What kind of disease is ischemia of the heart. Ischemic heart disease: causes, symptoms, diagnosis and treatment. Diseases that increase the risk of coronary disease

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. A chronic disease 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 a plentiful meal, 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 examinations using the X-ray contrast method, 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:

Anti-ischemic- reduce myocardial oxygen demand:

• 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 drugs that reduce blood clotting.
• ACE inhibitors- drugs of complex action to reduce pressure.
• Hypocholesterolemic medicines (fibrators, statins) - eliminate bad cholesterol.

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. Wherein surgical treatment A special stent is inserted 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 the preventive measures, maintaining a healthy lifestyle is effective ( proper nutrition, no bad habits, physical activity).

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:

Good day, dear readers!

In today's article, we will consider with you such a disease as coronary heart disease (CHD), as well as its symptoms, causes, classification, diagnosis, treatment, folk remedies and prevention of CHD. So…

What is ischemic heart disease?

Ischemic heart disease (CHD)- a pathological condition that is characterized by insufficient blood supply, and, accordingly, oxygen to the heart muscle (myocardium).

Synonyms for IHD– Coronary heart disease (CHD).

The main and most common cause IHD is the appearance and development of atherosclerotic plaques in the coronary arteries, which narrow and sometimes block blood vessels, which disrupts normal blood flow in them.

Now let's move on to the development of the IHD itself.

The heart, as we all know, is the "motor" of a person, one of the main functions of which is to pump blood throughout the body. However, just like a car engine, without enough fuel, the heart stops functioning properly and may stop.

The function of fuel in the human body is performed by blood. Blood delivers oxygen, nutrients and other substances necessary for normal functioning and life to all organs and parts of the body of a living organism.

The blood supply to the myocardium (heart muscle) occurs with the help of 2 coronary vessels that depart from the aorta. Coronary vessels, dividing into a large number of small vessels, go around the entire heart muscle, feeding each part of it.

If there is a decrease in the lumen or blockage of one of the branches of the coronary vessels, that part of the heart muscle remains without nutrition and oxygen, the development of coronary heart disease, or as it is also called, coronary heart disease (CHD) begins. The larger the artery is clogged, the worse the consequences of the disease.

The onset of the disease usually manifests itself in the form of strong physical exertion (running and others), but over time, if no action is taken, pain and other signs of coronary artery disease begin to haunt a person even during rest. Some signs of IHD are also -, swelling, dizziness.

Of course, the above model of the development of coronary heart disease is very superficial, but it reflects the very essence of the pathology.

IHD - ICD

ICD-10: I20-I25;
ICD-9: 410-414.

The first signs of IBS are:

• Elevated blood sugar;
• Elevated cholesterol;

The main signs of IHD, depending on the form of the disease, are:

• angina pectoris- characterized by pressing pain behind the sternum (capable of radiating to the left side of the neck, left shoulder blade or arm), shortness of breath during physical exertion (fast walking, running, climbing stairs) or emotional stress (stress), increased blood pressure,;
• Arrhythmic form- accompanied by shortness of breath, cardiac asthma, pulmonary edema;
• - a person develops an attack of severe pain behind the sternum, which is not relieved by conventional painkillers;
• Asymptomatic form- the person does not have any obvious signs indicating the development of coronary artery disease.
• , malaise;
• Edema, predominantly;
• , blurred consciousness;
• , sometimes with seizures ;
• Strong sweating;
• Feelings of fear, anxiety, panic;
• If you take nitroglycerin during pain attacks, the pain subsides.

The main and most common cause of the development of IHD is, the mechanism of which we spoke about at the beginning of the article, in the paragraph "Development of IHD". In short, the essence lies in the presence of atherosclerotic plaques in the coronary blood vessels, narrowing or completely blocking the access of blood to one or another part of the heart muscle (myocardium).

Other causes of IHD include:

• Eating - fast foods, lemonade, alcoholic products, etc .;
• Hyperlipidemia ( elevated level lipids and lipoproteins in the blood);
• Thrombosis and thromboembolism of the coronary arteries;
• Spasms of the coronary arteries;
• Dysfunction of the endothelium (inner wall of blood vessels);
• Increased activity of the blood coagulation system;
• The defeat of blood vessels - the herpes virus, chlamydia;
• Hormonal imbalance (with the onset of menopause, and other conditions);
• Metabolic disorders;
• hereditary factor.

An increased risk of developing coronary artery disease is in the following people:

• Age - the older the person, the higher the risk of developing coronary artery disease;
• Bad habits - smoking, drugs;
• Poor quality food;
• Sedentary lifestyle;
• Exposure to frequent;
• Male gender;

IHD classification

Classification of IHD occurs in the form:
1. :
- Angina pectoris:
— — Primary;
— — Stable, indicating the functional class
- Unstable angina (Braunwald classification)
- Vasospastic angina;
2. Arrhythmic form (characterized by a violation of the heart rhythm);
3. Myocardial infarction;
4. Postinfarction;
5. Heart failure;
6. Sudden coronary death (primary cardiac arrest):
- Sudden coronary death with successful resuscitation;
- Sudden coronary death with a fatal outcome;
7. Asymptomatic form of coronary artery disease.

IHD diagnostics

Diagnosis of coronary heart disease is carried out using the following examination methods:

• Anamnesis;
• Physical research;
• Echocardiography (EchoECG);
• Angiography and CT angiography of the coronary arteries;

How to treat coronary heart disease? IHD treatment is carried out only after a thorough diagnosis of the disease and determination of its form, because. It is on the form of IHD that the method of therapy and the means necessary for it depend.

Treatment for coronary heart disease usually includes the following therapies:

1. Limitation of physical activity;
2. Drug treatment:
2.1. Antiatherosclerotic therapy;
2.2. Supportive care;
3. Diet;
4. Surgical treatment.

1. Limitation of physical activity

As you and I already know, dear readers, the main point of IHD is insufficient blood supply to the heart. Due to the insufficient amount of blood, of course, the heart does not receive enough oxygen, along with various substances necessary for its normal functioning and life. At the same time, you need to understand that during physical exertion on the body, the load on the heart muscle also increases in parallel, which at one time wants to receive an additional portion of blood and oxygen. Naturally, because with coronary artery disease, blood is already insufficient, then under load this insufficiency becomes even more critical, which contributes to the deterioration of the course of the disease in the form of enhanced symptoms, up to a sudden cardiac arrest.

