Condition with ibs. Symptoms, types, diagnostic measures and treatment of ischemic heart disease. Coronary arteries and atherosclerosis

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

What it is?

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

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

Causes and risk factors

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

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

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

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

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

Classification

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

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

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

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

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

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

Clinical picture (symptoms)

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

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

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

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

Diagnostics

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

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

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

Complications

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

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

Also, the consequences of coronary disease include:

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

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

Treatment

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

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

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

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

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

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

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

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

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

Forecast

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

Prevention

In order to warn ischemic disease hearts, both in healthy people and in people at risk, you need to follow simple but effective recommendations:

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

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

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

Ischemic heart disease can strike by surprise

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

signs

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

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

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

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

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

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

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

Causes

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

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

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

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

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

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

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

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

Classification

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

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

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

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

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

Death statistics

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

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

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

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

Acute and chronic forms

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

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

myocardial infarction

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

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

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

The impact of bad habits

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

Risk factors for CAD include:

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

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

Smoking

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

smoking is poison

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

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

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

Alcohol

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

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

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

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

Obesity

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

Hypodynamia

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

Passive lifestyle is the right way to CHD

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

A global problem

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

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

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

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

Signs of coronary heart disease

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

Symptoms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnostics

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

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

Manifestations of coronary heart disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevalence of coronary heart disease

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

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

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

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

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

World Health Organization experts concluded that in the 70s of the XX century, mortality from cardiovascular diseases among men over 35 worldwide increased by 60%. At an international symposium in Vienna in 1979, it was reported that. of the 2 million deaths annually recorded in the United States, more than half are due to cardiovascular disease, including more than a third accounted for by coronary artery disease. In the US, about 650,000 people die from coronary artery disease every year.

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

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

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

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

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

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

Risk factors

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

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

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

Symptoms

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

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

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

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

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

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

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

Varieties of coronary heart disease

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

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

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

angina pectoris

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

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

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

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

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

myocardial infarction

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

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

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

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

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

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

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

Consequences of the disease

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

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

Therapeutic activities

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

Surgical treatment

When drug therapy fails positive result, the patient is prescribed surgical treatment of coronary heart disease. During the operation, the surgeon cleans the arteries from cholesterol.

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

Brachytherapy

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

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

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

Minimally invasive coronary surgery

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

The method of indirect myocardial revascularization with a laser

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

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

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge

Coronary artery disease is the most common heart disease, resulting in over 10 million premature deaths each year and is manifested by chest pain during exercise. IHD develops with a decrease in blood flow to the heart muscle due to the growth of atherosclerotic plaques in the arteries of the heart involved in the blood supply to the myocardium. A common symptom of cardiac ischemia in most cases is chest pain or discomfort that may radiate to the shoulder, arm, back, neck, or jaw. Sometimes angina can feel like heartburn. Typically, symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may be the only symptom of CAD without pain. Often the first sign of coronary artery disease is a heart attack.

To understand how coronary heart disease manifests itself, we will use the WHO definition:

• Sudden coronary death (primary cardiac arrest)
• Sudden coronary death with successful resuscitation
• Sudden coronary death (fatal)
• angina pectoris
• angina pectoris
• New onset angina pectoris
• Stable exertional angina with indication of functional class
• Unstable angina
• Vasospastic angina
• myocardial infarction
• Postinfarction cardiosclerosis
• Heart rhythm disorders
• Heart failure

Risk factors

Coronary artery disease has a number of well-defined risk factors:

• High blood pressure.
• Smoking - is associated with 36% of cases of coronary artery disease, you need to know that smoking even one cigarette a day doubles the risk of heart attack.
• Diabetes - Up to 40% of patients are diabetic.
• Obesity - noted in 20% of cases of coronary artery disease
• High level blood cholesterol is a predictor of the disease in 60% of patients
• Family history - about half of the cases are related to genetics.
• Excessive alcohol consumption is a risk factor for acute coronary syndrome.

What is coronary heart disease (CHD)?

The heart is a muscular organ that must constantly work to provide the body with blood, without which it dies. The heart does not stop for a minute, throughout life. For this reason, the heart must constantly receive oxygen and nutrients through the blood. The blood supply to the heart occurs through a powerful network of coronary arteries. If narrowing or blockage develops in these arteries, then the heart cannot cope with its work. In acute cases, part of the muscle tissue of the heart dies and myocardial infarction develops.

