IBS treatment. Signs and treatment of coronary artery disease. Murraya for arrhythmia, tingling and pain in the heart

Signs of coronary artery disease in men are often hidden: a person may not be aware that he is developing a pathology. You need to be attentive to your own health, pay attention to the signals of the body. Cardiovascular ailments are life-threatening. Ischemic heart disease is common among men: they suffer 2 times more often than women. IHD manifests itself in different ways: some people have anxiety symptoms, others are mild or absent altogether. If ischemic disease is asymptomatic, it means that it is progressing and will give complications in the future. If treatment is delayed, a lethal outcome is possible.

Pathology is divided into several types, depending on the symptoms. There are many factors that trigger coronary artery disease. IHD is subdivided into stable and unstable angina pectoris, primary and recurrent myocardial infarction, it can also manifest itself in the form of postinfarction cardiosclerosis and heart failure. Symptoms of coronary heart disease occur when the heart muscle (myocardium) is poorly oxygenated. Oxygen starvation of the myocardium occurs with atherosclerosis of the coronary arteries: in this case, the lumen of the veins narrows. It is associated with spasm of arteries not affected by atherosclerosis.

Also, the disease occurs due to impaired blood circulation in the myocardium. Another reason for oxygen starvation of the myocardium is a violation of blood clotting. Atherosclerosis has an undulating course, in this regard, the symptoms of ischemic disease are unstable: they can grow and subside. As we have already said, coronary heart disease can be asymptomatic, but alarming signals can appear during physical and psycho-emotional stress.

Risk factors and causes of pathology

Symptoms of coronary artery disease are more common in men, so gender is a predisposing factor. There are special hormones in the female body: they block atherosclerosis. IHD and atherosclerosis often develop in persons over 45 years of age. In the development of ischemia, heredity plays a role. It is worth noting that if a man smokes a lot, the functioning of organs is impaired. Because of bad habits, the heart muscle can be damaged.

Ischemia develops in men who smoke 15 cigarettes a day.

The next predisposing factor is high cholesterol. To avoid this problem, you need to regularly take tests, and, if necessary, start treatment. If the body has high cholesterol, serious illnesses can develop. In some men, ischemia occurs due to excess weight. A sedentary lifestyle also predisposes to illness. The factors for the development of ischemia can be isolated or superimposed on each other.

Manifestations of ischemia

Consider the signs of the disease. The prognosis of ischemic heart disease depends on its stage and the severity of symptoms. If ischemia is asymptomatic, the person is late seeking help. In this regard, the forecast is not as favorable as it could be. The latent form of ischemia entails the appearance of plaques on the vascular walls, but the lumen of the vessels will gradually narrow.

The form of ischemia is exertional angina: with such a pathology, pressure is felt in the chest, pain can radiate to the arm, radiate to the back, shoulders.

1. With this pathology, shortness of breath appears, in particular, with fast walking.
2. Some men have high blood pressure.
3. If the ischemia is latent, there is a high probability of plaque growth in the veins. In the future, the venous lumen will be closed by half. If ischemic disease is manifested by symptoms, a person feels pain in the heart, the functioning of the organ itself is disrupted. Gradually, the heart muscle becomes thinner. If we consider the narrowing of the arteries, it occurs abruptly, the lumen of the vessels closes completely.
4. With myocardial infarction, pain in the sternum is felt. The pressure rises, atrial fibrillation appears. At any stage of ischemia, a heart attack can occur. Even if the symptoms do not appear, the disease still progresses, and the symptoms intensify.
5. With ischemia of the heart, seizures appear. If we consider the attacks separately, then it is worth noting that they are more often manifested in men, since they have an increased pain threshold. Ischemia develops in those who work hard, overexert themselves physically. In order to avoid cardiovascular pathologies, including ischemia, you need to fully rest, allocate enough time for sleep.
6. The development of ischemia is promoted by smoking, alcohol abuse.

The clinical picture of the disease

An important sign of ischemia: chest discomfort. With such a pathology, a man quickly gets tired, as a rule, he cannot do hard work. Ischemia is characterized by increased blood pressure, palpitations, chest and heart pain. With such a disease, shortness of breath appears, jumps in blood pressure are observed (it is worth noting that the pressure can drop sharply). If a man has severe ischemia, he is often dizzy. Some patients have visual disturbances, heartburn, it hurts them to swallow. He is nauseous, and has a regular urge to vomit. If the pathology is asymptomatic, the person quickly gets tired. It is important to pay attention to shortness of breath. In most cases, a man cannot explain what caused it.

The peculiarity of ischemia is that it gives symptoms characteristic of indigestion. Potential discomfort during exercise. After its termination, the symptoms disappear. As the disease progresses, the symptoms become more pronounced. Cardiac obstruction is observed. It is important to detect ischemia at the asymptomatic stage, then it will be possible to start treatment in a timely manner and improve the prognosis. Latent ischemia is detected during a medical examination. If the pathology is diagnosed in a timely manner, it will be possible to avoid progression. Treatment in advanced stages is difficult. In this case, the doctor prescribes many medications and, if necessary, prescribes an operation.

Symptoms of progressive ischemia

The most common form of ischemia in men is angina pectoris. Previously, this ailment was called "angina pectoris". Symptoms of angina pectoris appear depending on what causes it. If a person has stable angina pectoris, he is disturbed by pressing pains in the heart. Unpleasant sensations can be given to the hand, left forearm.

Hypothermia can be the cause of angina pectoris. The disease develops as a result of intense physical activity. Unpleasant sensations with angina pectoris are given to the back, scapula. A man may experience shortness of breath, in which there will be a lack of air. The pain is localized on the left side of the sternum. With progressive angina pectoris, mental health is impaired: a person is often nervous, breaks down. This disease occurs in people who abuse alcohol and spend a lot of time in conditions of heavy physical activity. Hypertension is a predisposing factor. If we talk about shortness of breath, it can be accompanied by choking.

Against the background of angina pectoris, tachycardia often occurs. Unstable angina is dangerous because it can be asymptomatic. In this case, the patient will feel tired, unwell. It is worth noting that the progression of unstable angina is dangerous. It is necessary to learn to recognize the symptoms of ischemia and cardiac obstruction. It is important not to confuse cardiovascular diseases with pathologies associated with the gastrointestinal tract. Despite the forms and stages of ischemia, a person should feel the state of his body.