Physical activity is necessary, but already at the stage of rehabilitation after the acute stage of the disease, and only as prescribed by the attending physician.

2. Drug treatment (drugs for coronary artery disease)

Important! Before using drugs, be sure to consult your doctor!

2.1. Antiatherosclerotic therapy

V Lately, for the treatment of coronary artery disease, many doctors use the following 3 groups of drugs - antiplatelet agents, β-blockers and hypocholesterolemic (cholesterol-lowering) drugs:

Antiplatelet agents. By preventing the aggregation of erythrocytes and platelets, antiplatelet agents minimize their sticking and settling on the inner walls of blood vessels (endothelium), and improve blood flow.

Antiplatelet agents include the following drugs: acetylsalicylic acid ("Aspirin", "Acecardol", "Trombol"), "Clopidogrel".

β-blockers. Beta-blockers help to lower the heart rate (HR), which reduces the load on the heart. In addition, with a decrease in heart rate, oxygen consumption also decreases, due to the lack of which, coronary heart disease mainly develops. Doctors note that with the regular use of β-blockers, the quality and life expectancy of the patient improves, because. this group of drugs stop many symptoms of coronary artery disease. However, you should be aware that contraindications to taking β-blockers are the presence of concomitant diseases such as -, pulmonary pathologies and chronic obstructive pulmonary disease (COPD).

Among β-blockers, the following drugs can be distinguished: bisoprolol (Biprol, Kordinorm, Niperten), carvedilol (Dilatrend, Coriol, (Talliton), metoprolol (Betaloc, Vasocardin, Metocard", "Egilok").

Statins and fibrates- hypocholesterolemic (cholesterol-lowering) drugs. These groups of drugs lower the amount of "bad" cholesterol in the blood, reduce the number of atherosclerotic plaques on the walls of blood vessels, and also prevent the appearance of new plaques. The combined use of statins and fibrates is the most effective way fight cholesterol deposits.

Fibrates increase high-density lipoprotein (HDL) levels, which actually counteract low-density lipoprotein (LDL), and as you and I know, it is LDL that forms atherosclerotic plaques. In addition, fibrates are used in the treatment of dyslipidemia (IIa, IIb, III, IV, V), lower triglyceride levels and, most importantly, minimize the percentage of deaths from coronary artery disease.

Among the fibrates, the following drugs can be distinguished - "Fenofibrate".

Statins, unlike fibrates, have a direct effect on LDL, lowering its amount in the blood.

Among statins, the following drugs can be distinguished - Atorvastin, Lovastatin, Rosuvastin, Simvastatin.

The level of cholesterol in the blood in IHD should be - 2.5 mmol / l.

2.2. Supportive care

Nitrates. They are used to reduce the preload on the work of the heart by expanding the blood vessels of the venous bed and depositing blood, which stops one of the main symptoms of coronary heart disease - angina pectoris, which manifests itself in the form of shortness of breath, heaviness and pressing pain behind the sternum. Especially for the relief of severe attacks of angina pectoris, intravenous drip of nitroglycerin has recently been successfully used.

Among the nitrates, the following drugs can be distinguished: "Nitroglycerin", "Isosorbide mononitrate".

Contraindications to the use of nitrates are - below 100/60 mm Hg. Art. From side effects a decrease in blood pressure can also be noted.

Anticoagulants. They prevent the formation of blood clots, slow down the development of existing blood clots, and inhibit the formation of fibrin threads.

Among the anticoagulants, the following drugs can be distinguished: "Heparin".

Diuretics (diuretics). They contribute to the accelerated removal of excess fluid from the body, due to a decrease in the volume of circulating blood, thereby reducing the load on the heart muscle. Among diuretics, 2 groups of drugs can be distinguished - loop and thiazide.

Loop diuretics are used in emergency situations when the fluid from the body needs to be removed as quickly as possible. A group of loop diuretics reduce the reabsorption of Na +, K +, Cl- in the thick part of the loop of Henle.

Among the loop diuretics, the following drugs can be distinguished - Furosemide.

Thiazide diuretics reduce the reabsorption of Na +, Cl- in the thick part of the loop of Henle and the initial section of the distal tubule of the nephron, as well as the reabsorption of urine, and remain in the body. Thiazide diuretics, in the presence of hypertension, minimize the development of IHD complications from the cardiovascular system.

Among thiazide diuretics, the following drugs can be distinguished - "Hypothiazide", "Indapamide".

Antiarrhythmic drugs. Contribute to the normalization of heart rate (HR), which improves respiratory function, facilitates the course of coronary artery disease.

Among the antiarrhythmic drugs, the following drugs can be distinguished: Aymalin, Amiodarone, Lidocaine, Novocainamide.

Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors, by blocking the conversion of angiotensin II from angiotensin I, prevent spasms of blood vessels. ACE inhibitors also normalize, protect the heart and kidneys from pathological processes.

Among the ACE inhibitors, the following drugs can be distinguished: Captopril, Lisinopril, Enalapril.

Sedative drugs. They are used as a means of calming the nervous system, when emotional experiences and stress are the cause of an increase in heart rate.

Among the sedative drugs can be identified: "Valerian", "Persen", "Tenoten".

The diet for IHD is aimed at reducing the load on the heart muscle (myocardium). To do this, limit the amount of water and salt in the diet. Also, products that contribute to the development of atherosclerosis are excluded from the daily diet, which can be found in the article -.

Of the main points of the diet for IHD, we can distinguish:

• Calorie content of food - by 10-15%, and with obesity by 20% less than your daily diet;
• The amount of fat - no more than 60-80 g / day;
• The amount of proteins - no more than 1.5 g per 1 kg of human body weight / day;
• The amount of carbohydrates - no more than 350-400 g / day;
• The amount of table salt - no more than 8 g / day.

What not to eat with coronary artery disease

• Fatty, fried, smoked, spicy and salty foods - sausages, sausages, ham, fatty dairy products, mayonnaise, sauces, ketchups, etc.;
• Animal fats, which are found in large quantities in lard, fatty meats (pork, domestic duck, goose, carp and others), butter, margarine;
• High-calorie foods, as well as foods rich in easily digestible carbohydrates - chocolate, cakes, pastry, sweets, marshmallows, marmalade, jams and jams.

