1 standard has been established for diagnosing the disease Chronic ischemic heart disease

Chronic or just beginning cardiac ischemia can be established in many ways. The simplest and most informative of which are the following:

A thorough survey of the person who applied to the clinic, an in-depth analysis of the information received, collection of biomaterial for laboratory study and streamlining of health complaints. Superficial examination of the patient for swelling or discoloration skin. Listening to the heart muscle using a special instrument - a stethoscope. Testing a person using physical activity, during and after which the heart function is monitored.

A more accurate diagnosis is obtained instrumental methods. They give full information regarding the form and stage of the disease, how complicated it is, and what methods are best to treat it. Most often used:

• Biochemical study of blood in a laboratory. It provides the opportunity to establish the presence of specific enzymes, symptoms of inflammation and lipid metabolism disorders in the biomaterial.
• Electrocardiography, which is considered the most informative.
• Coronary angiography, which involves the injection of a substance with a contrasting color into the blood. Thanks to this method, the location and extent of cholesterol deposits in the arteries, the degree of narrowing of the latter and other important indicators are clarified.
• Echocardiography, which identifies existing disturbances in the functioning of specific parts of the myocardium.

Selective coronary angiography is considered the basis for the diagnosis of obstructive lesions of the coronary arteries of the heart. It is used to find out whether the narrowing of the vessel is significant, which arteries and how many of them are affected, in what place and over what extent. IN Lately Multislice computed tomography (MSCT) with intravenous bolus contrast has become increasingly common. Unlike selective coronary angiography, which is essentially X-ray surgery on the arterial bed and is performed only in a hospital setting, MSCT of the coronary arteries is usually performed on an outpatient basis using intravenous administration contrast agent. Another fundamental difference may be that selective coronary angiography shows the lumen of the vessel, and MSCT shows the lumen of the vessel, and, in fact, the wall of the vessel in which it is localized pathological process.

Coronary heart 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 disease hearts. At the first stage of formation, the disease develops asymptomatically and only after that the patient may experience an attack of angina. Treatment of pathology can be carried out with medications or surgical intervention. Here everything determines the degree of damage to the pathology.

Risk factors

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

The underlying cause of coronary heart disease is considered to be coronary vascular disease. It is characterized by blockage of 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 in the myocardium can be recognized during running or fast walking. Disorders of myocardial metabolism can be detected by such manifestations as pain behind the chest when a person is at rest. The frequency of angina attacks depends on how much smaller the lumen in the coronary artery.

Along with angina pectoris, a person can experience chronic symptoms. It is characterized by shortness of breath and increased swelling.

The lumen of the artery is completely closed when the plaque ruptures. Such events may cause a heart attack or cardiac arrest. The determining factor here is the area of ​​the heart muscle that is damaged. If the major artery is completely closed, the patient is expected to severe consequences, up to fatal outcome.

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:

• pain syndrome in chest, striking left hand or shoulder;
• heaviness behind the sternum;
• apathy and shortness of breath.

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

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

Types of coronary heart disease

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

1. Fast coronary death.
2. Seizure.
3. Myocardial infarction.
4. Post-infarction cardiosclerosis.
5. Insufficient blood circulation.
6. Violation of the rhythm of the organ.
7. Silent myocardial ischemia.
8. Microvascular ischemic heart disease.
9. New ischemic syndromes.

Of all the forms described, patients are most often 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 coronary heart disease. Its development is associated with atherosclerotic damage to the vessels of the heart, resulting in blood clots and blockage of the artery lumen. Damaged vessels are not able to fulfill their direct duties of transporting blood, even if the person performs minor physical activity. The result of this process is impaired metabolism, which manifests itself as pain.

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

1. Painful sensations behind the sternum, having a paroxysmal character. They affect the left arm, shoulder, and in some cases the back and shoulder blade.
2. Violation of heart rhythm.
3. Increased blood pressure.
4. The occurrence of shortness of breath, feelings of anxiety, pale skin.

Depending on the reasons that provoked angina, 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 painful sensations go away.
2. Spontaneous angina is a form of coronary heart disease, which is characterized by the presence of pain without justified reasons and lack of physical stress.
3. Unstable angina is a form of coronary heart disease, which is characterized by progression of the disease. Here the pain syndrome intensifies and the risk of developing acute heart attack myocardium and fatal outcome. The patient uses medications more and more as his condition has deteriorated significantly. With this form of the disease, immediate diagnosis and urgent therapy are required.

