How is ischemia of the heart manifested? What is coronary heart disease and how is it treated? Consequences and complications of coronary artery disease
Cardiologist
Higher education:
Cardiologist
Kuban State Medical University (KubGMU, KubGMA, KubGMI)
Level of education - Specialist
Additional education:
"Cardiology", "Course on magnetic resonance imaging of the cardiovascular system"
Research Institute of Cardiology. A.L. Myasnikov
"Course on functional diagnostics"
NTSSSH them. A. N. Bakuleva
"Clinical Pharmacology Course"
Russian Medical Academy of Postgraduate Education
"Emergency Cardiology"
Cantonal Hospital of Geneva, Geneva (Switzerland)
"Course in Therapy"
Russian State Medical Institute of Roszdrav
Ischemic heart disease is an extremely common pathological condition that develops as a result of chronic coronary insufficiency and impaired saturation of myocardial tissues with nutrients. IHD is considered the most common cause of premature disability. In addition, this condition often leads to the death of people suffering from coronary artery disease. When coronary heart disease develops, what it is and the reasons for its appearance, it is very difficult for a person who does not have a medical education to understand. But at the same time, it is very important for the patient to fully understand the danger of ischemia and follow the doctor's recommendations.
Most often, such a violation is observed in men, which causes their premature death. In women, signs of coronary heart disease, as a rule, are clearly manifested at the age of over 50, since until this time the body is reliably protected by the hormonal background. If any abnormalities in the functioning of the cardiovascular system appear, you should not self-medicate, since only a timely visit to a doctor and an early start of therapy can avoid the most negative consequences.
Causes of coronary heart disease
For modern medicine, the etiology of this condition is no longer a mystery. Approximately in 70% of cases, ischemic changes in the tissues of the heart develop against the background of atherosclerosis of the coronary arteries. Even a slight narrowing of the lumen of the blood channels that feed the myocardium, due to the formation of a cholesterol plaque, can provoke the appearance of such a pathological condition. As a rule, with 75% coronary stenosis, patients develop severe angina pectoris. The etiology of CAD includes other endogenous and exogenous factors, including:
- sedentary lifestyle;
- obesity;
- irrational nutrition;
- psycho-emotional overstrain;
- a long course of taking hormonal contraceptives;
- smoking;
- alcohol abuse;
- hypertension;
- atrial fibrillation;
- elevated level blood cholesterol;
- violation of water and electrolyte balance;
- thyroid dysfunction;
- diabetes;
- cholelithiasis.
Among other things, there is a high risk of developing coronary artery disease in those who have a genetic predisposition. The chance of this pathological condition in the elderly increases significantly, which in most cases is associated with hormonal disruptions. As practice shows, a higher rate of increase in ischemic damage to myocardial tissues is observed in the presence of a combination of adverse factors. In some cases, the prerequisites for the appearance of this pathological condition are laid when intrauterine development. Especially dangerous are heart defects that have not been identified and treated.
Classification of coronary disease
Modern cardiology takes into account a lot of parameters that characterize the development of this condition. Depending on the characteristics of the existing manifestations, the following types of coronary heart disease are distinguished:
- sudden coronary death;
- angina pectoris;
- painless form of myocardial ischemia;
- heart attack;
- postinfarction cardiosclerosis;
- conduction and rhythm disturbances;
- heart failure.
Each of these forms has its own characteristics of development and course. For example, sudden coronary death, as a rule, is the result of an abrupt cessation of myocardial oxygen supply as a result of coronary artery thrombosis. In addition, a similar pathological condition, accompanied by sudden cardiac arrest, may develop due to electrical instability of the myocardium. In most cases, with such a rapid aggravation of the degree of tissue ischemia, the death of the patient is observed in a matter of minutes. Sometimes it can take up to 6 hours from the onset of an attack to death.
Myocardial infarction can be both large-focal and small-focal. In this case, acute ischemic heart disease is observed, which can manifest itself with characteristic symptoms. In the presence of this condition, some parts of the heart begin to suffer from a lack of oxygen, so myocardial cells die. Cor pulmonale may develop. With timely medical care, the chances of avoiding a fatal outcome are quite high.
After a heart attack and in the presence of chronic atherosclerosis, cardiac ischemia is observed first, which then leads to the replacement of dead myocytes with fibrous tissue. This process leads to the formation of heart failure. Painless ischemia of the posterior wall of the myocardium is characteristic of people suffering from diabetes, as well as those who have a high pain threshold. In this case, atrial fibrillation, that is, spontaneous atrial fibrillation, can cause the death of a person who previously complained of heart problems. Such a sharp deterioration in the condition is often the first symptom of coronary artery disease.
A common form of ischemic disease is angina pectoris. It can be stable, unstable and spontaneous. This form of coronary heart disease in most cases does not show severe symptoms for a long time. Usually this pathological condition ends with myocardial infarction. In some cases, atrial fibrillation or severe arrhythmia may occur.
It is worth noting: when coronary heart disease occurs, the clinic largely depends on its form of flow and the severity of damage to the heart tissues. In cardiology, the term acute coronary syndrome is now increasingly used, under which various types of this pathological condition are hidden, including:
- myocardial infarction;
- unstable angina;
- atrial fibrillation;
- and sudden coronary death resulting from tissue death.
Symptomatic manifestations of ischemic disease
Usually this pathological condition is characterized by an undulating course, characterized by periods of relapses and remissions. However, in about 1/3 of patients, developing cardiac ischemia, which often causes premature death, does not lead to any deterioration in well-being and the appearance of pain.
In most cases, the disease develops over decades without manifesting severe symptoms. However, after changes in the myocardium reach a critical point, they can be detected as common signs pathology, as well as specific symptoms characteristic of a separate form of IHD. The characteristic manifestations of ischemia of the heart include:
- chest pain radiating to the arms, lower jaw, or back;
- deterioration in physical or emotional overstrain;
- clouding of consciousness;
- fainting;
- general weakness;
- dyspnea;
- bouts of dizziness;
- excessive sweating;
- swelling of the lower extremities.
As a rule, all these symptoms of coronary heart disease do not appear simultaneously. In most patients, against the background of a decrease in the nutrition of brain tissues, various neurological disorders are observed, including an unreasonable feeling of anxiety, apathy, panic attacks, and a bad mood. The most acute ischemic heart disease manifests itself in the form of sudden coronary death. In this case, respiratory arrest is observed, and the pulse ceases to be detected. In addition, there is a loss of consciousness, the pupils dilate, heart sounds are not audible, the skin becomes pale gray.
In most cases of cardiac ischemia with such an acute onset, the death of the patient is observed within a few minutes, less often it can take from 2 to 6 hours. Only in rare cases, with timely medical care, doctors manage to save the life of the patient, although this does not guarantee the absence of the consequences of this condition. For example, a patient often has persistently increased pressure, arrhythmia and other abnormalities appear. Thus, it is very important to understand why ischemia is dangerous and to undergo scheduled examinations at regular intervals.