With age, many people begin to develop atherosclerotic plaques in their arteries. The plaque gradually narrows the lumen of the artery, as a result of which the delivery of oxygen to the heart muscle decreases and pain develops in the region of the heart (angina pectoris). Narrowing of the lumen and inflammation around the plaque can lead to arterial thrombosis and complete cessation of blood flow in a certain area of ​​the myocardium. The muscle tissue of the heart may die. This is accompanied by pain and a decrease in the contractile function of the heart. Myocardial infarction develops, which in almost 50% of cases is accompanied by a fatal outcome.

With the development of plaques in the coronary vessels, the degree of narrowing of their lumen of the coronary arteries also increases, which largely determines the severity of clinical manifestations and prognosis. The narrowing of the lumen of the artery up to 50% is often asymptomatic. Clinical manifestations of the disease usually occur when the lumen is narrowed to 70% or more. The closer the stenosis is to the mouth of the coronary artery, the greater the mass of the myocardium undergoes ischemia in accordance with the area of ​​blood supply. The most severe manifestations of myocardial ischemia are observed with narrowing of the main trunk or mouth of the left coronary artery.

In the origin of myocardial ischemia, a sharp increase in its oxygen demand, angiospasm or thrombosis of the arteries of the heart plays an important role. The prerequisites for thrombosis may already arise at early stages development of an atherosclerotic plaque, due to the increased activity of the thrombus formation system, therefore it is important to prescribe antiplatelet therapy in a timely manner. Platelet microthrombi and microembolism can exacerbate blood flow disorders in the affected vessel.

Forms of coronary heart disease

Stable angina pectoris is a classic symptom of coronary artery disease, meaning pain in the region of the heart and behind the sternum that develops after exercise. Depending on this load, the functional class of angina pectoris is determined.

Stable angina develops when:

• Physical exercise or other activities
• Eating
• Anxiety or stress
• freezing

Unstable angina

Ischemic heart disease can develop to such an extent that pain in the heart occurs even at complete rest. This is a medical emergency (unstable angina) and can lead to a heart attack.

myocardial infarction

A form of coronary heart disease in which there is a sudden cessation of blood flow through any coronary artery with the development of a limited area of ​​\u200b\u200bdeath of the heart muscle. Heart attack without urgent surgery leads to mortality in half of patients. Heart attack and sudden coronary death are the main arguments in understanding why coronary heart disease is dangerous. Every patient should be aware that a prolonged attack of angina pectoris can be a sign of the onset of a heart attack.

Prognosis for coronary heart disease

Without timely myocardial revascularization, CAD has a poor prognosis. Sudden coronary death develops in 10% of patients, myocardial infarction in almost 50% of patients. Life expectancy in patients who are not treated with diagnosed CAD is no more than 5 years. Timely revascularization (stenting of the coronary arteries or coronary artery bypass grafting) significantly improves the quality and duration of life in these patients, reducing the risk of heart attack and sudden coronary death tenfold.

Treatment is carried out in clinics:

Make an appointment

Advantages of treatment in the clinic

Experienced cardiologists with extensive experience

Stress echocardiography for diagnosing difficult cases

Safe coronary angiography with a CT scanner

Angioplasty and vascular stenting with the best stents

Diagnostics

Examination by a competent cardiologist is the most important method for diagnosing coronary artery disease. The doctor will carefully collect an anamnesis, listen to complaints and determine an examination plan.
Timely diagnosis of coronary heart disease and the correct interpretation of symptoms allow you to prescribe adequate treatment.

Symptoms of coronary heart disease

The most common symptom is angina or chest pain. On this basis, it is determined functional classes diseases. Typically, patients describe the following symptoms:

• Heaviness in the chest
• Feeling of pressure in the heart
• Aches in the chest
• Burning
• squeezing
• Painful sensations
• Dyspnea
• Palpitations (irregular heartbeat, missed beats)
• fast heartbeat
• Weakness or dizziness
• Nausea
• sweating

Angina pectoris is usually felt as pain behind the sternum, but can be given to the left arm, neck, under the shoulder blade, to the lower jaw.

