What is ischemic cardiac arrest? Signs and treatment of coronary heart disease. Causes of cardiac ischemia

It is not for nothing that the heart is compared to the engine of the human body. And if this engine malfunctions, it can disable the entire body. The heart, as a mechanism, is characterized by high reliability, however, it can also be susceptible to various diseases. The most dangerous of them is ischemic disease. What are the manifestations of this disease, and how does it threaten a person?

Description of the disease

Everyone knows that the purpose of the heart muscle (myocardium) is to supply the body with oxygenated blood. However, the heart itself also needs blood circulation. The arteries that deliver oxygen to the heart are called coronary arteries. There are two such arteries in total; they arise from the aorta. Inside the heart they branch into many small ones.

However, the heart doesn’t just need oxygen, it needs a lot of oxygen, much more than other organs. This situation can be explained simply - after all, the heart works constantly and under enormous load. And if a person may not particularly feel the manifestations of a lack of oxygen in other organs, then a lack of oxygen in the heart muscle immediately leads to negative consequences.

Circulatory failure in the heart can occur for only one reason - if the coronary arteries allow little blood to pass through. This condition is called “coronary heart disease” (CHD).

In the vast majority of cases, narrowing of the blood vessels of the heart occurs due to the fact that they are clogged. Vasospasm, increased blood viscosity and the tendency to form blood clots also play a role. However, the main cause of coronary artery disease is atherosclerosis of the coronary vessels.

Atherosclerosis was previously considered a disease of older people. However, this is now far from the case. Now atherosclerosis of the heart vessels can also manifest itself in middle-aged people, mainly men. With this disease, the vessels become clogged with deposits of fatty acids, forming so-called atherosclerotic plaques. They are located on the walls of blood vessels and, narrowing their lumen, impede blood flow. If this situation occurs in the coronary arteries, the result is an insufficient supply of oxygen to the heart muscle. Heart disease can develop unnoticed over many years, without particularly manifesting itself, and without causing any particular concern to a person, unless in some cases. However, when the lumen of the most important arteries of the heart is blocked by 70%, the symptoms become obvious. And if this figure reaches 90%, then this situation begins to threaten life.

Types of coronary heart disease

In clinical practice, there are several types coronary disease hearts. In most cases, IHD manifests itself in the form of angina. Angina pectoris is the external manifestation of coronary heart disease, accompanied by severe chest pain. However, there is also a painless form of angina. With it, the only manifestation is rapid fatigue and shortness of breath even after minor physical exercise (walking/climbing several floors of stairs).

If attacks of pain occur during physical activity, then this indicates the development of angina pectoris. However, in some people suffering from coronary artery disease, chest pain appears spontaneously, without any connection with physical activity.

Also, the nature of changes in angina symptoms may indicate whether coronary artery disease is developing or not. If coronary artery disease does not progress, then this condition is called stable angina. A person with stable angina, subject to certain rules of behavior and appropriate supportive care, can live for several decades.

It’s a completely different matter when angina attacks become more and more severe over time, and the pain is caused by less and less physical activity. This type of angina is called unstable. This condition is a reason to sound the alarm, because unstable angina inevitably ends in myocardial infarction, or even death.

Vasospastic angina or Prinzmetal's angina are also classified into a certain group. This angina is caused by spasm of the coronary arteries of the heart. Spastic angina often occurs in patients suffering from atherosclerosis of the coronary vessels. However this kind angina pectoris may not be combined with this symptom.

Depending on the severity, angina is divided into functional classes.

Signs of coronary heart disease

Many people do not pay attention to the signs of coronary heart disease, although they are quite obvious. For example, this is fatigue, shortness of breath, after physical activity, pain and tingling in the heart area. Some patients believe that “this is how it should be, because I am no longer young.” However, this is a wrong point of view. Angina pectoris and shortness of breath during exercise are not the norm. This is evidence of serious heart disease and a reason to take immediate action and consult a doctor.

In addition, IHD can manifest itself with other unpleasant symptoms, such as arrhythmias, attacks of dizziness, nausea, and fatigue. Heartburn and abdominal cramps may occur.

Pain in coronary heart disease

The cause of pain is irritation of the nerve receptors of the heart by toxins formed in the heart muscle as a result of its hypoxia.

Pain in coronary heart disease is usually concentrated in the heart area. As mentioned above, pain in most cases occurs during physical activity or severe stress. If pain in the heart begins at rest, then with physical activity they usually intensify.

Pain is usually observed in the chest area. It can radiate to the left shoulder blade, shoulder, neck. The intensity of pain is individual for each patient. The duration of the attack is also individual and ranges from half a minute to 10 minutes. Taking nitroglycerin usually helps relieve pain.

Men often experience pain in the abdominal area, which is why angina pectoris can be mistaken for some kind of gastrointestinal disease. Also, pain due to angina pectoris most often occurs in the morning.

Causes of IHD

Coronary heart disease is often considered inevitable for people over a certain age. Indeed, the highest incidence of the disease is observed in people over 50 years of age. However, not all people develop IHD at the same time; some develop it earlier, some later, and some live to an old age without encountering this problem. Consequently, the development of IHD is influenced by many factors. And in fact, there is no single cause of coronary heart disease. Many circumstances have an impact:

bad habits (smoking, alcoholism);
overweight, obesity;
lack of physical activity;
wrong diet;
genetic predisposition;
some comorbidities, e.g. diabetes, hypertension.

All of these causes may play a role, but the immediate precursor to coronary atherosclerosis is an imbalance various types cholesterol in the blood and an extremely high concentration of so-called bad cholesterol (or low-density lipoprotein). When this concentration is above a certain limit, a person is highly likely to develop vascular atherosclerosis, and as a consequence, coronary heart disease. This is why it is important to monitor your blood cholesterol levels. This is especially true for people who are overweight, hypertensive, sedentary and have bad habits, as well as those who have many relatives who have died from cardiovascular diseases.

A definite negative factor is male gender. Statistics show that coronary heart disease develops much more often in men than in women. This is due to the fact that women produce female hormones in their bodies that protect blood vessels and prevent the deposition of cholesterol in them. However, after the onset female menopause the amount of estrogen produced by the female body decreases, and therefore the number of women suffering from coronary artery disease increases sharply, almost comparable to the number of men suffering from this disease.

