Ischemia, accompanied by disruption of the normal blood supply to the heart muscle, is today considered a very serious problem. It is this pathology that is the most common cause of sudden death. Moreover, as a rule, patients of working age suffer from the disease. Diagnosis of coronary heart disease is sometimes difficult. That is why it is worth reading the basic information about this disease.
What is coronary heart disease? Symptoms, diagnosis, treatment, possible complications - these are the points that should be studied in more detail. After all, the sooner a person notices the symptoms and sees a doctor, the higher the likelihood of a favorable outcome.
What is an affliction? General information
Whatis ischemic heart disease? Symptoms, diagnosis, therapy - this is what interests many patients. But first, let's get the basic facts straight.
Ischemic heart disease (CHD) is a pathology accompanied by functional and/or organic lesions of the heart muscle. Myocardial dysfunction in such a disease is associated with insufficient blood supply to the organ or its complete cessation.
It is worth noting that such a diagnosis of "ischemic heart disease" is most often made to men of active age (from 55 to 64 years). Of course, the development of the disease in female patients or in younger guys is not excluded.
This pathology is associated with an imbalance between myocardial demand for blood supply and actual blood flow. If the heart muscle, for one reason or another, does not receive enough oxygen and nutrients, which is inevitably observed when the blood supply is disturbed, then pathological changes are possible, including sclerosis, dystrophy and necrosis.
According to statistics, in about 60-70% of cases, an acute form of coronary artery disease leads to sudden death of the patient. That is why the correct and, most importantly, modern diagnosis of coronary heart disease is so important.
Reasons for the development of the disease. Description of risk factors
How and why does coronary heart disease develop? Diagnosis, treatment, rehabilitation are important issues. But first, you should learn more about the causes of the development of pathology.
Approximately in 97-98% of cases, this disease is associated with atherosclerosis of the coronary arteries. It is these vessels that provide nutrition to the myocardium. Accordingly, even a slight narrowing of the lumen of the coronary arteries adversely affects the condition of the muscles of the heart. Complete occlusion of the vessel leads to the development of acute ischemia, exertional angina, myocardial infarction, and sometimes to sudden death. The list of other causes includes thromboembolism (blockage of the lumen of the vessel by a blood clot).
Of course, the pathologies described above do not develop by themselves. They are caused by exposure to certain risk factors. Diagnosis of coronary heart disease should also be aimed at determining the causes of the development of the disease.
- First of all, it is worth mentioning hyperlipidemia. This condition is accompanied by a sharp increase in the level of lipids and lipoproteins in the blood. An abnormal increase in the amount of fat in the blood contributes to the development of atherosclerosis. It has been proven that the risk of developing coronary artery disease in people with hyperlipidemia increases by 2-5 times.
- One of the main risk factors is arterial hypertension. According to research results, the risk of developing coronary disease in patients with high blood pressure (we are talking about chronic pathology, and not random, temporary pressure surges) is 2-8 times higher.
- It is impossible not to mention heredity. If among the relatives of a person there are people suffering from coronary artery disease, then the likelihood of developing pathology is much greater.
- According to statistics, coronary heart disease (symptoms, diagnosis of the disease will be described below) is muchmore commonly diagnosed in older men. Therefore, the risk factors include the gender and age of the patient.
- Patients with diabetes (including in the latent form of the disease) are more likely to suffer from coronary artery disease.
- Risk factors include physical inactivity and obesity. It has been proven that cases of coronary disease are three times more likely to be diagnosed in people who lead a sedentary lifestyle. As you know, physical inactivity is often combined with obesity. Being overweight also increases the chances of developing the disease.
- Negatively, smoking also affects the work of the cardiovascular system, since nicotine causes spasm of small vessels, including the coronary arteries.
A correct diagnosis of coronary heart disease allows you to determine not only the stage and severity of the disease, but also its causes. Based on these data, the doctor will be able to draw up an effective treatment regimen. It should be understood that in most cases IHD develops under the influence of several factors at once.
Ischemic heart disease: classification
Under the term IHD combine various pathological conditions associated with impaired blood supply to the myocardium:
- Sudden coronary death. In this case, we are talking about primary cardiac arrest, which occurred as a result of electrical instability of the heart muscle. A person in this condition can be successfully resuscitated (of course, if the patient receives timely assistance).