A cardiologist can determine the diagnosis after:

• careful questioning
• Physical examination.
• Electrocardiography
• Echocardiography (ultrasound of the heart)
• 24-hour ECG monitoring (Holter study)
• Contrast coronary angiography (X-ray examination of the vessels of the heart)

Which patients are diagnosed with stress tests?

• With multiple risk factors for atherosclerosis and cardiovascular diseases
• WITH diabetes
• With complete blockade of the right bundle branch of His of unknown origin
• With ST segment depression less than 1 mm on resting ECG
• Suspicion of vasospastic angina

When should a stress test be performed in combination with imaging techniques?

• in the presence of changes in the ECG at rest (blockade of the left leg of the His bundle, the WPW phenomenon, a permanent artificial pacemaker, intraventricular conduction disturbances),
• if there is a decrease in the segment by 1 mm or more on the ECG at rest, caused by any reasons,
• to determine the viability of the affected area of ​​the heart muscle in order to resolve the issue of the appropriateness of surgical intervention on the coronary vessels (stenting, coronary artery bypass grafting).

Who Should Have an ECG Holter Monitor?

With the development of compact recording devices in the 1970s and 1980s, it became possible to record ECG data over a long period of time in daily activities. This is how Holter ECG monitoring was born, named after its inventor, Dr. Norman D. Holter.

The main indication for its implementation is the examination of patients with fainting and palpitations, especially non-rhythmic, it is also possible to detect myocardial ischemia, both in the presence and in the absence of clinical manifestations of coronary artery disease, that is, called "silent ischemia" of the myocardium. Angina attacks that occur once a day or not every day are best detected by changes on the holter. The study can be carried out in a hospital and at home.

When should echocardiography be performed in patients with coronary artery disease?

• In patients with myocardial infarction
• With symptoms of worsening heart function - peripheral edema, shortness of breath
• Patients with suspected chronic heart failure
• Determine the presence of pathology of the valvular apparatus of the heart

Indications for coronary angiography:

severe stable angina (class III or greater) despite optimal treatment
patients who have experienced cardiac arrest
life-threatening ventricular arrhythmias
patients who have previously undergone surgical treatment of coronary artery disease (stenting of the coronary arteries, or coronary artery bypass grafting), who develop early relapse of moderate or severe angina pectoris

General principles

Lifestyle changes: If you smoke, stop smoking, go for walks more often fresh air, reduce excess body weight. Avoid the dangers of eating fatty foods and eat a diet low in salt and sugar. Monitor your sugar levels carefully if you have diabetes. IHD is not treated with nitroglycerin alone. To continue an active life, it is necessary to establish contact with a cardiologist and follow his instructions.

Medications for coronary artery disease

The cardiologist may recommend drug therapy if lifestyle changes are not enough. Drugs are prescribed only by the attending physician. The most commonly prescribed drugs that reduce the risk of thrombosis (aspirin, Plavix). Statins may be prescribed to lower cholesterol for a long time. Heart failure should be treated with drugs that improve the function of the heart muscle (cardiac glycosides).

• Aspirin

In those with no history of heart disease, aspirin reduces the chance of myocardial infarction but does not change the overall risk of death. It is only recommended for adults who are at risk for blood clots, where the increased risk is defined as "men over 60, postmenopausal women, and young adults with a pre-existing CHD background (hypertension, diabetes, or smoking).

• Antiplatelet therapy

Clopidogrel plus aspirin (dual antiplatelet therapy, DAAT) reduces the likelihood of cardiovascular events more than aspirin alone. This drug is contraindicated in patients with gastrointestinal ulcers or a history of gastric bleeding. Antiplatelet therapy should be lifelong.

• β-blockers

Adrenoblockers reduce heart rate and myocardial oxygen consumption. Studies confirm an increase in life expectancy when taking β-blockers and a decrease in the frequency of cardiovascular events, including repeated ones. β-blockers are contraindicated in concomitant pulmonary pathology, bronchial asthma, COPD.

