Chronic coronary heart disease what is it

In clinical practice, several types of coronary heart disease are distinguished. In most cases, coronary heart disease manifests itself in the form of angina pectoris. Angina pectoris is an external manifestation of coronary heart disease, accompanied by severe chest pain. However, there is also a painless form of angina pectoris. With her, the only manifestation is fatigue and shortness of breath even after minor physical exercises (walking / climbing stairs several floors).

If bouts of pain occur during physical exertion, then this indicates the development of angina pectoris. However, in some people with coronary heart disease, chest pains appear spontaneously, without any connection with physical activity.

Also, the nature of the changes in the symptoms of angina pectoris may indicate whether coronary disease develops or not. If coronary heart disease does not progress, then this condition is called stable angina pectoris. A person with stable angina pectoris, subject to certain rules of behavior and with appropriate supportive therapy, can live for several decades.

It’s a completely different matter when angina attacks become harder and harder over time, and the pain is caused by less and less physical exertion. Such angina is called unstable. This condition is a cause for alarm, because unstable angina pectoris inevitably ends in myocardial infarction, or even death.

A vasospastic angina pectoris or Prinzmetall angina pectoris is also allocated to a specific group. This angina pectoris is caused by a spasm of the coronary arteries of the heart. Often spastic angina occurs in patients suffering from coronary arteriosclerosis. However, this kind of angina pectoris may not be combined with such a sign.

Depending on the severity, angina pectoris is divided into functional classes.

ClassPhysical activity restrictionsWhat are the stress conditions for heart attacks?
Inoat high intensity
IIsmallat medium (walking to a distance of more than 500 m, climbing to the third floor)
IIIpronouncedat low (walking to a distance of 100-200 m, climbing to the second floor)
IVvery highat very low (with any walking, daily activities) or at rest

The development of ischemia occurs against the background of problems with the blood supply to the heart muscle – it is not enough to ensure the metabolic needs of the heart. The thing is that the contraction of the heart muscle is a rather laborious process, which requires a sufficient supply of oxygen.

This element is always contained in normal blood flow, and if it is difficult, then oxygen starvation occurs – ischemia itself. This pathological condition manifests itself as a minor or serious violation in the blood supply to the walls of the heart.

Even with an initially insignificant failure, the organ still begins to experience a lack of oxygen and, as a result, the disease progresses to chronic. Violation of the blood flow appears due to damage and problems in the arteries (coronary).

Such damage in the arteries affects the patency of the plasma. This causes serious and often irreversible consequences for heart tissue. What caused and what constitutes an arterial disorder:

  • It is atherosclerotic in nature;
  • It takes place due to the accumulation of fat cells and other elements that are deposited in the arteries on the walls;
  • Such deposits lead to the formation of plaques;
  • Plaques affect the blockage of blood vessels, blocking blood flow;
  • Further, the situation leads to the formation of blood clots – blood clots.

Such blood clots tend to come off sooner or later, leading to death. Additionally, due to the formation of a blood clot in the artery, the blood flow slows down significantly, which is especially felt during physical exertion, when on the contrary it should accelerate.

Accordingly, often angina attacks in chronic coronary artery disease occur at the time of increasing physical activity. In this case, the disease in a chronic form may begin with minor damage to the inner wall of the coronary artery. Even at a very young age, the process can manifest itself.

Patients with chronic coronary heart disease complain of bouts of chest pain that go away after taking the medication (nitroglycerin), malfunctions in the heart rhythm. For a better diagnosis, there is a classification from the New York Heart Association:

  • First class – there are no distinct symptoms of the disease at this stage;
  • The second class – the disease manifests itself after physical exertion in severe form;
  • Third class – pain appears even after light physical exertion;
  • The fourth class – the manifestation of symptoms occurs even without exertion at rest.

Patients from grades 1-2 usually do not have any severe seizures and the disease does not affect life. When an increase in class occurs, then we can talk about progressive angina pectoris, which worsens the prognosis for the patient.

In the later stages, ischemia manifests itself even in a complete state of rest. In this case, there is a risk of heart attack and death. It is very important to understand that in a fairly large proportion of patients the disease does not develop at all in accordance with the indicated classes, but immediately passes to the stage of a heart attack or sudden death. Sometimes an asymptomatic course of the disease may even be present and recognition of the disease becomes possible only at a late stage.

