Symptoms of coronary disease shortness of breath. Symptoms, types, diagnostic measures and treatment of ischemic heart disease. Main Causal Factors

Heart disease is one of the key causes of death worldwide. The heart has always been considered almost the main organ in human body, and death was often associated with disruption of the heart muscle. Today, almost every second person in the world dies from heart problems. And a fair share of deaths are caused by coronary heart disease, the symptoms of which are important for everyone to know.

The picture is frightening, but you need to remember: the development of the disease can always be prevented if it is diagnosed in time and treatment is started. This article is devoted to defining the concept of ischemia and understanding what symptoms in coronary heart disease will help to make a diagnosis.

The deterioration of myocardial blood supply due to the condition of the coronary arteries is called (CHD). From the Latin language, the name of the disease means "I hold back the blood."

The main cause of coronary heart disease is an imbalance between the oxygen necessary for the heart muscle and the capacity of the circulatory system to supply it. Roughly speaking, the heart needs two sips of oxygen, and only one comes to it. This balance is disturbed due to problems with the coronary arteries - it is these vessels that serve as transport routes for the blood entering the heart.

Any insufficiency can always be due to two reasons: either the necessary substance is being delivered less than usual, or for some reason the need for it increases. Simplifying again, we get two situations. The first - when two sips of oxygen always entered the heart, and now suddenly only one comes. And the second - when both sips are still delivered to the heart, only today for some reason he needs as many as four. In both cases, the result is CAD.

Depending on what cardiac ischemia has symptoms and how intense they are, the disease has two conditional forms: acute (sudden attack that can end) and chronic (when a person is accompanied by angina attacks throughout his life).

Causes of coronary heart disease

Causes of coronary artery disease

The second name for IHD is coronary heart disease. It accurately signals that in the case of coronary artery disease, the causes of the disease lie in the coronary vessels. The lesion of these vessels may be of an organic nature or have a functional origin. Let's look at the causes of IHD in more detail.

Causes of organic damage to the coronary arteries

The most common causes of organic damage to the coronary arteries are. Occur as a result of partial or complete blockage of the vessel by cholesterol plaques. They partially block the lumen of the arteries and impair blood flow. Blood with oxygen enters the myocardium more slowly and in insufficient quantity. This is how ischemia occurs.

Causes of functional damage to the coronary arteries

The most common cause of functional damage to the coronary arteries are blood clots or spasms in the vessels. In the first case, the thrombus closes the lumen of the vessel and the blood flow velocity is disturbed even at rest. In the second, the spasm does not allow the arteries to expand at the moments when it is necessary to increase the speed of blood flow. As a result - all the same oxygen deficiency in the myocardium.

Risk factors for the development of cardiac ischemia

All the causes that contribute to the appearance of the disease are divided into two categories - non-modifiable and modifiable.

Non-modifiable risk factors for the development of cardiac ischemia:

• age - by the age of 50, the risk increases significantly;
• race - Caucasians suffer from coronary artery disease more often;
• gender - men are more susceptible to the disease;
• heredity - IHD disease in the family of the older generation significantly increases the likelihood of a similar disease in younger generations.

Alas, coronary heart disease, the causes of which fall under the categories described above, is almost inevitable. But this is not a reason to ignore the state of your health. Yes, we cannot change our gender and age, but we can change our lifestyle. Namely, lifestyle includes modifiable risk factors for the development of cardiac ischemia. Let's list them:

• Obesity. Literally the scourge of modernity. Overweight today affects up to 50% of the population. And where overweight - there are cholesterol plaques, increased stress on blood vessels and a sedentary lifestyle. All this is a direct road to IBS.
• Smoking. An addiction that reduces the duration of human life by an average of seven years. The risks of smoking are to reduce the amount of oxygen in the blood and vasospasm due to nicotine. When smoking is supplemented by an unhealthy diet, coronary heart disease almost always appears, the symptoms of which will not take long to wait.
• Diabetes. Diabetics often die of a heart attack. Diabetes and CAD are usually related.
• Stress. The intensity of modern life often provokes increased nervousness, constant stress and nervous tension. All this leads to vascular spasm, which also affects the coronary blood flow, which leads to cardiac ischemia.
• Physical inactivity. Or as it is also called, a sedentary lifestyle. Physical activity accelerates blood circulation, its lack - on the contrary, reduces and gradually leads to coronary artery disease. To maintain heart health, it is important to regularly engage in sports with a moderate load, move more.
• Increased blood clotting is a disease that provokes the formation of blood clots and increases the risk of ischemia.
• High blood pressure is another disease that can provoke cardiac ischemia.

Decreased supply of myocardial arterial blood

Symptoms of coronary artery disease

For timely diagnosis and more effective treatment, it is important to know how coronary heart disease manifests itself and be able to track the symptoms of coronary artery disease in oneself.

The most characteristic symptoms of ischemic disease:

• retrosternal pain, aggravated in case of physical activity;
• frequent feeling of weakness;
• a feeling of a violation of the rhythm of the heart;
• and other signs of heart failure.

The listed symptoms do not mean 100% presence of coronary heart disease, but they are alarming signals and the reason for a visit to the doctor.

Useful video

In the following video, a cardiologist will talk about the causes of coronary heart disease:

Conclusion

1. Today, coronary artery disease is a dangerous and widespread disease. Everyone should know about coronary heart disease, what it is, the symptoms and causes of this disease, since the effectiveness of treatment directly depends on the timely seeking medical help.
2. Most often, the cause of the disease is an unhealthy lifestyle that provokes vascular spasms and the deposition of cholesterol in the arteries.
3. To keep the heart healthy, it is important to be vigilant about the state of your body.

