Signs of ischemia. Cardiac ischemia

In this article we will find out:

Coronary artery disease (CHD) is defined by the World Health Organization as acute or chronic myocardial dysfunction due to a relative or absolute decrease in the supply of the myocardium with arterial blood, most often associated with a pathological process in the coronary artery system.

Thus, IHD is a chronic oxygen starvation of the heart muscle, which leads to disruption of its normal operation. Lack of oxygen leads to disruption of all functions of our heart. That is why ischemic heart disease is a complex concept that includes angina, myocardial infarction and heart rhythm disturbances.

Why does IHD occur?

To function properly, our heart needs a constant supply of oxygen through the blood. The coronary arteries and their branches supply blood to our heart. As long as the lumen of the coronary vessels is clean and wide, the heart does not experience a lack of oxygen, which means it is able to work efficiently and rhythmically without paying attention to itself under any conditions.

By the age of 35-40, it becomes more and more difficult to possess clean heart vessels. Our health is more and more influenced by the habitual way of life. Increased arterial pressure and the abundance of fatty foods in the diet contribute to the accumulation of cholesterol deposits on the walls of the coronary vessels. So the lumen of the vessels begins to narrow, from which our life directly depends... Regular stress and smoking, in turn, lead to spasm of the coronary arteries, which means that they further reduce blood flow to the heart. Finally, a sedentary lifestyle and excessive body weight as a trigger inevitably lead to the earliest onset of coronary heart disease.

CHD symptoms. How to distinguish from a heart attack?

Most often, the very first noticeable manifestations of coronary heart disease are paroxysmal pain in the sternum (heart) - angina pectoris. Painful sensations can "give" to the left arm, collarbone, shoulder blade or jaw. These pains can be both in the form of sharp stabbing sensations, and in the form of a feeling of pressure ("heart presses") or a burning sensation behind the breastbone. Such pains often make a person freeze, stop any actions and even hold their breath until they pass. Heart pain in coronary artery disease usually lasts at least 1 minute and no more than 15 minutes... Their occurrence may be preceded by severe stress or physical activity, but there may not be obvious reasons. From a heart attack, an attack of angina pectoris in coronary artery disease is distinguished by a lower intensity of pain, their duration is no more than 15 minutes and disappearance after taking nitroglycerin.

What causes coronary heart disease attacks?

When we discussed the blood supply to the heart, we said that clean coronary vessels allow our heart to work efficiently under any conditions. Cholesterol plaques narrow the coronary space and reduce blood flow to the myocardium (heart muscle). The more difficult the blood supply to the heart is, the less stress it can withstand without pain attack ... All this happens because any emotional and physical exercise require strengthening the work of the heart. In order to cope with such a load, our heart needs more blood and oxygen. But the vessels are already clogged with fatty deposits and spasmodic - they do not allow the heart to receive the necessary nutrition. What happens - the load on the heart is growing, but it cannot receive more blood. This is how oxygen starvation of the heart muscle develops, which, as a rule, is manifested by an attack of stabbing or pressing pains behind the sternum.

It is known that several harmful factors always lead to the onset of ischemic heart disease. They are often related to each other. But why are they harmful?

The abundance of fatty foods in the diet - leads to increase in blood cholesterol and its deposits on the walls of blood vessels... The lumen of the coronaries narrows - the blood supply to the heart decreases. Thus, distinct attacks of ischemic heart disease become noticeable if cholesterol deposits narrow the lumen of the coronary vessels and their branches by more than 50%.

Diabetes – accelerates the process of atherosclerosis and deposits of cholesterol plaques on the vessels. The presence of diabetes mellitus doubles the risk of coronary artery disease and significantly worsens the prognosis of patients. One of the most dangerous heart complications of diabetes mellitus is myocardial infarction.

Hypertension - high blood pressure creates excessive stress on the heart and blood vessels... The heart works in an excessively high mode of exhaustion. Blood vessels lose their elasticity - the ability to relax and allow more blood to pass through during exercise. There is a trauma to the vascular wall - the most important factor that accelerates the deposition of cholesterol plaques and narrowing of the vascular lumen.

Sedentary lifestyle - constant sedentary work at the computer, driving a car and lack of necessary physical activity lead to weakening of the heart muscle, venous stasis... It becomes increasingly difficult for a weak heart to pump stagnant blood. In these conditions, it is impossible to properly nourish the heart muscle with oxygen - coronary heart disease develops.

Smoking, alcohol, frequent stress - all these factors lead to spasm of the coronary vessels - which means that they directly cut off the blood supply to the heart. Regular spasms of the heart vessels, already blocked by cholesterol plaques, are the most dangerous precursors of the early development of angina pectoris and myocardial infarction.

What leads to ischemic heart disease and why should it be treated?

Cardiac ischemia - progressive disease. Due to increasing atherosclerosis, uncontrolled blood pressure and lifestyle over the years, the blood supply to the heart deteriorates to critical quantities. Uncontrolled and untreated coronary artery disease can progress to myocardial infarction, heart rate block, and heart failure. What are these conditions and how are they dangerous?

Myocardial infarction - This is the death of a certain part of the heart muscle. It develops, as a rule, due to thrombosis of the arteries feeding the heart. This thrombosis is the result of the progressive growth of cholesterol plaques. It is on them that blood clots are formed over time, which are able to block oxygen to our heart and endanger life.