Separately, we should dwell on such a prerequisite for the disease as an incorrect diet. As is known, the highest percentage of CHD incidence is in developed countries. Experts mainly attribute this fact to the fact that in European and American countries people consume more animal fats, as well as simple, easily digestible carbohydrates. And this, together with a sedentary lifestyle, leads to obesity and excess cholesterol in the blood.

It is not for nothing that doctors warn about foods containing bad cholesterol. These products include fatty meats, butter, cheese, eggs, caviar. The amount of these products in each person’s diet should be limited; they should not be consumed every day, or in small quantities. Although, on the other hand, only a small proportion of bad cholesterol enters the body from the outside, and the rest is produced in the liver. So the significance of this factor should not be exaggerated, not to mention the fact that cholesterol can be called harmful very conditionally, since it takes part in many metabolic processes.

Why is ischemic heart disease dangerous?

Many people suffering from IHD get used to their disease and do not perceive it as a threat. But this is a frivolous approach, because the disease is extremely dangerous and without proper treatment can lead to serious consequences.

The most insidious complication of coronary heart disease is a condition that doctors call sudden coronary death. To put it differently, this is cardiac arrest caused by electrical instability of the myocardium, which, in turn, develops against the background of coronary artery disease. Very often, sudden coronary death occurs in patients with a latent form of coronary artery disease. These patients often have no symptoms at all or are not taken seriously.

Another way to develop coronary heart disease is myocardial infarction. With this disease, the blood supply to a certain area of the heart deteriorates so much that necrosis occurs. The muscle tissue of the affected area of the heart dies and is replaced by scar tissue. This happens, of course, only if the heart attack does not lead to death.

A heart attack and ischemic heart disease itself can lead to another complication, namely chronic heart failure. This is the name for a condition in which the heart does not adequately perform its functions of pumping blood. And this, in turn, leads to diseases of other organs and disruptions in their functioning.

How does IHD manifest itself?

Above we indicated what symptoms accompany coronary heart disease. Here we will address the question of how it is possible to determine whether a person has atherosclerotic changes in blood vessels in the early stages, even at a time when obvious evidence of coronary artery disease is not always observed. In addition, such a sign as pain in the heart does not always indicate coronary heart disease. It is often caused by other reasons, for example, diseases associated with the nervous system, spine, and various infections.

An examination of a patient complaining of negative phenomena typical of coronary heart disease begins with listening to his heart sounds. Sometimes the disease is accompanied by noises typical of ischemic heart disease. However, this method often fails to detect any pathology.

The most common method of instrumental study of heart activity is a cardiogram. With its help, you can track the spread of nerve signals through the heart muscle and how its parts contract. Very often, the presence of coronary artery disease is reflected in the form of changes on the ECG. However, this does not always happen, especially in the first stages of the disease. Therefore, a cardiogram with a stress test is much more informative. It is carried out in such a way that while the cardiogram is being taken, the patient engages in some kind of physical exercise. In this state, all pathological abnormalities in the functioning of the heart muscle become visible. After all, during physical activity, the heart muscle begins to lack oxygen, and it begins to work intermittently.

Sometimes the method of 24-hour Holter monitoring is used. With it, the cardiogram is taken over a long period of time, usually within 24 hours. This allows you to notice individual deviations in the functioning of the heart, which may not be present on a regular cardiogram. Holter monitoring is carried out using a special portable cardiograph, which a person constantly carries in a special bag. In this case, the doctor attaches electrodes to the person’s chest, exactly the same as for a regular cardiogram.

Also very informative is the echocardiogram method - ultrasound of the heart muscle. Using an echocardiogram, the doctor can assess the performance of the heart muscle, the size of its sections, and blood flow parameters.

In addition, the following are informative when diagnosing IHD:

general analysis blood,
blood chemistry,
blood test for glucose,
measurement blood pressure,
selective coronography with contrast agent,
CT scan,
radiography.

Many of these methods make it possible to identify not only IHD itself, but also accompanying diseases that aggravate the course of the disease, such as diabetes mellitus, hypertension, blood and kidney diseases.

Treatment of coronary artery disease

Treatment of coronary artery disease is a long and complex process, in which sometimes the leading role is played not so much by the skill and knowledge of the attending physician, but by the desire of the patient himself to cope with the disease. At the same time, you must be prepared for the fact that a complete cure for ischemic heart disease is usually impossible, since the processes in the vessels of the heart are in most cases irreversible. However, modern methods make it possible to prolong the life of a person suffering from the disease for many decades and prevent his premature death. And not just to extend life, but to make it full, not much different from the life of healthy people.

Treatment in the first stage of the disease usually includes only conservative methods. They are divided into medicinal and non-medicinal. Currently in medicine, the most modern treatment regimen for the disease is called A-B-C. It includes three main components:

antiplatelet agents and anticoagulants,
beta blockers,
statins.

What are these classes of drugs for? Antiplatelet agents prevent platelet aggregation, thereby reducing the likelihood of intravascular thrombus formation. The most effective antiplatelet agent with the largest evidence base is acetylsalicylic acid. This is the same Aspirin that our grandparents used to treat colds and flu. However, regular Aspirin tablets taken regularly medicine not suitable in case of coronary heart disease. The thing is that taking acetylsalicylic acid carries the risk of stomach irritation, peptic ulcers and intragastric bleeding. Therefore, acetylsalicylic acid tablets for heart patients are usually coated with a special enteric coating. Or acetylsalicylic acid is mixed with other components that prevent its contact with the gastric mucosa, as, for example, in Cardiomagnyl.

Anticoagulants also prevent the formation of blood clots, but have a completely different mechanism of action than antiplatelet agents. The most common drug of this type is heparin.

Beta blockers prevent the action of adrenaline on special receptors located in the heart - adrenaline receptors of the beta type. As a result, the patient’s heart rate, the load on the heart muscle, and, as a result, its need for oxygen decreases. Examples of modern beta-blockers are metoprolol, propranolol. However, this type of medication is not always prescribed for ischemic heart disease, since it has a number of contraindications, for example, some types of arrhythmias, bradycardia, and hypotension.

