Coronary heart disease causes, symptoms, treatment and prevention methods

Coronary heart disease

Before talking about coronary heart disease, it is necessary to tell how the heart muscle receives oxygen and nutrients, so necessary for its normal functioning. The fact is that the heart, being a muscle pump, receives absolutely nothing from the blood that it pumps, which “passes” through this pump.

But the heart is the same organ as all the others, moreover, it is in constant mechanical work, and, of course, must have a constant flow of oxygen and nutrients.

This happens as follows: from the aorta base (the largest vessel of our body that leaves the left ventricle of the heart), two coronary arteries depart – the right and left.

They return to the heart, there branch out, enter the myocardium and form a system of small arteries, which supplies the heart with everything necessary. From all this it follows that the heart has its own blood supply system. Well, now, about coronary heart disease.

Coronary heart disease is a pathological condition characterized by an absolute or relative violation of the myocardial blood supply due to damage to the coronary arteries of the heart, as a rule, atherosclerosis, in other words, the appearance of hemodynamically significant atherosclerotic plaques in the coronary arteries and, as a result, a local decrease in arterial lumen.

Coronary heart disease is a myocardial damage caused by a coronary circulation disorder resulting from an imbalance between coronary blood flow and the metabolic needs of the heart muscle.

In other words, there is a deficiency of oxygen and nutrients in the area of ​​the myocardium for which the affected vessel is responsible. As each plaque develops and increases, the number of plaques increases, the degree of stenosis of the coronary arteries increases, which largely determines the severity of clinical manifestations and the course of coronary heart disease.

Narrowing the lumen of the artery to 50% is often asymptomatic. Typically, clear clinical manifestations of the disease occur when the lumen is narrowed to 70% or more. The more proximal (closer to the beginning of the artery) stenosis is located, the greater the mass of the myocardium undergoes ischemia in accordance with the zone of blood circulation.

Coronary heart disease (CHD) is a cardiological disease that is characterized by an absolute or relative violation of the blood supply to the myocardium due to damage to the arteries of the heart.

In other words, with this pathology, the heart muscle needs more oxygen than it enters with the blood. The concept of “coronary heart disease” includes both angina pectoris and myocardial infarction.

This pathological condition was identified in 1965 by the World Health Organization (WHO) as an independent disease and is defined as coronary heart disease.

The occurrence of coronary heart disease is associated with the development of atherosclerosis of the heart vessels, in which numerous plaques form on the walls, leading to their partial or complete blockage. Also, the cause of the development of pathology is insufficient blood flow to the heart or inflammation of the arteries.

For a long time, cardiac ischemia was considered only a male disease, since IHD was not diagnosed in women. Currently, both women and men aged 40–65 years are affected by this disease, and there is a tendency to rapidly “rejuvenate” the disease.

This happens due to the widespread risk factors for the development of pathology, which include hypertension, smoking, alcohol abuse, obesity, diabetes, hereditary predisposition, sedentary lifestyle, constant stress and overwork.

Coronary heart disease has a characteristic undulating course: the acute form of the disease is replaced by a chronic one. At the initial stage of its development, pathology is manifested by sudden bouts of angina pectoris, occurring, as a rule, after intense physical exertion or psychological overwork.

At the same time, patients have severe pressing pain in the heart, shortness of breath and fear of death, breathing is difficult. However, over time, seizures become more frequent and occur for no apparent reason – the disease becomes chronic.

The danger of cardiac ischemia lies in the development of severe complications in the absence of timely treatment, among which myocardial infarction, chronic heart failure, and a rhythm disturbance in heart contractions are distinguished.

These consequences not only worsen the quality of life of the patient, but also lead to severe disability or death. Annually, 2,5 million people die from this disease.

The dynamics of the treatment of patients with coronary heart disease is largely determined by the timeliness and quality of diagnosis of the clinical form of the disease, the adequacy of the prescribed outpatient treatment, as well as the timeliness of urgent hospitalization and emergency cardiac surgery.