Stable angina

The stable form of the disease has the same symptomatology. If the symptoms increase rapidly, unstable angina pectoris develops - a life-threatening pathology. You need to start treatment as soon as possible. It is difficult to stop the attacks of pathology with medications. If the signs of the disease grow in waves and last 1-2 hours, blood pressure begins to jump, and the heart rate changes. In this case, one can judge the progression of unstable angina pectoris. A dangerous condition can turn into myocardial infarction. In the acute form of the ischemic process, blood circulation in the vessels is disturbed. Tissue hypoxia develops gradually.

Symptoms of ischemia may subside within 10 minutes, otherwise they last more than an hour. With this disease, blood clots of the heart vessels may appear. Hypoxic hunger leads to the death of vital cells. If a person feels severe pain in the sternum, you need to see a doctor. Common symptoms of ischemia are heart pain, dizziness, and nausea. Cramping abdominal pain may also be present. In some patients, respiratory functions are impaired, suffocation appears.

Symptoms of ischemia develop in different ways: they may appear once and in the future do not remind of themselves. The disease leads to increased sweating. On an EKG, a specialist can diagnose post-infarction changes: they are a sign that a healing scar is present in the heart. Angina pectoris requires immediate treatment. If shortness of breath and spasm is detected, resembling gastrointestinal disorders, you should consult a doctor. It is worth noting that against the background of such symptoms, pain in the limbs may be present.

About prevention

Ischemia can occur due to oxygen deprivation of the myocardium. The cause of the disease is coronary insufficiency: the disease develops due to the fact that the coronary vessels undergo deformation. For the prevention of ischemia, it is worth giving up smoking, drinking alcohol. It is important to control blood pressure, treat diseases associated with high cholesterol levels. Ischemic disease can occur against the background of diabetes mellitus, in this regard, it is necessary to competently treat this ailment. It is recommended to lead an active lifestyle.

Ischemic heart disease has taken a leading place in the list of the main problems of medicine in the XXI century. Pathology has become the leading cause of death among the population in many countries of the world, including developed Europe. A slight downward trend in the popularity of ischemic heart disease was observed in the United States at the end of the last century, but in general, the spread of the disease is observed among individuals different ages and gender.

Ischemic heart disease (CHD) - general concept, which combines acute and chronic pathological processes with a similar pathogenesis. The key importance in the formation of ischemic heart disease is assigned to the violation of the coronary circulation, as a result of which the metabolic exchange in the heart muscle changes. In other words, the myocardium requires more oxygen and nutrients than it receives with the available blood flow.

The course of ischemic heart disease is divided into acute, in the form of myocardial infarction, and chronic, when the patient is disturbed by periodic attacks of angina pectoris.

A special role in determining the type and nature of the course of ischemic heart disease is assigned to modern diagnostic methods. The patient's complaints, objective research, laboratory parameters and the results of instrumental methods are taken into account. All this makes it possible to make an accurate diagnosis and in the future to prescribe effective treatment... Otherwise, an unfavorable prognosis is given.

Video: Ischemic heart disease - causes, diagnosis, treatment

IHD classification

The disease is considered in various headings, classifiers and open databases. But the most commonly used International classification diseases of the 9th and 10th revision. According to ICD-10, IBS stands under I20-I25 font, and in ICD-9 - under 410-414.

According to material from Wikipedia, the term "ischemic heart disease" comes from lat. morbus ischaemicus cordis from Old Greek. ἴσχω - “I hold back, I hold back” and αἷμα - “blood”.

In the IHD group, the following clinical forms are distinguished:

1. Angina pectoris, which in turn is divided into unstable and stable, or exertional angina.
2. Myocardial infarction (primary).
3. Myocardial infarction (repeated).
4. Previously suffered myocardial infarction, expressed in postinfarction cardiosclerosis.
5. Sudden coronary death, which can result in successful resuscitation and death.
6. Heart failure.

When making a diagnosis, the clinical form of the disease must be indicated, for example: “IHD: stable angina pectoris II FC”. Some clinical forms are considered in separate classifications, according to which the required designation is necessarily indicated in the final diagnosis.

Braunwald classification of unstable angina

	A - there is an external cause that increases ischemia. Secondary unstable angina	B - no external cause of angina pectoris Primary unstable angina	C - occurs within 2 weeks after myocardial infarction.
I - new-onset, progressive angina pectoris, without rest angina	IA	IB	IC
II - resting angina pectoris within a month, but not in the next 48 hours	IIA	IIB	IIC
III - rest angina in the next	IIIA	IIIB	IIIC

A - there is an external cause that increases ischemia. Secondary unstable angina pectoris B - there is no external cause of angina pectoris. Primary unstable angina pectoris C - occurs within 2 weeks after myocardial infarction. Postinfarction angina pectoris.
I - new-onset, progressive angina, without rest angina IA IB IC
II - angina at rest within a month, but not in the next 48 hours IIA IIB IIC
III - rest angina in the next 48 hours IIIA IIIB IIIC

In addition to the above classification, in the group of unstable angina pectoris, early postinfarction SC, progressive and first-emerging, as well as Prinzmetal, or variant, are distinguished.

The classification of myocardial infarction is very voluminous and is considered according to the stages of development, the scale and anatomy of the lesion, the localization of the necrotic focus, and the course of the disease. In addition, there are more modern classifications developed on the basis of general considerations of the European, American and world cardiological communities.

Causes of ischemic heart disease

The development of the disease is directly related to the insufficient amount of oxygen that enters the heart muscle. Due to oxygen starvation, the myocardium begins to lose the ability to perform its functions, and the larger the affected area, the more pronounced the clinical picture of the disease. In some cases, blood flow in the coronary vessels stops so abruptly that an acute oxygen deficiency occurs with all the ensuing consequences.

Why does blood flow in the coronary vessels stop? This may involve one or more pathological mechanisms:

1. Atherosclerosis and thrombosis.
2. Atherosclerosis of the coronary vessels.
3. Spasm blood vessels.

There are also so-called extravascular etiological factors that contribute to the development of coronary artery disease. In some cases, risk factors play an important role, contributing to the manifestation clinical picture sluggish process.

