Coronary insufficiency syndrome what is it, methods of treatment

The heart is the most important organ in our body. It is responsible for pumping blood to different corners of our body, and a violation of its functions adversely affects the state of all cells of the human body. If the activity of the heart is disturbed suddenly, acute heart failure may develop.

This is a dangerous condition that requires immediate diagnosis, first aid and proper treatment.

Let’s talk about what constitutes acute cardiovascular failure, the symptoms and treatment of such a disorder will be examined in more detail, we will clarify what emergency care is needed for patients with this diagnosis.

Symptoms of Acute Cardiovascular Failure

The acute form of heart failure occurs when weakening the activity of one of the departments of the heart, for example, the left atrium or the left or right ventricle.

Acute left ventricular failure makes itself felt in cardiac asthma and alveolar pulmonary edema. An attack of cardiac asthma occurs in response to physical or psychological stress.

It usually develops at night, which causes the patient to wake up from fear with a feeling of shortage of air and a heartbeat. Cardiac asthma leads to coughing, severe weakness and cold sweat.

The patient sits down and lowers his legs.

With an increase in stagnant pressure, pulmonary edema develops. With sudden suffocation, a cough occurs, which is accompanied by the release of a significant amount of sputum, foamy and pink.

Breathing becomes bubbling, and moist rales are heard through breathing. The patient’s face turns blue, his veins swell, and cold sweat appears on his skin. The pulse becomes threadlike and arrhythmic, the pressure decreases.

The acute form of left atrial insufficiency makes itself felt by the same manifestations as the acute form of left ventricular failure.

In acute insufficiency of the right ventricle, stagnation occurs inside the vascular system of a large circle of blood circulation.

The patient is worried about cyanosis, pain, or pressure in the region of the heart. The pulse on the periphery becomes weak and frequent, the pressure drops sharply.

Acute Cardiovascular Failure – An Emergency

If an attack of heart failure occurs, it is necessary to immediately provide first aid to the patient.

The victim should be placed in a comfortable position and give him a quick-acting medicine: Nitroglycerin and Validol under the tongue.

Such a medicine gives a positive effect in thirty seconds. With low blood pressure, Validol can be used without nitroglycerin.

You can use such drugs repeatedly, they are not able to accumulate in the body and cause dependence.

If there is a suspicion of left ventricular failure, the patient must be seated. If right ventricular failure has developed, it is worth giving it an elevated position in bed.

How is acute cardiovascular failure corrected, which treatment is effective?

In the acute form of cardiovascular failure, the patient is shown hospitalization. The methods of therapeutic effect depend on the factor that caused this violation. So with myocardial infarction, you can cope with the problem by restoring the coronary blood flow through the problem artery, this can be achieved by conducting systemic thrombolysis.

Therapy of the acute form of congestive right ventricular failure requires correction of the conditions that provoked the development of this disorder. Doctors are taking measures to treat pulmonary embolism and asthmatic status or other conditions.

For the treatment of acute heart failure, doctors provide adequate analgesia using narcotic analgesics. Vasomotor agitation requires the use of psychotropic drugs.

An important role is played by proper infusion therapy, it is carried out under the control of blood pressure indicators. To increase cardiac output, doctors administer dopamine, dopamine, to the patient. In some cases, epinephrine and norepinephrine may be used.

  • In order to improve the microcirculation processes, they resort to the use of anticoagulants and fibrinolytics.
  • With right ventricular failure, diuretics, prednisone and nitrates are sometimes used, which can reduce the load on the heart and improve the activity of the right ventricle.

Also, with this pathology, cardiac glycosides are used in combination with polarizing agents. Some of these drugs can also be used for left ventricular failure, depending on the particular course of the disease.

After the condition of the patient with acute cardiovascular insufficiency is normalized, he is transferred to the cardiology department and further therapy is carried out.

The duration of the attacks, their severity, the conditions of occurrence are the factors that determine the classification of the disease into mild, moderate, severe. The degree of vascular damage (the strength of spasms, their “clogging” with blood clots (blood clots), sclerotic plaques) is another reason that affects the formal separation of acute coronary insufficiency.

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Lightweight

A mild form of coronary insufficiency arises as a result of a reversible circulatory disturbance during active emotional or physical exertion. A person feels a slight pain, a sudden short-term “interception” of breath, but the legal capacity at these moments is not impaired. The attack lasts from a few seconds to two minutes, quickly stops.

Moderate

Attacks of moderate severity occur during normal, but prolonged exertion, for example, when a person walks for a long time or climbs uphill (stairs). Failure during a severe emotional upheaval, anxiety, and disorder is not ruled out. When there is a syndrome of moderate coronary insufficiency, there is a pressing pain in the left part of the chest, well-being is sharply worsened, and working capacity is reduced. An attack of coronary heart failure lasts about ten minutes, is removed only by taking fast-acting nitroglycerin.