Sad European statistics claim that coronary heart disease together with a stroke in the brain constitutes a catastrophic majority, namely 90% of all diseases of the cardiovascular system.

This indicates that coronary heart disease is one of the most common diseases, as well as the most common causes of mortality in modern humans.

It often leads to prolonged and permanent disability of the active population, even in the most developed countries of the world. All this characterizes the task of finding more effective methods of treating coronary heart disease as one of the leading tasks among the first medical problems of the XNUMXst century.

Causes of cardiac ischemia and risk factors

The main and most frequent reason for the development of coronary heart disease is atherosclerosis, the mechanism of which we talked about at the beginning of the article, in the paragraph “Development of coronary heart disease.”

In short, the bottom line is the presence in the coronary blood vessels of atherosclerotic plaques, narrowing or completely blocking the access of blood to a particular area of ​​the heart muscle (myocardium).

Among other causes of coronary heart disease can be identified:

  1. Eating low-useful and harmful foods – fast foods, soft drinks, alcoholic beverages, etc .;
  2. Hyperlipidemia (elevated blood lipids and lipoproteins);
  3. Thrombosis and thromboembolism of coronary arteries;
  4. Spasms of the coronary arteries;
  5. Endothelial dysfunction (inner wall of blood vessels);
  6. Increased blood coagulation system;
  7. Damage to blood vessels by infection – herpes virus, cytomegalovirus, chlamydia;
  8. Hormonal imbalance (with the onset of menopause, hypothyroidism and other conditions);
  9. Metabolic disorders;
  10. Hereditary factor.

The following people have an increased risk of developing CHD:

  • Age – the older the person, the higher the risk of developing coronary heart disease;
  • Bad habits – smoking, alcohol, drugs;
  • Poor nutrition;
  • Sedentary lifestyle;
  • Susceptibility to frequent stress;
  • Male gender;
  • Arterial hypertension (hypertension);
  • Obesity;
  • Diabetes;
  • Tachycardia.

IHD >

Classification of coronary heart disease occurs according to the form:

  1. Angina Pectoris:
    • Primary
    • Stable, indicating the functional class;
    • Unstable angina pectoris (Braunwald classification);
    • Vasospastic angina pectoris;
  2. Arrhythmic form (characterized by a violation of the heart rhythm).
  3. Myocardial infarction.
  4. Postinfarction cardiosclerosis.
  5. Heart failure.
  6. Sudden coronary death (primary cardiac arrest).
    • Sudden coronary death with successful resuscitation;
    • Sudden coronary death with fatal outcome;
  7. Asymptomatic form of ischemic heart disease.

The main etiological factor in the development of coronary heart disease is coronary atherosclerosis. Atherosclerosis develops sequentially, undulating and steadily. As a result of the accumulation of cholesterol, an atherosclerotic plaque forms in the artery wall.

Excess cholesterol leads to an increase in plaque in size, and there are obstacles to blood flow. Subsequently, under the influence of systemic adverse factors, the plaque transforms from stable to unstable (cracks and tears occur).

The platelet activation mechanism and the formation of blood clots on the surface of an unstable plaque are triggered. Symptoms are aggravated with the growth of an atherosclerotic plaque, which gradually narrows the lumen of the artery.

A decrease in the arterial lumen area by more than 90-95% is critical, causing a decrease in coronary blood flow and a deterioration in well-being, even at rest.

Symptoms of Coronary Heart Disease

The first signs of coronary heart disease, as a rule, are painful sensations – that is, signs are purely subjective. The sooner the patient draws attention to them, the better. The reason for contacting a cardiologist should be any unpleasant sensation in the heart, especially if it is unfamiliar to the patient and has not been experienced before.

However, the same applies to “familiar” sensations that have changed their nature or conditions of occurrence. Suspicion of coronary heart disease should occur in the patient and if pain in the sternal region occurs during physical or emotional stress and goes away at rest, have the nature of an attack.