Development factors

The key etiological factor in the development of ischemic heart disease is atherosclerosis. With this pathology, a narrowing of the lumen of the coronary arteries is observed, due to which the needs of the myocardium for blood supply do not coincide with the real capabilities of the bloodstream.

In atherosclerosis, specific plaques are formed, which in some cases overlap the vessel lumen by 80%. Then myocardial infarction develops, or, as a lighter option, angina pectoris.

The formation of an atherosclerotic plaque does not occur simultaneously. This can take months or even years. At the beginning, low-density lipoproteins are deposited on the walls of the coronary vessels, which begin to gradually affect the epithelium located nearby.

At the site of the lesion, platelets and other blood cells accumulate, due to which the lumen of the vessel is blocked by an increasingly protruding part of the plaque. If the pathological formation occupies up to 50% of the lumen of the vessel, then the clinic of the disease is sluggish or not at all pronounced. Otherwise, IHD develops in one clinical form or another.

Each coronary artery supplies blood to a specific area of ​​the myocardium. The further from its distal end is the region of the vessel affected by atherosclerosis, the more extensive ischemia or necrosis can be. If the mouth of the left coronary artery or the main trunk is involved in the pathological process, then the most severe ischemia of the heart muscle develops.

In addition to the developmental factors that lie inside the vessel, there are also extravasal causes. First of all, it is arterial hypertension, which most often provokes a spasm of the coronary vessels. The formation of ischemic heart disease is facilitated by frequent and severe tachycardia, as well as myocardial hypertrophy. In the last two cases, the oxygen demand of the heart muscle increases sharply and, if they are not satisfied, ischemia develops.

Risk factors

Predisposing circumstances are of great importance in the formation of coronary artery disease by modern scientists and leading clinicians. Against their background, a pathological condition with all the ensuing consequences can develop with the highest probability. Risk factors for coronary artery disease are in many ways similar to those in atherosclerosis, which is associated with the direct involvement of atherosclerotic plaque in partial or complete overlap of the vessel lumen.

Ischemic heart disease is associated with many risk factors (RF), so a kind of classification was required to streamline them for better perception.

1. Biological RF:

• Men are more likely to get sick than women.
• In older people, atherosclerosis is more often determined, which means that the likelihood of myocardial ischemia is higher.
• Hereditary predispositions that contribute to the development of diabetes mellitus, hypertension, dyslipidemia, and hence ischemic heart disease.

2. Anatomical, physiological and metabolic RF:

• Diabetes mellitus, mainly of the insulin-dependent type.
• Overweight and obesity.
• Arterial hypertension.
• An increased amount of lipids in the blood (hyperlipidemia) or a violation of the percentage of different types of lipids (dyslipidemia).

3. Behavioral RF:

• Improper nutrition.
• Having bad habits, especially smoking and drinking.
• Physical inactivity or excessive physical activity.

Muscular-elastic hyperplasia of the intima of the arteries, including coronary arteries, is another possible risk factor for the onset of coronary artery disease, but today it is under study. Changes in blood vessels by the type of hyperplasia are determined already among children, therefore, there are assumptions about the promotion of a similar RF to the development of coronary artery disease at an older age. In addition, the role of the CDH13 gene and its mutation in the formation of ischemia is being studied, but this assumption has not yet been fully proven.

IHD types

In patients with coronary artery disease, such clinical forms as myocardial infarction and angina pectoris are most often determined. Other varieties are less common, and they are more difficult to diagnose. Based on this, the clinic and course of myocardial infarction, angina pectoris, sudden coronary death and postinfarction cardiosclerosis will be considered.

Myocardial infarction

A similar diagnosis can be made when there is confirmed by clinical, laboratory and instrumental methods of myocardial necrosis. It can be small or large, but regardless of this, the patient should be sent to the intensive care unit as soon as possible.

• Large-focal myocardial infarction is characterized by pathognomonic changes that are determined on the ECG and during laboratory diagnostics... Especially important is the increase in blood serum lactate dehydrogenase, creatine kinase and a number of other proteins.

Such enzymes indicate the activity of the redox reaction taking place in the body. If normally these components are found only in cells, then when they are destroyed, proteins pass into the blood, therefore, by their number, one can indirectly judge the scale of necrosis.

• Small-focal myocardial infarction is often carried by patients "on their feet", since the clinic may not be pronounced, and changes in the ECG and in analyzes are also not as critical as in the case of large-focal myocardial infarction.

Angina pectoris

The disease has a characteristic clinical sign - chest pain, which can arise from any stress (physical or emotional). The pain can be felt as a burning sensation, heaviness or severe discomfort, while often spreading along the nerve fibers to other parts of the body (scapula, lower jaw, left hand.

The duration of an attack of angina pectoris is most often 1-10 minutes, much less often - up to half an hour.

Another characteristic of angina pectoris is pain relief with nitroglycerin, which practically does not help with myocardial infarction. Also, painful sensations can go away on their own if an emotional or physical irritant has been eliminated.

Characteristics of individual forms of exertional angina:

• For the first time, angina pectoris is quite variable in its course, therefore it is not immediately possible to make an accurate diagnosis. This is usually given up to three months. During this period, the patient's condition is monitored, the development of the disease, which can turn into a progressive or stable form.
• Stable angina pectoris - characterized by the occurrence pain with a certain pattern. The severity of stable angina pectoris is determined by functional classes, the corresponding FC must be indicated in the final diagnosis.
• Progressive angina pectoris - the intensity of pain attacks increases rather quickly, while the patient's resistance to physical and emotional stress decreases. This form of angina pectoris is poorly controlled by nitroglycerin and, in severe cases, the administration of narcotic analgesics may be required.

Angina pectoris occurs spontaneously and is not associated with any physical or emotional stimuli. This form of angina pectoris is often determined at rest, at night or in the morning. This pathology is defined as spontaneous angina pectoris.

Sudden coronary death

The second clinical designation is primary cardiac arrest. Its formation is associated with electrical instability of the myocardium. Such a diagnosis is made only if there is no confirmation of the definition of another specific form of ischemic heart disease. For example, the heart may stop due to myocardial infarction, and then death from myocardial infarction is indicated in the diagnosis.