What can you eat with coronary artery disease

• Food of animal origin - low-fat meats (low-fat chicken, turkey, fish), low-fat cottage cheese, egg white;
• Cereals - buckwheat, oatmeal;
• Vegetables and fruits - mostly green vegetables and orange fruits;
• Bakery products - rye or bran bread;
• Drinking - mineral water, low-fat milk or kefir, unsweetened tea, and juices.

In addition, the diet for IHD should also be aimed at eliminating an excessive amount of extra pounds (), if present.

For the treatment of coronary heart disease M.I. Pevzner developed a therapeutic nutrition system - diet No. 10s (table No. 10s). These vitamins, especially C and P, strengthen the walls of blood vessels and prevent cholesterol deposits in them, i.e. formation of atherosclerotic plaques.

Ascorbic acid also contributes to the rapid breakdown of "bad" cholesterol and its removal from the body.

Horseradish, carrots and honey. Grate the horseradish root so that it comes out 2 tbsp. spoons and fill it with a glass of boiled water. After, mix the horseradish infusion with 1 glass of freshly squeezed carrot juice and 1 glass of honey, mix everything thoroughly. You need to drink the remedy for 1 tbsp. spoon, 3 times a day, 60 minutes before meals.

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

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

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

Main cause of coronary artery disease

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

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

Video: IHD and atherosclerosis

When do we take risks?

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

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

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

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

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

Video: the occurrence and course of ischemia

Does everything depend on us?

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

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

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

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

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

Types and forms of coronary heart disease

Currently, there are many types of coronary heart disease. The classification of coronary artery disease, proposed in 1979 by a working group of WHO experts, is still relevant and is used by many doctors. It is based on the allocation of independent forms of the disease, which have peculiar characteristic manifestations, a certain prognosis and require a special type of treatment. Over time and the advent of modern diagnostic methods, other forms of coronary artery disease have been studied in detail, which is reflected in other, newer classifications.

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

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

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

Manifestations of myocardial ischemia

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

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

Angina pectoris and its types

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

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

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

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

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

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

Myocardial infarction, what does this concept mean?

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

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

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

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

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

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

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

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

How to recognize a heart attack?

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

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

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

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

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

Video: how the heart works, myocardial infarction

Consequences and complications of coronary artery disease

Postinfarction cardiosclerosis

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

Chronic heart failure

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

Acute heart failure

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

Cardiogenic shock

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

Arrhythmia

Methods for diagnosing coronary heart disease

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

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

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

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

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

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

Methods of treatment of various forms of myocardial ischemia

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

Proper nutrition

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

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

Medical therapy

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

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

Operation

Surgical treatment of cardiac ischemia is reduced to:

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

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

Video: lecture by a specialist on the treatment of ischemia

After discharge from the hospital

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

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

Ischemic heart disease is not in vain considered one of the most common and dangerous heart diseases. Unfortunately, it knows no boundaries, neither age, nor geographical, nor economic.

Ischemic heart disease can strike by surprise

Sometimes, instead of the term "coronary heart disease", the names "ischemia", "coronary disease" or "coronary sclerosis" are used, these terms were in the list of diseases of the WHO in the last century. But even now, in some sources, and in medical practice, these names of the disease are found, which have different stages, require different methods of treatment, and therefore bear different names.

signs

Most often, ischemia signals its presence with periodic bouts of burning pain in the chest. The pain is severe, its character is oppressive.

Sometimes signs of coronary heart disease are complaints of patients about a feeling of general weakness, nausea and an unpleasant feeling of lack of air. Pain in this case can be localized between the shoulder blades, felt behind the sternum, in the neck or left arm.

Painful sensations are the first signs of this disease. You should listen carefully to your own well-being, and as soon as the slightest suspicion of heart problems is felt, it is better to immediately contact a cardiologist.

If before such reactions of the body did not occur, this is the first sign of the need for a cardiological examination.

Discomfort in the chest is also an alarm signal of the body.

In some people suffering from this ailment, it is manifested by pain in the back, left arm, lower jaw. Also, symptoms of coronary heart disease are changes in heart rate, shortness of breath, heavy sweating, nausea.

If none of the listed signs of the disease is present, it is still sometimes important to be examined, albeit with a preventive purpose, because coronary heart disease in a third of patients does not manifest itself at all.

Causes

Clinically, coronary heart disease (CHD) characterizes a chronic pathological process caused by insufficient blood supply to the myocardium, or heart muscle.

Violation of the blood supply to the myocardium occurs due to damage to the coronary arteries, and can be absolute or relative.

The reason for the lack of oxygen in the myocardium is the blockage of the coronary arteries, which can be caused by a blood clot, a temporary spasm of the coronary artery, or atherosclerotic plaques accumulated in the vessel. Sometimes the reason lies in their fatal combination. Violation of normal blood flow in the coronary arteries and causes myocardial ischemia.

Throughout life, each person to some extent has deposits of cholesterol and calcium, in the walls of the coronary vessels there is an overgrowth of connective tissue, which leads to a thickening of their inner membrane and a narrowing of the total lumen of the vessel.

As you can see, the risk of the disease increases with age.

Narrowing of the coronary arteries, which leads to a partial limitation of the blood supply to the heart muscle, can cause angina attacks. These attacks most often occur with a sharp increase in the workload on the heart and its need for additional oxygen.

The occurrence of thrombosis of the coronary arteries is also caused by the narrowing of their lumen. The danger of coronary thrombosis is that it is the cause of myocardial infarction, leading to necrosis and further scarring of the affected area of ​​the heart tissue.

In addition, this also leads to dysrhythmia or heart block, in the worst case scenario of the progression of the disease.

Classification

In accordance with the clinical manifestations, causes of occurrence and degree of progression, IHD has several clinical forms that occur in patients individually or in combination: angina pectoris, myocardial infarction, cardiosclerosis.

Currently, physicians use the modern classification of coronary heart disease, adopted in 1984 by the WHO with amendments and additions by the VKSC.

According to this classification, all the various features of the clinical manifestations of cardiac ischemia, as well as the corresponding prognosis and treatment methods, can be combined into the following groups:

• sudden coronary death, or primary cardiac arrest - according to the results of treatment, two groups of primary cardiac arrest are distinguished - with the practice of successful resuscitation or with a fatal outcome;
• angina pectoris, which in turn is subdivided into angina pectoris, unstable and vasospastic angina pectoris;
• myocardial infarction;
• postinfarction cardiosclerosis;
• heart rhythm disturbances;
• heart failure.

