What is it - myocardial ischemia, not everyone knows. This term is used to define a condition in which an organ or part of an organ does not receive enough oxygen. As a result, oxygen starvation occurs.
Ischemia can occur for a variety of reasons, it can be a symptom of very serious illnesses, in particular, such as a heart attack. With a long course, it becomes chronic and requires serious treatment.
Feature of the disease
Despite the fact that the heart muscle is constantly in contact with the blood, it does not receive oxygen and nutrients from it. This can be provoked by the fact that the heart is covered from the inside by the endocardium, that is, the inner membrane that prevents the absorption of blood into the heart.
Myocardium works around the clock, and the need for energy raw materials and it is quite high. The coronary arteries, which envelop the organ from all sides, provide the delivery of nutrients and oxygen to the heart muscle. Their value is very great, since from normalThe work of the heart depends on the he alth of the whole organism. Therefore, during the course of the disease, the functioning of internal organs may be disrupted.
Many are interested in what it is - myocardial ischemia, for what reasons the disease occurs, what signs it has. This is a condition in which there is a strong oxygen starvation of the heart muscle. It occurs for a variety of reasons and can lead to serious complications over time.
Quite common is painless myocardial ischemia (ICD-10 - I25.6), which is almost asymptomatic, but can provoke serious complications. There is a direct relationship between the incidence rate and the age of the patient. The maximum level is observed in people after 50 years.
Women mostly experience painless ischemia, while acute ischemia is more common in the male population. For women, the main risk factor for the onset of the disease is the onset of menopause, during which there is an increase in cholesterol levels and a tendency to increase pressure.
Types of ischemia
It is important not only to know what myocardial ischemia is, but also what types of diseases there are. These include the following:
- painless;
- acute coronary death;
- angina;
- cardiosclerosis;
- myocardial infarction.
Painless form - a type of ischemic heart disease, which has characteristic manifestations in instrumental or laboratory examination of the heart. Distinctivea feature is the absence of pain or other signs of ischemia. Also, this species occurs in patients with impaired pain sensitivity or in those who have previously suffered a heart attack.
Acute coronary death is myocardial ischemia, which leads to cardiac arrest and death of the patient. A similar violation occurs when the main arteries are blocked. Angina pectoris is a recurrent myocardial ischemia, the attack of which is accompanied by very sharp pain behind the sternum, a feeling of heat, shortness of breath and increased heart rate.
Myocardial infarction is an acute ischemia that leads to the death of part of the heart muscle and deterioration of its functioning. Cardiosclerosis is a complicated form of the disease, when, as a result of oxygen starvation, part of the heart muscle is replaced by connective tissue that cannot perform its functions normally.
Painless ischemia
What is myocardial ischemia? The symptoms and treatment of this disease is very important to know for those who have been diagnosed with this disease. Quite often there is a painless form of the disease. An accurate diagnosis can only be made with additional instrumental techniques.
For painless myocardial ischemia, all the same mechanisms of development are inherent as in other clinical forms, with the only difference that they are episodic and are not accompanied by the development of a characteristic clinical picture.
The painless form of myocardial ischemia can occur equally often in individuals with a previously unidentified diagnosis, and in patients suffering from other clinical forms for a long timepathology, such as angina pectoris.
The occurrence of painless ischemia is facilitated by a decrease in the overall pain threshold to various stimuli. The pathogenetic basis is mainly the need of the heart muscle for oxygen.
To make a diagnosis, a comprehensive examination using instrumental techniques is required.
Causes of occurrence
Among the main causes of myocardial ischemia, it is necessary to highlight the following:
- atherosclerosis;
- lack of potassium;
- spasm of the coronary arteries;
- blockage of arteries;
- overweight;
- diseases of the endocrine system;
- sedentary lifestyle.
Each of the arteries feeds a certain part of the heart muscle, so when one of the vessels is blocked, they remain without food. With hypokalemia, there is much more fluid and sodium, which leads to tissue edema. The edematous cell is not able to fully absorb nutrients and function normally.
Main symptoms
Signs of myocardial ischemia in each case can manifest themselves in completely different ways. However, there are a number of symptoms that are characteristic of almost all forms of coronary artery disease. Among the external signs, it is necessary to highlight such as:
- appearance of burning, paroxysmal pain behind the sternum;
- feeling very weak;
- may experience occasional nausea;
- patients complain of shortness of breath or shortness of breath at rest.
Primary symptoms of myocardial ischemia may be distant, when discomfort occurs and then disappears on its own. This makes the person think it's just malaise or fatigue.
In addition, with some types of myocardial ischemia, there are absolutely no signs. In this case, the pathology is detected only during echocardiography or ECG.
Diagnostics
It is very important to diagnose myocardial ischemia and treat it in time to prevent the development of complications. In some cases, it happens that external signs of pathology are completely absent. Diagnosis implies:
- examination of the patient;
- collection and analysis of anamnesis;
- conducting instrumental and laboratory studies.
Instrumental survey methods remain the most effective, in particular, such as:
- electrocardiography;
- coronary angiography;
- echocardiography;
- tomography;
- ultrasound diagnostics;
- dopplerography of the arteries;
- angiography;
- intraesophageal electrocardiography;
- Holter monitoring.
In addition, laboratory diagnostics are very important for the detection of the disease, since ischemia is characterized by a change in such indicators as:
- troponins;
- creatine phosphokinase;
- myoglobin;
- aminotransferase.