Ischemic heart disease is a lack of blood supply to the myocardium (heart muscle). The disease is very dangerous - for example, in acute development, coronary heart disease immediately leads to myocardial infarction, which causes death in middle-aged and elderly people.

Table of contents:

Causes of coronary heart disease

The main cause of the development of the disease in question is atherosclerosis of the coronary arteries, which is accompanied by the deposition of cholesterol plaques in the vessels and narrowing of their lumen.

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Of course, atherosclerosis of the coronary arteries does not occur on its own - it is caused by malnutrition, bad habits, and a sedentary lifestyle.

It is noteworthy that coronary heart disease can occur acutely - in this case, we will talk about saving the patient's life. But quite often the disease under consideration has a gradual development - at first there is practically no narrowing of the lumen of the coronary artery, and the patient will experience only mild, non-intense symptoms during physical exertion, and after some time the disease will make itself felt even in absolute rest.

With coronary heart disease, there is an insufficient supply of oxygen to the heart muscle, which can affect the patient's well-being in different ways: it all depends on the form of coronary artery disease.

Silent coronary heart disease

It is also called asymptomatic, because the patient does not experience any inconvenience, cannot identify the exact symptoms, and generally considers himself to be absolutely healthy. This form of IHD is quite insidious - it can turn into an acute one at any time and then it will be difficult to save a person.

To prevent the most severe development of the clinical picture, doctors recommend visiting a cardiologist at least once every 6 months and undergoing a preventive examination - this will help identify incipient coronary heart disease and provide timely assistance.

angina pectoris

Regular attacks, chest pain, shortness of breath are characteristics of angina pectoris. This form of coronary heart disease can last for a long period, the patient will complain only of discomfort and deterioration of health during exercise.

Unstable angina

A dangerous condition that may indicate the onset of myocardial infarction - at least doctors place a patient with signs of unstable angina in a medical institution and carry out not only treatment, but also round-the-clock monitoring of the work of the heart muscle.

Unstable angina is manifested by frequent attacks, each subsequent one will differ in the intensity of pain and the addition of unusual symptoms.

Arrhythmic form of coronary artery disease

It proceeds in the form of atrial fibrillation, is characterized by cardiac arrhythmias, can quickly and suddenly turn into a chronic form of leakage.

The arrhythmic form of coronary heart disease is often perceived by doctors as a signal for urgent action - the patient is placed in a medical institution, he is prescribed a full examination and competent treatment.

myocardial infarction

This form of coronary heart disease is the most dangerous for the normal life of the patient - myocardial infarction is the process of death of a section of the heart muscle, which always proceeds in an acute form. Myocardial infarction develops due to the separation of a plaque or thrombus from the wall of the coronary artery, which leads to blockage of its lumen.

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In this case, only professionals can help.

With a sharp decrease in the amount of blood supplied to the heart muscle due to complete blockage of the coronary artery, the heart stops and clinical death occurs.

Note:all these forms of coronary disease can occur/develop independently, but most often there is a combination. For example, angina pectoris and arrhythmia are often diagnosed at the same time, which, if left untreated, necessarily leads to myocardial infarction.

Symptoms of coronary heart disease

The disease under consideration can proceed quite secretly, therefore it is recommended to pay attention to even minor changes in the work of the heart. anxiety symptoms are:

• recurrent chest pain that may radiate to the arm, shoulder blade, or neck;
• feeling of tightness in the chest;
• burning sensation or heaviness in the chest;
• intermittent feeling of lack of air;
• feeling anxious for no apparent reason;
• general weakness;
• nausea and vomiting of unknown etiology.

Treatment of coronary heart disease

When the first symptoms of the disease in question appear, after visiting a cardiologist and clarifying the diagnosis, the patient will be offered, first of all, to radically change his life - to adjust both his lifestyle and diet. Of course, both drug therapy and regular monitoring of the work of the heart will be prescribed, some folk remedies will also be effective in the treatment of coronary heart disease - therapy should be carried out in a complex manner.

Nutrition for IHD

The menu of a patient with diagnosed coronary heart disease should be based on the principle of rational nutrition, balanced consumption of foods with a low content of cholesterol, fat and salt.

It is necessary to exclude or significantly reduce the use of:

• meat and fish dishes, including broths and soups;
• rich and confectionery products;
• Sahara;
• semolina and rice dishes;
• animal by-products (brains, kidneys, etc.);
• spicy and salty snacks;
• chocolate
• cocoa;
• coffee.

It is very important to include the following products in the menu:

Note:you need to eat with diagnosed coronary heart disease fractionally - 5-7 times a day, but in small portions. If there is excess weight, then it is imperative to get rid of it - this is a heavy burden on the kidneys, liver and heart.

We change the way of life

To prevent the development of the most severe forms of coronary heart disease, you need to follow only three rules:

1. move more. Nobody says that you need to set Olympic records, but it is necessary to abandon the car, public transport and the elevator in favor of walking. You can’t immediately load your body with kilometers of roads traveled - let everything be within reason. In order for physical activity not to cause a deterioration in the condition (and this happens with ischemia!), be sure to get advice from your doctor about the correctness of the exercises.
2. Leave your bad habits in the past. Smoking and drinking alcohol is like a blow that will definitely lead to a worsening of the condition. Even an absolutely healthy person does not get anything good from smoking and drinking alcohol, to say nothing of a sick heart.
3. Take care of your nerves. Try to avoid stressful situations, learn to calmly respond to troubles, do not succumb to emotional outbursts. Yes, it's hard, but it is this tactic that can save a life. Talk to your doctor about taking sedatives or decoctions medicinal plants with a calming effect.

