Changing lifestyle: If you smoke, give up this, more often walk in the fresh air, reduce excess body weight. Avoid the dangers of consuming fatty products and follow the diet with low salt and sugar. Carefully monitor the sugar level if they suffer from diabetes. The CHD is not treated only by applying nitroglycerin. To continue active life, you must establish contact with the cardiologist and follow its instructions.
Medicines for IBS
A cardiologist can advise drug therapy if the lifestyle changes will seem insufficient. Preparations appoints only the attending physician. Most often, drugs that reduce the risk of thrombosis (aspirin, platinum) are prescribed. To reduce cholesterol levels, statins can be applied for a long time. Cardic insufficiency should be treated with drugs that improve the function of the heart muscle (heart glycosides).
Those who had a history of heart disease, aspirin reduces the likelihood of myocardial infarction, but does not change the overall risk of death. It is recommended only for adults who are exposed to the hazard of the formation of thromboms, where the increased risk is defined as "men older than 60 years old, women in postmenopausal and young people with a background for the development of the IBS (hypertension, diabetes or smoking).
- Antitrombocyte therapy
Clopidogrel plus aspirin (double antithromobocutary therapy, DAAT) more reduces the likelihood of cardiovascular events than only aspirin. This preparations are contraindicated in patients with gastrointestinal ulcers or gastric bleeding in history. Antitrombocyte therapy should be carried out for life.
Adrenoblays reduce heart rate and consumption of oxygen myocardium. Studies confirm an increase in lifespan when receiving β-adrenobloclars and a decrease in the frequency of cardiovascular events, including repeated. β-adrenoblays are contraindicated with accompanying light pathology, bronchial asthma, COPD.
- β-adrenoblays with proven properties of improved forecasting with IHD:
- Carvedilol (dilantrend, acridylol, Talliton, Coriol).
- Metoprolol (Betalok Zok, Betalok, Egilov, Metokard, Vazocardin);
- Bisoprolol (Concorp, Niperthen, Coronal, Bisogamma, Biprol, Cordinorm);
Preparations of this group reduce cholesterol levels due to a decrease in its synthesis in the liver, or inhibit the absorption of cholesterol coming from food, affecting the causes of atherosclerosis. Medicines are applied to reduce the rate of development of existing atherosclerotic plaques in the wall of the vessels and the prevention of new ones. There is a positive effect on the degree of progression and development of IHD symptoms, the lifespan, also these drugs reduce the frequency and severity of cardiovascular events, possibly contributing to the restoration of the lumen of the vessel. The target level of cholesterol in patients with IHD should be lower than those without IHD, and is 4.5 mmol / l. In the blood tests, the Target Level of LDL in patients with IHD should be no more than 2.5 mmol / l. Determining the level of lipids must be carried out every month. Main preparations: Lovastatin, Simvastatin, Atorvastatin, Rosavastatin.
The class of drugs that increase the anti-theaterogenic fraction of lipoproteins - HDL, with a decrease in which mortality from IBA increases. Apply to the treatment of dyslipidemia IIA, IIB, III, IV, V. differ from statins by the fact that reduce triglycerides and can increase the fraction of the HDL. Statins mainly reduce LDL and do not have a significant effect on LPONP and HDL. Therefore, the maximum effect is manifested in a combination of statins and fibrats.
Nitroglycerin is a major drug that stops the styled pain in the heart. Nitrates mainly act on the venous wall, reducing the preload on myocardium (by expanding the vessels of the venous bed and blood deposition). The unpleasant effect of nitrate is to reduce blood pressure and headaches. Nitrates are not recommended for arterial pressure below 100/60 mm Hg. Art. Modern studies have been proven that the reception of nitrates does not improve the prediction of patients with IBS, that is, does not lead to an increase in survival, and therefore are used as a drug to relieve the symptoms of IBS. Intravenous drip administration of nitroglycerin, allows you to effectively deal with angina phenomena, mainly against the background of high blood pressure numbers. Every patient with IBS should know that if the reception of nitroglycerin at home did not remove the sore pain, then it is necessary to cause ambulance, as it was possible to develop a heart attack.
Coronary angioplasty and stenting
This is a modern technology for restoring coronary arteries with IHD. The meaning is to inflate atherosclerotic plaques with a special cylinder and strengthen the vascular wall with a metal frame - a wall. Coronary angioplasty is carried out without cuts in patients with severe angina or myocardial infarction.
Open operation for the narrowings of coronary arteries. The meaning is to create a workaround for blood. As a collaboration, their own veins or patient artery are used. The operation can be carried out with or without artificial blood circulation. Due to the development of coronary angioplasty technology, the aorticonophone shunting retreats to the second plan, as it is more traumatic and is used only with extensive lesions of the coronary direction.
Up to 90% of cardiovascular diseases can be prevented if you avoid installed risk factors. Prevention includes adequate exercise, decrease in obesity, high blood pressure, healthy nutrition, cholesterol level decline and smoking cessation. Medicines and physical exercises are approximately equally effective. A high level of physical activity reduces the likelihood of ischemic heart disease by about 25%.
In diabetes mellitus, hard control of blood sugar reduces cardiac risk and other problems, such as renal failure and blindness.
The World Health Organization (WHO) recommends "low or moderate alcohol use" to reduce the likelihood of the development of ischemic heart disease, while abuse is very dangerous for the heart.
The diet with a high content of fruits and vegetables reduces the risk of developing cardiovascular diseases and death. Vegetarians have a lower risk of heart disease due to their greater use of fruits and vegetables. It has been shown that consumption of transgins (commonly contained in hydrogenated products, such as margarine) causes atherosclerosis and increases the risk of coronary heart disease.
- Secondary prophylaxis
- Secondary prophylaxis is the prevention of further complications of existing diseases. Effective lifestyle changes include:
- Weight control at home
- Refusal of bad habits - cessation of smoking
- Avoid consumption of transgins (in partially hydrogenated oils)
Reducing psychosocial stress
Regular determination of blood cholesterol
Aerobic exercises, such as walking, jogging or swimming, can reduce the risk of mortality from coronary heart disease. They reduce the blood pressure and the amount of cholesterol in the blood (LDL), and also increase HDL cholesterol, which is a "good cholesterol". It is better to be treated by physical education than to expose yourself the danger of surgical interventions on the heart. Read more about treatment in our clinic Publication date July 19 2020.
July 23, 2020. Definition of the disease. Causes of the disease Ischemic heart disease (IBS) .
- This is an acute or chronic disease associated with a decrease or complete stopping of myocardial blood supply (muscular heart fabric). The CHD occurs as a result of the narrowing of the glorification of the arteries of the heart when atherosclerotic plaques appear in them. The influx of blood to the heart and its "nutrition" decreases or stops completely, which leads to the development of ischemia. Most often, the disease is manifested by an attack of pain in the heart (angina region) against the background of a physical or emotional load. If the load is excessive, the heart attack (death) of myocardium can develop
[five] In economically developed countries, IBS is very common. According to the World Health Organization, the death rate from heart disease and vessels is 31% and is the most common cause of death in the world. In the Russian Federation, mortality from heart disease and blood vessels is 57%, of which 29% drops to the share of IBS. .
Not only the elderly, but also people of younger age suffer from coronary heart disease, for example, men at the age of 40. However, the frequency of ischemic heart disease increases significantly with age
The cause of the occurrence and development of IBS is atherosclerosis of heart (coronary) arteries, which supply myocardia blood. There are modifiable (changeable) and unmodified (unchangeable) risk factors for the development of IBS. Changeable factors, elimination or correction of which significantly reduce the risk of developing and developing the IBS: one.
Smoking. It has been proven that smoking increases mortality from heart disease and vessels (including IBS) by 50%. It should be noted that the risk grows with age and the number of cigarettes of cigarettes. Benzole, Nicotine, Ammonia, the damp gas contained in tobacco smoke cause an increase in blood pressure and an increase in heart rate (tachycardia). Smoking enhances blood coagulation and the development of atherosclerosis, contributes to the development of heartframe spasms. 2. High cholesterol ( Hyperholesterolemia
). Thanks to numerous studies conducted in different countries of the world, it was established that the increase in the blood cholesterol level is an independent risk factor for the Risk of IBS, both in men and women. In persons with a moderate increase in cholesterol levels (5.2-6.7 mmol / l), it is two times more common than in humans with a normal blood cholesterol (less than 5.2 mmol / l). With a pronounced increase in cholesterol (more than 6.7 mmol / l), the incidence of IBS increases by 4-5 times. The ongoing "bad" cholesterol of low density lipoproteins (HSLPNP) is most influenced by the risk of occurrence and development of the IBS. .3.
Arterial hypertension The risk of developing the CHD with an increase in blood pressure increases three times, especially with pathological changes in target organs (for example, in heart and kidneys). .four.
Diabetes Atherosclerosis and IHR develop 10 years earlier in patients with diabetes mellitus compared with people who do not have this disease.
five. Reducing the level of "good" cholesterol high density lipoproteins (HSLPVP) and an increase in the content of triglycerides (TG) in the blood.
6. Low physical activity (hypodymna). 6. Excess body (
7. Food with excess calorie and high animal fat content. eight.
Stress factors and personality type A (stress-coronary profile).
The cause of the occurrence and development of IBS is atherosclerosis of heart (coronary) arteries, which supply myocardia blood. There are modifiable (changeable) and unmodified (unchangeable) risk factors for the development of IBS. For people with a so-called stress coronary profile (type of personality a), the following features are characteristic: anger, depression, a sense of constant anxiety, aggressiveness. Psycho-emotional stress in combination with the specified personality features is accompanied by high emissions to the blood of catecholamines. This increases the frequency of heart abbreviations, causes an increase in blood pressure and strengthens the need for the heart muscle in oxygen.
Smoking. Factors that cannot be changed:
Male gender. Elderly age.
Arterial hypertension 3. Early development of IBS (in particular myocardial infarction) in close relatives of the patient.
Menopause and postmenopausal period.
The hormonal function of the ovaries protects the female organism from the development of IBS. The risk of developing the disease in women is increasing after the onset of menopause.
It should be emphasized that the risk of IBA increases with a combination of several factors.
When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
- Symptoms of Ischemic Heart Disease
- Symptoms of IBS depend on the clinical form of the disease. Main forms:
- Sudden heart (coronary) death;
- angina ("breast toad", pain in the heart);
- myocardial infarction (death);
- cardiosclerosis (substitution of muscle tissue connective);
- blood circulation failure;
heart rhythm disorders; Myocardial Cheering Ischemia.
With a sudden cardiac (coronary) death Approximately three minutes after stopping the blood circulation in the cerebral cells of the brain, irreversible changes occur, so immediate diagnosis and emergency care is necessary. The reason for this state consists in sudden ventricular fibrillation - a malfunction of heart rhythm, which is characterized by a chaotic reduction in the muscles of the heart with a high frequency. After 3-4 seconds after the onset of fibrillation appear Dizziness and weakness. After 15-20 seconds Loses consciousness. 40 seconds develop characteristic Causes - one-time tonic reduction of skeletal muscles. At the same time, that is, in 40-45 seconds, start Expand pupils and reaches the maximum size after 1.5 minutes. The maximum expanded pupils indicate that half the time passed during which the brain cells are still possible to restore. Breathing first noisy and frequent, then gradually penetrates. Ischemic heart disease (IBS) .
In the second minute of sudden cardiac death Breathing stops Under angina which is one of the most frequent clinical forms of IBS, arise
Top-like pain or discomfort in the heart area. This is due to the insufficient blood supply to the heart muscle (ischemia), which is associated with a decrease in blood flow, but without the development of necrosis (samples) of the heart muscle.
Characteristic of pain.
Most often, pains are compressing and pressing character and occur pariety. The most typical localization of the pain behind the sternum. In most cases, pain appears inside the chest, in the region of the top of the sternum, and then distributed to the entire area of the heart. Less often the pain begins on the left, near the sternum, it is possible to localization in the field of epigastria. Pains are often accompanied by painful sensations, a sense of approaching death, "cardiac longing", sometimes nausea and even vomiting.
For angina, the irradiation (distribution) of pain in the left shoulder or left hand (brush, left mysinette), left blade, to the cervical area, lower jaw and teeth, rarely - on the right shoulder, right blade and even in the lumbar region. It should be noted that in some cases the pain during angina may be localized not behind the sternum, but in an atypical location, for example, only in places of irradiation or in the right half of the chest.
Pain intensity. The pain under angina is quite intense, but each patient has its strength, which is explained by the threshold of pain sensitivity. There are also nonsense forms of IBS.
Factors causing angokard attack. The main factors causing pain attacks are the physical and emotional load, an increase in blood pressure and tachycardia (regardless of the cause of its occurrence).
The main clinical symptom of spastic angradia It is suddenly occurring at rest, out of connection with the physical activity or a rise in blood pressure, an attack of intense pain in the heart. This pain has, as a rule, typical prudged localization and distribution and lasts 10-20 minutes. A characteristic feature is the appearance of bouts of pain in the time of time from midnight to 8 am, often in 3-4 o'clock. Stenicard attacks sometimes become cyclical, in the form of a series of attacks of 2-5 seizures, following one by one at intervals from 2-15 to 30-60 minutes. Stenicard attacks are single, but they can occur regularly: once a day, once a week or a month. Ischemic heart disease (IBS) .
The most characteristic symptom of myocardial infarction is pain.
Most patients with heart pains are extremely intense. Patients characterize them as strong, compensation, compressing. Many patients note intensive burning or sharp "daggie" pain. In typical cases, most patients pain is localized in the stubborn area, but quite often captures the zone to the left of the sternum or even the entire surface of the chest. The pain always lasts several dozen minutes. During painful attack, patients experience a sense of death, doomes, longing, are restless and excited
Pathogenesis of Ischemic Heart Disease The development of the IBS is based on the narrowing or complete blockage of heart arteries atherosclerotic plaques, as well as thrombotic masses (with myocardial infarction). In case of disease, the need of myocardium in oxygen and ensuring its blood does not correspond to each other. The heart muscle lacks blood, which delivers oxygen and nutrients to its cells.
One of the most common forms of IBS is angina ("breast toad"). There are several pathogenetic Types of angina:
- 1. Angina, due to an increase in the need of myocardium in oxygen.
- An increased need of myocardium in oxygen in patients with angina may cause:
- excessive release of adrenaline and the excitation of the sympathetic nervous system under the influence of psycho-emotional and physical stress, while rapid heartbeat (tachycardia) occurs;
- Acceptance of food, especially overeating and consuming products causing increased gas formation in the intestines;
- sexual intercourse accompanied by emotional and physical overload, activation of the cardiovascular system;
- Tachycardia of any origin - with an increase in body temperature, excessive thyroid function (thyrotoxicosis), unrest and experiences, physical exertion, etc.;
hypokalemia (decrease in blood potassium concentration); The effects of cold, as well as inhalation of frosty air.