Complications of coronary heart disease
Violations of hemodynamics in the heart muscle and increasing ischemic tissue damage provoke numerous morphological changes that determine the form of the course and the prognosis of coronary artery disease. Due to the development of this condition, the appearance of insufficiency of the energy metabolism of myocardial cells is observed. In most patients, due to damage to the tissues of the heart, there is a violation of the contractile function of the left ventricle, which is transient. Due to such processes, a rapid decrease in the number of cardiomyocytes can be detected. They are replaced by connective tissue, which is not able to perform their function.
Among other things, there is a violation of diastolic and systolic function. Due to damage to the tissues of the heart, there is a disorder of conduction, excitability and contractility of the myocardium. All these changes, as a rule, are irreversible and lead to persistent heart failure. Among other things, against the background of IHD, acute conditions appear, including heart attacks and strokes.
Methods for diagnosing coronary heart disease
Since IHD is manifested by a wide variety of symptoms, it is necessary to entrust the definition of the problem to the doctor. If you suspect the presence of this pathological condition, you must definitely consult a cardiologist and undergo a comprehensive examination. First of all, the doctor needs the most complete history to find out the conditions under which certain symptoms appear, the duration of pain attacks and the nature of the symptoms present. In addition, an important diagnostic criterion is the evaluation of the effectiveness of the use of nitroglycerin preparations.
Next, auscultation is performed, which allows you to obtain certain data regarding the existing pathological changes, and make a preliminary diagnosis. To clarify it, electrocardiography and ECG are usually prescribed first of all. This is the main research method for coronary artery disease, which allows you to identify characteristic changes even in cases where there is no pronounced manifestation of the disease. In addition, laboratory blood tests are performed to determine the presence of enzymes and substances resulting from the destruction of cardiomyocytes. Among other things, a study of the level of cholesterol and glucose, ALT and AST is required. Deciphering the data received by the doctor allows him to determine how this condition will develop further.
An echocardiogram may be done to determine the size of the heart. This research method allows you to evaluate the contractile capabilities of the myocardium, determine the condition of the valves and cavities of the heart and identify acoustic noise. In controversial cases and if there are suspicions about the presence of other pathological conditions, stress echocardiography may be indicated, which allows to detect the presence of myocardial ischemia during dosed physical activity. Transesophageal electrocardiography is often performed to assess conduction. This research method is not used in all cases. During this diagnostic test, a special catheter is inserted into the esophagus, through which it is possible to register all indicators of the work of the heart without interference, which is usually created by the skin and fatty tissue. Given that such an examination for coronary heart disease is not very pleasant for the patient, it is far from always carried out.
Often, coronary angiography is prescribed to determine the patency of the vessels that feed the myocardium. Usually this study allows you to determine the degree of need for surgery on the coronary arteries. This diagnostic method is not 100% safe, since allergic reactions, including anaphylactic shock, are quite possible.
Comprehensive treatment of coronary heart disease
The approach to therapy largely depends on the existing symptomatic manifestations in IHD, as well as the general condition of the patient's body. Treatment of coronary heart disease can be carried out through conservative techniques and various types of surgical interventions. Methods of therapy are selected by the attending physician, depending on the severity of the existing symptomatic manifestations.
If this disease is detected at an early stage and is not accompanied by pronounced signs of hemodynamic disturbances, non-drug treatment will be sufficient. Usually the doctor recommends giving up all bad habits. Among other things, the patient needs to completely change his lifestyle. Feasible physical activity, long walks in the fresh air, as well as a sparing diet low in substances that contribute to the formation of atherosclerotic plaques, can eliminate areas of damage to the heart muscle and improve the overall condition of the cardiovascular system.
A necessary measure is to reduce the level of salt consumed. In the presence of excess weight, a special low-fat diet is prescribed. Patients are advised to reduce the daily dose of water consumed in order to reduce the risk of edema and other manifestations of this pathological condition. In such mild cases, when the patient does not have chest pain, and complaints are limited to periodic discomfort, spa treatment can help restore the functioning of the organ and prevent further development of damage to the heart wall. Often, patients themselves neglect the recommendations of doctors, considering them optional, which usually has extremely adverse consequences.
If the stage at which the development of coronary heart disease was detected is advanced, in addition to the methods of conservative therapy, targeted treatment with drugs is required. The scheme for taking such drugs is prescribed by the doctor individually, depending on the characteristics of the existing symptomatic manifestations. In most cases, beta-blockers, antiplatelet agents and hypocholesterolemic agents are prescribed. When the patient has no contraindications, antiarrhythmic drugs, diuretics, nitrates and other drugs may be additionally prescribed.
In the presence of a severe form of cardiac ischemia, when conservative therapy does not achieve a pronounced effect, the patient is assigned a consultation with a cardiac surgeon to determine whether surgery is required. Often, surgical therapy is used when there is a risk of developing a heart attack. Coronary artery bypass grafting is often performed to restore blood circulation to the affected tissue area. This surgical intervention involves the imposition of an autovenous anastomosis. This allows blood to bypass the affected areas of the blood vessels, which contributes to the nutrition of tissues damaged by ischemia. Such an intervention can be carried out both using an artificial education apparatus and on a working organ. In some cases, a minimally invasive operation called transmissible coronary angioplasty can be performed. This technique involves the introduction of a catheter with a balloon into the damaged areas of the arteries, which allows you to expand the narrowed blood vessels.
Currently, combined methods of treatment are actively used, including both the surgical removal of existing sections of blood vessels that prevent the nutrition of myocardial tissues, and conservative methods of exposure. In most cases, this therapy, combined with lifestyle changes, restores the health of the heart tissues. The prognosis for coronary artery disease depends on many factors, including the stage of neglect of the process, the complexity of therapy and the person's willingness to follow the doctor's recommendations.
Prevention of coronary disease
At present, the only way to prevent the formation of severe pathologies of the cardiovascular system is to maintain as much as possible healthy lifestyle life. It is very important to avoid bad habits from a young age, including smoking and drinking alcohol. The toxic substances contained in this tobacco smoke, and the breakdown products of alcohol, lead to damage to the tissues of the heart and the walls of blood vessels. In addition, it is very important to maintain a normal body weight. You should start to eat right, including a large number of vegetables and fruits in the diet.
Hypodynamia provokes ischemic changes, so it is necessary to perform physical exercises to create a sufficient load on the cardiovascular system. Among other things, people who are predisposed to the appearance of coronary heart disease should try to avoid serious emotional upheavals. Compliance with the regime of work and rest is a necessary measure to reduce the risk of developing this pathological condition.
