Painless myocardial ischemia is a special form of ischemic heart disease with detectable symptoms of insufficient blood supply to the heart muscle, which is not manifested by pain. Such a disease is not accompanied by symptoms characteristic of ischemia in the form of shortness of breath, arrhythmia and pain.
At the same time, objective research methods (we are talking about electrocardiography, Holter monitoring and coronary angiography) can record myocardial changes characteristic of angina pectoris. Despite the absence of symptoms, silent ischemia has an unfavorable prognosis, requiring timely therapy in the form of lifestyle correction, drug treatment, and sometimes forced cardiac surgery. Next, we will talk in detail about such a disease as painless myocardial ischemia, find out what the factors of its development and symptoms are, and in addition, we will understand its diagnosis and treatment.
Description
BBIM in cardiology is one of the variants of ischemia,in which there is an objective confirmation of myocardial disease, but there are no clinical manifestations. This pathology is observed in patients suffering from various forms of ischemia, and even in individuals without previously diagnosed coronary pathologies. The prevalence of this disease is about five percent of the population.
The chance of getting painless myocardial ischemia increases in patients with aggravated heredity, the presence of essential hypertension, obesity, physical inactivity, diabetes and bad habits. Signs of SIMI can be detected on an electrocardiogram in every eighth subject who is over fifty-five years old. Next, let's move on to considering the causes of the described pathology and find out what are the provoking factors.
Reasons
Episodes of silent myocardial ischemia, like typical pain attacks of angina pectoris, can occur under the influence of various factors in the form of physical exertion, stress, cold, smoking, and in addition, high fever and drinking in large quantities. At the same time, the reasons that underlie BBIM and arise from the action of the above factors are:
- Presence of stenosis of the coronary vessels. In most situations, stenosis is caused by atherosclerotic lesions of the arteries of the heart. With varying degrees of severity, this condition is diagnosed in more than half of patients with episodes of painless ischemia. Doctors consider it clinically important to reduce the lumen of the coronary arteries to seventy percent. In addition to atherosclerosis, stenosis can be caused by systemic vasculitis andtumor process.
- Development of angiospasm of the coronary arteries. This condition occurs due to stress and workload. What are other causes of painless myocardial ischemia?
- Presence of thrombosis of the coronary arteries. Often this is caused by the process of ulceration of atherosclerotic plaques in the vessels, and at the same time, the ingress of blood clots from other areas of the circulatory system and the failure of platelet coagulation functions. A thrombus can block the lumen of the vessel completely or partially. Thus, episodes of ischemia or myocardial infarction may occur.
Risk groups
There are some risk groups, among which the likelihood of MIMD is very high. We are talking about people who have had a heart attack, and in addition, about patients who are at risk of developing ischemia. Also, painless myocardial ischemia can affect those who have hypertension or chronic obstructive pulmonary disease. This category includes representatives of professions with an extremely high level of stress, we are talking about pilots, air traffic controllers, drivers, surgeons and so on.
Below, consider the classification of painless myocardial ischemia.
Classification
In order to properly assess the severity of the patient's well-being at the time of treatment and track the dynamics of pathology in cardiology, a classification based on anamnesis data, and in addition, on episodes of ischemia and the clinical picture, is used. According to her, there are three types of painless type of ischemia:
- The first type. The development of painless ischemia among patients withproven by coronary angiography obvious stenosis of the cardiac artery. These patients do not have angina attacks, abnormal heart rhythms and congestive heart failure.
- In the second type, the patient's history records ischemia without angina, but with myocardial infarction.
- Against the background of the third type, silent ischemia occurs in patients with angina pectoris. Every day, such patients experience painless and painful attacks of ischemia.
In practical medical practice, specialists widely use a classification that includes two types of disease: the first type is AFMI, which occurs without obvious symptoms that are characteristic of myocardial ischemia, and the second type is when silent ischemia is combined with painful angina pectoris episodes and others forms of IHD.
Are there symptoms of painless myocardial ischemia?
Symptoms
The insidiousness of painless ischemia lies in the complete painlessness of its episodes. There are only two indicators according to which a patient or a doctor may suspect the development of a pathology: the presence of a diagnosed angina pectoris and ischemia in history and the direct detection of MIH as part of a preventive study of heart functions with fixation of a characteristic change on the cardiogram. In seventy percent of cases, it is possible to talk about the existence of painless ischemia among patients who have had a heart attack or have coronary artery disease. Almost all of these patients have four painless attacks for each new deterioration in well-being.
How does your heart hurt? Symptoms in women and men whoform the clinical picture of the disease, can proceed typically and atypically.
In women with heart disease, attacks are less acute, pain often radiates to the neck, arms, and back. Often, against this background, nausea and vomiting are observed, and cough and shortness of breath are much more common than in men.
Common signs of cardiac pathologies can be considered:
- shortness of breath, extreme fatigue from normal activities;
- nausea, upper stomach pain;
- swelling of the lower extremities in the evening;
- frequent urination at night;
- throbbing headache;
- pain in elbows and wrist;
- chest pain.
Now we know how the heart hurts. Symptoms in women and men are important to recognize in a timely manner.
Complications
The presence of this pathology in patients is an extremely unfavorable sign, indicating a high risk of complications in painless myocardial ischemia. In such patients, the frequency of sudden cardiac death is three times higher than in people with pain attacks. Myocardial infarctions in the presence of this disease have less pronounced, but at the same time implicit symptoms, whose intensity is not enough to alert the patient and force him to take all precautions. And for this, you usually need to stop or reduce physical activity, use certain medications and consult a doctor for help. Obvious clinical symptoms occur already when extensive myocardial damage occurs, andthe risk of death grows exponentially.