Medical therapy

As a rule, patients with diagnosed coronary heart disease are prescribed nitroglycerin and its derivatives - drugs that promote vasodilation. As a result, the blood flow through the coronary artery is significantly accelerated and improved, the heart muscle is fully supplied with oxygen.

The intake of acetylsalicylic acid will also be effective - it prevents vascular thrombosis and improves blood composition. As part of therapy, it can be prescribed and medicines that lower cholesterol levels.

note: there can be no question of any self-treatment! Any, even the most harmless at first glance, drugs should be prescribed by a specialist.

ethnoscience

Do not forget that the funds belonging to the category " ethnoscience". Of course, you need to consult with your doctor and get his approval in principle for the use of various decoctions and infusions from medicinal plants - this is an indispensable condition for achieving a therapeutic effect.

The most popular prescription drugs to take with coronary heart disease:

Take 1 tablespoon of dried fruits, pour 250-300 ml of boiling water and insist for 2-3 hours. It is better to cook everything in a thermos. Ready infusion is filtered through 2-3 layers of gauze.

How to apply: 2 tablespoons of infusion three times a day 20 minutes before eating. Duration of admission - 30 days, then you need to take a break for 2-3 weeks.

Hawthorn is excellent for angina pectoris and in combination with motherwort herb - they are taken in 6 tablespoons, poured with 7 cups of boiling water and insisted for 10-12 hours. You need to take this decoction 1 glass 3 times a day before meals.

Herbal preparations

Mix white mistletoe leaves (1 tablespoon) and buckwheat flowers (2 tablespoons), pour all 300 ml of boiling water and leave to infuse for 10-12 hours (preferably overnight). You need to consume 2 tablespoons of infusion three times a day before meals.

Mix jaundice grass, sunflower reed flowers, dill seeds (2 tablespoons each) and coltsfoot leaves (1 tablespoon). 1 tablespoon of the mixture is poured with a glass of boiling water and infused for 60 minutes. Take an infusion of ½ cup 3-5 times a day before meals.

Grind the corn root (40 grams), add lovage herb officinalis to it in the same amount, pour water so that the mass is completely immersed in it, cook for 8-10 minutes. Then the decoction is infused for 40-60 minutes and taken 1/3 cup three times a day after meals.

Mix horsetail, hawthorn flowers and herb mountaineer bird (each 20 g) and pour a glass of boiling water, leave for 20-30 minutes, strain. The resulting amount should be drunk during the day in small sips.

Note:all listed herbal preparations can be taken no more than 30 days in a row. Then you need to take a break, undergo a preventive examination and consult with your doctor about the advisability of further use.

Horseradish

With its help, inhalations are made, which will be useful for coronary heart disease and other diseases of the main organ in the body.

Grate 5 g of horseradish root on a fine grater, pour a glass of boiling water and leave for 1 hour. Then inhalations are done either over a wide and shallow basin (bowl) or over the spout of a teapot.

Diagnosis of coronary heart disease is the main thing in the whole process of treating this insidious disease. It is impossible at the very first pain in the chest to independently decide that the disease in question is developing. The most reasonable thing is to immediately contact a specialist to conduct a full examination and make an accurate diagnosis.

Coronary heart disease (CHD) has become a serious social problem, because most of the world's population has one or another of its manifestations. The rapid pace of life in megacities, psycho-emotional stress, the use of large amounts of fat in the diet contribute to the onset of the disease, and therefore it is not surprising that residents of developed countries are more susceptible to this problem.

IHD is a disease associated with changes in the wall of the arterial vessels of the heart with cholesterol plaques, which ultimately leads to an imbalance between the needs of the heart muscle for the substances necessary for metabolism and the possibilities of their delivery through the cardiac arteries. The disease can proceed even acutely, even chronically, has many clinical forms that differ in symptoms and prognosis.

Despite the emergence of various modern methods treatment, coronary artery disease still occupies a leading position in the number of deaths in the world. Often, cardiac ischemia is combined with the so-called, which also occurs with atherosclerotic lesions of the vessels that provide it with blood. A fairly common, in other words, cerebral infarction is a direct consequence. Thus, the common causes of these serious diseases also determine their frequent combination in the same patient.

Main cause of coronary artery disease

In order for the heart to be able to deliver blood to all organs and tissues in a timely manner, it must have a healthy myocardium, because there are many biochemical transformations necessary to perform such an important function. The myocardium is supplied with vessels called coronary vessels, through which “food” and breathing are delivered to it. Various influences, unfavorable for the coronary vessels, can lead to their failure, which will lead to a violation of the movement of blood and nutrition of the heart muscle.

Modern medicine has studied the causes of coronary heart disease quite well. With increasing age, under the influence of exposure external environment, lifestyle, nutritional habits, as well as in the presence of a hereditary predisposition, occurs. In other words, protein-fat complexes are deposited on the walls of the arteries, which eventually turn into an atherosclerotic plaque, which narrows the lumen of the vessel, disrupting the normal blood flow to the myocardium. So, direct cause of myocardial ischemia.

Video: IHD and atherosclerosis

When do we take risks?

Risk factors are conditions that pose a threat to the development of the disease, contribute to its occurrence and progression. The main factors leading to the development of cardiac ischemia can be considered the following:

• An increase in cholesterol levels (), as well as a change in the ratio of various fractions of lipoproteins;
• Malnutrition (abuse of fatty foods, excessive consumption of easily digestible carbohydrates);
• Physical inactivity, low physical activity, unwillingness to play sports;
• Availability bad habits such as smoking, alcoholism;
• Concomitant diseases accompanied by metabolic disorders (obesity, decreased thyroid function);
• Arterial hypertension;
• Age and sex factor (it is known that coronary artery disease is more common in older people, and also in men more often than in women);
• Features of the psycho-emotional state (frequent stress, overwork, emotional overstrain).