Coronarogenic pain that occurs with a severe attack does not go away without medical intervention. It is so strong that a person is seized with a fear of death; he experiences additional emotional arousal that only worsens his condition. A severe attack lasts from ten minutes to half an hour, leading to a heart attack, death.

Cardiologists distinguish several forms of the course of coronary syndrome. Each of them has distinctive characteristics by which it is possible to diagnose the type of disease.

Forms of coronary circulation disorders:

  1. Asthmatic – due to poor blood circulation, ventricular failure begins to progress. This form of the disease is observed in a quarter of patients with coronary artery disease. Congestive processes in the pulmonary circulation cause symptoms that are similar to signs of bronchial asthma. The patient begins shortness of breath, occasionally – even choking, the skin acquires a bluish tint. When listening to the lungs, wheezing is pronounced. The patient suffers from a severe cough with sputum discharge.
  2. Abdominal. A rather rare condition is observed in 3% of patients. Most often, tissue sites located behind the heart muscle are affected. At this point, nerve fibers are excited and symptoms intertwine with the digestive system. These include nausea, bloating, vomiting, upset, belching. The patient is concerned about pain under the ribs or in the abdominal cavity. Thanks to these symptoms, it is sometimes difficult to establish a real diagnosis.
  3. Painless. A rare, but very complex and unsafe form of coronary heart failure. The victim practically does not feel pain or does not attach the necessary importance to chest discomfort. The heart rhythm is slightly confused, and breathing may not be disturbed. That is why the patient rarely seeks help from specialists.
  1. Cerebral type of ailment is observed mainly in elderly people. In the elderly, blood circulation in the vessels of the brain is often impaired, which is provoked by atherosclerosis. Symptoms – severe dizziness, sharp headaches, blurred eyes, tinnitus, loss of consciousness is possible.
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It is categorically not recommended to independently engage in the diagnosis of the disease and to be treated with medicines.

Causes

The main part of the heart of any person is the myocardium – the muscle that is responsible for all its activities as a whole. Blood is constantly circulating through the vessels of the myocardium, due to which the heart is supplied with oxygen and nutrients.

In addition, through them, metabolic products are derived from the tissues of the heart. All this movement of blood through the vessels is called coronary circulation.

If the flow of blood to the heart stops, the myocardium stops receiving oxygen and other nutrients, and then coronary insufficiency appears.

According to development options, acute and chronic types of coronary insufficiency are distinguished. Very often, acute coronary insufficiency can develop within a day, and sometimes several hours.

It occurs due to the reduction of coronary arteries, filling them with gas bubbles and other foreign particles. Because of this, ischemia occurs – a violation of the blood supply to the myocardium, leading to blocking the flow of oxygen into the heart.

This condition can lead to myocardial infarction, and possibly to death.

Chronic coronary insufficiency is determined by a gradual decrease in blood flow to the myocardium, this period can last for several years. The reasons may be changes in the properties of blood (its thickening), atherosclerosis (artery walls lose their flexibility due to the appearance of deposits of cholesterol and other fats on them), as well as other cardiovascular diseases.

Types of coronary insufficiency are usually united by one term – coronary heart disease.

The most frequent and characteristic manifestations of coronary insufficiency will be pressing, burning pains in the region of the heart or in the sternum. In addition, pain can give off to the entire left side of the body – the neck, shoulder blade or arm.

This can happen regardless of any external factors, even in a calm state. This disease is called angina pectoris – this is one of the variants of coronary heart disease.

In chronic ischemia, such symptoms occur constantly.

In addition to pain in the heart, symptoms of the disease are shortness of breath, cough, tachycardia. Deterioration can be caused by severe stress and any physical exertion. Climbing to any height, fast running, emotional stress and panic can be the causes of unpleasant symptoms of ischemia.

A situation is considered dangerous when seizures become larger and last longer.

At this stage, urgent hospitalization is necessary, since in this condition the likelihood of developing myocardial infarction is high. And this is acute coronary insufficiency, which can lead to the death of the patient.

It is necessary to be extremely suspicious of any pain that occurs in the left part of the chest, because at a young age they should not be. In addition, young people who have the prerequisites for this disease look much older than their age.