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Methods of examination

The importance and necessary information for the treatment of a disease in a chronic form can be obtained by conducting an electrocardiogram. It should be obtained both at rest of the patient, and during physical dosed loads using a bicycle ergometer. By analyzing the electrocardiogram, it will be possible to accurately understand the severity of ischemia and where the foci of the disease are located, what degree of damage and the nature of the heart rhythm failure.

In addition, an important diagnostic method is color Doppler ultrasound, as well as an echocardiographic examination. Using these types of studies, it is possible to determine what changes have undergone contractile capabilities of the myocardium. The foci and prevalence of the disease are determined by the functioning of the walls in the ventricles of the heart. Due to echocardiographic studies, it is possible to identify volumes of the left ventricle and other important hemodynamic parameters.

In ambiguous cases, selective coronarography may be used. Especially this examination method is prescribed for young people and in middle age. Still this type of research becomes a decisive factor in the case of undoubted ischemia and the solution of the question regarding the advisability of surgical intervention.

Chronic ischemia has its own characteristics of treatment. Non-drug therapies, drug treatments, surgical revascularization, as well as endovascular methods can be used. The direction regarding non-drug therapy can include activities related to nutrition and lifestyle correction. This can act as an excellent prophylaxis of the disease.

Medications are prescribed depending on the class of the disease and the individual characteristics of the patient – these may be hypocholesterolemic drugs, diuretics, antiplatelet agents. In the event that there is no result from ongoing therapy with medications, there is a risk of heart attack and consultation with a cardiac surgeon is required regarding surgical treatment.

IHD, unlike other diseases, is a whole group of pathologies with a huge number of symptoms that correlate with the cause of the disease. Moreover, various types of coronary heart disease spontaneously pass from one to another, which creates great difficulty in the diagnosis and adequate therapy. In practice, there are two fundamentally different forms of IHD over the course of the course:

  • acute myocardial ischemia – the most common cause of fulminant death;
  • chronic coronary heart disease, which is combined with retrosternal discomfort, arrhythmias, other negative symptoms that exist for a long period of time.

There is a more complex, detailed classification of the disease.

IHD classification

Classification of coronary heart disease occurs according to the form: 1. Angina pectoris: – Angina pectoris: – Primary; – – Stable, indicating the functional class— Unstable angina (Braunwald classification) – Vasospastic angina; 2. Arrhythmic form (characterized by a violation of the heart rhythm); 3. Myocardial infarction; 4.

It is customary to distinguish a chronic and acute form of coronary heart disease. The first category includes heart failure, arrhythmia, cardiosclerosis. Acute ischemia includes sudden death, unstable angina, heart attack. There are also several classes of the disease, which are characterized by certain features:

  1. Walking or climbing stairs does not cause bouts. Symptoms of pathology are manifested with prolonged or intense exertion.
  2. There is a slight restriction of motor activity. The attack sometimes develops after waking up, eating, stressful situations.
  3. A significant limitation of activity. The attack catches up after 200 meters of habitual walking.
  4. The ability to do any physical work is completely lost. Anginal pains appear even in a calm state.

By this term is meant a natural fatal outcome. In men, cardiac arrest is much more common than in women in a 10: 1 ratio. This form of the disease in most cases is associated with ventricular fibrillation, when there is a chaotic contraction of different heart fibers at a heart rate of 300-600 beats / minute.

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CHD – angina pectoris

Under this condition, ischemic syndrome is understood, which is manifested by sternal pain, which extends to the epigastrium, jaw, upper limbs, and neck. The immediate cause of the pathology is insufficient blood supply to the heart muscle. Stable angina pectoris is easily stopped by drugs, since it has stereotypic seizures.

CHD – cardiosclerosis

When the connective scar tissue grows in the myocardium, and the valves are deformed, then this pathology is called cardiosclerosis. This condition is a manifestation of chronic coronary artery disease. The atherosclerotic form of the disease has a long development process, and its progression disrupts the heart rhythm, which provokes necrotic changes and scarring of the myocardial tissue. Sclerotic changes lead to the development of acquired heart disease or bradycardia.

Necrosis of the muscle layer due to insufficient blood supply is called myocardial infarction. This form of coronary heart disease – what is it? The disease in clinical manifestation distinguishes three degrees: pain (1-2 days), fever (7-15 days), scarring (2-6 months). A heart attack is preceded, as a rule, by an exacerbation of coronary heart disease, which manifests itself in an increase in angina attacks, a sensation of a disturbance in the rhythm of the heart, and initial signs of heart failure. This condition is called preinfarction.