In a disease such as coronary heart disease, symptoms can be detected at an early stage, seek medical help and start treatment in a timely manner. After all, the first step in the diagnosis of any disease is always the definition of characteristic signs, external manifestations.
The heart of a person, working without interruption, often fails. And the most common reason for this is coronary disease, or, as it is also called, hungry heart syndrome, when the heart muscle does not receive enough oxygen. IHD is the main cause of morbidity and mortality worldwide, despite the high achievements in modern medicine.
Risk factors and early signs of the disease
The first and main cause of coronary artery disease is growing, carrying an increase in blood pressure, an increase in blood viscosity and an acceleration of its coagulability.
If a person has bad habits, then they can also cause coronary disease, active smokers and people who abuse alcohol are at risk. Not proper nutrition when carbohydrates and animal fats predominate in the diet, it also contributes to the development of coronary artery disease.
A sedentary lifestyle, overweight, high blood cholesterol, diabetes, and genetic predisposition also contribute to the onset of the disease. It is necessary to take into account the fact that both the age of a person and his gender play a role in the development of coronary disease. For example, men over the age of 50 are three times more likely to have the condition than women. On the other hand, hormonal changes in women during menopause can lead to the development of coronary artery disease.
What should be of concern? The first signs of ischemia are purely subjective, such as the occurrence of painful sensations in the region of the heart. You should immediately pay attention to this, especially if this has not been noticed before. Or the nature and conditions of occurrence have already changed in previously experienced sensations.
Any retrosternal pain (paroxysmal or monotonous), regardless of the strength of the combat sensations and the age of the patient, any symptoms of coronary heart disease should be a reason to see a doctor.
Ischemic disease proceeds mainly in waves: the period of exacerbation is replaced by a period of calm, when there are no symptoms. IHD can develop for decades, changing forms, symptoms and clinical manifestations. According to statistics, about 30% of patients do not experience symptoms of coronary heart disease at all and do not know about their disease. This is painless myocardial ischemia. In other cases, the following signs of coronary heart disease may occur:
- chest pain;
- pain in the arm, leg, under the shoulder blade, under the rib, on one side of the neck, or under the jaw;
- nausea;
- dyspnea;
- sweating;
- palpitations and arrhythmias.
Symptoms of angina pectoris
With angina pectoris, which is the most common form of ischemia, a person feels paroxysmal severe pain. People call angina pectoris angina pectoris, which got its name because of the pressing feeling in the chest area. Usually the pain radiates to one part of the body, more often to the left. In some cases, a person feels aching pain in the arm, shoulder, neck, back. The intensity of pain sensations is different: from slight to very strong. An attack of angina pectoris is accompanied by mental manifestations: anxiety, fear of death, dreary mood, inexplicable apathy, lack of air. The patient's breathing and heart rate increase, he turns pale, the body temperature drops, the skin becomes moist. The duration of the attack lasts on average no more than 10 minutes. It can be quite easily stopped with nitroglycerin.
An attack can be provoked by stress (emotional and physical), heat, stuffiness, exposure to the cold, urban smog.
There are two options for the development of angina pectoris: stable and unstable. In the first case, pain occurs during exercise and disappears on its own at rest or after taking nitroglycerin. The second is more dangerous, because even at rest or with slight exertion, chest pains and shortness of breath appear, this lasts for quite a long time, for hours, and can lead to.
Other forms of ischemia
Symptoms of angina attacks and myocardial infarction at the initial stage are similar. However, later on it varies greatly. With myocardial infarction, intense retrosternal pain that does not subside for a long time is not stopped by nitroglycerin. Often there is an increase in body temperature, pressure, the patient may feel suffocation, arrhythmia. Mental overstrain, excessive fatigue or increased physical activity, as well as hypertensive crisis provoke myocardial infarction.
Postinfarction cardiosclerosis has signs of heart failure and arrhythmias.
Heart failure is manifested by shortness of breath, palpitations, increased fatigue and swelling. With arrhythmia, a person complains about the "wrong" beating of his heart. This is a manifestation of bradycardia (slow heartbeat), tachycardia (rapid heartbeat), or irregular heartbeat.
A few days before sudden coronary death, one of the forms of coronary artery disease, the patient has the following symptoms: unpleasant sensations, which are paroxysmal in nature, in the retrosternal region, psychoemotional disorders. Signs of sudden death are the absence of a pulse and heart sounds, respiratory arrest, dilated pupils.
A cardiologist can make a correct diagnosis. For this, the patient is sent for operational instrumental studies, a biochemical blood test is done. If there is a suspicion of damage to the coronary arteries, coronary angiography is done. The sooner treatment is started and the causes that contribute to the development of the disease are eliminated, the more chances a person has to lead a full life in the future.
Under the general name coronary heart disease (CHD, coronary disease) unite a group of diseases caused by oxygen starvation of tissues caused by insufficiency of coronary blood flow, absolute or relative. The root cause of myocardial blood supply disorders is atherosclerotic stenosis of the coronary arteries. Cardiac ischemia is considered as a cardiac form of arterial hypertension and atherosclerosis. Ischemic phenomena caused by the course of other diseases are not classified as manifestations of IHD.
Ischemic heart disease has many variants of the course and clinical manifestations, new data on the causes and mechanisms of the development of pathology appear every year. Therefore, there is no single classification of cardiac ischemia yet. In clinical practice, acute and chronic coronary artery disease are distinguished. Acute myocardial ischemia is divided into the following forms:
- Sudden coronary death;
- Painless myocardial ischemia:
- angina;
Chronic forms of coronary artery disease:
- Postinfarction cardiosclerosis;
- Atherosclerotic diffuse cardiosclerosis;
- Chronic aneurysm of the heart.
Sudden coronary death
In this form, the disease can be asymptomatic, the heart stops unexpectedly, in the absence of visible prerequisites for a fatal outcome. With immediate medical attention, successful resuscitation of the patient is possible. Many cases occur outside the hospital, mortality in this form of IHD approaches 100%.
Factors that increase the likelihood of sudden coronary death:
- Heart failure;
- Severe arterial hypertension;
- Strong psycho-emotional stress;
- Ischemia of the heart, aggravated by ventricular forms of arrhythmia;
- Postponed myocardial infarction;
- Chronic intoxication;
- Disorders of carbohydrate or fat metabolism.
Painless myocardial ischemia
The disease is asymptomatic for a long time and often leads to sudden death of the patient. In this case, ischemia leads to typical complications: arrhythmias and heart failure. Often, signs of painless ischemia are detected by chance, when contacted for other reasons. At risk are people with heavy physical labor, the elderly, suffering from diabetes. The painless form of coronary artery disease is more common in people who abuse alcohol.
Sometimes the disease is manifested by sensations of vague discomfort in the chest, accompanied by a decrease in blood pressure. There may be heartburn or shortness of breath, sometimes weakness in the left arm.