Myocardial infarction

Coronary heart disease often manifests itself in the form of myocardial infarction. Here, necrosis of the muscles of the organ occurs due to sudden cessation feeding him with blood. The disease most often 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 menopause, there is a greater chance of myocardial infarction. By the age of 70, the disease can affect both men and women equally.
2. Men drink alcohol and smoke more.

In addition to the risk factors presented, the following reasons may contribute to the occurrence of myocardial infarction:

• violation of coagulation and anticoagulation systems;
• insufficient development of “bypass” circulatory pathways;
• metabolic and immune disorders combined with damage to the heart muscle.

This form of IHD is characterized by the death of the patient, which most often occurs in front of witnesses. It occurs instantly or within 6 hours from the time the heart attack occurs.

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

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

Consequences of the disease

Coronary heart disease due to untimely treatment can cause many complications:

1. Post-infarction cardiosclerosis.
2. Chronic heart failure.
3. Acute heart failure.
4. Cardiogenic shock.

Therapeutic measures

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

Surgical treatment

When drug therapy didn't give hers positive result, the patient is prescribed surgery coronary heart disease. During the operation, the surgeon cleanses the arteries of cholesterol.

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

Brachytherapy

Coronary heart disease is a pathology that today is actively treated with radiation. This technique is used in cases where, after angioplasty, secondary damage to the blood vessels of the organ has occurred. This treatment is prescribed upon diagnosis severe form IHD.

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

The essence of the operation is that the patient is connected to a machine, thanks to which artificial blood circulation is carried out. It functions instead of the heart muscle during surgery. The organ itself is temporarily stopped forcibly. This therapy is in great demand, since there are practically no complications after it. Decrease 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 cause of IHD is blockage of the first and anterior coronary arteries. In this situation, the surgeon replaces the damaged vessel with the artery that was taken from the victim’s chest. This treatment does not involve a complete opening of the sternum.

Method of indirect myocardial revascularization with laser

This therapy is prescribed when surgery and angioplasty are impossible. During the operation, the heart muscle is pierced in several places using a laser. New ones form at the puncture sites blood vessels. The operation can be performed as a separate therapy or as a systemic approach.

Coronary heart disease is a very serious and dangerous disease that contributes to the formation large quantity 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 timely determine the causes of the disease and its manifestations.

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Chronic coronary heart disease is a pathology in which the blood supply to the myocardium is impaired. This occurs due to atherosclerotic deposits on the walls of the coronary arteries and/or plaques formed. Since the lumen of the vessels is narrowed, blood flow to the heart is reduced. As a result, the heart begins to work harder to ensure proper oxygen supply. This leads to expansion of the heart muscle. The condition is fraught with sudden arrhythmia, occlusion (impaired patency) of the coronary arteries, and heart attack. HIBS is the main cause of death from heart attack. Men suffer from ischemic heart disease more often: even in age group over 70 years of age the ratio remains 2:1.

People at risk for HIHD include:

• patients with a family history;
• high cholesterol levels;
• overweight;
• smokers;
• high blood pressure;
• preferring foods high in fat (even if they do not lead to weight gain).

Causes of chronic ischemic heart disease (CHD)

Research shows that CAD begins when certain agents damage the inner layers of the coronary arteries.

The main reasons contributing to the development of HIHD:

• smoking;
• high levels of certain fats and cholesterol in the blood;
• inflammation of blood vessels;
• high blood pressure;
• elevated blood sugar due to insulin resistance or diabetes;
• metabolic syndrome;
• absence physical activity;
• poor nutrition;
• elderly age;
• family history of early ischemic heart disease.

Research into the influence of other possible factors risk of developing HIHD:

1. High level C-reactive protein(CRP), which is a sign of inflammation in the body.
2. High levels of triglycerides in the blood.
3. Sleep apnea. With absence apnea treatment increases the risk of high blood pressure, heart attack, stroke.
4. Stress. Research shows that the trigger may be emotional disorder, anger.
5. Alcohol. Drinking worsens other risk factors for coronary artery disease.
6. Preeclampsia during pregnancy.

Symptoms of HIBS

In the early stages of IHD, it is practically asymptomatic. Discomfort and/or chest pain (angina) is the most common symptom of HIHD. Pain is felt when the heart does not receive enough blood and oxygen. Pain under the breastbone, in the upper back, neck, arms, abdomen, a feeling of heaviness, as if someone is squeezing the heart - these symptoms are usually associated with activity or emotions. The condition normalizes with rest, pain is relieved with nitroglycerin.

Other symptoms:

• dyspnea;
• fast fatiguability;
• general weakness.