As you can see, most of the above factors are quite banal. How do they affect the occurrence of myocardial ischemia? Hypercholesterolemia, nutritional and metabolic disorders are prerequisites for the formation of atherosclerotic changes in the arteries of the heart. In patients having, on the background of count When pressure is released, a spasm of blood vessels occurs, in which their inner shell is damaged, and also develops. It is difficult for the coronary arteries to provide sufficient blood supply to the increased mass of the myocardium, especially if they are narrowed by accumulated plaques.

It is known that only one smoking can increase the risk of death from vascular diseases by about half. This is due to the development of arterial hypertension in smokers, an increase in heart rate, an increase in blood coagulation, and an increase in atherosclerosis in the walls of blood vessels.

Risk factors also include psycho-emotional stress. Some features of a person who has a constant feeling of anxiety or anger, which can easily cause aggression against others, as well as frequent conflicts, lack of understanding and support in the family, inevitably lead to high blood pressure, increased heart rate and, as a result, an increasing need myocardium in oxygen.

Video: the occurrence and course of ischemia

Does everything depend on us?

There are so-called non-modifiable risk factors, that is, those that we cannot influence in any way. These include heredity (the presence of various forms of coronary artery disease in the father, mother and other blood relatives), elderly age and gender. In women, various forms of coronary artery disease are observed less frequently and at a later age, which is explained by the peculiar action of female sex hormones, estrogens, which prevent the development of atherosclerosis.

In newborns, young children and adolescents, there is practically no sign of myocardial ischemia, especially those caused by atherosclerosis. IN early age ischemic changes in the heart can result from coronary vessels or malformations. Ischemia in newborns and more often affects the brain and it is associated with violations of the course of pregnancy or the postpartum period.

It is unlikely that each of us can boast of excellent health, constant adherence to diet and regular exercise. Large workloads, stress, constant haste, the inability to eat balanced and regular are frequent companions of our daily rhythm of life.

It is believed that residents of megacities are more prone to the development of cardiovascular diseases, including coronary artery disease, which is associated with high stress levels, constant overwork and lack of physical activity. However, it would be nice to go to the pool or gym at least once a week, but most of us will find a lot of excuses not to do this! Someone does not have time, someone is too tired, and a sofa with a TV and a plate of delicious homemade food on the day off beckons with incredible strength.

Many people do not attach significant importance to lifestyle, so polyclinic doctors need to timely identify risk factors in patients at risk, share information about possible consequences overeating, obesity, sedentary lifestyle, smoking. The patient must clearly understand the outcome that ignoring the coronary vessels can lead to, therefore, as they say: forewarned is forearmed!

Types and forms of coronary heart disease

Currently, there are many types of coronary heart disease. IHD classification proposed in 1979 working group WHO experts, still remains relevant and is used by many doctors. It is based on the selection independent forms diseases that have peculiar characteristic manifestations, a certain prognosis and require a special type of treatment. With the passage of time and the advent modern ways diagnosis, other forms of coronary artery disease have been studied in detail, which is reflected in other, newer classifications.

Currently, the following clinical forms of IHD are distinguished, which are presented:

1. Sudden coronary death (primary cardiac arrest);
2. Angina pectoris (here, its forms such as exertional angina and spontaneous angina pectoris are distinguished);
3. (primary, repeated, small-focal, large-focal);
4. Post-infarction;
5. Insufficiency of blood circulation;
6. Violation of the heart rhythm;
7. Painless myocardial ischemia;
8. Microvascular (distal) CAD
9. New ischemic syndromes ("stunning" of the myocardium, etc.)

For statistical accounting of the incidence of coronary heart disease, the International Classification of Diseases of the 10th revision is used, with which every doctor is familiar. In addition, it should be mentioned that the disease can occur in an acute form, for example, myocardial infarction, sudden coronary death. Chronic ischemic heart disease is represented by such forms as cardiosclerosis, stable angina, chronic.

Manifestations of myocardial ischemia

Symptoms of cardiac ischemia are varied and are determined by the clinical form that they accompany. Many people know such signs of ischemia as pain in the chest, radiating to the left arm or shoulder, heaviness or a feeling of constriction behind the sternum, fatigue and shortness of breath even with little physical exertion. In the event of such complaints, as well as in the presence of risk factors in a person, he should be asked in detail about the features of the pain syndrome, find out what the patient feels, what conditions could provoke an attack. Usually, patients are well aware of their disease and can clearly describe the causes, the frequency of attacks, the intensity of pain, their duration and nature, depending on physical activity or taking certain medications. medicines.

Sudden coronary (cardiac) death - this is the death of the patient, often in the presence of witnesses, occurring suddenly, instantly or within six hours of the onset of a heart attack. It is manifested by loss of consciousness, cessation of breathing and cardiac activity, dilated pupils. This condition requires urgent medical measures, and the sooner they are provided qualified specialists the greater the chance of saving the patient's life. However, even with timely resuscitation, the death rate in this form of coronary artery disease reaches 80%. This form of ischemia can also be observed in young people, which is most often due to a sudden spasm of the coronary arteries.

Angina pectoris and its types

Angina pectoris is perhaps one of the most common manifestations of myocardial ischemia. It occurs, as a rule, against the background of atherosclerotic lesions of the heart vessels, however, in its genesis, an important role is played by the tendency of the vessels to spasm and an increase in the aggregation properties of platelets, which entails the formation and blockage of the lumen of the artery. Even with minor physical exertion, the affected vessels are not able to provide normal blood flow to the myocardium, as a result, its metabolism is disturbed, and this is manifested by characteristic pain sensations. Symptoms of coronary heart disease in this case will be as follows:

• Paroxysmal intense pain behind the sternum, radiating to the left arm and left shoulder, and sometimes to the back, shoulder blade, or even to the abdomen;
• Violation of the heart rhythm (increase or, conversely, decrease in heart rate, appearance);
• Changing indicators blood pressure(more often its increase);
• The appearance of shortness of breath, anxiety, pallor of the skin.