A high risk of sudden coronary death is observed in those patients who have signs of narrowing on coronary angiography. a large number coronary vessels. Expansion of the left ventricle is considered an unfavorable condition. The likelihood of developing sudden coronary death after a heart attack significantly increases. Also, any myocardial ischemia, including without pronounced painful sensations, can be considered as a danger due to a sharp cessation of cardiac activity.

Postinfarction cardiosclerosis

In clinical practice, this disease is considered a complication of a previous myocardial infarction. To make such a diagnosis, take at least 2 months. In some cases, postinfarction cardiosclerosis is considered as an independent disease, but for this the presence of angina pectoris, heart failure, etc. should not be confirmed. In addition, signs of focal or diffuse cardiosclerosis should be present on the ECG.

In relatively mild cases, patients feel interruptions in the rhythm of the heart. The severe course of the disease is accompanied by shortness of breath, edema, heart pain, inability to endure the load, etc. The complexity of the pathology lies in the fact that there is a more or less noticeable progression of the process, which can only be temporarily maintained by a well-chosen therapy.

Video: Types and forms of coronary heart disease

Diagnostics

Patients with coronary heart disease are dealt with by a cardiologist, who, during the initial appointment, pays attention to clinical symptoms. With ischemic heart disease, the following characteristic complaints are distinguished:

• Chest pain, which in most cases is associated with emotional and physical stress.
• Improper work of the heart, which is accompanied by weakness and arrhythmia.
• Swelling in the legs, indicating heart failure.
• Feeling of shortness of breath.

The medical history is of considerable importance during the examination. This is when the doctor asks clarifying questions about the nature of the pain, its duration, etc. The amount of physical activity that the patient can withstand relatively calmly also matters. For a correct diagnosis, information should be obtained on the effectiveness of various pharmacological drugs, including nitroglycerin. Risk factors are additionally specified.

All patients with suspected coronary artery disease undergo electrocardiography... This indirect diagnostic method cannot accurately indicate how many cardiomyocytes have died, but with its help, such myocardial functions as automatism and conduction ability are determined.

The following signs of myocardial infarction are clearly visible on the ECG:

• The appearance of a pathological Q wave, which in some leads is combined with a negative T wave.
• In an acute heart attack, the ST segment rises high and manifests itself as a “sailboat” or “cat's back” ..
• With myocardial ischemia, depression of the ST segment is noted.
• If there is a scar in the myocardium on the ECG for two days or more, a negative T wave of weak expression and a pathological Q wave are determined.

An ECG is necessarily complemented by an ultrasound of the heart. With the help of this modern method studies can in real time assess the state of the heart muscle, how much the contractile ability of the heart has suffered from a heart attack, and whether there are any irregularities in the operation of the valve apparatus. If necessary, echocardiography is combined with Doppler ultrasound to assess the potential for blood flow.

Laboratory research are relevant for the diagnosis of myocardial infarction, since during the development of the pathological process, various biochemical parameters change. First of all, protein fractions are determined, which are normally found only inside the cell, and after the destruction of cardiomyocytes, they enter the blood. For example, in the first 8 hours after a heart attack, the level of creatine kinase rises, and on the first day - myoglobin. Up to 10 days, troponins are determined, the amount of lactate dehydrogenase and aminotransferase is also important.

When the structure of the myocardium is disturbed, a nonspecific reaction is observed in the form of an increase in the concentration of AST and ALT, the erythrocyte sedimentation rate (ESR) and the appearance of neutrophilic leukocytosis.

In patients with coronary artery disease, the lipid profile must be examined. For this, indicators such as total cholesterol, triglycerides, high and low density lipoproteins, apolipoproteins and the atherogenic index are determined.

Functional tests in combination with ECG registration, they allow assessing the capabilities of the heart muscle under the influence of physical exertion. For early diagnosis of the disease, this is extremely important, since not all patients at rest show clinical changes. A person can be stressed in various ways. The most common is an exercise bike. Also often used Treadmill, walking up the stairs, etc.

Additional instrumental studies:

• CT angiography (or angiography of the coronary vessels) is performed in order to obtain X-ray images with vessels contrasting with a special substance. The images obtained show blockage of arteries, their occlusion, and the degree of patency is also assessed.
• Holter monitoring - consists in recording an ECG for a day or two, for which the patient carries a special device with him all the time. The study allows you to determine not pronounced and hidden changes in cardiac activity, when a standard ECG cannot record changes due to the rare occurrence of an attack.
• Intraesophageal ECG - performed in cases where no changes are recorded on the standard ECG, but there is Clinical signs the presence of additional foci of arousal. For the study, an active electrode is inserted into the esophagus, which studies the electrical activity of the atria and the atrioventricular node.

CHD treatment

The treatment tactics are based on the classification of coronary heart disease, since each clinical form has its own specific therapy method. Despite this, there are general directions for the management of patients with coronary artery disease, which are as follows:

• Moderate physical stress is important in stabilizing patients with coronary artery disease, since the higher the physical activity, the greater the need for oxygen, and due to the impaired blood supply to the heart muscle, this only aggravates the course of the disease by provoking new attacks. If the patient is recovering, then gradually the physical activity increases.
• Diet food - should be as gentle as possible for the myocardium, therefore, the amount of salt and the volume of water are reduced. When determining atherosclerosis, products such as smoked meats, pickles, and animal fats are excluded from the diet. Also, high-calorie and fatty foods are not recommended for consumption. If the patient is obese, then they are especially careful about calculating calories, since energy expenditure should be related to the energy supplied from food.

Drug therapy

US cardiologists have proposed a treatment regimen under the abbreviation “A-B-C”. It is based on the use of drugs from three pharmacological groups: antiplatelet agents, beta-blockers, statins (considered cholesterol-lowering drugs). If a concomitant disease in the form of hypertension is determined, then drugs are added to treat this pathology.

