a pathology. They are a consequence of the influence of other diseases, therefore, with the timely elimination of the cause, the process can be reversed without harm to health. The prognosis will improve if you follow all the doctor's recommendations and prevent the condition from worsening, since cardiomyocytes will take time to fully recover. In mild cases, it is possible to cure without drug therapy.

Less optimistic prognosis with a combination of moderate changes with signs of heart failure. The process can be completely reversed if the muscle tissues of the myocardium have not yet been replaced by connective tissues that do not transmit electrical signals. Doctors usually prescribe medications that improve metabolic processes and give recommendations for correcting nutrition and rest.

Serious diffuse changes cause development dangerous forms heart failure and cardiosclerosis. It is impossible to eliminate them completely. Treatment consists in attempts to stop the pathological process and improve the patient's quality of life.

Moderate changes in the myocardium are among the common pathological abnormalities in the structure of the heart muscle. In most cases, they do not lead to anything and do not appear. The problem is found mainly during a routine inspection. As a means of treatment, the doctor prescribes drugs that improve metabolic processes in cardiomyocytes and stabilize the work of the heart. If the case is neglected, then it is not possible to completely reverse the changes and the patient will have to take medications for life.

Cardiovascular disease is the leading cause of death in the world. Most deaths are associated with coronary artery disease. In order to recognize and prevent heart problems in time, various diagnostic methods are used, in particular, an electrocardiogram (ECG) and an ultrasound scan (echo-CG).

And in patients who received the result of ECHO-KG or ECG, which says "diffuse changes in the myocardium", the question arises: what is it?

The myocardium is the muscular middle layer of the heart that contains contractile cells (cardiomyocytes). The coordinated contraction of cardiomyocytes causes the heart to contract and expel blood. As a type of muscle tissue, the myocardium is unique among all other muscle tissues in the human body.

The thickness of the myocardium determines the strength of the heart's ability to pump blood.

The heart muscle is adapted to be highly resistant to fatigue, so if the patient complains of rapid fatigue, this may indicate problems with the myocardium. Cardiomyocytes have a large number of mitochondria, which allows for continuous aerobic respiration. The heart muscle also has a large blood supply in relation to its size, which ensures a continuous flow of nutrients and oxygen to the heart, while ensuring the timely removal of metabolic waste.

The term "diffuse changes" means that the processes that have occurred in the myocardium do not have features typical for a particular disease. On the basis of only one conclusion about diffuse changes in the myocardium, the cardiologist will not be able to make an accurate diagnosis, he will need the results of a physical examination, questioning the patient about alarming symptoms, as well as blood test data and other studies.

Possible reasons diffuse changes in the heart muscle:

• A variant of the norm, that is, the absence of cardiac pathology. For example, in children, diffuse changes without complaints of shortness of breath, pain in the heart and fatigue belong to the normal variant.
• Hormonal or other types of metabolic disorders in the myocardium.
• Endothelial dysfunction (lining blood vessels, which separates the blood flow and deeper layers of the vascular wall).
• Autoimmune neuropathy.
• Abnormal glucose levels.
• The result of exposure to certain drugs, including cardiac glycosides, streptomycin and chlorpromazine.
• Inflammation of the myocardium, also called myocarditis.
• Disturbances in water-salt metabolism in the myocardium and in the body as a whole.
• Cardiosclerosis. With this pathology, myocardial muscle fibers are gradually replaced by connective tissue cells. This is due to inflammatory process or metabolic disorders.
• Lack of nutrients (such as proteins or carbohydrates), as well as vitamins and minerals. This can occur, for example, due to renal failure or chronic enterocolitis.
• Age-related changes in the myocardium. Often nonsignificant and asymptomatic.
• Drug and / or alcohol use.

Symptoms of diffuse changes in the myocardium are not specific. If the ECG showed mild diffuse changes, and the person does not complain of symptoms characteristic of heart disease, then these harmless changes are not focused on.

The doctor does not use the term "diffuse myocardial changes" as a definitive diagnosis and the name of a specific disease. For a cardiologist, this is just a diagnostic marker, which is a reason to prescribe additional studies.

Treatment of diffuse myocardial changes is aimed at eliminating the cause of this condition. It is important to restore the functioning of the heart muscle, and for this one should eat well, minimize negative experiences and take a complex of vitamins, which will be recommended by the attending cardiologist.

Changes in the myocardium on the ECG: what does it mean and what can threaten

An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the causes of chest pain. And it so happens that after the test, the doctor tells the patient that he has recorded changes in the myocardium on the ECG. What does this formulation mean? This is a signal that the heart muscle is undergoing changes. And the doctor's task is to find out their nature. They can be caused by age (for example, myocardial changes are very common in children and the elderly), or inflammatory disease... And, perhaps, the point is in intense sports. Athletes experience thickening of the myocardial walls. This condition has even received a special term - "sports heart".

Three types of changes can occur in the entire heart muscle or in any of its parts:

1. metabolic;
2. diffuse;
3. dystrophic.

The most common are diffuse moderate myocardial changes. What it is? This is a uniform lesion of all parts of the heart muscle. Possible causes are inflammation in the myocardium or problems with the exchange of water and salt. Or there may be a consequence of taking medications such as cardiac glycosides.

Moderate metabolic disturbances in the myocardium are usually associated with high loads and irritants, including hypothermia, overweight, stress. If stimuli act irregularly, the myocardium returns to normal.

Sometimes moderate dystrophic changes myocardium on an ECG. What does the difference in energy expenditure by the body and its supply to the heart mean?

Diabetes mellitus (DM) is one of the major metabolic disorders and currently affects over 250 million people worldwide. The number of people with diabetes is projected to rise to 350 million by 2030. This pathology is often the cause of moderate changes in the myocardium. We have already found out what it is, it remains to find out what the neglect of the ECG results can lead to.

If you do not pay attention to changes in the myocardium, accompanied by unpleasant symptoms, this can threaten the development ischemic disease heart, chronic cerebral ischemia and cardiomyopathy. What is chronic cerebral ischemia? In short, it is a gradual deterioration in cerebral blood flow. A frequent "companion" of this disease is stroke.

Symptoms that should be the reason for going to the doctor:

• Dyspnea.
• Painful sensations in the region of the heart.
• Regular and unexplained fatigue.

How to deal with moderate myocardial changes:

• Try to reset excess weight.
• Engage in the treatment of chronic (chronic) diseases.
• Do not overcool or overheat.
• Do not expose yourself to great nervous and physical tests.
• Donate blood for hormones and blood sugar.

What to do if changes in the myocardium are detected? It is imperative to sign up for a consultation with a cardiologist and work out a set of health measures together with a doctor.

Types of myocardial lesions: dystrophic and metabolic changes in the myocardium on the ECG

Damage to the heart muscle is metabolic, dystrophic and diffuse.

Metabolic changes in the myocardium on the ECG occur as a result of metabolic disturbances in the heart muscle.

This can be caused by the following reasons: exposure to cold, excess weight, strong stress on the body and psyche, a long-term disease in the body.

