Ischemic heart disease is a pathological condition caused by a lack of nutrition of the heart muscle due to narrowing of the lumen of the coronary vessels or their spasm. It combines several diagnoses, such as angina pectoris, myocardial infarction, cardiosclerosis, sudden coronary death and others.
Today, it is the most common disease in its category in the world and is the number one cause of death and disability in all developed countries.
Predisposing factors
To date, criteria have been developed by which it is possible to predict the development of a particular disease. Ischemic heart disease is no exception. There is not just a list, but a classification of risk factors, grouped according to a certain feature, that can contribute to the occurrence of this disease.
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Biological:
- age over 50 years old;
- gender - men get sick more often;- geneticpredisposition to dysmetabolic diseases.
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Anatomy:
- high blood pressure;
- obesity;- the presence of diabetes.
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Lifestyle:
- diet violation;
- smoking;
- physical inactivity or excessive exercise;- drinking alcohol.
Disease development
Pathogenetic causes of the development of the disease can be both extra- and intravascular problems, such as narrowing of the lumen of the coronary arteries due to atherosclerosis, thrombosis or spasm, or severe tachycardia with hypertension. But still, atherosclerosis is in the first place for the reasons for the development of a heart attack. Initially, a person develops a metabolic disorder, which is expressed in a persistent increase in blood lipids.
The next step is the fixation of lipid complexes in the walls of blood vessels and their perspiration inside the endothelial cells. Atherosclerotic plaques form. They destroy the wall of blood vessels, make it more fragile. This condition can have two outcomes - either a blood clot breaks off from the plaque and clogs the artery upstream of the blood, or the diameter of the vessel becomes so small that the blood can no longer circulate freely and nourish a certain area. In this place, a focus of ischemia is formed, and then necrosis. If this whole process takes place in the heart, then the disease will be called coronary artery disease.
There are several clinical forms and their corresponding treatment for coronary artery disease. Drugs are selected based on the pathophysiological component.
Sudden coronary death
Otherwise called cardiac arrest. It can have two outcomes: a person dies or ends up in intensive care. It is associated with sudden myocardial instability. This diagnosis is an exception when there is no reason to suspect another form of coronary artery disease. Treatment, drugs of choice for medical workers remain the same as in resuscitation. Another condition is that death must occur instantly and with witnesses or no later than six hours from the onset of a heart attack. Otherwise, it already falls under another classification.
Angina
This is one of the forms of coronary artery disease. It also has its own additional classification. So:
- Stable exertional angina.
- Vasospastic angina.
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Unstable angina, which, in turn, is divided into:
- progressive;
- first appeared;
- Prinzmetal angina.
The first kind is the most common. The Association of Cardiologists has long developed the treatment of coronary artery disease for angina pectoris. Drugs must be taken regularly and for a long time, sometimes for life. If you follow the recommendations, then you can postpone unpleasant he alth consequences for a while.
Myocardial infarction
It is set taking into account the data of the electrocardiogram, laboratory and anamnestic indicators. MostThe increase of such enzymes as LDH (lactate dehydrogenase), ALAT (alanine aminotransferase) and ACaT (aspartate aminotransferase) are considered informative, which are normally enclosed within the cell and appear in the blood only when it is destroyed.
A heart attack is one of the final outcomes of uncontrolled coronary heart disease. Treatment, drugs, help - all this can be late, because in an acute attack there is very little time left to reverse the damage.
Diagnosis
Naturally, any survey begins with a survey and inspection. Collect history data. The doctor is interested in such complaints as chest pain after exercise, shortness of breath, fatigue, weakness, palpitations. It will be important to note the evening swelling, warm to the touch. And also how is the treatment of coronary artery disease. Drugs can tell a lot to the doctor. For example, "Nitroglycerin". If it helps to relieve an attack, then this almost always speaks in favor of angina pectoris.
Physical examination includes measurement of pressure, respiratory rate and pulse rate and auscultation of the heart and lungs. The doctor is trying to hear pathological murmurs, increased heart tones, as well as wheezing and blisters in the lungs, which would indicate congestive processes.