Male gender. 2. Stegonland arising from the temporary disadvantage of ensuring the heart muscle with oxygen. In this case, the narrowing caused by the plaque in the heart artery is enhanced by the "layering" of an additional spasm and, as a result, the dynamic deterioration of the coronary blood flow. The arteries of the heart is often provoked by cold, psycho-emotional stressful situations and a sudden increase in blood pressure.
Mixed angina (found most often).
In the origin of mixed angina, they play a role as an increase in the needs of myocardium in oxygen and decrease in blood flow through cardiac arteries, as a result of which the security of myocardium is reduced by oxygen. During angina, regardless of its pathogenetic type, the same type of exchange processes occur in the heart muscle. The violation of energy metabolism in myocardium is accompanied by a decrease in its contractile function. First, he suffers from the relaxation of the heart during the diastole (the period of relaxation of the heart muscle), then the reduction of the heart is disturbed during the systole (reducing period of the heart muscle). The violation of energy metabolism leads to a change in the flow of electrical processes on muscular fiber membranes, which causes the myocardial changes in the ECG characteristic of ischemia (insufficient blood supply).
The main cause of myocardial infarction (samples) It is the atherosclerosis of the heart arteries (the occurrence of plaques in the arterial wall), the gap of the atherosclerotic plaques and the developing thrombosis (clogging of the thrombus) artery with myocardium blood. The spasm of coronary arteries is also important.
- At the heart of sudden cardiac death
- The following pathologies lie:
- ventricular fibrillation - inconsistent and very rapid reductions in ventricles;
- Trepping ventricles - ventricular reductions are coordinated, but their frequency is too large and blood release during systole from the heart does not occur in the aorta; Asistolia - complete cessation of heart activities; .
Electromechanical heart dissociation - cessation of the pump function of the left ventricle while maintaining electrical activity of the heart
- Classification and stage of development of ischemic heart disease Clinical classification includes the following IBS forms:
- Sudden heart (coronary) death (primary heart stop)
- - This is death that comes instantly or within 1-6 hours. It is due to the most often fibrillation of ventricles and is not related to signs that allow you to put any other other than the CHD, diagnosis.
- Unstable walls of angina: for the first time arising (continues to one month from the moment of occurrence, characterized by the variability of the clinical picture); progressive angina stress; spontaneous (vasospast angina);
- Stable angina stress (there is more than one month, characterized by stereotypical (the same) bolt or discomfort attacks in the heart area in response to the same load.
- Inexacade (sample) myocardium (primary, repeated):
- With the token q - large-scale, through the entire wall of myocardium;
- Without a q - small-scale, not so extensive.
- Cardiosclerosis after heart attack cardiac muscle.
- Insufficiency of blood circulation (ischemic cardiopathy). Heart rhythm.
Cheering or "Mile" ischemia (insufficient blood supply) - The clinical form of IBS, in which the transient violation of the supply of the heart muscle with blood is not accompanied by a pain attack and is detected only with the help of tool methods of the survey.
- According to the functional classification of angina Developed by Canadian Cardiovascular Society distinguish the following classes of angina:
- I class. Casual, ordinary physical activity (walking or lifting the stairs) does not cause a painful attack. Pain appears as a result of intensive, fast or long-term load.
- Class II. There is a slight limitation of daily activities and familiar physical activity. The bouts of pain occur when walking at a level place at an average pace (from 80 to 100 steps per minute) for a distance of more than 500 meters, with a staircase in the stairs more than one floor. The risk of an attack of angina rises with emotional excitement, after eating, in cold and windy weather, in the morning after awakening.
- III class. A pronounced restriction of everyday physical activity. Pain attacks occur when walking at a normal pace at a level place at a distance from 100 to 500 meters and at a lift to one floor. IV class. .
The minimum household and emotional load cause pain, patients are not capable of performing any physical activity without an attack of angina. The attack of pain occurs when walking at a level place at a distance of less than 100 meters. Characteristic pain in peace, during sleep and when switching to a horizontal position
Complications of ischemic heart disease
- CHA complications include heart arrhythmias and conduction disorders. They are associated with ischemia (insufficient blood supply) in the field of sinus node, an atrioventricular compound and other departments of the conductive heart system.
- Violations of rhythm and conductivity often complicate the course of heart attack (samples) of the heart muscle. Chronic ischemia (insufficient blood supply) Myocardial with IHD causes:
- diffuse cardiosclerosis (replacement of the midst of the middle of the heart muscle with a connective tissue);
- change of heart muscle;
ischemic cardiomyopathy (decrease in the contractile ability of myocardium);
Chronic heart failure. IV class. .
Heart failure may complicate the course of various forms of IBS, but it may be its only manifestation.
Post-infarction cardiosclerosis is diagnosed in two months from the moment of myocardial infarction. The diagnosis is based on the identification of the absence of a reduction in myocardium in ultrasound examination of the heart, as well as on the basis of the presence of various heart arrhythmias and conductivity disorders. Post-infarction cardiosclerosis contributes to the development of blood circulation deficiency
Female cases can be both a form of IBS (sudden heartfelt) and the complication of its flow during rhythm violations.
Diagnosis of Ischemic Heart Disease Early and timely diagnosis of IBS is of great importance. Stress angina with a clear clinical picture (that is, with all the classical typical characteristics of anginaartic pain) to identify relatively easy. However, the likely diagnosis of angina must be confirmed by instrumental techniques.
During the attack of pain, it is important, but it is not always possible to fix it during a painful attack, as it continues for a long time, the patient stops the load, stops and accepts nitroglycerin. It is important to note that the changes in the ECG during a pain attack, as well as during the intercreant period there may be absent. For diagnosis of IHD and angina applied
Halter ECG monitoring - ECG registration is carried out in conditions of the usual activity for a patient of activity during the day or longer. During daily monitoring, the examiner leads a diary of daily activity, in which the time of sleep, the power mode, the type and time of physical activity, arising during the day of the symptoms (pain in the heart, dizziness, faint, etc.) and the time of their appearance. Daily Halter monitoring ECG allows not only to diagnose IHD, but also to identify rhythm disorders, as well as signs of high risk of coronary complications. To identify IHD, hidden insufficiency of blood supply to the heart and evaluating cardiac blood flow reserves are used
Load ECG tests
- which provoke ischemia (insufficient blood supply) myocardium by increasing the need of the heart muscle in oxygen.
- ECG-samples with exercise are most often used:
- Tredmil test - a test track.
- Contraindications for carrying out load tests:
- acute myocardial infarction;
- severe degree of blood circulation deficiency;
- quickly progressive or unstable angina;
- high blood pressure;
- aneurysms (vessel protrusion) vessels;
- pronounced aortic stenosis (narrowing of the aortic valve);
- acute thrombophlebitis (blockage of the veins of the lower limbs with a bunch of blood);
- pronounced violations of the heart rhythm; Asistolia - complete cessation of heart activities; .
severe respiratory failure;
- Acute infectious diseases
- The criteria for a positive test with a load indicating the presence of IBS are:
- development during the sample of a typical attack of angina;
- change in the interval of ST according to the "ischemic" type (cowospace or horizontal reduction of ST with a significant amplitude and durability);
- the occurrence of various ventricular rhythm disorders at moderate load (less than 70% of the maximum heart rate);
attack of suffocation; Flowing blood pressure by 25-30% of the initial level.
Selective coronary angiography - Study of the coronary arteries using X-ray after the insertion of a contrast agent through special catheters on the shoulder or femoral artery. In a planned order, it is carried out at a very low tolerance to the loads, the absence of the effect of drug therapy, the patient's disability loss due to frequent pain attacks. Based on the results of coronaryography, a decision is made to carry out surgical treatment in order to restore blood flow through cardiac arteries (aorto-coronary shunting or stenting the arteries of the heart).
Stable angina should be distinguished from other forms of angina and myocardial infarction. Myocardial infarction differs from the angina region significantly greater intensity and the duration of the pain in the field of heart, the ineffectiveness of nitroglycerin reception, characteristic of infarction signs on the ECG. With myocardial infarction, there is an increase in ESP (erythrocyte sedimentation rate), increased maintenance of cardiospecific enzymes: KFK-MV, LDH-1, troponin T and I.
Diagnosis of vasospad angina
During selective coronary and explicit signs of atherosclerotic damage to the coronary arteries are not detected. However, the coronary spasm (the narrowing of heart arteries) is developing in areas with minimal atherosclerotic changes that do not affect blood flow in the arteries of the heart or under the influence of physical activity.
One of the important risk factors for the development of vasospadic angina is smoking. A predisposing factor can be a decrease in magnesium in the blood (hypomagnation). Provocate a pain attack can hyperventilation (breathing), local or general cooling. At the ECG during the attack, characteristic changes appear. "Silent" (olebolic) Form IBS can be detected during the daily monitoring of the ECG on the Holter. Cheerful ischemia can be an independent form of IHD or to be combined with its other forms (arrhythmias and angina).
Myocardial infarction diagnosis Based on a typical clinical picture, ECG data, the determination of the biomarkers of the heart muscle necrosis. :
- Important in the diagnosis of myocardial infarction
- Laboratory studies IV class. .
The general blood test reflects the resorption necrotic syndrome (due to the absorption of the decay products of the heart muscle), are characterized by changes in the biochemical test of serum; Markers of the death of the cordial muscle cells (myocytes) are changes in the blood concentration of creatinephosphocinatenes (KFK), lactate dehydrogenase (LDH), aspartataminotransferase (ASAT), mioglobin blood content, cardiotroponins T and I (TNT and TNI) For
Ultrasound of the heart The most important sign of myocardial infarction is revealed - violation of the local myocardial reduction. Echocardiography allows you to evaluate the prevalence of heart attack and the state of the contractile function of myocardium by estimating the emission fraction. And also identify such complications of acute infarction as the formation of cloth thrombles (blood clots) in the cavities of the heart, the appearance of the aneurysm of the heart, the breaking of the interventricular partition or the separation of the nobble muscles. In the hospital, an emergency selective coronary angiography is carried out. During this study, you can reveal a clogged artery and restore its permeability.
Diagnosis of sudden death It should be put immediately for 10-15 seconds, and it is impossible to spend precious time on the definition of blood pressure, listening to the heart tones, searching the pulse on the radial artery and an ECG record. Pulse should be determined only on the carotid artery.
- Diagnosis of clinical death
- put on the basis of the following main diagnostic criteria:
- lack of consciousness;
- no breathing or sudden appearance of noisy and frequent breathing;
- Lack of pulse at carotid arteries;
Expansion of pupils;
Changing the color of the skin, the appearance of a pale gray painting of the skin of the face.
Treatment of ischemic heart disease
Treatment with stable angina includes anti-infant drugs, antiagregants, thinning blood, cholesterol level correction, psychopharmacological impacts, surgical treatment, spa treatment, elimination of risk factors, physical workouts, lifestyle change.
- The use of antianginal drugs is the basis of the treatment of stable angina, as they reduce the action of the main IBS mechanism - the inconsistency between the need of the heart muscle in oxygen and delivery to it. The following groups of antichangative means are distinguished:
- Nitrates (short and prolonged forms) - eliminate spasm, expand heartframes, improve the coronary collateral (bypass) blood flow (Nitroglycerin, Isosorbide Mononitrate, Isosorbide Dinitrate).
- Beta-adrenergic receptor blockers - Reduce the need for heart muscle in oxygen due to the reduction in heart rate and blood pressure, increase the delivery of oxygen to myocardium by increasing collateral (bypass) blood flow, have antiarrhythmic activity and increase the threshold of ventricular fibrillation (bisoprolol, metoprolol, nebivolol).
- Calcium antagonists - Insertion of calcium ions inward inward cells and thereby prevent their damage, expand the coronary artery, reduce oxygen consumption by the heart muscle due to the reduction of blood pressure and heart rate (verapamil, diltiazem, amlodipine).
- Activators of potassium channels - Activate potassium channels, thanks to which calcium flow into smooth muscle cells is blocked and coronary artery (nicorandyl) are expanding.
Antiagregants (drugs reduced platelet functional activity) Be sure to be included in the CHD treatment program. The most commonly used acetylsalicylic acid ("Cardiomagnet", "Trombo-Ass", "Aspirin-Cardio") and clopidogrel. Normalization of lipid profile It has a beneficial effect on the state of coronary blood flow and reduces the clinical manifestations of the CHA. Correction of lipid disorders is carried out using a diet, cholesterol reducing agents Ischemic heart disease (IBS) .
(statins) and physical activity. Statins (atorvastatin, rosevastatin) are prescribed individually in dosages that contribute to a decrease in "bad" cholesterol to the target level
- Patient with acute myocardial infarction (im)
- It is necessary to quickly deliver to the hospital to prevent complications and increase chances for survival. The treatment is determined by the myocardial infarction stage:
In the acute and most acute period, the purpose of treatment is to prevent the midst of the midst of the heart muscle, eliminate pain and other symptoms; When moving the disease to the subacted stage and in the post-infarction period, the purpose of therapeutic effects is to reduce the risk of relapse and possible complications. .
One of the main tasks of therapy of acute infarction is the restoration of blood current on cardiac arteries. Be sure to stop pain. The intensity of pain in this period is so great that the patient may die due to the stop of the heart from her. It is necessary to prevent heavy complications
- [nine] For the treatment of acute drugs, drugs from various pharmacological groups are used:
- Package preparations. Analgesics are used from a group of narcotic anesthetic drugs (morphine, "Omnopon", "Promedol") in combination with analgin, antihistamine preparations ("Dimedrol").
- Thrombolytic therapy. The purpose of this therapy is to dissolve the thrombus in the heart artery and restore the main blood flow in the arteries of the heart, and also to prevent further thrombosis. The reduction of blood flow is aimed at preventing the distribution of the header muscle. The smaller the necrosis zone (death), the greater the chances of the patient for successful rehabilitation, below the risk of complications, many of which are life-threatening. For dissolution, thrombolytics (streptocinas, urocinase, alteplelase) are injected intravenously.
Preparations from this group affect blood cells (platelets and erythrocytes). The action of antiagregants prevents platelet gluing, and the blood flow is improving. The main applied drug is "aspirin" (acetylsalicylic acid), inhibitors of platelets P2Y12 receptors (ticagrelor, prasuagrel and clopidogrel) are also used. Restoration of blood flow through cardiac arteries is also possible using surgical treatment (stenting or aorto-coronary shunting). The procedure of coronary stenting is based on a balloon catheter into a narrow portion of the coronary artery under the control of X-ray. In this case, the atherosclerotic plaque is "crushed", and the lumen of the arteries of the heart expands. After that, the vessel can be installed stent - a durable mesh tube that resembles a spring that repeats the relief of the vessel and supports its frame. .