If the factor that caused the metabolic change in the myocardium on the ECG disappeared, then the body, as a rule, returns to normal without the help of drugs.

But if the factor continues to act constantly, then the change in the myocardium can become irreversible.

More serious causes of metabolic changes in the myocardium on the ECG are:

• arrhythmia;
• exposure to radiation;
• hypertonic disease;
• alcoholism;
• angina pectoris;
• myocardial dystrophy.

Dystrophic changes in the myocardium on the ECG can be the result of common cardiac pathology, such as heart disease, coronary artery disease, and myocardial inflammation. Launched metabolic changes in the myocardium can eventually lead to dystrophic ones. The most common sign of dystrophic changes is pain in the left chest. Unlike metabolic changes, dystrophic ones are irreversible.

Significant diffuse (aka nonspecific) changes in myocardial tissue occur when:

1. myocarditis - myocardial damage of an infectious or inflammatory nature;
2. violation of blood circulation in the myocardium (myocardiosclerosis), and subsequent heart failure;
3. violation of water-salt metabolism;
4. dystrophic myocardial damage.

The consequence of metabolic changes in the myocardium on the ECG may be myocardial ischemia. In this state, the heart sharply adapts to the limited supply of oxygen and substrates, and undergoes an abrupt switch from aerobic to anaerobic metabolism. This change in energy metabolism can cause calcium overload, as well as a decrease in the synthesis of one of the most important chemical structures of the body - ATP energy - in the myocardium, which contributes to functional damage to the heart muscle.

The consequence of dystrophic changes in the myocardium on the ECG can be an irreversible process called "change in the left ventricular myocardium." Usually this is left ventricular hypertrophy (aka cardiomyopathy), leading to the fact that the septum between the left and right ventricle loses its elasticity. Is it dangerous? Undoubtedly, because cardiomyopathy is one of the main causes of heart failure and sudden death from arrhythmia.

Prevention of myocardial changes

Despite significant improvements in medical care, cardiovascular disease remains the leading cause of death and disability worldwide, mainly from heart attack and stroke. Preventable risk factors such as high blood pressure, cholesterol levels and diabetes, as well as lifestyle factors such as smoking and obesity, play a significant role in most deaths.

There are many steps you can take to prevent changes in the myocardium. One way is to eat heart-healthy foods like whole grains, vegetables, fruits, and reduce your intake of sugar, saturated fat, trans fat, and cholesterol.

This is especially important for people with diabetes, hypertension and high cholesterol levels.

In addition, it is important to quit smoking if metabolic or degenerative changes in the myocardium are recorded on the ECG. Quitting smoking will significantly reduce your risk of heart attack and improve both heart function and lung health. You should also avoid secondhand smoke (stay near a smoker).

Prophylactically, within the framework of a national project, she underwent an examination at a local hospital, including an EKG. The results scared me. Moderate deviations of atrial depolarization. Signs of moderate hypoxia of the ventricular myocardium. Possible ischemic changes myocardium of the ventricles. Sinus rhythm. Normal pos. EOS. Signs of overload or initial signs LV hypertrophy.

Is everything so serious, what can be done, can overweight BMI 27.2 affect this?

Such definitions are described in the manuals, perhaps the doctor was simply not experienced enough. Again, exactly such changes on the ECG in a person of 80 years old would not raise doubts. But for 30 years they are implausible. So most likely there is nothing wrong and there is no ischemia either. But it would be nice to scan the ECG and send it to us.

Myocardial ischemia: causes, symptoms, diagnosis, treatment

Myocardial ischemia is the basis of ischemic heart disease (CHD) - the most common pathology of the cardiovascular system in humans. According to statistics, at least half of elderly men and a third of women suffer from it, and mortality from various forms of ischemia reaches 30%.

The disease has no geographic boundaries, is common in both developing and developed countries with a high level of medicine. Long time IHD can be asymptomatic, only occasionally making itself felt by unpleasant sensations in the heart.

Painless myocardial ischemia is of great importance. The disease does not manifest itself in any way for many years, but it can cause extensive heart attack and sudden death. According to some reports, this form of pathology affects up to 20% of practically healthy people, but with risk factors.

Causes and types of ischemia of the heart

The reasons that lead to ischemic changes in the heart muscle have not been heard except by the lazy one. Among the main risk factors are:

• Elderly age;
• Male;
• Hereditary predisposition (familial dyslipidemia);
• Smoking;
• Comorbidities such as diabetes, hypertension, obesity;
• Lipid spectrum disorders;
• Hypodynamia.

Elderly patients are the main contingent of cardiology departments. This is not accidental, because with age, dystrophic processes occur in the vessels, metabolic disorders are aggravated, and concomitant pathology joins. It should be noted that in recent years ischemia has been showing clear signs of "rejuvenation", especially among residents of large cities.

Women, due to hormonal characteristics, are less susceptible to heart ischemia, since estrogens have a kind of protective effect, but by about 70 years, when persistent menopause occurs, their incidence rates are equal to those in men. The lack of estrogen predetermines the earlier development of atherosclerosis and, accordingly, ischemic heart damage in men.

Violation of fat metabolism causes the deposition of lipid formations on the walls of the arteries, which impede blood flow and lead to oxygen starvation of the heart tissues. These phenomena are significantly aggravated by general obesity and diabetes mellitus. Hypertension with crises contributes to damage to the inner lining of the arteries and the circular deposition of fat in them, which causes a significant deficit in blood flow.

These factors lead to the appearance of direct causes of lack of oxygen in the heart: atherosclerosis, vasospasm, thrombus formation.

causes of impaired coronary blood flow and subsequent myocardial ischemia

Varieties of myocardial ischemia according to the International Classification of Diseases are as follows:

Angina is the most frequent form ischemia of the heart, which is diagnosed in most elderly people who do not even present complaints (asymptomatic form). The absence of pain should not be soothing, especially in persons with concomitant diseases predisposing to atherosclerosis and susceptible to risk factors.

A heart attack is myocardial necrosis, when an acute lack of oxygen leads to the death of cardiomyocytes, a violation of cardiac activity with a high risk of death. Heart attack is one of the most severe and irreversible manifestations of ischemia. After the healing of the necrosis focus, a dense scar remains at the site of injury (postinfarction cardiosclerosis).

With a significant amount of necrotization, they speak of a large-focal infarction, often it penetrates the entire thickness of the heart muscle (transmural infarction). Small foci of necrosis can be found under the membranes of the heart. Subepicardial ischemia occurs under the outer shell (epicardium), subendocardial ischemia - inside, under the endocardium.

forms of myocardial necrosis (infarction) due to ischemia and their reflection on the ECG

All forms of ischemia sooner or later lead to depletion of compensatory mechanisms, structural changes and a steadily increasing heart failure. Such patients have a high risk of thromboembolic complications with damage to the brain, kidneys, and extremities. Thrombi especially often appear with subendocardial ischemia, when the inner layer of the heart is involved.

A special form of the disease is the so-called transient, or painless, mute, ischemia of the heart muscle. It occurs in about half of patients with coronary artery disease, does not give any symptoms, however, changes in myocardial cells still occur and they can be identified, for example, using an ECG.