• Antiplatelet agents - prevent the adhesion of red blood cells and platelets, as well as their further adhesion to the inner wall of the vessel. As a result, blood rheology improves, and the risk of blood clots is reduced. Of the drugs in this group, acecardol, aspirin are most often used, and clopidogrel is also prescribed.
• Beta-blockers - according to the mechanism of action, they stimulate adrenergic receptors in myocardial cells, which leads to a decrease in cardiac contractility. This, in turn, has a beneficial effect on the condition and performance of the organ. Drugs from this group are contraindicated in some lung diseases. Today, metoprolol, carvedilol, bisoprolol are most often used.
• Statins and fibrates are anti-cholesterol-lowering drugs, since they help slow the growth of existing atherosclerotic plaques and prevent the formation of new ones. To some extent, they can alleviate the severity of the course of an IHD attack. From this group, lovastatin, simvastatin, rosuvastatin, atorvastatin are most often prescribed. Fibrates, of which fenofibrate is the most famous, can increase the level of high-density lipoproteins, which have antiatherogenic significance.

Depending on the indications and concomitant pathology, the patient may be prescribed nitrates (expand the venous bed and thereby relieve the load from the heart), anticoagulants (do not allow blood clots to form), diuretics (loop or thiazide). Antiarrhythmics in the form of amiodarone may also be prescribed to treat and prevent rhythm disturbances.

Video: What drugs are used to treat coronary artery disease (CHD)?

Natural lipid-lowering agents

V complex therapy lipid-lowering agents such as aspirin and policosanol can be used. The latter name is a generic term for long-chain alcohols that are made from vegetable waxes. Today, they are often determined in various food additives.

In the process of application, policosanol does not have a negative effect on coagulation, while it contributes to an increase in the concentration of high density lipoproteins and a decrease in the fraction of “harmful” low density lipoproteins. Additionally, the substance has an antiplatelet effect.

Endovascular coronary angioplasty

It is an alternative to open surgery. Used when different forms Ischemic heart disease, even in the case of progression of the pathology and in order to prevent complications. This method combines coronary angioplasty and endovascular technologies, often represented by transluminal and translucent instrumentation.

For expansion of spasmodic vessels, due to which myocardial ischemia occurs, stenting is most often used, less often balloon angioplasty. All manipulations are performed under the control of coronary angiography and fluoroscopy. For the introduction of the required instrumentation, a large vessel is selected, mainly the femoral artery is preferred.

Video: Coronary Artery Stenting

Surgery

Under some circumstances, coronary artery disease does not respond to medication. Then the option of surgical intervention is considered, in particular, coronary artery bypass grafting. The purpose of this technique is to connect the coronary vessels to the aorta by means of an autograft (represented mainly by the great saphenous vein).

The main indications for surgical intervention in coronary artery disease:

• multiple lesions of the coronary vessels;
• determination of the stem stenosis in the area of ​​the left coronary vessel;
• determination of ostial stenosis in the area of ​​the right or left coronary vessel;
• stenosis of the anterior coronary vessel, which does not lend itself to angioplasty.

Surgical treatment cannot be carried out when the patient has multiple lesions of the peripheral coronary vessels located diffusely. Also, a contraindication is considered a low contractility of the myocardium, the presence of heart failure in the stage of decompensation and a post-infarction state, which is not more than 4 months.

Drug-free treatment

Conservative therapy, if necessary, can be supplemented with non-drug methods of exposure, which also help to improve the condition of the myocardium.

The main methods of non-drug treatment:

• Hirudotherapy - known as leech therapy. In the saliva of these creatures there are components with an antiplatelet effect, as a result of which the prevention of thrombus formation is carried out. It is difficult to judge the effectiveness of the method, since it does not have approval from the field of evidence-based medicine.
• Shock wave therapy of the heart - low power shock waves are used to implement the technique. Under their action, new vessels begin to form in the myocardium, which noticeably improves blood supply to the tissues. This is exactly what is needed to reduce the ischemic zone. The non-invasive method is most often used in the absence of efficacy from conservative and surgical treatment... According to some researchers, an improvement in myocardial perfusion is observed in almost 60% of patients.
• Enhanced external counterpulsation - by the method of conduction, it is similar to internal counterpulsation. Refers to non-surgical methods and is based on the work of special air cuffs that are worn on the legs. Due to the sharp pumping of air from the cuffs during the period of systole, the pressure in the vascular bed decreases, which means that the load of the heart is removed. At the same time, during the diastole period, the bloodstream, on the contrary, is intensely filled with blood, which makes it possible to improve the condition of the myocardium. After extensive research in the United States, the method was approved and is now widely used in clinics.

Forecast

The conclusion on the development of the disease largely depends on the severity of the clinic and the severity of structural changes in the myocardium. In most cases, a relatively poor prognosis is given, since it is impossible to reverse the disease regardless of the treatment. The only thing is that therapy helps to improve the patient's well-being, to make attacks less frequent, in some cases it is possible to significantly improve the quality of life. Without treatment, the disease progresses very quickly and is fatal.

Ischemic heart disease is an acute or chronic myocardial damage resulting from a decrease or cessation of arterial blood supply to the heart muscle, which is based on pathological processes in the coronary artery system.

IHD is a widespread disease. One of the leading causes of death, temporary and permanent disability worldwide. In the structure of mortality, cardiovascular diseases are in the first place, of which IHD accounts for about 40%.

Forms of ischemic disease

IHD classification (ICD-10; 1992)

1. Angina pectoris
   • - Stable exertional angina
   • - Unstable angina
2. Primary myocardial infarction
3. Recurrent myocardial infarction
4. Old (previous) myocardial infarction (postinfarction cardiosclerosis)
5. Sudden cardiac (arrhythmic) death
6. Heart failure (myocardial damage due to coronary artery disease)

The main reason for the violation of myocardial oxygen supply is a mismatch between coronary blood flow and the metabolic requirements of the heart muscle. This may be due to:

• - Atherosclerosis of the coronary arteries with a narrowing of their lumen by more than 70%.
• - Spasm of unchanged (little changed) coronary arteries.
• - Disorders of microcirculation in the myocardium.
• - An increase in the activity of the blood coagulation system (or a decrease in the activity of the anticoagulant system).