With myocardial infarction, there is a sudden attack of unbearable, tearing pain in the chest or in the region of the heart. This pain can radiate to the left arm, scapula or jaw. In this state, the patient has cold sweat, blood pressure may drop, nausea, weakness and a feeling of fear for his life appear. Myocardial infarction differs from attacks of angina pectoris in coronary artery disease by unbearable pain that lasts a long time, more than 20-30 minutes and slightly decreases from taking nitroglycerin.

Heart attack - a life-threatening condition that can lead to cardiac arrest... That is why when the above symptoms appear, you must immediately call an ambulance.

Heart rhythm disorders - blockages and arrhythmias... Prolonged violation of the adequate blood supply to the heart in coronary artery disease leads to various heart rhythm failures. With arrhythmias, the pumping function of the heart can significantly decrease - it pumps blood ineffectively. In addition, in case of a gross disturbance of the heart rhythm and conduction possible cardiac arrest.

Cardiac arrhythmias in coronary artery disease can be asymptomatic and recorded only on an electrocardiogram. However, in some cases, patients feel them in the form of a frequent heartbeat behind the breastbone ("pounding heart"), or, on the contrary, an obvious slowing of the heartbeat. Such attacks are accompanied by weakness, dizziness and, in severe cases, can lead to loss of consciousness.

Development chronic heart failure - is the result of untreated coronary heart disease. Heart failure is inability of the heart to cope with physical activity and fully provide the body with blood... The heart becomes weak. With mild heart failure, severe shortness of breath occurs during exertion. In case of severe insufficiency, the patient is unable to endure the lightest household loads without pain in the heart and shortness of breath. This condition is accompanied by edema of the limbs, a constant feeling of weakness and malaise.

Thus, heart failure is the result of the progress of coronary heart disease. The development of heart failure can significantly worsen the quality of life and lead to complete loss of performance.

How is coronary artery disease diagnosed?

The diagnosis of ischemic heart disease is based on the results of instrumental and laboratory research... Performed blood test, with decoding of the profile of cholesterol and sugars. To assess the functioning of the heart (rhythm, excitability, contractility), eCG recording (electrocardiogram). For an accurate assessment of the degree of narrowing of the blood vessels supplying the heart, contrast agent and an X-ray examination is performed - coronary angiography... The collection of research data shows the current state of metabolism, heart muscle and coronary vessels. In combination with symptoms, this makes it possible to diagnose IHD and determine the prognosis of the course of the disease.

Treatment of ischemic heart disease with drugs. Perspectives. What is important to know?

First of all, you need to understand that drugs do not treat the main cause of coronary heart disease - they temporarily muffle the symptoms of its course. As a rule, for the treatment of ischemic heart disease, a whole complex of different drugs is prescribed, which must be taken every day from the moment of appointment. for life... In the treatment of ischemic heart disease, drugs of several main groups are prescribed. Medicines of each group have a number of fundamental restrictions on use in patients with ischemic heart disease. So treatment becomes impossible, or dangerous to health in the presence of certain diseases in different patients. Superimposed on each other, these restrictions significantly narrow the possibilities of drug treatment of coronary heart disease. In addition, the collection side effects from different drugs, is, in fact, a disease separate from IHD, which much reduces the quality of human life.

Today, the following groups of drugs are used for drug prevention and treatment of coronary artery disease:

• Antiplatelet agents
• B-blockers
• Statins
• ACE inhibitors
• Calcium antagonists
• Nitrates

Each group of these drugs has completely certain limits of applicability and a number of associated side effects, which are important to know about:

Antiplatelet agents - blood thinning drugs. The most commonly used drugs are aspirin. All medicines this group contraindicated during pregnancy and lactation... The drugs provide irritating and ulcerative effect on the stomach and intestines. That is why taking these funds poses a risk for patients who already have peptic ulcer stomach, duodenum or inflammatory diseases intestines. With prolonged use of aspirin-containing drugs occurs risk of development allergic reaction respiratory tract... This is especially important to take into account if a patient with coronary artery disease already has bronchial asthma or bronchitis, because medications can trigger an attack. It must be borne in mind that all drugs in this group exert significant stress on the liver and therefore highly undesirable for use in hepatic diseases.

B-blockers - a huge group of drugs that occupy one of the main places in drug treatment Ischemic heart disease. All beta-blockers have significant application restrictions. This group of drugs should not be taken by patients with bronchial asthma, bronchitis, COPD and diabetes mellitus ... This is due to side effects in the form of possible bronchospasm and spikes in blood sugar.

Statins - These drugs are used to lower blood cholesterol levels. The entire line of drugs prohibited during pregnancy and lactationsince statins can cause fetal abnormalities... Drugs highly toxic to the liver, and therefore not recommended for relevant diseases. If taken, regular laboratory monitoring of the inflammatory parameters of the liver is required. Statins can cause skeletal muscle atrophy, as well as aggravate the course of the existing myopathies... For this reason, if you experience muscle pain while taking these drugs, you should consult a doctor. Statins are categorically incompatible with alcohol intake.

Calcium channel blockers - also used in combination with other drugs to lower blood pressure. The entire group of these drugs. When diabetes mellitus taking this group of drugs in the treatment of coronary artery disease is highly undesirable. This is associated with the risk of serious violations of the ionic balance in the blood. In the case of old age and the presence of disorders of cerebral circulation, taking drugs of this group is associated with the risk of developing a stroke... The drugs are categorically incompatible with alcohol intake.

ACE (angiotensin converting enzyme) inhibitors - most often used to lower blood pressure in the treatment of coronary artery disease. Reduces the concentration of the most important ions in the blood. They have a detrimental effect on the cellular composition of the blood. Toxic to the liver and kidneys, and therefore not recommended for use in the corresponding diseases. With prolonged use, they cause a constant dry cough.