The third class of first-line drugs for the treatment of coronary artery disease are drugs that lower bad cholesterol in the blood (statins). The most effective among statins is atorvastatin. Over six months of therapy with this drug, atherosclerotic plaques in patients are reduced by an average of 12%. However, your doctor may prescribe other types of statins - lovastatin, simvastatin, rosuvastatin.

Fibrate class drugs are also designed to reduce bad glycerol. However, the mechanism of their action is not direct, but indirect - thanks to them, the ability of high-density lipoproteins to process “bad” cholesterol increases. Both types of drugs, fibrates and statins, can be prescribed together.

Other drugs can also be used for ischemic heart disease:

antihypertensive drugs (if coronary heart disease is accompanied by hypertension),
diuretics (for poor kidney function),
hypoglycemic drugs (with concomitant diabetes mellitus),
metabolic agents (improving metabolic processes in the heart, for example, mildronate),
sedatives and tranquilizers (to reduce stress and relieve anxiety).

However, the most commonly used type of medication taken directly during an attack of angina is nitrates. They have a pronounced vasodilating effect, help relieve pain and prevent such a terrible consequence of coronary artery disease as myocardial infarction. The most famous drug of this type, used since the century before last, is nitroglycerin. However, it is worth remembering that nitroglycerin and other nitrates are symptomatic drugs for a single dose. Their constant use does not improve the prognosis for coronary heart disease.

The second group of non-drug methods to combat IHD is physical exercise. Of course, during the period of exacerbation of the disease, with unstable angina, any serious loads are prohibited, since they can be fatal. However, during the rehabilitation period, patients are prescribed therapeutic exercises and various physical exercises, as prescribed by the doctor. Such dosed exercise trains the heart, makes it more resistant to lack of oxygen, and also helps control body weight.

If the use of medications and other types of conservative therapy do not lead to improvement, then more radical methods are used, including surgical ones. The most modern method of treating coronary heart disease is balloon angioplasty, often combined with subsequent stenting. The essence of this method is that a miniature balloon is inserted into the lumen of a narrowed vessel, which is then inflated with air and then deflated. As a result, the lumen of the vessel expands significantly. However, after some time, the gap may narrow again. To prevent this from happening, the artery walls are strengthened from the inside using a special frame. This operation is called stenting.

However, in some cases, angioplasty is powerless to help the patient. Then the only option is coronary artery bypass surgery. The essence of the operation is to bypass the affected area of the vessel and connect two sections of the artery, in which atherosclerosis is not observed. For this purpose, a small piece of vein is taken from the patient from another part of the body and transplanted in place of the damaged section of the artery. Thanks to this operation, blood is able to reach the necessary areas of the heart muscle.

Prevention

It is well known that treatment is always more difficult than avoiding illness. This is especially true for such a serious and sometimes incurable disease as ischemic heart disease. Millions of people around the world and in our country suffer from this heart disease. But in most cases, the onset of the disease is not due to an unfavorable combination of circumstances, hereditary or external factors, but to the person himself, his incorrect lifestyle and behavior.

Let us recall once again the factors that often lead to early incidence of coronary artery disease:

sedentary lifestyle;
a diet containing large amounts of bad cholesterol and simple carbohydrates;
constant stress and fatigue;
uncontrolled hypertension and;
alcoholism;
smoking.

Changing something on this list, making sure that this problem goes away from our lives and we do not have to be treated for IHD, is within the power of most of us.

Under the general name coronary heart disease (CHD, coronary disease) is 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 events caused by other diseases are not classified as manifestations of ischemic heart disease.

Coronary heart disease has many variants of its course and clinical manifestations; new data about the causes and mechanisms of development of the pathology appear every year. Therefore, there is no unified classification of cardiac ischemia yet. In clinical practice, acute and chronic ischemic heart disease is distinguished. Acute myocardial ischemia is divided into the following forms:

Sudden coronary death;
Silent myocardial ischemia:
Angina pectoris;

Chronic forms of IHD:

Post-infarction cardiosclerosis;
Atherosclerotic diffuse cardiosclerosis;
Chronic cardiac aneurysm.

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 care 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;
Cardiac ischemia, aggravated by ventricular forms of arrhythmia;
Previous myocardial infarction;
Chronic intoxication;
Disorders of carbohydrate or fat metabolism.

Silent 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: arrhythmia and heart failure. Often, signs of silent ischemia are detected accidentally, when visiting for other reasons. Those at risk include people with heavy physical labor, the elderly, and those with diabetes. The painless form of IHD is more common in people who abuse alcohol.

Sometimes the disease manifests itself as a feeling of vague discomfort in the chest, accompanied by a decrease in blood pressure. Heartburn or shortness of breath are possible, and sometimes weakness in the left arm.

Holter monitoring and/or stress ECG are required to confirm the diagnosis. During an exercise-induced attack, the ECG shows characteristic signs of ischemia. Treatment of silent ischemia is carried out according to a scheme typical for all forms of coronary artery disease. The prognosis varies depending on the severity of the detected lesion.

Angina pectoris

Has a paroxysmal course. Angina attacks develop in cases where the myocardium requires more oxygen than it currently receives. The patient experiences a feeling of suffocation, discomfort, pressure or pain in the heart, and the heart rhythm changes. The nature and intensity of anginal pain during anginal attacks varies greatly. The pain radiates down the left side of the chest, into the arm, neck, jaw, and under the shoulder blade. Radiation to the right side or epigastric region occurs less frequently. 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;
Transition from heat to cold.

The attacks have a clearly defined beginning and end, pass spontaneously after removing the load or are stopped with vasodilators (nitroglycerin or validol).

There are several forms of angina, in particular, stable and unstable. With a stable course, the onset of an attack is relatively predictable; equal loads are accompanied by stereotypical reactions. If the pain does not go away within 15 minutes, despite eliminating the provoking factor and/or taking nitroglycerin, irreversible changes begin in the myocardium and a heart attack develops.

A weakening of the effectiveness of conventional medications indicates a possible transition of angina to unstable or progressive. Angina that occurs for the first time is also classified as unstable. 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 should be monitored by a cardiologist to promptly identify changes in health status and prevent complications.