To limit the zone of ischemia and necrosis (death), the heart muscle is needed besides the restoration of blood flow in the arteries of the heart, reduce the load on the heart. For this purpose, beta blockers are used that reduce heart rate frequency
- Forecast. Prevention
- The forecast for IHD influence:
- the presence of risk factors and age;
- The severity of the symptoms of angina and its functional class;
- Results of instrumental studies, in particular samples with a load;
Moved myocardial infarction;
- treatment nature, including the use of methods of myocardial revascularization (aorto-coronary shunting, stenting).
- The following factors adversely affect the forecast:
- recent (up to 1 year) myocardial infarction;
- transferred sudden coronary death with successful resuscitation;
- For the first time, angina (after its stabilization, the forecast is improved);
- III and IV functional class of angina;
- reinforcement and increase in duration or appearance of angina attacks in peace in patients with stable stress angina;
- cardiomegaly (increasing heart), rhythm disorders, heart failure;
- elderly age;
- ECG changes alone;
- Arterial hypertension and left ventricular hypertrophy;
- Positive results of the load sample (the lower the tolerance for physical exertion and the more expressed changes in the ECG, the worse the forecast);
Reducing the ejection fraction determined by the ultrasound of the heart; In economically developed countries, IBS is very common. According to the World Health Organization, the death rate from heart disease and vessels is 31% and is the most common cause of death in the world. In the Russian Federation, mortality from heart disease and blood vessels is 57%, of which 29% drops to the share of IBS. Multi-seeing damage to the coronary channel according to selective coronary angiography.
IBS Prevention is primary or secondary
- . Primary prevention is aimed at preventing the development of atherosclerosis and IHD and is to eliminate or decrease the action of reversible risk factors. The main reversible risk factors are smoking, arterial hypertension, hyperlipidemia (raising cholesterol).
- The most important activities within the framework of primary prevention are the normalization of the lifestyle, which implies:
- limit salt and fats in food;
- control blood pressure;
- Being physically active - Morning gymnastics, dosage walking, running, classes in wellness groups, sports games, skiing, etc.;
Stop smoking and refuse to abuse alcohol: in persons who dig a pack of cigarettes per day, the risk of developing IHD is significantly higher than in non-smoking; Smoking significantly increases the risk of sudden death; Atherosclerosis of heart arteries in smokers is expressed stronger than non-smoking;
Eliminate negative psycho-emotional stressful situations, create a state of mental comfort both at work and at home, use psychotherapy. MEASURES OF PRESSING PROGRESSING IBS (secondary prevention):
1. Control the level of blood pressure. Upon increasing blood pressure, hypotensive (reduced blood pressure) drug drugs, which choose a doctor, depending on the level of pressure and the presence of concomitant diseases. The purpose of treatment is to reduce blood pressure up to 130/80 mm Hg. Art. It is necessary to go to this target level gradually and only under the control of the attending physician.
2. Control the level of cholesterol. In patients with IHD, the general cholesterol level should be below 4.5 mmol / l (preferably less than 4.0 mmol / l), and the LDL cholesterol level is less than 1.5 mmol / l. It is necessary to adhere to healthy nutrition and take drugs that reduce blood cholesterol.
3. Stop smoking. Smoking and health are incompatible! The refusal of this harmful habit is significantly reduced by the risk of heart attack and stroke, regardless of age and smoking.
4. Enlarge physical activity. Walking, cycling, swimming. The load should be reasonable and well portable, do not cause the attacks of angina or the appearance of shortness of breath. Before proceeding with exercise, you must consult with your doctor.
5. Take medicines.
Must be able to constantly accept medical drugs prescribed by the attending physician to improve well-being, increasing the tolerance of physical exertion and improving the forecast - increase life expectancy.
Heart Ischemia (IBS) is a violation of the blood supply of the heart muscle associated with the defeat of the coronary arteries. The condition proceeds in acute and chronic form, from which the clinical picture of the disease depends.
For such a section of medicine, like cardiology ischemic heart disease - a long-studied condition, so treatment does not cause difficulties. Qualified medical personnel "Klikini ABC" will provide better medical care, experts will indicate which clinical recommendations for coronary heart disease should be observed to prevent exacerbation of the disease.
Ischemic myocardial heart disease is a common cause of death. Every year in Russia there are more than 700 thousand deaths that are caused by different forms of pathology. Men occurs more often after 55 years. The disease is associated with a disadvantage of myocardial blood supply. Long-term ischemia of the heart leads to the development of hypoxia of tissues and various dystrophic changes in them.
Here we see average prices in clinics that are located in the area of these metro stations, but in accordance with the Federal Law "On Advertising", we do not specify the names of the clinics.
Causes and risk factors
The etiology of the disease in 97% of cases is associated with atherosclerosis coronary arteries. Due to the narrowing of the lumen of the vascular walls of the heart fabric, the necessary portion of blood does not receive, the oxygen deficiency is developing, accompanied by the corresponding symptomatics.
- Also IBS Ischemic heart disease occurs against the background of thromboembolism or spasm of coronary arteries, which often develop against the background of atherosclerosis.
- In the risk group of the face with:
- hyperlipidemia (an abnormally high indicator of lipids, blood lipoproteins);
- bad habits (smoking);
- hereditary predisposition;
errors in nutrition;
- According to the characteristics of clinical manifestations, pathology is divided into the following forms:
- Asistolia (Heart Stop).
- Angina (parole pains, it is stable and unstable).
- Cheerful ischemia.
- Heart attack of coronary heart disease (myocardium).
- Postnomatic cardiosclerosis (substitution by the connective tissue of myocardial fibers).
Heart failure.Heart conduction disorder.
- Symptoms IBS
- Clinical manifestations are largely dependent on the form of pathology. In general, chronic ischemic heart disease is distinguished by wave-like flow: periodic aggravation and sacrifice of symptoms. Approximately a third of patients do not feel disturbing manifestations. However, over time, pathology progresses and begins to disturb:
- pulling, cutting, gulp pain irradizing in the upper limbs, lower back;
- feeling of lack of air during exacerbations;
Violation of perception.If you ignore the symptoms of IBS, the disease acquires a chronic form at which the edema of the legs is additionally possible.
ComplicationsMany patients who suffer from ischemia flowing in a light form, over time ceases to perceive the disease as a threat, which is very in vain. They are unlikely to guess than dangerous ischemic heart disease. Pathology is inclined to progress and without treatment leads to severe consequences.
Chronic ischemic heart disease causes a heart attack at which the ottime of the heart muscle tissue develops. Also, the disease threatens a sudden coronary death at which a complete stop of the heart occurs. Pathology can provoke a worsening of the heart and reduce its ability to pump blood.
DiagnosticsDiagnostics includes a set of activities. The doctor polls the patient regarding the disturbing symptoms and the nature of their flow (what the exacerbations are associated, as often bother), lets an anamnesis (whether the patient was chewed earlier, whether treatment was carried out, which chronic diseases have, etc.).
- ECG has important in the diagnosis of pathology. The technique allows you to detect violations of the normal functioning of the heart. EchoCG helps to determine the size of the organ, the condition of the valves, cavities, evaluate the contractile ability, the presence of acoustic noise. Sometimes they are carried out echocardiography with exercise. The method allows you to identify the latent form of the IBS.
- To determine the state of the vessels is prescribed to coronary art. It helps to establish the degree of occlusion, stenosis, vessel patency. Visualize the heart in different planes allows MRI.
Treatment of IBSIBS therapy should be comprehensive. The patient is prescribed a non-drug treatment with a lifestyle and nutrition correction. The patient should reduce physical activity in order not to increase the need of myocardium in oxygen. A diet is also needed, which will improve blood indicators, reduce the likelihood of deposits on the walls of the vessels and reduce the load on the heart muscle. The patient needs to limit salt, fats, rapid carbohydrates. It is important to monitor the calorieness of food consumed.
Drug therapy can also be assigned: antiagregants (increase blood flow), beta-adrenoblasts (to reduce the frequency of heart cuts) and hypocholesterolemic agents (reduced cholesterol in the blood). If there are no restrictions on use, they can assign nitrates (to reduce pain symptoms), diuretics (to reduce blood pressure, edema), etc. If the therapeutic effect is missing or not expressed, there is a high risk of heart attack during ischemic heart disease, then the operation is shown .
Procedures conducted in the treatment of IBS:
|Angioplasty and stunt implantation. This is the minimum invasive endovascular procedure, carried out in order to expand clogged or narrowed vessels. Stenting involves the installation of a special frame in the lumen of the vessels.||Aorticoronary artery shunting is the restoration of blood supply to the area of ischemia.|
|Forecast of coronary heart disease and prevention||The CHA has a favorable forecast of coronary heart disease in the early appeal to the doctor and timely treatment. Each case is individual and depends on the degree of myocardial damage, root causes of pathology (diabetes mellitus, fat exchange disorders, etc.). Sometimes it is enough to receive medicines, zozh and PP. Other situations require operation. It is important for clinical recommendations for ischemic heart disease regarding the lifestyle, each patient observed: did not smoke, did not use alcohol, followed weight, nutrition, psychological health, controlled blood pressure and with disturbing symptoms addressed a doctor.|
|If you are worried about the heartache, you are in the risk area of the development of pathology, then do not postpone the campaign to the doctor. Cardiologists "Klikini ABC" will have professional assistance in the treatment of HR and help to establish the root cause of pathology to make treatment as efficient as possible.||Prices for the treatment of ischemic heart disease|
|price, rub.||Program number 3. Treatment of ischemic heart disease. Diagnostics and treatment (2 receptions).|
Program number 3. Treatment of ischemic heart disease. Diagnosis and treatment (4 receptions). 3400 rubles
Program number 3. Treatment of ischemic heart disease. Clinical instrumental examination. 7000 rubles
Program number 4. Examination of patients with ischemic heart disease. 7000 rubles
7200 rubles 7000 rubles
Comparison of price for treatment in Moscow clinics 7000 rubles
Street 19052 400 rubles.
- Park of Culture
- No one knows the patients with coronary heart disease in Russia, no one knows, under supervision there is a little less than 8 million, this diagnosis is given 600-700 thousand Russians and dies as much as much. Angina - one of the forms of IBS takes into the world another 8 years before laid. It is known that a quarter of all visitors of the Russian clinic appeal precisely about the IBS. Almost half of the infarction in the hospital first learned that it turns out to suffer from ischemic disease. Therefore, it is believed that patients with IBS are much larger than being taken into account by official statistics, it is possible that even more.
- Our expert in this area:
- Head of the hospital, doctor-therapist
What is today understanding under ISS?
At the end of the last century, UBS understood only the angina and stress angina, and myocardial infarction. But then, the infarction was interpreted much wider, and not only the morphological necrosis of the wall, and there was no concept of "acute coronary syndrome", describing the clinical picture of a heart attack. Today, the concept of coronary heart disease includes eight "large" clinical and pathological syndromes with a division into a variety of options:
angina and nonsense ischemia,
heart attack and focal dystrophy of myocardium,
Rhythm disorders and heart failure.
In IBS, a sudden death was made - instantaneous or within 6 hours of heart attack death, and marked "in the presence of witnesses."
- Stenzardia is different: for the first time arising, stable, progressive, spontaneous or vasespascular. Myocardial infarction can be small-scale and large-scale or transmural. But the dystrophy and cardiosclerosis after a heart attack with IHS only focal, extensive have a different nature and are called differently.
- Why is the ischemic disease arise?
- Ischemic heart disease means damage to myocardium due to blood flow violations by coronary arteries. When the need for the heart muscle in oxygen is higher than the possibility of its delivery, then it arises ischemia. Causes are different, frequent: irreversible narrowing atherosclerotic plaque, vessel spasm, thrombosis. Less often, the attacks of the IBS cause congenital anomalies with improper disorder of the coronary vessel from the main supply barrel, autoimmune lesion, an overdose of vasoconstructuring drugs and some drugs.
The probability of developing IBS increases excess "bad" cholesterol, arterial hypertension, diabetes, smoking and lack of loads, and obesity. All listed risk factors are not eternal, but modifiable - their influence can be reduced. It is noted that predominantly IWS struck men, adversely affects heredity, with age the frequency of the disease increases, but the ratio of floors is aligned. These are the last factors that increase the likelihood of acquiring CHD, it is impossible to remove.
What happens angina
Classical angina has three special clinical signs that distinguish it from everything else, these signs arise in a bundle, but the presence of everyone is necessary.
The pain appears during the voltage of physical or emotional.
2-5-minute pain is localized behind the sternum, gives to the left hand, back or, less often, lower jaw. Not always pain can be perceived as pain, sometimes there is a feeling of gravity, burning sternum or shortness of breath. In the classic version of the angina, the pains under the spoon or blade do not fit, on the right in the chest, but when there is a third sign, then doubts that this angina disappear.
The pain passes from the nitroglycerin tablet or during the cessation of movements.
When only two signs of three classic are noted, they are talking about atypical or possible angina. No relation to angina, I have no other pain sensations, localized not in typical places, local, more than half an hour, which are not associated with the movement, which are not reacting to nitroglycerin, increasing during the feeling of the patient. It is anything, but not angina.
Stenicardic pains may occur with the defeat of not only the coronary arteries themselves, but small vessels derived from them. This option is not easy to identify, because coronoagoagiography well visualizes the arteries, the diameter of which is at least 0.4 mm, and the minor vasculars are two or four times already. In physical exertion, the disruption of the functioning of the microShospots leads to excessive spasms and inadequate relaxation. This variant of angina is called microvascular or X-coronary syndrome.
For microvascular, three own features are also required. First, according to the clinical picture, this is a typical or atypical angina, with its inherent localization of pain and a reaction to the load. Secondly, it is diagnosed on ECG with load samples, myocardial scintigraphy or echo kg. Thirdly, the function of the left ventricle should be normal, and the coronary arteries of large and medium diameters should not be modified, that is, there can be no cause of angina. But in almost 70% of cases, classical and microvascular angina coexist.