Depending on the causes of occurrence, there are various variants of the course of angina pectoris. It can be angina pectoris that occurs against the background of physical or emotional stress. As a rule, when taking nitroglycerin or at rest, the pain goes away.

Spontaneous angina- a form of cardiac ischemia, which is accompanied by the appearance of pain for no apparent reason, in the absence of physical or emotional stress.

Unstable angina- this is a form of progression of coronary heart disease, when there is an increase in the intensity of pain attacks, their frequency, while the risk of developing acute myocardial infarction and death. The patient at the same time begins to consume more nitroglycerin tablets, which indicates a deterioration in his condition and a worsening of the course of the disease. Such a form requires special attention and urgent treatment.

Read more about all types of angina pectoris and its treatment.

Myocardial infarction, what does this concept mean?

Myocardial infarction (MI) is one of the most dangerous forms of coronary artery disease, in which necrosis (necrosis) of the heart muscle occurs as a result of a sudden cessation of blood supply to the heart. Heart attack is more common in men than in women, and this difference is more pronounced in young and adulthood. This difference can be explained by the following reasons:

1. Later development of atherosclerosis in women, which is associated with hormonal status (after the onset of menopause, this difference begins to gradually decrease and finally disappears by the age of 70);
2. Greater prevalence of bad habits among the male population (smoking, alcoholism).
3. The risk factors for myocardial infarction are the same as those described above for all forms of coronary artery disease, however, in this case, in addition to narrowing the lumen of the vessels, sometimes for a considerable length, usually, still going on and .

In various sources, with the development of myocardial infarction, the so-called pathomorphological triad is distinguished, which looks like this:

The presence of atherosclerotic and an increase in its size over time can lead to its rupture and the release of contents to the surface of the vascular wall. Plaque damage can be promoted by smoking, high blood pressure, and intense exercise.

Damage to the endothelium (the inner layer of the artery) when the plaque ruptures causes increased blood clotting, "sticking" of platelets to the site of damage, which inevitably leads to. According to different authors, the incidence of thrombosis in myocardial infarction reaches 90%. First, the thrombus fills the plaque, and then the entire lumen of the vessel, while the movement of blood at the site of thrombus formation is completely disrupted.

Spasm of the coronary arteries occurs at the time and place of thrombus formation. It can also occur throughout the coronary artery. Coronarospasm leads to a complete narrowing of the lumen of the vessel and the final stop of the movement of blood through it, which causes the development of necrosis in the heart muscle.

In addition to the reasons described, others play an important role in the pathogenesis of myocardial infarction, which are related to:

• With a violation of the coagulation and anticoagulation systems;
• With insufficient development of "bypass" tracts of blood circulation (collateral vessels),
• With immunological and metabolic disorders at the site of damage to the heart muscle.

How to recognize a heart attack?

What are the symptoms and manifestations of myocardial infarction? How not to miss this formidable form of coronary artery disease, so often leading to the death of people?

Often, MI finds patients in a variety of places - at home, at work, in public transport. It is important to identify this form of coronary artery disease in time in order to immediately begin treatment.

The clinic of a heart attack is well known and described. As a rule, patients complain of acute, " dagger”, retrosternal pain that does not stop when taking nitroglycerin, changing body position or holding the breath. A painful attack can last up to several hours, while there is anxiety, a feeling of fear of death, sweating, cyanosis of the skin.

With the simplest examination, disturbances in the rhythm of the heart, changes in blood pressure (a decrease due to a violation of the pumping function of the heart) are quickly detected. There are cases when necrosis of the heart muscle is accompanied by changes in the gastrointestinal tract (nausea, vomiting, flatulence), as well as the so-called "painless" myocardial ischemia. In these cases, diagnosis can be difficult and requires the use of additional methods of examination.

However, with timely treatment, it becomes possible to save the patient's life. In this case, at the site of the focus of necrosis of the heart muscle, a focus of dense connective tissue will appear - a scar (the focus of post-infarction cardiosclerosis).

Video: how the heart works, myocardial infarction

Consequences and complications of coronary artery disease

Postinfarction cardiosclerosis

Postinfarction cardiosclerosis- one of the forms of coronary heart disease. A scar in the heart allows the patient to live more than one year after a heart attack. However, over time, as a result of a violation of the contractile function associated with the presence of a scar, one way or another, signs of heart failure begin to appear - another form of coronary artery disease.

Chronic heart failure

Chronic heart failure accompanied by the occurrence of edema, shortness of breath, a decrease in exercise tolerance, as well as the appearance of irreversible changes in the internal organs, which can cause the death of the patient.

Acute heart failure

Acute heart failure can develop with any type of coronary artery disease, however, it most often occurs in acute myocardial infarction. So, it can be manifested by a violation of the work of the left ventricle of the heart, then the patient will have signs of pulmonary edema - shortness of breath, cyanosis, the appearance of foamy pink sputum when coughing.

Cardiogenic shock

Another manifestation of acute circulatory failure is. It is accompanied by a drop in blood pressure and a pronounced violation of the blood supply to various organs. The condition of the patients is severe, consciousness may be absent, the pulse is threadlike or not detected at all, breathing becomes shallow. In the internal organs, as a result of a lack of blood flow, dystrophic changes develop, foci of necrosis appear, which leads to acute renal and hepatic failure, pulmonary edema, impaired function of the central nervous system. These conditions require immediate action, because they directly represent a mortal danger.