Severe physical or emotional stress, attacks of tachycardia or prolonged angina pectoris attack can lead to myocardial infarction. The increased demand of the myocardium stimulates increased blood flow 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, and tissue necrosis develops in the affected area. The degree of myocardial damage depends on the location and degree of blockage of the coronary vessels. Damage to small arteries of the coronary bed leads to the development of small foci of necrosis; when the lumen of one of the coronary arteries is completely blocked, a large-focal, transmural or extensive myocardial infarction develops.

A possible myocardial infarction is indicated by severe sudden pain in the chest, 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. Atypical symptoms of a heart attack include abdominal pain, nausea, and vomiting. It is important to note that the signs of coronary artery 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, even painless.

Suspicion of myocardial infarction is a direct indication for emergency hospitalization of the patient. Modern methods of treating coronary artery disease have significantly shortened the recovery time after a heart attack, but it is still impossible to completely restore myocardial function. In the post-infarction period, coronary heart disease becomes chronic. The patient is forced to take maintenance medications for life and be monitored by a doctor.

Chronic forms of IHD

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 due to the gradual replacement of cardiomyocytes with connective tissue elements. The connective tissue is not capable of contraction; 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 the infarction occurs, and 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. Inflammatory diseases of the myocardium, physical inactivity, chronic intoxication, overeating, and unbalanced nutrition contribute to the development of cardiosclerosis.

Cardiosclerosis is an irreversible pathology; 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 the post-infarction chronic course of IHD. It is a sac-like protrusion of a thinned area of the myocardium and refers to pathologies that do not imply a favorable outcome without qualified help. Conservative methods of treating coronary heart disease with an 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 damage to the coronary arteries. Atherosclerosis and arterial hypertension are the main underlying diseases for the development of IHD. Factors that indirectly contribute to the development of this pathology include:

Poor 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 under constant overload; obesity is one of the most common causes of many cardiac pathologies. Therefore, all recommendations on how to treat cardiac ischemia must include a point about the need to keep weight under control.
Emotional stress. The release of adrenaline in stressful conditions prepares the body to choose “flight or fight”, the heart switches to a more intense mode of operation. Acute coronary heart disease often first manifests itself precisely against the background of severe anxiety. 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. Occasional consumption of alcohol, tobacco in any form or narcotic substances leads to short-term disruption of the heart and cardiovascular system as a whole. with systematic use, the heart works in an abnormal mode almost constantly, which becomes the cause of pathological changes in the vessels and myocardium.
Endocrine diseases, in particular diabetes mellitus, dysfunction thyroid gland, adrenal tumors.
Insufficient or excessive physical activity.

Additional risk factors include old age, male gender, and deficiency of certain microelements.

Symptoms

The classic manifestation of cardiac ischemia is an attack of angina pectoris with characteristic chest pain, known as anginal pain. The pain is described as burning, pressing, stabbing, and the intensity varies from vague discomfort to unbearable. Anginal pain radiates along the left side of the chest (rarely on the right), in left hand, in the neck, jaw. With a large heart attack, pain spreads throughout the chest. The attack has a clearly defined beginning and end and goes away when the influence of the provoking factor is removed or after taking vasodilator drugs. Anginal pain may be accompanied by:

Dyspnea. Manifests itself as a reaction to oxygen deprivation during each attack. As the disease progresses, shortness of breath may bother the patient even at rest.
Dizziness, loss of consciousness.
Increased heart rate.
Increased sweating. The sweat is usually cold and sticky.
Nausea, less often – vomiting, which does not bring relief.

In severe attacks of angina and developing heart attack, an additional sign of ischemia is an unreasonable fear of death, restlessness, anxiety, bordering on panic. It should be noted that types of ischemia with a non-standard course may be accompanied by symptoms reminiscent of clinical manifestations of neurological, gastroenterological and other pathologies.

Diagnostics

The initial stage of diagnosis is always an analysis of the medical history, the patient’s life and family history to determine hereditary predisposition to the development of cardiac pathology. During a physical examination, the doctor determines the presence of murmurs in the heart and lungs, and an increase in the size of the heart.

For rate general condition body and identifying possible metabolic disorders are carried out:

General urine and blood tests;
Blood chemistry;
Test for the presence of cardiac-specific enzymes;
Coagulogram.

The most informative diagnostic methods are instrumental research methods, such as:

ECG, stress ECG;
24-hour Holter monitoring;
EchoCG;
Coronary angiography;
Multislice CT.

Diagnostic methods are selected individually, depending on the patient’s condition, expected diagnosis, treatment tactics and technical capabilities of the clinic.

Treatment

Treatment of coronary heart disease includes a whole range of measures. First of all, it is necessary to stabilize the patient’s condition and prevent possible complications.

For drug therapy 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. The patient will have to take some medications for IHD for life.

When conservative treatment is obviously ineffective, patients are advised to undergo surgical treatment of ischemia. To restore blood flow in the affected myocardium, they are performed.

IHD (in the deciphered definition - coronary heart disease) groups a complex of diseases. They are characterized by unstable blood circulation in the arteries supplying 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 in working age people around the world. WHO experts estimate that the disease is becoming cause of the annual death of more than 7 million people. By 2020, mortality could double. It is most widespread among men 40–62 years old.

The combination of the processes discussed below increases the risk of morbidity.

Main causative factors:

Atherosclerosis. The disease, which occurs in a chronic form, affects the arteries that approach the heart muscle. The vascular walls become denser and lose their elasticity. Plaques formed by a mixture of fats and calcium narrow the lumen, and the deterioration of blood supply to the heart progresses.
Spasm of coronary vessels. The disease is caused or formed without it (under the influence of external negative factors, for example, stress). The spasm changes the activity of the arteries.
Hypertonic disease- the heart is forced to fight high pressure in the aorta, which disrupts its blood circulation and causes angina pectoris and heart attack.
Thrombosis/thromboembolism. In the artery (coronary), a thrombus is formed as a result of the disintegration of an atherosclerotic plaque. There is a high risk of blocking a vessel with a blood clot that formed in another part of the circulatory system and entered here with the bloodstream.
or .

