Coronary heart disease is a formidable disease, from which 700 thousand patients die in Russia every year.
Mostly men aged 55 to 65 years suffer from pathology. An untreated illness, or the late initiation of its therapy, can lead to disability, or even death of the patient.
Coronary artery disease develops against the background of an imbalance between the need for blood supply to the heart muscle and the actual coronary circulation. Another option - the need for blood supply remains the same, but the coronary circulation is greatly impaired.
What it is?
Coronary artery disease is a pathological disturbance of myocardial activity caused by insufficient or abruptly terminated blood supply to the heart muscle.
This disease is characterized by the occurrence of acute (myocardial infarction or cardiac arrest) or chronic (angina pectoris, postinfarction cardiosclerosis, heart failure) conditions.
Most often, ischemic heart disease is the result of a person reaching a certain age. In patients older than 50 years, the pathology is much more common, although some young people may also have some of its symptoms. The situation with coronary artery disease is very ambiguous, since in some patients the disease manifests itself earlier, in others later, and in some people it may not even occur at all even in old age.
The development of pathology is influenced by numerous factors, both pathological and external. Accelerate the occurrence of coronary artery disease may have a patient:
- bad habits;
- addiction to junk food;
- obesity or overweight;
- genetic susceptibility to the disease;
- hypertension, etc.
Hypodynamia and failure to follow a diet in the presence of CVD can also lead to coronary heart disease.
The above factors predispose to the development of atherosclerotic disease, which occurs due to a violation of the ratio of different types of cholesterol. Pathologists occur with prolonged increases in LDL (low density lipoprotein, or bad cholesterol) and lower HDL (high density lipoprotein, or "good" cholesterol). The formation of cholesterol plaques causes a narrowing of the lumen of the coronary vessels, against the background of which ischemia develops.
It is for this reason that it is extremely important to regularly measure the concentration of cholesterol in the blood. And this concerns, first of all, hypertensive patients, patients with obesity and bad habits. Persons with similar medical conditions in the family history are also advised to monitor the level of LDL.
CHD is most susceptible to male representatives. The fact is that the female body produces sex hormones that protect vessels from cholesterol deposits, in men, the concentration of such substances is scanty. Although during menopause, when estrogen and progesterone levels decrease, CRP and, therefore, coronary disease, can be felt.
Failure to follow the diet for CVD and the abuse of harmful food also leads to an excess of harmful cholesterol in the body. This problem is particularly relevant in the developed countries of Europe, as well as in the United States.
The menu of many people is dominated by fatty meats, butter, hard cheeses, eggs and various types of caviar. Such products should be limited to the maximum, but it is not always necessary to completely exclude them from the diet. In the end, with food, only a small amount of cholesterol enters the human body, because most of it is synthesized by the liver.
Therefore, the harmfulness of cholesterol is a relative and ambiguous question. After all, it is known that a substance takes an active part in many metabolic processes.
Symptoms and forms of coronary heart disease
The classification of IHD approved in 1979 is generally accepted. Such a gradation of pathology implies its division into several independent diseases with their own specific symptoms, but belonging to the same class. In addition, the treatment and life projections of these ailments differ, which also caused such a classification.
To date, there are 5 main clinical forms of coronary heart disease. Each of them requires more detailed consideration.
Sudden cardiac or coronary death
This is the most dangerous form of coronary heart disease, accompanied by a high percentage of mortality. Death can occur instantaneously, or within 6 hours from the time the seizure develops, which is characterized by severe chest pain. The causes of this condition may lie in:
- cardiac arrhythmias;
- complete obstruction of the coronary arteries;
- severe electrical instability of the heart muscle.
Sudden cardiac / coronary death most often occurs due to excessive consumption of alcoholic beverages. Typically, patients do not even realize that they have coronary heart disease than they expose themselves to even greater risk of developing this condition and, as a consequence, a sudden death.
This is a rather severe form of coronary artery disease, which can lead to disability or death of the patient. Patients with myocardial infarction complain of severe, acute, rending pain in the heart zone or behind the sternum. Pain can radiate to the scapula, left arm, lower jaw. The duration of the attack - more than 30 minutes.
A distinctive feature of myocardial infarction is that after taking nitroglycerin pain does not go away completely. They can only decrease for a short time or only slightly.