Holter monitoring and/or stress ECG is required to confirm the diagnosis. During an exercise-induced seizure, the ECG shows characteristics ischemia. Treatment of painless ischemia is carried out according to the scheme typical for all forms of coronary artery disease. The prognosis varies depending on the severity of the identified lesion.
angina pectoris
Has a paroxysmal course. Angina attacks develop when the myocardium requires more oxygen than it receives at the moment. The patient has a feeling of suffocation, discomfort, compression or pain in the heart, the heart rhythm changes. The nature and intensity of anginal pain in angina attacks vary greatly. The pain radiates along the left side of the chest, into the arm, neck, jaw, under the shoulder blade. Less often, irradiation occurs to the right side or the epigastric region. Signs of coronary heart disease in men in most cases manifest themselves in the form of classic angina attacks.
An attack can be triggered by:
- Unusual or excessive physical activity;
- Strong excitement, emotional stress;
- Binge eating;
- The transition from warm to cold.
Attacks have a clearly defined beginning and end, disappear spontaneously after the load is removed or are stopped by vasodilators (nitroglycerin or validol).
There are several forms of angina pectoris, in particular, stable and unstable. With a stable course, the onset of an attack is relatively predictable, the same loads are accompanied by stereotypical reactions. If within 15 minutes the pain does not go away, despite the elimination of the provoking factor and / or the intake of nitroglycerin, irreversible changes begin in the myocardium, a heart attack develops.
The weakening of the effectiveness of the usual drugs indicates a possible transition of angina into unstable or progressive. Unstable also includes angina, which arose for the first time. In this case, the prognosis is unclear, signs of ischemia may disappear completely, the disease may become stable or lead to myocardial infarction. The most dangerous is progressive angina, in which attacks become more frequent, longer and more painful. This condition often precedes myocardial infarction. Patients with any form of angina pectoris should be observed by a cardiologist for timely detection of changes in health status and prevention of complications.
Strong physical or emotional stress, tachycardia attacks or a prolonged angina attack can lead to myocardial infarction. The increased demand of the myocardium stimulates an increased flow of blood into the coronary bed and, at the same time, damage to atherosclerotic plaques is possible. The damaged plaque completely or partially blocks the lumen of the vessel, tissue necrosis develops in the affected area. The degree of myocardial damage depends on the location and degree of blockage of the coronary vessels. The defeat of the small arteries of the coronary bed leads to the development of small foci of necrosis, with complete blockage of the lumen of one of the coronary arteries, a macrofocal, transmural or extensive myocardial infarction develops.
A possible myocardial infarction is indicated by severe sudden pain behind the sternum, accompanied by a fear of death. The pain radiates throughout the chest, the direction and area of irradiation depend on the location and extent of myocardial damage. Among the atypical symptoms of a heart attack are abdominal pain, nausea, and vomiting. It is important to note that the signs of coronary disease in women and people with diabetes often differ from classic anginal pain. The clinical variant of the course may refer to one of the rare variants of the course, up to painless.
Suspicion of myocardial infarction is a direct indication for emergency hospitalization of the patient. Modern methods of treating coronary artery disease have significantly reduced the recovery time after a heart attack, but it is still impossible to completely restore myocardial function. In the postinfarction period, coronary heart disease becomes chronic. The patient is forced to take maintenance drugs for life and be observed by a doctor.
Chronic forms of coronary artery disease
Cardiosclerosis
Cardiosclerosis can be focal or diffuse.
The focal form is a connective tissue scar that replaces a necrotic area of the heart muscle after a myocardial infarction. diffuse cardiosclerosis develops as a result of the gradual replacement of cardiomyocytes with connective tissue elements. The connective tissue is not capable of contractions, due to the increased load on the unchanged areas of the myocardium, their hypertrophy occurs, accompanied by deformation of the valves. Focal cardiosclerosis is detected after the final scarring of the necrotic area of the heart muscle, i.e. 3-4 months after myocardial infarction. Hypertrophy of areas of the heart walls not affected by a heart attack occurs, dangerous forms of arrhythmia and chronic heart failure develop.
Diffuse cardiosclerosis develops slowly, years may pass from the onset of pathological changes to the first clinical manifestations. Contribute to the development of cardiosclerosis inflammatory diseases myocardial infarction, physical inactivity, chronic intoxication, overeating, unbalanced nutrition.
Cardiosclerosis refers to irreversible pathologies, maintenance therapy does not eliminate arrhythmia and manifestations of CHF, but only alleviates the patient's condition.
heart aneurysm
Cardiac aneurysm is another variant of post-infarction chronic course of coronary artery disease. It is a saccular protrusion of a thinned area of \u200b\u200bthe myocardium and belongs to pathologies that do not imply a favorable outcome without qualified help. Conservative methods of treating coronary heart disease with aneurysm are used to strengthen the myocardium and stabilize the patient's condition before surgery.
Causes of the disease
The main cause of most cases of coronary artery disease is atherosclerotic lesions of the arteries of the coronary bed. Atherosclerosis and arterial hypertension are the main background diseases for the development of coronary artery disease. Factors indirectly contributing to the development of this pathology include:
- Wrong nutrition. This category includes foods rich in fats and fast carbohydrates. Such food leads either to the direct formation of cholesterol plaques on the walls of blood vessels, or to profound metabolic disorders and obesity.
- Excess weight. In overweight people, the heart works in constant overload mode, obesity is one of the most common causes of many cardiopathologies. Therefore, all recommendations on how to treat cardiac ischemia necessarily contain a clause on the need to keep weight under control.
- Emotional overstrain. The release of adrenaline in stressful conditions prepares the body for the choice of “flight or fight”, the heart switches to a more intense mode of operation. Acute coronary heart disease often first manifests itself against the background of strong excitement. In a state of chronic stress, myocardial wear accelerates. In addition, the biochemistry of stress contributes to the formation of cholesterol deposits on the walls of blood vessels.
- chronic intoxication. The episodic use of alcohol, tobacco in any form or drugs leads to a short-term disruption of the heart and the cardiovascular system as a whole. with systematic use, the heart works in an abnormal mode almost constantly, which causes pathological changes in the vessels and myocardium.
- Endocrine diseases, in particular, diabetes mellitus, thyroid dysfunction, adrenal tumors.
- Insufficient or excessive physical activity.
Additional risk factors include older age, male gender, insufficiency of some trace elements.