Atherosclerosis is the main cause of the development of coronary artery disease.

Risk factors include:

hereditary factor - the disease is transmitted from parents to children;
persistently elevated “bad” cholesterol, causing the accumulation of HDL – high-density lipoprotein;
smoking;
obesity of any degree, fat metabolism disorders;
arterial hypertension – high blood pressure;
diabetes (metabolic syndrome) - a disease caused by a disruption in the production of the pancreatic hormone - insulin, which leads to disruptions in carbohydrate metabolism;
lifestyle deprived of physical activity;
frequent psycho-emotional disorders, character and personality traits;
adherence to unhealthy fatty foods;
age – risks increase after 40 years;
gender – men suffer from ischemic heart 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 the concept of acute coronary syndrome. It combines some forms of coronary artery disease: myocardial infarction, angina pectoris, etc. Sometimes sudden coronary death is included here.

What is dangerous, complications, consequences

Coronary heart disease indicates the presence of changes in the myocardium, which leads to the formation of progressive failure. Contractility weakens, the heart does not provide the body with the required amount of blood. People with IHD get tired quickly and experience constant weakness. Lack of treatment increases the risk of death.

Clinic of the disease

Manifestations can appear complexly or separately, depending on the form of the disease. There is a clear relationship between the development pain localized in the heart area, and physical activity. There is a stereotype of their occurrence - after a rich meal, under unfavorable 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 to the left shoulder, arm, shoulder blades or both arms, to the left prescapular area, to the cervical region, jaw;
painful attacks last no more than ten minutes, after taking nitrates they subside within five minutes.

We talked in more detail about, including differences in symptoms between men and women and risk groups, in a separate article.

If the patient does not seek treatment and the disease continues for a long time, the picture is complemented 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 discussed is a cardiologist. Prompt access to 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 carried out.

According to the plan, the patient receives a set of stress tests (physical, radioisotope, pharmacological), undergoes examinations using the X-ray contrast method, computed tomography of the heart, electrophysiological study, and Doppler sonography.

How and with what to treat

The tactics of complex therapy for IHD are developed based on the patient’s condition and an accurate diagnosis.

Therapy without drugs

Principles of treatment of ischemic heart disease:

daily dynamic cardio training (swimming, walking, gymnastics), the degree and duration of the load is determined by the cardiologist;
emotional peace;
formation of a healthy diet (ban on salty, fatty foods).

Pharmacological support

The treatment plan may include the following drugs:

Anti-ischemic– reduce myocardial oxygen demand:

Calcium antagonists are effective in the presence of contraindications to beta blockers and are used when the effectiveness of therapy with their participation is low.
beta blockers - relieve pain, improve rhythm, dilate blood vessels.
nitrates – stop attacks of angina pectoris.

Antiplatelet agents– pharmacological drugs that reduce blood clotting.
ACE inhibitors– complex action drugs to lower blood pressure.
Hypocholesterolemic medications (fibrators, statins) – eliminate bad cholesterol.

As additional support and as indicated, the treatment plan may include:

diuretics– diuretics to relieve swelling in patients with coronary artery disease.
antiarrhythmics– maintain a healthy rhythm.

Find out more in a separate publication.

Operations

Regulating the blood supply to the myocardium surgically. A new vascular bed is brought to the ischemic site. The intervention is implemented in case of multiple vascular lesions, low effectiveness of pharmacotherapy and a number of concomitant diseases.

Coronary angioplasty. In this surgical treatment of coronary artery disease, a special stent is inserted into the affected vessel, which keeps the lumen normal. Heart blood flow is restored.

Prognosis and prevention

Cardiologists note that IHD has a poor prognosis. If the patient follows all the instructions, the course of the disease becomes less severe, but it does not disappear completely. Among preventive measures, management is effective healthy image life (proper nutrition, absence of bad habits, physical activity).

All persons who are predisposed to developing the disease are recommended to regularly visit a cardiologist. This will allow you to maintain a full quality of life and improve your prognosis.

A useful video about what kind of diagnosis is “coronary heart disease”; all the details about the causes, symptoms and treatment of coronary artery disease are described:

Having felt pain in the heart or regular malaise associated with unpleasant sensations in the chest, we go to a cardiologist and, after undergoing a series of examinations, we see three mysterious letters in the line with the inscription “diagnosis” - IHD. What it is? Let's figure it out.

Diagnosis: IHD

Coronary heart disease is a lesion of the myocardial walls caused by impaired circulatory function, which can manifest itself in both chronic and acute forms.

The history of coronary artery disease is the occurrence of an imbalance between the required level of blood supply to the heart muscle and the actual coronary blood supply. This condition can occur if the need for blood supply sharply increases, but it does not happen, or under normal conditions the level of blood flow decreases. Then various changes occur in the myocardium due to oxygen starvation of tissues, which are characterized by the presence of: dystrophy, sclerosis or necrosis. Such conditions can be considered as an independent disease or a component of more severe forms: myocardial infarction, angina pectoris, heart failure, cardiac arrest or post-infarction cardiosclerosis.

Thus, answering the question “IHD: what is it,” we can say that it is a deficiency of blood supply to myocardial tissue, leading to its physiological changes, that is, the development of ischemia.

Causes and risk factors

In most cases, the causes of ischemia are atherosclerosis of the arteries of varying degrees of complexity, from the presence of plaques to complete blockage of the lumens. In this case, a disease called “angina pectoris” develops.

Also, against the background of atherosclerotic changes, spasms of the coronary arteries may occur, as a result of which the most common forms of coronary heart disease occur - angina pectoris, arrhythmia, hypertension.

Factors contributing to the development of this disease include:

Arterial hypertension, which increases the chances of ischemia by 5 times.
Hyperlipidemia causes the development of atherosclerosis and, as a consequence, ischemia.
Smoking. Nicotine causes a steady contraction of vascular muscle tissue, impairing blood circulation throughout the body.
Impaired carbohydrate tolerance as a result of diabetes mellitus.
Obesity and physical inactivity become prerequisites for the development of ischemia.
Heredity and old age.