The main etiological factor in the development of coronary heart disease is atherosclerosis of the coronary arteries. Atherosclerosis develops consistently, in waves and steadily. As a result of the accumulation of cholesterol in the artery wall, an atherosclerotic plaque forms. Excess cholesterol leads to an increase in plaque size, and blood flow is obstructed. Later, under the influence of systemic adverse factors, the plaque transforms from stable to unstable (cracks and ruptures appear). The mechanism of activation of platelets and the formation of blood clots on the surface of an unstable plaque is triggered. Symptoms worsen with the growth of atherosclerotic plaque, gradually narrowing the lumen of the artery. A decrease in the area of ​​the lumen of the artery by more than 90-95% is critical, it causes a decrease in coronary blood flow and a deterioration in well-being even at rest.

Risk factors for coronary heart disease:

1. Gender (male)
2. Age> 40-50 years
3. Heredity
4. Smoking (10 or more cigarettes per day for the past 5 years)
5. Hyperlipidemia (total plasma cholesterol> 240 mg / dL; LDL cholesterol> 160 mg / dL)
6. Arterial hypertension
7. Diabetes
8. Obesity
9. Hypodynamia

Symptoms

The clinical picture of ischemic heart disease

The first description of angina pectoris was offered by the English physician William Geberden in 1772: “... pain in the chest that occurs while walking and forcing the patient to stop, especially while walking shortly after eating. It seems that this pain, if it continues or intensifies, can take a person's life; at the moment of stopping, all unpleasant sensations disappear. After the pain continues for several months, it stops immediately when it stops; and in the future it will continue to arise not only when a person walks, but also when he lies ... " Usually, symptoms of the disease first appear after 50 years. In the beginning, they occur only with physical exertion.

The classic manifestations of coronary heart disease are:

• - Pain behind the sternum, often radiating to the lower jaw, neck, left shoulder, forearm, hand, back.
• - The pain is pressing, constricting, burning, choking. The intensity is different.
• - Provoked by physical or emotional factors. At rest, they stop on their own.
• - Lasts from 30 seconds to 5-15 minutes.
• - Fast effect of nitroglycerin.

Coronary artery disease treatment

Treatment is aimed at restoring normal blood supply to the myocardium and improving the quality of life of patients. Unfortunately, purely therapeutic treatments are not always effective. There are many surgical methods of correction, such as coronary artery bypass grafting, transmyocardial laser myocardial revascularization and percutaneous coronary interventions (balloon angioplasty, coronary artery stenting).

Selective coronary angiography is considered the "gold standard" in the diagnosis of obstructive lesions of the coronary arteries of the heart. It is used in order to find out whether there is a significant narrowing of the vessel, which arteries and how many are affected, in what place and over what extent. Recently, multispiral computed tomography (MSCT) with intravenous bolus contrast has become more widespread. Unlike selective coronary angiography, which is essentially an X-ray surgical intervention 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 of a contrast agent. Another fundamental difference may be that selective coronary angiography shows the lumen of the vessel, and MSCT and the lumen of the vessel, and, in fact, the vessel wall in which the pathological process is localized.

Depending on the changes in the coronary vessels detected during coronary angiography, various methods of treatment can be offered:

Coronary artery bypass grafting is an operation worked out for many years in which the patient's own vessel is taken and sutured to the coronary artery. Thus, a path is created to bypass the affected area of ​​the artery. Blood in a normal volume enters the myocardium, which leads to the elimination of ischemia and the disappearance of angina attacks. CABG is the method of choice for a number of pathological conditions, such as diabetes mellitus, trunk damage, multivessel disease, etc. The operation can be performed with artificial circulation and cardioplegia, on a beating heart without artificial circulation, and on a beating heart with artificial circulation. Both veins and arteries of the patient can be used as shunts. The final decision on the choice of a particular type of operation depends on the specific situation and the equipment of the clinic.

Balloon angioplasty, which was popular in its time, has lost its relevance. The main problem is the short-term effect of the performed X-ray surgical intervention.

A more reliable and, at the same time, minimally invasive method of restoring and maintaining a normal vessel lumen is stenting. The method is essentially the same as balloon angioplasty, but a stent (a small transformable metal mesh frame) is mounted on the balloon. When inserted into the narrowing site, the balloon with the stent is inflated to the normal diameter of the vessel, the stent is pressed against the walls and retains its shape permanently, leaving the lumen open. After installing the stent, the patient is prescribed long-term antiplatelet therapy. During the first two years, control coronary angiography is performed annually.

In severe cases of obliterating atherosclerosis of the coronary arteries, when there are no conditions for CABG and X-ray surgical interventions, the patient may be offered transmyocardial laser myocardial revascularization. In this case, an improvement in myocardial circulation occurs due to the flow of blood directly from the cavity of the left ventricle. The surgeon places a laser on the affected area of ​​the myocardium, creating many channels with a diameter of less than 1 millimeter. The channels promote the growth of new blood vessels through which blood enters the ischemic myocardium, providing it with oxygen. This operation can be performed both independently and in combination with coronary artery bypass grafting.

After the elimination of aortocoronary stenosis, the quality of life is noticeably increased, working capacity is restored, the risk of myocardial infarction and sudden cardiac death is significantly reduced, and life expectancy is increased.

Currently, the diagnosis of ischemic heart disease is not a sentence, but a reason for active action on the choice of the optimal treatment tactics, which will save life for many years.

Ischemia, accompanied by a violation of the normal blood supply to the heart muscle, is today considered a very serious problem. It is this pathology that is the most common cause of sudden death. Moreover, as a rule, patients of working age suffer from the disease. Diagnosis of the heart is sometimes difficult. That is why it is worth familiarizing yourself with the basic information about this disease.

What are Symptoms, Diagnosis, Treatment, possible complications- these are the points that are worth studying in more detail. After all, the sooner a person notices the symptoms and see a doctor, the higher the likelihood of a favorable outcome.

What is the disease? general information

What is coronary artery disease? Symptoms, diagnosis, therapy - this is what interests many patients. But first, it's worth understanding the basic facts.

It is a pathology that is accompanied by functional and / or organic lesions of the heart muscle. Disorders of the myocardium with such an ailment are associated with insufficient blood supply to the organ or its complete cessation.

It should be noted that such a diagnosis of ischemic heart disease is most often given to men of active age (from 55 to 64 years old). Of course, the development of the disease in female patients or in younger guys is not excluded.

