The cause of myocardial ischemia can be a blockage of the vessel with an atherosclerotic plaque, the formation of a blood clot or vasospasm. A gradually increasing blockage of the vessel usually leads to chronic myocardial blood supply insufficiency, which manifests itself as a stable angina pectoris. The formation of a blood clot or spasm of the vessel leads to acute insufficiency of the blood supply to the myocardium, that is, to myocardial infarction.
In 95–97% of cases, atherosclerosis becomes the cause of coronary heart disease. The process of blocking the lumen of the vessel with atherosclerotic plaques, if it develops in the coronary arteries, causes heart failure, i.e. ischemia. However, in fairness it should be noted that atherosclerosis is not the only cause of coronary artery disease.
Insufficient nutrition of the heart can be caused, for example, by an increase in the mass (hypertrophy) of the heart during hypertension, in people with physical labor or athletes. Some other reasons for the development of coronary heart disease are noted. Sometimes coronary heart disease is observed with abnormal development of the coronary arteries, with inflammatory vascular diseases, with infectious processes, etc.
However, the percentage of cases of coronary heart disease for reasons not related to atherosclerotic processes is quite small. In any case, myocardial ischemia is associated with a decrease in the diameter of the vessel, regardless of the causes that caused this decrease.
Of great importance in the development of coronary heart disease are the so-called risk factors for coronary heart disease, which contribute to the occurrence of coronary heart disease and pose a threat to its further development. Conventionally, they can be divided into two large groups: mutable and unchanged risk factors for coronary heart disease.
Various models are proposed in epidemiological studies to classify the many risk factors associated with cardiovascular disease. Alternatively, risk indicators can be classified as follows.
– genetic factors that contribute to dyslipidemia, hypertension, glucose tolerance, diabetes mellitus and obesity. ischemic physical culture
– arterial hypertension (AH);
– obesity and the nature of the distribution of fat in the body;
– behavior that contributes to the occurrence of diseases of the coronary arteries.
The likelihood of developing coronary heart disease and other cardiovascular diseases increases synergistically with an increase in the number and “power” of these risk factors.
Consideration of individual factors.
Age: it is known that the atherosclerotic process begins in childhood. The results of autopsy studies confirm that atherosclerosis progresses with age. The prevalence of stroke is even more related to age. With every decade after reaching the age of 55, the number of strokes doubles.
Observations show that the degree of risk increases with age, even if other risk factors remain in the “normal” range. However, it is clear that a significant degree of increased risk of coronary heart disease and stroke with age is associated with those risk factors that can be affected.
Modification of the main risk factors at any age reduces the likelihood of the spread of diseases and mortality due to initial or recurring cardiovascular diseases. Recently, much attention has been paid to the impact on risk factors in childhood, in order to minimize the early development of atherosclerosis, as well as reduce the “transition” of risk factors with age.
Gender: Among the many conflicting provisions regarding coronary heart disease, one is not in doubt – the predominance of male patients. In women, the number of diseases is slowly increasing at the age of 40 to 70 years. In menstruating women, IHD is rare, usually with risk factors, smoking, hypertension, diabetes mellitus, hypercholesterolemia, as well as diseases of the genital area.
Genetic factors: the importance of genetic factors in the development of coronary heart disease is well known, for people whose parents or other family members have symptomatic coronary heart disease, there is an increased risk of developing the disease. The associated increase in relative risk varies significantly and can be 5 times higher than in individuals whose parents and close relatives did not suffer from cardiovascular diseases.
The excess risk is especially high if the development of coronary heart disease in parents or other family members occurred before the age of 55. Hereditary factors contribute to the development of dyslipidemia, hypertension, diabetes mellitus, obesity and possibly certain patterns of behavior that lead to the development of heart disease.
Poor nutrition: most risk factors for developing coronary heart disease are related to lifestyle, one of the most important components of which is nutrition. Due to the need for daily food intake and the huge role of this process in the life of our body, it is important to know and maintain an optimal diet.
Diabetes mellitus: both types of diabetes significantly increase the risk of developing coronary heart disease and peripheral vascular disease, more so in women than in men. The increased risk is associated both with diabetes itself and with the greater prevalence of other risk factors in these patients (dyslipidemia, arterial hypertension).