Arrhythmia

Methods for diagnosing coronary heart disease

Currently, there are many modern and diverse methods for detecting coronary blood flow disorders and cardiac ischemia. However, one should not neglect the simplest and most accessible, such as:

1. Careful and detailed questioning of the patient, collection and analysis of complaints, their systematization, clarification of family history;
2. Inspection (detection of the presence of edema, discoloration of the skin);
3. Auscultation (listening to the heart with a stethoscope)
4. Carrying out various tests with physical activity, in which there is a constant monitoring of the activity of the heart (veloergometry).

These simple methods in most cases make it possible to accurately determine the nature of the disease and determine a further plan for the examination and treatment of the patient.

Instrumental research methods help to more accurately determine the form of coronary artery disease, the severity of the course and prognosis. Most often used:

• electrocardiography- a very informative way of diagnosing various options myocardial ischemia, since ECG changes in various conditions have been studied and described quite well. ECG can also be combined with dosed physical activity.
• (detection of lipid metabolism disorders, the appearance of signs of inflammation, as well as specific enzymes that characterize the presence of a necrotic process in the myocardium).
• , which allows, by introducing a contrast agent, to determine the localization and prevalence of lesions of the coronary arteries, the degree of their narrowing by a cholesterol plaque. This method also makes it possible to distinguish coronary artery disease from other diseases when diagnosis using other methods is difficult or impossible;
• (detection of violations of the movement of individual sections of the myocardium);
• radioisotope diagnostic methods.

To date, electrocardiography seems to be quite affordable, fast and, at the same time, very informative method research. So, it is quite reliable with the help of it is possible to identify large focal myocardial infarction(decrease in the R wave, the appearance and deepening of the Q wave, the rise of the ST segment, which takes the characteristic shape of the arc). Depression of the ST segment, the appearance of a negative T wave or the absence of any changes on the cardiogram will manifest subendocardial ischemia with angina pectoris. It should be noted that now even linear ambulance teams are equipped with ECG devices, not to mention specialized ones.

Methods of treatment of various forms of myocardial ischemia

Currently, there are many different ways to treat coronary heart disease, which can not only prolong the life of the patient, but also significantly improve its quality. These can be conservative (the use of drugs, exercise therapy) and surgical methods (operations that restore the patency of the coronary vessels).

Proper nutrition

An important role in the treatment of coronary artery disease and rehabilitation of the patient is played by the normalization of the regimen, the elimination of existing risk factors. It is mandatory to explain to the patient that, for example, smoking can minimize all the efforts of doctors. So, it is important to normalize nutrition: exclude alcohol, fried and fatty foods, foods rich in carbohydrates, in addition, in the presence of obesity, it is necessary to balance the amount and calorie content of food consumed.

The diet for coronary disease should be aimed at reducing the consumption of animal fats, increasing the proportion of fiber, vegetable oils in food (vegetables, fruits, fish, seafood). Despite the fact that significant physical activity is contraindicated for such patients, correct and moderate exercise therapy helps to adapt the affected myocardium to the functionality of the vessels that supply it with blood. Hiking, dosed physical exercises under the supervision of a specialist are very useful.

Medical therapy

Drug therapy of various forms of coronary artery disease is reduced to the appointment of so-called antianginal drugs that can eliminate or prevent angina attacks. These drugs include:

In all acute forms of coronary artery disease, fast and qualified assistance is needed with the use of effective painkillers, thrombolytics, it may be necessary to administer plasma-substituting drugs (with the development of cardiogenic shock) or defibrillation.

Operation

Surgical treatment of cardiac ischemia is reduced to:

1. restoration of the patency of the coronary arteries (when a tube is inserted at the site of atherosclerosis of the vessel, preventing further narrowing of its lumen);
2. or to create a bypass blood supply (, mammary coronary bypass grafting).

With the onset of clinical death, it is very important to start resuscitation measures in time. If the patient's condition worsens, severe shortness of breath appears, heart rhythm disturbances, it is already too late to run to the clinic! Such cases require an ambulance call, as the patient may need to be hospitalized as soon as possible.

Video: lecture by a specialist on the treatment of ischemia

After discharge from the hospital

Treatment with folk remedies can only be effective in combination with traditional methods. The most common use of various herbs and collections, such as chamomile flowers, motherwort herb, birch leaf tincture, etc. Such infusions and herbal teas can have a diuretic, calming effect, improve blood circulation in various organs. Given the severity of the manifestations, the high risk of death, the use of purely non-traditional means of influence is unacceptable therefore, it is highly undesirable to look for any means that can be recommended by ignorant people. Any use of a new drug or folk remedy must be discussed with the attending physician.

In addition, when the worst is over, in order to prevent a recurrence, the patient should take for granted the appointment of drugs to correct the lipid composition of the blood plasma. It would be great to dilute drug treatment with physiotherapy procedures, a visit to a psychotherapist and receiving spa treatment.

Video: coronary heart disease in the program “Live healthy!”

One of the presenters will answer your question.

The questions in this section are currently being answered by: Sazykina Oksana Yurievna, cardiologist, therapist

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In this article we will learn:

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

Thus, coronary artery disease 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 coronary heart disease is a complex concept that includes angina pectoris, myocardial infarction And cardiac arrhythmias.

Why does IBS occur?

Our heart needs a constant supply of oxygen from the blood to function properly. 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 lack oxygen, which means that 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 have pure heart vessels. Our habitual lifestyle is increasingly affecting our health. High blood pressure and an 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, smoking, in turn, lead to spasm of the coronary arteries, which means that even in more reduce blood flow to the heart. Finally, a sedentary lifestyle and excessive body weight as a trigger inevitably lead to the earliest occurrence of coronary heart disease.