Classification

"IHD: what is it?" - a question arises for a person and his relatives if a doctor makes such a diagnosis. To understand what risks a patient faces, it is necessary to refer to WHO recommendations for identifying and systematizing forms of the disease:

Coronary death or cardiac arrest usually develops suddenly and is an unexpected condition. If such a patient is away from other people and is unable to call for help, sudden death may occur after a heart attack.
Angina pectoris, which can be stable, post-infarction, spontaneous.
Painless form of ischemia.
Myocardial infarction.
Cardiosclerosis post-infarction.
Arrhythmia.
Heart failure.

IHD: symptoms

Depending on the form in which ischemia develops, clinical manifestations may be different. However, as a rule, the disease is not permanent, but periodic in nature, when states of exacerbation and complete absence of symptoms can alternate. Most often, patients who are diagnosed with coronary artery disease do not suspect the presence of any heart disease, since they do not feel constant ailments or any regular pain in the heart area. Therefore, the disease can develop over several years and be aggravated by other more severe conditions.

With IHD, symptoms may manifest as follows:

Pain in the area of the heart muscle, especially during physical activity and stress.
Pain occurring on the left side of the body: in the back, arm, left side of the jaw.
Shortness of breath, rapid heart rhythms, sensations of rhythmic disturbance.
A state of general weakness, nausea, dizziness, increased sweating.
Swelling in the lower extremities.

It is quite rare for all of these symptoms to occur at the same time to give a complete picture of what is happening. However, any feeling of discomfort in the sternum or the presence of the symptoms described above, especially with a stable or frequently recurring occurrence, should be a signal to be examined for the presence of coronary artery disease in any form.

Progression of the disease

Possible complications of coronary artery disease are damage or functional changes in the state of the myocardium, which cause:

Violations of diastolic and systolic functions.
Development of atherosclerotic foci.
Disorders of the contractile function of the left ventricle of the heart.
Disorders of automatic contractility and excitability of myocardial tissue.
Insufficient level of ergonomics and metabolism of myocardial cells.

Such changes can lead to a significant and prolonged deterioration of coronary circulation and can progress to heart failure.

Diagnosis of IHD

Ischemia can be detected through the combined use of various methods of instrumental observation and analysis, as well as during the initial examination of the patient and collection of anamnesis.

When conducting an oral interview, the cardiologist pays attention to the patient’s complaints, the presence of some discomfort in the heart area, regular descending edema in the lower extremities, as well as cyanosis of the skin tissue.

Laboratory diagnostic analysis is used to study the presence of specific enzymes, the level of which increases when IHD occurs, these are: creatine phosphokinase, aminotransferase, myoglobin.

Additionally, a study of the level of blood sugar, cholesterol, lipoproteins, triglycerides, the level of androgenic and antiandrogenic densities, and nonspecific markers of cytolysis is prescribed.

The most informative and mandatory are ECG and EchoCG studies. They allow you to detect the slightest changes in the work of the myocardium, as well as visually assess the size and condition of the heart muscle, its valves, the presence of noise in the heart and its ability to contract.

In the early stages of development, when there are no pronounced symptoms that could be recorded during a survey or standard studies, ECG studies are used when a special load is given to the heart muscle in the form of physical exercises that help identify the most minor changes in the condition of the myocardium.

Also, when the symptoms are inconsistent, Holter 24-hour ECG monitoring can be used, the essence of which is to monitor the work and condition of the heart on a portable device for one day in order to record changes in the work of the heart. This study is most often used in the development of angina pectoris.

Based on the diagnosis of IHD, treatment and prevention can be prescribed both preventively, in order to prevent more severe forms, and as restorative therapy. Methods can cover both traditional and traditional medicine.

Treatment

In the course of diagnosing and identifying the diagnosis of coronary artery disease, treatment consists of using various approaches aimed at achieving the best result, these are:

Drug therapy.
Non-drug treatment.
Carrying out coronary artery bypass surgery.
Application of methods of angioplasty of coronary vessels.

Drug therapy for ischemic heart disease consists of prescribing drugs: beta-blockers, antiplatelet agents, hypocholesterolemic drugs. Diuretics, nitrates, and antiarrhythmic drugs may also be prescribed.

The effect of non-drug correction on the condition consists of prescribing a special diet and dosed physical activity; herbal remedies and contrasting water procedures can also be used.

When coronary heart disease does not respond well to drug treatment, the question may be raised about the need for coronary artery bypass surgery or coronary angioplasty.

The method of coronary artery bypass grafting involves the application of an autovenous anastomosis, bypassing the narrowing of the arteries, and thereby ensuring normal blood supply to the damaged area of the myocardium. Coronary angioplasty - expansion of blood vessels by placing special balloons in them and applying frame structures ensuring normal blood flow through the lumen of the vessel.

Forecast

When a diagnosis of IHD is made, treatment is prescribed to stop further development and prevent its more severe forms. However, changes in the condition of the myocardium are irreversible, and therefore any type of treatment will not lead to complete healing.

Prevention of coronary artery disease

The most effective preventative measures are the elimination of threat factors that provoke the development of the disease and adherence to a special dietary regimen, as well as moderate physical activity.

Having received an answer to the question: “Diagnosis of IHD, what is it?” - first of all, you need to seek advice from a cardiologist and follow all his recommendations, and also take seriously the possible consequences in the absence of treatment and preventive measures.

Which of us has not been bothered by pain in the heart at least once in our lives? Unfortunately, there are very few such people. For some, heart pain occurs all at once, for others it occurs quite often. There are many reasons for such sensations, one of them is coronary heart disease. IHD – what it is, how it manifests itself and how you can cope with it, this article will tell you.

Coronary heart disease is a disease that results in a discrepancy between the heart muscle's need for oxygen and its delivery to it. It can be either an acute or chronic process.

Causes

IHD is a disease that occurs when there is insufficient blood flow to the heart. This is caused by damage to the coronary arteries. This can happen in the following cases:

atherosclerotic lesion is the main cause of the disease. An atherosclerotic plaque growing in a vessel closes its lumen, as a result of which a smaller volume of blood passes through the coronary artery;
congenital genetic anomalies of the coronary arteries - a developmental defect that formed in utero;
inflammatory diseases of the coronary arteries (coronaritis), resulting from systemic connective tissue diseases or periarteritis nodosa;
an aortic aneurysm that is in the process of dissection;
syphilitic damage to the walls of the coronary vessels;
thromboembolism and embolism of the coronary arteries;
congenital and acquired heart defects.