Treatment of chronic coronary heart disease

Important for ischemic heart disease early diagnosis. Since the first signs of HIHD are similar to the symptoms of other cardiovascular pathologies, then it is necessary differential diagnosis. An experienced cardiologist will definitely refer the patient for an ECG, ultrasound of the heart, coronary angiography, prescribe Holter monitoring and others necessary research and analyses. Only after this will a treatment plan be drawn up and the correct recommendations given.

Therapy usually begins with medicines and lifestyle changes. Food with low content fat, regular moderate exercise, weight loss, quitting smoking - this is only part of the battle for healthy coronary arteries. To prevent the development of coronary heart disease and prevent deterioration, the doctor will prescribe medications: nitrates that relieve pain, antiplatelet agents that thin the blood, statins that lower cholesterol levels, calcium antagonists, beta blockers and other drugs needed by a particular patient.

An implantable defibrillator may be necessary to prevent sudden life-threatening arrhythmias. If doctors believe a patient's CAD is severe enough, they offer surgical or non-invasive procedures to improve the condition and save a life.

For detailed consultations, make an appointment with cardiologists medical centers President-Med

Cardiac ischemia, coronary artery disease (CHD): symptoms, treatment, forms, prevention

Coronary heart disease (CHD) has become serious social problem, because most of the planet’s population has one or another manifestation of it. The fast pace of life in megacities, psycho-emotional stress, and consumption of large amounts of fat in food 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 walls of the arterial vessels of the heart by cholesterol plaques, which ultimately leads to an imbalance between the needs of the heart muscle for substances necessary for metabolism and the possibilities of their delivery through the heart arteries. The disease can be either acute or chronic, and has many clinical forms, differing in symptoms and prognosis.

Despite the emergence of various modern methods treatment, IHD still occupies the leading position in the number of deaths in the world. Often, cardiac ischemia is combined with the so-called ischemia, which also occurs with atherosclerotic damage to the vessels that supply it with blood. Quite common, in other words, cerebral infarction is a direct consequence. Thus, common reasons these serious illnesses also determine their frequent combination in the same patient.

Main cause of coronary artery disease

In order for the heart 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 important function. The myocardium is equipped with vessels called coronary vessels, through which “food” and breathing are delivered to it. Various influences, unfavorable for coronary vessels, can lead to their failure, which will lead to disruption of blood flow 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 the external environment, lifestyle, dietary habits, and also in the presence of hereditary predisposition, happens. In other words, protein-fat complexes are deposited on the walls of the arteries, which over time turn into an atherosclerotic plaque, which narrows the lumen of the vessel, disrupting the normal blood flow to the myocardium. So, immediate cause development 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 are:

• Increased cholesterol levels (), as well as changes in the ratio of various fractions of lipoproteins;
• Eating disorders (abuse fatty foods, excessive consumption of easily digestible carbohydrates);
• Physical inactivity, low physical activity, reluctance to play sports;
• Availability bad habits such as smoking, alcoholism;
• Concomitant diseases accompanied by metabolic disorders (obesity, decreased thyroid function);
• Arterial hypertension;
• Age and gender factors (it is known that IHD is more common in older people, and also in men more often than in women);
• Peculiarities psycho-emotional state(frequent stress, overwork, emotional overstrain).

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

It is known that only one smoking can increase the risk of death from vascular diseases about half. This is explained by the development in smokers arterial hypertension, increased heart rate, increased blood clotting, as well as increased atherosclerosis in the walls of blood vessels.

Risk factors also include psycho-emotional stress . Some personality traits constant feeling anxiety or anger, which can easily cause aggression towards others, as well as frequent conflicts, lack of mutual understanding and support in the family, inevitably lead to increased blood pressure, increased heart rate and, as a consequence, an increased need for oxygen in the myocardium.

Video: 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 various forms IHD in father, mother and other blood relatives), older age and gender. In women, various forms of IHD are observed less frequently and in more late age, which is explained by the peculiar action of female sex hormones, estrogens, which prevent the development of atherosclerosis.

In newborns, small 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 occur as a result of coronary vessels or developmental defects. Ischemia in newborns most often affects the brain and is associated with disturbances during pregnancy or the postpartum period.

It is unlikely that each of us can boast excellent health, constant adherence to diet and regular exercise. Heavy workload, stress, constant rush, inability to eat balanced and regularly are frequent companions of our daily rhythm of life.

It is believed that residents of megacities are more prone to developing cardiovascular diseases, including ischemic heart disease, which is associated with high stress levels, constant overwork and lack of physical activity. However, it would be nice to visit the pool or gym at least once a week, but most of us will find a lot of excuses not to do this! Some people don’t have time, some are too tired, and a sofa with a TV and a homemade plate tasty food on a day off it beckons with incredible force.