In parallel with this, the patient is tormented by feelings of lack of air, cold sweats, severe weakness, hypotension, an attack of fear or panic may appear. A heart attack is often accompanied by nausea, sometimes with vomiting. For the disease is characterized by the death of the tissue of the heart muscle - myocardium, due to which the body loses the ability to normally contract. The healthy part of the heart begins to work with increased stress, which can later lead to the rupture of dead tissue. It is for this reason that people call a heart attack "heart failure."
Any physical activity is a serious danger to the life of the patient. The essence of the therapy is to accelerate the process of scarring of the dead tissues of the heart, and the organ continued to function. This effect is achieved through the use of special medical drugs. In the absence of contraindications to patients, an individual schedule of physical activity is developed.
Angina pectoris is accompanied by severe pain in the left side of the chest, localization - retrosternal space. There is a feeling of heaviness, pressure in the heart. Previously, this phenomenon was called "angina pectoris".
Pain syndrome may have a different character - oppressive, stabbing, compressive. Pain can be given in the left shoulder blade, arm, lower jaw, stomach. Along with them, symptoms such as feelings of anxiety or fear, cold sweat, tremor of the limbs, and lack of air can also appear.
Angina pectoris usually lasts for several minutes. It develops suddenly and, as a rule, at the time when a person performs active physical exertion. Because of the manifestation of angina, the patient must stop to wait until the condition passes by itself. As a result, angina pectoris is also called the "disease of shop window observers."
Heart rhythm and conduction disorders
This form of coronary artery disease has many other types of heart disorders. Their cause is a failure in the process of conducting cardiac impulses through the conductive cardiac system. As a result, patients have complaints about the feeling that the heart is intermittent, trembling, freezing.
Such cardiac rhythm or conduction disturbances can occur against the background of endocrine system malfunctions, metabolic disorders, drug or toxic effects on the body. In some cases, arrhythmias are caused by structural changes in the cardiac conduction system and myocardial tissues.
Heart failure is a pathology that is characterized by the inability of the heart to supply the body with the necessary amount of blood due to a decrease in the contractile activity of the myocardium. The disease often develops after patients with heart attacks, arrhythmias, or cardiac conduction disorders.
In any etiology of this disease, the work of the heart is impaired and unsatisfactory. For CH characterized by:
- dyspnea at rest;
- swelling of the lower extremities;
- swelling of the veins in the neck;
- enlarged liver in size;
- general weakness even with little exertion and at rest.
In addition, while listening to the chest, the doctor may hear pulmonary rales.
Statistical accounting of the incidence of CHD is carried out using ICD 10 revision. Pathology can occur in acute form in the form of myocardial infarction or sudden coronary death. Other forms of the disease are stable angina, cardiosclerosis, CHF.
Diagnosis of coronary heart disease is a time consuming process that requires a variety of research procedures. And it concerns not only hardware examination, but also laboratory tests.
To begin with, a detailed patient survey is conducted, during which the doctor examines the symptoms that are disturbing the patient. Next, a phonendoscopy is performed — a procedure for listening to the chest (in this case, the heart) with a phonendoscope. Only after that other diagnostic procedures are prescribed:
- ECG. With the help of an electrocardiograph, electrical impulses are propagated to the heart. The procedure helps to identify the transferred heart attack, which the patient himself might not have known. A variation of this research is Holter ECG monitoring. For this purpose, a special device is used - a holter with an integrated ECG device. Periodically, it turns on, and captures the activity of the heart. All information is recorded on the device, and then decrypted by a specialist.
- Echocardiogram (EchoCG). In other words, it is an ultrasound of the heart that helps to understand how the heart functions as a whole, and to identify defects in the activities of its individual parts.
- ECG or echocardiography with a load. In many patients, IHD attacks develop only during physical or psychological stress. The diagnostic measures under consideration are based on the use of electrodes or sensors and the occupation of a person on a stationary bike or a treadmill. During this process, the devices read information about the work of the heart.
- Coronary angiography. The procedure helps to assess the patency of the coronary arteries. To do this, a special contrast agent is introduced into the vessels, followed by X-ray. Thanks to the dye, the doctor identifies the affected vascular areas where atherosclerotic foci are located. However, coronary angiography is not a safe manipulation. She has a number of contraindications, including: pregnancy, lactation, child age, intolerance to a contrast agent, etc. Moreover, such an event can give complications to the heart or kidneys. But if it is necessary to perform a stenting or coronary artery bypass surgery, the benefits of this study greatly exceed the possible risks.
- CT Using computed tomography, you can determine the amount of calcium deposits on the vascular walls. Based on the data obtained, the risk of myocardial infarction is assessed. For a more detailed picture of the patient is directed to MRI.