• β-blockers with proven properties to improve prognosis in coronary artery disease:
• Carvedilol (Dilatrend, Acridilol, Talliton, Coriol).
• Metoprolol (Betaloc Zok, Betaloc, Egiloc, Metocard, Vasocardin);
• bisoprolol (Concor, Niperten, Coronal, Bisogamma, Biprol, Cordinorm);

• Statins

Preparations of this group reduce the level of cholesterol in the blood by reducing its synthesis in the liver, or inhibit the absorption of cholesterol from food, affecting the causes of atherosclerosis. Medicines are used to reduce the rate of development of existing atherosclerotic plaques in the vessel wall and prevent the emergence of new ones. There is a positive effect on the degree of progression and development of symptoms of coronary artery disease, on life expectancy, and these drugs also reduce the frequency and severity of cardiovascular events, possibly contributing to the restoration of the lumen of the vessel. The target cholesterol level in patients with coronary heart disease should be lower than in those without coronary artery disease, and equal to 4.5 mmol/l. In blood tests, the target level of LDL in patients with coronary artery disease should be no more than 2.5 mmol / l. Determination of lipid levels should be carried out every month. Main drugs: lovastatin, simvastatin, atorvastatin, rosuvastatin.

• Fibrates

They belong to the class of drugs that increase the anti-atherogenic fraction of lipoproteins - HDL, with a decrease in which increases mortality from coronary artery disease. They are used to treat dyslipidemia IIa, IIb, III, IV, V. They differ from statins in that they reduce triglycerides and can increase the HDL fraction. Statins predominantly lower LDL and do not significantly affect VLDL and HDL. Therefore, the maximum effect is manifested with a combination of statins and fibrates.

• Nitroglycerin preparations

Nitroglycerin is the main drug that relieves retrosternal pain in the heart. Nitrates mainly act on the venous wall, reducing the preload on the myocardium (by expanding the vessels of the venous bed and depositing blood). An unpleasant effect of nitrates is a decrease in blood pressure and headaches. Nitrates are not recommended for use with blood pressure below 100/60 mm Hg. Art. Modern studies have shown that taking nitrates does not improve the prognosis of patients with IHD, that is, it does not lead to an increase in survival, and therefore they are used as a drug to relieve symptoms of IHD. Intravenous drip of nitroglycerin allows you to effectively deal with the symptoms of angina pectoris, mainly against the background of high blood pressure. Every patient with coronary artery disease should know that if taking nitroglycerin at home did not relieve chest pain, then an ambulance should be called, as a heart attack may have developed.

Coronary angioplasty and stenting

This is a modern technology for restoring the patency of the coronary arteries in IHD. The point is to inflate the atherosclerotic plaque with a special balloon and strengthen the vascular wall. metal frame- stent. Coronary angioplasty is performed without incisions in patients with severe angina or myocardial infarction.

Coronary artery bypass grafting

Open surgery for narrowing of the coronary arteries. The point is to create a bypass for the blood. The patient's own veins or arteries are used as a bypass. The operation can be performed with or without cardiopulmonary bypass. Due to the development of coronary angioplasty technology, coronary artery bypass grafting recedes into the background, as it is more traumatic and is used only for extensive lesions of the coronary bed.

Prevention

Up to 90% of cardiovascular disease can be prevented by avoiding established risk factors. Prevention includes adequate exercise, reduction of obesity, treatment of high blood pressure, healthy eating, cholesterol lowering and smoking cessation. Medicines and exercise are about equally effective. A high level of physical activity reduces the likelihood of coronary heart disease by about 25%.

In diabetes, tight blood sugar control reduces heart risk and other problems such as kidney failure and blindness.
The World Health Organization (WHO) recommends "low to moderate alcohol consumption" to reduce the chances of developing coronary heart disease, while alcohol abuse is very dangerous for the heart.

Diet

A diet high in fruits and vegetables reduces the risk of heart disease and death. Vegetarians have a lower risk of heart disease due to their higher consumption of fruits and vegetables. Consumption of trans fats (commonly found in hydrogenated foods such as margarine) has been shown to cause atherosclerosis and increase the risk of coronary heart disease.

Secondary prevention

Secondary prevention is the prevention of further complications of pre-existing diseases. Effective lifestyle changes include:

• Weight control at home
• Giving up bad habits - smoking cessation
• Avoid consumption of trans fats (in partially hydrogenated oils)
• Reducing psychosocial stress
• Regular determination of blood cholesterol levels

Physical activity

Aerobic exercise such as walking, jogging, or swimming may reduce the risk of death from coronary heart disease. They lower blood pressure and blood cholesterol (LDL), and increase HDL cholesterol, which is the "good cholesterol". It is better to be treated with physical education than to expose yourself to the danger of surgical interventions on the heart.