In addition to this systematizing picture of the various manifestations of coronary artery disease, until recently there was another classification recommended by WHO experts in 1979.

Death statistics

According to the then method of dividing coronary artery disease into classification groups, in the clinical form "angina pectoris" a subgroup "coronary syndrome X" was distinguished, unstable angina pectoris was considered in three different clinical manifestations. Also, such a picture of the disease as “painless form of coronary artery disease” was allocated to a separate diagnosed group.

Compliance with the classification of the disease when making a diagnosis is of paramount importance for the success of all further treatment of the patient.

It is unacceptable to formulate a diagnosis of coronary artery disease for a patient without subsequent decoding of the form, because in general such a diagnosis does not at all clarify the real information either about the nature of the disease or about the criteria for choosing the optimal method of treatment.

A correctly formulated diagnosis, in which the clinical form of the disease through the colon follows the general diagnosis of CAD, is the first step towards choosing a further course of treatment.

Acute and chronic forms

The course of cardiac ischemia is undulating, alternating periods of acute coronary insufficiency (coronary crises) that occur against the background of chronic, or relative, insufficiency of the coronary circulation. Accordingly, acute and chronic forms of coronary artery disease are distinguished.

The acute form of IHD is manifested by ischemic myocardial dystrophy and myocardial infarction. Often, ischemic myocardial dystrophy leads to acute heart failure, a complication that often becomes the direct cause of sudden death.

myocardial infarction

Myocardial infarction is the necrosis of the heart muscle caused by coronary artery disease. As a rule, this is an ischemic infarction with a hemorrhagic corolla.

In the systematization of IHD, the forms that characterize chronic coronary heart disease are diffuse small-focal cardiosclerosis or large-focal post-infarction. The latter in some cases is complicated by chronic aneurysm of the heart.

Both acute ischemic heart disease and the chronic form of this disease can cause irreparable damage to the health and life of the patient.

The impact of bad habits

According to WHO statistics, among the various causes of coronary artery disease and other cardiovascular diseases, there are those that most often lead to the development of cardiac pathologies.

Risk factors for CAD include:

• increased blood cholesterol, or hypercholesterolemia;
• carbohydrate metabolism disorders, especially diabetes mellitus;
• arterial hypertension;
• prolonged use of alcohol;
• smoking;
• obesity;
• physical inactivity against the background of stress instability;
• individual characteristics of behavior.

As can be seen from the listed causes leading to the occurrence of coronary artery disease, this disease often has a number of causes, being complex. Therefore, measures for its prevention and treatment should also be comprehensive. Patients suffering from ischemia of the heart, you must first get rid of bad habits.

Smoking

One of the habits that most often lead to coronary atherosclerosis and myocardial infarction is smoking. Long-term smoking has a narrowing effect on the coronary vessels, and also leads to increased blood clotting and slowing of blood flow.

smoking is poison

Another reason for the harmful effects of nicotine on the heart is that nicotine causes an increased flow of adrenaline and norepinephrine into the blood, substances that are released in large quantities during emotional and physical overload, or stress.

Their excessive concentration leads to insufficiency of the coronary circulation due to an increase in the demand of the heart muscle for oxygen. Also, adrenaline and norepinephrine have a damaging effect on the inner surface of blood vessels.

The recently established similarity of the negative effects on the cardiovascular system of long-term negative emotions and nicotine proves how mistaken is the habit of many smokers to puff on the next cigarette to calm down.

Alcohol

This is the second most harmful habit for patients diagnosed with coronary artery disease. According to statistical medical data, among men, about a third of patients with myocardial infarction abuse alcohol. Drinking alcohol often causes an attack of angina pectoris.

A feature of coronary artery lesions in alcohol-dependent patients is a high degree of development of the disease process. Among non-alcoholic patients of the same age, this process is much less associated with pain.

The insidiousness of alcohol is that immediately after taking it, a slight narcotic effect occurs, pain disappears and a false impression arises about the vasodilating effect of alcohol on the heart. Very soon, however, there is a rapid vasospasm, an increase in blood viscosity leads to impaired blood flow.

Therefore, in the stage of intoxication of patients, there are so many heart and brain attacks that are very difficult to stop, especially if we take into account the incorrect action of cardiac glycosides against the background of the presence of alcohol in the blood.

Obesity

Obesity is another scourge that whips up the heart muscle. It has a negative effect on the cardiovascular system through a direct effect on the heart muscle (muscle obesity), as well as setting in motion a complex mechanism of nervous and hormonal effects.

Hypodynamia

Physical inactivity is now recognized as one of the most influential factors triggering the occurrence of coronary heart disease.

Passive lifestyle is the right way to CHD

A sedentary lifestyle is a serious reason for the development of atherosclerosis, thrombosis and other disorders of the normal functioning of the cardiovascular system.

A global problem

The dynamics of recovery of patients with IHD is largely determined by the timeliness and quality of diagnosis of the clinical form of the disease, the adequacy of the prescribed outpatient treatment, as well as the timeliness of urgent hospitalization and emergency cardiac surgery.

Sad European statistics claim that coronary artery disease, together with a stroke of the brain, make up a catastrophic majority, namely 90% of all diseases of the cardiovascular system.

This indicates that coronary heart disease is one of the most common diseases, as well as the most common causes of death in modern man.

It often leads to long-term and permanent disability of the active population, even in the most developed countries of the world. All this characterizes the problem of finding more effective methods treatment of coronary artery disease as one of the leading tasks among the first medical problems of the 21st century.

Signs of coronary heart disease

In this article, we will look at the main signs of coronary artery disease in adults.

Symptoms

The main clinical forms of ischemic heart disease include: angina pectoris (the most common initial form), acute myocardial infarction. cardiac arrhythmias, heart failure. as well as sudden coronary cardiac arrest. All of the above stages of coronary artery disease differ from each other in their severity and the presence of secondary complications.

The main signs of coronary artery disease, which should alert the patient and force him to consult a doctor for medical help, are: frequent shortness of breath, weakness, periodic pain in chest, vertigo, sweating. These symptoms occur in more than 80% of all initial stages of coronary disease.

In most cases, patients note a significant deterioration in general well-being as a result of increased physical activity on the body, which aggravates the course of the disease.

As coronary heart disease progresses, there may be a significant aggravation of the resulting angina attacks, which indicates a fairly rapid deterioration of the underlying disease.