The diagnosis of CHD is always made only with decoding. For example, in the patient's card can be written: "coronary artery disease: first manifested exertional angina." Coronary artery disease in all cases is accompanied by atherosclerotic lesion of blood vessels, which can lead to very serious and dangerous consequences.
In most patients, angina pectoris is manifested - bouts of intense chest pain. Myocardial infarction, post-infarction cardiosclerosis, and heart failure are the worst variants of coronary artery disease.
How to treat?
To date, there are many techniques that help in the treatment of coronary artery disease. Their use helps to reduce the frequency of manifestations of the disease, prevent complications, prolong the life of the patient and improve its quality.
Therapy may be conservative or surgical.
Pharmacotherapy for ischemic heart disease is reduced to the use of antianginal medications that help minimize the incidence of angina attacks. Most commonly used:
- Nitrates (for example, the drug nitroglycerin). This tool helps to expand the coronary arteries and stimulate the transport of oxygen to the myocardium. Nitroglycerin is advisable to use for angina pectoris, chest pains with myocardial infarction, pulmonary edema.
- Beta-blockers (Bisoprolol, Atenolol, Metaprolol, Anaprilin, etc.). They stop tachycardia, lower blood pressure, reduce myocardial oxygen demand, thin the blood. Beta-blockers are indicated for angina and CHF.
- Calcium antagonists (verapamil, nifedipine, pharmadipine, etc.). Such drugs have a pronounced antianginal, antihypertensive effect, as well as improve endurance of the body during exercise.
- Thrombolytics and antiplatelet agents (Heparin, Streptokinase, etc.). Therapy with the use of these funds is necessary for myocardial infarction. These groups of drugs accelerate the process of dissolution of a blood clot, improving the permeability of the affected vessel.
In case of acute IHD attacks, immediate medical intervention is necessary. First aid is the use of painkillers, thrombolytic, and sometimes plasma-substituting drugs. In some cases, defibrillation is performed.
When drug therapy is ineffective, or there is a threat of heart attack, surgical treatment of coronary artery disease is performed:
- Coronary angioplasty, which is not only a medical, but also a diagnostic procedure. A stent is inserted into the affected artery to prevent re-narrowing of its lumen.
- Aortic coronary bypass. Surgical method creates a bypass channel, which makes it possible to resume blood supply to the myocardium.
It is possible to use other surgical techniques - minimally invasive coronary bypass surgery, brachytherapy, transmyocardinal laser revascularization, etc. The choice of the type of surgical intervention depends on the severity of the course of coronary artery disease, its form and the presence of certain indications.
Nutrition and Diet
In the treatment of coronary artery disease, not only the conduct of pharmacotherapy, but also the elimination of factors provoking repeated attacks of the disease is of paramount importance. One of them is a poor diet with a predominance of junk food.Another nuance is smoking, which considerably aggravates the course of IHD, and in fact nullifies the effect of all previously conducted therapeutic measures.
Diet for this pathology requires complete exclusion from the diet:
- fried and fatty dishes;
- animal fats;
- products enriched with easily digestible carbohydrates.
If the patient suffers from obesity, a separate diet is developed for him with a parallel restriction on calories.
To maintain normal heart function, it is recommended to use:
- cereals, soups;
- vegetable oils;
In case of IHD, intense physical exertion is contraindicated, but moderate activity is very helpful. So, a properly selected course of exercise therapy helps strengthen the heart muscle, supply it with oxygen, and improve blood circulation. Walking in the fresh air and doing some exercises under the control of a trainer will help to significantly reduce the number of attacks of CHD.
Prevention of ischemia is:
- avoiding alcohol abuse;
- full exclusion of smoking;
- maintaining a stable psycho-emotional state and avoiding stress;
- performing moderate physical exertion, maintaining a physically active lifestyle;
- reducing the frequency of consumption of harmful food;
- balanced nutrition, based on the use of cereals, fish, berries, vegetables and fruits;
- avoiding overeating;
- fight overweight and obesity.
If you follow all the above recommendations and rules, then even the patient who has a genetic predisposition can avoid ischemia.
The predictions for CHD are directly dependent on the form of its course and combination with various factors, especially pathological ones.
So, ischemia is considered unfavorable, occurring in conjunction with arterial hypertension, severe lipid metabolism disorders or diabetes. In this case, therapy helps to slow the further progression of the pathology, but it is not possible to completely get rid of it.