Many don't give significant lifestyle, therefore, clinic doctors need to promptly 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 can result from ignoring the coronary vessels, so as they say: forewarned is forearmed!

Types and forms of coronary heart disease

Currently, many types of coronary heart disease are known. The classification of IHD, proposed in 1979 by a WHO expert working group, still remains relevant and is used by many doctors. It is based on the identification of independent forms of the disease, which have peculiar characteristic manifestations, a certain forecast and require special type treatment. With the passage of time and the emergence modern methods diagnostics, other forms of IHD were 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 (here we distinguish such forms as angina pectoris and spontaneous angina);
3. (primary, repeated, small-focal, large-focal);
4. Post-infarction;
5. Circulatory failure;
6. Heart rhythm disturbances;
7. Painless myocardial ischemia;
8. Microvascular (distal) ischemic heart disease
9. New ischemic syndromes (“stunning” of the myocardium, etc.)

To statistically record the incidence of coronary heart disease, the International Classification of Diseases, X 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 coronary 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 compression behind the sternum, fatigue and shortness of breath even with minor physical exertion. If such complaints appear, as well as if a person has risk factors, he should be asked in detail about the characteristics of the pain syndrome, find out what the patient feels, what conditions could provoke the attack. Typically, patients are well aware of their disease and can quite clearly describe the causes, frequency of attacks, intensity pain, their duration and nature depending on physical activity or taking certain medications.

Sudden coronary (heart) death - this is the death of a patient, often in the presence of witnesses, occurring suddenly, instantly or within six hours from the moment of the heart attack. It manifests itself as loss of consciousness, cessation of breathing and cardiac activity, and dilation of the pupils. This condition requires urgent therapeutic measures, and the sooner they are provided by qualified specialists, the more likely save the patient's life. However, even with timely resuscitation measures, the incidence of deaths in this form of IHD reaches 80%. This form of ischemia can also be observed in young people, which is most often caused by a sudden spasm of the coronary arteries.

Angina and its types

Angina is perhaps one of the most common manifestations of myocardial ischemia. Occurs, as a rule, against the background of atherosclerotic lesions of the heart vessels, but there are many in its genesis important role plays a role in the tendency of blood vessels to spasm and an increase in the aggregation properties of platelets, which entails the formation and blockage of the arterial lumen by them. Even with minor physical exertion, the affected vessels are not able to ensure normal blood flow to the myocardium, as a result, its metabolism is disrupted, and this is manifested by characteristic pain. Symptoms of coronary heart disease will be as follows:

• Paroxysmal intense pain behind the sternum, radiating to the left arm and left shoulder, and sometimes - in the back, shoulder blade or even in the abdominal area;
• Heart rhythm disturbances (increased or, conversely, decreased heart rate, appearance);
• Changes in blood pressure (usually increased);
• The appearance of shortness of breath, anxiety, pale skin.

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

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

Unstable angina is a form of progression of coronary heart disease, when the intensity of pain attacks and their frequency increases, and the risk of developing acute myocardial infarction and death. The patient begins to consume more nitroglycerin tablets, which indicates a worsening of his condition and a worsening of the disease. This form requires special attention and emergency treatment.

Read more about all types of angina and its treatment.

Myocardial infarction, what does this concept mean?

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

1. Later development of atherosclerosis in women, which is associated with hormonal status (after 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, but in this case, in addition to narrowing the lumen of blood vessels, sometimes for a considerable distance, usually, is also happening .

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

The presence of atherosclerosis and an increase in its size over time can lead to its rupture and the release of contents to the surface vascular wall. Smoking, increased blood pressure, intense physical exercise.

Damage to the endothelium (the inner layer of the artery) when a plaque ruptures causes increased blood clotting and “sticking” of platelets to the site of damage, which inevitably leads to. According to various authors, the incidence of thrombosis during myocardial infarction reaches 90%. First, the thrombus fills the plaque, and then the entire lumen of the vessel, and 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 occur along the entire length of the coronary artery. Coronary spasm leads to complete narrowing of the lumen of the vessel and final stop 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 associated with:

• With a violation of the coagulation and anticoagulation systems;
• With insufficient development of “bypass” circulatory pathways (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 ischemic heart disease, which so often leads to the death of people?

Often, MI finds patients in the most different places– at home, at work, on public transport. It is important to identify this form of IHD in time in order to begin treatment immediately.