Symptoms
The classic manifestation of cardiac ischemia is an attack of angina pectoris with characteristic retrosternal pain, known as anginal. The pain is described as burning, pressing, stabbing, varying in intensity from vague discomfort to unbearable. Anginal pain radiates along the left side of the chest (rarely - on the right), into the left arm, neck, jaw. With a massive heart attack, pain spreads throughout the chest. The attack has a clearly defined beginning and end, passes when the influence of the provoking factor is removed or after taking vasodilator drugs. Anginal pain may be accompanied by:
- Dyspnea. It manifests itself as a reaction to oxygen starvation during each attack. As the disease progresses, shortness of breath can disturb the patient even at rest.
- Dizziness, loss of consciousness.
- Increased heart rate.
- Increased sweating. Sweat is usually cold and clammy.
- Nausea, less often - vomiting, which does not bring relief.
In severe attacks of angina pectoris and a developing heart attack, an additional sign of ischemia is an unreasonable fear of death, anxiety, anxiety bordering on panic. It should be noted that types of ischemia with a non-standard course may be accompanied by symptoms resembling the clinical manifestations of neurological, gastroenterological and other pathologies.
Diagnostics
The initial stage of diagnosis is always the analysis of the medical history, the patient's life and family history to determine the hereditary predisposition to the development of cardiopathology. During a physical examination, the doctor determines the presence of murmurs in the heart and lungs, an increase in the size of the heart.
To assess the general condition of the body and identify possible metabolic disorders, the following is carried out:
- General urine and blood tests;
- Blood chemistry;
- Examination for the presence of cardiospecific enzymes;
- Coagulogram.
The most informative diagnostic methods are instrumental research methods, such as:
- ECG, stress ECG;
- 24-hour Holter monitoring;
- echocardiography;
- Coronary angiography;
- Multislice CT.
Diagnostic methods are selected individually, depending on the patient's condition, the proposed diagnosis, treatment tactics and the technical capabilities of the clinic.
Treatment
Treatment of coronary heart disease includes a whole range of activities. First of all, it is required to stabilize the patient's condition and prevent possible complications.
In the medical treatment of IHD, the following drugs are used:
- Anti-ischemic, in particular, calcium antagonists or beta-blockers;
- ACE inhibitors;
- Drugs that lower blood cholesterol levels;
- Antiplatelet agents, anticoagulants to improve blood flow.
Additionally, diuretics, antiarrhythmic drugs and vasodilators are prescribed. Some medications for coronary artery disease the patient will have to take for life.
With obviously ineffective conservative treatment, patients are shown surgical treatment of ischemia. To restore blood flow in the affected myocardium are performed.
Under IHD (in deciphering the definition - ischemic heart disease) a complex of diseases is grouped. They are characterized by unstable blood circulation in the arteries that supply the myocardium.
Ischemia - insufficient blood supply - is caused by narrowing of the coronary vessels. Pathogenesis is formed under the influence of external and internal factors.
IHD leads to death and disability of people of working age around the world. WHO experts have calculated that the disease is becoming the cause of the annual death of more than 7 million people. By 2020, mortality could double. It is most common among men aged 40-62.
The combination of the processes discussed below increases the risk of morbidity.
Main causative factors:
- Atherosclerosis. flowing in chronic form an ailment that affects the arteries that go to the heart muscle. The vascular walls thicken and lose their elasticity. Plaques formed by a mixture of fats and calcium narrow the lumen, the deterioration of the blood supply to the heart progresses.
- Spasm of the coronary vessels. The disease is caused or formed without it (under the influence of external negative factors, such as stress). The spasm changes the activity of the arteries.
- Hypertonic disease- the heart has to fight high pressure in the aorta, which disrupts its circulation and causes angina pectoris and heart attack.
- Thrombosis/thromboembolism. In the artery (coronary), as a result of the collapse of an atherosclerotic plaque, a thrombus is formed. There is a high risk of blockage of the vessel by a thrombus, which formed in another part of the circulatory system and got here with the bloodstream.
- or .
Atherosclerosis is the main cause of coronary artery disease.
The risk factors are considered to be:
- hereditary factor - the disease is transmitted from parents to children;
- steadily elevated "bad" cholesterol, causing the accumulation of HDL - high density lipoprotein;
- smoking;
- obesity of any degree, disorders of fat metabolism;
- arterial hypertension - a high level of pressure;
- diabetes (metabolic syndrome) - a disease caused by a violation of the production of the pancreatic hormone - insulin, which leads to malfunctions of carbohydrate metabolism;
- lifestyle deprived of physical activity;
- frequent psycho-emotional disorders, character and personality traits;
- adherence to an unhealthy fatty diet;
- age - risks increase after 40 years;
- gender - men suffer from coronary artery disease more often than women.
Classification: forms of coronary heart disease
IHD is divided into several forms. It is customary to distinguish between acute and chronic conditions.
Cardiologists manipulate such a thing as acute coronary syndrome. It combines some forms of coronary artery disease: myocardial infarction, angina pectoris, etc. Sometimes this includes sudden coronary death.
What is dangerous, complications, consequences
Ischemic heart disease indicates the presence of changes in the myocardium, which leads to the formation of progressive insufficiency. Contractility weakens, the heart does not provide the body with the required amount of blood. people with coronary artery disease get tired quickly and experience constant weakness . Lack of treatment increases the risk of death.
Clinic of the disease
Manifestations can emerge in a complex or separately, depending on the form of the disease. There is a clear relationship between development pain localized in the region of the heart, and physical activity. There is a stereotype of their occurrence - after rich food, under adverse weather conditions.
Description of pain complaints:
- character - pressing or squeezing, the patient feels a lack of air and a feeling of increasing heaviness in the chest;
- localization - in the precordial zone (along the left edge of the sternum);
- negative sensations can spread along the left shoulder, arm, shoulder blades or in both hands, in the left pre-scapular zone, in the cervical region, jaw;
- pain attacks last no more than ten minutes, after taking nitrates they subside within five minutes.
We talked in more detail about, including differences in signs in men and women and risk groups, in a separate article.
If the patient does not seek treatment and the disease proceeds for a long time, the picture is supplemented by the development of swelling in the legs. The patient suffers from severe shortness of breath, which forces him to take a sitting position.
A specialist who can help with the development of all the conditions considered is a cardiologist. Timely medical attention can save lives.
Diagnostic methods
Diagnosis of IHD is based on the following examinations:
To clarify the diagnosis and exclude the development of other diseases, a number of additional studies are being implemented.
According to the plan, the patient receives a complex of stress tests (physical, radioisotope, pharmacological), undergoes X-ray contrast examinations, computed tomography of the heart, electrophysiological examination, dopplerography.
How and what to treat
The tactics of complex therapy for coronary artery disease is developed based on the patient's condition and an accurate diagnosis.
Therapy without medication
Principles of IHD treatment:
- daily cardio training in dynamics (swimming, walking, gymnastics), the degree and duration of the load is determined by the cardiologist;
- emotional peace;
- the formation of a healthy diet (a ban on salty, fatty).