In medicine, arrhythmias are called interruptions in the work of the heart when the regularity and frequency of contractions change. The arrhythmic form of ischemic heart disease is the most common, as it is often the only symptom of the disease. Not only chronic coronary heart disease, but also bad habits, prolonged stress, drug abuse, and other diseases can provoke arrhythmia. This form of ischemic heart disease is characterized by a slow or rapid heartbeat due to impaired functionality of electrical impulses.

This is a temporary violation of the blood supply to the myocardium, which is not accompanied by a pain attack, but is recorded on the cardiogram. The painless form of coronary heart disease can manifest itself or be combined with other forms of myocardial ischemia. According to the classification, it is divided into several types:

  1. First. It is diagnosed in patients with coronary angiography, but only if other forms of coronary heart disease have not been previously detected.
  2. Second. Appears in people who have had a heart attack, but without angina attacks.
  3. Third. It is diagnosed in patients with a diagnosis of progressive angina pectoris.

Methods of examination

Concretizing individual nosological forms of cardiac ischemia is quite difficult, since the main reason is common, and the clinical manifestations are very different. WHO recommends systematizing CHD as follows:

  1. Primary cardiac arrest or instantaneous coronary death is an unpredictable pathological condition, probably due to electrical instability of the heart muscle, which occurs within 6 hours after a heart attack in front of witnesses. There are two outcomes: successful resuscitation measures or a lethal, uncontrollable scenario.
  2. Angina of exertion: stable (divided into functional classes – from I to IV) and unstable (occurring for the first time, after surgery, after a heart attack, is steadily progressing) is another form of coronary heart disease.
  3. Cardiac ischemia without pain (diagnosed by chance with an instrumental examination of the patient).
  4. Myocardial infarction: transmural (large focal) and small focal (local). The essence is tissue necrosis due to the absence or insufficiency of nutrition and oxygen supply.
  5. Post-infarction cardiosclerosis, which develops on the background of the replacement of muscle fibers by connective tissue, which violates the contractility of the myocardium – a form of chronic ischemic heart disease.
  6. LDCs: arrhythmias, tachycardia, tachysystole, bradycardia, extrasystoles, flicker, fibrillation – precursors of angina pectoris or heart attack.
  7. Heart failure: acute and chronic, from stage I to IV – the result of malnutrition by coronary heart.
  8. Special forms of angina pectoris: X-syndrome, refractory, spontaneous angina pectoris (vasospastic, variant, Prinzmetal).

IHD medicines

A cardiologist may recommend drug therapy if lifestyle changes are not enough for him. Drugs are prescribed only by the attending physician. Most often, drugs are prescribed that reduce the risk of thrombosis (aspirin, plavix). To lower cholesterol, statins can be prescribed for a long time. Heart failure should be treated with drugs that improve cardiac muscle function (cardiac glycosides).

For those with no history of heart disease, aspirin reduces the likelihood of myocardial infarction, but does not alter the overall risk of death. It is recommended only for adults who are at risk of blood clots, where the increased risk is defined as “men over 60, postmenopausal women and young people with a background for the development of coronary artery disease (hypertension, diabetes or smoking).

Clopidogrel plus aspirin (dual antiplatelet therapy, DAAT) reduces the likelihood of cardiovascular events more than taking aspirin alone. This drug is contraindicated in patients with a history of gastrointestinal ulcers or gastric bleeding. Antiplatelet therapy should be carried out for life.

Adrenergic blockers reduce heart rate and myocardial oxygen consumption. Studies confirm an increase in life expectancy when taking β-blockers and a decrease in the frequency of cardiovascular events, including repeated ones. β-blockers are contraindicated in concomitant pulmonary pathology, bronchial asthma, COPD.

  • β-blockers with proven prognosis improvement properties for coronary heart disease:
  • Carvedilol (Dilatrend, Acridilol, Talliton, Coriol).
  • Metoprolol (Betalok Zok, Betalok, Egilok, Metocardium, Vasocardine);
  • bisoprolol (Concor, Niperten, Coronal, Bisogamma, Biprol, Cordinorm);

Drugs in this group reduce blood cholesterol by reducing its synthesis in the liver, or inhibit the absorption of cholesterol from food, affecting the causes of atherosclerosis. Medicines are used to reduce the rate of development of existing atherosclerotic plaques in the vessel wall and prevent the occurrence of new ones.