Transient ischemia of the heart is significantly more common among hypertensive patients, smokers, patients with congestive heart failure. Without exception, all patients with a mute form of pathology have a lesion of the great vessels of the heart, multiple severe atherosclerosis, and a large length of narrowing areas. It is still not clear why painless ischemia occurs with significant vascular lesions, but perhaps this is due to the good development of collateral blood flow.

What happens in the heart during ischemia?

The main symptom of ischemic heart disease is considered to be pain syndrome, which occurs both in the chronic course of the disease, and in its acute forms. The appearance of pain is based on irritation of nerve receptors by metabolic products that are formed under conditions of hypoxia. The heart works continuously, pumping colossal volumes of blood, so the costs of oxygen and nutrients are very high.

Blood to the heart muscle enters through the coronary vessels, and collateral blood flow to the heart is limited, therefore, when the arteries are damaged, the myocardium always suffers. Atherosclerotic plaque, thrombus, sudden vasospasm create an obstacle to blood flow, as a result of which muscle cells do not receive the blood they supply, pain and characteristic structural changes in the myocardium appear.

In cases of chronic myocardial ischemia, usually with atherosclerosis, the heart muscle "starves" constantly, against this background, the stimulation of fibroblast cells that form connective tissue fibers occurs, and cardiosclerosis develops. The involvement of conductive nerve bundles contributes to arrhythmias.

Vascular catastrophes in thrombosis, plaque rupture, spasm are accompanied by complete and sudden cessation of blood flow through the vessels, blood does not reach the heart muscle, and acute myocardial ischemia "pours out" into a heart attack - necrosis of the heart muscle. Often, against the background of long-term chronic ischemia, acute forms of the disease occur.

Ischemic changes are usually recorded in the left side of the heart, as it experiences a much greater load than the right parts. The myocardium is thicker here, and good blood flow is needed to provide oxygen. Ischemia of the wall of the left ventricle usually forms the basis of ischemic heart disease, here the main events in necrosis of the heart muscle "unfold".

Manifestations of myocardial ischemia

Clinical signs of cardiac ischemia depend on the degree of arterial damage and the course of the pathology. The most common type of ischemia is exertional angina, when pain occurs at the time of physical exertion. For example, a patient climbed the stairs, ran, and the result is chest pain.

The symptoms of angina pectoris are:

• Pain in the region of the heart, behind the sternum, extending into the left arm, interscapular region, aggravated or appearing with physical exertion;
• Shortness of breath when walking fast, emotional overload.

If these symptoms last up to half an hour, are relieved by taking nitroglycerin, occur during exertion, then they talk about exertional angina. When complaints appear spontaneously, at rest, we are talking about rest angina. Worsening pain, decreased resistance to stress, poor drug effects can be a sign of progressive angina.

Myocardial infarction is a very severe form of ischemia, which is manifested by burning, severe chest pain due to necrosis of cardiomyocytes. The patient is restless, there is a fear of death, possibly psychomotor agitation, shortness of breath, cyanosis of the skin, interruptions in the rhythm of heart contractions are possible. In some cases, necrosis is not quite typical - with pain in the abdomen, completely without pain.

Another manifestation of cardiac ischemia can be arrhythmia - atrial fibrillation, intracardiac conduction disturbances in the form of blockages, tachycardia. In this case, patients experience interruptions in the activity of the heart, a strong heartbeat or a feeling of fading.

The most dangerous variant of coronary heart disease is sudden cardiac death, which can occur against the background of an attack of angina pectoris, necrosis, arrhythmia. The patient loses consciousness, heart and breathing stops. This condition requires immediate resuscitation measures.

In the advanced stages of heart ischemia, signs of heart failure increase, cyanosis of the skin and mucous membranes appears, edema first on the limbs, then fluid accumulates in the body cavities (chest, abdominal, pericardial). The patient complains of weakness, severe shortness of breath, is forced to take a half-sitting or sitting position.

Diagnosis and treatment of myocardial ischemia

Diagnosis of coronary heart disease is based on clarification of complaints, features of the course of the disease, the relationship of symptoms with exercise. The doctor listens to the lungs, where wheezing often appears due to congestion, palpation of the liver may show its increase in chronic heart failure. Auscultation of the heart makes it possible to diagnose the presence of additional murmurs, rhythm disturbances.

There are no reliable signs that allow a diagnosis to be made during the examination, therefore, laboratory and instrumental tests are additionally carried out. The patient is prescribed biochemical analysis blood with the study of the lipid spectrum, it is mandatory to conduct an ECG, including with exercise (bicycle ergometry, treadmill). A large amount of information can be obtained from Holter monitoring.

On ECG signs ischemia is considered a decrease or elevation of the ST segment more than 1 mm. Registration of arrhythmias, blockade of impulse conduction is possible. Large-focal infarction is characterized by the presence of a deep Q wave, changes in the T wave in the form of a sharp rise in the acute stage, it is negative in the acute and subacute period.

various forms of ischemia on the ECG

For laboratory confirmation of heart attack, a number of studies are carried out. So, a general blood test will show an increase in ESR, leukocytosis, which speak of an inflammatory response to necrosis. Analysis of protein fractions makes it possible to establish an increase in some of them (ALT, AST, CPK, troponins, myoglobin, etc.). It is worth noting that such informative indicators as the level of troponins, myoglobin, cardiac fractions of CPK are determined by far not in all institutions due to the lack of equipment, therefore, patients resort to the help of private clinics, and sometimes even remain without analysis.

To clarify the state of the coronary arteries, coronary angiography, contrast-enhanced CT, MSCT, scintigraphy are performed, which are especially necessary for painless ischemia.

Treatment of cardiac ischemia depends on the form of the disease, the patient's condition, and concomitant pathology. With different types of coronary artery disease, it is different, but its principles still remain the same.

The main directions of therapy for cardiac ischemia:

• Limitation of physical and emotional stress while maintaining sufficient physical activity (walking, feasible gymnastics);
• A diet aimed at normalizing fat and carbohydrate metabolism (the same as in atherosclerosis - restricting animal fats, carbohydrates, the predominance of fruits, vegetables, dairy products, fish in the diet); decrease in body weight in obesity by reducing the calorie content of food and its volume;
• Drug therapy, including diuretics, beta-blockers, calcium antagonists, nitrates for pain attacks, antiplatelet agents.

Drug therapy is the most important and mandatory component of the treatment of myocardial ischemia. The list of medicines is selected individually, and the patient must strictly follow all the recommendations of the cardiologist.

All patients with ischemic heart disease take antiplatelet agents. The high efficiency of acetylsalicylic acid in small doses has been proven, on the basis of which drugs that are safe for long-term use have been created (thrombosis, aspirin cardio, cardiomagnyl). In some cases, anticoagulants (warfarin) are prescribed, and heparin is administered for myocardial infarction.

Beta-blockers are also considered the main group of agents in the treatment of myocardial ischemia. They reduce the frequency of heart contractions and its need for oxygen, prolong the life of patients. The most common are metoprolol, bisoprolol, carvedilol.