IBS 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. 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 sternum. Such pains often cause a person to freeze, stop any activities and even hold their breath until they pass. Heart pain in IHD usually lasts at least 1 minute and no more than 15 minutes. Their occurrence may be preceded by severe stress or physical exertion, but there may not be obvious reasons. An attack of angina pectoris in IHD is distinguished from a heart attack by a lower intensity of pain, their duration is no more than 15 minutes and disappearance after taking nitroglycerin.

What causes IBS attacks?

When we discussed the blood supply of the heart, we said that clean coronary vessels allow our heart to work efficiently under any conditions. Cholesterol plaques narrow the lumen of the coronaries and reduce blood flow to the myocardium (heart muscle). The more difficult the blood supply to the heart, the less stress it can withstand without a pain attack. All this happens because any emotional and physical stress requires an increase in 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 is that the load on the heart grows, and it can no longer receive blood. This is how the 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 occurrence of IHD. Often they are related to each other. But why are they harmful?

The abundance of fatty foods in the diet- leads to increased cholesterol in the blood and its deposits on the walls of blood vessels. The lumen of the coronaries narrows - the blood supply to the heart decreases. So, distinct attacks of IHD 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 cardiac complications of diabetes is myocardial infarction.

Hypertension- high blood pressure creates excessive stress on the heart and blood vessels. The heart works in an excessively high mode for exhaustion. Blood vessels lose their elasticity - the ability to relax and allow more blood to flow when exercised. Traumatization of the vascular wall occurs - the most important factor accelerating the deposition of cholesterol plaques and narrowing of the lumen of the vessels.

Sedentary lifestyle- constant sedentary work at the computer, movement by car and lack of necessary physical activity lead to weakening of the heart muscle, venous congestion. It becomes harder and harder for a weak heart to pump stagnant blood. Under these conditions, it is impossible to fully nourish the heart muscle with oxygen - IHD develops.

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

What does coronary artery disease lead to 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 CAD can progress to myocardial infarction, heart rhythm blocks, and heart failure. What are these conditions and why are they dangerous?

myocardial infarction- This is the death of a certain area of ​​\u200b\u200bthe heart muscle. It develops, as a rule, due to thrombosis of the arteries supplying the heart. Such thrombosis is the result of a 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, a sudden attack of unbearable, tearing pain behind the sternum or in the region of the heart occurs. This pain may radiate to the left arm, shoulder blade, or jaw. In this condition, the patient has a cold sweat, blood pressure may drop, nausea, weakness and a feeling of fear for one's life appear. Myocardial infarction differs from angina attacks in coronary artery disease by unbearable pain that lasts a long time, more than 20-30 minutes and is slightly reduced by taking nitroglycerin.

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

Heart rhythm disturbances - blockade and arrhythmias. Prolonged disruption of adequate blood supply to the heart in coronary artery disease leads to various failures of the heart rhythm. With arrhythmias, the pumping function of the heart can significantly decrease - it pumps blood inefficiently. In addition, in the case of a severe violation of the heart rhythm and conduction possible cardiac arrest.

Cardiac arrhythmias in IHD 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 sternum (“heart pounding”), or vice versa, an obvious slowdown in 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 exertion and fully provide blood to the body. The heart becomes weak. With mild heart failure, severe shortness of breath occurs during exertion. In case of severe insufficiency, the patient is not able to endure the lightest household loads without pain in the heart and shortness of breath. This condition is accompanied by swelling 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 impair the quality of life and lead to complete loss of function.

How is CAD diagnosed?

The diagnosis of coronary heart disease is made based on the results of instrumental and laboratory studies. Performed blood analysis, with deciphering the profile of cholesterol and sugars. To assess the functioning of the heart (rhythm, excitability, contractility) is carried out ECG recording(electrocardiograms). For accurate assessment the degree of narrowing of the vessels supplying the heart, a contrast agent is injected into the blood and an X-ray examination is performed - coronary angiography. The totality of these studies shows the current state of metabolism, heart muscle and coronary vessels. In combination with symptoms, this allows you to make a diagnosis of coronary artery disease and determine the prognosis of the course of the disease.

Treatment of IHD 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 coronary artery 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 IHD, drugs of several main groups are prescribed. The medicines of each group have a number of fundamental restrictions on the use in patients with IHD. Thus, treatment becomes impossible or dangerous to health in the presence of certain diseases in different patients. Superimposed on each other, these limitations significantly narrow the possibilities of drug treatment of coronary heart disease. In addition, the aggregate side effects from different drugs, is essentially a disease that is already 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 well-defined limits of applicability and a number of associated side effects that are important to know about:

Antiplatelet agents- blood-thinning drugs. The most commonly used drugs are aspirin-containing drugs. All drugs in this group contraindicated during pregnancy and lactation. The drugs have irritant and ulcerative action to the stomach and intestines. That is why taking these drugs poses a risk for patients who already have gastric ulcer, duodenal ulcer or inflammatory bowel disease. Long-term use of aspirin-containing drugs causes risk of developing an allergic reaction respiratory tract . This is especially important to consider if a patient with coronary artery disease already has bronchial asthma or bronchitis, because. medicines can trigger an attack. It must be borne in mind that all drugs in this group put a lot of 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 the drug treatment of coronary artery disease. All beta-blockers have significant limitations for use. 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 jumps in blood sugar.