Vazospadic or variant angina
From classical angina, this is distinguished by the fact that ischemia arises alone and without psychological stress. The Vasospastic version of the IBS can also lead to a heart attack, sudden death due to the development of dangerous arrhythmias: ventricular tachycardia and fibrillation. If the "ordinary" angina region is a consequence of incomprehension to increase the need and the possibility of blood supply to myocardium, then the vasospastic is due to the exclusively spasm of the coronary artery without increasing the needs of myocardium. After reasoning the spasm of a practically unchanged coronary artery, have not yet found out. But it is precisely such angina disease that occurs when heocoled, violation of the exchanging of electrolytes, systemic autoimmune diseases and cocaine use. This is the angina of the young, and even in the absence of risk factors, but not smoking. Pain with vasospadic angina is very strong and typical of localization, often the attack develops at night or early in the morning. Syncoon may indicate a serious rhythm violation. But the intensity of repeated attacks is very different, and the person can transfer high physical exertion.
Heart Ischemia (IBS) is a violation of the blood supply of the heart muscle associated with the defeat of the coronary arteries. The condition proceeds in acute and chronic form, from which the clinical picture of the disease depends.
Myocardial Ischemia without painful syndrome
It is not angina, but can also bring to myocardial infarction. It is not necessary that all attacks are absolutely painless, it is possible to alternate asymptomatic ischemia with angina. As a rule, such ischemia is detected on ECG with load samples or daily monitoring. Interestingly, in atherosclerosis, the fifth part of the patients occurs such an option of ischemia, it is also characteristic of diabetes for patients. It occurs during the day, but with extensive atherosclerosis of coronary vessels can develop at night against the background of full rest. It is clear that the patient ischemia without painful syndrome does not notice.
How to treat angina?
The doctor will prescribe medicinal drugs, perhaps will conduct a myocardial revascularization - the restoration of blood flow through coronary arteries, but the normal quality of life and the rarity of the attacks exclusively in the hands of the patient HRS itself. It is necessary to fulfill all the recommendations on the reception of drugs, except that always and everywhere to have a fast-acting nitroglycerin tablets, remember the emergency call number and, perhaps, the phone number of his attending physician.
And still requires a chance of herself. It is necessary to skip smoking, save yourself from excess weight and change your nutrition - all this is called a change in lifestyle with the wrong to healthy. This occupation is forever, for the rest of my life, of course, without immersion in illness and fanaticism. Change nutrition is easy, limiting animal fats and increasing the consumption of plant fiber.
With overweight it is better to part under the control of a nutritionist, so that stress does not provoke the seizures of ischemia. As for the use of alcohol, it is possible in moderate quantity. The volume of permitted physical exertion must be stated with the attending physician, before unscheduled loads, the reception of nitroglycerin can get rid of the attack of ischemia. This set of measures will help to avoid ischemia, and at the same time it is the prevention of aging diseases: diabetes mellitus, arterial hypertension, malignant tumors.
The material was prepared by a physician-therapist, the head of the hospital "Medicine 24/7" by Tafinte Catherine Anatolyevna.
Ischemic heart disease is the most serious problem of modern cardiology and medicine as a whole. In Russia, about 700 thousand deaths caused by various forms of IBS are recorded annually, the Mortality from IBU is about 70%. Ischemic heart disease is more affecting the men of active age (from 55 to 64 years old), leading to disability or sudden death. The IBS group includes acutely developing and chronically occurring states of myocardial ischemia, accompanied by subsequent changes: dystrophy, necrosis, sclerosis. These states are considered, among other things, as independent nosological units.
Coronary artery disease
- The overwhelming majority of (97-98%) of clinical cases of IBS are caused by atherosclerosis of coronary arteries of varying degrees of severity: from a minor narrowing of the lumen atherosclerotic blushing to complete vascular occlusion. With 75% coronalosis, the cordious muscle cells react to the lack of oxygen, and the patients develop a stress angina.
Other reasons for CHD are served by thromboembolism or spasm of coronary arteries, developing usually against the background of an already available atherosclerotic lesion. Cardiospasm aggravates the obstruction of coronary vessels and causes a manifestation of coronary heart disease.
The factors contributing to the emergence of IBS include:
Promotes the development of atherosclerosis and increases the risk of ischemic heart disease in 2-5 times. The most dangerous in terms of risk of IBS are hyperlipidemines of types IIA, IIB, III, IV, as well as a decrease in the content of alpha-lipoproteins.
Arterial hypertension increases the likelihood of IBS for 2-6 times. In patients with systolic blood pressure = 180 mm Hg. Art. And the above ischemic heart disease occurs up to 8 times more often than in hypotoniki and people with a normal level of blood pressure.
According to various data, smoking cigarettes increases the incidence of IBS in 1.5-6 times. Mortality from the ischemic heart disease among men 35-64 years, smoking 20-30 cigarettes daily, 2 times higher than among the non-smoking of the same age category.
errors in nutrition;
Physically lowactive people risk sick of IBS 3 times more than persons leading an active lifestyle. With a combination of hypodynamine with overweight, this risk increases at times.
Violation of tolerance for carbohydrates With diabetes mellitus, including latent, the risk of incidence of ischemic heart disease is 2-4 times.
The factors that create a threat to the development of IBS should also include burded heredity, male gear and elderly age patients. With a combination of several predisposing factors, the degree of risk in the development of ischemic heart disease increases significantly.
- The causes and speed of the development of ischemia, its duration and severity, the initial state of the cardiovascular system of the individual determine the occurrence of one or another form of ischemic heart disease.
- The development of the IBS is based on the imbalance between the need of the heart muscle in blood supply and actual coronary blood flow. This imbalance can be developed due to the sharply increased need of myocardium in blood supply, but its insufficient implementation, or with a normal need, but a sharp decrease in coronary blood circulation. The deficit of myocardial blood supply is especially expressed in cases where the coronary blood flow is reduced, and the need for the heart muscle in the influx of blood increases sharply. Insufficient blood supply to heart tissues, their oxygen starvation is manifested by various forms of coronary heart disease.
As a working classification, on the recommendation of WHO (1979) and VKNC AMN USSR (1984), Cardiology-clinicians use the following systematization of forms of IBS:
1. Sudden coronary death
- (or the primary stop of the heart) - a suddenly developed, unexpected state, based on the electrical instability of myocardium. Under a sudden coronary death is an instant or coming no later than 6 hours after a heart attack, death in the presence of witnesses. Allocate sudden coronary death with successful resuscitation and with death.
- 2. angina:
Stenicard of voltage (load):
stable (with the definition of functional class I, II, III or IV); Unstable: for the first time arising, progressive, early postoperative or post-infarction angina;
3. Cheering form of myocardial ischemia. 4. Myocardial infarction:
large-scale (transmural, q-infarction);
5. Postinfarclical cardiosclerosis.
6. Heart conduction disorders and rhythm
Violation of perception.
7. Heart failure
- (shape and stage).
- In Cardiology, there is a notion of "acute coronary syndrome", which unites various forms of coronary heart disease: unstable angina, myocardial infarction (with Q-teeth and without Q-teeth). Sometimes a sudden coronary death caused by IHD includes this group.
- The clinical manifestations of the CHA are determined by a specific form of the disease (see myocardial infarction, angina). In general, the ischemic heart disease has a wave-like flow: periods of steadily normal well-being alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially with solemn ischemia myocardium, do not feel at all the presence of IBS. The progression of ischemic heart disease can develop slowly, decades; At the same time, the forms of the disease can change, and therefore, the symptoms.
- The general manifestations of the CHD include zealous pains associated with physical exertion or stress, back pain, hand, lower jaw; shortness of breath, reinforced heartbeat or sensation of interruptions; Weakness, nausea, dizziness, clouding consciousness and fainting, excessive sweating. Often, the IHD is already detected at the stage of the development of chronic heart failure when swelling on the lower extremities, a progress of breath, forcing the patient to take a forced seitoring position.
- The listed symptoms of ischemic heart disease are usually not found at the same time, with a certain form of the disease, there is a predominance of certain manifestations of ischemia.
The preponderances of the primary stop of the heart with ischemic heart disease can serve as an accurately arising sensation of discomfort for the sternum, the fear of death, psycho-emotional lability. With a sudden coronary death, the patient loses consciousness, the respiratory stop occurs, there is no pulse on the trunk arteries (femoral, sleepy), the tones of the heart are not tones, pupils are expanding, the skin is expanded, the skin covers become a pale-gray shade. Cases of the primary stop of the Heart are up to 60% of EBS lethal outcomes, mainly at the pre-hospital stage.
Hemodynamic disorders in the heart muscle and its ischemic damage cause numerous morpho-functional changes that determine the forms and forecast of IBS. The result of myocardial ischemia are the following decompensation mechanisms:
Insufficiency of energy metabolism of myocardial cells - cardiomyocytes;
"Stunned" and "sleeping" (or hinding) myocardium - the form of a reduction in the left ventricle in patients with IBS, having a transit nature;
Development of diffuse atherosclerotic and focal post-infarction cardiosclerosis - a decrease in the number of functioning cardiomyocytes and the development in their place of connective tissue;
impairment of systolic and diastolic functions of myocardium;
Disorder of cases of excitability, conductivity, automatic and myocardial cuttlebility.
The listed morpho-functional changes in myocardial with IHD lead to the development of a resistant reduction in coronary blood circulation, i.e. heart failure.
Cardiologists are diagnosed with cardiologists under conditions of a cardiological hospital or a dispensary using specific instrumental techniques. When polling the patient, complaints and the presence of symptoms characteristic of the heart disease are characteristic of the ischemic disease. In case of inspection, the presence of edema, cianosose of skin cover, noise in the heart, rhythm disorders.
Laboratory and diagnostic analyzes suggest a study of specific enzymes that increase in unstable angina and infarction (creatinephosphocinate (for the first 4-8 hours), Troponin-I (7-10 days), Troponin-T (10-14 days), aminotransferase , lactate dehydrogenase, Mioglobin (in the first day)). These intracellular protein enzymes in the destruction of cardiomyocytes are released into blood (resorption necrotic syndrome). The level of total cholesterol, low (atherogenic) and high (anti-theaterogenic) density, triglycerides, blood sugar, Alt and Ast (nonspecific cytolysis markers) is also being studied.
- The most important method of diagnosing cardiological diseases, including ischemic heart disease, is an ECG - registration of the electrical activity of the heart, which allows to detect violations of the normal mode of operation of myocardium. EchoCG - Method of ultrasound of the heart allows you to visualize the size of the heart, condition of cavities and valves, assess the reduction of myocardium, acoustic noise. In some cases, the Echocardiography is carried out with Echocardiography - ultrasound diagnostics with dosage exercise, registering myocardial ischemia.
- In the diagnosis of ischemic heart disease, functional tests with a load are widely used. They are used to identify early stages of IHD, when disorders are still impossible to determine at rest. Walking, lift along the stairs, load on simulators (exercise bike, treadmill), accompanied by an ECG fixation of the heart performance indicators, are used as load tests. The limited application of functional samples in some cases is caused by the impossibility of performing the required load volume by patients.
- Holter daily monitoring ECG suggests the registration of the ECG, which is performed during the day and detecting periodically emerging disorders in the heart of the heart. For research, a portable apparatus (Holter monitor) is used, fixed on the shoulder or belt of the patient and relieving readings, as well as a self-surveillance diary, in which the patient marks its actions and occurring changes in well-being. The data obtained during monitoring are processed on the computer. ECG monitoring allows not only to identify the manifestations of coronary heart disease, but also the causes and conditions for their occurrence, which is especially important in the diagnosis of angina.
- Sexual electrocardiography (CPEKG) allows you to evaluate the electrical excitability and conductivity of myocardium in detail. The essence of the method is to introduce the sensor in the esophagus and the registration of the performance of the heart, bypassing the interference created by the skin cover, subcutaneous fatty tissue, chest.
Coronaryography in the diagnosis of ischemic heart disease allows you to contrast myocardial vessels and determine the violations of their passability, the degree of stenosis or occlusion. Coronaryography is used to address the issue of blood vessels. When the contrast agent is administered allergic phenomena, including anaphylaxis.
Treatment of IBS
Tactics of treatment of various clinical forms of ischemic heart disease has its own characteristics. However, it is possible to designate the main directions applied to the treatment of IBS:
carrying out the surgical revascularization of myocardium (aorto-coronary shunting);
The use of endovascular techniques (coronary angioplasty).
Non-drug therapy includes measures to correct lifestyle and nutrition. With different manifestations of the IBS, the restriction of the activity mode is shown, since the physical activity increases the need of myocardium in blood supply and oxygen. The dissatisfaction of this need for the heart muscle actually causes the manifestations of IBS. Therefore, with any forms of coronary heart disease, the patient's activity is limited, followed by a gradual expansion of it during rehabilitation.
Diet with IHD provides for a limitation of water intake and salt with food to reduce the load on the heart muscle. In order to slow down the progression of atherosclerosis and combating obesity, a low-live diet is also assigned. Restricted, and if possible, the following groups of products are excluded: Fats for animal origin (butter, fat, fatty meat), smoked and fried food, fast suction carbohydrates (baking, chocolate, cakes, candy). To maintain normal weight, it is necessary to follow the balance between consumed and consumed energy. If you need to reduce the weight, the deficiency between consumed and consumed energy supply should be at least 300 kl daily, taking into account that a person spends about 2000-2500 kl during normal physical activity.
Drug therapy for IHD is assigned according to the formula "A-B-C": antiagregants, β-adrenoblays and hypocholesterolemic drugs. In the absence of contraindications, it is possible to appoint nitrates, diuretics, antiarrhythmic drugs, etc. The lack of effect from the medicinal therapy of ischemic heart disease and the threat to the development of myocardial infarction are an indication to the consultation of the cardiac surgeon to address the issue of operational treatment.
To the surgical revascularization of myocardium (Aorticoronary shunting - AKSH) resort to restoring the blood supply to the area of ischemia (revascularization) in resistance to pharmacological therapy (for example, with a stable angina stress III and IV FC). The essence of the AKS method is to impose an auto-neutomine anastomosis between the aorta and the affected arteries of the heart below its narrowing or occlusion. Thus, a bypass vascular course is created, delivering blood to the myocardial ischemia. Access operations can be carried out using artificial blood circulation or on a working heart. Multiply invasive surgical procedures with IHD include percutaneous transluminal coronary angioplasty (STI) - a balloon "expansion" of the tried vessel, followed by an implantation of the frame-stent, holding suspicious for the blood flow of the vessel.
Prediction and prevention
How to treat angina?
The definition of prediction with IHD depends on the relationship of various factors. So adversely affects the forecast combination of ischemic heart disease and arterial hypertension, heavy lipid metabolic disorders and diabetes. Treatment can only slow down the steady progression of IBS, but not to stop its development.
- The most effective prevention of IBS is to reduce the adverse effects of the threat factors: the exclusion of alcohol and tobacco-baked, psycho-emotional overloads, maintaining optimal body weight, physical education, control, Healthy nutrition.