Nitrates - most often used by patients to relieve attacks of pain in the heart (nitroglycerin tablet under the tongue), can also be prescribed for the prevention of angina pectoris. This group of drugs prohibited for use during pregnancy and lactation... The drugs have a serious effect on vascular tone, and therefore their use causes headache, weakness, lowering of blood pressure. For this reason, nitrate treatment is dangerous for people with impaired cerebral circulation, hypotension and intracranial pressure... With prolonged use of nitrates, their effectiveness is significantly reduced due to addictive - the previous dosages cease to relieve angina attacks. Nitrates are categorically incompatible with alcohol intake.

Given the above, it becomes obvious that the treatment of coronary artery disease with drugs is only able to temporarily restrain the progress of the disease, causing significant side effects in a sick person. The main disadvantage of drug therapy is impact on the symptoms of the disease without eliminating the cause itself the development of coronary heart disease.

The main reason for the development of ischemic heart disease. Why does this disease develop?

Ischemic heart disease is a metabolic disease... It is because of the profound metabolic disturbance in our body that cholesterol is deposited on the vessels, blood pressure rises and a spasm of the heart vessels occurs. With the steady progress of coronary artery disease it is impossible to cope without correcting the metabolism in the body.

How to correct metabolism and stop the progress of ischemic heart disease?

It is widely known that blood pressure must be monitored. It is no less known that there are strictly defined numbers of "healthy" blood pressurethat correspond to the norm. Anything above and below is a deviation leading to illness.

It is equally known that the constant consumption of fatty and high-calorie foods leads to the deposition of cholesterol in blood vessels, obesity. Thus, it becomes clear that fats and calories in food also have a strictly defined rate, within which a person is healthy. Excessive fat intake leads to illness.

But how often do sick people hear that their breathing is deeper than normal? Do people with coronary heart disease know that excessive deep breathing every day plays a key role in the development of their disease? Do IHD patients know that as long as they breathe deeper than a healthy physiological norm, no medication can stop the progress of the disease? Why it happens?

Breathing is one of the most important vital functions in our body. Exactly our breath plays a key role in metabolism... The work of thousands of enzymes, the activity of the heart, brain and blood vessels directly depends on it. Breathing, like blood pressure, has strictly defined norms at which a person is healthy... For years, people with coronary heart disease breathe excessively deeply. Excessively deep breathing changes the gas composition of the blood, destroys the metabolism and leads to the development of coronary heart disease... So with deep breathing:

• There is a spasm of the vessels supplying the heart... Because carbon dioxide is excessively washed out of our blood - natural factor relaxation of blood vessels
• Oxygen starvation of the heart muscle develops and internal organs - without enough carbon dioxide in the blood, oxygen cannot reach the heart and tissues
• Arterial hypertension develops - a rise in blood pressure - a reflex defense reaction of our body to oxygen starvation of organs and tissues.
• The course of the most important metabolic processes is disrupted... Excessive breathing disturbs the healthy proportions of blood gases and its acid-base state. This entails disruption of the normal functioning of a whole cascade of proteins and enzymes. All this contributes to the disruption of fat metabolism and accelerates the deposition of cholesterol in the vessels.

Thus, excessively deep breathing is the most important factor in the development and progression of coronary heart disease. That is why taking whole handfuls drugs does not allow to stop ischemic heart disease. Taking medication, the patient continues to breathe deeply and destroy the metabolism... Dosages rise, the disease progresses, the prognosis becomes more serious - but deep breathing remains. Normalization of breathing of a patient with coronary artery disease - bringing him to a healthy physiological norm, capable stop the progress of the disease, be of great help with medication and save life from a heart attack.

How can you normalize breathing?

In 1952, the Soviet physiologist Konstantin Pavlovich Buteyko performed revolutionary discovery in medecine - The discovery of deep breathing diseases... Based on it, he developed a cycle of special breathing exercises that allows you to restore healthy normal breathing. As the practice of thousands of patients who have passed through the Buteyko Center has shown, normalization of breathing by itself eliminates the need for patients with initial stages of the disease for ever. In severe, advanced cases, breathing becomes a huge help, allowing, together with drug therapy save the body from the non-stop progress of the disease.

In order to study the method of Dr. Buteyko and achieve a significant result in the treatment, the supervision of an experienced methodologist is required. Attempts to normalize breathing on their own using materials from unverified sources, at best, do not bring results. It is necessary to understand breathing - a vital function of the body. Establishing a healthy physiological breathing is of great benefit, improper breathing is a huge harm to health.

If you want to normalize your breathing - apply for a correspondence course on the Internet. Classes are held under the supervision of an experienced methodologist, which allows you to achieve the desired result in the treatment of the disease.

Chief Physician of the Center for Effective Training in the Buteyko Method,
Neurologist, chiropractor
Konstantin Sergeevich Altukhov

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 oxygen supply to the heart muscle. Recently, a fairly common disease of cardio-vascular system, which leads to severe irreparable deterioration in health and even death. The risk group includes mainly men, women during the period, as well as after menopause, which, with a change in hormonal levels, brings with it a weakening of the body and provokes many diseases.

There are several forms of cardiac ischemia:

• Initial - it is painless. There is a decrease in blood pressure, discomfort in the chest, shortness of breath.
• Primary arrest is characterized by cardiac arrest. In this case, without immediate professional help, it is fatal.
• Angina pectoris. There is a blockage of the coronary arteries with plaque causing pain in the chest, arm, neck, face.
• Heart attack. Termination of full blood flow 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 on time, serious complications are possible. At the first sign, you should immediately consult a doctor. The cardiovascular system is involved in the blood circulation of the whole organism, and the heart, as its independent organ, also needs blood supply. The coronary vessels or arteries feed the myocardium and heart muscle.