Next, the doctor sends the patient for a laboratory and physical examination. We have already talked about the analyzes, and from the studies, the most common are ECG, EchoCG and ultrasound of the heart.
Treatment
So we moved on to the most basic. We are interested in the treatment of IHD. Drugs play a leading role in it, but not only they help to improve well-being. First of all, the patient needs to be explained that he will have to completely change his lifestyle. Remove excessive physical activity, balance sleep and rest, and eat well. Diet should be given special attention. It should contain potassium, calcium and sodium necessary for the heart, but at the same time limit the intake of s alt, water, foods with excess amounts of animal fats and carbohydrates. If a person is overweight, then it is necessary to correct it.
But besides this, methods have been developed for the pharmacological elimination of such a problem as coronary heart disease. Treatment - drugs in the form of tablets, capsules, powders and solutions. With proper selection and regular use, you can achieve excellent results.
Antiplatelet agents
Groups of drugs for the treatment of coronary artery disease are divided into several classifications, but the most common - according to the mechanism of action. We will use it. Antiplatelet agents improve blood flow. They act on the coagulation and anticoagulation systems, somewhat uncoupling them, and thus achieve liquefaction. These include Aspirin, Clopidogrel, Warfarin and others. When prescribing them, it is always necessary to control the INR (international normalized ratio) in order to prevent the person from bleeding.
Betablockers
Have an effect on receptors in the walls of blood vessels, slowing down the heartbeat. As a result, it consumes less oxygen and needs less blood, which is very useful with narrowed coronary arteries. This is one of the most common drugs for coronary artery disease. Treatment, drugs of choice, and dose depend on the associated conditions. There are selective and non-selective beta-blockers. Some of them act more gently, others - a little harder, but an absolute contraindication is the patient's history of bronchial asthma or other obstructive pulmonary disease. Among the most common drugs are Biprolol, Visken, Carvedilol.
Statins
Doctors spend a lot of effort on the treatment of coronary artery disease. Drugs are being improved, new approaches are being developed, and studies are being carried out on the causes of the disease. One of these advanced approaches is to influence the precipitating factors, namely dyslipidemia or imbalance of blood fats. It has been proven that a decrease in cholesterol levels leads to a slowdown in the formation of atherosclerosis. And this is the main cause of IBS. Signs, treatment, drugs - all this has already been identified and developed, you just need to be able to use the available information for the benefit of the patient. Examples of effective remedies are Lovastatin, Atorvastatin, Simvastatin and others.
Nitrates
The work of these drugs is one of the diagnostic signs that helpconfirm the presence of the disease. But they are also needed as part of a program that is included in the treatment of coronary artery disease. Medications and preparations are carefully selected, the dose and frequency of administration are adjusted. They affect the smooth muscles in the walls of blood vessels. Relaxing, these muscles increase the diameter of the lumen, thus increasing the amount of blood supplied. This helps to relieve ischemia and pain attack. But, unfortunately, nitrates cannot prevent the development of a heart attack in the global sense of the word, and does not increase life expectancy, therefore, it is recommended to take these medicines only during an attack (Dinisorb, Isoket), and choose something else on a permanent basis.
Anticoagulants
If, in addition to angina pectoris, the patient has a threat of thrombosis, then these drugs for coronary artery disease are prescribed to him. Symptoms and treatment, drugs depend on how much this or that link of the pathological process prevails. One of the most famous means of this series is Heparin. It is administered in a large dose once in acute myocardial infarction, and then for several days the level in the blood plasma is maintained. Clotting time must be carefully monitored.
Diuretics
Drugs for the treatment of IHD are not only pathogenetic, but also symptomatic. They affect such a link as high blood pressure. If you increase the amount of fluid that the body will lose, then you can artificially reduce the pressure to normal numbers and eliminate the threat of a second heart attack. But don't do it too fastprovoke a collapse. There are several types of these drugs, depending on which part of the loop of Henle (section of the nephron) they affect. A competent doctor will select the medicine necessary in this situation. One that does not aggravate the patient's condition. Stay he althy!