Risk group

Etiological factors include risk factors, which are divided into 2 groups - those that change and those that do not change (that is, those that depend on the person and those that the person cannot change).

Unchangeable risk factors:

Age – 61 years and older (according to some sources, 51 years).
Compounded heredity – the presence of atherosclerosis, coronary heart disease in close relatives (parents, grandparents).
Gender – predominantly occurs in men; IHD is much less common in women.

Modifiable risk factors:

Insufficient physical activity.
Long-term increase in blood pressure, then blood pressure (arterial hypertension or essential hypertension).
Excess weight and metabolic syndrome.
Dyslipidemia is an imbalance between “good” (high-density lipoproteins) and “bad” (low-density lipoproteins) lipids towards the latter.
Long history of smoking.
Concomitant disorders of carbohydrate metabolism - diabetes mellitus or prolonged hyperglycemia.
Eating disorders – eating fatty foods rich in simple carbohydrates, eating food in large quantities, not following the eating regimen.

Development mechanisms

IHD is what is defined as a discrepancy between myocardial oxygen demand and oxygen delivery. Consequently, the development mechanisms are connected precisely with these two indicators.

The heart's need for the amount of oxygen it needs is determined by the following indicators:

size of the heart muscle;
contractility of the left and right ventricle;
blood pressure value;
heart rate (HR).

Failure in oxygen delivery occurs mainly due to narrowing of the lumen of the coronary vessels by atherosclerotic plaques. In the affected vessels, damage to their inner lining occurs, as a result of which the endothelium stops secreting vasodilators and begins to produce vasoconstrictors, which further reduces the lumen of the vessels.

Another mechanism of development is the rupture of an atherosclerotic plaque, as a result of which platelets adhere to the site of damage to the vascular wall, forming platelet masses that close the lumen of the vessels, reducing the flow of passing blood.

Types of IHD

Coronary heart disease is classified as follows:

SCD – sudden cardiac death.
Angina:

at rest;
in tension (unstable, stable and new);
spontaneous.

Silent ischemia.
Myocardial infarction (small and large focal).
Cardiosclerosis after a heart attack.

Sometimes two more items are included in this classification, such as heart failure and cardiac arrhythmia. This classification of IHD was proposed by WHO and has remained virtually unchanged to date. The above diseases are clinical forms of IHD.

Clinical picture

Symptoms of IHD depend on its clinical form. They can vary in strength, duration and nature of pain, in the presence or absence of certain symptoms.

Sudden cardiac death

This is death that occurs within one hour after the onset of cardiac symptoms, associated with cardiac causes, natural, and preceded by loss of consciousness.

The causes of sudden death are immediate ischemic heart disease, congenital heart defects, cardiomyopathies, coronary artery anomalies and Wolff-Parkinson-White syndrome (ventricular preexcitation).

Symptoms of this IHD (clinical form) may begin with vague pain in the chest, then after a few weeks shortness of breath, palpitations and weakness occur. After these symptoms occur, sudden loss of consciousness occurs (as a result of cardiac arrest, cerebral circulation is stopped). Upon examination, dilated pupils, absence of all reflexes and pulse, and respiratory arrest are revealed.

Stable exertional angina

This form is characterized by the occurrence of pain in the chest, which appears during exercise and/or strong emotions, when being in the cold, and can also appear in a calm state, when eating large amounts of food.

In this clinical form, you can understand a little more about what it is, called coronary artery disease. As a result of various reasons that were described above, myocardial ischemia occurs, and first the layers that are located under the endocardium are affected. As a result, the contractile function and biochemical processes in the cells are disrupted: since there is no oxygen, the cells switch to an anaerobic type of oxidation, as a result of which glucose breaks down into lactate, which reduces the intracellular pH. A decrease in intracellular acidity leads to the fact that energy in cardiomyocytes is gradually depleted.

In addition, angina leads to the fact that the concentration of potassium inside the cell decreases, while the concentration of sodium increases. Because of this, a failure occurs in the process of relaxation of the heart muscle, and the contractile function suffers for the second time.

Depending on cardiac stress tolerance, the Canadian Society of Cardiology has identified the following functional classes of angina pectoris:

Functional class (FC) I - an angina attack is not caused by normal physical activity, but occurs only with very strong or prolonged stress.
FC II is equivalent to a mild limitation of physical activity. In this case, the attack is provoked by walking more than 200 m on level ground or climbing more than one flight of stairs.
FC III is a significant limitation of physical activity, in which chest pain occurs even when walking on level ground or climbing one flight of stairs.
With FC IV exertional angina, any physical activity without discomfort and chest pain is impossible, and attacks can also occur at rest.

Symptoms of coronary artery disease include pain and its equivalents (shortness of breath and fatigue). The pain is localized behind the sternum, lasts from 1 to 15 minutes, and has an increasing character. If the discomfort lasts more than 14 minutes, there is a danger that it is no longer angina, but a myocardial infarction. There are two conditions for the cessation of unpleasant sensations: abolition of physical. exercise or taking nitroglycerin under the tongue.

The pain can be squeezing, pressing or bursting, and there is a fear of death. Irradiation occurs in both the left and right parts of the chest, and in the neck. Irradiation to the left arm, shoulder and scapula is considered classic.

Signs of coronary heart disease include accompanying symptoms: nausea, vomiting, excessive sweating, tachycardia and increased blood pressure. The patient is pale, freezes in one position, as the slightest movement increases the pain.

Unstable angina (UA)

NS is an acute myocardial ischemia, the severity and duration of which is not sufficient to cause myocardial infarction.

This type of IHD occurs due to the following reasons:

sharp spasm, thrombosis or embolization of the coronary arteries;
inflammation of the coronary vessels;
rupture or erosion of an atherosclerotic plaque with further formation of a blood clot on the damaged surface of the vessel.