A positive effect on the degree of progression and development of symptoms of coronary heart disease, on life expectancy is noted, also these drugs reduce the frequency and severity of cardiovascular events, possibly contributing to the restoration of the lumen of the vessel. The target cholesterol level in patients with coronary artery disease should be lower than in patients without coronary artery disease, and is 4,5 mmol / L.

They belong to the class of drugs that increase the antiatherogenic fraction of lipoproteins – HDL, with a decrease in which the mortality from coronary heart disease increases. They are used to treat dyslipidemia IIa, IIb, III, IV, V. They differ from statins in that they lower triglycerides and can increase the HDL fraction. Statins predominantly lower LDL and do not have a significant effect on VLDL and HDL. Therefore, the maximum effect is manifested with a combination of statins and fibrates.

Nitroglycerin is the main drug that relieves chest pain in the heart. Nitrates mainly act on the venous wall, reducing preload on the myocardium (by expanding the vessels of the venous channel and depositing blood). An unpleasant effect of nitrates is a decrease in blood pressure and headaches.

Nitrates are not recommended for use with blood pressure below 100/60 mm Hg. Art. Modern studies have shown that taking nitrates does not improve the prognosis of patients with coronary artery disease, that is, does not lead to increased survival, and therefore are used as a drug to relieve symptoms of coronary artery disease. Intravenous drip of nitroglycerin allows you to effectively deal with the phenomena of angina pectoris, mainly against the background of high numbers of blood pressure.

Causes and risk factors

Many causes can cause the development of coronary heart disease, but in 90% of cases it is coronary atherosclerosis.

There are 3 groups of the most common factors in which chronic ischemia is likely to develop. – This is a biological predisposition that occurs in the body pathology and lifestyle features. Factors can be biological in nature, the following people are most susceptible to the disease:

  • Men;
  • In old and old age;
  • With genetic predisposition.

In addition, the situation may be affected by atherosclerosis, hypertension, obesity, diabetes, etc. The following bad habits are the key reasons for the development of the disease in a chronic condition:

  1. Smoking;
  2. Poor nutrition, unbalanced and overeating;
  3. Decreased physical activity leading to physical inactivity;
  4. Reception of alcoholic drinks.

Each of these factors, when conducting research, proved to be a significant factor affecting the likelihood of developing a disease. The thing is that an unbalanced diet leads to dyslipidemia – an imbalance between good and bad cholesterol. Arterial problems can also be greatly affected by emotional stress, radiation exposure, and heredity.

Spasm of the coronary arteries and other pathological phenomena

In addition to atherosclerotic vascular stenosis and thrombosis, spasms of the coronary arteries have a strong effect. The phenomenon is a dysfunction of the autonomic nervous system. The fact is that the branches of the ANS supply organs and tissues with nerve endings to ensure communication with the central nervous system. In this case, the supply concerns the arterial bed of the heart. Therefore, with dysfunction, cramping occurs, which significantly disrupts normal blood flow.

In addition to spasms, there are other situations of a pathological nature. They also lead to the formation of chronic myocardial ischemia, although they do not directly affect the area of ​​the coronary arteries. We are talking about such diseases:

  • Tachycardia – the heart rate increases and, accordingly, the heart’s metabolic needs increase, and the arterial bed will not always be able to compensate for them;
  • Arterial hypertension – due to increased blood pressure, the load on the heart muscle increases, which leads to its hypertrophy, thickening of the walls occurs and the arterial bed becomes unable to provide blood supply to the entire thickness of the tissues.

There are a lot of factors why chronic coronary heart disease develops. In many respects, the decisive role why chronic coronary heart disease develops is played by neglect of one’s health and an incorrect lifestyle.

This is a modern technology for restoring patency of coronary arteries in coronary artery disease. The point is to inflate the atherosclerotic plaque with a special balloon and strengthen the vascular wall with a metal frame – a stent. Coronary angioplasty is performed without incisions in patients with severe angina pectoris or myocardial infarction.

Open surgery for narrowing of the coronary arteries. The point is to create a workaround for blood. As a bypass, the patient’s own veins or arteries are used. The operation can be performed with or without cardiopulmonary bypass. Due to the development of coronary angioplasty technology, coronary artery bypass grafting recedes into the background, as it is more traumatic and is used only for extensive lesions of the coronary bed.