Given the violation of the lipid spectrum, statins and fibrates are prescribed, which reduce the amount of atherogenic cholesterol fractions (LDL, VLDL) and increase anti-atherogenic (HDL). Lovastatin, simvastatin, clofibrate, fenofibrate are used.

Nitrates (nitroglycerin) are effective in relieving pain attack... They are used in tablets or injectable forms... A side effect is a decrease in blood pressure, dizziness and fainting, so hypotensive patients should be extremely careful.

Diuretics are necessary for the elimination of fluid that creates unnecessary stress on the myocardium. Loop (furosemide), thiazide (indapamide) diuretics are used.

ACE inhibitors are included in most treatment regimens for myocardial ischemia, since they not only maintain blood pressure at normal levels, but also relieve arterial spasm. Prescribed lisinopril, capropril, enap.

For arrhythmias, antiarrhythmic drugs are indicated. In cases of tachycardia, beta-blockers will be effective, in other forms - amiodarone, cordarone.

With severe coronary artery disease, when drug treatment does not lead to the desired result, they resort to surgical correction of vascular changes. Endovascular techniques are used (balloon angioplasty, stenting), as well as more radical surgery - coronary artery bypass grafting.

The prognosis for ischemia of the heart is always serious, most of patients become disabled, there is still a high risk of complications and death. Given the widespread prevalence of ischemia itself, and the factors leading to its appearance, as well as high level disability among patients, the problem does not lose its relevance, and the attention of specialists is concentrated on the search for new effective methods of treatment and prevention of an insidious disease.

Myocardial changes on the ECG - what does it mean for the diagnosis

Most heart pathologies can be diagnosed on an ECG. The reasons for their appearance are due to concomitant diseases and the characteristics of the patient's lifestyle.

What does this mean if myocardial changes were found on the ECG? In most cases, the patient needs conservative treatment and lifestyle correction.

Description of the procedure

An electrocardiogram (ECG) is one of the most informative, simple and affordable cardiac studies. It analyzes the characteristics of the electrical charge that stimulates the contractions of the heart muscle.

Dynamic recording of charge characteristics is carried out on several muscle sites. The electrocardiograph reads information from electrodes placed on the ankles, wrists and chest skin in the area of \u200b\u200bthe heart projection and converts them into graphs.

Norm and deviations - possible causes

Normally, the electrical activity of the areas of the myocardium, which is recorded by the ECG, should be uniform. This means that intracellular biochemical exchange in the heart cells occurs without pathologies and allows the heart muscle to produce mechanical energy for contractions.

If the balance in the internal environment of the body is disturbed various reasons - the following characteristics are recorded on the ECG:

• diffuse changes in the myocardium;
• focal changes in the myocardium.

The reasons for such changes in the myocardium on the ECG can be both harmless conditions that do not threaten the life and health of the subject, and serious dystrophic pathologies that require urgent medical attention.

• rheumatism, as a consequence of scarlet fever, tonsillitis, chronic tonsillitis;
• complications typhus, scarlet fever;
• consequences of viral diseases: influenza, rubella, measles;
• autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.

One of the reasons for changes in muscle tissue can be cardiodystrophy - a metabolic disorder in heart cells without damage to the coronary arteries. Lack of nutrition of cells leads to a change in their normal life, impaired contractility.

• The ingestion of toxic metabolic products into the blood due to severe impaired renal and liver function;
• Endocrine diseases: hyperthyroidism, diabetes mellitus, adrenal tumor, and, as a result, excess hormones or metabolic disorders;
• Constant psycho-emotional stress, stress, chronic overwork, starvation, unbalanced nutrition with nutritional deficiencies;
• Children have a combination of increased loads with a sedentary lifestyle, vegetative-vascular dystonia;
• Lack of hemoglobin (anemia) and its consequences - oxygen starvation of myocardial cells;
• Severe infectious diseases in acute and chronic form: influenza, tuberculosis, malaria;
• Dehydration of the body;
• Avitaminosis;
• Alcohol intoxication, occupational hazards.

Definition by cardiogram

With diffuse lesions of the heart, deviations from the normal picture are noted in all leads. They look like numerous areas with impaired conduction of electrical impulses.

This is expressed on the cardiogram as a decrease in the T waves, which are responsible for repolarization of the ventricles. With focal lesions, such deviations are recorded in one or two leads. These deviations are plotted as negative T waves in the leads.

If focal changes are represented, for example, by scars remaining in the connective tissue after a heart attack, they appear on the cardiogram as electrically inert areas.

Diagnostics

Deciphering electrocardiogram data takes 5-15 minutes. Her data can reveal:

• The size and depth of the ischemic lesion;
• Localization of myocardial infarction, how long ago it happened in the patient;
• Electrolyte metabolism disorders;
• Enlargement of cardiac cavities;
• Thickening of the walls of the heart muscle;
• Intracardiac conduction disorders;
• Heart rhythm disorders;
• Toxic myocardial damage.

Features of diagnosis for various pathologies of the myocardium:

• myocarditis - the cardiogram data clearly show a decrease in teeth in all leads, a violation of the heart rhythm, the result general analysis blood shows the presence of an inflammatory process in the body;
• myocardial dystrophy - eCG indicators are identical to the data obtained with myocarditis, this diagnosis can only be differentiated using data laboratory research (blood biochemistry);
• myocardial ischemia - ECG data show changes in the amplitude, polarity and shape of the T wave, in those leads that are associated with the ischemic zone;
• acute myocardial infarction - horizontal displacement of the ST segment upward from the isoline, trough-shaped displacement of this segment;
• cardiac muscle necrosis - irreversible death of myocardial cells is reflected in the ECG graph as a pathological Q wave;
• transmural necrosis is an irreversible damage to the wall of the heart muscle throughout its thickness, expressed in the cardiogram data, as the disappearance of the R wave and the acquisition of the QS type by the ventricular complex.

When making a diagnosis, you should additionally pay attention to the symptoms of concomitant diseases. It can be pain in the heart during myocardial ischemia, swelling of the legs and arms with cardiosclerotic changes, signs of heart failure as a result of a heart attack on the legs, tremors of the hands, dramatic weight loss and exophthalmos with hyperthyroidism, weakness and dizziness with anemia.

The combination of such symptoms with diffuse changes detected on the ECG requires an in-depth examination.

What diseases do they accompany

Pathological changes in the myocardium, identified on the ECG, may be accompanied by impaired blood supply to the heart muscle, repolarization processes, inflammatory processes and other metabolic changes.

A patient with diffuse changes may show the following symptoms:

• dyspnea,
• chest pain
• increased fatigue,
• cyanosis (blanching) of the skin,
• heart palpitations (tachycardia).

Diseases accompanied by changes in the heart muscle:

• Myocardial dystrophy - violation of biochemical metabolic processes in the heart;
• Allergic, toxic, infectious myocarditis - inflammation of the myocardium of various etiology;
• Myocardiosclerosis - replacement of heart muscle cells with connective tissue, as a consequence of inflammation or metabolic diseases;
• Water-salt metabolism disorders;
• Hypertrophy of parts of the heart muscle.