- Angina. In this case, the pathology can take on different forms. Distinguish between stable, unstable,spontaneous and some other types of angina pectoris. Pathology is accompanied by soreness behind the sternum, which often spreads to the left shoulder and shoulder blade.
- Myocardial infarction. A condition that is accompanied by necrosis of a certain area of the heart muscle, which occurs against the background of insufficient blood supply.
- Cardiosclerosis. In most cases, this pathology develops as a result of a previous heart attack. Areas of the heart muscle that have undergone necrosis begin to change - muscle fibers are replaced by connective tissue, as a result of which the myocardium loses its contractile properties.
- Irregular heart rhythm. These pathologies almost inevitably occur during vasoconstriction, because the blood begins to pass in "jumps".
- Heart failure. Chronic violation of myocardial trophism may be accompanied by a violation of the physiological activity and anatomical structure of the heart.
Which symptoms to look out for?
What is coronary heart disease? Diagnosis, treatment is, of course, important information. However, many patients are interested in symptoms. What are the first signs of IHD? What violations should I look out for?
- Disorders of the heart are often accompanied by shortness of breath. At first, breathing problems appear during physical activity, for example, when walking quickly, climbing stairs, etc. But as the disease progresses, shortness of breath appears even in a state ofrest.
- The list of symptoms also includes arrhythmias. Patients complain of increased and rapid heartbeat.
- IHD is often accompanied by drops in blood pressure - patients are diagnosed with hypo- or hypertension.
- Angina is accompanied by pain in the chest. Some patients note a feeling of squeezing and burning behind the sternum. The pain can radiate to the shoulder, neck, shoulder blade. Sometimes the pain syndrome is very intense and cannot be controlled with drugs.
Unfortunately, the diagnosis and treatment of chronic coronary heart disease is often difficult, because in most cases, people ignore slight shortness of breath and weak, intermittent tingling in the heart area. People turn to the doctor already at the later stages of the development of the disease.
Tests for suspected ischemia
If a patient sees a specialist with complaints of intermittent chest pain and shortness of breath, the doctor first of all takes a complete history. It is important to find out exactly when the symptoms began, whether close relatives have heart disease, whether the patient has bad habits, etc.
In the future, laboratory studies are being carried out. For example, they determine the level of troponins, myoglobin and aminotransferases in the blood - it is these protein compounds that are released when cardiomyocytes are destroyed.
In addition, the patient's blood is checked for the presence of an increased amount of glucose, lipoproteins and cholesterol - this helps to diagnose concomitant diseases, and sometimes to determine the causecoronary disease (such as atherosclerosis).
Instrumental diagnostics
Deciding in the diagnosis of coronary heart disease is such a simple and affordable study as an electrocardiogram. During the procedure, the doctor can check the electrical activity of the heart, detect certain myocardial rhythm disturbances.
Echocardiography is also obligatory. This study allows you to determine the size of the heart, evaluate its contractile activity, visualize the condition of the valves and myocardial cavities, and study specific acoustic noises. Additionally, stress echocardiography is performed, since symptoms of ischemia can sometimes be detected only during physical activity.
Daily ECG monitoring is also informative. A special device is attached to the patient's shoulder, which measures cardiac activity during the day. In addition, the patient should write down his actions, changes in well-being in a special diary.
Often a transesophageal electrocardiogram is performed. A special sensor is inserted into the patient's esophagus, which records the performance of the heart. Thus, the doctor can evaluate the conductivity and electrical excitability of the myocardium.
Quite often, doctors prescribe positron emission tomography (PET) to patients. Diagnosis of coronary heart disease involves the study of myocardial blood flow. This technique also makes it possible to measure the rate of glucose utilization in a particular area of the myocardium, to evaluate the activity of fatty acids metabolism.acids, measure the amount of oxygen consumed. PET diagnosis of coronary heart disease is performed if any segment of the heart muscle looks like a scar.
A lot of useful information can be obtained after coronary angiography. A contrast agent is injected into the coronary vessels, and then its movements are traced. Using this procedure, a specialist can determine the presence of vascular disorders, as well as the degree of occlusion and stenosis.
The differential diagnosis of coronary heart disease is also important, because symptoms such as pain behind the sternum and in the shoulder, as well as shortness of breath develop against the background of other diseases, including autonomic neurosis, pathologies of the peripheral nervous system, paraneoplastic syndrome, pleural lesions etc.