First aid

You need to know how to behave in case of symptoms indicating acute coronary insufficiency. Timely help will help save a person’s life. To do this, follow these steps:

  1. Call an ambulance immediately. In the first minutes of an attack, the victim often begins to develop arrhythmia (heart rhythm disturbance). Most often it is ventricular fibrillation or ventricular tachycardia. And these violations can not be dealt with without a special device that restarts the heart – the defibrillator.
  2. Give the patient a lying position (if there is no cough and shortness of breath) or a sitting position.
  3. Provide fresh air, loosen or unbutton clothing.
  4. If possible, the victim should take Nitroglycerin or Validol. Nitroglycerin immediately enters the bloodstream and helps relieve chest pain. If the pain did not go away at the initial dose, the pill can be taken after 10 minutes a second time. Nitroglycerin begins to act within a minute, the tablet must be put under the tongue. However, it cannot be used if the blood pressure during the attack has decreased. Validol exerts its effect later, usually after 2 minutes. It immediately increases coronary blood flow and usually also has a calming effect. It also needs to be put under the tongue.

Usually these actions relieve chest pain and other unpleasant symptoms of acute coronary insufficiency. The attack usually lasts from two to twenty minutes. But it also happens that the pain begins to intensify, the attack lasts more than half an hour, and this is already a prerequisite for the development of myocardial infarction. Therefore, one of the first actions should remain an ambulance call.

Prevention

To prevent the development of acute coronary insufficiency, prophylaxis will be the same as for all cardiovascular diseases – reducing the adverse effects of environmental factors. To do this, observe the following rules:

  1. Stop smoking and drinking any alcoholic beverages.
  2. Try to completely eliminate stress and any emotional stress.
  3. Do sport. It can be any physical activity that brings pleasure – running, swimming, brisk walking, skiing. However, it is not worth overloading yourself either.
  4. Follow a diet, do not overeat. It is necessary to include more vegetables and fruits in your diet, refuse fatty, spicy foods.
  5. Maintain optimal body weight, try to get rid of extra pounds.
  6. Check blood cholesterol and monitor blood pressure.

Acute coronary insufficiency is one of the most unpleasant conditions that a person can experience. However, these easy-to-follow rules will help improve health and reduce the number of attacks of coronary insufficiency.

Acute coronary insufficiency – a state of the body in which there is a complete or partial blockage of the blood supply to the heart muscle.

This pathology often leads to sudden coronary death. This article will talk about what causes this condition, about methods of diagnosis and treatment, and how to provide emergency care.

Causes of

Acute coronary syndrome (ACS) is another name for this pathology. Basically, it begins as a result of atherosclerotic vascular lesions.

The pathogenesis (development mechanism) of this disease consists in the deposition of cholesterol in the walls of the arteries, because of which they lose elasticity, the blood flow is difficult. The ICD-10 disease code is 124.8.

With a partial violation of the blood supply to the myocardium, a lack of oxygen occurs, the cells do not receive the substances necessary for vital functions. This condition is called coronary heart disease. With complete blocking of the movement of blood, a heart attack develops.

Reasons why ACS may occur:

  • thrombotic stenosis;
  • stratification of the walls of arteries;
  • spasm of blood vessels;
  • fibrosis;
  • the presence of a foreign body (embolus) in the blood supply system;
  • inflammation of the serous membrane of the heart (endocarditis);
  • narrowing of the lumen of the vessels.

Disruption of myocardial blood supply is also possible due to injuries in the region of the heart (for example, a knife wound), surgical operations.

People with the following diseases are at increased risk of ACS

  • ischemia, previous heart attacks;
  • myocardial dystrophy and myocarditis (inflammation of the muscle tissue of the heart);
  • tachycardia;
  • diabetes;
  • hypertension;
  • congenital tendency to sudden cardiac arrest;
  • pathology of the vascular system (thrombophlebitis, thromboembolism).

Also, risk factors are such conditions:

  • obesity, unhealthy diet (leading to the accumulation of cholesterol);
  • smoking, taking cocaine;
  • low motor activity;
  • advanced age (the risk of ACS increases after 45 in men, 55 in women).

In about half the cases of coronary insufficiency, no symptoms appear. A person feels weak dizziness, he has an accelerated heartbeat. In other cases, signs of pathology appear in combination.

Symptoms of acute coronary insufficiency before death include:

  • pressing or painful, often burning sensations in the sternum;
  • pain is projected into other parts of the body (abdomen, shoulder blades, arms, etc.);
  • profuse sweat;
  • convulsions;
  • secretion of foam from the mouth;
  • the appearance of dyspnea;
  • nausea, sometimes with vomiting;
  • respiratory depression, shortness of breath;
  • sudden pallor;
  • severe dizziness, sometimes with loss of consciousness;
  • causeless weakness.

Pathology rarely occurs in people who do not have any cardiovascular disease.

A person who has frequent angina attacks can confuse its symptoms with ACS. However, there are some differences. With a typical violation of the heart, pain lasts 5-10 minutes, and with coronary syndrome they last a longer time – up to 6 hours.

Angina pectoris is characterized by discomfort, tightness in the chest. Pain in ACS can be of such strength that it blocks any movement.

When a patient enters the clinic, the doctor conducts an examination and makes a preliminary diagnosis.