To differentiate them, additional examinations are required.

Additional diagnostic tests

Cardiogram data, despite their informativeness, cannot be the basis for an accurate diagnosis. In order to fully assess the degree of changes in the myocardium, additional diagnostic measures are prescribed by the cardiologist:

• General clinical analysis blood - the level of hemoglobin and such indicators of the inflammatory process as the level of leukocytes in the blood and ESR (erythrocyte sedimentation) are assessed;
• Analysis for blood biochemistry - the indicators of the content of protein, cholesterol, glucose are estimated to analyze the work of the kidneys, liver;
• General clinical urine analysis - indicators of kidney function are assessed;
• Ultrasound in case of suspected pathology of internal organs - according to indications;
• Daily monitoring of ECG indicators;
• Exercise ECG;
• Ultrasound of the heart (echocardiography) - the state of the heart is assessed to find out the cause of myocardial pathology: expansion (dilation), hypertrophy of the heart muscle, signs of a decrease in myocardial contractility, impaired motor activity.

Treatment for focal and diffuse disorders

In the treatment of myocardial pathologies, various groups of drugs are used:

• Corticosteroid hormones - as an anti-allergic agent;
• Cardiac glycosides - for the treatment of diffuse changes in the myocardium, manifestations of heart failure (ATP, Cocarboxylase);

Diuretics - for the prevention of edema;

Means for improving metabolism (Panangin, Magnerot, Asparkam);

Antioxidants (Mexidol, Actovegin) - to eliminate the negative effect of lipid oxidation products;

Antibiotics - for anti-inflammatory therapy;

Drugs for the treatment of concomitant diseases;

Vitamin preparations.

If conservative treatment does not lead to significant improvements in the patient's condition with myocardial diseases, he undergoes an operation to implant a myocardial pacemaker.

The main provisions of dietary nutrition:

• Salt and excess fluid intake is limited to a minimum;
• Spicy and fatty foods are not recommended;
• The menu should include vegetables, fruits, lean fish and meat, dairy products.

Changes in the myocardium detected on the ECG require additional laboratory and instrumental examination. If necessary, a cardiologist will prescribe treatment in a hospital or outpatient... Timely measures taken will help to avoid serious complications.

Myocardial ischemia of the heart muscle

According to statistics, more than half of older men and about a third of women suffer from various heart diseases. Myocardial ischemia is one of the most common pathologies, it is widespread both in highly developed countries and in those where the level of medicine leaves much to be desired.

The particular danger of this disease lies in the fact that it can proceed in a latent form for years, only occasionally manifesting itself as unpleasant sensations in the region of the heart, and subsequently causes a massive heart attack and sudden death.

So, let's figure out what it is - myocardial ischemia, and what types of pathology are there.

Heart damage in myocardial ischemia

Typically, the disease is classified as follows:

• Angina pectoris is the most common form of ischemia. It is usually asymptomatic, it is diagnosed mainly in elderly people. People with prerequisites for atherosclerosis are especially susceptible to this pathology.
• Myocardial infarction is one of the most severe and irreversible manifestations of ischemia. This condition is a necrosis of areas of the myocardium due to an acute lack of oxygen, and is often the cause of death. But even with successful healing of the necrotic focus, a scar will still remain in its place (postinfarction cardiosclerosis).
• Cardiac arrhythmias are disruptions in the normal functioning of the heart, in which it stops contracting with the proper frequency.
• Sudden coronary death.
• Postinfarction cardiosclerosis.
• Heart failure.

In any case, myocardial ischemia causes the gradual development of pathological changes in the heart. Such patients are especially at risk of blood clots in the vessels of the limbs, kidneys or brain.

A special form of pathology is transient ischemia of the heart muscle. This disease occurs in approximately 1/2 of the patients suffering from ischemic heart disease, while it does not manifest itself at all externally - deviations can be detected only with the help of instrumental examination. Most often, this pathology develops in smokers, hypertensive patients and patients with congestive heart failure.

The main symptom by which one can suspect coronary heart disease is pain that occurs in both chronic and acute forms of pathology.

The heart is an organ that works without interruption, pumping a huge amount of blood through the body, and expending a large amount of nutrients and oxygen. And suddenly arising vascular spasms, blood clots and atherosclerotic plaques interfere with normal blood circulation, resulting in pain and pathological changes.

Ischemia of the left ventricular myocardium is usually the basis of all ischemic heart diseases, since the left side of the organ has a much greater load than the right one, and for its normal supply of oxygen, invariably good blood circulation is needed.

The reasons

The causes of myocardial ischemia can be very diverse, but among the main provocateurs it is customary to single out the advanced age of patients, belonging to male sex, genetic predisposition, diabetes mellitus, obesity, smoking, hypertension, hypodynamia and metabolic disorders.

Smoking as one of the causes of heart ischemia

Of course, people of venerable age are the main patients of cardiology departments, since over the years metabolic processes in the body deteriorate, various diseases develop, and degenerative changes in the vessels begin. Although recently there has been a clear tendency of cardiac pathologies towards rejuvenation, especially among residents of megacities.

In the female body, estrogens play a certain protective role, therefore, in the fair sex, myocardial ischemia occurs much less frequently than in men. However, around the age of 70, when the period of persistent menopause begins, the chances of getting sick are equal for both sexes.

Obesity entails a huge number of pathologies, since it causes the deposition of lipid formations on the arterial walls, as a result of which blood circulation is impeded and hypoxia (oxygen starvation) of the heart tissues begins. The situation is further aggravated by the presence of diabetes mellitus in a patient.

All of these factors provoke the emergence of the main causes of lack of oxygen - vasospasm, blood clots, atherosclerosis.

Symptoms

Symptoms of myocardial ischemia largely depend on the type of disease and the degree of arterial lesion. The most common type of disease is the so-called exertional angina, when pain in the region of the heart appears after any physical effort.

Signs of angina pectoris are:

• Pain in the chest region, which radiates to the left arm and the area between the shoulder blades, and appears or intensifies during the period physical activity.
• Shortness of breath with emotional strain or brisk walking.

If the listed signs and symptoms occur only at moments of exertion, last no more than half an hour and are removed with nitroglycerin, they speak of exertional angina. In the case when pain occurs for no apparent reason, we can talk about the so-called rest angina. If the pain tends to intensify from case to case, the effect of medication is gradually lost and resistance to physical exertion decreases, they speak of a progressive form of pathology.

Pain in the heart is the main symptom of ischemia

Myocardial infarction is an extremely severe ischemic manifestation, which makes itself felt with very severe pain in the retrosternal region. A person becomes restless, he has shortness of breath, the skin becomes cyanotic, there is a fear of death and psychomotor agitation. In rare cases, the patient begins to have a stomach ache, and there are no direct manifestations of a heart attack.

A very dangerous variant of ischemia is sudden cardiac death, which occurs against the background of cardiac arrhythmia, an attack of angina pectoris or necrosis. This condition requires urgent resuscitation measures.