It should also be noted that recently there has been a fairly large number of cases of the development of painless forms of coronary artery disease, which are quite difficult to detect in the early stages of development, and which are much worse treatable. Therefore, it is very important at the slightest disturbance of the heart to consult a cardiologist in a timely manner to prevent the development of undesirable consequences.

angina pectoris is an early and initial sign of coronary artery disease, which is manifested by periodic pain in the region of the heart, chest, giving under the left arm, shoulder blade, in the jaw. The pain may be accompanied by tingling, squeezing, be quite pressing, and generally last no more than 10-15 minutes. then remissions are possible again.

Angina pectoris or, as the people say, "angina pectoris" can be of 2 types: tension and calm. The first occurs under the influence of physical stress on the body, it can develop as a result of stress or psycho-emotional disorders. Rest angina mostly occurs without cause, in some cases an attack can occur during sleep.

Both types of angina pectoris are very well removed by taking 1-2 tons of nitroglycerin under the tongue with a minimum interval between doses of at least 10 minutes.

Remember: this type of coronary artery disease requires a mandatory consultation with a cardiologist with a cardiogram of the heart and the appointment of an appropriate treatment so as not to provoke further progression of the disease and its possible transition to a more severe, life-threatening stage for the patient.

Advanced myocardial infarction is a very serious complication of coronary artery disease requiring emergency medical care. The main signs of a heart attack are severe, pressing and compressive pain in the region of the heart, which is not relieved by nitroglycerin preparations. In addition, a heart attack may be accompanied by shortness of breath, weakness, nausea, or vomiting, mostly yellowish in color.

The attack causes a feeling of fear, anxiety, general weakness, dizziness, in the area of ​​\u200b\u200bthe heart there may be a strong contraction, tingling.

In some cases, a feeling of severe pain can cause a sudden loss of consciousness in the patient.

Therefore, in cases of acute myocardial infarction, the patient should be immediately hospitalized in order to avoid death and prevent the possible development of unwanted complications.

Chronic heart failure is one of the main signs of coronary heart disease, which is manifested by constant shortness of breath, the patient complains that he does not have enough air, he begins to periodically suffocate, the upper and lower tissue integuments of the body become cyanotic, as a result of acute circulatory disorders, local blood stagnation occurs , the patient's chest becomes barrel-shaped.

With all the data, the above signs of coronary artery disease, it is necessary to go to the hospital as soon as possible to a cardiologist in order to timely diagnose the disease, since the development of coronary artery disease at its first stage can be at least slightly suspended in its further progression.

Sudden cardiac arrest(coronary death) is a formidable complication of acute myocardial infarction, as a result of untimely provision of emergency medical care for it. It is manifested by a sharp cessation of cardiac activity with a stop to the further functioning of all vital organs and systems.

If in the next 2-3 minutes. the patient will not be provided with urgent resuscitation, then after 4-6 minutes. irreversible processes occur in the cerebral cortex and central nervous system, which leads to complete biological death.

Attention: timely diagnosis of the disease at an early stage of its development will allow you to carry out a fairly effective treatment, as well as prevent further development unwanted complications.

Diagnostics

• examination of the patient by a doctor, patient complaints of pain in the chest area;
• obligatory electrocardiogram of the heart;
• coronary angiography (makes it possible to determine the state of the coronary arteries of the heart, as well as to identify the presence of pathological changes in them);
• computed tomography of the chest cavity;
• angiography of the main arteries of the heart.

In this article, we found out the main signs of coronary heart disease.

Manifestations of coronary heart disease

The word heart attack means the necrosis of a part of the tissue of any organ due to a violation of the patency of the vessel that feeds this tissue. In addition to myocardial infarction (heart), there are infarctions of the lung, kidney, spleen and other organs. All of them occur in cases where one of the relatively large arteries supplying this organ with blood is clogged and a part of the tissue that received oxygen and all the substances necessary for its vital activity from this artery undergoes dystrophy and dies. Due to the morphological and functional features of the heart muscle and the arteries supplying it, the frequency of myocardial infarction is incomparably higher than the frequency of lesions of this kind of other organs. At the site of the formed myocardial infarction (Fig. 4), scar connective tissue gradually develops in the future, which is functionally unequal to the heart muscle. In this regard, if the myocardial infarction is large in area, heart weakness and other complications occur, leading to adverse consequences.

A person with a completely healthy heart can suffer from a myocardial infarction due to damage to one of the coronary arteries that feed the heart.

So, myocardial infarction is a catastrophe caused by complete or partial blockage of the coronary artery. When the lumen of the vessel is partially closed, the possibility of infarction will be determined by how large the discrepancy between the needs of the myocardium in

oxygen (which depends on the intensity of the work of the heart) and the actual supply of the heart muscle with arterial blood.

With complete blockage of the coronary artery, energy-rich phosphorus compounds - ATP and CF - are quickly consumed in the heart muscle. This leads to the fact that a part of the heart muscle, the supply of which has stopped due to a violation of the patency of the artery, stops contracting after a short time, and the muscle cells in this place do not recover ATP and CF

soon die. As a result of the cessation of contractions of a relatively large part of the left ventricle, cardiac weakness (failure) develops, which sharply aggravates the condition of a sick person.

In most cases, the lumen of the coronary artery narrows gradually as a result of the formation of one or more atherosclerotic plaques in one of the sections of the vessel, which we will discuss in more detail below. Sometimes the plaque itself is small, but a blood clot forms on its rough or ulcerated surface, which completely or partially closes the lumen of the artery. An increase in blood pressure contributes to an additional narrowing of the artery at the location of the atherosclerotic plaque. With excessive physical stress, even a small plaque can be an obstacle to a sharply increasing blood flow through the coronary arteries and cause the development of myocardial infarction. It is very likely that the episode known to us from the history of Ancient Greece with the messenger from Marathon, who ran 42 km to Athens and fell dead, is such an example.

Close to a heart attack is another manifestation of atherosclerosis of the coronary arteries - angina pectoris, characterized by pain in the region of the heart, behind the sternum, often radiating to the left arm or shoulder blade. Just like myocardial infarction, angina is the result of insufficient blood supply to the heart muscle (ischemia).

At the suggestion of the World Health Organization, the term "ischemic heart disease" has been established, which refers to all conditions accompanied by insufficient blood supply to the heart muscle.