The main factors on the basis of which coronary insufficiency is diagnosed:

  • lack of pulse;
  • breath blocking;
  • the patient is in an unconscious state;
  • pupils do not respond to light;
  • the face becomes earthy.

To confirm the diagnosis, the following studies are carried out:

  • ECG;
  • coronary angiography;
  • MRI;
  • echocardiography;
  • scintigraphy of the heart muscle.

Electrocardiography shows changes in the electrical characteristics of the heart when pathologies are detected. Violation of blood flow in the coronary arteries is characterized by a typical deviation of the electrocardiogram.

Coronarography (angiography of arteries adjacent to the myocardium) gives a visual picture of their narrowing. This analysis is carried out using a contrast agent visible on x-ray. A reagent catheter is inserted through the vein on the patient’s leg into the coronary region. After this, a series of images is taken, according to which the doctor determines whether there is obstruction of the vessels.

Using echocardiography (ultrasound of the heart), changes in the structure of the myocardium, its valve apparatus, are examined. The operation of the valves directly affects the blood circulation process.

Moderate

The main causes of coronary insufficiency

What causes of coronary heart failure can be identified?

  • Reduction in the gaps of blood vessels, which is characteristic of atherosclerosis. Lipoproteins accumulate on the inner walls of blood vessels, in particular those with a low density. With certain reactions of the body, these substances form connective tissues, due to which the gaps of the vessels narrow.
  • Spasm. During seizures (mainly triggered by a nervous strain), the membranes of the coronary arteries contract. At the same time, the gap decreases, but the amount of blood that comes to the heart remains the same. In most cases, such spasms pass quickly enough, but sometimes the vessel narrows completely – due to a lack of oxygen, muscle cells of the heart begin to die.
  • Atherosclerotic vascular injury. Plaques, which are formed due to the high level of “bad” cholesterol in the blood, disrupt the blood flow.
  • Inflammation on the walls of blood vessels. Inflammatory changes begin when harmful viruses and infections are in the blood, after which the walls of the vessels suffer due to the work of auto-aggressive antibodies.
  • Thrombosis in vessels.
  • Deficiency of oxygen in the blood. Usually this cause is manifested with other diseases. The heart receives a small amount of oxygen, even with a normal blood flow. Over time, with a weakening of circulation, oxygen starvation may occur.

Blood oxygen deficiency

For the clinical causes of coronary and heart failure, subcompensated and decompensated diabetes mellitus can be added.

The following factors influence the appearance of atherosclerotic plaques:

  1. Active and passive smoking. Not only is the smoker in danger – tobacco smoke has a toxic effect on the body, as a result of which the cells of the inner layer of arteries change, and the risk of blood clots on them increases.
  2. Fatty, fried foods. Junk food is the main cause of metabolic disorders, which leads to insufficient intake of vitamins and minerals by the body. An increase in blood cholesterol also causes the formation of blood plaques.
  3. Alcoholic beverages and the use of psychotropic drugs. Maintaining the wrong lifestyle affects primarily internal organs, including the heart.
  4. Stress, emotional outburst. Negative emotions badly affect all the functions of the body, including can lead to spasm of the heart muscle.
  5. Physical activity – both low and excessive. The lack of physical activity leads to stagnation of blood in the veins, a decrease in blood flow velocity, and, accordingly, a slow delivery of oxygen to the heart. Increased physical activity leads to malfunctions of the heart rhythm and can trigger an attack.
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Smoking

Hypertensive patients and people with heart rhythm disturbances are at risk of coronary heart failure. Patients with such diseases should be especially careful so as not to provoke an attack.

Forms of pathology and their symptoms

Acute coronary insufficiency includes the following symptoms:

    Painful sensations are the most common and most significant symptom. The pain in the left side of the chest can be different – both in duration and in intensity. It is possible to note paroxysmal painful sensations, which often appear after high physical activity, but sometimes can overtake the patient in a relaxed state. During the contraction of the walls of the vessel, blood flow to the heart is limited and a spasm occurs.

Pain in the left chest

The second type of pain is moderate-intensity attacks with compressive and cutting pains. This pathology is already cons >Loss of consciousness

A feature of the progression of coronary insufficiency is an increase in its symptoms. Specialists distinguish three degrees of acute coronary insufficiency syndrome.

PowerDescription
FirstThe narrowing of the gaps in the arteries is insignificant, seizures are rare – they occur during severe tension. Coronary insufficiency of 1 degree on the ECG is not visible or is detected with prolonged observation.
The secondBlood circulation is impaired in one or two coronary arteries. Under normal loads, angina pectoris is observed.
The thirdRegardless of the load, acute seizures occur, a fast heart rate is noticed. In this case, the blood flow is difficult in a sufficiently large area, some vessels can be completely clogged with plaques.