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Symptoms of Coronary Heart Disease

According to statistics, chronic ischemia affects about 2 thirds of people from all over the planet regarding the manifestation of symptoms and 1 third are fatal cases. The topic of consideration of symptoms of chronic coronary heart disease is extremely relevant and requires detailed coverage. Initially, the disease develops gradually, the lumen of the coronary arteries narrows and the blood supply to the myocardium decreases, so the symptoms also tend to develop over time.

Coronary heart disease has its clinical manifestations, which is preceded by the first signs of the disease, which patients usually pay little attention to.

Such pathology precursors include:

  • unpleasant sensations behind the sternum: tingling, a feeling of discomfort, transient minor pain that is associated with exertion, fatigue, age, but is not regarded as a warning moment about the pathology;
  • fatigue, which becomes chronic. A person gets up not recovering during the night, in the morning feels overwhelmed, unwell, but thinks that this is the norm: weather, poor sleep, colds;
  • shortness of breath during exercise, disappearing after a short rest;
  • coronary artery disease – it can be manifested by arrhythmia, sudden, short-term, without consequences, which I also consider the age norm from work overload, household chores;
  • the precursors of coronary heart disease are attacks of lightheadedness, vertigo, fainting;
  • signs of coronary heart disease – heartburn or colic in the abdomen.

Any of these unpleasant symptoms, and even more so, their combination is a reason for consultation with a cardiologist.

Nature of pain

With the development of coronary heart disease, it is worth paying attention not only to the signs of ischemic disease, but also to the nature of the pain behind the sternum, the cause of which is irritation of the nerve ending receptors by the toxins formed in the myocardium due to hypoxia of the heart muscle. Triggers of this situation can be stress or physical activity.

Abdominal pain is rarely perceived as cardiac. But in men, the first signs usually give just such a localization. Another feature of cardialgia is their beginning mainly in the morning.

Gender differences

Symptoms of coronary disease in men and women do not differ by sex, they depend only on the form of IHD: shortness of breath, arrhythmia, cardialgia are characteristic of both sexes. But there are age-related gender specifics.

In men, clinical manifestations are first detected after the age of 55, in women after 65. The first clinical manifestations of IHD in men are AMI (acute myocardial infarction), and in women, angina pectoris. Moreover, one of its varieties – form X occurs only in women. Sex and age features are associated with estrogenic protection of the female body.

The main symptoms of coronary heart disease are manifested in 9 acute and chronic variants of the course of the disease. In each case – its own symptoms, presented in the table.

Symptom of ischemic heart diseaseCharacterization of clinical manifestations
Sudden cardiac arrest (coronary death)A person immediately loses consciousness, precursors are practically absent, retrosternal discomfort, emotional lability, fear of death are rarely noted. More often – spontaneous respiratory arrest.

In the absence of emergency assistance up to indirect heart massage, mechanical ventilation in a hospital, death occurs

Heart attack (AMI)This form of coronary heart disease is characterized by severe pain with localization directly behind the sternum (the region of the heart does not hurt), radiating to the jaw, teeth, wrist, fingers. The nature of the pain is pressing or burning, the duration of the attack is more than 15 minutes. The reason is any load.

Nitroglycerin does not help. Hyperhidrosis occurs, weakness, pressure drops

The combination of a heart attack with encephalopathy, pre-strokeSuch a situation gives shortness of breath, cough, dizziness, fainting, signs of impaired speech, abdominal pain, arrhythmia, swelling of the legs, ascites
Angina pectorisIt is characterized by intolerable pain, but unlike a heart attack, the attack is relieved by Nitroglycerin. There are no other symptoms.
Cardiosclerosis after a heart attackThe diagnosis is made one month after AMI. Common signs:

There is a risk of recurrence of a heart attack, constant monitoring by a doctor is required

Heart rhythm disturbances of different genesisA type of chronic course of coronary heart disease. Heart rate is fast or slow, with interruptions or fading, a feeling of weakness
Heart failure (heart failure)The main symptom is swelling in combination with rapid fatigability, shortness of breath, symptoms of the main pathology, against which deficiency arose
Special forms of coronary heart diseaseThis includes X-syndrome, vasospastic and refractory angina pectoris. Symptoms are identical to angina of exertion, aggravated by spasm of peripheral vessels, immunity to conventional treatment
Painless ischemia of the heartLatent, detected by chance during instrumental examination of the patient

Cardiac ischemia has symptoms of physical and mental manifestations. The first include arrhythmia, weakness, shortness of breath, increased sweating. The patient has spontaneous chest pains that do not stop even after taking nitroglycerin, he becomes very pale. Mental symptoms of coronary heart disease:

  • a sharp lack of oxygen;
  • apathy, dreary mood;
  • panic fear of death;
  • causeless concern.

