If the oxygen usage by the myocardium does not match and its consumption, hypoxia or coronary heart disease (IHD) establishes. It can be scientifically symptomatic or asymptomatic.
There are the list below conditions in which it is constantly required to look for coronary heart disease:
- anginal discomfort;
- shortness of breath at rest or with very little physical effort;
- repeating discomfort in the chest;
- heart failure;
- short-term convulsion of capillary providing the heart muscle;
- stenosis or blockage of the arteries that feed the heart.
- Mechanism of disease advancement
- scientific image
- General concepts of treatment
- Ischemic heart disease and impotence
- Ischemic heart disease and menopause
- IHD and dyslipidemia
- Ischemic heart disease and diabetes mellitus
- Coronary artery disease, atrial fibrillation and antithrombotic treatment
Mechanism of disease advancement
Ischemic heart disease takes place in circumstances that provoke the look of an increased need for oxygen in the heart muscle.
These consist of:
- workout tension;
- weight problems;
- systemic connective tissue illness;
- hormone dysfunctions;
- kidney pathology;
- vascular sores of the extremities;
- undesirable eco-friendly scenario;
- using alcohol, nicotine and other compounds that are vascular toxins.
Gradually, the practical reserve of myocardial vessels reduces, cholesterol deposits appear in the walls of capillary, the lumen, vascular tone suffers, the variety of potassium ions and blood lipids boosts. Dysfunction of the endothelial membrane of the vessel wall slowly establishes, which causes a boost in its permeability, the deposition of cholesterol plaques.
All these elements at first happen without scientific signs and are not identified on the ECG. The most useful method for identifying coronary heart disease in its early duration is the evaluation of myocardial wall perfusion.
Ischemic conditions development depending on the premorbid background, genetics, the strength of direct exposure to damaging ecological elements.
IHD is not a sentence and a prompt check out to a physician at the really early phases of the disease provides a consistent and long-lasting scientific result and protects the lifestyle.
There is no point in awaiting the look of scientific signs of coronary heart disease, given that it just has nonspecific symptoms for an extended period of time, such as basic weak point, despair, and reduced resistance to regular exercise.
After 40 years, it is required to frequently take blood tests and carry out an active look for threat elements for the advancement of coronary heart disease, which consists in the prompt medical diagnosis of conditions such as:
- a boost in the quantity of blood triglycerides;
- infraction of the ratio of lipids of low, high density;
- increased blood sugar level or impaired glucose tolerance.
When scientific signs appear, clients experience pain, which can be found from the stomach location to the lower teeth, or in between the shoulder blades. Periodically there is discomfort and pain behind the breastbone.
Reflected discomfort in the shoulder girdle, more frequently the left, as much as the fingertips of both hands, accompany very little physical effort or psycho-emotional experiences. Autonomic signs such as a sensation of suffocation, a sensation of worry of death, disturbances in the pulse, lightheadedness, sweating, and tiredness might exist.
A particular function of undesirable feelings and discomfort syndrome is that it stops instantly after the disappearance of provoking elements.
When an individual kept in mind the look of an undesirable feeling in the area of the heart, behind the breast bone in the limbs or upper abdominal area, it is required to attempt to examine it according to such specifications as – area, connection with tension or tension, period, what signs are accompanied, what is the nature and period of an attack of discomfort, after what it goes through.
When the above indications of ischemic heart disease have actually appeared, you ought to speak with a physician in order to prevent major conditions, problems and repercussions. An extra assessment will be recommended, which will make it possible to make the right medical diagnosis and recommend appropriate treatment.
Heart anemia is identified by recommending tests and extra assessment techniques. But in parallel with this disease, it is required to omit anemia, heart flaws, arterial high blood pressure, arrhythmias, cardiomyopathy, kidney disease, thyroid gland, diabetes mellitus, intercostal neuralgia.
Non-intrusive strategies are utilized, the essence of which is the lack of penetration into human cavities and tissues. These consist of resting and unpleasant ECGs, tension ECGs with physical or medicinal tests, ECHO cardiography, Holter tracking, magnetic resonance imaging, chest x-ray, blood and urine tests.
Modern techniques for confirmation of coronary heart disease are myocardial perfusion scintigraphy, positron emission tomography, single-photon emission calculated tomography, stress-MRI of the heart with medicinal filling with dobutamine.