This pathology is associated with an imbalance between the myocardial demand for blood supply and the actual blood flow. If the heart muscle, for one reason or another, does not receive enough oxygen and nutrients, which is inevitably observed when the blood supply is disturbed, then pathological changes are possible, including sclerosis, dystrophy and necrosis.

According to statistics, in about 60-70% of cases, the acute form of coronary artery disease leads to sudden death of the patient. That is why the correct and, most importantly, modern diagnostics of coronary heart disease is so important.

The reasons for the development of the disease. Description of risk factors

How and why does coronary heart disease develop? Diagnostics, treatment, rehabilitation are important issues. But first, it's worth learning more about the causes of the development of pathology.

In about 97-98% of cases, this disease is associated with It is these vessels that provide nutrition to the myocardium. Accordingly, even a slight narrowing of the lumen negatively affects the condition of the muscles of the heart. Complete occlusion of the vessel leads to the development of acute ischemia, exertional angina, heart attack, and sometimes to sudden death. Other causes include thromboembolism (blockage of the vessel lumen by a blood clot).

Of course, the pathologies described above do not develop by themselves. Their appearance is caused by the impact of certain risk factors. Diagnosis of coronary heart disease should also be aimed at determining the causes of the development of the disease.

• First of all, it is worth mentioning hyperlipidemia... This condition is accompanied by a sharp increase in the level of lipids and lipoproteins in the blood. An abnormal increase in the amount of fat in the blood contributes to the development of atherosclerosis. It has been proven that the risk of developing ischemic heart disease in people with hyperlipidemia increases by 2-5 times.
• One of the main risk factors is arterial hypertension... According to research results, the risk of coronary artery disease in patients with high blood pressure (we are talking about chronic pathology, and not about random, temporary pressure surges) is 2-8 times higher.
• It is impossible not to mention about heredity... If among a person's relatives there are people suffering from coronary artery disease, then the likelihood of developing pathology is much greater.
• According to statistics, coronary heart disease (symptoms, diagnosis of the disease will be described below) is much more often diagnosed in older men. Therefore, the risk factors include floor and age the patient.
• Patients with diabetes mellitus(including in the latent form of the disease) are more likely to suffer from coronary artery disease.
• Risk factors include hypodynamia and obesity... It has been proven that cases of ischemic disease are three times more likely to be diagnosed in people with an inactive lifestyle. As you know, physical inactivity is often combined with obesity. Being overweight also increases the chances of developing the disease.
• Negative at work of cardio-vascular system smoking also affects, since nicotine causes spasm of small vessels, including coronary arteries.

Correctly performed diagnosis of coronary heart disease allows you to determine not only the stage and severity of the disease, but also its causes. Already based on these data, the doctor will be able to draw up effective scheme treatment. It should be understood that in most cases IHD develops under the influence of several factors at once.

Coronary artery disease: classification

Under the term ischemic heart disease, various pathological conditions associated with impaired blood supply to the myocardium are combined:

• Sudden coronary death. In this case, we are talking about primary cardiac arrest, which occurred as a result of electrical instability of the heart muscle. A person in a similar state can be successfully resuscitated (of course, if the patient receives timely assistance).
• Angina pectoris. In this case, the pathology can take different forms. There are stable, unstable, spontaneous and some other types of angina pectoris. Pathology is accompanied by soreness behind the sternum, which often extends to the left shoulder and scapula.
• Myocardial infarction. A condition that is accompanied by necrosis of a certain area of ​​the heart muscle, which occurs against the background of insufficient blood supply.
• Cardiosclerosis. In most cases, a similar pathology develops as a result of a previously suffered heart attack. Areas of the heart muscle that have undergone necrosis begin to change - muscle fibers are replaced by connective tissue, as a result of which the myocardium loses its contractile properties.
• Violations heart rate... These pathologies almost inevitably arise with vasoconstriction, because the blood begins to pass through "jerks".
• violation of myocardial trophism may be accompanied by a violation of the physiological activity and anatomical structure of the heart.

What symptoms are worth looking out for?

What is coronary artery disease? Diagnostics and treatment are, of course, important information. However, many patients are interested in symptomatology. What are the first signs of ischemic heart disease? What violations should you pay attention to?

• Heart problems are often accompanied by shortness of breath. At first, breathing problems appear during physical activity, for example, when walking fast, climbing stairs, etc. But as the disease progresses, shortness of breath appears even at rest.
• Arrhythmias are also included in the list of symptoms. Patients complain of palpitations and palpitations.
• IHD is often accompanied by changes in blood pressure - patients are diagnosed with hypo- or hypertension.
• Angina pectoris is accompanied by chest pain. Some patients note a feeling of squeezing and burning behind the breastbone. The pain can be given to the shoulder, neck, shoulder blade. Sometimes the pain syndrome is very intense and cannot be relieved by drugs.

Unfortunately, the diagnosis and treatment of chronic ischemic heart disease is often difficult, because in most cases people ignore mild shortness of breath and mild, recurring tingling sensations in the heart. The doctor is consulted already at the later stages of the development of the disease.

Tests for suspected ischemia

If a patient turns to a specialist with complaints of recurrent chest pain and shortness of breath, the doctor first of all collects a complete history. It is important to find out exactly when the symptoms occurred, whether close relatives have heart disease, whether the patient has bad habits, etc.

In the future, laboratory studies are carried out. For example, the level of troponins, myoglobin and aminotransferases in the blood is determined - it is these protein compounds that are released during the destruction of cardiomyocytes.

In addition, the patient's blood is checked for increased amounts of glucose, lipoproteins and cholesterol - this helps to diagnose concomitant diseases, and sometimes determine the cause of coronary artery disease (for example, atherosclerosis).

Instrumental diagnostics

Decisive in the diagnosis of coronary heart disease is such a simple and accessible study as an electrocardiogram. During the procedure, the doctor can check the electrical activity of the heart, detect certain violations of the myocardial rhythm.

Echocardiography is also required. This study allows you to determine the size of the heart, assess its contractile activity, visualize the state of the valves and myocardial cavities, and study specific acoustic noises. Additionally, stress echocardiography is performed, since the symptoms of ischemia can sometimes be detected only during physical activity.