In addition, any monotonous pain for sternal pain also requires an immediate visit to a cardiologist, regardless of the strength of the pain, nor of the young age of the patient, nor of his well-being at other times.

As already mentioned, ischemic heart disease usually proceeds in waves: periods of calm without manifestation of severe symptoms are replaced by episodes of exacerbation of the disease. Coronary heart disease can develop for decades, during the progression of the disease, its forms and, accordingly, clinical manifestations and symptoms can change.

It turns out that the symptoms and signs of coronary heart disease are symptoms and signs of one of its forms, each of which has its own characteristics and course. Therefore, we will consider the most common symptoms of coronary heart disease in the same sequence in which its main forms were considered in the section “Classification of coronary heart disease.”

However, it should be noted that about one third of patients with coronary heart disease may not experience any symptoms of the disease at all, and not even know about its existence. This is especially true for patients with painless myocardial ischemia.

Symptoms of coronary heart disease, such as chest pain, arm pain, lower jaw pain, back pain, shortness of breath, nausea, excessive sweating, palpitations, or heart rhythm disturbances may bother others.

Consider the symptoms depending on the type of coronary heart disease:

    Sudden coronary death.

Sudden coronary death does not have time to manifest itself precisely because it takes people “by surprise”. Cessation of cardiac activity usually occurs due to severe cardiac arrhythmias – ventricular fibrillation or due to electromechanical dissociation.

It is important to know the risk factors that greatly increase the likelihood of sudden coronary death. The main one is smoking.

The statistics speak for themselves: from the group of people under 50 who died suddenly, there were no non-smokers, and 95% of them abused cigarettes.

Men are 10 times more likely to end their lives this way. Myocardial hypertrophy, which occurs in hypertensive patients or people with obesity, is also important. In this case, there is electrical instability in the enlarged heart and insufficient supply of it with oxygen, since the growth of the coronary vessels “does not keep pace” with the increase in myocardial mass.

In the presence of risk factors for coronary death, an inadmissible inattention to the slightest harbingers of heart trouble is unacceptable. Persons who have had a previous myocardial infarction may experience fatigue, a feeling of suffocation and compression in the sternum.

Especially it is worth paying attention if the patient has a significant pathology of the coronary vessels, and the symptoms are not clearly associated with any apparent cause. Attacks of compressive pain behind the sternum can also become more frequent as an unstable angina pectoris.

The second group is people who have signs of myocardial ischemia on the ECG, but no pain or other symptoms. Such patients are not inclined to limit themselves in physical activity, smoking and other risk factors, which a sick heart sometimes does not forgive.

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The third group of people who do not have any symptoms or precursors. It is they who die suddenly, seemingly completely healthy. Such people will be able to help only properly organized emergency care and training the population in its methods.

Angina pectoris and myocardial infarction.

The main symptom of these forms of ischemic heart disease is pain. In intensity with angina pectoris, these are moderate pains, and with myocardial infarction the pain is severe, accompanied by cold sweat and fear of death, sometimes leading to loss of consciousness.

The pain in angina pectoris usually can be stopped by taking a nitroglycerin tablet under the tongue. Nitroglycerin usually does not affect a heart attack, and pain can only be relieved with narcotic drugs.

By localization – a classic attack of angina pectoris and heart attack are characterized by compressive pains behind the sternum, extending to the left hand. But pain can occur both in the stomach and in the back, given to the interscapular space, in the shoulder or lower jaw.

Pain with angina pectoris occurs during physical or emotional stress, when it is stopped, they disappear in case of stable angina pectoris. If there is an increase in angina attacks and a decrease in the level of stress at which it occurs – we can talk about unstable angina, which is often a harbinger of myocardial infarction.

Vasospastic angina is characterized by intense night pains that occur at rest and are based on spasm of large coronary arteries. It is called a variant of unstable angina.

Depending on the location of the lesion, it manifests itself in various disorders of the rhythm and conduction of the heart or the development of symptoms of heart failure.