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

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

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

Post-infarction cardiosclerosis

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

Chronic heart failure

Chronic heart failure accompanied by the occurrence of edema, shortness of breath, decreased tolerance to physical activity, as well as the appearance irreversible changes in the internal organs, which can cause the death of the patient.

Acute heart failure

Acute heart failure can develop in any type of coronary artery disease, however, it most often occurs in acute myocardial infarction. So, it can manifest itself as a disruption 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 acute failure blood circulation – . It is accompanied by a drop in blood pressure and a pronounced disruption of the blood supply to various organs. The condition of the patients is severe, consciousness may be absent, the pulse is threadlike or not detectable at all, breathing becomes shallow. In internal organs, as a result of lack of blood flow, they develop dystrophic changes, foci of necrosis appear, which leads to acute renal, liver failure, pulmonary edema, dysfunction of the central nervous system. These conditions require immediate action because they directly pose a mortal danger.

Arrhythmia

Methods for diagnosing coronary heart disease

Currently, there are many modern and in a variety of ways detection of coronary blood flow disorders and cardiac ischemia. However, one should not neglect the simplest and most accessible ones, such as:

1. Careful and detailed questioning of the patient, collection and analysis of complaints, their systematization, clarification of family history;
2. Examination (detecting the presence of edema, changes in skin color);
3. Auscultation (listening to the heart with a stethoscope);
4. Carrying out various tests with physical activity, during which the activity of the heart is constantly monitored (bicycle ergometry).

These simple methods in most cases, they allow one to accurately determine the nature of the disease and determine a further plan for examination and treatment of the patient.

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

• electrocardiography– a very informative way to diagnose various types of myocardial ischemia, since ECG changes under 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 characterizing the presence necrotic process in the myocardium).
• , which allows, by introducing a contrast agent, to determine the localization and extent of damage to the coronary arteries, the degree of their narrowing by cholesterol plaque. This method also allows you to distinguish IHD from other diseases when diagnosis using other methods is difficult or impossible;
• (detection of disturbances in the movement of individual sections of the myocardium);
• radioisotope diagnostic methods.

Today, electrocardiography seems to be a fairly accessible, fast and, at the same time, very informative research method. Thus, it is possible to identify quite reliably large focal myocardial infarction(decrease in the R wave, appearance and deepening of the Q wave, elevation of the ST segment receiving characteristic shape arcs). Depression of the ST segment, the appearance of a negative T wave or the absence of any changes on the cardiogram will manifest itself subendocardial ischemia with angina pectoris. It should be noted that now even linear ambulance teams are staffed ECG devices, not to mention specialized ones.

Treatment methods for various forms of myocardial ischemia

Currently, there are many different methods of treating coronary heart disease, which can not only prolong the patient’s life, but also significantly improve its quality. These may be conservative (use of medications, physiotherapy) 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 and the elimination of existing risk factors. It is imperative to explain to the patient that, for example, smoking can minimize all the efforts of doctors. So, it is important to normalize your diet: eliminate 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, proper and moderate physical therapy helps adapt the affected myocardium to the functional capabilities of the vessels supplying it. Walking and dosed physical exercise under the supervision of a specialist are very useful.

Drug therapy

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

In all acute forms of coronary artery disease, prompt and qualified assistance is required with the use of effective painkillers, thrombolytics, and the administration of plasma replacement drugs (if cardiogenic shock develops) or defibrillation may be required.

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 damage to the vessel by atherosclerosis, preventing further narrowing of its lumen);
2. or to create a bypass route of blood supply (mammary coronary bypass).

When advancing clinical death It is very important to start resuscitation measures on time. If the patient’s condition worsens, severe shortness of breath appears, or heart rhythm disturbances occur, it is too late to run to the clinic! Similar cases require calling an ambulance, since the patient may need to be hospitalized quickly.

Video: lecture by a specialist on the treatment of ischemia

After discharge from hospital

Treatment with folk remedies can only be effective in combination with traditional methods. The most common use of various herbs and infusions, such as chamomile flowers, motherwort herb, tincture of birch leaves, etc. Such infusions and herbal teas can have a diuretic, calming effect, improve blood circulation in the various organs. Considering the severity of the manifestations, the high risk of death, the use of strictly unconventional means impact , therefore, it is extremely undesirable to look for any means that can be recommended by ignorant people. Any use of a new medicine or folk remedy should be discussed with the attending physician.