Rice. 4. Myocardial infarction, which developed as a result of blockage of one of the branches of the left coronary artery (indicated by an arrow)

Thus, angina pectoris, myocardial infarction, very often various disturbances in the rhythmic work of the heart (arrhythmias), as well as cases of sudden death (see below) are manifestations of the same disease - coronary heart disease (CHD).

In coronary artery disease, the supply of oxygen to the heart muscle lags behind the actual need for oxygen, while normally, the supply of oxygen to the myocardium exceeds the need for it. As a result of myocardial ischemia, signs characteristic of IHD appear (Fig. 5).

Rice. 5. Scheme of the occurrence of myocardial ischemia and some of its manifestations

Of course, there are many different forms of myocardial infarction and angina pectoris. Sometimes it is difficult to draw a clear clinical line between a prolonged attack of angina pectoris and a non-severe myocardial infarction. Some patients suffer from angina pectoris for many years without causing serious consequences. However, more often angina pectoris serves as a prelude to myocardial infarction or eventually leads to cardiac weakness or irregular work of the heart.

There are many cases when a myocardial infarction is preceded by only a few attacks of angina pectoris, to which a person did not attach any importance and did not consider it necessary to consult a doctor.

In close connection with the problem of finding out the causes of myocardial infarction, there is the problem of studying the causes of the so-called sudden death that occurs a few hours after the first manifestations of the disease (in a practically healthy person). The basis of sudden death, as a rule, is a rapidly occurring coronary insufficiency due to a sharp and prolonged spasm of one of the coronary arteries or an acutely developed large-focal myocardial infarction. And the immediate cause of death is deep heart rhythm disturbances: instead of ordered effective contractions of the heart muscle, chaotic twitches of individual muscle bundles begin, the so-called ventricular fibrillation, or heart asystole, develops, and the effective work of the heart stops. Such a state, if it is delayed for several minutes, becomes incompatible with life.

In order to seek help in a timely manner and develop the correct line of one's behavior, it is important to know well how IHD manifests itself.

Signs of angina pectoris and myocardial infarction. For the first time, the classic description of an attack of "angina pectoris" (the so-called angina pectoris) was made by V. Heberden in 1768 at a lecture at the Royal College of Therapeutics in London.

During an attack of angina pectoris, a person has a feeling of pressure, heaviness, mixed with a feeling of dull pain in the central part of the chest, behind the sternum, sometimes somewhere deep in the throat. In some people, relatively severe pain is accompanied by fear, weakness, the appearance of cold sweat, but after 2-3 minutes the pain disappears and the person feels healthy again. In other people, this is not pain, but a kind of burning sensation, pressure behind the sternum or in the neck. (Fig. 6)

Usually, such short-term attacks occur in the morning when a person is in a hurry to work, especially in cold windy weather. This is a typical exertional angina.

Often, angina pectoris attacks develop after a hearty meal, during physical exertion, or shortly after great emotional stress, negative mental influences, or other unrest.

Figure 6. The area of ​​distribution of pain in angina pectoris

With rest angina, often occurring at night or early in the morning, when the patient is at rest, a large role is played by the factor of vascular spasm (one of the sections of the coronary artery). As a rule, such spasms occur in patients with arterial hypertension or with coronary arteries affected by atherosclerosis.

V last years the term "unstable angina" has become widespread. It is opposed to the definition of "stable angina", which is understood as a condition characterized by the patient's habitual attacks of short-term retrosternal pain that occurs in certain situations (fast walking against the wind, especially after eating, during unrest, etc.). A patient with stable angina pectoris should be systematically treated. There are no indications for his urgent hospitalization. Another thing is if angina pectoris appeared for the first time in life or its attacks became more frequent, if, along with angina pectoris, angina pectoris appeared at rest, attacks began to be worse removed by nitroglycerin, became sharper or longer. This type of angina is called unstable. Patients with unstable angina pectoris should be taken under special supervision, sharply limit their physical and emotional stress, monitor their ECG, and strengthen treatment with vasodilators. In most cases, such patients need to be hospitalized for intensive monitoring and active treatment. Attacks of unstable angina are also harbingers of myocardial infarction.

As already noted, it is not always easy to define a clear line between angina pectoris and myocardial infarction. Sometimes patients endure non-severe myocardial infarction “on their feet”, without medical assistance. However, for myocardial infarction in the initial period, a more typically violent and severe course. Acute myocardial infarction most often occurs as an attack of sharp, piercing, lingering pain or as a very painful feeling of squeezing the chest, as if someone is squeezing it in a vise. The patient is frightened, restless, he has difficulty breathing, he rushes about the room, not finding a place for himself. Excitation is replaced by weakness, cold sweat, especially if the pain lasts more than 1-2 hours.

During such an attack, nitroglycerin, which previously relieved the condition, almost does not reduce pain or has only a short-term effect. In the midst of pain, the patient becomes pale, his pulse is weak and frequent, the rise in blood pressure is replaced by its fall. This is the most dangerous period of the disease. Immediate medical intervention is required. Only by administering special medicines, an ambulance or emergency doctor manages to cope with an attack, and sometimes the patient has to be urgently hospitalized.

If a person first has an attack of angina or develops an attack of chest pain, accompanied by weakness, cold sweat, nausea and vomiting, dizziness, or a brief loss of consciousness, it is extremely important to call a doctor right away. Only a doctor is able to assess the characteristics of certain manifestations of the disease and prescribe additional studies, the results of which can make an accurate diagnosis, decide on the need for hospitalization and recommend the correct treatment.

All patients who are suspected of having a myocardial infarction should be in a hospital where there is the possibility of careful examination, observation and intensive treatment. There are wards in specialized departments where especially seriously ill patients are sent in order to establish permanent electrocardiographic monitoring for them, enhanced monitoring of medical and paramedical personnel and, as a result, to promptly recognize and treat such complications of myocardial infarction, which 10-15 years ago were considered incompatible with life.

In some patients, myocardial infarction develops suddenly, almost without any precursors, in the midst of seeming complete health. However, if such “healthy” people are examined before myocardial infarction, then the vast majority of them can detect certain signs of atherosclerosis of the heart vessels or metabolic disorders that developed long before the heart attack.

Establishing a diagnosis of myocardial infarction is sometimes difficult. An electrocardiogram, the results of a study of the cellular and biochemical composition of the blood, and data from other auxiliary diagnostic methods help to recognize the disease.