- Ischemic heart disease (IBS) - the lesion of myocardium (heart muscle), which arises due to the violation of its blood supply due to the narrowing of the coronary arteries. Most often, their clogging occurs due to atherosclerosis - the formation of deposits of fatty acids (so-called atherosclerotic plaques) on the walls of the vessels. Atherosclerosis is considered to be a disease of the elderly, and earlier it was more often diagnosed in older patients. However, in our time, this pathology "younth", as well as ischemic heart disease.
- IHD is one of the main causes of mortality in developed countries. At the age of 30-39 years old, men are diagnosed 5 times more often than in women, in 40-49 years old - men are more often 3 times, in 50-59 - at 2, and after 70 years, pathology with equal frequency is found and In women, and in men.
Ischemic heart disease can be warned, and if it has already arisen - slow down its development and improve the quality of life of the patient. In the clinic, the exploitory cardiologists work, which in a short time will put an accurate diagnosis and appoint optimal treatment. You can sign up for reception at any time convenient for you.
heart attack and focal dystrophy of myocardium,
Features of the disease
- The heart muscle is responsible for the blood supply to the whole organism. Thanks to its work, the blood containing oxygen comes to all organs. At the same time, the heart is required to "breathe", as it makes a lot of work daily. Oxygen in large quantities, along with blood comes to the heart on two coronary arteries, descending from the root of aorta (the main, largest artery in the body) and the infant heart. If it is not enough, it immediately affects the function of the heart, and therefore, throughout the body. Ischemic heart disease is called insufficient blood flow to myocardium by coronary arteries.
- The cause of blood supply to the blood supply is the difficulty of passing blood by coronary arteries. It can be caused:
Narrowing vessels due to formation on their walls atherosclerotic plaques.
- Increased blood viscosity.
- Spasm arteries.
- And yet, in most cases, the violation of the flow of oxygen-enriched blood is caused by atherosclerosis (95-97% of cases).
- Eliminate factors that increase the possibility of atherosclerosis and IBS development. They can be divided into:
- Controlled - which can be influenced.
- Uncontrolled - for which it is impossible to influence, but they must be taken into account when developing therapeutic and preventive measures.
- Controlled factors include:
- Harmful habits are smoking and alcohol abuse.
- Arterial hypertension is a constant increase in blood pressure.
- Hydodina (low-live lifestyle).
errors in nutrition;
Increased in the blood of "harmful" cholesterol.
Among uncontrollable factors:
- Age: After 50-60 years, the risk of developing the disease is significantly increased.
- Gender: Men's pathology occurs more often.
- Heredity - the presence of IBS in close relatives.
By the nature of the flow, coronary heart disease can be 2 types: Acute ischemic heart disease (acute coronary syndrome) is a dangerous state expressing in a sudden decrease in blood flow to the heart muscle. It is expressed by a strong pain in the chest and in the shoulders, hands, back, jaw the upper part of the abdomen. Accompanied by shortness of breath, dizziness, fainting, nausea or vomiting. Acute coronary syndrome is able to lead to a fatal outcome or myocardial infarction.
Chronic ischemic heart disease manifests itself angina, chronic heart failure, heart rate impaired.
The most frequent manifestation of chronic IBS is angina. These are paroxy, burning or compressive stubborn pains in the left hand and usually passing after taking nitroglycerin or at rest. Stegonland is manifested in physical or emotional loads, smoking, improving blood pressure, in the cold and divided into several types:
- Stable angina stress - pain occurs during significant physical or emotional loads, but pathology does not progress, its manifestations remain the same.
- Unstable angina pain - pain in time enhanced and manifested even during minor physical activity, this form can lead to a myocardial infarction or a fatal outcome, so you should seek medical care as soon as possible.
Vazospadic angina-pain - pain is caused by spasm of coronary arteries, can manifest itself as a complication of stable angina stress. Reference!
In rare cases, it is not observed in the angina of pain, and the symptoms of the state are strong fatigue and shortness of breath, even with weak physical activity. Complications of IBS
Complications of IBS (its most severe forms) are: Myocardial infarction. Sudden coronary death.
Myocardial infarction -
Necrosis (death) of a portion of the heart muscle, due to the blockage of coronary arteries, as a result, oxygen starvation. Most often, this condition is caused by a gap of an atherosclerotic plaque, which is why there is a sudden overlap of the vessel by a thrombus. Myocardial infarction manifests itself pain in the chest concentrating in the center, it can also be squeezing. As a rule, pain gives to nearby organs - the jaw, hand, the upper part of the abdomen or in the inter-opaque region. With necrosis, the dignity of the myocardium is disturbed by the pump function of the heart, rhythm and blood flow, which affects the blood supply to other organs. Condition requires urgent medical care. If the heart attack ended with a fatal outcome, a scar tissue is formed on the site of the deceased portion of myocardium.
- Coronary sudden death
- Cardiosclerosis after heart attack cardiac muscle.
- Call the primary stop of the heart due to the violation of its rhythm. Its most frequent reasons are the launched atherosclerosis of the coronary arteries and myocardial infarction. Coronary sudden death occurs in a period of up to 6 hours from the beginning of a heart attack. At the same time, the patient's cardiovary and pulmonary resuscitation is carried out.
- Also corhemic heart disease can lead to
- chronic heart failure
- . With this condition, the heart does not regularly cope with its main function of the "pump" - to filling and emptying blood. The patient has shortness of breath, increased fatigue, a decrease in physical activity, swelling. The blood supply to other organs is disturbed. With chronic heart failure in the body, the fluid is delayed and accumulated in soft tissues.
- Ischemic heart disease: symptoms
- Signs of IBS are:
- Pains: in the field of heart, behind the sternum, they can also be atypical and observed in the abdomen or back.
Deterioration tolerability of physical exertion.
By the nature of the flow, coronary heart disease can be 2 types: Increased fatigue.
Permanent feeling of fatigue.
Weakness in the lower limbs.
- Swelling legs.
- Downtry fears, anxiety attacks.
- Due to oxygen starvation in myocardium toxins are formed. They annoy nervous endings, and because of this, the patient experiences pain. As a rule, they are bredit and last from 30 seconds to 10 minutes. It must be borne in mind that there is a painless form of ischemic illness, in which the patient does not feel pain, but he has other signs of pathology.
- Atypical pains localized in the stomach, and not in the heart, are usually observed in men. Patients often take them for tract pathology and do not turn to the doctor. In this case, it is also possible to recognize the availability of other symptoms (anxiety, shortness of breath, etc.). It is also important to pay for the occurrence of pain. Angocardia is most often manifested in the morning.
Diagnosis of IBS
- In the early stages, the ischemic heart disease can manifest themselves quite weak. The diagnosis of IHD begins with the collection of anamnesis, visual inspection and listening to cardiac tones (noises are observed during pathology). The patient is assigned to the instrumental research methods:
- The electrocardiogram is alone and under load, allows you to estimate the contractile ability of the heart muscle, the passability of nerve signals.
- Veloergometry is a variety of ECG, in which you can clear the hidden coronary failure and tolerance to physical exertion.
Daily monitoring ECG is a method of continuous registration of heart dynamics during the day.
Echocardiogram - heart ultrasound, allows you to determine the size of the heart departments, the nature of the blood flow, the contractile ability of myocardium.
Angiography is a method of contrasting blood vessels using an ahiograph device.
- The following studies can be assigned to identify concomitant diseases:
- Blood tests: common, biochemical, on sugar.
Ischemic heart disease: treatment
- CHA treatment can be both conservative and surgical. In most cases, complete cure is not possible: vascular changes are usually irreversible. However, high-quality medical care can significantly improve the patient's condition, prevent the development of complications, improve the quality of life until the previous level.
- In the early stages of coronary heart disease, conservative treatment is carried out - drug and non-drugs. As medicinal therapy, the patient is assigned:
- Anticoagulants - Preparations that prevent thrombosis.
- Beta-blockers - medicines blocking beta-adrenoreceptors and, as a result, reduced blood pressure, making a pulse more rare: under their influence, the heart is slower than blood and, accordingly, needs fewer oxygen.
Statins are medicines that reduce the level of "harmful" cholesterol in the blood.
For the relief of the attacks of angina, symptomatic treatment is carried out, which implies the reception of nitrates. The most famous drug of this category is nitroglycerin. It is used as a temporary measure that improves the patient's condition, but does not affect the course of the disease in general.
Since IBA is able to cause pathology of other organs and systems or related heart diseases, treatment may include drugs that increase the functions of these organs:
Diuretics (diuretic) - with renal diseases.
Hypoglycemic drugs - for the treatment of diabetes.
Angioplasty and stunt implantation. This is the minimum invasive endovascular procedure, carried out in order to expand clogged or narrowed vessels. Stenting involves the installation of a special frame in the lumen of the vessels.
Metabolic preparations - improving metabolic processes.
Hypotensive medicines - for the treatment of hypertension.
Since stresses negatively affect the condition and operation of the heart, tranquilizers and sedatives can also be appointed to the patient.
Non-drug treatment methods include exercises. In the period of exacerbation of the disease, physical expenditures are excluded. But therapeutic physical culture is actively used during the rehabilitation period. Special exercises allow you to strengthen the heart and make it more resistant to physical exertion.
If conservative therapy does not give a result or it is insufficient, surgical treatment is prescribed. The most common operation is angioplasty, usually followed by stenting.
- Angioplasty implies the expansion of the narrowed vessel using a mini-cylinder introduced into the scene of the narrowing. The cylinder under local anesthesia, controlling what is happening in real time on the monitor screen is introduced into the affected artery catheter and inflated. Atherosclerotic plaques are pressed into the vessel walls. Then the balloon is blown and removed from the artery. In a third of cases, a relapse is possible after the operation. To avoid re-narrowing the vessel, the stent is installed in the artery. This is a metal frame tube, which is injected into the vessel section subjected to angioplasty. It mechanically prevents the narrowing of the artery and contributes to the improvement of blood flow.
- Sometimes angioplasty does not give the desired result. In this case, an aortocamonary shunting is carried out - eliminate the affected area of artery and replace its shunt (vascular prosthesis).
- Ischemic heart disease is a disease in which human blood supply is disturbed due to the pathologies of the coronary arteries.
HebS is a fairly common disease. That is why, probably, almost everyone imagines that this is the disease. It is one of the main causes of death mortality, as well as the loss of performance. It is for this reason that modern doctors pay attention to this disease.
In European countries, IBS and the brain stroke are about 90% of all pathologies of the heart and vessels. It is at the IUD that accounts for 30% of all deaths. Ischemic heart disease is present in 30% of women and 50% of men. This difference is explained by some features of the hormonal background (women's sex hormones prevent the vessel atherosclerosis). However, if you consider that during Klimaks, the hormonal background of a woman is changing, the risk of developing the IBS also rises.
- Etiology and Pathogenesis IBS
- Among the main factors of calling IBC can be allocated:
- Atherosclerosis of coronary vessels. Most often, the pathological process affects the front branch of the left coronary artery vessels. In more rare cases, the disease amazes the right branch of the arteries;
spasm of coronary arteries, changing their reactivity and increases their sensitivity to various adverse factors;
Various diseases of the coronary arteries.
The IHD development mechanism itself lies in the fact that the vessels cannot fully supply blood, and accordingly, oxygen, myocardial nutrients.
Such a phenomenon is evolving for the following reasons:
The defeat of the coronary arteries, resulting in a circulatory disorder;
- an increase in the load on the heart to meet its metabolic need;
- Combination of vascular pathologies and metabolic disorders. Under normal conditions, coronary vessels of a person may increase to 5 times to make a greater amount of blood to myocardium.
- Risk factors ischemic heart disease
- Many factors can cause the development of coronary heart disease. And if some of them can still be affected, then others cannot be eliminated.
- Fat factors. These include races, human age, genetic predisposition and sexuality. For example, Africans are much less likely to face this disease, rather than Europeans (especially those who live in the northern part of the mainland). The risk of developing coronary heart disease is significantly increasing in people whose family had relatives who died from myocardial infarction to 55 years.
- Disposable factors. Despite the fact that a person cannot change his race and age, he can still eliminate other factors and thus reduce the risk of pathology. Often they are interconnected, that is, eliminating one of them, the others can be eliminated in the same way. For example, a decrease in fatty food consumption will lead to a decrease in the amount of cholesterol in the blood, which will entail the weight loss and, as a result, a decrease in blood pressure. All this in aggregate can significantly reduce the risk of the occurrence of IBS.
- Disposable factors:
Obesity is manifested in the form of an excess amount of fatty tissue in the body. According to statistics, 1/2 part of people over 45 years have extra weight. As a rule, obesity causes an alimentary causes. That is, human weight increases significantly as a result of consuming calorie food in excessive amounts, as well as reduced physical activity;
Smoking is one of the most common causes of ischemic heart disease. Moreover, the negative impact of the harmful habit of the body is repeatedly enhanced if it is combined with an increase in cholesterol in the blood. According to scientists research, smoking can shorten the life of a person for 7 years. This is due to the fact that this harmful habit reduces the blood oxygen level. It provokes vessels spasm and thus increases blood pressure;
Sugar diabetes - one of their most dangerous risk factors IBS. Diabetics are several times more often sick of IBS than the rest. They often have a decrease in coronary blood flow, and they are much heavier tolerant of myocardial infarction. Moreover, doctors claim that almost all patients with sugar debit, in which the duration of the disease is 10 years or more, have a heavy form of atherosclerosis of the vessels - the causes of the development of ischemic heart disease. Myocardial infarction is the main cause of diabetic death;
Mental overvoltage can also cause IHD. This is due to the fact that during stress, the heart works faster, as a result of which the pressure in the vessels increases, and the delivery of oxygen and vitamins to the heart deteriorates;
- Low physical activity is the ODA from the most important problems of humanity in the 21st century. After all, it often leads to the emergence of various diseases of the heart and vessels, including ischemic heart disease. It was noted that men under 40-50 years old engaged in mental labor, it is 5 times more likely to have CDS. The risk of developing the disease is also greatly rising in athletes who finished their career and stopped playing sports;
- Hypertension can also cause problems with heart and vessels. An increase in the volume of the left ventricle of the heart and hypertension is highly likely to lead to a fatal outcome;
reinforced blood clotting. The blockage of blood vessels is often ends with a heart attack and blood circulation impairment, causes the formation of atherosclerotic plaques in the vessels.
It is different from other diseases with a huge number of symptoms, which are sometimes somewhat different depending on what caused a disease. In addition, the opinions of doctors regarding the mechanism of development of the pathological process from time to time change. This is due to the fact that every year cardiologists learn more and more facts about this disease.
The CRS classification is very complex, and it is practically impossible to install it correctly, since quite often different types of IBS are combined with each other and spontaneously go from one form to another. However, the special classification of IBS is still available.