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

• Atherosclerosis. The formation of cholesterol on the walls of blood vessels.
• Arterial hypertension. Due to the constant increase in blood pressure, the left ventricle increases and the blood supply is disturbed.
• Diabetes. Leads to the formation of cholesterol plaques that impede blood circulation.
• Thrombosis. The mechanism of rapid blood clotting makes it impossible for blood to enter the organs through the vessels.

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

It is not only diseases that can provoke disturbances and malfunctioning of the organs of the cardiovascular system, but also the characteristics of the body and the life of the person himself:

• Stress, nervous strain. Lead to persistent arrhythmia, impaired intake nutrients and oxygen to the organs.
• Genetic predisposition... It is inherited along with the genetic code.
• Gender. In men, ischemia is more common.
• Excess weight... Exceeding normal body weight leads to an increase in blood volume, which the heart must push out in one contraction. The tone of the walls gradually deteriorates, the load on the vessels increases.
• Availability bad habits... Smoking causes excessive amounts 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, since they are more vulnerable to ischemia. This is due not only to physiological characteristics. The reasons are difficult working conditions, bad habits and stressful situations.

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

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

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

Signs of ischemia of the heart in women and children

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

Individual signs of heart ischemia in women still have:

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

In women, the cause for ischemia of the heart can be stress, hard mental work, age 55 and older. 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 manifests its characteristic symptoms:

• Painful sensations, feeling of constriction 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. AT childhood mortality from ischemic disease is much higher. Therefore, at the first even the slightest suspicion of a malfunction of the heart, an ambulance is urgently required.

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

In such cases, you need to know exactly the rules of how to provide first aid for angina pectoris:

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

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

With angina pectoris, you cannot cause excitement, give unfamiliar drugs and force a person to move. Before the arrival of an ambulance, it is better to keep quiet and, in case of strong anxiety, apply valerian tincture.

Most the best way to avoid ischemia is to constantly monitor your health and undergo a medical examination. If symptoms suddenly appear in the chest or left side of the body, consult a specialist.

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

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

Many diseases are the result of the wrong lifestyle of the person himself. It is necessary to take into account environmental problems, which also play big role in poor health. Avoid stressful situations and unnecessary stress in every possible way.

IHD occupies a strong leading position among the most common heart pathologies, often leads to partial or complete disability and has become a social problem for many developed countries of the world. A busy rhythm of life, constant stressful situations, weakness, inappropriate nutrition with a high fat intake - all these reasons lead to a steady increase in the number of people suffering from this serious illness.

The term "coronary heart disease" includes a whole group of acute and chronic conditions that are caused by insufficient supply of oxygen to the myocardium due to narrowing or blockage of the coronary vessels. Such oxygen starvation of muscle fibers leads to disruption in the functioning of the heart, changes in hemodynamics and persistent structural changes in the heart muscle.

Most often this disease is provoked by atherosclerosis of the coronary arteries, in which the inner wall of the vessels is covered with fatty deposits (atherosclerotic plaques). Subsequently, these deposits harden, and the vascular lumen narrows or becomes impassable, disrupting the normal delivery of blood to the myocardial fibers. From this article you will learn about the types of coronary heart disease, about the principles of diagnosis and treatment of this pathology, about the symptoms and what the cardiologist's patients need to know.

Currently, due to the expansion of diagnostic capabilities, cardiologists distinguish such clinical forms Ischemic heart disease:

• primary cardiac arrest (sudden coronary death);
• and spontaneous angina pectoris;
• myocardial infarction;
• postinfarction cardiosclerosis;
• insufficiency of blood circulation;
• heart rhythm disturbances (arrhythmias);
• painless ischemia of the heart muscle;
• distal (microvascular) ischemic heart disease;
• new ischemic syndromes (hibernation, stunnedness, metabolic adaptation of the myocardium).

The above classification of ischemic heart disease belongs to the system of the International Classification of Diseases X.

Causes

In 90% of cases of coronary artery disease is provoked by a narrowing of the lumen of the coronary arteries, caused by atherosclerotic changes in the walls of blood vessels. In addition, disturbances in the correspondence of coronary blood flow and metabolic requirements of the heart muscle may result from:

• spasm of little or unchanged coronary vessels;
• a tendency to thrombus formation due to disorders of the blood coagulation system;
• microcirculation disorders in coronary vessels.

Risk factors for the development of such etiological causes of coronary artery disease can be:

• age over 40-50 years;
• smoking;
• heredity;
• arterial hypertension;
• diabetes;
• obesity;
• an increase in total plasma cholesterol (more than 240 mg / dl) and LDL cholesterol (more than 160 mg / dl);
• hypodynamia;
• frequent stress;
• poor nutrition;
• chronic intoxication (alcoholism, work in toxic enterprises).

Symptoms

In most cases, IHD is diagnosed already at the stage when the patient has its characteristic signs. This disease develops slowly and gradually, and its first symptoms make themselves felt when the lumen of the coronary artery narrows by 70%.