Pharmacological support
The following drugs may be included in the treatment plan:
- Calcium antagonists are effective in the presence of contraindications to beta-blockers and are used with low effectiveness of therapy with their participation.
- beta-blockers - relieve pain, improve rhythm, dilate blood vessels.
- nitrates - stop angina attacks.
- Antiplatelet agents– pharmacological preparations that reduce blood clotting.
- ACE inhibitors- drugs of complex action to reduce pressure.
- Hypocholesterolemic medicines (fibrators, statins) - eliminate bad cholesterol.
Anti-ischemic- reduce myocardial oxygen demand:
As additional support and according to indications, the therapy plan may include:
- diuretics- diuretics to relieve swelling in patients with coronary artery disease.
- antiarrhythmics- maintain a healthy rhythm.
Learn more about in a separate post.
Operations
Surgical regulation of myocardial blood supply. A new vascular bed is brought to the site of ischemia. The intervention is implemented in case of multiple vascular lesions, with low efficiency of pharmacotherapy and in a number of concomitant diseases.
Coronary angioplasty. In this surgical treatment of IHD, a special stent is introduced into the affected vessel, which keeps the lumen normal. The blood flow of the heart is restored.
Forecast and prevention
Cardiologists point out that IHD has a poor prognosis. If the patient complies with all prescriptions, the course of the disease becomes not so severe, but it does not disappear completely. Among preventive measures, maintaining a healthy lifestyle (proper nutrition, absence of bad habits, physical activity) is effective.
All persons who are predisposed to the development of the disease are recommended to visit a cardiologist regularly. This will help maintain a full quality of life and improve the prognosis.
A useful video about what kind of diagnosis it is - "coronary heart disease", all the details about the causes, symptoms and treatment of coronary artery disease are given:
What is coronary heart disease and how is it treated?
IHD is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of the fairer sex of a number of hormones that prevent the development of atherosclerosis of blood vessels. With the onset of menopause, there is a change hormonal background, so the possibility of developing coronary disease increases dramatically.
What it is?
Ischemic heart disease is a lack of blood supply to the myocardium (heart muscle).
The disease is very dangerous - for example, in acute development, coronary heart disease immediately leads to myocardial infarction, which causes death in middle-aged and elderly people.
Causes and risk factors
The vast majority (97-98%) of clinical cases of coronary artery disease is due to atherosclerosis of the coronary arteries of varying severity: from a slight narrowing of the lumen by an atherosclerotic plaque to complete vascular occlusion. At 75% coronary stenosis, the cells of the heart muscle react to a lack of oxygen, and patients develop angina pectoris.
Other causes of coronary artery disease are thromboembolism or spasm of the coronary arteries, usually developing against the background of an already existing atherosclerotic lesion. Cardiospasm exacerbates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.
Factors contributing to the occurrence of IHD include:
- Hyperlipidemia - contributes to the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of coronary artery disease are hyperlipidemia types IIa, IIb, III, IV, as well as a decrease in the content of alpha-lipoproteins.
- Arterial hypertension - increases the likelihood of developing coronary artery disease by 2-6 times. In patients with systolic blood pressure = 180 mm Hg. Art. and above, coronary heart disease occurs up to 8 times more often than in hypotensive patients and people with normal blood pressure.
- Smoking - according to various sources, cigarette smoking increases the incidence of coronary artery disease by 1.5-6 times. Mortality from coronary heart disease among men aged 35-64 who smoke 20-30 cigarettes daily is 2 times higher than among non-smokers of the same age group.
- Physical inactivity and obesity - physically inactive people are 3 times more likely to develop coronary artery disease than those who lead an active lifestyle. When physical inactivity is combined with overweight, this risk increases significantly.
- Diabetes mellitus, incl. latent form, increases the risk of coronary heart disease by 2-4 times.
Factors posing a threat to the development of coronary artery disease should also include aggravated heredity, male gender and advanced age of patients. With a combination of several predisposing factors, the degree of risk in the development of coronary heart disease increases significantly. The causes and rate of development of ischemia, its duration and severity, the initial state of the cardiovascular system of the individual determine the occurrence of one form or another of coronary heart disease.
Signs of coronary artery disease
The disease under consideration can proceed quite secretly, therefore it is recommended to pay attention to even minor changes in the work of the heart. Warning symptoms are:
- intermittent feeling of lack of air;
- feeling anxious for no apparent reason;
- general weakness;
- recurrent chest pain that may radiate to the arm, shoulder blade, or neck;
- feeling of tightness in the chest;
- burning sensation or heaviness in the chest;
- nausea and vomiting of unknown etiology.
Symptoms of coronary heart disease
IHD is the most extensive pathology of the heart and has many forms.
- Angina. The patient develops pain or discomfort behind the sternum, in the left half of the chest, heaviness and a feeling of pressure in the region of the heart - as if something heavy had been placed on the chest. In the old days they said that a person has "angina pectoris". The pain can be different in nature: pressing, squeezing, stabbing. It can give (radiate) to the left arm, under the left shoulder blade, lower jaw, stomach area and be accompanied by the appearance of severe weakness, cold sweat, a sense of fear of death. Sometimes, during exercise, it is not pain that occurs, but a feeling of lack of air, passing at rest. The duration of an angina attack is usually a few minutes. Since pain in the region of the heart often occurs when moving, a person is forced to stop. In this regard, angina pectoris is figuratively called "the disease of shop window observers" - after a few minutes of rest, the pain, as a rule, disappears.
- Myocardial infarction. Terrible and often disabling form of coronary artery disease. With myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the sternum, extending to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin, it does not completely disappear and only briefly decreases. There is a feeling of lack of air, cold sweat, severe weakness, lowering blood pressure, nausea, vomiting, a feeling of fear may appear. Reception of nitropreparations does not help or assist. The part of the heart muscle deprived of nutrition becomes dead, loses its strength, elasticity and ability to contract. And the healthy part of the heart continues to work with maximum tension and, contracting, can break the dead area. It is no coincidence that a heart attack is colloquially referred to as a heart rupture! It is only in this state that a person has to make even the slightest physical effort, as he is on the verge of death. Thus, the meaning of the treatment is that the place of the rupture is healed and the heart is able to work normally further. This is achieved both with the help of medications and with the help of specially selected physical exercises.
- Sudden cardiac or coronary death is the most severe of all forms of CAD. It is characterized by high mortality. Death occurs almost instantly or within the next 6 hours from the onset of an attack of severe chest pain, but usually within an hour. The causes of such a cardiac catastrophe are various kinds of arrhythmias, complete blockage of the coronary arteries, severe electrical instability of the myocardium. The causative factor is alcohol intake. As a rule, patients do not even know that they have coronary artery disease, but they have many risk factors.