So, doctors highlight 2 forms of the disease:
Acute ischemic heart disease. It is accompanied by an acute circulatory impairment and is often the cause of instant death;
Chronic ischemic heart disease. It combines with discomfort in the chest, some types of arrhythmias and violations in the work of the heart. Moreover, all these unpleasant symptoms may be present at once all together and separately.
Myocardial infarction is a severe heart disease, which leads to the protracted flow of angina. With this disease, as a result of insufficient blood supply to the heart, it is formed on it areas of necrosis.
The most common cause of myocardial infarction is to block vessels atherosclerotic plaques or blood clots.
If the patient had a complete closure of the vessel, then as a result, he develops a large-scale heart attack. With this type of infarction in patients, one, but a very large plot of necrosis appears. If the blood clogging occurred not completely, then the foci of necrosis on the heart will be small, but there will be quite a lot of them.
In no case do not treat infarction by folk remedies. Therapy of this pathology should be engaged exclusively by the doctor.
This is the most severe and most dangerous variety of IBS. In this case, the patient over the entire time feels quite normal, after which he suddenly has a heart stop.
Sudden death with ischemic heart disease can happen, even if a person sits in a calm state or even sleeps. With this form of ischemic heart disease, the percentage of deaths is the biggest, as it develops sharply and, as a rule, outside the hospital.
This form of coronary heart disease differs from the rest of the complete absence of pain and many other unpleasant symptoms. That is why the disease is usually detected late or is not detected at all. As a result, patients often die. Diagnosing asymptomatic IBS can only be an experienced cardiologist after numerous studies.
It is important to say that with a timely handling of the doctor, this form of coronary heart disease is amenable to therapy.
This form of ischemic heart disease is observed in people who experienced myocardial infarction in the past. With it, on the affected heart muscles, coarse scars appear, which may have different sizes and attend different quantities.
Arrhythmia is a combination of various pathologies of the heart-vascular system, leading to the failures in the rhythm of the heart. The most often arrhythmia is developing as a result of damage to various parts of the heart, diseases of the endocrine sphere and some neurological pathologies.
Sport with ischemic heart disease
Some patients after they were diagnosed with IHD, are interested, and is it possible to play sports?
Need to! Light physical exertion with ischemic heart disease is the main component in the treatment of this pathology.
Due to sports, patients can strengthen the muscles of the heart, blood vessels and improve blood circulation. To achieve the maximum result, sports is recommended for several years. Most often in this case, doctors recommend walking and swimming.
Ischemic heart disease, the symptoms of which are very diverse, it is in the first place among the main causes of mortality and disability in people of the working-age population. And although these indicators are gradually decreasing annually, it is connected only with the timely identification of the disease and adequate treatment.
Sexual differences in patients with IBS
Signs of ischemic disease in men and women do not have gender (sex) differences and depend on the form of the disease itself. That is: pain, shortness of breath, interruptions appear equally. Differences are associated with age, varieties of pathology and subjective experiences. Although, of course, there are exceptions.
The symptoms of ischemic disease in men are first revealed at the age of 55. It is noticed that they have the first manifestation of the IBS infarction of myocardium, among representatives of the weaker sex - angina region. Also last more often develops H. syndrome
reinforced blood clotting. The blockage of blood vessels is often ends with a heart attack and blood circulation impairment, causes the formation of atherosclerotic plaques in the vessels.
The symptoms of coronary heart disease in women arise over the age of 65. This is associated with physiological features, namely, with the protective properties of estrogen - female sex hormones. Only after the occurrence of menopause and their sharp decrease in the vessels are subject to atherosclerotic process - the main reason of the IBS.
Women are also more predisposed to the development of exteroidal reactions by type of different phobias and panic attacks, according to the clinic resembling cardiovascular pathology. In this connection requires a more thorough collection of anamnesis and a special approach to its assessment and interpretation.
- Clinical features of varieties of IBS
- The CHA consists of 9 sharp and chronic clinical forms. And in each particular case will be their characteristic differences in symptoms.
- Sudden coronary death
- Sudden coronary death is manifested by a heart stop. Externally, a person immediately loses consciousness. Moreover, it almost does not happen precursor.
- Among the "full health", a person dies if reanimation techniques (indirect heart massage, artificial ventilation of the lungs or defibrillator) will be ineffective.
Pains for coronary heart disease are most characteristic of myocardial infarction and stress angina. There is a typical pain syndrome when developing pathologies data. Already in a survey, the patient's bed with a larger percentage of confidence can be addressed by a preliminary diagnosis.
The pain or sense of discomfort has the following several decisions:
Localization (place where hurts) - most often behind the sternum, from the top of the abdomen to the lower jaw in the middle line. Heart area does not hurt. If the pain is available there, you need to look for another pathology. Unusual places are teeth, inter-opacculent space, as well as shoulders, wrists and fingers (more often - on the left side).
- Character - from a sense of gravity and discomfort to pressure and unbearable burning.
- Duration - more than 15 minutes. Sometimes it lasts up to several days, and its intensity increases.
- Communication with load is straight. Usually the patient in recent times or at the time of the appearance of pain did physically any work or suffered a serious emotional stress. Also occurs after abundant food or outdoor intake.
- The reaction to nitrates is negative. The pain or sense of discomfort does not disappear even at large doses of nitroglycerin or its analogues when taking a tongue.
- General features will also be weakness, abundant sweating, the drop in blood pressure.
- Symptoms of myocardial infarction and coronary heart disease, in general, are peculiar, sometimes - with their complete absence in the initial stages of development, and depend on the location and parameters of the very focus of dead cardiomyocytes.
- Atypical infarct forms are:
- dyspnea; The feeling that there is not enough air, cough (with asthmatic)
Dizziness, loss of consciousness, darkening in the eyes (with collaptoid)
Violation of speech, paresis or passing weakness in the limbs (under cerebral)
Pain in the abdomen, nausea, diarrhea, vomiting (with gastralgic)
heartbeat and interruptions (at arrhythmic)
In no case do not treat infarction by folk remedies. Therapy of this pathology should be engaged exclusively by the doctor.
The appearance of leg edema, increase in the liver and abdomen due to the accumulation of liquids in it (with swelling)
Weakness, sweating (with a low-stream)
Combined - can combine signs of different forms
With this variety of IBS, the most frequent feature is pain. It is similar to those with a heart attack, but has differences directly indicating the diagnosis of angina region.
Localization and its character may be the same, however, a positive reaction to nitrates is noted - pain or discomfort in the chest immediately or within 2-3 minutes disappear when taking nitroglycerin or its analogues under the tongue. It also disappears after stopping the load.
In the intergenial period, and when there are no provoking effects, other symptoms are absent.
The specified diagnosis is set in 28 days from the moment of the onset of myocardial infarction and is manifested by general signs characteristic of the heart failure clinic. These include shortness of breath with load, interruptions and heartbeat, swelling of the legs, as well as weakness, sweating. In the occurrence of pain syndrome, it is impossible to exclude the development of a repeated or recurrent infarction, which requires an immediate appeal for help.
Arrhythmias and blockades
This form of IBS refers to chronic, where the pulse with ischemic heart disease is its characteristic and indicative feature.
A feeling of rapid or slow heartbeat, "fading" and interruptions in its work - the main symptoms of the CHD in this case.
In addition, the feeling of lack of air appears when the pulse and heart rate are accepted against the background of the Tahiarhythmic IBS form.
Non-specific complaints of general malaise, sweating may also be disturbed.
Chronic heart failure
Evenkers with ischemic heart disease (as a symptom) appear when developing the weakness of the heart muscle. It is primary or considered as a consequence of acute forms of IBS (after a heart attack).
The fluid delay syndrome begins with the appearance of symmetric edema on both legs in the evening. This distinguishes them from the renal edema appearing on the face and in the morning, as well as from edema in chronic venous insufficiency, when only one leg swells more often.
When progressing, edema disease may rise and reach anterior abdominal wall.
With CHF, the patient appears increased fatigue, sharp weakness. The usual physical activity becomes in a burden.
Dyspnea with ischemic heart disease is also found with a severe degree of heart failure (cardiac asthma). It is enhanced in the position lying, therefore, to relieve respiration, many patients sleep with an elevated head end (lining under the head of 2-3 pillows).
Also for CXN characteristic signs of the underlying disease that led to the development of the weakness of the heart muscle.
Special forms of IBS
These include vasospadic and refractory angina, cardiac x syndrome. The symptoms are similar to the clinic of the conventional angina stress, however, the phenomena of the peripheral spasm of the vessels are accompanied, as well as a negative reaction to standard treatment of angina.
Myocardine ischemia ischemia is detected only when additional examination methods are detected. Typical pains (as with other IBS forms) is not.
When a similar clinic is found, an immediate appeal to a specialist is recommended.
A family practice, therapist and cardiologist will help in this matter. Therefore, you should not pull a visit to the doctor and engage in self-medication, self-taking some drugs or using folk methods on the advice of relatives or neighbors.
Only timely diagnostics and treatment of IWC can extend the patient's life.
The diagnosis of ischemic heart disease (IBS) is necessary to determine the exact form of the disease, since the term itself combines several pathologies into one group. This is necessary to determine the further tactics of the patient, because treatment directly depends on the timely formulation of the correct diagnosis.
The survey includes the collection of complaints, disease history, a general inspection, laboratory and instrumental methods.
How to suspect IBS?
The preliminary diagnosis is established with a primary examination of the patient therapist or cardiologist. These specialists know how to diagnose ischemic heart disease.
In addition to the characteristic symptoms and complaints imposed by the patient, during the inspection, it is possible to identify signs of ischemic heart disease.
Under acute pathology, to which myocardial infarction includes angina, or a sudden heart rate breakdown, the patient's condition can be extremely difficult until the loss of consciousness. In this case, his accompanying are polled.
When conducting an inspection, a special emphasis is aimed at examining the cardiovascular system.
The pallor or sinusiness of the skin, swelling of the legs and the legs can be signs of coronary pathology.
In the region of the heart, congenital or acquired deformations of the chest in the type of heart robbery can be determined.
With percussion of borders, heart dullness can be shifted. Auscultation can be heard over noises and interruptions.
The pulse with ischemic heart disease can be both crucified and participated (depending on the form of the disease). That is, it is not very indicative.
Arterial pressure with a concomitant hypertensive disease can be increased. When developing acute heart failure, for example, on the background of myocardial infarction, the pressure on the contrary can be reduced.
Laboratory research methods
- Analyzes with ischemic heart disease can help in the formulation of a faithful diagnosis. Assess general analysis and biochemical blood markers.
- Common blood test reflects the quantitative characteristic of red blood cells, hemoglobin, leukocyte formula and erythrocyte sedimentation rate (EE).
- The main indication for this analysis is to identify the concomitant pathology, which can imitate or distort the main symptoms of cardiovascular diseases.
With an extensive myocardial infarction, leukocytosis is possible and the SE acceleration in the first few days. They reflect the processes of necrosis (decay) of the heart muscle.
The results of the analyzes are interpreted in accordance with the terms of the prescription.
Must be assigned a general analysis of urine, blood test for glucose, the biochemical indicators of the kidney work are evaluated in order to identify background metabolic diseases and diabetes.
Diagnosis "Ischemic heart disease", namely, myocardial infarction, with great reliability can be confirmed after the blood test for enzymes. These include:
Normally in the blood, they are present in minor quantities, since they are mainly intracellular substances. In acute destruction of cardiomyocytes as a result of myocardial infarction, their massive output in the bloodstream is observed, which is reflected in the biochemical analysis in the form of the growth of their concentration above the above-mentioned norms.
- Such an increase can be associated not only with a heart attack. Other frequent reasons include liver diseases, severe heart failure or pathology of skeletal muscles.
- An important indicator also detects in the blood of troponins - protein components of the heart muscle. Their detection is more specific only in the first hours of the death of myocardial cells. Blood fence on this indicator does not make sense with a two-day infarction already developed.
- The blood test for electrolytes determines the potassium and sodium content. Their concentration affects the rhythm of heart abbreviations and can cause arrhythmias.
- And of course an important stage in establishing the diagnosis of the IBS is to determine the lipid spectrum of blood.
- The concentration of total cholesterol and its fractions reflects the predisposition of a person to the development of atherosclerosis, which is the main factor in the development of such pathology of the cardiovascular system as ischemic heart disease.
Diagnosis of IBS using instrumental methods.
To the main procedures, allowing to determine the diagnosis of "IBS" with great reliability in the patient, belong:
Halter monitoring ECG
Conducting functional samples
Also patients are carried out x-ray of the organs of the chest to exclude the pathology of the respiratory organs.
The main study that is carried out primarily in suspected of acute forms of such pathology as ischemic heart disease - ECG.
It is a procedure for capturing and registering bioelectric heart fields. For the study requires special equipment in the form of electrocardiograph and electrodes. The first is a receiver with a writing element (specially configured) and millimeter paper. And on the chest and all limbs are superimposed with special electrodes by type of plates with wires. As a result of the electrical signals in the electrocardiograph of electrical signals from the heart muscle on a millimeter film, curves are drawn in the form of a teeth - a graphic image of the abbreviations of various parts of the heart - atrial and ventricles. With all the forms of IBS, an ECG has a peculiar picture.
Under an acute infarction of different localizations, the appearance of a pathological tooth q or lifting ST segment is higher than isolate in the appropriate leads. In the scarring stage, these changes can completely disappear.
When angina, at the time of the attack, it is also possible to fix similar ischemic changes passing without a trace after the episode relief.
In the Arrhythmic form of the CHD, you can reveal the rhythm disorders both with rare (bradyistolia) and with rapid (tachyarhythmia) cardiac abbreviations. Extraordinary abbreviations can also appear - extrasystole.
In the heart failure relating to chronic IBS, it is possible to see the elongation of the main segments and the deformed ventricular complexes due to the slowdown of the pulse or hypertrophy (increase) cameras.
The blood test for electrolytes determines the potassium and sodium content. Their concentration affects the rhythm of heart abbreviations and can cause arrhythmias.
The interpretation of the results obtained are engaged in the doctors of functional diagnostics.
But even in the presence of pathological changes on the film, a comprehensive assessment of the data obtained in aggregate with the clinic and other research methods is necessary.
Since there are often cases of hyperdiagnosis of the disease.
Refers to the Gold Standard for the diagnosis of the pathology of coronary vessels. Thanks to him, a visual assessment of the degree of narrowing of the lumen of blood vessels of the heart with the help of a contrasting substance was introduced there.
The study itself is fixed by a series of X-rays.
Often diagnostic coronary photography goes into therapeutic, when a stent (hollow mesh tube) is immediately installed in the region of the narrowed vessel) to expand the lumen and improve the coronary blood flow.