Diagnostics

Diagnosis of myocardial ischemia is carried out by examining and interviewing the patient, listening to the heart and lungs, on the basis of which the doctor may suspect the diagnosis. To confirm or refute it, the patient is assigned a number of additional studies: electrocardiogram in a calm state and with stress, biochemical blood test, Holter monitoring.

To clarify the diagnosis, examinations such as coronary angiography, MSCT, contrast-enhanced CT and scintigraphy are also performed. Unfortunately, due to the lack of the necessary equipment, some of the examinations are not available in all medical institutions, so patients have to go to private clinics to conduct them.

ECG procedure to clarify the diagnosis of myocardial ischemia

Treatment

Treatment of myocardial ischemia is prescribed individually for each patient, and depends on the severity of the pathology, the patient's condition, the presence or absence of concomitant diseases. At the same time, the basic principles of therapy in all cases remain unchanged.

First of all, the treatment of ischemic diseases involves:

• Moderate physical activity (exercise, walking) and exclusion of excessive overload.
• Compliance with a special diet (the same as prescribed for atherosclerosis), aimed at improving metabolism. If the body weight is significantly higher than the norm, it must be reduced by reducing the amount of food and reducing its calorie content.
• Medication therapy, medications for which are prescribed by the doctor individually.

All patients, without exception, are prescribed antiplatelet agents - acetylsalicylic acid, on the basis of which they are created, shows excellent results in the fight against pathology. If necessary, the doctor additionally prescribes the use of anticoagulants. With a heart attack, heparin is required.

Beta-blockers are considered very important drugs, which can regulate the heart rate and reduce the need for oxygen, thereby increasing the life expectancy of patients.

Fibrates and statins help reduce the content of atherogenic cholesterol fractions, while increasing the number of antiatherogenic ones.

Nitroglycerin is very effective in relieving pain symptoms. It is used both in tablet form and in injections. However, this drug should be used with extreme caution in hypotensive patients, as its side effects can be a sharp drop in blood pressure, fainting and dizziness.

To remove excess fluid, which creates a load on the myocardium, diuretics are used - thiazide, diuretic and loop drugs.

Almost all treatment regimens for ischemic diseases include aCE inhibitors, as they relieve vasospasm and normalize pressure, stabilizing its values.

If the patient has a cardiac arrhythmia, he is prescribed antiarrhythmic drugs. For tachycardia, beta-blockers will be required, for other forms, cordarone or amiodarone.

In the event that the arteries are very severely affected, and drug therapy does not have the desired effect, surgical correction is carried out. Both more gentle techniques (stenting or balloon angioplasty) and radical (coronary artery bypass grafting) are used.

Ischemic heart disease always has an extremely serious prognosis. The overwhelming majority of people as a result of this pathology acquire disability, the risk of complications and even death is extremely high. Due to the widespread prevalence of the disease, experts make every possible effort to find the best way treatment of pathology and its successful prevention.

The term "ischemia of the heart" does not mean a diagnosis, but a pathological condition in which the blood supply to a part of the myocardium is impaired. The heart muscle works non-stop all life, ensures the movement of blood through the body. But the myocardium itself must also receive oxygen and nutrients through the coronary arteries to support performance, restore energy balance.

Violation of vascular patency from a short-term spasm to complete overlap of the diameter causes coronary heart disease (IHD). This is how the diagnosis sounds in accordance with the modern cardiological classification.

Why is myocardial ischemia dangerous?

Ischemia of the heart is the main cause of sudden mortality in the working-age population. More often it develops in men from 40 to 50 years old, after 50 years it affects both men and women equally.

The lack of blood supply to the area of \u200b\u200bthe heart leads to the replacement of muscle cells with scar tissue. In this process, part of the affected area is necrotic. It is important that in this place nerve bundles can pass through which impulses are transmitted and propagated, commands about the correct contractions. The heart rhythm is broken.

Exclusion of a large portion of the myocardium from movement leads to a decrease in the force of contractions. The adjacent muscle fibers are unable to take over the overload. This contributes to the gradual development of heart failure.

A weak scar of the heart wall becomes thinner with constant jerks. Perhaps the development of aneurysm and myocardial rupture.

Where is the most vulnerable point?

When studying the consequences of ischemia, it was found that the most susceptible area is the left ventricle from the anterior wall of the heart, especially its apex. This is due to the peculiarities of the blood supply to this area.

Ischemia of the posterior wall of the left ventricle and the base of the heart occupies the second position in frequency.

The lateral regions, the right ventricle, and the atria are less likely to be damaged.

Why does ischemic disease develop?

Work on the study of ischemic heart disease, prevention of severe forms of ischemia and new methods of treatment is underway in all countries. The main causes of the disease have been identified.

• Narrowing of the coronary arteries is possible with a pronounced atherosclerotic process. The heart vessels belong to the type of arteries in which atherosclerotic plaques are deposited between the inner and middle layers. Their increase leads to a gradual narrowing of the lumen of the coronary arteries, slows down blood flow and helps platelet deposition, which additionally causes thrombosis and blocks the vessel. Among the factors contributing to atherosclerosis are hypertension, diabetes mellitus and endocrine disorders, obesity, and lack of physical activity.
• Not everyone knows that before the deposition of low density lipoproteins in the plaque of the intima, the arteries are damaged by viruses (influenza, cytomegalovirus, adenovirus). This is confirmed by the simultaneous increase in the manifestations of coronary heart disease and the spread of influenza infection among the population. Prevention of influenza prevents the cause of ischemia.
• Stressful conditions affect the coronary vessels, causing spasm under the influence of adrenaline. With good stability, the spasm is quickly relieved, the blood supply is not disturbed. But in people with frequent overexertion nervous regulation it doesn't. Prolonged spasm causes malnutrition.
• Nicotine and alcohol act as provoking factors of vasospasm, disruption of the nervous control function. The smoke of cigarettes contains substances that directly paralyze blood vessels.
• Hereditary predisposition plays a role in families with these factors.

The diagram shows the mechanism of narrowing of the coronary vessel

The main clinical forms of ischemic heart disease

International classification approved clinical forms diseases with characteristic manifestations and symptoms. This is necessary to develop standards of treatment at all stages of medical care.

"Angina pectoris" or angina

A typical symptom of angina pectoris is oppressive pain behind the sternum radiating to the left into the shoulder, fingers, under the scapula, into the jaw. Other features:

1. Attacks are associated with physical exertion, overeating, excitement, inhalation of cold air.
2. The duration of the pain is from 15 to 30 minutes. They pass on their own after stopping the load, taking nitroglycerin.
3. A stable course of the disease is favorable for the selection of treatment. Patients carry with them drugs that quickly relieve pain, stop smoking, control physical activity.
4. The unstable form is more difficult to cope with. Attacks occur unexpectedly, without apparent reasons... Increased frequency indicates a pre-infarction state. A similar view may occur for the first time in life or develop after an acute heart attack.
5. For the progressive form of angina pectoris, prolonged attacks at night, accompanied by suffocation, are typical. The dose of nitroglycerin has to be increased.