More about treatment in our clinic

Price

Estimated cost of treatment standards

Expert advice

Ultrasound diagnostics

Laboratory diagnostics

Electrophysiological studies

Radiation diagnostics

Angiography of coronary artery bypass grafts (in addition to coronary angiography) Coronary artery bypass angiography is performed in addition to standard coronary angiography if the patient has previously undergone coronary artery bypass surgery. Allows assessing the patency of coronary bypass grafts and the condition of the coronary arteries below the anastomosis between the graft and the coronary artery.
Coronary angiography Examination of the vessels of the heart. It is carried out through a puncture in the arm. The duration of the diagnosis is about 20 minutes.
Femoral coronary angiography using a stapling device (AngioSeal) - outpatient Examination of the vessels of the heart on an x-ray unit with the introduction of contrast. Access on the thigh is used. After the examination, the puncture hole is closed with a special stapling device.
X-ray of the lungs Plain radiography of the lungs - a general x-ray examination of the chest organs in a direct projection. It allows you to assess the state of the respiratory system, heart, diaphragm. It is a screening method to rule out serious lung and heart problems in preparation for major surgery. If any pathology is suspected, additional projections for x-rays are assigned.

Hospital services

The cost of endovascular interventions on the heart

Angioplasty of one coronary artery for type A lesion according to the ACC / AHA classification (excluding the cost of stent implantation) Angioplasty and stenting of the coronary artery is performed in coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Type A lesion is the least difficult for angioplasty. The opening of the balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents coated with drug or absorbable. The cost of the stent is paid separately.
Angioplasty of coronary arteries in bifurcation lesions Angioplasty and stenting of the coronary artery is performed in coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Bifurcation lesion implies angioplasty of the main artery and its large branch. The opening of this balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents, drug-coated or resorbable stents can be placed.
Angioplasty of one coronary artery for type B lesion according to the ACC/AHA classification (excluding the cost of stent implantation) Angioplasty and stenting of the coronary artery is performed in coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Type B lesions are moderately difficult to angioplasty. The opening of the balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents, drug-coated or resorbable stents can be placed. The cost of the stent is paid separately.

Ischemic heart disease is partly a male disease - female sex hormones prevent the development of coronary artery disease and myocardial infarction in the beautiful half of humanity. However, according to statistics, at least 1/5 of the fairer sex is faced with this disease, primarily after menopause: then the frequency of these diseases in both sexes levels off. Signs and symptoms of coronary artery disease in men and women differ little. But many women do not attach importance to the first manifestations of the disease in their lives and get an appointment with a doctor already at a rather late stage of the development of the disease.

Ischemic heart disease develops mainly due to blockage of the coronary arteries by atherosclerotic plaques. The result of the process is coronary heart failure. Additionally, the balance between the amount of oxygen necessary for the stable proper functioning of the myocardium and the amount of oxygen entering the body is disturbed. Also, the heart muscle cannot provide a person with enough blood.

Important! Coronary heart disease is just another name for coronary heart disease, occasionally used by doctors.

Why ischemia is considered a "male" disease

In the case of men, the development of coronary disease often occurs before the age of forty. In women, this disease is diagnosed an order of magnitude later - usually after 50 years (at this time menopause usually occurs). The protective barrier in this situation is the female hormone estrogen, which supports the organs of the cardiovascular system, ensuring its stable operation. After menopause, the necessary hormones stop being produced. This entails the development of pathologies of the heart and blood vessels, while simultaneously providing fertile ground for the development of coronary heart disease.

At-risk groups

Since menopause occurs at different ages for each female representative, the initial signs of ischemia can be detected as early as 45-55 years. But by the age of 65, a third of women are already diagnosed with coronary artery disease.

Important! It is noteworthy that in men the indicator of the number of people who applied with concern about the work of the cardiovascular system is steadily decreasing, while in the fair sex, on the contrary, it is increasing.