Symptoms of coronary heart disease include typical and atypical complaints. Typical complaints include prolonged pain (more than 15 minutes), pain at rest, and night attacks. Atypical complaints include pain in the epigastric region, indigestion that develops acutely, and increased shortness of breath.

Unlike myocardial infarction, there are no markers of necrosis in the blood. This is the main difference when carrying out differential diagnosis.

Prinzmetal's angina

This type refers to a variant in which unpleasant sensations in the chest appear at rest, while a transient rise in the ST segment is detected on the electrocardiogram. It occurs due to a temporary, transient spasm of the coronary arteries; variant angina is in no way associated with physical activity. A painful attack can be stopped either independently or after taking nitroglycerin.

Coronary heart disease of this type is characterized by the occurrence of typical coronary pain in the chest, often at night or early in the morning, lasting more than 15 minutes. A concomitant symptom is the appearance of migraine and, and also in the presence of this type of angina, the presence of aspirin-induced asthma is very often detected.

The diagnostic sign is sudden fainting due to ventricular arrhythmias that appear at the peak of pain.

The cause of myocardial ischemia in this case is not an increased need for oxygen, but simply a decrease in oxygen delivery to the heart muscle.

Diagnosis of coronary heart disease

Diagnosis of coronary artery disease includes anamnesis, physical examination data (described above), as well as additional research methods:

ECG is one of the main diagnostic methods, one of the first to reflect changes in the myocardium that occur during an attack: rhythm and conduction disturbances are possible. In unclear diagnostic cases, 24-hour ECG monitoring (Holter) is performed.
Laboratory tests - general blood test (no specific changes), biochemical blood test (increased biochemical markers of myocardial necrosis: troponins, CPK, myoglobin).
Stress tests are used for differential diagnosis of clinical forms of IHD among themselves, as well as IHD with other diseases, to determine individual tolerance to physical activity, to assess work ability, or to evaluate the effectiveness of treatment.

Cases when stress testing cannot be done: recent myocardial infarction (less than 7 days), the presence of unstable angina, acute cerebrovascular accident, thrombophlebitis, fever or the presence of severe pulmonary insufficiency.

The essence of this technique is a stepwise dosed increase in physical strength. load, during which simultaneous recording of an electrocardiogram and blood pressure is recorded.

A test is considered positive when typical pain appears in the chest, without changes on the ECG. If signs of ischemia occur, the test should be stopped immediately.

An echocardiographic study is carried out to assess its contractility. It is possible to conduct a stress ultrasound, which evaluates the mobility of the structures and segments of the left ventricle during: after the administration of dobutamine or physical activity. It is used to diagnose atypical forms of angina or when it is impossible to conduct stress tests.
Coronary angiography is the gold standard for diagnosing coronary heart disease. It is performed for severe types of angina or severe myocardial ischemia.
Scintigraphy is visualization of the heart muscle, which can identify areas of ischemia (if any).

Treatment of coronary artery disease

Treatment of coronary heart disease is complex and can be either medicinal (conservative and surgical) or non-medicinal.

Non-drug treatment of coronary artery disease includes addressing risk factors: eliminating unhealthy diets, reducing excess body weight, normalizing physical activity and blood pressure, as well as correcting carbohydrate metabolism disorders (diabetes mellitus).

Drug treatment is based on the prescription of various groups of drugs for the most complete and comprehensive treatment. The following main groups of drugs are distinguished:

Nitrates

Short-acting - used to relieve an attack and are not suitable for treatment. These include nitroglycerin, the effect of which occurs within a few minutes (from one to five).
Long-acting - these include isosorbide mono- and dinitrate, used to prevent attacks.

Beta blockers - to reduce myocardial contractility:

Selective (block only one type of receptor) - metoprolol and atenolol.
Non-selective (block all sympathetic receptors that are located both in the heart and in other organs and tissues) - propranolol.

Antiplatelet agents (aspirin, clopidogrel) - reduce blood clotting by affecting platelet aggregation.
Statins - simvastatin, nystatin (reduce the concentration of cholesterol in low-density lipoproteins, that is, they affect risk factors).
Metabolic agents – preductal, increases oxygen delivery to the heart muscle.
Angiotensin-converting enzyme inhibitors (lisinopril, ramipril) or angiotensin receptor blockers (losartan, valsartan).

It is possible to use combinations of these drugs.

Surgery

Surgical treatment of coronary heart disease consists of two main methods: percutaneous transluminal coronary angioplasty (balloon dilatation) and coronary artery bypass grafting.

Balloon dilatation is the method of choice for one- or two-vessel disease with normal left ventricular ejection fraction. Under high pressure, a balloon is inserted into the narrowed area of the coronary artery, which is inflated and fixed. It is possible to implant a stent, which prevents re-stenosis.
Coronary artery bypass surgery is an operation in which an anastomosis is created between the internal mammary artery or aorta and the coronary artery below the site of narrowing. As a result, the blood supply to the myocardium is restored. It is the method of choice for two- or three-vessel disease, a decrease in left ventricular ejection fraction of less than 45%, and in the presence of concomitant pathology (for example, diabetes mellitus).

Coronary bypass grafting should be used in the following cases:

narrowing of the left coronary artery by more than 50%;
IHD of functional classes III and IV, which does not respond to active therapy;
severe ischemia in combination with narrowing of two or more coronary arteries.

Complications after the procedure are divided into early and late. Early ones include death and the occurrence of myocardial infarction. By late stage there is a re-occurrence of stenosis in the coronary arteries.

Coronary artery disease is a terrible disease, but many people do not understand this and try to treat themselves using folk remedies. This can lead to severe consequences, even death.

Doctors recommend using folk remedies not instead of, but together with medical treatment or as a preventive measure in the presence of risk factors. Some of these remedies include hawthorn, rose hips, motherwort and buckwheat. In general, in medicine you cannot self-medicate, especially in the presence of this pathology, and even the use of folk remedies should be discussed with a doctor.

In the presence of cardiac ischemia, treatment and symptoms of the disease differ somewhat depending on the clinical form of the patient.

Thus, IHD - dangerous disease both in itself and due to the development of complications. With timely diagnosis and treatment, the disease has a favorable outcome. The main thing is not to delay going to the doctor, especially if you have symptoms or at least one of the risk factors.