Only clients dealing with damaging production elements, driving cars, go through a yearly assessment with intriguing tests, that makes it possible to prompt detect the existing asymptomatic myocardial hypoxia.
Ordinary individuals require to pay comparable attention to their health.
If suggested, CT angiography of the vessels feeding the myocardium, intrusive coronary angiography, the function of which is to find stenosis, identify the reserve of blood circulation, and deal with the concern of whether myocardial revascularization is shown, are recommended.
Even asymptomatic heart anemia identified throughout workout tests needs major treatment.
General concepts of treatment
Before beginning treatment, it is required to remove all the provoking elements that affect the development of hypoxia and coronary heart disease.
These consist of smoking cigarettes, weight problems, little exercise, and alcohol.
A big share in the complex of preventive procedures is inhabited by an active, mobile way of life. Physical activity ought to be routine and routine in daily life.
Considering that throughout sex, the usage of oxygen by the myocardium boosts, the heart rate increases, and high blood pressure increases. If required, using nitroglycerin is suggested prior to sexual relations, so as not to cause coronary heart disease.
It is now commonly understood what ischemic disease is, and that it is effectively treated with nitrates. To avoid an attack of angina pectoris, short-acting nitrates are utilized, for instance, nitroglycerin under the tongue, 0,3 mg every 5 minutes up until the discomfort subsides.
In this case, it is required to take a seat or rest, given that a standing position can result in fainting. Cardiac discomfort anemia is relieved quicker by aerosol nitroglycerin than by sublingual administration.
There are long-acting nitrates such as isosorbide dinitrate. Also, the dose type of nitroglycerin in the type of spots is regularly recommended.
Side results from taking nitrates are hypertension and headaches. Cephalalgia is quickly dropped in taking nitrates, however it triggers undesirable feelings in clients and decreases adherence to the treatment of ischemic heart disease.
Coronary artery disease needs the consultation of beta-blockers when there is a sped up heart rate. But their adverse effects are anxiety, increased tiredness, blockage of the tracheobronchial tree, impotence, hypoglycemia.
Verapamil, diltiazem, calcium villains, ivabradine, nicorandil, trimetazidine, ranolazil, allopurinol are likewise utilized. Cardiac anemia declines throughout treatment with these representatives, as seen on the ECG.
Ischemic heart disease and impotence
Risk elements consist of impotence. It is intensified by the routine usage of beta-blockers, antihypertensive drugs, diuretics. It has actually been shown that the consultation of statins at the same time deals with impotence, heart anemia, and enhances effectiveness.
In addition, clients in this group are enabled to utilize drugs such as sildenafil, tadalafil, vardenafil. But the synchronised usage of these drugs and nitroglycerin is strictly forbidden, given that they potentiate each other, an unmanageable drop in high blood pressure, collapse takes place.
Ischemic heart disease and menopause
For rather a long period of time, hormonal agent replacement treatment with estrogens was utilized to avoid a boost in the occurrence of coronary heart disease in females after 60 years. Its efficiency is presently being gone over.
Hormone replacement treatment is required to minimize the general threat of myocardial damage in menopause, osteoporosis, bone fractures, dementia, diabetes, metabolic syndrome. Moreover, it is the early consultation of estrogens throughout menopause that is particularly reliable.
The earlier hormonal agent replacement treatment is recommended, the better you can eliminate such symptoms of menopause as anxiety, irritation, excitability, sleep disruptions, amnesia, stomach weight problems, the development of resistance to insulin treatment, impaired glucose tolerance, heart diseases, hypercholesterolemia.
IHD and dyslipidemia
Most specialists in the field of fat metabolic process conditions think that this issue is brought on by the individual’s way of life. Therefore, prior to recommending drug treatment, it is required to comply with a lipid-lowering, hypocholesterolemic diet plan, alter the way of life, and omit unhealthy routines.
Features of cardioprotective nutrition consist of using fresh plant foods, seafood, omega-3s, nuts, a little alcohol, restricting salt with excess potassium-containing foods.
An boost in the quantity of natural fresh food – hazelnuts, peanuts, beans, entire grains of oats, barley, cocoa, additional virgin olive oil – should be performed taking into consideration the existence of concomitant pathology. For example, in infraction of purine metabolic process, beans and cocoa are contraindicated.