Statins These drugs are used to lower blood cholesterol levels. The entire line of drugs prohibited during pregnancy and lactation since statins can cause fetal abnormalities. Preparations highly toxic to the liver, and therefore not recommended for relevant diseases. If taken, regular laboratory monitoring of inflammatory parameters of the liver is necessary. Statins can cause skeletal muscle atrophy, as well as aggravate the course of an already 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 means to lower blood pressure. The entire group of these drugs. When diabetes the use of 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 advanced age and the presence of disorders of cerebral circulation, the use of drugs in this group is associated with stroke risk. The drugs are categorically incompatible with the intake of alcohol.

ACE inhibitors (angiotensin-converting enzyme)- most often used to lower blood pressure in the treatment of coronary artery disease. Reduce the concentration of the most important ions in the blood. They adversely affect the cellular composition of the blood. They are toxic to the liver and kidneys, and therefore are not recommended for use in the relevant 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), they can also be prescribed to prevent 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 blood pressure. For this reason, nitrate treatment is dangerous for people with cerebrovascular accident, 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 can only temporarily restrain the progress of the disease, causing significant side effects in a sick person. The main disadvantage of drug therapy is affecting the symptoms of a disease without eliminating the cause itself development of coronary heart disease.

The main reason for the development of coronary artery disease. Why does this disease develop?

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

How to fix the metabolism and stop the progress of coronary artery 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 pressure that are in line with the norm. Everything above and below is a deviation leading to illness.

It is no less known that the constant consumption of fatty and high-calorie foods leads to the deposition of cholesterol in the vessels, obesity. Thus, it becomes clear that fats and calories in food also have a strictly defined norm within which a person is healthy. Excess consumption of fat leads to disease.

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

Breathing is one of the most important vital functions in our body. Exactly our breathing 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 under which a person is healthy.. For years, patients with coronary heart disease breathe excessively deeply. Excessively deep breathing changes the gas composition of the blood, destroys metabolism and leads to the development of coronary heart disease.. So with deep breathing:

• There is a spasm of blood vessels supplying the heart. Because carbon dioxide is excessively washed out of our blood - a natural factor in relaxing blood vessels
• Oxygen starvation of the heart muscle and internal organs develops– without enough carbon dioxide in the blood, oxygen cannot reach the heart and tissues
• Arterial hypertension develops- rise in blood pressure - a reflex protective reaction of our body to oxygen starvation of organs and tissues.
• The course of the most important metabolic processes is disrupted. Excessive depth of breathing disturbs the healthy proportions of blood gases and its acid-base balance. This entails disruption of the normal operation of a whole cascade of proteins and enzymes. All this contributes to the violation 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 of drugs does not stop IHD. Taking medication, the patient continues to breathe deeply and destroy the metabolism. Dosages are rising, the disease is progressing, the prognosis is becoming more and more serious - but deep breathing remains. Normalization of breathing of a patient with IHD - bringing it to a healthy physiological norm, is capable of stop the progress of the disease to be of great help in the treatment of medicines and save a life from a heart attack.

How can you normalize breathing?

In 1952, the Soviet physiologist Konstantin Pavlovich Buteyko made revolutionary discovery in medecine - 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, the normalization of breathing itself forever eliminates the need for medicines for patients with initial degrees of the disease. In severe, neglected cases, breathing becomes a huge help, allowing, together with drug therapy, to save the body from the unceasing progress of the disease.

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

If you want to normalize your breathing - apply for a distance learning 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, manual therapist
Konstantin Sergeevich Altukhov

IHD occupies a strong leading position among the most common pathologies of the heart, 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, poor nutrition with a large amount of fat - all these reasons lead to a steady increase in the number of people suffering from this serious illness.

The term "ischemic heart disease" combines 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). In the future, 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, the principles of diagnosis and treatment of this pathology, the symptoms and what cardiologist patients need to know.

Currently, due to the expansion of diagnostic capabilities, cardiologists distinguish the following clinical forms of coronary artery disease:

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

The above classification of coronary artery disease refers to the International Classification of Diseases X system.

Causes

In 90% of cases, coronary artery disease is provoked by 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 the metabolic needs of the heart muscle may be the result of:

• spasm of slightly changed or unchanged coronary vessels;
• tendency to thrombosis due to disorders of the blood coagulation system;
• violations of microcirculation in the coronary vessels.

Risk factors for the development of such etiological causes of IHD can be:

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

Symptoms

In most cases, coronary artery disease 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 is narrowed by 70%.

Most often, coronary artery disease begins to manifest itself as symptoms of angina pectoris:

• 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 a feeling 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 may disappear on its own (after the cessation of the load) or after taking Nitroglycerin.

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

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

Diagnostics

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

After questioning the patient, the cardiologist conducts:

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

Based on the data obtained, the following additional laboratory and instrumental examination methods can be prescribed to the patient:

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

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

Treatment

IHD treatment 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 (prescribing medications, diets, 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 a violation of the coronary circulation, the patient is recommended to give up bad habits and follow certain rules of rational nutrition. When compiling his daily diet, a patient with coronary artery disease should adhere to the following principles:

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

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

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

• angioplasty of a coronary vessel with: this technique is aimed at restoring the patency of a 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 for blood to enter the area of ​​myocardial ischemia, for this, sections of the patient's own veins or the internal thoracic artery can be used as a bypass;
• transmyocardial laser myocardial revascularization: this operation can be performed when it is impossible to perform coronary artery bypass grafting, during the intervention, the doctor using a laser creates a lot of the thinnest channels in the damaged area of ​​the myocardium, which can be filled with blood from the left ventricle.

In most cases, surgical treatment significantly improves the quality of life of a patient with coronary artery disease and reduces the risk of myocardial infarction, disability and death.

Educational film on the topic "Ischemic heart disease"