You can determine the degree of the disease, the form (acute or chronic coronary insufficiency) on an ECG – that this is how the procedure is going to be told by an observing cardiologist.

At the first symptoms of a starting attack of coronary heart failure or the identification of its syndrome in the neighbor, it is necessary to call an ambulance and take urgent action. The crisis during coronary insufficiency is best tolerated while sitting, leaning against the back of a chair or sofa.

Emergency care for acute coronary syndrome:

  1. At the first signs of the syndrome, calm down and suspend activity. In a calm state, the load on the heart muscle decreases and normal circulation is gradually restored.
  2. In parallel with the cessation of activity, you need to take first-aid drugs – Validol or Nitroglycerin.

In acute coronary syndrome, emergency doctors must give the patient pain medications (often these are narcotic drugs) and aspirin with clopidogrel to thin the blood. If the seizure is not stopped by drugs, the patient is taken to a hospital, where surgery can be prescribed according to the doctor’s recommendation.

Without proper treatment, bouts of acute coronary insufficiency can cause sudden death. A very important role is played by timely first aid and referral to the hospital. Studies show that the death from coronary insufficiency outside the walls of the hospital is almost two times higher than the mortality from a heart attack in the walls of this institution.

As a rule, the emergency team carries out resuscitation together. But what if the person is unconscious, and the ambulance has not arrived yet?

Before proceeding with the actions, it is necessary to determine whether the patient is conscious, whether he breathes independently. Be sure to check for a pulse. If the victim does not answer the simplest questions, what is his name and where is he, you can gently pat him on the cheeks. If the reaction did not follow, then the person is unconscious.

How does cardiopulmonary resuscitation occur:

  1. Stage 1 – you need to ensure airway patency. The victim should be put on a flat surface, tilt his head back slightly, holding with one hand. With your second hand, press on the chin, opening the jaw. After that, wrapping your fingers in a bandage or clean cloth, release the mouth of accumulated saliva or other flu />

Cardiac arrest is the basis for cardiopulmonary resuscitation.

First aid at the onset of acute heart failure should be provided at the site of the attack. Its main goal is to reduce the load on the myocardium and the correct redistribution of blood from the lungs.

First aid measures should begin when the first signs of acute heart failure appear:

  • intensifying shortness of breath (breathing is difficult when the patient tries to lie down);
  • cough;
  • noisy breathing;
  • cyanosis of the lips, tip of the nose, fingers;
  • anxiety;
  • feeling of fear, etc.

When such symptoms appear, it is necessary to carry out such measures:

  1. The patient must be seated in a comfortable position (the back should be maximally raised). If possible, to ensure a decrease in blood flow to the heart, the patient’s legs and hands can be lowered into hot water.
  2. Call an ambulance, describing the symptoms to the dispatcher.
  3. Provide the patient with a sufficient influx of fresh air (open the window, remove clothing that restricts breathing).
  4. Reassure the patient.
  5. Measure the pressure at a systolic pressure of at least 90 mm. Hg. Art. give the patient to take a tablet of Nitroglycerin or Nitrosorbit and a tablet of a diuretic (Lasix, Pyrethanide). Taking nitrate drugs can be repeated every 5-10 minutes (but not more than 3-4 tablets) until the condition improves, constantly monitoring blood pressure.
  6. 15-20 minutes after the patient was seated, a tourniquet can be applied to one thigh. You can change the location of the tourniquet every 20-40 minutes, avoiding prolonged squeezing of the leg.
  7. When cardiac arrest is performed, a set of measures for cardiopulmonary resuscitation is performed: precardial stroke, indirect heart massage and artificial respiration.

The ambulance team can provide such events:

  1. Oxygen therapy. For oxygen inhalation, special oxygen masks, air ducts or oxygen inhalers are used. If necessary, the doctor performs tracheal intubation. With the development of pulmonary edema, antifoam agents (70-96% alcohol or Antifomsilan solution) can be added to oxygen.
  2. To eliminate bronchospasm, intravenous administration of Eufillin solution is used.
  3. With high blood pressure, ganglioblockers (Benzohexonium, Pentamine, Arfonad) or vasodilators (sodium nitroprusside) and diuretics (Lasix, Ethacrine acid) are introduced.
  4. With normal blood pressure, venous vasodilators (Nitroglycerin, Isoket, Nitro) are used.
  5. With low blood pressure, sympathomimetic amines (Dobutamine, Dopamine) are used to stabilize systolic blood pressure and eliminate arrhythmias. After that, in the case of a tachysystolic form of atrial fibrillation or flutter, cardiac glycosides are administered (Korglikon, Strofantin K). In order to eliminate edema, diuretics are introduced (Lasix, Ethacrine acid).
  6. To inhibit the respiratory center and increase breathing efficiency, the patient is injected with Morphine hydrochloride solution or Droperidol solution.
  7. To prevent thromboembolism or thrombosis, heparin solution is administered, which must be repeated every 6 hours (under the control of blood coagulation rate indicators).
  8. To prevent damage to the membranes of the alveoli, glucocorticoids (Prednisolone or Hydrocortisone solution) are introduced.