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

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

Depending on the nature of the disease, it is divided into two clinical forms - acute and chronic. Chronic ischemic heart disease is one of the most important problems of humanity. The disease is characterized by a high mortality rate due to cardiac arrest. Every year, more than 70% of people around the world die from this disease. Elderly people are more susceptible to hibs, most of whom are men aged 50–60 years.

The heart muscle (myocardium), thanks to the blood flow, consumes a lot of oxygen. When the heart muscle is damaged, its blood supply is disrupted or stopped. The cause of this condition is cholesterol plaques that form on the walls of the coronary vessels of the myocardium. They interfere with the delivery of oxygen and other nutrients to the heart. As a result, a condition develops oxygen starvation– ischemia.

Symptoms of HIBS disease

Chronic ischemic heart disease is characterized by a gradual development, during which signs of the disease appear and disappear. If the disease is not treated at this stage, it will progress and can be fatal.

In chronic ischemia, the following symptoms are expressed:

• increased blood pressure;
• heaviness or paroxysmal pain behind the sternum, radiating to the left arm, shoulder, and sometimes to the shoulder blade, back, and abdominal area;
• pain that occurs during any activity and goes away at rest;
• interruptions in myocardial function (changes in heart rate);
• swelling of the lower extremities;
• shortness of breath, difficulty breathing;
• severe weakness with minor exertion;
• pronounced pallor of the skin;
• anxiety, panic states.

Due to stagnation of blood in the vessels, work deteriorates internal organs: stomach, liver and kidneys.

Diagnosis of the disease

For the diagnosis of chronic ischemic heart disease early stage There are a number of modern informative methods. With their help it is clarified clinical diagnosis and the method of subsequent treatment is determined.

First of all, the doctor conducts a detailed survey of the patient, auscultates, analyzes complaints, and finds out family history.

Next stage - lab tests to identify different inflammatory processes in the patient’s body and other disorders. For this purpose the following is carried out:

• biochemical and general analysis blood;
• lipidogram.

Instrumental research methods

The use of specific instrumental techniques in diagnosis gives a fairly accurate picture of the disease.

– a diagnostic method that records the electrical activity of the myocardium. It detects various changes in heart rhythm and is also able to detect its consequences. Various options coronary disease have been studied for a long time, and the method of electrocardiography can obtain sufficient information on ECG changes during the examination.

You can measure the size of the heart muscle, examine contractility hearts, cardiac cavities and valves, acoustic noise. The combination of ultrasound diagnostics with physical activity (stress echocardiography) makes it possible to register ischemic disorders in the myocardium.

Bicycle ergometry is a common functional test. With its help, changes in the activity of the heart are revealed that are invisible at rest, but only during physical activity - in particular, in the form of exercises on an exercise bike.

To record disturbances in myocardial activity, a special device is used - a Holter monitor. It is attached to the patient’s belt or shoulder, and the device takes readings for a full day. For a more accurate study, the patient should keep a diary of monitoring his well-being.

Such careful monitoring allows specialists to find out and study:

• under what conditions does a patient develop manifestations of chronic ischemic heart disease;
• the nature of disturbances in the functioning of the myocardium, the degree of their severity;
• study the frequency of heart rhythm interruptions;
• catch heart beats.

Transesophageal electrocardiography (TEE) is a very accurate research method using a sensor inserted into the esophagus, where it records myocardial performance without interference created by external manifestations of human activity.

The coronary angiography method is used in severe cases. Coronary angiography examines the vessels of the heart muscle, determines violations of their patency, the degree of stenosis, and the location of the affected arteries by administering a specific substance. This research method allows you to diagnose HIHD and distinguish it from any other similar disease. Coronary angiography helps in deciding the need for surgery on myocardial vessels.

Left ventriculography is performed at the same time as coronary angiography. This method is also used to clarify indications for surgery.

Radionuclide testing helps to conduct a more accurate diagnosis of the myocardium and its functional state, on the basis of which one can judge the effectiveness surgery for the patient.

To diagnose symptoms of complications of ischemic disease - myocardial aneurysm, some manifestations of heart failure, an x-ray examination is prescribed.

After spending full diagnostics disease, the doctor prescribes proper treatment for the patient.

Treatment methods for HIBS

Depending on the clinical forms of the disease, treatment of cardiac ischemia is carried out in the following main areas:

• therapy without the use of drugs;
• drug therapy;
• surgical intervention.

Non-drug therapy

Not drug therapy aimed at correcting the patient's lifestyle. Physical activity requires an increased supply of oxygen to the heart, but during illness the body cannot satisfy this need due to damaged cardiac arteries. Therefore, during the treatment process, the patient’s activity is minimized.