How to treat coronary heart disease?
In fact, therapy for this disease must be comprehensive.
Means for the treatment of coronary heart disease are selected only by a doctor, since much depends on the general condition of the patient, the presence of other diseases, etc. Sometimes specialists prescribe beta-blockers, which help lower blood pressure. Preparations containing nitroglycerin help to dilate blood vessels, including the coronary arteries. Proper intake of ACE inhibitors improves blood flow. With atherosclerosis, patients are prescribed drugs that contain a statin, as they help to adjust the level of cholesterol in the blood. Forthrombosis prevention can be used acetylsalicylic acid. In the presence of edema, diuretics are sometimes used.
It is also worth noting that the patient needs to change his lifestyle a little, in particular, eat right. Restriction of physical activity is also shown. If the severity of coronary disease is small, then patients are recommended feasible loads, for example, swimming, walking, cycling. Such activities help strengthen blood vessels. But if we are talking about a severe form of the disease and severe shortness of breath, then sports and physical activity will have to be abandoned for a while.
Proper nutrition for ischemia
Diet for coronary heart disease is extremely important. Doctors recommend patients to adhere to some rules:
- It is necessary to sharply limit the amount of table s alt. In addition, it is not recommended to drink too much liquid. This will help relieve stress on the heart muscle.
- In order to slow down the development of atherosclerosis, it is important to limit the amount of foods containing animal fats and cholesterol. The list of prohibited foods includes lard, fatty meats, butter. Doctors recommend giving up fried, too spicy and smoked foods. Foods rich in simple, easily digestible carbohydrates negatively affect he alth. That is why it is important to limit the amount of sweets, pastries, chocolate and other sweets in the diet.
- If a patient has developed coronary heart disease against the background of obesity, then it is important to start the fight against overweight. Of course you need to lose weight.slowly and carefully, as too strict a diet is stressful for the body. Doctors recommend eating right, engaging in feasible physical labor (in the absence of contraindications), maintaining the correct energy balance (energy consumption should be more than the number of calories consumed with food by about 300).
Surgery
Unfortunately, in most cases it is difficult to do without surgery, since drug treatment only helps to relieve symptoms and prevent complications.
- Coronary artery bypass grafting is an operation during which the surgeon takes the patient's own vessel and sutured to the coronary artery in such a way as to create a bypass for blood flow. The myocardium again begins to receive oxygen and nutrients in sufficient quantities, which leads to the elimination of ischemia.
- At one time, such a technique as balloon angioplasty was widely used. During the procedure, a special balloon is inserted into the lumen of the vessel, with the help of which the surgeon literally inflates the artery, returning it to its normal size and normalizing blood flow. Unfortunately, the procedure is only temporary.
- Stenting is more effective. The meaning of the operation is the same - to expand the vessel. But during the procedure, a metal mesh frame (stent) is inserted into the lumen of the affected artery - this is how the vessel retains its natural shape permanently.
Possible Complications
Unfortunately, many patients face such a problem as coronary heart disease. Therapy helps to slow down the development of the disease and prevent the occurrence of complications. But with the wrong treatment or its absence, it is possible:
- insufficient energy metabolism of cardiomyocytes;
- various forms of left ventricular contractility disorders;
- development of cardiosclerosis (the number of functioning cardiomyocytes is significantly reduced, they are replaced by connective tissue elements that are not able to contract);
- violations of diastolic and systolic myocardial function;
- disturbances in conduction, contractility and excitability of the myocardium, partial loss of autoregulation.
Prevention measures and forecasts
It should be said right away that the prognosis for patients with a similar diagnosis depends on the general condition of the body, the degree of damage to the coronary vessels, and the presence of other diseases. If we are talking about a mild degree of ischemia, then it responds quite well to therapy. The prognosis is not so favorable for patients who, along with coronary artery disease, suffer from diabetes mellitus and arterial hypertension.
As for prevention, there are no specific remedies. People at risk should maintain a he althy lifestyle. It is important to eat right, limiting the amount of fatty, fried and overly spicy foods, foods rich in bad cholesterol.
Smoking has a negative effect on the state of blood vessels. It is important to keep fit by regularly engaging in moderate exercise, such as exercising in the gym and walking outdoors. Patients with hypertension need to constantly monitor their blood pressure.
These simple rules will help not only prevent the development of ischemia, but also significantly improve the functioning of the whole organism.