Increased prevalence occurs even with carbohydrate intolerance, detected with the help of carbohydrate loading. The “insulin resistance syndrome”, or “metabolic syndrome” is carefully studied: a combination of impaired carbohydrate tolerance with dyslipidemia, hypertension and obesity, in which there is a high risk of developing CHD.
Overweight (Obesity): Obesity is one of the most significant and most easily modifiable risk factors for coronary heart disease. Compelling evidence has now been obtained that obesity is not only an independent risk factor for cardiovascular disease, but also one of the links – possibly the trigger – of other factors.
Low physical activity: in people with low physical activity, coronary heart disease develops more often than in people leading a physically active lifestyle. When choosing a program of physical exercises, it is necessary to take into account 4 points: the type of physical exercises, their frequency, duration and intensity. For the purposes of preventing coronary heart disease and strengthening health, physical exercises are most suitable, which involve regular rhythmic contractions of large muscle groups, brisk walking, jogging, cycling, swimming, skiing, etc.
Smoking: smoking affects both the development of atherosclerosis and the processes of thrombosis. Cigarette smoke contains over 4000 chemical components. Of these, nicotine and carbon monoxide are the main elements that have a negative effect on the activity of the cardiovascular system.
Alcohol consumption: the relationship between alcohol consumption and mortality from coronary heart disease is as follows: drinkers and drinkers have a much higher risk of death than drinkers moderately (up to 30 g per day in terms of pure ethanol). Despite the fact that moderate doses of alcohol reduce the risk of developing coronary heart disease, another effect of alcohol on health (increased blood pressure, risk of sudden death, impact on psychosocial status) does not allow alcohol to be recommended for the prevention of coronary heart disease.
Psychosocial factors: it is known that people with higher levels of education and socio-economic status have a lower risk of developing coronary heart disease than with lower ones. This pattern can only partially be explained by the difference in the level of generally recognized risk factors. The independent role of psychosocial factors in the development of IHD is difficult to determine, since their quantitative measurement is very difficult.
The greatest success in preventing CHD can be achieved by following two main strategic directions. The first of them – population – consists in changing the lifestyle of large groups of the population and their environment in order to reduce the influence of factors contributing to the CHD epidemic. The second is to identify individuals at high risk for the development and progression of coronary heart disease to reduce it later.
– arterial hypertension (i.e. high blood pressure),
– disorders of carbohydrate metabolism (in particular diabetes mellitus),
– a sedentary lifestyle (lack of exercise),
The most dangerous from the point of view of the possible development of coronary heart disease are arterial hypertension, diabetes mellitus, smoking and obesity.
– age (over 50-60 years);
– burdened by heredity, that is, cases of IHD in the immediate family.
Depending on the results of stress testing, the patient is assigned one of the following classes of functionality:
- no limits. Everyday physical work is carried out by the sick without any labor. Shortness of breath and fatigue does not occur, the heart works in a normal rhythm.
- moderate restriction. Performing daily work causes shortness of breath, and the patient also has a feeling of fatigue. The heartbeat goes astray. At rest, none of this is observed.
- strong limitation. At rest, no symptoms are observed, however, they appear even from a minimal load (less than everyday).
- full restriction. All symptoms are noted and at rest, from the slightest physical activity they are noticeably amplified.
There are contraindications for therapeutic physical exercises, in particular these are: periodic attacks of angina pectoris, especially at rest; severe violation of the rhythm of the heartbeat (extrasystole, arrhythmia, etc.); persistent hypertension of arteries (more than 170/110 mm. mercury); diabetes in acute form.
6 exercise therapy for children with heart disease
Physical education is required not only for adult patients with diseases of the cardiovascular system, but also for children. This need is established when diagnosing a child with congenital or acquired heart disease, which leads to a varying degree of heart failure.
The first degree of circulatory failure is manifested by shortness of breath during physical exertion, impaired nervous regulation (sleep impairment, fatigue). The second and third degree are more pronounced. The child may experience edema, shortness of breath at rest or with minor physical exertion.
The following is a set of exercises that is allowed for compensated heart disease, that is, patients with unexpressed or almost unexpressed circulatory failure. However, even in this case, 2 conditions must be observed:
- 1. The load should increase gradually. At the beginning of the course, only 3-4 exercises are performed, and they should be repeated only 2-3 times. Subsequently, the load increases.