Most often, IHD begins to manifest itself as symptoms of exertional angina:

• feeling of discomfort or appearing after physical, mental or psycho-emotional stress;
• the duration of the pain syndrome is no more than 10-15 minutes;
• pain causes feelings of anxiety or fear of death;
• pain can radiate to the left (sometimes to the right) half of the body: arm, neck, shoulder blade, lower jaw etc.
• during an attack, the patient may experience: shortness of breath, a sharp feeling of lack of oxygen, increased blood pressure, nausea, increased sweating, arrhythmia;
• pain can disappear on its own (after the end of the load) or after taking Nitroglycerin.

In some cases, angina pectoris can manifest itself as atypical symptoms: proceed without pain, manifest itself only as shortness of breath or arrhythmia, pain in the upper abdomen, a sharp decrease in blood pressure.

Over time and in the absence of treatment, coronary artery disease progresses, and the above symptoms can appear at a much lower intensity of exercise or at rest. The patient has an increase in the frequency of attacks, they become more intense and prolonged. This development of ischemic heart disease can lead to (in 60% of cases it first occurs after a prolonged angina attack), or sudden coronary death.

Diagnostics

Diagnosis in case of suspected coronary artery disease begins with a detailed consultation with a cardiologist. The doctor, after listening to the patient's complaints, necessarily asks questions about the history of the appearance of the first signs of myocardial ischemia, their nature, and the patient's internal sensations. Anamnesis is also collected about previous illnesses, family history and medications taken.

After interviewing the patient, the cardiologist conducts:

• pulse measurement and;
• listening to the heart with a stethoscope;
• tapping the borders of the heart and liver;
• general examination to detect edema, changes in the condition of the skin, the presence of pulsation of the veins, etc.

Based on the data obtained, the patient may be assigned such additional laboratory and instrumental methods surveys:

• ECG (in the initial stages of the disease, an ECG with exercise or pharmacological tests may be recommended);
• (daily monitoring);
• phonocardiography;
• radiography;
• biochemical and clinical blood test;
• Echo-KG;
• myocardial scintigraphy;
• transesophageal pacing;
• catheterization of the heart and large vessels;
• magnetic resonance coronary angiography.

The scope of the diagnostic examination is determined individually for each patient and depends on the severity of the symptoms.

Treatment

Treatment of ischemic heart disease is always complex and can be prescribed only after a comprehensive diagnosis and determination of the severity of myocardial ischemia and damage to the coronary vessels. These can be conservative (prescription of drugs, diet, exercise therapy, spa treatment) or surgical techniques.

The need for hospitalization of a patient with coronary artery disease is determined individually, depending on the severity of his condition. At the first signs of impaired coronary circulation, the patient is advised to give up bad habits and adhere to certain rules of good nutrition. When compiling his daily diet, a patient with coronary artery disease should adhere to the following principles:

• reducing the amount of foods containing animal fats;
• refusal or sharp limitation of the amount of table salt consumed;
• an increase in the amount of plant fiber;
• introduction of vegetable oils into the diet.

Drug therapy for different forms IHD is aimed at preventing angina attacks and may include various antiangial drugs. The treatment regimen may include the following groups of drugs:

In the initial stages of ischemic heart disease drug therapy can significantly improve health. Compliance with the doctor's recommendations and constant dispensary observation in many cases can prevent the progression of the disease and the development of severe complications.

With low efficiency conservative treatment and large-scale damage to the myocardium and coronary arteries, a patient with coronary artery disease may be recommended to perform surgical operation... The decision on the tactics of intervention is always selected individually. To eliminate the zone of myocardial ischemia, the following types of surgical operations can be performed:

• angioplasty of the coronary vessel with: this technique is aimed at restoring the patency of the coronary vessel by introducing a special stent (mesh metal tube) into its affected area;
• coronary artery bypass grafting: this method allows you to create a bypass path for blood to enter the zone of myocardial ischemia, for this, the patient's own vein or the internal thoracic artery can be used as a shunt;
• transmyocardial laser revascularization of the myocardium: this operation can be performed if it is impossible to perform coronary artery bypass grafting, during the intervention, the doctor uses a laser to create in the damaged area of \u200b\u200bthe myocardium many of the thinnest channels that can fill with blood from the left ventricle.

In most cases surgery significantly improves the quality of life of a patient with ischemic heart disease and reduces the risk of myocardial infarction, disability and death.

Educational film on the topic "Ischemic heart disease"

Is a disease that is a violation of myocardial circulation. It is caused by a lack of oxygen, which is carried through the coronary arteries. Manifestations of atherosclerosis prevent its entry: narrowing of the lumens of blood vessels and the formation of plaques in them. In addition to hypoxia, that is, a lack of oxygen, the tissues are deprived of some of the beneficial nutrients necessary for the normal functioning of the heart.

Coronary artery disease is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of the fairer sex of a number of hormones that prevent the development of vascular atherosclerosis. With the onset of menopause, the hormonal background changes, so the possibility of developing coronary artery disease increases dramatically.

Within the framework of the classification of coronary heart disease, the following forms are distinguished:

Painless form. This myocardial ischemia is characteristic of people with a high pain threshold. Hard physical labor, alcohol abuse contribute to its development. The elderly, as well as the sick, are at risk. This form of ischemia is painless, which is why it is often called dumb. However, in some cases, there may be chest discomfort. It occurs in the early stages of the development of the disease. Typical symptoms painless ischemia of the heart is tachycardia, angina pectoris, sharp. Possible weakness in the left hand, shortness of breath or.

Primary cardiac arrest. It refers to sudden coronary death. It occurs immediately after a heart attack or within a few hours after it. Overweight, smoking, arterial hypertension contribute to this manifestation of coronary heart disease, and ventricular fibrillation becomes the cause. Allocate sudden coronary death with successful resuscitation or resulting in death. In the first case, a qualified health care must be rendered immediately. If defibrillation is not done in time, the patient dies.