- Heart failure. Heart failure is manifested by the inability of the heart to provide sufficient blood flow to the organs by reducing contractile activity. The basis of heart failure is a violation of the contractile function of the myocardium, both due to its death during a heart attack, and in violation of the rhythm and conduction of the heart. In any case, the heart contracts inadequately and its function is unsatisfactory. Heart failure is manifested by shortness of breath, weakness during exertion and at rest, swelling of the legs, enlargement of the liver and swelling of the jugular veins. The doctor may hear wheezing in the lungs.
- Cardiac arrhythmias and conduction disorders. Another form of IBS. It has a large number various kinds. They are based on a violation of the conduction of an impulse along the conduction system of the heart. It is manifested by sensations of interruptions in the work of the heart, a feeling of "fading", "gurgling" in the chest. Heart rhythm and conduction disturbances can occur under the influence of endocrine, metabolic disorders, intoxication and drug exposure. In some cases, arrhythmias can occur with structural changes in the conduction system of the heart and myocardial diseases.
Diagnostics
First of all, the diagnosis of coronary disease is carried out on the basis of the patient's feelings. Most often they complain of burning and pain in the chest, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, palpitations and rhythm disturbances. Be sure to perform electrocardiography if ischemia is suspected.
Echocardiography is a research method that allows you to assess the state of the myocardium, determine the contractile activity of the muscle and blood flow. Blood tests are performed. Biochemical changes can reveal coronary heart disease. Conducting functional tests involves physical activity on the body, for example, walking up the stairs or doing exercises on the simulator. Thus, it is possible to identify pathologies of the heart at an early stage.
How to treat ischemic heart disease?
First of all, the treatment of coronary heart disease depends on the clinical form. For example, although some drugs are used for angina and myocardial infarction general principles treatment, however, the tactics of treatment, the selection of an activity regimen and specific drugs can radically differ. However, there are some general areas that are important for all forms of coronary artery disease.
Medical treatment
There are a number of groups of drugs that can be indicated for use in one form or another of coronary artery disease. In the US, there is a formula for the treatment of coronary artery disease: "A-B-C". It involves the use of a triad of drugs, namely antiplatelet agents, β-blockers and hypocholesterolemic drugs.
- β-blockers. Due to the action on β-arenoreceptors, blockers reduce the heart rate and, as a result, myocardial oxygen consumption. Independent randomized trials confirm an increase in life expectancy when taking β-blockers and a decrease in the frequency of cardiovascular events, including repeated ones. At present, it is not advisable to use the drug atenolol, since, according to randomized trials, it does not improve the prognosis. β-blockers are contraindicated in concomitant pulmonary pathology, bronchial asthma, COPD. The following are the most popular β-blockers with proven prognostic properties in coronary artery disease.
- Antiplatelet agents. Antiplatelet agents prevent the aggregation of platelets and erythrocytes, reduce their ability to stick together and adhere to the vascular endothelium. Antiplatelet agents facilitate the deformation of erythrocytes when passing through the capillaries, improve blood flow.
- fibrates. They belong to a class of drugs that increase the anti-atherogenic fraction of lipoproteins - HDL, with a decrease in which increases mortality from coronary artery disease. They are used to treat dyslipidemia IIa, IIb, III, IV, V. They differ from statins in that they mainly reduce triglycerides and can increase the HDL fraction. Statins predominantly lower LDL and do not significantly affect VLDL and HDL. Therefore, for the most effective treatment of macrovascular complications, a combination of statins and fibrates is required.
- Statins. Cholesterol-lowering drugs are used to reduce the rate of development of existing atherosclerotic plaques and prevent the occurrence of new ones. These drugs have been proven to have a positive effect on life expectancy, and these drugs reduce the frequency and severity of cardiovascular events. The target cholesterol level in patients with coronary heart disease should be lower than in those without coronary artery disease, and equal to 4.5 mmol/l. The target level of LDL in patients with coronary artery disease is 2.5 mmol/l.
- Nitrates. The drugs in this group are derivatives of glycerol, triglycerides, diglycerides and monoglycerides. The mechanism of action is the influence of the nitro group (NO) on the contractile activity of vascular smooth muscles. Nitrates mainly act on the venous wall, reducing the preload on the myocardium (by expanding the vessels of the venous bed and depositing blood). side effect nitrates is to lower blood pressure and headaches. Nitrates are not recommended for use with blood pressure below 100/60 mm Hg. Art. In addition, it is now reliably known that nitrate intake does not improve the prognosis of patients with coronary artery disease, that is, it does not lead to an increase in survival, and is currently used as a drug to relieve symptoms of angina pectoris. Intravenous drip of nitroglycerin allows you to effectively deal with the symptoms of angina pectoris, mainly against the background of high blood pressure.
- lipid-lowering drugs. The effectiveness of complex therapy of patients suffering from coronary heart disease with the use of policosanol (20 mg per day) and aspirin (125 mg per day) has been proven. As a result of therapy, there was a persistent decrease in LDL levels, a decrease in blood pressure, and normalization of weight.
- Diuretics. Diuretics are designed to reduce the load on the myocardium by reducing the volume of circulating blood due to the accelerated removal of fluid from the body.
- Anticoagulants. Anticoagulants inhibit the appearance of fibrin threads, they prevent the formation of blood clots, help stop the growth of already existing blood clots, increase the effect of endogenous enzymes that destroy fibrin on blood clots.
- loop diuretics. Reduce the reabsorption of Na +, K +, Cl - in the thick ascending part of the loop of Henle, thereby reducing the reabsorption (reabsorption) of water. They have a fairly pronounced fast action, as a rule, they are used as emergency drugs (for forced diuresis).
- Antiarrhythmic drugs. Amiodarone belongs to III group antiarrhythmic drugs, has a complex antiarrhythmic effect. This drug acts on Na + and K + channels of cardiomyocytes, and also blocks α- and β-adrenergic receptors. Thus, amiodarone has antianginal and antiarrhythmic effects. According to randomized clinical trials, the drug increases the life expectancy of patients who regularly take it. When taking tablet forms of amiodarone, the clinical effect is observed after approximately 2-3 days. The maximum effect is achieved after 8-12 weeks. This is due to the long half-life of the drug (2-3 months). In this regard, this drug is used in the prevention of arrhythmias and is not a means of emergency care.
- Angiotensin-converting enzyme inhibitors. Acting on the angiotensin-converting enzyme (ACE), this group of drugs blocks the formation of angiotensin II from angiotensin I, thus preventing the implementation of the effects of angiotensin II, that is, leveling vasospasm. This ensures that the target blood pressure figures are maintained. The drugs of this group have a nephro- and cardioprotective effect.