It is a long (from several hours to 7 days) ECG registration, since a single ECG may not have time to register pathology.
It is mainly carried out by patients with complex heart rate impaired, night painful episodes in the heart, as well as with an unclear diagnosis or to control the treatment for the purpose of its correction.
By design, the device is similar to an electrocardiograph, but only portable, and instead of paper there is a special magnetic tape for recording.
Conclusion is also issued by a functional diagnostic.
The concentration of total cholesterol and its fractions reflects the predisposition of a person to the development of atherosclerosis, which is the main factor in the development of such pathology of the cardiovascular system as ischemic heart disease.
Samples with load
Conducted both with the help of a treadmill or bike bar and using a 6-timer test.
The need for such samples is due to the fact that some forms of IWC are manifested clinically only during physical stress. It is at this moment that ischemia (lack of oxygen) of myocardium develops due to the inconsistency of the need for the heart muscle and the amount of blood supplied according to the narrowed blood vessels.
Such a changed work of the heart is registered on the ECG.
The testimony for testing is also the need to clarify the diagnosis, form and severity of IBS, selection and control of treatment efficacy.
The technique is associated with a certain risk, so it is necessarily carried out only in the presence of a specialist doctor who can conduct cardioreanimation.
The test immediately stops with the deterioration of the well-being of the subject or when serious deviations appear on the ECG.
Allows visually in real time to estimate the dimensions of the chambers and the thickness of the heart walls, the contractile ability (fraction of the emission) of various myocardial departments, as well as the presence of additional formations (thrombus, tumor) in the atrial cavity or ventricles.
It is carried out with the help of a special ultrasound apparatus by a diagnostician.
In the study, you can clearly see the work of the heart and the valve apparatus, as well as observe the rhythm and frequency of abbreviations.
- More shown in chronic forms of IBS, namely, in the heart failure and the formation of the aneurysm in the post-infarction period.
- Signs of coronary heart disease in men and women practically do not differ. However, the first disease occurs at earlier age. Unfortunately, IBS is constantly "younger." Therefore, with the slightest suspicion, urgent appeal for medical help. On time, the diagnosis can not only save the lives, but also prevent serious complications. This will improve the forecast, quality of life and well-being in the future.
- Photo: Emax.ru.
- The diagnosis of ischemia sometimes sounds like a sentence, because, unfortunately, this disease is incurable and postponing an unpleasant imprint on the life of the disease. Therefore, the question can be cured by ischemic heart disease, any cardiologist will give a negative answer. But at the same time, without medicines, in this case, it is not necessary, since it is properly chosen by the treatment of coronary heart disease in aggregate with a healthy lifestyle will help significantly extend the patient's life, to avoid serious complications and facilitate the course of ischemia.
- Rules in the treatment of ischemic heart disease
How to avoid ischemic heart disease? To successfully deal with ischemia and avoid its development, it is necessary to comply with a number of important rules:
Control of blood pressure. It is impossible to allow a sharp and long-term increase in blood pressure. For control, it is necessary to measure pressure every day to measure the pressure in order to take measures in a timely manner. Normally, the pressure should not exceed 140 per 90 units.
Healthy nutrition. The first thing that the doctor does after the diagnosis of ischemic heart disease will be prescribed a low-holesterol diet. A diet and a list of recommended and prohibited products are selected individually depending on the severity of the disease, the age of the patient and its individual characteristics.
Control of cholesterol levels. The blood test to the level of cholesterol is carried out regularly by appointment of the doctor. In case of any deviations from the norm, drug treatment and nutrition are adjusted. In this case, the total amount of cholesterol in the blood should not exceed 5 mmol / l. Part of this volume is high density cholesterol, which is considered useful and necessary. It should be at least 1 mmol / l. The rest of the mass is declined by low-density harmful cholesterol. But at the same time it should not be more than 3 mmol / l. To understand how to treat ischemic heart disease, you need to understand with what kind of cholesterol did the patient entered, and control this level throughout the entire therapeutic process.
Compliance with sleep mode. So that the heart worked in a comfortable environment, it is impossible to overload the body, including violations of the sleep mode. It is necessary to go to bed at the same time: the most comfortable for your biological clock. It is also necessary to sleep at least 7 days and no more than 10 hours. Deviations from this norm in a large or smaller side negatively affect the work of the heart muscle.
Fresh air. It is very important to prevent oxygen starvation of the body. If possible, it is necessary to pay 30-40 minutes a day on the outdoor walk. If walking or long walking is contraindicated in rehabilitation of patients with coronary heart disease, and the patient does not have the ability to be frequent and for a long time on the street, it is necessary to ventilate the room daily after awakening and before bedtime. This will beneficially affect sleep quality, and will also allow blood to saturate with sufficient oxygen.
Rejection of bad habits. You should forget about such bad habits as drinking alcohol and smoking. They intoxitize the body, change the composition of the blood for the worse and deplete the heart muscle.
These rules must be respected not only in the treatment, but also for the prevention of coronary heart disease.
Medicines for the treatment of ischemic heart disease
With ischemic heart disease therapy, primarily conducting drugs. To do this, a complex of various groups of drugs, such as ACE inhibitors (ENAPRIL, Lisinopil), beta-blockers (anaprilin), nitrates (nitroglycerin), statins (atorvastatin), anti-aggregants (aspirin), anticoagulants (warfarin). In the complex, these drugs help maintain blood pressure in the normal state, removing heart attacks, maintain blood viscosity in a discharged form, reduce the level of low-density harmful cholesterol and prevent the appearance of blood clots. Such assistance in ischemic heart disease will help to avoid more radical methods of treatment and the emergence of complications.
- In addition to these drugs, patients often prescribe various multivitamin complexes for maintaining the body and the immune system, anti-inflammatory drugs of nonsteroidal nature, antihypoxants, diuretics. These drugs are prescribed to improve the effectiveness of complex therapy.
- Do not forget about the treatment of folk remedies and herbs. There are a large number of plants that are capable of providing auxiliary effect. For example, hawthorn, garlic, horseradish, valerian and mother-in-law. The hawthorn favorably affects the heart and the composition of the blood, garlic is an anti-inflammatory agent, horseradish improves blood circulation, Valerian and dyeing helps to normalize pressure with accompanying hypertension.
- The drugs described above constitute a combination of funds for the treatment of ischemic heart disease. Specific methods of treatment, drugs and their dosage should be appointed directly attending a doctor after all necessary analyzes. Is the ischemic heart disease are treated? At the moment there is no. But the body needs to be maintained and avoiding complications. With this type of disease, it is impossible to deal with self-treatment and uncontrolled treatment, as it is fraught with serious complications and even the likelihood of death.
- Surgical treatment of ischemic heart disease
- In the event of the ineffectiveness of the remaining techniques, surgical treatment of coronary heart disease is used. This is a complex and danger procedure characterized by long-term rehabilitation. With ischemic heart disease, the shunting is made in the case of a heart attack. With ischemic heart disease, the operation sometimes remains the only option (in the event of a high risk of developing complications).
- After the shunting, a high blood flow to the heart is ensured by the formation of a new channel, which reduces the load on the affected vessels. For example, if the ischemic disease arose due to the coronary artery thrombosis, its shunt is carried out. As a result, the intelligence required for the influx of blood and the blood supply of the heart muscle comes to normal.
Shunting usually implies long-term rehabilitation: at least 6 months. During this period, it is necessary:
Limit physical exertion;
Do not lift gravity;
Avoid stress and emotional loads;
Comply with a lowholesterol diet;
Do not drink alcohol;
The duration of the functioning of shunt is about 6 years. After their wear, a re-operation replacement can be assigned. Immediately after the operation, the patient's movement should not be limited. The first weeks need to do light gymnastics, warm joints of the brushes, stop and neck. It is also necessary to walk. On the day it is recommended to pass at least 50 meters (depending on the well-being). This will help prevent such complications as pneumonia caused by the stress of fluid in bronchi.
After discharge from the hospital, physical activity should be limited. But this does not mean that you do not need to move at all. Usually, before the discharge, the doctor conducts a survey of the body to readiness for further livelihoods and issues recommendations on a set of exercises that can help in this case. It is also necessary to go daily daily. The distance must be calculated individually in such a way as not to overload the body. Walking outdoors should be a daily ritual.
- Able-bodied person who suffered shunting may have to change the type of activity. To increase the life expectancy of the valve, you can not give a greater load on the heart. If the work took a lot of strength and energy, is associated with frequent stress or exercise, it must be changed to a more sparing activity.
- So, in the treatment of ischemic heart disease, it is most often possible to do with the drug and maintaining a healthy lifestyle. It is necessary to do it under the direct control of the doctor. In the event of the risk of infarction or the onset of other complications, an operation is assigned, which (thanks to the impaired shunt) will help improve the blood supply to the heart and will benefit on the quality of life.
- Photo: Medicinemoscow.ru.
- Reducing the severity of symptoms and mortality, as well as improved quality of life and forecast of the disease pursues pharmacotherapy of coronary heart disease.
- In addition to the anti-hiece agents, this is achieved by adjusting nutrition, lifestyle, physical activity, and with a severe degree of coronary arteries - revascularization with the restoration of the vessel affected by atherosclerosis. Treatment by folk remedies does not have an evidence base and is likely to be effectively only at the prevention of pathology.
- Preparations for ischemic heart disease are divided into several groups of action mechanisms. They include:
- Beta blockers,
What to take with ischemic heart disease is advised only by a qualified specialist after diagnostic methods and diagnosis.
A group of drugs that contributes to the removal of the main feature of the IBS - pain - with a stainlessness angina. The antiagonal mechanism of action is based on the release of nitrogen oxide, expanding blood vessels, including both cardiac. Due to this, it begins to take more blood with oxygen and nutrients, eliminating their disadvantage, and the pain passes. Refines symptomatic therapy, the cause and forecast of the disease do not affect.
The whole group is divided into short and long-term preparations. First include nitroglycerin, nitrosorbide, erythic. They are suitable for relieving the attack of ischemia due to the quick effect. With sudden angry pains or to prevent (prevention) are taken under the tongue (in the form of spray and tablets). But their action is also versal and ends for several hours.
The prolonged (durable) includes isosorbide di- and mononitrate (pecterol, monocinx). Used as warning pain attacks with stable angina twice a day.
The main side effects are the development of resistance (addiction), strong headaches, as well as a sharp pressure drop due to the expansion of blood vessels. Therefore, there are means of choosing with frequent sophisticated spacing episodes against the background of hypertensive disease with high blood pressure numbers. Do not be recommended for use in patients with adhesive ads below 110/70 mm RT Art.
The problem of addiction is solved by the course reception of medicines with alternation of "rest" from them. The reception scheme appoints the attending physician.
Medicines for the treatment of ischemic heart disease include a group of beta adrenobloclars. Influence the forecast. According to the mechanism, the action differ from nitrates, as they affect directly on the work of the heart muscle. The effect is associated with the effects of cell receptors that reduce the heart rate and their strength. Myocardia begins to work less intensively, the load decreases, and after this decreases the need for oxygen.
Tablets for ischemic heart disease from this group are widely used for the treatment of arrhythmias, reducing the excitability of cells and blocking the conduct of pulses.
The main funds include metoprolol, bisoprolol, carvedilol, propranolol, atenolol, nebivolol and others.
Among the basic testimony to use - myocardial infarction, post-infarction cardiac cardiosclerosis, angina, chronic heart failure and HRC arrhythmic form.
These means for the treatment of ischemic heart disease are contraindicated with bronchial asthma and COPD, bradycardia (rare pulse less than 60 shots per minute), hypotension (ad less than 90/60 mm HF), including on the background of collapse or cardiogenic shock, atrioventricular blockades 2-3 degrees (when the electrical pulse of myocardium is disturbed) and individual intolerance. Not recommended to children under 18 (no clinical studies), during pregnancy and breastfeeding.
The most frequent side reactions, in addition to allergies, include a pulse immunity of less than 56 blows per minute, a sharp drop of blood pressure, bronchospasm and dysfunction of the sexual system.
An individual approach requires all the treatment of ischemic heart disease, preparations and doses are therefore selected in accordance with the testimony and contraindications.
These include Enalapril, Perindopril, Ramipril, Lisinopril, Fozinopil, Captive, etc.
The main indication of the CHD is chronic heart failure, even though funds and belong to the preparations of the first line of treatment of hypertension. It has been proven that drugs have the property of remodeling cardiac cameras, reducing the degree of hypertrophy (thickening) of myocardium. Positively affect the forecast, reducing the percentage of mortality from heart attack and decompensation of HSN, especially against the background of myocardial dysfunction of the left ventricle.
Contraindicated in individual intolerance, bilateral stenosis (narrowing) of renal arteries, the increased content of potassium in the blood, as well as during pregnancy and breastfeeding.
The main side effects are a sharp decline in hell, dry cough. What is the indication to replace them with a group of Sartan (Valsartan, Telemisartan), similar to the mechanism.
Doses and reception scheme are selected individually in accordance with the parameters of blood pressure, starting with starting doses.
Given the reason for the development of the IBS, which consists in 80% of cases in the damage to the arteries atherosclerotic process, hypolypidemic drugs are prescribed to reduce and stabilize cholesterol plaques. Preparations of choice - statins. These include Atorvastatin, Rosavastatin, Simvastatin.
Showing with a modified lipid profile: the level of total cholesterol is higher than 4.5 mmol / l, low density lipoproteins are higher than 1.8 mmol / l.
Beta-adrenergic receptor blockers
Reduce the concentration of lipid fractions due to the impact on the liver, namely, due to the blockade of the GMG-CoA-reduction responsible for further cholesterol education.
Side effects - Hyperfermenimia Alat and Asat (inner enzymes of liver cells), myopathy, allergy.
Contraindicated in diseases of the liver and kidney, myopathies, pregnancy, lactation, individual intolerance and children.
Accepted once a day. The usual starting dosage of 20 mg with a gradual increase of it to obtain the desired level of lipids under the control of blood enzymes.
Reception of the drug, subject to the achievement of the proper level of cholesterol and its fractions lifelong.
Antiagregants and anticoagulants
Used to prevent vascular complications by type of thrombosis in coronary arteries and "thinning" blood. These include aspirin and its analogs (thrombo ass, cardiomagnet), as well as clopidogrel. Showing all forms of IBS. The optimal daily dose of aspirin 75-150 mg. Contraindicated at high risk of bleeding.
Presented by two intragroup varieties: dihydropyridine (nifedipine, amlodipine) and NEDIGIDROPIRODINOV (verapamil, diltiaze) drugs. The latter and are used to treat the CHD.