Diagnosis
In view of the absolute painlessness of the course of the disease in question, the diagnosis of painless myocardial ischemia is based on instrumental research methods that can provide objective information about the presence and degree of cardiac ischemia. The most significant markers of such ischemia are changes in the work of the heart that do not have a clinical manifestation, but are recorded by means of equipment. In addition, it is possible to suggest the development of painless ischemia when assessing the blood supply to the myocardium. These and other data are obtained using the following diagnostic methods:
- Electrocardiogram at rest is one of the most common and elementary diagnostic methods in execution. This method allows you to obtain information about the characteristic changes in the work of the heart. Its disadvantage is the ability to register information only in a state of physical rest, while painless seizures can sometimes occur only during exercise.
- Holter ECG. This diagnostic technique is more informative than the usual electrocardiogram. This method gives much more complete information, since it is carried out in a natural, and in addition, in the patient's everyday environment. Thanks to this method, the number of episodes of MIMS is revealed, their total duration is determined along with the dependence on emotional and physical activity throughout the day.
- Except Holter ECG,it is advisable to conduct bicycle ergometry. The essence of this method is to register the electrocardiogram and the level of pressure with a dosed increase in physical activity. Due to the increasing heart rate, the demand for oxygen in the myocardium increases. In the presence of painless ischemia in a patient, an increase in blood supply is simply impossible due to pathologies of the coronary vessels, thus, the heart muscle suffers from ischemia, which is recorded by electrocardiography.
- Performance of coronary angiography. This method is considered one of the basic diagnostic methods due to the proven relationship between pathology and stenosis of the coronary arteries. The technique allows you to determine the nature along with the degree of narrowing of the cardiac arteries. It is also possible to establish how many vessels are affected and what is the total extent of the stenosis. The data from this study greatly influences the patient's choice of therapy.
Next, let's talk about what are the treatments for painless myocardial ischemia.
Treatment
Algorithms for the treatment of the described disease correspond to those for other forms of ischemia. The goal of therapy is to eliminate the pathogenetic and etiological foundations of the disease. Therapy begins with the exclusion of all risk factors, for example, physical inactivity, smoking, an irrational diet with excessive amounts of animal fat, s alt, alcohol, and so on. A special role is given to the correction of disorders in lipid and carbohydrate metabolism, pressure control and maintaining satisfactory glycemia.in the presence of diabetes. Drug therapy is aimed at supporting the myocardium, and at the same time at increasing its performance and normalizing the rhythm. As part of the treatment, doctors provide for the use of the following types of drugs:
- Adrenergic blockers have the ability to lower the heart rate, providing a pronounced antianginal effect and improving exercise tolerance. Thanks to a pronounced antiarrhythmic effect, life prognosis improves.
- Calcium antagonists reduce the heart rate by dilating the coronary and peripheral arteries and normalizing the heart rhythm. Due to the ability to inhibit metabolic processes in cardiomyocytes, their oxygen demand decreases and tolerance to any load increases. The occurrence of episodes of the disease is less effectively prevented in comparison with adrenoblockers.
- The use of nitrates reduces resistance within the coronary arteries, which stimulates collateral blood flow. Thanks to nitrates, the blood flow is redistributed towards the ischemic areas of the myocardium, thereby increasing the number of active collaterals. Also, thanks to such drugs, the lumen of the coronary vessels expands in areas of atherosclerotic lesions and a cardioprotective effect occurs.
- Through the use of nitrate-like vasodilators, stimulation of the release of peripheral arteries is achieved. Due to this, the blood supply to the myocardium is greatly improved, and in addition, the need for oxygen in myocytes is reduced. These drugs do not eliminatecauses painless ischemia, but the frequency of its episodes decreases.
- The use of statins. These drugs act on one of the very important links in the pathogenesis, namely atherosclerotic processes. Thanks to such drugs, the level of low-density lipoproteins is effectively reduced. Due to this effect, the formation of atherosclerotic plaques in the body, which usually occur on the walls of the coronary arteries, is prevented, preventing the narrowing of the lumen and impaired perfusion of the heart muscle.
Mild heart failure
The main function of the heart is to supply the body with oxygen and all kinds of nutrients, and in addition, the removal of their waste products. Depending on whether people are resting or actively working, the body requires a different amount of blood. To adequately meet the needs of the human body, the heart rate, along with the size of the lumen of the vessels, can vary significantly.
The diagnosis of "mild heart failure" indicates that the heart has ceased to supply organs and tissues with oxygen and nutritional ingredients sufficiently. The condition is usually chronic and the patient may live with it for a long time before being diagnosed.
Holter Electrocardiogram
Holter monitoring is a functional study of the cardiovascular system and is named after the founder of Holter. This techniqueresearch makes it possible to carry out continuous recording of cardiac dynamics during ECG using a special portable device. The Holter diagnostic technique makes it possible to monitor changes in the functioning of the heart and monitor blood pressure throughout the day in the conditions of the patient's natural activity.
Such monitoring is necessary to prevent painless myocardial ischemia. In addition, Holter monitoring is recommended in cases where the electrocardiogram is normal, but the person experiences pain symptoms along with temporary heart rhythm disturbances that occur sporadically and do not always manifest themselves at the doctor's office. The Holter technique helps to detect any cardiac disorders during the day, which is simply impossible when diagnosing with other methods. In this way, heart he alth information can be analyzed during sleep or when the patient is active while awake.