Other treatments for coronary artery disease
Other non-drug treatments:
- Hirudotherapy. It is a method of treatment based on the use of antiplatelet properties of leech saliva. This method is an alternative and has not been clinically tested for compliance with the requirements of evidence-based medicine. Currently, it is used relatively rarely in Russia, it is not included in the standards of medical care for coronary artery disease, it is used, as a rule, at the request of patients. The potential positive effects of this method are the prevention of thrombosis. It should be noted that when treated according to approved standards, this task is performed using heparin prophylaxis.
- Stem cell treatment. When stem cells are introduced into the body, it is expected that the pluripotent stem cells that have entered the patient's body will differentiate into the missing cells of the myocardium or vascular adventitia. Stem cells actually have this ability, but they can turn into any other cells in the human body. Despite numerous statements by the supporters of this method of therapy, it is still far from practical application in medicine, and there are no clinical studies that meet the standards of evidence-based medicine, which would confirm the effectiveness of this technique. WHO notes this method as promising, but does not yet recommend it for use. practical application. In the vast majority of countries in the world, this technique is experimental, and is not included in the standards of medical care for patients with coronary artery disease.
- The method of shock wave therapy. The impact of shock waves of low power leads to myocardial revascularization. An extracorporeal source of a focused acoustic wave allows you to influence the heart remotely, causing "therapeutic angiogenesis" (vascular formation) in the area of myocardial ischemia. The impact of UVT has a double effect - short-term and long-term. First, the vessels dilate, and blood flow improves. But the most important thing begins later - new vessels appear in the affected area, which provide a long-term improvement. Low-intensity shock waves induce shear stress in the vascular wall. This stimulates the release of vascular growth factors, starting the process of growth of new vessels that feed the heart, improving myocardial microcirculation and reducing the effects of angina pectoris. The theoretical results of such treatment are a decrease in the functional class of angina pectoris, an increase in exercise tolerance, a decrease in the frequency of attacks and the need for drugs.
- quantum therapy. It is a therapy by exposure to laser radiation. The effectiveness of this method has not been proven, an independent clinical study has not been conducted. Equipment manufacturers claim that quantum therapy is effective for almost all patients. Drug manufacturers report on studies that prove the low effectiveness of quantum therapy. In 2008, this method is not included in the standards of medical care for coronary artery disease, it is carried out mainly at the expense of patients. It is impossible to assert the effectiveness of this method without an independent open randomized study.
Nutrition for IHD
The menu of a patient with diagnosed coronary heart disease should be based on the principle of rational nutrition, balanced consumption of foods with a low content of cholesterol, fat and salt.
It is very important to include the following products in the menu:
- red caviar, but not in large quantities - a maximum of 100 grams per week;
- seafood;
- any vegetable salads with vegetable oil;
- lean meats - turkey, veal, rabbit meat;
- skinny varieties of fish - pike perch, cod, perch;
- fermented milk products - kefir, sour cream, cottage cheese, fermented baked milk with a low percentage of fat content;
- any hard and soft cheeses, but only unsalted and mild;
- any fruits, berries and dishes from them;
- yolks chicken eggs- no more than 4 pieces per week;
- quail eggs - no more than 5 pieces per week;
- any cereals, except for semolina and rice.
It is necessary to exclude or significantly reduce the use of:
- meat and fish dishes, including broths and soups;
- rich and confectionery products;
- Sahara;
- semolina and rice dishes;
- animal by-products (brains, kidneys, etc.);
- spicy and salty snacks;
- chocolate
- cocoa;
- coffee.
Eating with diagnosed coronary heart disease should be fractional - 5-7 times a day, but in small portions. If there is excess weight, then you must definitely get rid of it - this is a heavy burden on the kidneys, liver and heart.
Alternative methods of treatment of coronary artery disease
For the treatment of the heart, traditional healers made up a lot of different recipes:
- 10 lemons and 5 heads of garlic are taken per liter of honey. Lemons and garlic are crushed and mixed with honey. The composition is kept for a week in a dark, cool place, after insisting, take four teaspoons once a day.
- Hawthorn and motherwort (1 tablespoon each) are placed in a thermos and poured with boiling water (250 ml). After a couple of hours, the product is filtered. How to treat ischemia of the heart? It is necessary half an hour before breakfast, lunch and dinner to drink 2 tbsp. spoons of infusion. It is advisable to additionally brew a decoction of wild rose.
- Mix 500 g of vodka and honey and heat until foam forms. Take a pinch of motherwort, marsh cudweed, valerian, knotweed, chamomile. Brew the grass, let it stand, strain and mix with honey and vodka. To accept in the morning and in the evening at first on a teaspoon, in a week - on the dining room. The course of treatment is a year.
- Mix a spoonful of grated horseradish and a spoonful of honey. Take one hour before meals and drink water. The course of treatment is 2 months.
Funds traditional medicine help if you follow two principles - regularity and strict adherence to the recipe.
Surgery
With certain parameters of coronary heart disease, there are indications for coronary bypass surgery - an operation in which the blood supply to the myocardium is improved by connecting the coronary vessels below the site of their lesion with external vessels. The best known is coronary artery bypass grafting (CABG), in which the aorta is connected to segments of the coronary arteries. For this, autografts (usually the great saphenous vein) are often used as shunts.
It is also possible to use balloon dilatation of blood vessels. In this operation, the manipulator is introduced into the coronary vessels through a puncture of the artery (usually the femoral or radial), and the vessel lumen is expanded by means of a balloon filled with a contrast agent, the operation is, in fact, coronary vessel bougienage. Currently, “pure” balloon angioplasty without subsequent stent implantation is practically not used, due to low efficiency in the long-term period. In case of incorrect movement of the medical device, a fatal outcome is possible.
Prevention and lifestyle
To prevent the development of the most severe forms of coronary heart disease, you need to follow only three rules:
- Leave your bad habits in the past. Smoking and drinking alcohol is like a blow that will definitely lead to a worsening of the condition. Even an absolutely healthy person does not get anything good from smoking and drinking alcohol, to say nothing of a sick heart.
- Move more. Nobody says that you need to set Olympic records, but give up the car, public transport and an elevator in favor of walking is necessary. You can’t immediately load your body with kilometers of roads traveled - let everything be within reason. In order for physical activity not to cause a deterioration in the condition (and this happens with ischemia!), be sure to get advice from your doctor about the correctness of the exercises.
- Take care of your nerves. Try to avoid stressful situations, learn to calmly respond to troubles, do not succumb to emotional outbursts. Yes, it's hard, but it is this tactic that can save a life. Talk to your doctor about taking sedatives or decoctions medicinal plants with a calming effect.
Ischemic heart disease is not only a recurring pain, a long-term violation of the coronary circulation leads to irreversible changes in the myocardium and internal organs, and sometimes to death. Treatment of the disease is long, sometimes involves lifelong medication. Therefore, heart disease is easier to prevent by introducing some restrictions into your life and optimizing your lifestyle.