Heart rhythm disorders.

Sometimes, in response to the load, not pain, but rhythm disturbances occur – extrasystole, atrial fibrillation, blockade, which can lead to a serious violation of hemodynamics.

The initial development of IHD is characterized by manifestations of circulatory failure in the form of palpitations and shortness of breath during exertion. In the expanded stage, edema appears, attacks of suffocation, already without load, in a prone position.

Diagnostics

If there is a suspicion of coronary heart disease, comprehensive diagnostics are needed, which helps:

  1. Assess the condition of the myocardium.
  2. Assess the condition of the coronary arteries.
  3. Find out if there are concomitant disorders: high blood pressure, high cholesterol, diabetes, kidney damage and other pathologies.
  4. Develop treatment tactics.
  5. Understand whether heart surgery is needed.

Diagnostics begins with a consultation with a cardiologist who will in detail ask you about your complaints, current illnesses, general condition, lifestyle and much more.

If there are indications for surgery, a cardiologist will refer you to a consultation with a cardiac surgeon. If you have diabetes or high blood sugar, you will be referred for consultation to an endocrinologist who will help clarify the treatment tactics.

You will also be prescribed a blood test:

  • General blood test – provides general information about the main indicators of the state of the blood.
  • A blood test for sugar and glycated hemoglobin – helps confirm or rule out diabetes.
  • Lipid profile – allows you to evaluate total cholesterol, “bad” cholesterol, “good” cholesterol, atherogenicity index.
  • Urea and kratinin – helps to evaluate the work of the kidneys, especially if there are signs of the development of arterial hypertension.

Urinalysis – helps confirm or rule out kidney damage, as well as assess the severity of these lesions. Then apply the diagnostic procedures:

    Measurement of blood pressure (BP).

The procedure, necessary for everyone who has a suspicion of coronary artery disease, helps to assess the pressure in the arteries and identify its disorders characteristic of coronary artery disease.

Helps assess the shape of the heart and its size.

It helps to evaluate the electrical activity of the myocardium and to identify this or that arrhythmia, heart attack, signs of myocardial hypertrophy.

Holter ECG monitoring.

The method helps to “catch” abnormalities in the heart for 1-3 days, which could not be diagnosed on a regular ECG.

ECG with load. You pedal the bicycle ergometer, walk or run along the treadmill. At the same time, ECG and blood pressure are being recorded.

The method helps to evaluate how your cardiovascular system generally works during dosed physical activity.

Ultrasound of the heart (ECHO cardiography).

It helps to evaluate blood flow in all chambers of the heart and main vessels, to study the work of heart valves, to detect foci of post-infarction changes in the heart muscle and to evaluate the structure of the myocardium.

Multispiral computed tomography. Multispiral computed tomography is a very informative and reliable method for the diagnosis of coronary artery disease in the early stages using x-rays.

Allows you to study the structure of the valves, identify their abnormalities, detect myocardial damage – scars, aneurysms, hypertrophy, assess the condition of the heart cavities and pericardium, detect and evaluate plaques.

If, after all the necessary tests and diagnostic procedures, our specialists decide that you may need surgery, you will be referred for coronary angiography.

Coronaroangiography is the gold standard for diagnosing coronary artery disease. The doctor introduces a special long probe through the thigh into the vessels and an X-ray contrast agent that “stains” the vessels.

Modern x-ray technology allows you to accurately visualize the location of plaques, to assess their size and the degree of narrowing of the lumen of the arteries. The method allows you to accurately determine the need for surgery and its type.

Heart Ischemia Treatment

Ischemia develops gradually over the years. Recovery and further full life depends on timely diagnosis and treatment of the disease. Treatment, in turn, depends on the degree of damage to the coronary vessels. It can be medical or surgical.

If coronary heart disease is detected at an early stage, then often to change it, you just need to change your lifestyle.