Myocardial infarction

The pains are localized in the anterior regions chest (irradiation as in angina pectoris), are intense and persistent, last up to several days. In specialized departments, anesthesia is used to completely remove them. The beginning is most often in the morning. Nausea, vomiting, dizziness, increasing weakness, shortness of breath are observed. Sometimes there is a burning sensation in the epigastrium and bloating occurs.

Depending on the prevalence, there is a different degree of damage to the activity of the left ventricle of the heart, the rhythm is disturbed, and acute heart failure develops. A state of shock with a sharp drop in blood pressure requires intensive therapy, and does not always end with a favorable outcome.

It is necessary to treat myocardial infarction in specialized department.

Cardiosclerosis

This form of ischemia is characterized by the development of multiple cicatricial foci. The cause of cardiosclerosis is the overgrowth of atherosclerotic plaques in the lumen of the heart vessels.

If the affected area is small, the course of the disease progresses gradually, but inevitably leads to heart failure with shortness of breath, tachycardia, and edema in the legs.

Ischemic heart disease without pain

This form was singled out in the classification to characterize the symptoms of the course in people with high pain threshold, those whom we call "patient."

Often a similar clinic is observed in the elderly, alcoholics, people with diabetes mellitus... Instead of pain, patients feel weakness, nausea, palpitations, increased shortness of breath, heartburn.

Sudden death

With primary cardiac arrest, which occurs within a few hours after the onset of an attack of pain, complications develop quickly. Resuscitation can be successful if specialized care is provided immediately. Most often, death occurs in people with multiple risk factors.

Diagnostic signs

Diagnosis of ischemic disease begins with a doctor's examination, questioning the patient. A clear description of the complex of symptoms indicates signs of one of the forms of myocardial ischemia. Auscultation can reveal rhythm disturbances. The disease does not produce typical noises.

In an ambulance car

At the ambulance level, an ECG study is carried out. Doctors of various specialties are familiar with the signs of acute coronary pathology. The ECG tape shows the rhythm of contractions, an increase in the load on certain parts of the heart, the zone and size of ischemia, necrosis (with a heart attack), focal or diffuse cardiosclerosis are determined.

In the hospital

In laboratories medical institution necessarily determine the level of lipoproteins and total cholesterol, triglycerides, glucose. As a rule, the growth of these indicators is accompanied by ischemia. Much importance is attached to the study of enzymes that indicate the destruction of myocardial tissue. Leukocytosis and accelerated ESR indicate the stage of myocardial infarction.

By eCG teeth you can get enough information about ischemia

In a specialized department of the hospital, additional tests based on ECG are used: they check the change in heart contractions under the influence of dosed physical activity (squats, bicycle ergometer) or arrange a simulation of the load by introducing special drugs. It happens that ischemic changes are detected, although they were not observed at rest.

The ECG is performed several times, changes are possible not on the first day of the attack, but in the subsequent.

Holter monitoring allows you to record eCG changes during the day. The decryption shows changes during physical activity, in a dream. Thus, it is possible to register periodic rhythm disturbances. This is important for the patient's treatment.

The heart ultrasound is based on the use of echocardiography. The method records the size of the heart and cavities, allows you to see the operation of the valve apparatus. Modern devices give all data in digital values. The doctor can only analyze them in a complex. To identify hidden signs of ischemia, stress tests with stress tests are used.

A general X-ray examination of the chest organs allows you to reveal the expanded size of the heart shadow, suspicion of aneurysm, and see signs of congestion in the lungs.

The patient is put on electrodes for Holter monitoring

In specialized centers

The method of magnetic resonance imaging measures the amount of cardiac output, shows blood clots.

Angiography (coronary angiography) - an x-ray of the heart after the introduction of contrast agents into the vascular bed. What matters is the picture of the vessels feeding the heart muscle. The examination is necessary to resolve the issue of surgical treatment, to select the optimal location for stent placement.

Under the control of an X-ray apparatus, catheterization of the cardiac cavities is performed. The method allows you to measure the indicators of blood flow in the cavities, shows the violation of the valves, heart defects, reveals the impaired patency of the coronary vessels.

How is ischemia treated?

Coronary artery disease is treated on an outpatient basis or in a hospital, depending on the form and severity of the patient's condition.

Necessarily with an increase in the frequency of angina attacks, bed rest is necessary. Acute myocardial infarction will require a longer sparing regimen. This is the only way to reduce the burden on the heart.

Patient's nutrition

The diet for ischemic heart disease is based on the principle of preventing the deepening of risk factors: animal fats (cholesterol) and sweets (glucose) are limited as much as possible.

Such a sign should be hung at home for every patient with coronary artery disease.

The diet excludes: fatty meat, bacon, butter, smoked meats, all fried foods, sweet confectionery and sweets. For relieving bloating, vegetable dishes with cabbage, legumes, and hot spices are not recommended.

Dairy products (kefir, cottage cheese, sour cream) can be consumed with reduced fat content.

Shown is boiled fish, poultry dishes, vegetable oil, cereals, salads from fresh and boiled vegetables. Fruit is not limited.

You can drink green tea, juices, still mineral water.

Drug therapy

In a serious condition, treatment is determined by symptomatic needs: anti-shock measures, analgesic drugs, drugs that affect fibrinolysis (if possible, dissolve a blood clot in the coronary vessels).

In the future, patients must take:

• nitrates (reduce the oxygen demand of the heart muscle);
• statins (lowering cholesterol levels);
• anticoagulants (deprive platelets of the ability to stick together and resist thrombus formation).

When initial symptoms heart failure diuretics are prescribed. Patients with hypertensioncomplicated by ischemia, it will be necessary to revise the previously taken medications and their dosage.

Patients are encouraged to constantly carry drugs of the nitroglycerin group or a small spray can (Izoket). The onset of pain in the region of the heart cannot be tolerated. It is necessary to immediately take the recommended funds under the tongue.

To cure patients, excitement and stress, hard work, and physical activity are categorically contraindicated.

Folk remedies

Treatment folk remedies helps to lower blood cholesterol, adds vitamins and defenses during the recovery period. Try folk ways it is not recommended to work on pain in the heart. it good supplement to the diet.

Hawthorn berries ripen in autumn, you can collect and prepare your own tincture

• eat viburnum berries in seeds;
• drink nutmegs with milk;
• take oatmeal jelly, broth before meals;
• add cardamom to cereals and drinks;
• drink a tincture of young pine cones;
• the famous recipe "for all diseases" - honey with garlic and lemon;
• decoction of woodlice herbs, nettle, bluehead;
• tinctures of valerian, hawthorn, motherwort are sold in a pharmacy ready-made, relieve unnecessary stress, improve the rhythm of contractions.

All treatments are good if the patient has an inner mindset to heal. Little things like quitting smoking and alcohol don't matter when it comes to life or early death.

All people know that the most important body in the human body it is the heart. Any disturbances in his work immediately affect his well-being. A person cannot live without this organ. Therefore, it is very important to monitor the condition and activity of the cardiovascular system.