- 2. Constantly observed by a doctor. This is especially necessary when the child shows shortness of breath after doing exercises or other physical exertion.
|Position||Complex of exercises|
|Standing on both legs|
|Standing on one leg (in the first days they are performed with the help of hands, holding on to the wall or back of the chair, after without support)|
Feet need to be alternated.
|Standing on toes||Perform squats with a straight back. In the first days, they are held by the back of the chair, squats should be insignificant – swaying in the knee joints. Do 5-6 repetitions. In the following days, the exercise is done completely, first with support, then without it.|
In addition to the presented set of exercises, with compensated forms of heart defects, children can engage in sports games (tennis, volleyball, basketball). But their duration and intensity of the load should be determined by the attending or school doctor.
It is very important to detect and immediately eliminate coronary heart disease in order to prevent the development of irreversible consequences. For this, medical workers have developed a special list of common symptoms, the presence of which indicates the progression of this disease in the human body:
- the presence of intense pain that is localized in the region of the heart;
- the occurrence of arrhythmias;
- the appearance of a panic feeling of fear;
- decreased physical activity;
- passive perception of everything that happens;
- the appearance of uncomfortable sensations in the region of the heart, there is a feeling of tightness of this muscle;
- various psycho-emotional disorders (frequent mood swings, increased irritation, etc.);
- vomiting and nausea are frequent;
- the appearance of shortness of breath even with minor physical exertion;
- excessive secretion of cold and clammy sweat.
When the above symptoms appear, the patient needs, as soon as possible, contact the nearest medical institution for qualified help. Based on the symptoms, the patient’s age and the diagnostic tests performed, an experienced specialist prescribes the most effective therapeutic technique, thanks to which it is possible to quickly stop ischemic pathology and the disease that provokes its development. One of the most effective therapeutic methods is considered exercise therapy for coronary heart disease.
Exercises for the treatment of coronary heart disease
Legend: IP – starting position; TM – the pace is slow; TS – average pace.
1. IP – standing over the seat of a chair, hands on his belt. Take your hands to the sides – inhale; hands on the belt – exhale. Exercise is performed 4-6 times. Uniform breathing.
2. IP is the same. Hands up – inhale; lean forward – exhale. So 5-7 times. TS.
3. IP – standing, hands in front of the chest. Take your hands to the sides – inhale; return to SP – exhale. 4-6 times. TM
4. IP – standing by a chair. Sit down – exhale, get up – inhale. 5-7 times. TM
5. SP – sitting. Bend the right leg – cotton; return to the IP. Same thing with the other leg. 3-5 times. TS.
6. IP – sitting on a chair. Crouch in front of the chair; return to the IP. Do not hold your breath. 5-7 times. TM
7. SP – the same legs are straightened, hands are in front. Bend your knees, hands – on the belt; return to the IP. 4-6 times. TS.
8. SP – standing. To take the right leg back, arms up – inhale; return to SP – exhale. Same thing with the left foot. 4-6 times. TM
9. IP – standing, hands on the belt. Tilts left and right 3-5 times. TM
10. SP – standing, hands in front of the chest. Take your hands to the sides – inhale; return to SP – exhale. 4-6 times. TS.
11. SP – standing. Take your right foot and arm forward. Same thing with the left foot. 3-5 times. TS.
12. IP – standing, hands up. Crouch; return to the IP. 5-7 times. TS. Uniform breathing.
13. IP – the same hands up, brush in the “lock”. Torso rotation. 3-5 times. TM Do not hold your breath.
14. SP – standing. Step from the left foot forward – arms up; return to the IP. Same thing with the right foot. 5-7 times. TS.
15. IP – standing, arms above the chest. Turns left and right with the extension of the arms. 4-5 times. TM
16. IP – standing, hands to the shoulders. Straighten your arms in turn. 6-7 times. TS.
17. Walking on the spot or around the room – 30 sec. Uniform breathing.
Combined therapy of IHD
Combined therapy of coronary heart disease must necessarily contain therapeutic gymnastic and physical exercises. Before recommending a patient any set of classes, a cardiologist needs to establish the functional class of the patient, in other words, to determine what kind of load he can withstand. This is done through special stress tests on a moving track and stationary bike.