  1. Firstly, you should stop smoking, because nicotine constricts blood vessels and this can cause an attack of angina pectoris. Nicotine also provokes the formation of blood clots, which increases the risk of heart attacks.
  2. Secondly, reduce the consumption of animal fats, which increase blood cholesterol, which leads to an additional risk of developing atherosclerosis. It is also necessary to exclude fatty dairy products, eggs, chicken skin, pork, etc. from the diet in favor of fruits and vegetables.
  3. Thirdly, physical activity should be increased. To strengthen the cardiovascular system, you need to walk more, jog, swim.

However, with angina attacks about any physical activity, you must consult your doctor. It is also necessary to monitor your weight, because overweight can lead to the development of ischemia.

Medication

With the medical treatment of ischemia, many drugs are used. Some of them reduce the load on the heart, which reduces its need for oxygen, others help to improve blood flow to the myocardium or relieve angina attacks.

If the attack is severe, then a combination of drugs is prescribed. Essential medicines include calcium channel blockers, beta blockers, and nitrates. Calcium channel blockers dilate blood vessels, reduce calcium intake, which reduces the load on the heart muscle.

  • BETA BLOCKERS. Beta-blockers, combining with cardiac beta-adrenergic receptors, neutralize the effects of adrenaline on these receptors. As a result, the heart contracts less often, which reduces its need for oxygen.
  • NITRATES. Nitrates promote relaxation of the smooth muscles of the vascular wall. This significantly reduces the load on the ventricles, reduces the work of the heart and its oxygen consumption.

In addition, drug treatment of cardiac ischemia may include the appointment of:

  1. antiplatelet agents (acetylsalicylic acid, clopidogrel), due to which the blood “liquefies”, its fluidity improves, the ability of platelets and erythrocytes to adhere to blood vessels decreases, and erythrocytes pass through capillaries;
  2. beta-blockers (metoprolol, bisoprolol, carvedilol).

With these drugs, the frequency of contractions of the heart muscle decreases, as a result of which the necessary amount of oxygen enters the myocardium.

It should be borne in mind that beta-blockers have a number of contraindications: the presence of bronchial asthma, pulmonary failure, chronic lung disease;

  • statins and fibrators (lovastatin, simvastatin, atorvastatin, rosuvastatin, fenofibrate). Using these drugs lowers blood cholesterol;
  • anticoagulants (heparin), which have a “thinning” effect on the blood, as a result of which the blood flow becomes better, the development of existing blood clots stops.

    In addition, there are obstacles to the emergence of new blood clots. The drug is administered either intravenously or subcutaneously in the stomach;

  • diuretics (loopback – furosemide, thiazide – hypotazide, indapamide). Thanks to the use of these drugs, fluid is eliminated from the body, which significantly reduces the load on the myocardium.
  • In the treatment of coronary heart disease, it is also possible to use inhibitors of the angiotensin-converting enzyme (enalaprine, captopril, lisinopril), antiarrhythmic drugs (amiodarone), antibiotics and other drugs (ethylmethylhydroxypyridine, mildronate, mexicor, coronators, trimethazidine).

    Surgery

    Surgical treatment of ischemia is usually carried out for people suffering from frequent bouts of angina pectoris or who have suffered myocardial infarction. In such patients, the coronary arteries are greatly narrowed, and surgical intervention is required to increase blood flow to the heart muscle.

    If symptoms of angina pectoris worsen despite taking medication, surgery in a cardiac catheterization laboratory may be recommended, as a result of which the blocked artery is cleansed.

    Surgical treatment of cardiac ischemia is possible with:

      coronary angioplasty (PTCA), during which a guiding catheter is inserted into the artery in the groin or arm, then a hair-thin wire is inserted through the coronary artery through it.

    An even thinner catheter is then inserted into the blocked artery through the guide wire. The end of a thin catheter is equipped with a tiny ball. As soon as the ball reaches the point of blockage, it is inflated to expand the artery, and blood flow improves.

    The platelet is flattened and remains on the artery wall. Then the ball is removed along with the catheter. Sometimes this procedure is called PTCA, that is, they use an abbreviation for its full name: percutaneous transluminal coronary angioplasty.