Compressing or pressing pain, discomfort in the chest area - these are the main symptoms that determine this form of coronary artery disease. It often manifests itself in the form of heartburn, colic, or nausea. Chest pains can radiate to the neck, left arm or shoulder on the same side, sometimes to the jaw and back. Discomfort occurs during active physical activity, after eating, especially when overeating, a sharp increase in blood pressure. Stress and hypothermia cause angina. In all these situations, there is a need for more oxygen for the muscle of the heart, but because of the clogged arteries with plaque, this is not possible. To cope with pain, which can last up to 15 minutes, it is enough to stop physical activity, if it was caused by it, or to take short-acting nitrates. The most popular of these drugs is nitroglycerin.




Angina pectoris can be stable and unstable. In the first case, it is caused by the action of environmental factors: smoking, significant physical activity. You can deal with it with the help of nitroglycerin. If it becomes ineffective, this indicates the development of unstable angina. It is more dangerous, as it often becomes the cause of myocardial infarction or death of the patient. One of the types of unstable angina pectoris is the first-onset angina pectoris. home distinctive feature this form of the disease - the onset of seizures began no later than a few months ago. The cause of the first-onset angina pectoris can be strong emotional or physical stress. In this case, the coronary arteries can function normally. The second group of patients is formed by patients who have undergone and have pathology of the coronary arteries. If the development of the disease occurs imperceptibly, it is highly likely that it will develop into stable angina pectoris. But another option is also possible. Often, the first symptoms soon disappear, the attacks stop, and over the next years, the patient's angina does not appear in any way. This requires regular examinations to prevent unexpected myocardial infarction.

Cardiosclerosis can be diffuse and focal. In the first case, scar tissue replaces heart cells evenly, being distributed throughout the muscle. With focal cardiosclerosis, connective tissue affects only certain areas. It is usually caused by myocardial infarction.

Plaques in the arteries cause the development of atherosclerotic cardiosclerosis. The development of myocarditis cardiosclerosis is promoted by inflammatory process directly to the heart muscle. Overeating, smoking, a sedentary lifestyle increases the risk of the disease. For a long time, cardiosclerosis can be asymptomatic, especially in the case of atherosclerotic form. Patients during rehabilitation and prevention should follow a diet that involves the minimum intake of salt, fat and fluids.

There are several main symptoms of heart ischemia:

Pain in the chest and behind the chest.It can have a stabbing, baking or constricting character. Unpleasant sensations arise unexpectedly and disappear after 3-15 minutes. In the early stages of coronary artery disease, discomfort may be mild. Severe pain given to the left arm and shoulder, less often to the jaw and right side. They appear during sports, or with strong emotional stress. To get rid of the discomfort caused by physical activity, it is enough to take a short break. When such measures do not help and the attacks become severe, they resort to the help of medications.

Dyspnea. Like pain, it first appears during movement and is caused by a lack of oxygen in the body. As the disease progresses, shortness of breath is accompanied by each attack. The patient experiences it even at rest.

Heartbeat disorders.It becomes more frequent, and in this case the blows are felt more strongly. Interruptions are also possible at some moments. At the same time, the heartbeat is felt very weak.

General malaise.The patient experiences, may fall into, gets tired quickly. There is increased sweating and nausea, turning into vomiting.

In the old days it was called "angina pectoris". This phrase is not accidental, because angina pectoris is not pain, but severe squeezing and burning in the chest and esophagus. May feel in the form of pain in the shoulder, arm, or wrist, but this is less common. Angina pectoris can be easily confused with heartburn. Unsurprisingly, some people try to deal with it and use soda for this. In cardiology, angina pectoris is considered the most striking symptom, indicating the presence of ischemic and allowing to prevent myocardial infarction. It is much worse when the disease proceeds without external manifestations. The asymptomatic form in most cases is fatal.

With a heart attack, there is a complete overlap of the lumen of the arteries with plaques. The pain increases gradually and after half an hour it becomes unbearable. The unpleasant sensations may not go away for several hours. In the chronic form of ischemic heart disease, the lumen of the vessel does not completely overlap, the attacks of pain are shorter.

Psychological symptoms.With a heart attack, the patient may experience unexplained fear and anxiety.

The main reasons due to which cardiac ischemia can occur are as follows:

Atherosclerosis. The myocardium is bent around by two main arteries through which blood flows to the heart. They are called coronary and branch out into many small vessels. If the lumen of at least one of them is partially or completely closed, certain parts of the heart muscle do not receive the necessary nutrients, and most importantly, oxygen. The arteries supplying the heart with blood no longer exist, so its work is disrupted, and coronary artery disease develops.

The clogging of the arteries is due to the damaging arteries. It involves the formation of cholesterol plaques in the arteries that prevent blood from moving. Performing active movements with a lack of oxygen in the heart muscle is accompanied by pain.

At this stage, ischemic disease is expressed in the form of exertional angina. Gradually, myocardial metabolism worsens, pain intensifies, becomes longer and appears at rest. Heart failure develops, the patient suffers from shortness of breath. If the lumen of a coronary artery is suddenly blocked as a result of a ruptured plaque, blood stops flowing to the heart and a heart attack occurs. As a result, a lethal outcome is possible. The patient's condition after a heart attack and its consequences largely depend on the blockage of the artery. The larger the affected vessel, the worse the prognosis.

