What is IHD, we will consider in this article.
Ischemic disease is characterized by organic and functional lesions of the myocardium, which are caused by a lack or complete cessation of blood supply to the heart muscle (ischemia). IHD manifests itself as acute (cardiac arrest, myocardial infarction) and chronic (post-infarction cardiosclerosis, angina pectoris, heart failure) conditions. The clinical symptoms of this pathology are determined by its specific form. IHD is the most common cause of sudden death, including among people of working age.
Symptoms and treatment of coronary heart disease are presented below.
Description of pathology
Ischemic disease is a very serious problem in modern cardiology and medical science in general. At the present stage, about 600 thousand deaths are recorded in our country, resulting from various forms of coronary artery disease (ICD 10 I24.9 - acute form, I25.9 - chronic) annually, and worldwide mortality from thisdisease is about 75%. This pathology in most cases occurs in men from 50 to 70 years old and can lead to disability and rapid death.
What is IHD is interesting to many.
What is the basis of formation?
The formation of the disease is based on an imbalance between the need for blood supply to the tissues of the heart muscle and coronary blood flow. This phenomenon can develop due to a high myocardial oxygen demand and insufficient supply, or with a normal need, but a decrease in coronary blood supply.
The deficit of blood supply to the cells of the heart muscle is especially pronounced when there is a decrease in coronary blood flow, and the need for myocardial blood flow increases. Lack of blood supply to the tissues of the heart, their hypoxia is manifested by various forms of coronary heart disease.
The group of similar diseases includes conditions of myocardial ischemia in acute and chronic form, which are accompanied by its subsequent changes: necrosis, dystrophy, sclerosis. Similar pathologies of the condition are considered in cardiology, as well as nosological independent units.
Why do IHD and angina occur?
Causes and factors of occurrence
In the overwhelming majority (96%) of clinical cases, the occurrence of such a disease is due to atherosclerotic changes in the coronary arteries of varying severity: from an insignificant narrowing of the arterial lumen by an atherosclerotic plaque to absolute vascular occlusion. At 80% of coronary stenosis, the tissues of the heart muscle begin to respond to a lack of oxygen, and patients develop the so-called exertional angina.
Other prerequisites
Other conditions that can provoke the development of symptoms of coronary artery disease in people are spasm or thromboembolism of the coronary arteries, which usually develops against the background of an already present atherosclerotic lesion of the arteries. Cardiospasm increases the obstruction in the coronary vessels and causes the main symptoms of coronary disease.
Provoking factors
Factors that, in addition to vascular atherosclerosis, contribute to the occurrence of IHD include:
- Hyperlipidemia, which contributes to the formation of atherosclerotic changes and increases the risk of developing coronary artery disease by several times. The most dangerous in terms of risk are hyperlipidemia types II, III, IV, and a decrease in the content of alpha-lipoproteins.
- Arterial hypertension, which increases the likelihood of coronary artery disease by 6 times. In people with a systolic pressure of 180 mm Hg. Art. and above, such a pathology occurs up to 9 times more often than in people with normal or low blood pressure.
- Smoking. According to statistics, smoking dramatically increases the incidence of this pathology by 4 times. Mortality from coronary disease among smokers aged 30-55 who smoke 20-30 cigarettes daily is twice as high as non-smokers of the same age group. What else increases the risk of CHD?
- Obesity and physical inactivity. Physically inactive people are at riskdie from cardiac ischemia 3 times more than those who lead a more active lifestyle. With concomitant obesity, such risks increase significantly.
- Impaired carbohydrate tolerance.
- In the presence of diabetes mellitus, including in a latent form, the risk of morbidity with pathology increases by about 3 times.
Factors that pose a threat to the formation of this pathology should also include hereditary predisposition, advanced age and male sex of patients. If there are several predisposing factors at once, the likelihood of occurrence increases.
The rate and causes of ischemia, as well as its severity, duration and initial state of the human heart and vascular systems determine the occurrence of one or another type of coronary disease.
What is IHD is now clear. Consider further the classification of the disease.
Classification of pathology
In clinical cardiology, the following systematization of forms of ischemic pathology has been adopted:
1. Primary cardiac arrest (coronary death) is a rapidly developing condition, which is presumably based on electrical instability of the myocardium. Sudden coronary death is considered to occur no later than 6 hours after the onset of a heart attack or instantaneous death. There is a sudden coronary death with positive resuscitation and one that ended in death.
2. Angina with coronary artery disease, which is subdivided, in turn, into:
- stable(functional class I, II, III or IV);
- unstable: new onset, early postoperative, progressive, or postinfarction;
- spontaneous - Prinzmetal's angina, vasospastic.
3. Painless forms of ischemic myocardial disorders.
4. Myocardial infarction:
- Q-infarction, transmural (large focal);
- not a Q-infarction (small focal).