IHD forms

With myocardial ischemia for the successful treatment of pathology, doctors distinguish clinical symptoms according to the forms of IHD:

  1. Coronary death. Symptoms develop rapidly: the pupils do not respond to light, there is no consciousness, pulse, or breathing.
  2. Angina pectoris. Pressing, cutting, compressing and burning pain is localized in the epigastrium or behind the sternum. An attack of angina pectoris lasts from 2 to 5 minutes, and is quickly stopped by drugs. Vasospastic angina is characterized by a feeling of discomfort behind the sternum at rest. With the first occurrence of angina pectoris there is an increase in blood pressure, spontaneous seizures up to 15 minutes with physical exertion. Early post-infarction angina occurs after myocardial infarction.
  3. Cardiosclerosis Pulmonary edema, diffuse or focal myocardial damage, rupture of the aneurysm, persistent violation of the heart rhythm are observed. The patient has swelling of the feet, lack of air, dizziness, with time – pain in the hypochondrium, an increase in the abdomen. Post-infarction cardiosclerosis is characterized by attacks of nocturnal asthma, tachycardia, progressive shortness of breath.
  4. Heart attack. Severe pain behind the sternum, extending to the jaw, left shoulder blade and arm. It lasts up to half an hour, while taking nitroglycerin does not pass. The patient develops cold sweat, a sharp decrease in blood pressure, weakness, vomiting, fear of death.
  5. Coronary syndrome X. Pressive or constricting pain in the atrial region or behind the sternum, which lasts up to 10 minutes.

What is dangerous pathology

No one canceled the fact that coronary heart disease is the result of malnutrition and oxygen supply to the most important organ of the human body. Patients with coronary heart disease get used to their disease, cease to consider it dangerous to health. It is such carelessness that leads to the most dangerous consequences.

The most insidious is called – spontaneous cardiac arrest. Electrical lability of the heart muscle is a direct consequence of coronary heart disease, often a latent form of the disease.

A person goes to bed in perfect order, and in the morning his breathing stops, his heart stops. It is difficult for relatives to believe that the cause is myocardial ischemia, which has been present in the patient for several years. Symptoms of coronary heart disease were not recorded, but an autopsy clearly visualized a scar on the heart.

Another danger is the development of acute myocardial infarction with tissue necrosis, the development of post-infarction cardiosclerosis, impaired contractility of the myocardium without the possibility of recovery. A fatal outcome is likely.

Heart failure in the acute and chronic form is no less dangerous. The heart ceases to perform the proper functions, the blood does not flow in sufficient quantities to the internal organs, which leads to their first functional and then organic deformation with loss of working capacity.

Many people suffering from ischemic heart disease become accustomed to their disease and do not perceive it as a threat. But this is a frivolous approach, because the disease is extremely dangerous and, without proper treatment, can lead to a grave consequence.

The most insidious complication of coronary heart disease is a condition that doctors call sudden coronary death. In other words, it is cardiac arrest caused by electrical instability of the myocardium, which, in turn, develops against the background of IHD. Very often, sudden coronary death occurs with patients with latent coronary artery disease. In such patients, often the symptoms are either completely absent or not taken seriously.

Another way of developing coronary heart disease is myocardial infarction. With this disease, the blood supply to a certain part of the heart deteriorates so much that its necrosis occurs. The muscle tissue of the affected area of ​​the heart dies, and scar tissue appears in its place. This happens, of course, only if the heart attack does not lead to death.

A heart attack and coronary heart disease in itself can lead to another complication, namely, chronic heart failure. This is the name of a condition in which the heart does not properly perform its blood pumping functions. And this, in turn, leads to diseases of other organs and violations of their work.


Coronary heart disease is always accompanied by impaired blood flow, for this disease is attributed to hemodynamic disorders that cause many morphological, functional changes in the body. They determine the prognosis of coronary heart disease. The bottom line is the decompensation of the pathological process:

  • at the first stage, a failure in the cardiocyte energy system is observed;
  • on the second – the contractility of the left ventricle is violated (transient process);
  • the third stage is the replacement of cardiac muscle cells with connective tissue;
  • the fourth is a change in the ability to contract and relax the heart;
  • fifth – an automatism disorder, a violation of the cardiac conduction system with the development of arrhythmias, flicker, fibrillation.