The patient is monitored for the entire period of tests: the pulse rate is recorded, an ECG is recorded, and blood pressure is monitored.
In addition to monitoring within the framework of stress testing, an additional daily monitoring of the ECG, as well as pressure in the cardiac arteries, is mandatory, this allows you to notice abnormal heart activity in time, for example, during exercises involving significant household loads.
Echocardiography is separately performed both during physical activity and in a state of inaction.
Physiotherapeutic procedures are very important in the recovery period. They are selected by a physiotherapist.
Balneotherapy involves the use of therapeutic baths – radon, carbon dioxide, iodine-bromine, chloride. There may be contraindications to such a procedure, such as pain, persistent angina pectoris, arrhythmia, hypertension. If the patient has more pronounced angina, then the gentle method in the form of four-chamber baths is used.
Also applied are the methods of electrosleep, galvanic collar, electrophoresis with painkillers and sedatives. Recently, a new method of physiotherapy has appeared – laser therapy.
Rehabilitation should take place gradually and only under the supervision of a doctor. Coronary heart disease and angina pectoris can recede only if you follow all the recommendations and take care of your body.
Physical therapy for coronary heart disease perfectly affects the performance of the cardiovascular system, stabilizes the respiratory system and other equally important processes, and also helps the human body adapt to the adverse effects of existing external factors (climate, stressful situations, etc.) .
The purpose of the necessary therapeutic exercises depends entirely on the pathology group present:
- Group 1 – people whose angina progresses without an attack of myocardial infarction;
- Group 2 – combines patients who have suffered a myocardial infarction and, as a result, acquired cardiosclerosis;
- Group 3 – victims who have revealed post-infarction aneurysm of the left side of the heart ventricle.
The distribution of physical activity should be in accordance with the present stage of the disease, so as not to harm the weakened body. The severity of the disease is as follows:
- Stage 1 – hypoxia of the heart muscle is not accompanied by serious symptoms;
- Stage 2 – ischemia of the heart, with certain physical exertion, has a number of minor signs;
- Stage 3 – myocardial disease is accompanied by pronounced symptoms, which manifest themselves even at rest.
The most effective and safe set of physical exercises should be determined exclusively by a qualified doctor, starting from the results of the diagnostic examination and the individual characteristics of the human body present.
Before the appointment of exercise therapy, patients with CVD are tested physical exercises that help determine the ability of the rehabilitated. Usually two types of test are used: treadmill test and bicycle ergometry. They allow you to determine the risk of complications and a safe amount of exercise.
Exercise therapy is prescribed for the rehabilitation of patients and for secondary prevention in the following cases:
- arterial hypertension;
- a stroke;
- cardiac ischemia;
- transferred heart surgery (angioplasty, coronary artery bypass grafting, heart transplantation, prosthetics of heart valves and great vessels);
- chronic heart failure;
- obliterating diseases of the peripheral arteries.
Any physical exercise is contraindicated in the presence of painful manifestations. The patient can use any other workouts that match his abilities.
There are no absolute contraindications to exercise therapy in CVD. But there are relative, which are associated with one of two circumstances:
- 1. Temporary. Exercise therapy should not be used in the acute period of the disease.
- In almost all CVDs, except hypotension, loads leading to:
- to increase intrathoracic pressure, since this provokes an increase in resistance in the vascular system with an increase in blood pressure and difficulty in blood circulation (exercises with holding the breath, straining);
- to a sharp movement, maximum mobilization of blood circulation (strength exercises, sports, speed-power loads);
- to high emotionality and competitiveness, as they slow down the patient’s self-control (sports games, exercises with sports elements).
In addition, all loads should correspond to the degree of insufficiency.
Exclusion of physical activity is necessary in the event that a malfunction occurs in the human body or the patient’s health condition worsens significantly when performing the prescribed therapeutic exercises. It is also forbidden to resort to physical therapy for coronary heart disease, if the following adverse symptoms are present:
- palpitations undergo a significant increase in heart rate;
- severe shortness of breath or other symptoms of the fact that the circulatory process is unstable;
- blood pressure rises significantly;
- elevated body temperature, which, as a rule, indicates the presence of certain diseases in the body;
- the appearance of pain in muscle tissue or any other disorders of the musculoskeletal function.