    A stent is a small, trellised spiral metal tube or frame above a ball. In the blockage, the balloon is inflated, resulting in the stent being released. After this, the ball is removed, but the stent remains in place, so that it is possible to prevent narrowing of the artery.

    Over time, there is a likelihood of re-clogging of the arteries, the treatment of which is carried out using only angioplasty, and using stenting. For many people, a stent is a better solution, since its effect is longer;

    aterectomy. In some cases, platelets can become very hard, large, and can turn into lime, making treatment with angioplasty or a stent impossible.

    In such cases, platelets are removed using a device that resembles a drill in appearance. The procedure only works when the localization of the blockage or narrowing is in a relatively small separate section of the artery.

    For atherectomy, a directional catheter, a transluminal retrievable catheter (AngioJet), and a rotational aterectomy can be used. In addition, platelets can be burned with an excimer laser;

  • brachytherapy, in which the blockage is exposed to radiation. A radiation source is placed inside or near the artery. It is advisable to apply the procedure when the patient has already undergone angioplasty or stent treatment, but a blockage has reappeared;
  • aorto-coronary artery bypass grafting (CABG), which is used in case of blockage of several coronary arteries or if significant blockage is present in the left main artery.

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    The clogged parts of the artery are bypassed using blood vessels that are “borrowed” from the chest (internal chest artery), legs (saphenous vein), or arms (radial artery).

    The heart is stopped for the period of the surgical operation, and the patient’s body is connected to a machine – a cardiopulmonary bypass machine;

    In this case, the blocked artery can be replaced by an artery from the chest by the surgeon, for which a small incision is made, the chest cavity is not opened completely, which helps to avoid blockage;

    transmyocardial laser revascularization (TMP), during which the surgeon performs several punctures with a laser catheter in the heart muscle.

    Thanks to these small openings, it is possible to form new blood vessels. This procedure can be performed either separately or in conjunction with coronary artery bypass grafting.

    Treatment with folk remedies

    Before using folk remedies for coronary heart disease, be sure to consult your doctor! The following recipes are used:

      Hawthorn and motherwort. Pour in a thermos 1 tbsp. a spoonful of hawthorn and 1 tbsp. spoon of motherwort, then pour them 250 ml of boiling water.

    Allow the product to brew for a couple of hours, then strain it and drink 2 tbsp. tablespoons 3 times a day, 30 minutes before meals. The effectiveness of the drug increases with the additional use of a rosehip broth.

    Horseradish, carrots and honey. Grate the horseradish root to get 2 tbsp. spoon and pour it in a glass of boiled water.

    After, mix the horseradish infusion with 1 cup freshly squeezed carrot juice and 1 cup honey, mix everything thoroughly. You need to drink the drug for 1 tbsp. spoon, 3 times a day, 60 minutes before eating.

  • Horseradish. Make a mixture of 1 teaspoon of grated horseradish and 1 teaspoon of honey, which you need to eat 1 time a day with water. The course of treatment is 45 days.
  • Collection 1. Make a collection of the following ingredients in crushed form – 2 tbsp. tablespoons of reed flowers of a sunflower, grass of a jaundice and dill seeds, and also 1 tbsp. spoons of coltsfoot leaves. Mix everything thoroughly and pour 1 tbsp. a collection spoon with a glass of boiling water, then cover the container, set aside for an hour for infusion, strain and take the infusion of 100 g, 6 times a day, for 30 days, 30 minutes before eating.
  • Collection 2. Make a collection of the following ingredients in powdered form – 50 g of flowers of hawthorn, 30 g of mountaineer bird and 20 g of grass horsetail.

    Mix everything thoroughly, after which 2 tbsp. collection spoons pour 250 g of boiling water, cover the product and set aside for insisting, for 2 hours. After that, you need to strain the product and drink 1 sip during the day.