And if, after the ECG, some changes were revealed, and the doctor said that you have moderate changes in the myocardium. Is it worth worrying in this case, and what measures should be taken?

What are moderate changes in the myocardium

The human heart works throughout life without rest or interruption. Therefore, over the years, even healthy person this organ gets tired, and various disorders occur in the work of the cardiovascular system. Changes in the myocardium are not always life-threatening, some simply require correction of the daily regimen and nutrition.

If a person does not make complaints, and changes are found only during a routine medical examination, then you should not worry.

But if there are various deviations in health, you need to sound the alarm. And the first thing to do is make an appointment with a cardiologist.

The main complaints of the patient with changes in the myocardium

• interruptions in the heart;
• heart pain;
• fluctuations in blood pressure;
• lack of air at the slightest physical exertion;
• drowsiness;
• fatigue, weakness.

Is treatment required in this case? It all depends on the appearance of the transformations, because they are all classified into varieties.

Varieties of pathological changes

There are several types of myocardial transformations

• non-specific;
• dystrophic;
• metabolic;
• diffuse.

Depending on the type, therapy is prescribed. Let's take a look at each variety.

Non-specific changes

Moderate nonspecific changes in the ventricular myocardium are the safest type

Usually these conditions do not pose a particular danger to life and health, they can be completely reversible. Often they do not manifest themselves in any way, but are seen only on the cardiogram. A patient with nonspecific changes in the myocardium most often does not present any complaints.

They arise for a reason

• poisoning food or chemicals ;
• frequent stress;
• infectious diseases;
• improper nutrition;
• overwork;
• violation of the daily routine;
• lack of sleep;
• taking alcoholic beverages.

Otherwise, nonspecific changes in the myocardium are called repolarization. In this case, special therapy is usually not required, but the doctor may advise you to adjust the work and rest regimen, diet, and feasible sports.

Dystrophic changes

Dystrophic changes in the myocardium occur due to the lack of nutrients that the heart muscle should receive. Otherwise, this condition is also called "cardiodystrophy".

Cardiac dystrophy occurs for many reasons

• physical overload;
• frequent stress;
• low hemoglobin;
• diseases endocrine system, in particular - diabetes mellitus;
• poisoning;
• dehydration of the body;
• infectious diseases;
• chronic diseases;
• disorders of the kidneys and liver, causing intoxication;
• diets that lead to a lack of vitamins;
• alcoholic intoxication.

Sometimes dystrophic changes occur in childhood. In this case, they do not require treatment, since the children's heart is prone to changes. The same can be said for older people, whose the cardiovascular system already subject to fatigue and, as a result, imperfect.

Often dystrophic changes in the myocardium can be seen in schoolchildren taking exams.

Diffuse changes

These are changes that evenly affect the heart muscle. They arise as a result of myocardial inflammation due to a large number of medications or a violation of the water-salt balance. This leads to metabolic disorders and to disease, hypoxia.

Among the causes of hypoxia, the following can be distinguished

• frequent stress;
• chronic diseases;
• physical overload;
• excess weight;
• hypothermia of the body;
• alcoholic intoxication.

This condition can be easily corrected with the correct diet and daily regimen. A good sleep.

The symptoms of the disease are as follows

• dark circles under the eyes;
• dyspnea;
• increased fatigue;
• flies before the eyes;
• decreased performance;
• lack of air;
• drowsiness.

When these signs appear, an urgent need to consult a specialist, conduct an examination.

Metabolic changes

Dysmetabolic changes in the myocardium are considered the most harmless and do not have any symptoms and, as a rule, are detected after the next examination. They arise due to overwork, stress, due to the intake of certain drugs.

Usually the doctor recommends in these cases, simply change the daily routine or take a break. However, you should not take this disease lightly and ignore the doctor's advice, because this can lead to serious consequences.

Left ventricular hypertrophy

This is already a dangerous change in the myocardium, requiring careful conservative and sometimes surgical treatment.

Normally, the wall thickness of the left ventricular myocardium is 7-11 mm, but with some complications ( high blood pressurefor example) the heart has to distill more blood. As a result, the myocardial wall is stretched, not withstanding the overload, and an increase in the size of the ventricle develops.

This condition is called left ventricular hypertrophy. It can be both congenital and acquired. The latter is found in athletes and people experiencing constant physical overload. Therefore, people who have linked their lives with sports are recommended to undergo regular medical examinations.

Otherwise, LVH is called an overworked heart. It is especially dangerous when LVH occurs during pregnancy. Then there is a threat to both the life of the mother and the fetus. Therefore, urgent action is needed.

There are diseases that provoke left ventricular myocardial hypertrophy:

• arterial hypertension;
• atherosclerosis of the aorta;
• constriction aortic valve.

But if the expansion of the myocardium is not more than 18 mm, then no treatment is prescribed.

What are the symptoms of this disease?

Usually a person feels with left ventricular hypertrophy:

• dizziness;
• weakness;
• shortness of breath;
• swelling;
• chest pain;
• interruptions in the heart.

Symptoms usually increase after exercise and stress. They also increase during pregnancy.

Diagnostic and treatment methods

When these symptoms appear, a person should urgently contact medical institution for the purpose of examination.

It usually consists of procedures such as

• external examination of the patient, measurement of blood pressure, pulse;
• echo cardiograms;
• electrocardiogram;
• duplex scanning of the aorta.

Doppler echocardiography is sometimes done to measure blood flow velocity and turbulence.

If identified moderate changes in the left ventricular myocardiumthen supportive treatment can be prescribed. These are usually preparations containing potassium and magnesium (for example, Panangin or Asparkam).

Also, the doctor will advise a special diet, which involves avoiding salty, smoked, fatty foods. On the contrary, it will be beneficial to include foods rich in potassium and magnesium in the diet.

Healthy foods

• fish caviar;
• dried apricots;
• raisins;
• buckwheat;
• bananas;
• prunes;
• walnuts;
• fish of the salmon family.

But if there is left ventricular hypertrophy, special treatment is required. When this disease is combined with hypertension, antihypertensive drugs are usually prescribed.

This is usually

• angio-converting enzyme inhibitors;
• beta blockers;
• drugs that block calcium channels.

If LVH is accompanied by aortic atherosclerosis, then the following drugs are prescribed

• statins;
• endotheliotropic drugs;
• blood thinners.

With concomitant arrhythmias, nitrates and antiarrhythmic substances are prescribed

If left ventricular myocardial hypertrophy is caused by a heart defect, then surgery cannot be avoided.

There are usually two types of surgery for LVH: aortic valve replacement and aortic stenting.

There is a treatment for this condition with folk remedies. This recipe helps a lot.

You need to take a lemon, mince it, add dried apricots, prunes, raisins, pour honey. Take the mixture in a teaspoon in the morning.

Forecast

With a mild course of the disease, the prognosis is favorable if you follow all the doctor's recommendations: normalize the daily regimen, establish a balanced diet, and proper rest.

If there is left ventricular hypotrophy, complicated by heart disease, then surgery is necessary. In its absence, life expectancy is no more than five years in 95% of patients.