In the process of aging, everything is formed on the walls of blood vessels. large quantity atherosclerotic plaques, which are cholesterol deposits. An increase in the volume of plaques leads to a deterioration in the process of blood flow to the heart. The main signal is angina - severe chest pain in the region of the heart. This pathological process can be triggered by a number of factors, including:

Attention! According to doctors, the largest number of women who have been diagnosed with coronary heart disease additionally suffer from diabetes mellitus or arterial hypertension. Against the background of these diseases, the occurrence of coronary artery disease is most likely.

General signs of coronary artery disease

Depending on the clinical form, the signs of coronary artery disease may be different. They also differ in the degree of danger to the health and life of the patient and the severity of the existing pathological processes. There are 5 main clinical forms, which are presented in the table below.

Clinical form	Description	Image	signs
Acute myocardial infarction	It is a long-term form of cardiac ischemia, in which necrosis of the cells of the muscle tissue of the heart occurs. The main feature is burning and sharp pain in the chest, against which drugs containing nitroglycerin do not help.		1. Increasing mixed shortness of breath. 2. Loss of consciousness. 3. Irradiation of pain in the epigastric area or the left arm. 4. Acute heart failure. 5. Disorders of the digestive system. 6. Cyanosis of the lower and upper extremities, as well as the nasolabial triangle
stable angina	It proceeds in the form of acute severe pain behind the sternum. Development occurs due to temporary myocardial ischemia		1. One attack lasts no more than 15 minutes, and it can be stopped by taking the drug with nitroglycerin. 2. Symptoms appear after nervous tension, stress or physical exertion. 3. With the "care" of ischemia, symptoms stop appearing
Unstable angina	Most often appears after myocardial infarction or during the first stage of coronary artery disease		1. Attack time usually exceeds 15 minutes, and the use of drugs with nitroglycerin is ineffective. 2. Symptoms are expressed by shortness of breath and pain in the sternum, which may appear for no apparent reason
Cardiosclerosis	Occurs after the patient has had an acute myocardial infarction. In this case, tissue necrosis causes the replacement of damaged cells with connective tissue.		1. There is a mixed shortness of breath. 2. The patient develops edema, which first forms in the evening, later becomes permanent. 3. Various manifestations of arrhythmia are observed
Sudden coronary death	Has two possible outcomes		1. Sudden death, in which it is possible to achieve a positive outcome of resuscitation. 2. Sudden coronary death, in which the patient cannot be saved

Attention! The sooner a person is treated for an attack, the less likely they are to die. It is necessary to stop the attack by increasing the patient's air supply, administering a sedative and drugs with nitroglycerin. Then transfer it under the control of cardiologists.

The main differences in the signs of coronary artery disease in women

As already mentioned, the development of coronary heart disease in women proceeds differently than in men. To avoid a situation where the disease is in a neglected state, it is advisable to know in advance the key “disagreements” female form ischemic heart disease with male.

Important! Medical statistics show that coronary heart disease is the most common cause of death in women.

1. For the female half of the population, the onset of coronary heart disease is acute myocardial infarction. In this case, death often occurs during the first manifestation of cardiac ischemia.
2. For the female body, unstable angina is more characteristic than stable. Symptoms and pain can occur not only during the day, but also at night during sleep. Attacks are characterized by duration, drugs with nitroglycerin help little.
3. The risk factors listed above affect the female body to a greater extent than the male one. As a result, coronary artery disease can develop more rapidly than in men.
4. The female half of humanity turns to doctors much more often than the stronger sex when symptoms of coronary artery disease appear. However, this is not always the case, since some symptoms of coronary heart disease can be confused with manifestations of menopause. Plus, ladies are more prone to depression and neuroses amid worries about their illness.
5. Women are more likely to have angina attacks that are not accompanied by pain. In addition to the absence of pain, other signs of myocardial ischemia or angina pectoris may not appear. Hence the low percentage of women in whom the disease was diagnosed in the early stages.

IHD is a serious violation of the cardiovascular system, endangering not only the health of the patient, but also life. Despite the fact that in women this disease develops at a later age compared to men, it can have an equally strong effect on their body. Also, do not forget that the course of the disease in the case of a representative of the beautiful half of humanity follows schemes that are fundamentally different from men's. Unfortunately, this makes many people think that women cannot have coronary heart disease. However, this is not the case. Therefore, when the first signs indicating the development of coronary artery disease appear, you should contact a specialist to identify the disease at an early stage.

Video - IHD in women