After improving the patient’s condition or stopping the patient’s attack, they are urgently hospitalized in the intensive care cardiology department. During transportation of the patient, the legs should be slightly raised.

At the stage of hospital care, the relief of an attack of acute heart failure is aimed at:

  • increased contractility of the heart;
  • decreased tone in the vascular bed;
  • elimination of arrhythmia;
  • reduced fluid retention;
  • thrombosis prophylaxis.

The complex of therapy includes such events:

  1. Recovery of respiratory function and oxygen therapy on a ventilator.
  2. The appointment of nitrates.
  3. Repeated administration of Morphine hydrochloride, Lasix, and Dopamine.
  4. The use of antifoam agents for pulmonary edema (alcohol or Antifomsilan are introduced into the ventilator).
  5. Introduction of cardiac glycosides (Digoxin, Strofantin K, etc.).
  6. Appointment of beta-blockers (Anaprilin, Obzidan).
  7. Appointment of antiplatelet agents (Aspirin, Cardiomagnyl) or Heparin.

Moderate

Diagnostics

The most important role in the diagnosis of coronary insufficiency is played by electrocardiography performed under conditions of dosed physical activity. A characteristic ECG sign of coronary insufficiency is ST segment depression that occurs during maximum physical activity or 2–5 minutes after it. As an indirect sign of coronary insufficiency, arrhythmia arising from a stress test should also be considered.

In order to assess the condition of the coronary arteries, to accurately identify the site of occlusal or stenotic lesions, coronarography is performed – a method of radiological diagnosis using a contrast medium.

Laboratory diagnosis of coronary insufficiency includes determining the concentration in the blood serum of electrolytes, glucose, creatine kinase, lactate dehydrogenase, triglycerides, low and high density lipoproteins, ALT and AST, total cholesterol. Of particular diagnostic importance is the determination of pathways I and T, markers of hypoxic myocardial damage. Their detection is a sign of a heart attack or myocardial infarction.

Treatments for acute coronary insufficiency

In addition to coronary heart disease, as the main manifestation of coronary insufficiency, there are a number of diseases that occur with bouts of pain in the heart, such as angina pectoris or complicated by the formation of a focus of necrosis in the heart muscle (heart attack):

  • coronary arteritis (with Takayasu disease, Kawasaki, systemic lupus erythematosus, syphilis);
  • violation of the structure of arteries (deformation) after radiation therapy, a hereditary change in the formation of fibrin fibers;
  • heart defects;
  • compression of the arteries with a tumor or adhesion;
  • vessel trauma;
  • bacterial endocarditis, myocarditis;
  • thyrotoxicosis;
  • overlap of the lumen with a thrombus or embolus.

The basis of the fight against coronary insufficiency syndrome is drug therapy. Treatment is focused on eliminating the cause of the disease and relieving the main symptoms.

With exacerbated symptoms of coronary heart failure and for first aid, if the patient is conscious, the following drugs are used: Nitroglycerin – to provide oxygen to the heart muscle cells. Blood circulation is getting better and there is an improvement. Isosorbide dinitrate has a similar effect.

Antiplatelet agents and anticoagulants. The drugs of these groups are focused on changing blood characteristics – viscosity and tendency to thrombosis.

  • Aspirin helps to thin the blood, prevents the formation of blood clots. Even if the coronary arteries are narrowed, more liquid blood will still be easier to pass to the heart.
  • Clopidogrel. Used with the likelihood of thrombosis. The drug modifies the enzymatic system of platelet receptors, so that plaques do not form.
  • Ticlopidine. The drug is also used to prevent the formation of clots: it does not allow them to stick together.

Beta blockers. The remedies used for coronary circulation insufficiency help reduce the oxygen demand of the heart, stabilize blood pressure (especially with hypertension), and regulate heartbeat. Thanks to taking medications, the force of contraction of the heart muscle is reduced, and the need for myocardium in oxygen is reduced.

During acute seizures, there are unpleasant tingling in the area of ​​the heart, giving off to the limbs or abdomen. To stop the pain a bit, you can use:

  • Morphine is a powerful painkiller, but it is a narcotic. Typically, morphine is a prescription.
  • Droper >Morphine

In the presence of an inflammatory process, corticosteroids are used in the body, and antibiotics are used for infections.

No herb, fruit, vegetable or other product can cure such a serious disease as coronary heart failure. But with the right approach, the recipes of traditional medicine will help to slightly improve the patient’s condition and maintain it at the level after drug therapy.