Statins are the ideal treatment for the integrated treatment of coronary artery disease and dyslipidemia. They considerably lower blood cholesterol levels. But they have particular adverse effects. Myalgia and muscle weak point are regularly kept in mind, transaminases in the blood boost, which suggests hepatotoxicity.
The advancement of hemoglobinuria and the advancement of intense kidney failure were likewise kept in mind.
The above problems are more typical in individuals with serious concomitant pathology and in clients taking a a great deal of drugs at the very same time, in specific prescription antibiotics and antifungal representatives.
Diabetes mellitus establishes quicker in clients with impaired glucose tolerance while taking statins. Some clients, while taking statins, experience intellectual and mnestic conditions, weakening of memory, attention, and working capability.
An alternative approach of treatment for clients in this group is just following a stringent diet plan or utilizing ezetimibe, which obstructs the absorption of cholesterol in the intestinal tract. It can be utilized as monotherapy or in mix with statins to deal with clients with familial hypercholesterolemia.
Ischemic heart disease and diabetes mellitus
Patients with impaired carb metabolic process are at high threat of establishing cardiovascular pathology. The existence of diabetes mellitus increases the occurrence of coronary artery disease by 5-6 times.
More than 60% of clients with type 2 diabetes mellitus currently experience coronary artery disease at the time of medical diagnosis confirmation.
Often, myocardial anemia and hypoxia continue without scientific symptoms or are leveled by signs of hyperglycemia, microangiopathy, retinopathy, kidney damage, polyneuropathy.
That is why this classification of clients typically has mute myocardial infarctions, a high threat of postinfarction problems, rhythm disruptions, and unexpected vascular death.
Patients with diabetes mellitus ought to be particularly thoroughly assessed to recognize the threat of establishing cardiovascular pathology.
Indicators such as smoking cigarettes, waist area in females over 79 cm and in guys over 96 cm, genetic history, glycosylated hemoglobin level, quantity of protein in urine, blood creatinine level, arterial high blood pressure, increased blood cholesterol level, strength of exercise are evaluated.
Empagliflozin is thought about as the ideal drug. Treatment with this drug ought to be begun as early as possible. This considerably decreases the threat of death from heart diseases.
Thiazolidinedione is contraindicated in diabetes mellitus.
Attention! For clients of this group, the advancement of hypoglycemia is really harmful, given that versus this background arrhythmia, intellectual and mental illness, dementia establish.
Antithrombotic treatment is compulsory in clients with coronary artery disease and diabetes mellitus.
Coronary artery disease, atrial fibrillation and antithrombotic treatment
Ischemic heart disease needs not just keeping a heart rate of no greater than 66 per 1 minute, however likewise routine antithrombotic treatment. Anticoagulants ought to be recommended so that signs and treatment associate with each other and with the threat of establishing hemorrhagic problems.
It is required to accomplish an affordable balance in between the threat of thromboembolic problems, bleeding, bearing in mind that this is such an unsafe condition that needs routine medical guidance.
An unambiguous indicator for the consultation of anticoagulant treatment is – ischemic heart disease, condition after stenting, atherosclerosis of the carotid or peripheral arteries, atrial fibrillation.
The following drugs are recommended – warfarin, aspirin. These drugs can be utilized as monotherapy or in mix with each other. However, when administered at the same time, they, considerably minimizing the threat of thromboembolic problems, increase the threat of lethal bleeding.
An alternative drug is dabigatran. But he likewise has contraindications and problems, so he can just be recommended by a physician, taking into consideration scientific and lab information.
Cardiovascular pathology is adjoined with illness of all organs and systems in the body. One emerging issue causes a series of conditions that need medical intervention.
The threat of establishing lethal conditions versus the background of myocardial hypoxia increases lot of times in the existence of concomitant pathology of the kidneys, endocrine organs, peripheral arteries and other conditions.
At the start of the advancement of the disease, the balance in between the required and readily available quantity of oxygen for the heart muscle is disrupted. Gradually, all systems are associated with the hypoxic procedure, which causes numerous organ failure.
Against the background of ischemic heart disease, hepatic, kidney, and breathing failure establish, the function of the peripheral and main nerve systems suffers.
Timely medical diagnosis, effectively picked treatment, taking into consideration the existing concomitant pathology, considerably extends life span and enhances its quality.
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