Improper nutrition.The reason for the formation of plaques on the walls of blood vessels is an excess of cholesterol in the body that comes with food. In general, this substance is necessary, as it is used to create cell walls and the production of a number of hormones. It is deposited on the walls of blood vessels under the influence of stressful situations.

Emotional stress causes the production of a special substance. It in turn promotes the deposition of cholesterol in the arteries. A properly composed diet allows to reduce its amount in the body. It is worth limiting the use of foods that contain saturated fats: butter, sausage, fatty cheeses and meats. It is recommended to give preference to fats found in fish, nuts, corn. Rapidly assimilated and high-calorie food contributes to the development of heart ischemia.

Bad habits.Alcohol abuse and smoking affect the work of the heart muscle. Cigarette smoke contains a large amount of chemical substances, among which are carbon monoxide, which impedes the transport of oxygen, and nicotine, which increases. In addition, smoking affects the formation of blood clots and the development of atherosclerosis.

Sedentary lifestyle or excessive exertion.Uneven physical activity puts additional stress on the heart. The reason for the development of ischemia can be both physical inactivity and physical activity that exceeds the capabilities of the body. It is recommended to exercise regularly, individually determining the intensity, duration, frequency of training.

Obesity. Numerous studies have found a direct relationship between overweight and mortality from cardiovascular disease. Therefore - one of the factors contributing to the development of ischemia.

Diabetes.The risk of developing coronary heart disease is great for patients with type I and II diabetes. They need to normalize their carbohydrate metabolism to reduce their risks.

Psychosocial reasons.There is an opinion that people with a higher social status and education are less exposed to coronary artery disease.

Diagnosis of coronary artery disease is primarily based on the patient's feelings. Most often they complain of burning and chest pain, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, irregular heartbeat and rhythm. If ischemia is suspected, electrocardiography is mandatory. Echocardiography is a research method that allows you to assess the state of the myocardium, to determine the contractile activity of the muscle and blood flow. Blood tests are done. Biochemical changes can detect coronary heart disease. Carrying out functional tests involves physical activity, such as walking up stairs or exercising on a machine. Thus, it is possible to identify pathologies of the heart in the early stages.

For the treatment of ischemia in the complex, drugs of the following groups are used: antiplatelet agents, adrenergic blockers, fibrates and statins. Specific funds are selected by the doctor depending on the form of the disease. Antiplatelet agents improve blood flow, with the help of adrenergic blockers, it is possible to reduce the frequency of contractions of the heart muscle and reduce oxygen consumption. The action of fibrates and statins is directed at atherosclerotic plaques. The drugs reduce the rate of their appearance and prevent new formations on the walls of blood vessels.

The fight against angina pectoris is carried out with the help of nitrates. Natural lipid-lowering drugs are also widely used to treat coronary artery disease. Anticoagulants affect the formation of blood clots, and diuretics help remove excess fluid from the body.

Since plaques in the vessels cause their narrowing, it is possible to artificially increase the lumen in the coronary arteries. For this, stenting and balloon angioplasty are performed. During these bloodless surgical interventions the lumen in the vessels expands, and the blood flow is normalized. These methods have replaced the traditional bypass surgery, which today is performed only for some forms of coronary artery disease. During such an operation, the coronary arteries are connected to other vessels below the site of the blood flow disturbance in them.

Besides drug treatment and general therapy, the patient needs moderate physical activity. Depending on the form of ischemia, a set of exercises is developed by a doctor. After all, excessive physical activity increases the oxygen demand of the heart muscle and has a negative effect on the development of the disease.

If you have an unexpected attack while walking or playing sports, you should stop and rest, take a sedative and go out into the fresh air. Then you should take a nitroglycerin tablet.

This drug works within 5 minutes. If the pain persists, you need to drink 2 more tablets. The ineffectiveness of nitroglycerin indicates serious problems, therefore, if there is no improvement in the condition, an urgent need to go to the hospital. Prevention of coronary heart disease involves avoiding alcohol consumption, smoking, proper balanced diet and regular exercise. You need to monitor your weight and control. Having positive emotions and the absence of stress is important.

The basic principles of ischemic diet are as follows:

Patients with coronary artery disease will have to minimize salt, sugar, sweets and sweets, confectionery in their diet, that is, all sources simple carbohydrates, fatty meat, caviar, spicy and salty dishes, chocolate, coffee and cocoa.

The most important thing is to limit the consumption of foods high in cholesterol and fat. You need to eat a little, but often.

It is imperative to eat foods that contain vitamin CA, B, C, potassium, calcium.

Vegetable oil used for cooking should be replaced with corn oil, olive oil. It is much healthier and contains fatty acids that have a positive effect on blood circulation.

The diet should be dominated by dairy products, with the exception of butter, cereals, seafood, vegetable soups, lean sea fish, for example, cod, protein omelet, turkey, chicken.

• It is recommended to steam the dishes. In addition, food can be boiled or stewed.