Treatment of insufficiency at home is aimed at strengthening the heart, improving the functioning of blood vessels and establishing blood circulation.

    Nettle leaves should be collected until June (when its active flowering begins), dried in the sun. Shredded leaves (5 tbsp. L.), Pour 500 ml of boiling water and simmer over low heat. Close the l >Horse chestnut tincture

In addition to drug and folk treatment, it is also recommended to adhere to simple preventive actions in order to stop the development of coronary insufficiency.

With the treatment of coronary insufficiency, which occurs as a result of clogging or narrowing of blood vessels, it is better not to delay. Any delay can be a threat to the development of the disease. In the case when drug therapy is not able to cope with the task (to restore blood flow in acute syndrome), surgical treatment of the patient may be necessary.

When shunting, blood flow is restored using special shunts, bypassing the narrowed gaps in the vessels or clogged arteries. A piece of vein is usually taken from the lower leg, sutured to the coronary artery on one side and to the aorta on the other.

This method is considered a guaranteed method of restoring normal blood flow to the heart muscle. After removing a piece of material from the lower leg, complications are not expected in that place – the circulatory system is quite extensive, and therefore does not disturb blood circulation in the leg.

The positive aspects of this method include the minimal risk of developing atherosclerosis in new tissues, since the vein and artery differ in structure.

More about the bypass procedure – in the video.

Stenting is similar to a bypass procedure. The essence of the intervention is the installation of a special frame made of metal in the vessel. After installation, the frame in the lumen expands and remains in this form. It expands the walls of blood vessels, providing the blood with a place for normal circulation.

The following methods of surgical prophylaxis can be distinguished for those who are vulnerable:

  • Aneurysmectomy – surgical removal of an artery aneurysm;
  • Restoring and improving patency of the bloodstream;
  • Radiofrequency ablation – with the help of current, the affected area is destroyed, due to which the heart rhythm is disturbed;
  • Installation of an automatic defibrillator (a device that corrects heart contractions).

It is possible to identify the disease and start timely treatment at the initial stage, for this it is recommended to visit a doctor at least once a year, and also take a general blood test every 6 months.

Combined therapy for coronary insufficiency includes:

  1. General measures aimed at eliminating the risk factors for coronary circulation insufficiency. These include: dosed physical activity, the correct alternation of work and rest regimes, a good sleep lasting at least 8 hours, quitting smoking and alcohol abuse, treatment of concomitant diseases, normalization of body weight, spa treatment.
  2. Antianginal and antiarrhythmic drug therapy aimed at stopping angina attacks and preventing their recurrence, treatment of conduction and arrhythmias.
  3. Other types of drug therapy. Depending on the indications, lipid-lowering drugs, anticoagulants, etc. are prescribed.

Therapy of chronic coronary insufficiency is carried out with drugs of the following groups:

  • vasodilators;
  • drugs acting on the adrenergic innervation of the myocardium;
  • anti-bradykinin agents;
  • drugs of other groups (diuretics, antiarrhythmic, antihypertensives, etc.).

With resistance to ongoing conservative therapy, surgical treatment is indicated, the purpose of which is to restore blood supply at the local site of myocardial ischemia (revascularization).

Most often resorted to coronary artery bypass grafting (CABG). The bottom line is to create an autovenous anastomosis between the affected coronary artery and the aorta below the site of occlusion or stenosis, which impede normal blood flow. Thanks to the anastomosis, the blood flows around the existing obstacle, and the blood supply to the myocardium in the ischemic zone is restored. Coronary artery bypass grafting can be performed on a working heart (“CABG on a beating heart”) or in cardiopulmonary bypass.

  1. The fight against risk factors for coronary heart disease includes diet, the exclusion of overeating, smoking, alcohol, competent alternation of rest with activity, normalization of weight.
  2. Drug treatment consists in the prophylactic use of antianginal and antiarrhythmic drugs, drugs that dilate blood vessels (coronaryolytics), anticoagulants, lipid-lowering and anabolic agents.

Surgical intervention and intravascular treatment is aimed at restoring normal blood flow in the coronary arteries:

  • coronary bypass surgery – restoration of blood flow with the help of special shunts, bypassing narrowed places on the vessels;
  • stenting – installation of scaffolds in the coronary vessels;
  • angioplasty – opening of the affected arteries with a special catheter;
  • direct coronary atherectomy – a decrease in the size of atherosclerotic plaques inside the vessels;
  • rotational ablation (rotablation) – mechanical cleaning of ships with a special drill.

Prevention

Coronary heart disease is an ailment that is easier to prevent than to cure. A number of preventive measures help prevent its occurrence and development:

  1. Regular physical education. Hiking, swimming with a gradual, mild increase in load, jogging.
  2. A balanced diet with a small amount of animal fats.
  3. Quitting smoking and alcohol.
  4. Exclusion of psychoemotional (stress) loads.
  5. Blood pressure control.
  6. Maintain a normal weight.
  7. Monitoring the amount of cholesterol in the blood.