    Collection 3. Make a collection of the following ingredients in crushed form – 2 tbsp. tablespoons of flowers of hawthorn and mistletoe leaves, as well as 1 tbsp. spoonful of caraway seeds, valerian root, lemon balm leaves and periwinkle grass.

    Mix everything thoroughly and pour 1 tbsp. collection spoon with a glass of boiling water, then cover the container, set aside for an hour for infusion, strain and take the infusion of 100 g, 2 times a day, morning and evening, 30 minutes before eating.

    Collection 4. Make a collection of the following ingredients in crushed form – 100 g of hawthorn flowers, 100 g of pharmacy chamomile, 50 g of birch leaves, 50 g of heather grass, 50 g of horse chestnut flowers and 50 g of wheatgrass rhizome.

    Mix everything thoroughly, after which 1 teaspoon of the collection pour 250 g of boiling water, cover the product and set aside for insisting, for 30 minutes. After that, you need to strain and drink in a warm form, 100 g, 2 times a day, in the morning on an empty stomach and before bedtime.

    Diet for coronary heart disease

    Coronary heart disease (CHD) is a myocardial damage caused by a failure of the coronary circulation, which occurs due to a mismatch between the oxygen demand of the myocardium and its supply along with the blood through the arteries.

    The occurrence and progression of coronary heart disease is significantly affected by human nutrition. One of the most important risk factors in the development of this disease is the consumption of food with high energy value, especially simple carbohydrates (sugar, sweets, cakes, cakes, etc.), as well as animal fats, with a lot of fatty acids and cholesterol.

    The development of coronary heart disease is often associated with such a bad habit as smoking. Overstrain of the nervous system and frequent stressful situations, inadequate use of lipids in metabolic processes due to the limitation of human physical activity (hypodynamia) also contribute to the progression of coronary heart disease.

    It is known that overeating and insufficient physical activity of a person lead to the development of obesity, which contributes to the onset and progression of coronary heart disease, the diet of a patient suffering from coronary artery disease should be built on the principles of a balanced diet with moderate restriction of foods and dishes that contain a large amount of animal fats, cholesterol and salt .

    Food should be saturated with vitamins, especially ascorbic acid. It is necessary to exclude dishes rich in nitrogenous substances (meat, fish broths, etc.), and meat and fish should be consumed boiled. Food should contain in the daily diet 90-100 g of protein, 80-90 g of fat (30 g of which are vegetable) and 300-350 g of carbohydrates.

    The amount of carbohydrates in the diet is reduced by eliminating or restricting simple carbohydrates found in sugar, honey, preserves, pastries and sweets, sweets, semolina and rice dishes. At the same time, it is necessary to increase the intake of complex carbohydrates that are found in fiber of vegetables, unsweetened fruits and grains.

    Some macro- and microelements also inhibit the development of coronary heart disease: potassium, magnesium, phosphorus, iodine. Seafood, in which there is a lot of iodine: sea kale, fish, squid, crab, shrimp, etc., should be consumed more often.

    Potassium comes from fruits and baked potatoes. The most valuable sources of phosphorus for the human body are eggs (especially yolks), milk, liver, beans and peas. It is recommended to limit foods containing a lot of cholesterol and animal fats: caviar, brains, kidneys, etc.

    But these products should not be completely excluded from the diet. It should be noted that in egg yolks, cholesterol is found in the most rational proportion with lecithin, which improves cholesterol metabolism and prevents the development of atherosclerosis.

    Sour cream and cream also contain a lot of lecithin compared to butter, so these products should also be preferred vegetable oils (sunflower, corn, olive, etc.), rich in unsaturated fatty acids and phospholipids that keep cholesterol dissolved and this prevents the development of coronary heart disease.

    In addition, vegetable fats contribute to the intense secretion of bile and, together with it, cholesterol. In the treatment of coronary heart disease, you need to eat at least 4-5 times a day. Dinner should be light, 3 hours before bedtime. It is recommended to use mainly boiled or baked dishes.