5. Postinfarction cardiosclerosis.
6. Rhythm and cardiac conduction disorders.
7. Heart failure.
In cardiology practice, there is a term "acute coronary syndrome", which combines various types of coronary disease: myocardial infarction, unstable angina, etc. Sometimes this category includes sudden coronary death provoked by coronary artery disease.
Exertion Angina FC
This pathological process has several stages.
The first functional class, when an attack develops with increased physical activity.
The second functional class, which is the state that occurs in the background of the average load.
The third functional class, the clinical manifestations of which occur as a response to minor activity, for example, in the form of walking or during psycho-emotional stress.
The fourth functional class, which is characterized by the fact that attacks disturb the patient even at rest.
Symptoms of disease
Clinical symptoms of IHD(ICD-10 code I20–I25) is determined, as a rule, by the form of the disease. In general, such a pathology has an undulating course: the patient's stably normal state of he alth alternates with moments of exacerbation of ischemia. Approximately a third of all patients do not feel at all that they have coronary disease, the progression of which can develop slowly, sometimes even for decades, and not only the forms of the pathological process, but also the symptoms of coronary artery disease can change.
General signs of ischemia
Common signs of ischemia include pain in the sternum, which is associated with physical exertion or severe stress, pain in the back, arms, lower jaw, shortness of breath, increased heart rate or a feeling of interruption in the rhythm of the heart, weakness, nausea, clouding of consciousness etc. Often, coronary disease is detected already at the chronic stage of heart failure with the appearance of edema of the lower extremities, shortness of breath, which often forces the patient to consult a specialist.
The above symptoms of coronary artery disease (ICD code I20-I25) usually do not occur simultaneously, and with a specific form of pathology, there is a predominance of certain manifestations of ischemia.
Harbingers
Harbingers of the primary form of cardiac arrest during ischemia of the heart may be a paroxysmal feeling of discomfort behind the sternum, a panic attack, fear of death, as well as psycho-emotional instability. With a sudden form of coronary death, the patient loses consciousness, he has respiratory arrest, the absence of a pulse onmain arteries (carotid and femoral), heart sounds are not audible, the pupils dilate, the skin becomes pale grayish. Cases of this pathology account for up to 63% of deaths in coronary artery disease (ICD code: I20–I25), mainly even before the patient was hospitalized.
Diagnosis
Diagnosis of the disease is carried out in a hospital or dispensary using specific instrumental methods. Laboratory studies usually indicate the presence of specific enzymes that increase during heart attack and angina pectoris (creatine phosphokinase, troponin-I, troponin-T, myoglobin aminotransferase, etc.). In addition, the level of cholesterol, atherogenic and anti-atherogenic lipoproteins is determined. triglycerides, as well as cytolysis markers.
Symptoms and treatment of coronary artery disease are interrelated.
ECG, echocardiography, ultrasound of the heart, stress echocardiography, etc. are important methods for diagnosing such diseases. In the diagnosis of coronary artery disease, functional exercise tests are also widely used to detect early stages of ischemia.
ECG Holter monitoring is another diagnostic method that involves recording an ECG within 24 hours.
Transesophageal electrocardiography - a technique that allows you to assess the conductivity, electrical excitability of the myocardium.
Carrying out coronary angiography in determining coronary heart disease allows you to visualize the vessels of the heart muscle by introducing a contrast agent into the blood and determine violations of their patency, the presence of stenosis or occlusion. History of CAD mayvary individually.
IHD treatment
The tactics of treating certain forms of this pathology has some peculiarities. However, there are main conservative directions that are used to treat ischemia. These include:
- Drug therapy.
- Surgical revascularization of the heart muscle (coronary bypass grafting).
- Using endovascular techniques (coronary angioplasty).
Non-drug therapy includes measures to correct nutrition and lifestyle. In various forms of ischemia, limitation of activity is shown, since during exercise the myocardial oxygen demand increases, the dissatisfaction of which causes manifestations of coronary artery disease. Therefore, in any form of coronary artery disease, the patient's activity mode is limited.
Medications
Drug therapy for coronary artery disease (ICD-10 code I20-I25) involves the use of the following medications:
- antiplatelet agents;
- hypocholesterolemic drugs;
- β-blockers
- diuretics,
- antiarrhythmic drugs.
In cases where there is no effect in the implementation of drug and other therapy for pathology, various methods of surgical intervention are used.
We looked at what is CHD.
Forecast and prevention
Prognosis for coronary artery disease depends on various factors. Thus, the combination of coronary heart disease andarterial hypertension, severe disorders of lipid metabolism and diabetes mellitus. Therapeutic measures can only slow down the progression of coronary artery disease, but not stop it completely.
The most effective prevention of coronary artery disease is to reduce risk factors: you need to exclude alcohol and smoking, psycho-emotional overload, maintain optimal body weight, exercise, control blood pressure, eat right.