In many countries of the world, a preventive examination of the population is being carried out to detect latent HBO and underlying atherosclerosis of the coronary arteries. But so far, such inspections are not widespread. To prove that active prevention of myocardial infarction is necessary, we will provide some information about the spread of coronary artery disease and some of its complications.

Prevalence of coronary heart disease

It cannot be assumed that atherosclerosis did not occur in ancient times. Thus, atherosclerotic vascular lesions were found in Egyptian mummies. In the surviving ancient manuscripts of the Egyptians, in the Bible, heart pains are described, similar to those of angina pectoris. Hippocrates mentioned cases of blockage of blood vessels. The descriptions of the narrowed, tortuous sections of the vessels that Leonardo da Vinci left are interesting. He also noted that such changes are most often manifested in older people and suggested that they adversely affect the nutrition of tissues.

Since the 18th century, Italian anatomists began to describe cases of myocardial rupture in the dead, who during their lifetime suffered from pain in the heart. Correspondence of English scientists V. Heberden and E. Jenner (70s of the XVIII century) is known, in which E. Jenner gave examples of blockage of the coronary arteries in patients who died from an attack of angina pectoris (angina pectoris).

Russian doctors V. P. Obraztsov and N. D. Strazhesko in 1909 created a modern understanding of the clinical picture and the nature of acute coronary heart disease. The doctrine of coronary disease began to develop especially rapidly with the introduction of the method of electrocardiography (ECG) into clinical studies. In 1920, X. Purdy demonstrated ECG changes characteristic of myocardial infarction. Since 1928, the ECG method has been widely used in advanced cardiology clinics around the world. In our time, an electrocardiological study in 12-15 leads has become an integral method for diagnosing heart disease, not only in stationary, but also outpatient conditions. According to the results of an ECG examination of people during physical exertion, it is often possible to reveal hidden coronary disorders. Other subtle methods for diagnosing myocardial infarction are being improved by determining the activity of certain blood serum enzymes, for example, creatine phosphokinase, etc.

Thus, it is safe to say that myocardial infarction did not appear in the 20th century. Nevertheless, there is a complex of reasons that led to the widespread occurrence of this disease in our time.

Many do not imagine the whole danger of a sharp increase in cases of myocardial infarction and angina pectoris, since human psychology is being rebuilt gradually. Meanwhile, there are indisputable statistics showing that myocardial infarction and other "coronary catastrophes" have become the main cause of death in most of the most economically developed countries.

World Health Organization experts concluded that in the 70s of the XX century, mortality from cardiovascular diseases among men over 35 worldwide increased by 60%. At an international symposium in Vienna in 1979, it was reported that. of the 2 million deaths annually recorded in the United States, more than half are due to cardiovascular disease, including more than a third accounted for by coronary artery disease. In the US, about 650,000 people die from coronary artery disease every year.

The mortality rates of the population from cardiovascular diseases, including coronary artery disease, for a number of countries are shown in Fig. 7.

In general, in highly developed countries, out of ten people over 40 years old, five die from cardiovascular diseases. In Germany, about 250 thousand cases of myocardial infarction are registered annually, and the number of deaths from this disease from 1952 to 1974 increased by 5 times. In the Soviet Union, 514.4 thousand people died from atherosclerotic heart disease in 1976, in 1977 - 529.9 thousand people. According to the Central Statistical Bureau of the USSR for 1981, mortality from cardiovascular diseases in the country has stabilized, and in some union republics there has been a tendency to decrease it.

Rice. 7. Mortality of men aged 35-74 from various diseases per 100 thousand inhabitants in different countries

A population survey of large groups of residents of the largest cities of our country - Moscow, Leningrad and Kiev - was carried out in order to identify the prevalence of coronary artery disease among them and the factors contributing to its development. As expected, there was a regular increase in the prevalence of coronary artery disease with an increase in the age of the examined. So, among men of the city of Leningrad at the age of 20-29 years, the prevalence of coronary artery disease is less than 1%, 30-39 years - 5%, 40-49 years - 9%, 50-59 years - 18% and at the age of 60-69 years - 28 %. In general, it can be said that every sixth man aged 50-59 and every fourth man aged 60-69 are mountains. Leningrad suffer from coronary artery disease. Among women, the prevalence of coronary artery disease was approximately the same as among men, but severe forms of coronary artery disease were less common. According to the medical statistics of many countries, women in the premenopausal period get myocardial infarction incomparably less often than men. Therefore, the main attention was paid to the prevention of this disease among the male part of the population, although, as the results of population studies carried out during the USSR, it is necessary to carry out appropriate preventive measures among women.

It has already been noted above that coronary artery disease and myocardial infarction arise on the basis of atherosclerotic lesions of the coronary arteries of the heart. Modern medical literature is full of descriptions of the so-called CHD risk factors that contribute to the onset and progression of this disease. But first of all, we will try to tell you what atherosclerosis is and what its essence is.

Possession of knowledge about life-threatening situations and ways to overcome them often becomes saving for a person who finds himself on the verge of life and death. Such situations can undoubtedly include a heart attack called acute coronary heart disease. What is the danger of this situation, how to help a person with an acute attack of coronary artery disease?

Cardiac (oxygen starvation) develops due to insufficient oxygen supply to the myocardium caused by a violation of the coronary circulation and other functional pathologies heart muscle.

The disease can occur in acute and chronic form, and the second can be asymptomatic for years. What can not be said about acute coronary heart disease. This condition is characterized by a sudden deterioration or even cessation of coronary circulation, due to which death often becomes the outcome of acute coronary heart disease.

The most characteristic signs of acute ischemia:

• severe squeezing pains along the left edge or in the center of the sternum, radiating (radiating) under the shoulder blade, into the arm, shoulder, neck or jaw;
• lack of air, ;
• rapid or increased pulse, a feeling of irregularity in heart beats;
• excessive sweating, cold sweat;
• dizziness, fainting or impaired consciousness;
• change in complexion to an earthy shade;
• general weakness, nausea, sometimes turning into vomiting, which does not bring relief.

The occurrence of pain is usually associated with an increase in physical activity or emotional stress.

However, this symptom, most characteristically reflecting clinical picture, does not always appear. Yes, and all of the above symptoms rarely occur simultaneously, but appear singly or in groups, depending on the clinical. This often complicates the diagnosis and prevents timely provision of first aid for coronary artery disease. Meanwhile, acute ischemia requires immediate action to save a person's life.