All stages are a sequential mechanism for the development of heart failure, the main complication of coronary heart disease, which poses a threat to the patient’s life.

Diagnosis of IHD

An accurate diagnosis of coronary heart disease (CHD) is needed to determine the form of the disease, to choose the appropriate therapy. The algorithm is standard:

  • collection of complaints, medical history, physical (auscultation examination);
  • heart rate measurement; blood pressure measurement;
  • OAC, OAM, biochemistry – markers of the general condition of the patient (high ESR – a reason to suspect myocardial ischemia, especially in combination with leukocytosis);
  • blood testing for enzymes: CPK (creatine phosphokinase), ACaT (aspartate aminotransferase), ALaT (alanine aminotransferase);
  • research on troponins – protein components of cardiocytes (it makes sense in the first hours of a developing heart attack);
  • electrolyte test: potassium sodium (cause of arrhythmias);
  • determination of the lipid spectrum of the blood;
  • electrocardiography (ECG);
  • coronary angiography (CAG);
  • Halter
  • functional tests: bicycle ergometry, six-minute walk test;
  • echocardiography;
  • chest x-ray.

The volume of research is the prerogative of the doctor. Sometimes diagnostics are reduced to a minimum in order to gain time for prescribing therapy.

Methods of examination

Treatment of IHD with folk remedies

Important! Before using folk remedies for coronary heart disease, be sure to consult your doctor!

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.

Heart ischemia requires a healthy lifestyle. Folk remedies will help with this. Herbs and plants are able to positively affect blood vessels, myocardium, lipid metabolism, blood viscosity. The most popular with herbal medicine ischemic heart disease:

  • Hawthorn, which strengthens the myocardium, reduces heart rate, but the plant has a cumulative effect, affects blood pressure, so you need to take hawthorn tea with caution. Hawthorn fruits can be used all year round: dry berries (large spoon) are poured with 500 ml of boiling water, insist 15 minutes, drink in two divided doses with an interval of at least 6 hours.
  • You can prepare a decoction based on the berries of hawthorn, rosehip and motherwort: 100 g of each plant is poured with a liter of water, brought to a boil, after 7 minutes it is removed from the heat, cooled, filtered, taken in the morning, on an empty stomach in half a glass.
  • Horseradish leaves for coronary heart disease – improve microcirculation. But it is necessary to take decoctions from the plant with caution to those patients who have digestive problems. An alternative can be inhalation with horseradish root: the plant is rubbed, take a spoonful of mass, pour boiling water and breathe steam for 15 minutes.
  • You can combine horseradish with honey in equal proportions (100 g each). The mixture is eaten after breakfast and a half teaspoons, washed down with tea. The course is a month, a repeat after a three-week break.
  • Garlic – a vegetable rich in volatile, a natural antibiotic, relieves inflammation, that is, pain. Improves microcirculation. The recommended dose is a clove of garlic per day at lunch.

All folk recipes for the treatment of coronary heart disease should be approved by a doctor.

Prevention, prognosis

Preventing coronary disease is easier than curing. There are a number of rules:

  • constant monitoring of blood pressure, heart rate;
  • adherence to the hypocholesterol diet;
  • control of the lipid spectrum, blood sugar;
  • healthy sleep;
  • walks in the open air;
  • exclusion from the diet of alcohol, smoking cessation, refusal of drugs, strong coffee, energy drinks, sweet soda;
  • medical examination.

Adhering to this lifestyle, you can prevent the development of coronary heart disease, while maintaining the usual quality of life for many years.

Description of the disease

Everyone knows that the purpose of the heart muscle (myocardium) is to supply the body with oxygen-rich blood. However, the heart itself needs blood circulation. Arteries that deliver oxygen to the heart are called coronary. There are two such arteries; they extend from the aorta. Inside the heart, they branch out into many smaller ones.

However, the heart does not just need oxygen, it needs a lot of oxygen, much more than other organs. This situation is simply explained – because the heart works constantly and with a huge load. And if a person may not especially feel the manifestations of oxygen deficiency in other organs, then a lack of oxygen in the heart muscle immediately leads to negative consequences.