Below is a typical 7-day menu for patients with ischemia of the heart:

Monday

Breakfast - a slice of whole grain bread, a glass of weak tea without sugar

Lunch - vegetable salad, a slice of boiled skinless chicken, rice, a glass of fruit juice

Dinner - sugar-free cottage cheese casserole, a glass of kefir

Tuesday

Breakfast - scrambled eggs from several proteins, apple, tea

Lunch - baked potatoes, steamed cod, a slice of rye bread, tea

Dinner - vegetable stew, unsweetened yogurt

Wednesday

Breakfast - oatmeal, fruit juice

Second breakfast - cottage cheese with fruit

Lunch - vegetable salad dressed with olive oil, baked turkey, tea

Dinner - milk soup, tea

Thursday

Breakfast - boiled egg, a slice of whole grain bread, natural yogurt

Second breakfast - apple

Lunch - baked chicken, buckwheat, tea

Dinner - vegetable soup, a glass of kefir

Friday

Breakfast - oatmeal, apple, juice

Second breakfast - a glass of kefir

Lunch - soaked herring, baked, tea

Dinner - vegetable salad dressed with olive oil, a glass of milk

Saturday

Breakfast - cottage cheese casserole with fruit, tea

Second breakfast - natural yogurt

Lunch - boiled sea bass, vegetable salad, a glass of milk

Dinner - milk soup, tea

Sunday

Breakfast - millet porridge, natural yogurt

Second breakfast - protein omelet

Lunch - turkey and baked potatoes, tea

Dinner - vegetable soup, a glass of kefir

Education: In 2005, he completed an internship at the I. M. Sechenov First Moscow State Medical University and received a diploma in neurology. In 2009 completed postgraduate studies in the specialty "Nervous diseases".

Coronary artery disease (CHD) Is a pathological condition in which the heart muscle (myocardium) receives insufficient blood supply. The heart, like all other organs, must receive the substances necessary for normal functioning, which are delivered by the blood stream. The flow of fresh blood into the myocardium occurs through the heart's own arteries; they're called coronary arteries... Narrowing of the lumen of the coronary arteries leads to ischemia (local decrease in blood supply) of the heart muscle. Therefore, ischemic heart disease is sometimes called coronary heart disease.

IHD forms

The main forms of coronary heart disease are:

• ... The main manifestation is chest pain, shortness of breath, sweating, severe fatigue may also occur;
• heart rhythm disorder (arrhythmic form). Atrial fibrillation is most often observed;
• myocardial infarction is an acute form of ischemic heart disease. With a heart attack, part of the tissue of the heart muscle dies off (limited necrosis). The reason is the complete closure of the lumen of the artery;
• sudden cardiac arrest (coronary death).

IHD leads to the development of conditions such as postinfarction cardiosclerosis (proliferation of connective scar tissue at the site of necrotic lesion) and heart failure (when the heart is unable to provide its "motor" function at the proper level and provide sufficient blood supply). These conditions are also included in the concept of ischemic heart disease.

Causes of ischemic heart disease

In the overwhelming majority of cases, the cause of the development of ischemic heart disease is. Atherosclerosis is characterized by the formation of plaques (fatty deposits) on the walls of the arteries, which gradually block the lumen of the vessel. Such plaques can also appear on the walls of the coronary arteries. The gradually increasing disturbance of blood flow in the coronary arteries leads to the development of chronic forms of coronary artery disease. Sharp forms IHD, as a rule, is caused by blockage of the vessel by a thrombus or a detached part of an atherosclerotic plaque.
Other causes of ischemic heart disease are:

• spasm of the coronary arteries;
• increased blood clotting. In this case, the risk of blood clots increases;
• an increase in the size of the heart (a consequence of some diseases). In this case, the growth of the vascular network lags behind. The result is a lack of blood supply to the enlarged heart muscle;
• persistent low or high blood pressure (hypotension or hypertension);
• (thyrotoxicosis) and some others.

Factors contributing to the development of ischemic heart disease

The risk of developing coronary heart disease is increased by:

• smoking;
• high blood cholesterol;
• (overweight);
• arterial hypertension;
• hypodynamia (low physical activity).

At risk are people over the age of 50. Moreover, men suffer from coronary heart disease more often than women. The hereditary factor also matters: the likelihood of developing coronary artery disease increases if it was detected in one of the close relatives.

Ischemic heart disease symptoms

The symptoms of coronary artery disease depend on the specific form of the disease. There is also an asymptomatic course of coronary heart disease, which can be observed on early stage development of this disease.

In some cases, you should immediately call an ambulance:

• if the symptoms of ischemic heart disease (listed below) are observed for the first time;
• if chest pain is not relieved by nitroglycerin and lasts more than 15 minutes;
• if the pain is unusually severe or is accompanied by other, previously absent symptoms (for example, it radiates to the shoulder, arm, or lower jaw);
• with episodes of suffocation or loss of consciousness in a patient.

The main symptoms of coronary heart disease are as follows:

Nausea may be accompanied.

The occurrence of nausea in heart failure is due to dysfunction of the digestive organs due to hypoxia (oxygen deficiency in tissues) and reflex influences. Also, due to a change in the structure of the muscle tissue of the myocardium and a decrease in heart function, intracardiac pressure increases, tissue edema appears in the chest and peritoneum, which also contributes to the occurrence of nausea.

Dizziness

Dizziness in coronary artery disease occurs due to the fact that the brain does not receive the required amount of oxygen. Episodes of loss of consciousness (fainting) may occur.

Diagnostic methods for ischemic heart disease

When examining a patient, the doctor determines which diagnostic methods are necessary in this particular case.

Diagnosis of ischemic heart disease is carried out. To determine the state of the heart are used:

Inactive diagnostic method

It can be used to detect changes that cannot be detected during examination at rest (at a doctor's appointment). Sensors are attached to the patient's body, the information from which is sent to a portable device. The patient leads his usual lifestyle. The received data is then processed. Thus, violations of cardiac activity are detected.

Methods for the treatment of coronary artery disease

IHD treatment aims to normalize the blood supply to the heart muscle, reduce the risk of myocardial infarction, and reduce the frequency and intensity of angina attacks. Adequate treatment of ischemic heart disease, started in time, will improve the patient's quality of life and save life for many years.