In the presence of the above symptoms, you should consult a qualified doctor so that he chooses another method of treating cardiac ischemia.
Ways to prevent coronary heart disease
It is a series of measures that reduce the risk of ischemia. The priority direction of prevention is the elimination or mitigation of risks that can have a negative impact on health and cause ischemia. These include:
- lack of motor activity;
- lack of rational principles in nutrition;
- excess weight;
Primary prophylaxis of ischemic disease is intended to be carried out among a healthy population at risk. It is the influence of these negative factors that can subsequently lead to the development of ischemia. To avoid this, resort to the following measures:
- eating healthy foods;
- maintaining adequate weight;
- normalization of blood sugar;
- to give up smoking;
- compliance with the regime of motor activity;
- normalization of blood pressure.
The primary prevention of coronary heart disease is a state-level task. Its decision is based on the implementation of public health improvement programs. Unfortunately, at the moment this issue is not well developed.
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Body weight control
Every year, the number of overweight people is growing.
In addition, often overweight is a consequence of diabetes, which also serves as a risk factor for coronary artery disease.
Primary prevention of coronary heart disease necessarily includes weight control. For this, the use of BMI calculation (body mass index) is recommended. The indicator is obtained by dividing the mass (in kilograms) by the height (in meters) squared (i.e., multiplied by itself).
Table. Body mass index, interpretation and recommendations.
|19 – 23||Weight is OK||Maintenance|
|23 – 27,5||Overweight||Reduction|
|27,6 – 30,0||1 degree of obesity||Reduction|
|30,0||2 degree of obesity||Reduction|
Calculation example: Initial data: height 180 cm, weight 65 kg. Calculation of BMI: 65/(1,8 × 1,8) = 65/3,24 = 20,06.
The following nutrition principles are distinguished in the prevention of coronary heart disease, contributing to a decrease in the risk of ischemia:
- The basic rule is refusal or restriction of sugar intake.
- An important role in the prevention of coronary heart disease plays a balanced diet.
- The amount of calories consumed should not exceed the amount of burned. This will avoid the formation of excess adipose tissue.
- Food restriction with increased amounts of animal fat. It is these lipids that cause cholesterol levels to rise.
- Prevention of coronary heart disease involves moderate salt intake. It is recommended to limit to 4 grams per day. This has a beneficial effect on blood pressure.
- It is recommended to consume a sufficient amount of water – up to 2 liters per day.
To give up smoking
It is imperative to prevent smoking among children and youth. It is possible for those suffering from a bad habit to resort to the following ways to solve the problem:
- taking nicotine replacement drugs (cytisine, tabex, etc.);
- taking homeopathic remedies that relieve intoxication and reduce cravings for cigarettes;
- the use of antidepressants in case of severe psycho-emotional dependence;
- visit to a psychologist for advice.
Prevention of coronary heart disease necessarily includes physical activity. They help increase muscle tone, improve blood circulation to all organs, including the heart itself. It is extremely important to understand that physical activity in the prevention of coronary heart disease should be dosed.
Excessive physical activity will give a negative result. Tempering or games with a sports bias are appropriate. Also, daily morning exercises are suitable for the prevention of coronary heart disease. The following exercises are possible:
- It is necessary to stand upright and place your hands on your belt. Spread your arms to the sides, take a breath and return to the starting position. You can repeat the exercise up to 10 times. It is important to monitor the respiratory rhythm. It must be stable.
- Starting position is similar to exercise 1. You need to raise your hands up, then inhale. Next – bend over and exhale. Repeat up to 10 times at an average pace.
- You need to stand up, stretch your arms forward, then part and inhale. After returning to the starting position, exhale. Exercise to perform slowly, up to 10 times.
- Sit on a chair, bend your leg at the knee, clap your hands under the knee. Repeat with the second leg. The cycle includes 5-7 repetitions.
- Stand next to the chair. Sit on the exhale, stand on the inhale. The cycle includes 5-7 repetitions.
For patients with diagnosed ischemia, secondary prevention of coronary heart disease plays an important role. She pursues the following goals:
- prevention of relapse of the disease;
- prevention of coronary artery spasm;
- stabilization of the rhythm of the heart muscle;
- Exercise therapy for coronary heart disease for recovery;
- pharmacological rehabilitation therapy.