The patient is prescribed physical therapy and short walks - such loads help the heart adapt to the limited blood supply during the period of illness.

The healing process is influenced by the patient's diet. Limit the amount of salt in food and water consumption to reduce the load on the heart. To improve the condition of blood vessels and normalize weight in obesity, the patient is prescribed a low-fat diet, including fiber, fruits, vegetables and fish products. Excluded from the diet:

• animal fats;
• roast;
• smoked;
• baking;
• alcoholic drinks.

Drug therapy

In chronic forms of IHD, it follows the “A-B-C” formula and consists of antiplatelet agents, β-blockers and hypocholesterolemic drugs. Patients are also prescribed:

• diuretics;
• antiarrhythmic, antianginal drugs;
• nitrites;
• ACE inhibitors;
• calcium channel blockers;
• anticoagulants;
• statins;
• fibrates.

Medicines are prescribed to each patient individually. The age, features of the course of the disease and the absence of pathologies in the patient are taken into account. Self-medicating or taking medications without the advice of a medical specialist is life-threatening.

Surgical intervention

Surgery is necessary if drug therapy does not bring the desired result. Before prescribing it, the cardiac surgeon conducts a thorough diagnosis to determine:

• contractile function of the myocardium;
• condition of the coronary arteries;
• level and localization of narrowing of the coronary arteries;
• severity of the disease;
• resistance of the disease to drug therapy.

Surgical intervention is aimed at restoring the patency of clogged vessels and improving blood flow in them. The operation is prescribed in the following conditions:

• unstable angina resistant to drug therapy;
• narrowing of the trunk of the left coronary artery by 70%, damage to three coronary arteries;
• damaged coronary bed with artery narrowing by 75%;
• ischemic myocardial dysfunction;
• intolerance to minimal physical activity on the heart;

Basic surgical methods for chronic ischemic heart disease:

• coronary angioplasty;
• walling.

IN in some cases These operations are contraindicated in certain groups of patients:

• those suffering from concomitant serious diseases;
• in cases with constantly elevated blood pressure;
• having excess weight;
• with certain lesions in the myocardium.

Complications of chronic ischemic heart disease

Coronary heart disease provokes extremely Negative consequences for the entire human body if left untreated.

– the main manifestation of ischemic myocardial disease. The reasons for its occurrence are blood clots that block the passage in the arteries, which are formed when hyperaggregation (increased adhesiveness) of platelets occurs due to spasms in the vessels.

They are widely known and accessible, but the disease does not respond well to them. This disease can be caused not only by ischemic heart disease; there are many other causes of heart rhythm disturbances.

In chronic ischemic heart disease, these disorders arise precisely because of the presence of ischemic foci in the heart muscle.

Or, occurs under the influence of physical or emotional stress. It manifests itself as pain, which can be relieved by taking nitroglycerin. Sometimes they go away on their own if you lie quietly in a well-ventilated area.

When (and stress), pain occurs regardless of physical or emotional stress, most often at rest. In fact, this is an intermediate stage between chronic cardiac ischemia and heart attack. The occurrence of such attacks means that the disease is progressing and the heart is experiencing a lack of oxygen even at rest. If attacks of pain become more frequent and intense, this indicates possible development acute myocardial infarction.

Heart failure is also a complication of chronic ischemic heart disease. It is formed under the influence of various functional disorders in the functioning of the heart muscle.

A frequent complication of myocardial ischemia is formation. In CHF, the heart muscle contracts weakly and therefore pumps insufficient volume of blood necessary for normal operation internal organs. For this reason, various violations occur in them. Acquiring congestive heart failure sharply reduces the patient's chances of survival.

Complications of HIHD in the form of chronic heart failure are expressed by symptoms such as:

• swelling;
• dyspnea;
• inability to exercise;
• irreversible changes in internal organs.

Most often develops with various heart diseases. AHF syndrome affects the left ventricle of the myocardium; the patient develops signs of pulmonary edema in the form of shortness of breath and pink sputum during coughing. Acute heart failure often progresses to a heart attack or stroke.

It is also a complication of chronic ischemic heart disease. This is a fairly common pathology. The most common types of arrhythmia:

• extrasystoles;

Arrhythmia sometimes goes unnoticed and patients do not attach serious importance to it. This attitude is dangerous, since any form of arrhythmia can be fatal.

The chronic form of cardiac ischemia is a rather dangerous disease. Almost any of the listed complications of HIHD lead to the death of the patient without timely and correct treatment.