Experienced specialists already during a visual examination, as well as based on the symptoms of the patient, can make a diagnosis. But to confirm it and complete the picture, a number of additional studies should be carried out, thanks to which it will be possible to prescribe the appropriate treatment.

  • KLA (general blood test). In the presence of inflammatory changes in the body, the level of red blood cells will be significantly increased.
  • A biochemical blood test will show what the cause of the disease is.
  • Blood coagulation test – analyzes the density of the material and the predisposition to blood clots in the bloodstream.
  • Coronography, during which the coronary arteries are evaluated, and their work is analyzed.
  • X-ray, ultrasound of the chest, which are carried out with a dubious diagnosis. Ultrasound also determines heart defects and other pathologies.
  • An electrocardiogram is the main diagnostic method in which the work of the myocardium is examined.
  • Computer tomography makes it possible to see coronary artery stenosis, as well as to cons />

All sorts of pathologies can accompany dysfunctions of the coronary vessels, so there is a need for differential diagnosis of other diseases. This may include gastritis, cramping of the esophagus and other ailments associated with the digestive system.

To prevent the development of coronary insufficiency, it is recommended:

  • Lead the right lifestyle – eliminate alcohol, cigarettes and drugs from the diet;
  • Limit the use of fatty foods, sweet, spicy and salty;
  • At least half an hour a day, take time for an easy warm-up, preferably in the morning;
  • Walk more, take walks in the fresh air even for no reason;
  • Check the body for the presence of chronic diseases, if they exist, conduct a course of treatment;
  • In case of heart disease or problems with blood pressure – on the recommendation of a doctor, take medications to normalize the condition;
  • Normalize weight, with overweight try to get r >Exclude alcohol

A regular visit to a specialist and taking tests will help not only to identify the origins of coronary disease, but also to prevent many other diseases of the internal organs. Using a blood test, you can determine the onset of inflammation, and also detect the level of sugar and cholesterol in the blood – based on these indicators, you may need to correct them with medications.

For heart diseases, the patient is shown once a year to do an electrocardiogram to track changes in the myocardium. If necessary, coronary angiography is performed – a procedure that allows you to identify abnormal disorders in the functioning of blood vessels.

From the video you will learn coronary insufficiency – what it is, its main symptoms and causes.

Prevention of coronary insufficiency is based on the exclusion of factors contributing to its occurrence and progression. Recommended:

  • smoking cessation and alcohol abuse;
  • the exception of psycho-emotional overload;
  • physical education classes;
  • healthy eating
  • control of blood pressure;
  • maintaining optimal body weight.

What is the disease dangerous: possible complications and consequences

What are the changes in the schedule of the heart on the ECG with coronary insufficiency? During the ultimate load or a few minutes after it, a decrease in the ST segment is observed – this indicator is also characteristic of myocardial infarction. Among other things, the formation of a Q wave is considered a confirming sign of a heart attack. During an ECG load, arrhythmia can also be considered.

Exacerbated long-term coronary heart failure manifests itself with similar symptoms. The ST segment is reduced, while the T wave can be modified. Prinzmetal angina is characterized by an increase in the ST segment.

Acute coronary insufficiency as a cause of death is a common phenomenon. Coronary disease is often asymptomatic, a person does not know about heart pathology, does not pay attention to mild attacks. As a result, the disease progresses, leading to complications, without treatment of which sudden coronary death often occurs. In addition to this most serious consequences, the disease leads to the following complications:

  • arrhythmias of all kinds;
  • changes in heart anatomy, myocardial infarction;
  • inflammation of the pericardial sac – pericarditis;
  • aortic aneurysm;
  • rupture of the heart wall.

Causes and symptoms of coronary insufficiency, as well as emergency methods and treatment

  1. If you feel pain, you should immediately stop all active actions: the intensity of the heart muscle decreases in a calm state, while the need for oxygen in the heart also decreases. Already due to this, the pain will decrease, and the coronary blood supply will partially recover.
  2. Simultaneously with the cessation of active actions, the patient should take instantly acting drugs: validol, nitroglycerin. These funds remain the only emergency first aid for a heart attack.

A person with an attack of coronary insufficiency needs first aid: put in bed, under the tongue give a tablet (0,0005 g) of nitroglycerin. An alternative is 3 drops of an alcohol solution (1%) of this medicine per sugar cube. If there is no nitroglycerin or it is contraindicated (for example, with glaucoma), it is replaced with validol, which has a milder vasodilating effect. It is necessary to apply a heating pad to the legs of the core, if possible, make oxygen inhalation. Immediately call an ambulance.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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