During prophylaxis, it is imperative to teach patients with coronary heart disease the basics of maintaining a good lifestyle. The specialist should monitor the patient’s condition on a regular basis, making adjustments to habits and behavior. Understanding the basics of a healthy lifestyle is laid in childhood and is supported by special programs. Following the basic rules of healthy lifestyle and giving up bad habits can significantly reduce mortality from coronary heart disease.
For patients with coronary heart disease and atherosclerosis, it is extremely important to eat properly. Diet becomes a key point in organizing rehabilitation therapy of the patient and prevention. Recommended:
- reduce the amount of fat in food of animal origin (eat lean foods with no more than 20 grams of fat per 100 grams of product);
- consume polyunsaturated fatty acids (found in fish, nuts, vegetable oils);
- reduce salt intake.
Body weight can be controlled based on the methodology described earlier, guided by the BMI indicator.
A healthy lifestyle is built on a combination of several factors. First of all, for the secondary prevention of ischemia, it is necessary:
- quit smoking;
- do not drink alcoholic beverages;
- observe motor mode;
- do swimming or gymnastics;
- spend enough time in the fresh air;
- pay attention to strengthening immunity and hardening;
- with coronary heart disease, it is recommended to take vitamins for prevention.
The complex of exercise therapy exercises for coronary heart disease allows you to increase blood circulation in order to further normalize the functions of the heart. The training program for prevention is developed based on the patient’s belonging to a specific group:
- 1 group (for patients with angina pectoris);
- Group 2 (cardiosclerosis after myocardial infarction);
- Group 3 (aneurysm of the left ventricle after myocardial infarction).
For the first group in the prevention of coronary heart disease patients, a dynamic load of all muscle groups with full amplitude is allowed. Classes can last up to half an hour.
For the second group of patients, it is necessary to focus on breathing exercises and the load of muscle groups of the heart at a slow or medium pace. Duration of exercise up to 25 minutes with mandatory rest breaks.
For the third group in the prevention of coronary heart disease, the duration of the exercise is set to no more than 15 minutes with incomplete amplitude. The pace is slow, pauses are required.
Physical therapy for prevention is contraindicated in:
- acute heart failure;
- pulmonary edema;
- severe shortness of breath;
- severe pain;
- elevated temperature;
- deterioration identified on the electrocardiogram.
Treatment in sanatoriums is comprehensive. Therapy is aimed at restoring the full functioning of the heart and blood vessels.
The following procedures are prescribed in the sanatorium:
- visit to the pool;
- oxygen therapy;
- mud treatment;
- circular shower;
- increased external counterpulsation (in the absence of contraindications).
The average cost of preventing coronary heart disease in sanatoriums with full board for 14 days ranges from 40 thousand to 300 thousand, depending on the level of the institution. It is also possible to purchase a course (treatment only). In this case, the price for 2 weeks will be 10-50 thousand rubles. However, with angina pectoris of grade 3–4, prevention in sanatoriums is contraindicated.
When detecting ischemia, it is extremely important to ensure regular monitoring by the cardiologist. Only a specialist is able, on the basis of examination and planned research, to take measures to prevent myocardial infarction. It is recommended to visit a cardiologist as a prophylaxis 1-2 times a year, in complicated cases 2-4 times.
Weakened physical exercises are an effective way to prevent coronary heart disease (apart from following the daily regimen and proper nutrition), since it has long been known that physical therapy with coronary heart disease, whether in active or inactive form, helps to stabilize the activity of the cardiovascular, respiratory and other systems .
Physical exercises accelerate the patient’s adaptation to climatic factors, increase the body’s resistance to diseases, emotional injuries.
Properly selected physical exercises inhibit the progression of many diseases and contribute to the restoration of frustrated functions. Particularly effective are gymnastics, sports, and hardening.
At the same time, do not forget that significant physical exertion contributes to significant changes in the body, disruption of metabolic processes, tissue hypoxia. The conclusion suggests itself – any physical education must be strictly dosed, it must be done exclusively under the supervision or according to the doctor’s instructions.
Do not abuse weight lifting in the morning, refuse long (over 60 minutes) runs, causing overwork.