Circulatory failure in the heart can occur for only one reason – if the coronary arteries leak a little blood. This condition is called “coronary heart disease” (CHD).

In the vast majority of cases, narrowing of the vessels of the heart occurs due to the fact that they are clogged. Vascular spasm, increased blood viscosity and a tendency to form blood clots also play a role. However, the main cause of IHD is coronary arteriosclerosis.

Atherosclerosis was previously considered a disease of the elderly. However, now this is far from the case. Now, atherosclerosis of the blood vessels of the heart can also occur in middle-aged people, mainly in men. With this disease, the vessels are clogged with deposits of fatty acids, forming the so-called atherosclerotic plaques.

They are located on the walls of blood vessels and, narrowing their lumen, inhibit blood flow. If this situation occurs in the coronary arteries, the result is an insufficient supply of oxygen to the heart muscle. Heart disease can develop imperceptibly for many years, not particularly manifesting, and not causing much concern to a person, except in some cases.

Signs of Coronary Heart Disease

Many people do not pay for signs of coronary heart disease, although they are fairly obvious. For example, this is fatigue, shortness of breath, after physical activity, pain and tingling in the heart. Some patients believe that “it should be so, because I am no longer young / not young.” However, this is an erroneous point of view.

In addition, coronary heart disease can manifest itself and other unpleasant symptoms, such as arrhythmias, dizziness, nausea, fatigue. Heartburn and abdominal cramps may occur.

Pain in coronary heart disease

The cause of the pain is irritation of the nerve receptors of the heart with toxins formed in the heart muscle as a result of its hypoxia.

Pain in coronary heart disease is usually concentrated in the heart. As mentioned above, pain in most cases occurs during physical exertion, severe stress. If pains in the heart begin at rest, then with physical exertion they tend to intensify.

Pain is usually observed in the sternum. It can radiate to the left shoulder blade, shoulder, neck. The intensity of pain is individual for each patient. The duration of the attack is also individual and ranges from half a minute to 10 minutes. Taking nitroglycerin usually helps relieve a pain attack.

Men often have abdominal pain, which is why angina pectoris can be mistaken for some gastrointestinal disease. Also, pain with angina pectoris most often occurs in the morning.

How is coronary heart disease

Above, we indicated which symptoms accompany coronary heart disease. Here we raise the question of how to determine whether a person has atherosclerotic changes in the vessels in the early stages, even at a time when obvious evidence of coronary artery disease is not always observed. Moreover, such a sign as pain in the heart is not always indicative of coronary heart disease. Often it is caused by other causes, for example, diseases associated with the nervous system, spine, various infections.

An examination of a patient complaining of negative phenomena typical of coronary heart disease begins with listening to his heart sounds. Sometimes the disease is accompanied by noise typical of IHD. However, often this method fails to identify any pathology.

The most common method of instrumental research of heart activity is a cardiogram. With its help, you can track the distribution of nerve signals in the heart muscle and how its departments are reduced. Very often, the presence of coronary heart disease is reflected in the form of changes on the ECG. However, this does not always happen, especially in the early stages of the disease.

Therefore, a cardiogram with a stress test is much more informative. It is carried out in such a way that during the removal of the cardiogram, the patient is engaged in some kind of physical exercise. In this state, all pathological abnormalities in the work of the heart muscle become visible. After all, during physical exertion, the heart muscle begins to lack oxygen, and it begins to work intermittently.

Sometimes the method of daily Holter monitoring is used. With it, the cardiogram is removed for a long period of time, usually during the day. This allows you to notice individual deviations in the work of the heart, which may not be present on a regular cardiogram. Holter monitoring is carried out using a special portable cardiograph, which a person constantly carries in a special bag. At the same time, the doctor attaches electrodes to the human chest, exactly the same as with a normal cardiogram.

Also very informative is the echocardiogram method – ultrasound of the heart muscle. Using an echocardiogram, a doctor can evaluate the performance of the heart muscle, the size of its departments, and blood flow parameters.

In addition, informative in the diagnosis of coronary heart disease are:

  • general blood analysis,
  • blood chemistry,
  • blood glucose test
  • blood pressure measurement
  • selective coronography with contrast medium
  • CT scan,
  • radiography.

Many of these methods make it possible to identify not only the IHD itself, but also the concomitant diseases that aggravate the course of the disease, such as diabetes mellitus, hypertension, blood and kidney diseases.

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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.