    Limit the amount of salt to 8-10 g per day. The diet includes high-grade foods that do not burden the stomach, heart, liver and kidneys, contain a small amount of cholesterol:

    • Rye bread,
    • borscht,
    • cabbage
    • milk,
    • fruit and vegetable soups,
    • low-fat meat soups (1 time per week).

    Low-fat veal, lamb, chicken or turkey (boiled), low-fat fish (cod, pike perch, perch), soaked low-fat herring (1 time per week), dairy products, cheese, omelet from egg whites. The use of yolks is limited to 4 pcs. in Week.

    Recommend vegetable dishes – vinaigrettes, salads with vegetable oil. Useful fruits, berries and fresh fruit juices. It is necessary to limit the use of fatty meat soups, fatty meat, beef and mutton fats, savory and savory snacks, coffee, cocoa, chocolate.

    With a tendency to obesity, it is necessary to exclude products containing simple carbohydrates, pastry, potatoes, pasta. A healthier diet is the foundation for the prevention of coronary heart disease. Follow these guidelines:

    • break the food into 3 main meals and 2 additional;
    • breakfast is required (25% of the daily calories), and dinner (15% of calories) should take place no earlier than 2 hours before bedtime;
    • do not drink flu >

    The most formidable complications of coronary heart disease are myocardial infarction and stroke. However, modern cardiology does not consider myocardial infarction as a complication, but as the acute and most severe form of IHD.

    But acute myocardial infarction is usually preceded by angina of various durations of the course, which, shortly before the development of myocardial infarction, acquires a progressive character, its attacks become more frequent, their duration increases, they are poorly stopped with nitroglycerin preparations.

    The fact is that this pathology occurs in patients with atherosclerosis of the coronary arteries. It is not always possible to establish which external factors led to the development of myocardial infarction in a particular patient.

    In some cases, a connection with physical or psychoemotional stress can be traced. In these cases, myocardial infarction occurs due to increased heart function and the release of adrenal hormones into the blood, which is accompanied by activation of blood coagulation processes.

    With increased work of the heart, the oxygen demand of the heart muscle increases, and turbulent blood movement in the area of ​​the existing atherosclerotic plaque, increased blood coagulation contribute to the formation of a blood clot in the area of ​​narrowing of the artery, especially if the surface of the atherosclerotic plaque is ulcerated.

    Typical manifestations of myocardial infarction are a feeling of severe compression or pain behind the sternum, or somewhat to the left or right of it.

    Irradiation of pain in the left shoulder girdle, shoulder, arm, less often in the neck and lower jaw, sometimes in the right half of the shoulder girdle, interscapular space, rarely in the epigastric region, is characteristic.

    Unlike angina pectoris, pain in myocardial infarction lasts more than half an hour, usually several hours, and in case of pericarditis, several days.

    Another complication of coronary heart disease is stroke. In this situation, a stroke occurs due to embolism, which occurs due to parietal thrombosis, less commonly, ulcerated atherosclerotic plaques serve as the source of emboli.

    Heart failure also refers to complications of coronary heart disease. It is manifested by edema, shortness of breath during physical exertion, rapid fatigue, muscle weakness, a feeling of chilliness. Later, the abdomen increases (flatulence, congestive enlargement of the liver, ascites), nausea and vomiting are possible (congestive gastritis).

    Prevention of IHD

    Prevention of coronary heart disease includes the following recommendations:

    • Refuse unhealthy and junk food, or at least minimize its use;
    • Try in your diet, give preference to the use of foods enriched with vitamins and minerals – fresh vegetables and fruits;
    • Give up alcohol, smoking;
    • Move more; when seated, do exercises in the workplace;
    • Do not leave to chance the diseases of the cardiovascular system so that they do not develop into a chronic form;
    • Watch your weight;
    • Avoid working with increased emotional stress, especially if you are very worried about various difficult situations, – if necessary, change your job;
    • Try to have peace with the people around you, especially in the family.
  • Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

    Detonic