Acute form of ischemic disease

Acute coronary heart disease is another form of myocardial disease, expressed by such complications as:

• myocardial infarction;
• cardiogenic shock;
• sudden coronary death (primary cardiac arrest).

Myocardial infarction is a very common complication of acute cardiac ischemia. The reason for its occurrence is the blockage of one of the heart arteries by the resulting plaque. Infarction can be large-focal or small-focal.

Symptoms of a heart attack:

• Sharp pain on the left behind the sternum, radiating to the left side of the body (arm, shoulder blade, lower jaw). Occurs suddenly or grows rapidly in a short period of time. Within half an hour from the moment of the attack, in the absence of medical assistance, the pain intensifies.
• Severe shortness of breath. When trying to do deep breath pain in the chest increases, which prevents the patient from breathing normally. There is a noticeable lack of oxygen, and suffocation may occur.
• A sharp drop in blood pressure leading to loss of consciousness. The reasons are a spontaneous change in heart rate, a decrease in the contractile function of the heart.
• Taking nitroglycerin during a heart attack does not eliminate pain due to a serious violation of the viability of cardiomyocytes (myocardial cells responsible for the contractility of the heart).

Acute complications

Another severe manifestation of the acute form of coronary heart disease is cardiogenic shock. Its signs:

• rapid drop in blood pressure;
• unconscious state;
• extremely weak pulse;
• shallow breathing.

Lack of blood supply leads to serious complications in the work of internal organs:

• acute renal and liver failure develops;
• pulmonary edema;
• disruptions in the functioning of the central nervous system are observed.

In this condition, a person needs urgent medical attention to prevent death.

Sudden coronary death is also a complication of acute ischemic heart disease. Death can overtake a person in an instant or within six hours from the onset of the attack. The approach of the VKS can be determined by several signs:

• emerging and intensifying feeling of suffocation;
• strong pressure behind the sternum;
• heaviness in the shoulders;
• dilated pupils;
• loss of consciousness;
• respiratory arrest;
• cessation of cardiac activity.

Most often, it overtakes active men who do not complain about their health. The cause of VCS is a violation of the heart rhythm: the contraction of myocardial fibers occurs chaotically, out of order, the heart rate per minute is more than three hundred.

It is rarely possible to save a person in such a condition. Even with timely implementation of all possible resuscitation procedures, death occurs in four out of five cases.

If heart failure syndrome occurs against the background of acute myocardial ischemia, it manifests itself as cardiac asthma or pulmonary edema.

A person with any acute form ischemic disease requires emergency assistance. For resuscitation, the following means are used:

• painkillers;
• thrombolytics;
• plasma replacement drugs;
• carrying out defibrillation.

Measures to prevent VCS

People who die suddenly sometimes have no obvious signs of impending death. But you should know that it is extremely rare that a person dies instantly without any pathology in the cardiovascular system. This means that you can and should carefully focus on your unhealthy feelings. This primarily applies to those who have suffered a myocardial infarction.

In the process of studying cases of VS, it was found that almost half of the patients had obvious signs her approach a few hours before her death. This means that they had the opportunity to avoid tragedy with timely examination and treatment.

Another risk group is patients with myocardial ischemia who do not have pain or other symptoms of the disease or are extremely mild. For this reason, people don't pass necessary examination and do not engage in treatment. Death in this case occurs due to a serious heart rhythm disorder.

The third group of people at risk of VCS are patients in whom it is not possible to identify acute myocardial disorders in any way. Here we can only hope for emergency medical care, since it is not possible to predict sudden death in this case.

Death from coronary heart disease occurs quite often due to a lack of seriousness in treating the disease. To prevent VS, doctors are required to inform patients about the possible threatening consequences of their illness. Mainly signs sudden death appear quite often. It is important not to ignore them, so as not to become a victim of your own indifference to your health.

Measures to prevent relapse of the disease

To prevent relapse of the disease, after discharge from the hospital, the patient should follow all the recommendations of the attending physician and follow certain rules:

• do not stop taking medications prescribed by your doctor;
• do physical therapy;
• V stressful situations go to see a psychotherapist;
• undergo sanatorium-resort treatment;
• regularly monitor blood pressure;
• maintain normal weight;
• stick to a healthy diet;
• avoid states of prolonged stress (driving a car, long airplane flights, being in a poorly ventilated area);
• exercise only under the supervision of a physical therapy specialist.

Don't get carried away alternative medicine without doctor's advice. Folk remedies quite effective in treatment various diseases, but which of them and how to use should be prescribed by a specialist.

To prevent coronary artery disease, they are almost the same as recommendations for maintaining health after hospital treatment for CHD.