Daily ECG monitoring is also informative. A special device is attached to the patient's shoulder, which measures cardiac activity throughout the day. In addition, the patient must write down his actions, changes in health in a special diary.

Transesophageal electrocardiography is often done. A special sensor is inserted into the patient's esophagus, which records the performance of the heart. Thus, the doctor can assess the conductivity and electrical excitability of the myocardium.

Quite often, doctors prescribe a positron emission tomography (PET) scan to patients. Diagnosis of coronary heart disease involves the study of myocardial blood flow. This technique also makes it possible to measure the rate of glucose utilization in a particular part of the myocardium, assess the activity of fatty acid metabolism, and measure the amount of oxygen consumed. PET diagnostics of coronary heart disease is performed if any segment of the heart muscle looks like a scar.

Mass useful information can be obtained after coronary angiography. A contrast agent is injected into the coronary vessels, and then its movements are monitored. With this procedure, a specialist can determine the presence of vascular patency disorders, as well as the degree of occlusion and stenosis.

Differential diagnosis of coronary heart disease is also important, because symptoms such as pain in the chest and shoulder, as well as shortness of breath, develop against the background of other diseases, including autonomic neurosis, pathologies of the peripheral nervous system, paraneoplastic syndrome, pleural lesions, etc.

How is coronary heart disease treated?

In fact, therapy for this disease must necessarily be comprehensive.

The remedies for the treatment of coronary heart disease are selected only by a doctor, since much here depends on the general condition of the patient, the presence of other diseases, etc. Sometimes experts prescribe beta-blockers, which help lower blood pressure. Preparations containing nitroglycerin help to dilate blood vessels, including coronary arteries. Correct intake of ACE inhibitors improves blood flow. With atherosclerosis, patients are prescribed medications that contain statin, as they help to adjust the level of cholesterol in the blood. Acetylsalicylic acid can be used to prevent thrombosis. Diuretics are sometimes used if edema is present.

It is also worth noting that the patient needs to make some lifestyle changes, in particular, eat right. Restriction of physical activity is also shown. If the severity of coronary artery disease is small, then patients are recommended to exercise feasible, for example, swimming, walking, cycling. Such activities help to strengthen the blood vessels. But if we are talking about a severe form of the disease and severe shortness of breath, then sports and physical activity will have to be abandoned for a while.

Proper nutrition for ischemia

Diet for coronary heart disease is extremely important. Doctors recommend that patients adhere to some rules:

• It is worth drastically limiting the amount table salt... Also, drinking too much fluids is not recommended. This will help relieve stress on the heart muscle.
• In order to slow down the development of atherosclerosis, it is important to limit the amount of foods containing animal fats and cholesterol. The list of prohibited include lard, fatty meats, butter... Doctors recommend giving up fried, too spicy and smoked foods. Foods rich in simple, easily digestible carbohydrates negatively affect health. That is why it is important to limit the amount of sweets, baked goods, chocolate and other sweets in the diet.
• If a patient develops coronary heart disease against a background of obesity, then it is important to start fighting overweight. Of course, you need to lose weight slowly and carefully, since too strict a diet is stressful for the body. Doctors recommend eating right, engaging in feasible physical labor (in the absence of contraindications), maintaining the correct energy balance (energy consumption should be more than the amount of calories consumed with food by about 300).

Surgical intervention

Unfortunately, in most cases, it is difficult to do without surgery, since drug treatment only helps to relieve symptoms and prevent the development of complications.

• Coronary artery bypass grafting is an operation in which the surgeon takes the patient's own vessel and sutures it to the coronary artery in such a way as to create a bypass path for blood flow. The myocardium again begins to receive oxygen and nutrients in sufficient quantities, which leads to the elimination of ischemia.
• At one time, such a technique as balloon angioplasty was widely used. During the procedure, a special balloon is inserted into the lumen of the vessel, with the help of which the surgeon literally inflates the artery, returning it to its normal size and normalizing the blood flow. Unfortunately, the procedure has only a temporary effect.
• Stenting is more effective. The sense of the operation is the same - to expand the vessel. But during the procedure, a metal mesh frame (stent) is inserted into the lumen of the affected artery - this way the vessel retains its natural shape all the time.

Possible complications

Unfortunately, many patients are faced with such a problem as coronary heart disease. Therapy helps to slow down the development of the disease and prevent complications. But with the wrong treatment or its absence, it is possible:

• insufficient energy metabolism of cardiomyocytes;
• various forms of impaired contractility of the left ventricle;
• the development of cardiosclerosis (the number of functioning cardiomyocytes is significantly reduced, they are replaced by connective tissue elements that are not able to contract);
• violations of diastolic and systolic myocardial function;
• violations of conduction, contractility and excitability of the myocardium, partial loss of autoregulation.

Preventive measures and forecasts

It should be said right away that the predictions for patients with a similar diagnosis depend on the general condition of the body, the degree of coronary artery disease, and the presence of other diseases. If we are talking about a mild degree of ischemia, then it responds quite well to therapy. The prognosis is not so favorable for patients who, along with ischemic heart disease, suffer from diabetes mellitus and arterial hypertension.

With regard to prevention, there are no specific remedies. People at risk should maintain a healthy lifestyle. It is important to eat right, limiting the amount of fatty, fried and overly spicy foods, foods rich in bad cholesterol.

Smoking negatively affects the state of blood vessels. It is important to keep fit by regularly exercising in the gym and walking in the fresh air. Patients with hypertension need to constantly monitor blood pressure indicators.

These simple rules will help not only prevent the development of ischemia, but also significantly improve the functioning of the whole body.

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

Forms of ischemic heart disease

The main forms of coronary heart disease are:

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

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

Causes of ischemic heart disease

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

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

Factors contributing to the development of ischemic heart disease

The risk of developing coronary heart disease is increased by:

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

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

Symptoms of ischemic heart disease

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

In some cases, you should immediately call an ambulance:

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

The main symptoms of coronary heart disease are as follows:

Nausea may be accompanied.

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

Dizziness

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

Methods for the diagnosis of coronary heart disease

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

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

Inactive diagnostic method

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

Methods for the treatment of coronary artery disease

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