Sequelae of coronary heart disease

How dangerous is an attack of ischemia of the heart?

What threatens a person with acute coronary heart disease? There are several ways to develop an acute form of IHD. Due to a spontaneously occurring deterioration in the blood supply to the myocardium, the following conditions are possible:

• unstable angina;
• myocardial infarction;
• sudden coronary (cardiac) death (SCD).

This entire group of conditions is included in the definition of "acute coronary syndrome", which combines different clinical forms of acute ischemia. Consider the most dangerous of them.

A heart attack occurs due to a narrowing of the lumen (due to atherosclerotic plaques) in the coronary artery, which supplies the myocardium with blood. The hemodynamics of the myocardium is disturbed so much that the decrease in blood supply becomes uncompensated. Further, there is a violation of the metabolic process and the most contractile function of the myocardium.

With ischemia, these disorders can be reversible when the duration of the lesion stage is 4–7 hours. If the damage is irreversible, necrosis (death) of the affected area of ​​the heart muscle occurs.

In the reversible form, necrotic areas are replaced by scar tissue 7–14 days after the attack.

There are also risks associated with complications of a heart attack:

• cardiogenic shock, serious failure of the heart rhythm, pulmonary edema against the background of acute heart failure - in the acute period;
• thromboembolism, chronic heart failure - after scarring.

Sudden coronary death

Primary cardiac arrest (or sudden cardiac death) provokes electrical instability of the myocardium. The absence or failure of resuscitation actions allows us to attribute cardiac arrest to SCD, which occurred instantly, or within 6 hours from the onset of the attack. This is one of the rare cases when the outcome of acute coronary heart disease is death.

Special hazards

Precursors of acute coronary artery disease are frequent hypertensive crises, diabetes mellitus, congestion in the lungs, bad habits and other pathologies that affect the metabolism of the heart muscle. Often, a week before an attack of acute ischemia, a person complains of pain in the chest, fatigue.

Particular attention should be paid to the so-called atypical signs of myocardial infarction, which make it difficult to diagnose, thereby preventing first aid for coronary heart disease.

You should focus on atypical infarct forms:

• asthmatic - when the symptoms manifest themselves in the form of aggravated shortness of breath and are similar to an attack of bronchial asthma;
• painless - a form characteristic of patients with diabetes mellitus;
• abdominal - when symptoms (bloating and abdominal pain, hiccups, nausea, vomiting) can be mistaken for manifestations of acute pancreatitis or (even worse) poisoning; in the second case, a patient who needs rest can arrange a “competent” gastric lavage, which will certainly kill a person;
• peripheral - when pain foci are localized in areas remote from the heart, such as the lower jaw, thoracic and cervical spine, edge of the left little finger, throat area, left hand;
• collaptoid - an attack occurs in the form of collapse, severe hypotension, darkness in the eyes, protrusion of "sticky" sweat, dizziness as a result of cardiogenic shock;
• cerebral - signs resemble neurological symptoms with a disorder of consciousness, understanding of what is happening;
• edematous - acute ischemia is manifested by the appearance of edema (up to ascites), weakness, shortness of breath, enlargement of the liver, which is characteristic of right ventricular failure.

Combined types of acute coronary artery disease are also known, combining signs of various atypical forms.

First aid for myocardial infarction

First aid

Only a specialist can establish the presence of a heart attack. However, if a person has any of the symptoms discussed above, especially those that have arisen after excessive physical exertion, a hypertensive crisis or emotional stress, it is possible, suspecting acute coronary heart disease, to provide first aid. What is it?

1. The patient should be seated (preferably in a chair with a comfortable back or reclining with legs bent at the knees), release him from tight or constricting clothing - a tie, bra, etc.
2. If a person has taken drugs previously prescribed by a doctor from (such as Nitroglycerin), they should be given to the patient.
3. If reception medicinal product and sitting quietly for 3 minutes will not bring relief, you should immediately call an ambulance, despite the heroic statements of the patient that everything will pass by itself.
4. In the absence of allergic reactions to Aspirin, give the patient 300 mg of this medicine, and the Aspirin tablets should be chewed (or crushed into powder) to accelerate the effect.
5. If necessary (if the ambulance is not able to arrive on time), you should take the patient to the hospital yourself, monitoring his condition.

According to the 2010 European Resuscitation Council guidelines, unconsciousness and breathing (or agonal convulsions) are indications for cardiopulmonary resuscitation (CPR).

Medical emergency care usually includes a group of activities:

• CPR to maintain airway patency;
• oxygen therapy - the forced supply of oxygen to the respiratory tract to saturate the blood with it;
• indirect heart massage to maintain blood circulation when the organ stops;
• electrical defibrillation, stimulating myocardial muscle fibers;
• drug therapy in the form of intramuscular and intravenous administration of vasodilators, anti-ischemic agents - beta-blockers, calcium antagonists, antiplatelet agents, nitrates and other drugs.

Can a person be saved?

What are the prognosis in the event of an attack of acute coronary heart disease, is it possible to save a person? The outcome of an attack of acute coronary artery disease depends on many factors:

• clinical form of the disease;
• patient comorbidities (eg. diabetes, hypertension, bronchial asthma);
• timeliness and quality of first aid.

The most difficult thing to resuscitate patients with a clinical form of coronary heart disease, called SCD (sudden cardiac or coronary death). As a rule, in this situation, death occurs within 5 minutes after the onset of the attack. Although it is theoretically believed that if resuscitation is carried out within these 5 minutes, a person will be able to survive. But such cases are almost unknown in medical practice.

With the development of another form of acute ischemia - myocardial infarction - the procedures described in the previous section may be useful. The main thing is to provide a person with peace, call an ambulance and try to relieve pain with the heart remedies at hand (Nitroglycerin, Validol). If possible, provide the patient with an influx of oxygen. These simple measures will help him wait for the doctors to arrive.

According to cardiologists, the worst-case scenario can be avoided only if one is attentive to one's own health - maintaining a healthy lifestyle with feasible physical activity, giving up bad addictions and habits, including regular preventive examinations to detect pathologies in the early stages.

Useful video

How to provide first aid for myocardial infarction - see the following video:

Conclusion

1. Acute coronary artery disease is an extremely dangerous type of cardiac ischemia.
2. In some clinical forms, urgent measures for acute ischemia of the heart may be ineffective.
3. An attack of acute coronary artery disease requires calling an ambulance and providing the patient with rest and taking heart medications.