The main effect is achieved by influencing intracellular calcium channels, due to which the extension of blood vessels is observed, as well as a decrease in heart rate.
The most frequent adverse reactions - swelling of the legs, headaches.
Preparations are contraindicated in hypotension, intracardiac blockades, severe degree of heart failure.
Help to remove excess fluid from the body, due to which the volume of circulating blood in vessels decreases and the load on the heart muscle is reduced.
Mix loop (Furymid, Toramsemid) and thiazide (indapamide, hypothiazide) diuretics.
There are their different forms - tablets and injections. In ischemic diseases are used to treat such forms as chronic heart failure with edema syndrome.
Contraindicated with pronounced hypotension, coma, hypovolemia (dehydration), low content of potassium and sodium in the blood, children under 3 years, during pregnancy and lactation, as well as in individual intolerance.
From adverse reactions, dizziness with a decrease in pressure, the muscles of the towers, allergies occur.
The group includes a large number of diverse drugs, including beta-blockers and calcium antagonists.
Preparations of potassium, cordaron, lidocaine, heart glycosides. This is an incomplete list of funds with antiarrhythmic activity.
Panangin, Asparkov and other potassium-containing means are shown as additional myocardial support after the suffered infarction or heart failure, improving cardiomyocyte metabolism.
Contraindicated with hypercali and magnesium, cardiogenic shock, renal failure.
The cordaron is appointed with rhythm and ventricular rhythm violations, especially after a heart attack, as the prevention of sudden arrhythmic death.
Contraindicated in diseases of the thyroid gland, blockades of heart, pregnancy, lactation, intolerance to iodine drugs.
Lidocaine can be used in the development of arrhythmic syndrome in patients against myocardial infarction in the acute period. Contraindicated in hearty blockades, cardiogenic shock.
Cardiac glycosides are prescribed at various rhythm disorders and under stagnant heart failure. Contraindicated in atrioventricular blocks. There is a danger in their overdose and the appearance of symptoms of glycosidic intoxication in the form of specific ventricular arrhythmias and AV-blockad.
Trimetazidine, Mexicor, Mildronat and other drugs from this group have antianginal, metabolic actions, and also protect myocardial cells from lack of oxygen. Assigned as supporting therapy for any forms of IBS, including during angina progression or to the acute phase of myocardial infarction.
Contraindicated in individual intolerance, as well as pregnant and nursing due to lack of clinical data of their application in these categorical categories.
Despite the development of the modern pharmaceutical industry and the regular creation of new drugs from IHD and other pathologies, no funds have not yet been found that allows you to completely get rid of atherosclerosis and its complications.
IHD requires lifelong therapy and a healthy lifestyle. In the complex therapy of this disease, folk remedies are widely used. There is a huge amount of herbs and plants that favorably act on the heart and artery, increase blood circulation, reduce cholesterol levels and blood viscosity. Here are the most popular folk remedies for phytotherapy IBS:
People's Treatment of IBS is unthinkable without hawker. This plant greatly strengthens the heart muscle, helps to reduce pressure and reduces the heart rate. It should take it with caution, as the pressure can fall very much.
Tea from the berries of the hawthorn. Fruits usually collected in the season of their maturation and dried. Tea from such fruits can be drinking all year. For this art. A spoonful of dry berries is poured with 450 ml of boiling water and brew 15 minutes. The resulting portion is divided into 2 receptions with a difference of at least 6 hours.
A decoction based on hawthorn with a rosehip and dyeing. 100 gr. Rosehip and hawthorn fruits and 50 gr. Herbs of a dye pouring a liter of water, bring to a boil for 7 minutes. After that, the decoction should be cooled, skip through the fabric or gauze and take on the floor of a glass in the morning on an empty stomach.
HorseradishThe root of this plant improves blood circulation and the blood supply to the internal organs, it is very important for patients with coronary heart disease. Treatment by folk remedies using horseradish is useful and efficient, but it is not recommended to be used inside with gastrointestinal diseases.
Inhalation with horseradish. A tablespoon of freshly conductive shit to pour boiling water and make inhalation within 15 minutes.
Honey with honey. Mix 100 gr. Khreno and as many honey and eating in the morning after eating 1.5 h. spoons, you can be powered with water or tea. Such treatment should be carried out with interruptions. It is not recommended to use a mixture for more than a month, during treatment you need to take a break for at least 3 weeks between courses.
- Garlic also favorably affects the process of blood circulation, in addition, it stops inflammatory processes and contributes to anesthesia when attacks. Treatment of IBS People's methods involves the use of garlic in raw form. It is recommended to add to the finished dishes or eat along the tooth in the day during food.
- Folk remedies under the CHA are very effective, but should not be engaged in self-medication without the knowledge of the doctor. The use of one or another recipe must be coordinated with it to avoid complications.
Information is referenced and is not a guide to action. Do not self-medicate. At the first symptoms of the disease
- Contact your doctor
- What leads to the appearance of IBS
- Ischemic heart disease (IBS) develops as a result of the impact of mechanisms that lead to a circulatory impaired in coronary vessels and oxygen starvation of myocardium.
- In atherosclerosis, blood cannot flow to heart in sufficient quantities due to the fact that the fat plaque narrows the lumen. For this reason, it becomes impossible to satisfy the need for cardiomyocytes in oxygen. As a result, pain attack (angina) is developing against the background of stress or exercise.
- Thromboembolia. The formation of blood clot is provoked by the decay of cholesterol plaque. Sometimes the thrombus is formed in the cavity of the heart, then it takes off and clogs the clearance of the arteries. With endocardius as a "plug" can perform a piece of valve tissue.
- Spasm of vessels. A sharp reduction in smooth muscle fibers in the system of coronary arteries is provoked by a rapid transition from the horizontal position to the vertical. Such a phenomenon is observed when inhalation of cold air, strong overcooling of the entire body, stress, using some drugs.
- In addition to the main reasons in the appearance of acute or chronic myocardial ischemia, the role of provoking factors also play:
- improper food with excess fatty food rich in cholesterol;
- obesity and violation of the exchange processes (including lipid);
- "Sitting" lifestyle;
endocarditis and heart defects;
errors in nutrition;
age after 45 in men and women over 55;
- the presence of vascular diseases;
- constant stresses that are accompanied by the increase in pressure and the increase in heartbeat;
- Alcohol and smoking.
- High cholesterol indicators in violation of metabolic processes and the tendency to the formation of thrombus are inherited. Therefore, the degree of probability of the appearance of the IBS is higher in those people whose relatives had a history of 45-65 years old, or died as a result of coronary insufficiency.
- When a diagnosis of ischemic heart disease, my colleagues still enjoy the classification that was adopted in the 80s of the last century.
- Sudden heart death. Refers to all fatal outcomes within the first 60 minutes after the start of the attack, which was preceded by the loss of consciousness, sharp symptoms of ischemia and a heart stop.
- Voltage. Arises as a result of a physical or psycho-emotional load.
- For the first time arising.
- The first class is manifested only with pronounced overloads and never happens during normal operation;
The second is placed in those who cannot have a quick 500 and more than 500 and more meters, as well as climb 6 floor and above;
The third class characterizes the development of an attack with insignificant voltage (it is conditionally accepted that when walking up to 100 meters and the rise to the first span);
The fourth grade corresponds to the appearance of a stubborn pain under the condition of complete rest, while a person cannot make any movement without developing heart acute ischemia with characteristic features for it.
This form of ischemic heart disease is observed in people who experienced myocardial infarction in the past. With it, on the affected heart muscles, coarse scars appear, which may have different sizes and attend different quantities.
Progressive (unstable). With this form, there is a deterioration in the state and reducing the effectiveness of treatment when conducting a normal lifestyle.
Spontaneous (printeal). A special form of ischemia, at which vasospasm occurs, causing pain syndrome. The external reasons for this role do not play. It takes hard, poorly stopped nitroglycerin.
Cheerful ischemia. It was introduced to the general list much later. Received by chance after ECG and load samples.
- How and why pain syndrome occurs with IHS
- The pathogenesis of the appearance of pain during the attack is well studied. Reducing blood flow or increasing oxygen need leads to the development of ischemia. The focus begins the enhanced release of active substances (mediators), causing irritation of pain receptors (histamine, bradykin). From the area of the lesion, signals on nerve fibers begin to go. First, they go into cervical and chest plexuses localized in the spine. From there, the impulses through the Talamus go to the bark of the brain, and there is already a feeling of pain.
- The severity of pain symptom with IHD does not depend on the degree of lesion. That is why there are "dumb" and atypical forms of angina and even a heart attack.
In my practice, I constantly come across the fact that patients with IBS are not asked for help immediately. This is because the first symptoms of ischemic disease grow gradually.
The most common complaint of a patient with angina or infarction is pain in the stubborn area - most of it is accompanied by a feeling of fear and panic. The irradiation is usually observed under the blade, in hand, and a part of the lower jaw with the Virgin. Some make complaints against the numbness of the upper limb, the lubrication in the bright joint. With a lack of oxygen in the region of the posterior heart of the heart, the pain spreading into the stomach zone. And it is very rarely noted in his right hand.
When I ask you to characterize the type of pain, a person indicates that she:
- The appearance of pain syndrome is associated with exercise - when a person ran, quickly walked, or climbed the stairs. Sometimes the attack was observed after stress, strong emotional tension, outdoor outside in cold weather. A sharp influx of blood to the heart is also noted when it is inserted from the position lying. All these factors lead to an increase in pressure, pulse increase and improving the need of myocardium in oxygen.
- pulling, cutting, gulp pain irradizing in the upper limbs, lower back;
- Pain with angina is short-term and does not last more than 5-15 minutes. As soon as a person stops, sitting down, calm down, it subsides, since the causes of acute ischemia are eliminated. Patients with experience are always nitroglycerin with them, which quickly removes the symptoms. If the intensity of the unpleasant feeling does not subscribe after taking the means, it most often indicates an extraordinary pathology, or indicates the development of a heart attack.
- With vasospast or spontaneous angina, pain and other signs of myocardial ischemia are developing without communication with exercise, it is marked in the morning hours, often provoked by the influence of cold. It is well removed only by calcium antagonists.
- Other frequent manifestations
Other signs of coronary heart disease are not always manifested, in some patients during the arrival period I watched the following symptoms:
pronounced shortness of breath with difficulty inhale;
increase or decrease in blood pressure;
Cheating (less often regeneration) heartbeat, arrhythmia.
- In some cases, instead of a classic attack indicating the presence of ischemic illness in the heart, it is possible to see its equivalents: shortness of breath, fatigue after the minimum load.
- Diagnosis of ischemic heart disease includes laboratory and instrumental techniques.
The biochemical methods of detecting in the blood of a number of enzymes help in determining the acute phase of the infarction, as they are allocated as a result of the destruction of cardiomyocytes. The first day after the attack, when the acute ischemia of myocardium and necrosis is observed, LDH and Mioglobin increases. The increase in KFK happens in the first 8 hours from the beginning, troponins are detected after 1-2 weeks
In obligatory procedure received by the patient with complaints and signs of a heart attack, I direct on the urgent cardiogram. It allows you to detect the presence of an increase in the left ventricle, the rhythm disturbance and the degree of expression of the lesion in a certain area of the heart.
- Signs of acute ischemia in myocardium on the ECG have the following form: The appearance of high and acute teeth of T. Although I observed an ECG in high asthenic people who have such signs are an option for the norm. Sub-endocardial ischemia of the front wall of the heart can be characterized by a negative T, and the two-phase prong appears on the border of the lesion zone and the normal portion of the myocardium.
- Another typical sign of acute ischemia is the displacement of the ST segment for a distance of more than 0.5 mm from the isolated. His rise in breasts testifies to the defeat of the left ventricle, and depression in the same areas speaks of the impaired rear wall blood flow. Necrosis in the development of a heart attack is manifested in the form of the appearance of a pathological tooth Q or a whole complex of QRS in the appropriate leads.
- In more detail about changes in the film in patients with ischemia, we told in the article by reference here. Other methods
The technique is associated with a certain risk, so it is necessarily carried out only in the presence of a specialist doctor who can conduct cardioreanimation.
In order to determine the IBS, the following techniques are also widely used:
They are recommended at the initial stage of ischemia, help to determine the disease in atypical manifestation and implicit deviations on the electrocardiogram. The principle is to artificially create an increased need of myocardial in oxygen and secure changes. For this purpose, cycle ergometry, sensit-mode electrocardialism and pharmacological samples with Isoprotenol preparations, Dipyridamol are most often used. In the presence of violations of blood under the arteries of the heart, the myocardium ischemia on the ECG is registered.
- Refers to the most informative methods for identifying coronary pathology. It allows you to conduct a study without provoking and without waiting for an attack. The right and left arteries of the heart introduce a contrast agent, and on the angiograph, a full-fledged picture of the state of the vascular bed is obtained.
In this case, it is a subsidiary diagnostic method. It allows you to evaluate the local and global minor reduction, shows the usefulness of the heart in systole and diastole, to determine the presence of complications with IHD.
- The treatment of coronary heart disease begins with the correction of the lifestyle and destination diet. I repeatedly had to face the fact that the patients belonged to this important part of therapy are not serious enough, and then wondered why the state does not occur so long. Correction of lifestyle
- What to take with ischemic heart disease is advised only by a qualified specialist after diagnostic methods and diagnosis. So, before you go to the pharmacy for medicines, you need to remember two important things:
- An individual approach requires all the treatment of ischemic heart disease, preparations and doses are therefore selected in accordance with the testimony and contraindications. Sparing mode. The elimination of physical exertion leading to an increased oxygen consumption by myocardium.
- The diet with the exception of animal fats, products with a high salt content and easily friendly carbohydrates. With overweight of the body, reduce the common calorie food.
- Medications Of course, one correction of nutrition and lifestyle will not be enough, so it is necessary to maintain the body and medication.
DeaGregants to prevent thrombus education.
I usually recommend "Aspirin" or "Plaviks").
("Nebivallol", "Bisoprolol"). Numerous and long-term studies prove an increase in the life expectancy of patients with IBS, which constantly use this group of medicines. They help to level the level of "harmful" cholesterol. If you treat ischemic heart disease with their help, then the patient's life is significantly extended. "Rosavastatin" is used for a rapid and strong decline, and in patients with diabetes and high triglycerides it is better to take "atorvastatin".
Nitroglycerin is used to relieve acute attack, or "isosorbide mononitrate" for internal use. Expanding the venous channel, the preparations of this series reduce the preload on the heart and quickly remove the attack of angina.
Reduce the volume of the vascular bed and make it easier for the work of the heart. Furosemide is used to quickly remove swelling. For the purpose of permanent reception, I recommend "Indapamide" or "Toramseid".