At the same time, the mostECG is considered a common method for detecting such pathologies. It is an indirect study that makes it possible to detect changes in the functioning of the myocardium. All diagnostic methods used allow us to assess the nature of the pathology and select the required therapy.
Features of treatment
Therapy is prescribed based on the results of the diagnosis. All patients with signs of insufficient blood supply should give up bad habits, normalize their diet, and minimize stress.
To stabilize the work of the cardiovascular system and coronary circulation, patients are prescribed groups of drugs such as:
- ACE inhibitors;
- antiplatelet agents;
- statins;
- beta blockers;
- diuretics;
- antiarrhythmics;
- organic nitrates.
The choice of drug and its dosage is determined separately for each patient. At the same time, the diagnosis of pathology and the presence of contraindications for the selected medication are of great importance. In some cases, episodes of myocardial ischemia are very rare and almost asymptomatic, so the disease can be detected already at advanced stages.
Normalization of blood circulation in this case cannot be achieved by using only conservative therapy. With such a course of the disease, the patient is recommended to undergo cardiac surgical correction of changes occurring in the coronary vessels. This may require radical and endovascular surgery. The choice of methods of cardiocorrectionis determined strictly individually depending on each specific case.
If it is possible to restore normal blood circulation in the area of ischemia, such a minimally invasive intervention as angioplasty with stenting can be performed. With massive lesions, larger operations are carried out.
Medications
In acute and chronic myocardial ischemia, medication is required. The choice of certain means is determined for each patient separately, depending on the diagnostic study.
Basically, doctors prescribe antiplatelet agents, in particular, such as Cardiomagnyl, Aspirin cardio, Thrombo ass. They normalize the process of blood circulation, and also reduce the load on the myocardium.
Beta-blockers such as Nebivolol, Carvedilol and Bisoprolol will help reduce the number of heartbeats and myocardial oxygen demand. Statins and fibrates lower cholesterol levels and prevent the progression of atherosclerosis. These drugs include the likes of Lovastatin and Fenofibrate.
ACE inhibitors such as "Captopril" and "Enap" normalize blood pressure and eliminate spasms of the arteries. Diuretics are required to eliminate excess fluid, which creates additional stress on the heart. These drugs include Lasix, Indapamide.
Antiarrhythmics are required to detect arrhythmias. Very often, doctors prescribe Amiadron and Kordaron. Organic nitrates, in particular,such as "Izoket" and "Nitroglycerin", are used for pain in the heart. With ischemia and myocardial infarction, the doctor may additionally prescribe other medications.
Operating
Treatment of myocardial ischemia at advanced stages is carried out with the help of surgery, since simply taking medications is no longer enough. Cardiac surgery may be required to restore vascular changes.
Depending on the nature of coronary vascular lesions, an operation using endovascular intervention or a radical intervention can be performed to eliminate the pathology. With a slight lesion of the coronary vessels, balloon angioplasty can be performed, followed by the installation of a metal stent. A similar technique consists in introducing a balloon made of polymer material into the lumen of the affected vessel. Under X-ray control, it is inflated in the required place, a special cylindrical metal frame is installed in the area of vasoconstriction, which will maintain the vessel in an expanded state. As a result, myocardial ischemia is eliminated in the affected area.
With more extensive damage to the coronary arteries, minimally invasive intervention may not be effective. In this case, a more radical operation, namely coronary artery bypass grafting, is performed to eliminate circulatory failure.
The intervention can be performed on an open heart or with a minimally invasivemethods. The essence of such an intervention is to create a shunt from transplanted vessels that ensure normal blood flow to a particular area of the myocardium. As a result, the coronary circulation becomes full, and the risk of myocardial infarction or sudden death is significantly reduced.
Possible Complications
If acute myocardial ischemia was not diagnosed in a timely manner, the disease can lead to sudden coronary death. In addition, it is worth noting that this may be the main cause of myocardial infarction.
With asymptomatic ischemia, the patient can realistically assess the severity of his condition for a long time and take the necessary measures. Obvious manifestations of myocardial necrosis in such patients are usually noticed already when extensive damage to the heart muscle occurs, and the risk of death increases significantly.
Forecast
Prognosis for ischemia is always poor. In the absence of timely treatment, this pathology can lead to disability of the patient and end with the onset of sudden death. According to statistics, painless ischemia increases the risk of developing heart failure and arrhythmia by 2 times, and the likelihood of sudden death can increase by 5 times.
That is why the solution of this problem remains relevant for modern cardiology, the timely detection of such circulatory disorders and their prevention is of great importance. Myocardial ischemia can lead tothe development of severe arrhythmia, angina pectoris, heart failure, myocardial infarction. To prevent the occurrence of such complications, you need to undergo preventive examinations and strictly follow all the recommendations of the attending doctor.
Prophylaxis
It is important not only to know what it is - myocardial ischemia, and how the treatment is carried out, but also how to prevent the onset of the disease. Key preventive measures include:
- giving up bad habits that lead to vasoconstriction;
- following a cholesterol-restricted diet;
- treatment of concomitant diseases (diabetes, hypertension, obesity);
- adequate exercise;
- restoration of mineral balance;
- blood thinning to prevent thrombosis.
The volume of physical activity must be selected taking into account the patient's weight and blood pressure indicators. Sometimes exercise is strictly contraindicated for obese people.
