Heart ischemia – causes, symptoms and treatment of heart ischemia

Coronary heart disease (CHD) develops as a result of the influence of mechanisms that lead to circulatory disorders in the coronary vessels and oxygen starvation of the myocardium.

  1. With atherosclerosis, blood cannot reach the heart in sufficient quantities due to the fact that a fatty plaque narrows the lumen. For this reason, it becomes impossible to satisfy the need for cardiomyocytes in oxygen. As a result, a pain attack (angina pectoris) develops against a background of stress or physical exertion.
  2. Thromboembolism. The formation of a blood clot is triggered by the breakdown of cholesterol plaque. Sometimes a blood clot forms in the cavity of the heart, then it comes off and clogs the lumen of the artery. With endocarditis, a piece of valve tissue may act as a “plug”.
  3. Spasm of the vessels. A sharp contraction of smooth muscle fibers in the coronary artery system is provoked by a rapid transition from horizontal to vertical position. This phenomenon is observed when inhaling cold air, severe hypothermia of the whole body, stress, the use of certain drugs.

In addition to the main causes in the appearance of acute or chronic myocardial ischemia, provocative factors also play a role:

  • malnutrition with an excess of fatty foods rich in cholesterol;
  • obesity and impaired metabolic processes (including lipid);
  • “Sedentary” lifestyle;
  • endocarditis and heart defects;
  • age after 45 for men and women over 55;
  • the presence of vascular diseases;
  • diabetes;
  • hypertension;
  • constant stress, which is accompanied by increased pressure and increased heart rate;
  • alcohol and smoking.

High cholesterol in metabolic disorders and a tendency to form blood clots are inherited. Therefore, the likelihood of developing IHD is higher in those people whose relatives had a history of heart attack at the age of 45-65, or who died as a result of coronary insufficiency.

Causes (pathogenesis) and risk factors

The main reasons that can cause ischemia of the heart are as follows:

Atherosclerosis. The myocardium is bent around by two main arteries through which blood flow to the heart is carried out. They are called coronary and branch into many small vessels. If the lumen of at least one of them is partially or completely closed, certain sections of the heart muscle do not receive the necessary nutrients, and most importantly – oxygen. There are no more arteries supplying the heart with blood, therefore its work is disrupted, and coronary artery disease develops.

Clogged arteries are due to atherosclerosis affecting the arteries. It involves the formation of cholesterol plaques in arteries that impede the movement of blood. Performing active movements with a lack of oxygen in the heart muscle is accompanied by pain.

At this stage, coronary disease is expressed in the form of angina pectoris. Gradually, myocardial metabolism worsens, pain intensifies, becomes longer and appears at rest. Heart failure develops, the patient suffers from shortness of breath. If the lumen of the coronary artery suddenly closes as a result of rupture of the plaque, the blood stops flowing to the heart, and a heart attack occurs. As a result, a lethal outcome is possible. The condition of the patient after a heart attack and its consequences are largely dependent on blockage of the artery. The larger the affected vessel, the worse the prognosis.

Improper nutrition. The cause of the formation of plaques on the walls of blood vessels is an excess of cholesterol in the body coming with products. In general, this substance is necessary, as it is used to create cell walls and the production of a number of hormones. On the walls of blood vessels, cholesterol is deposited under the influence of stressful situations.

Emotional stress causes the development of a special substance. It, in turn, contributes to the subsidence of cholesterol in the arteries. To reduce its amount in the body allows a properly composed diet. It is worth restricting the use of foods that have saturated fats: butter, sausages, fatty varieties of cheese and meat. It is recommended to give preference to fats contained in fish, nuts, corn. Promotes the development of ischemia of the heart quickly digestible and high-calorie foods.

Bad habits. Alcohol abuse and smoking affect the functioning of the heart muscle. Cigarette smoke contains a large number of chemicals, among which are carbon monoxide, which impedes the transport of oxygen, and nicotine, which increases arrhythmia. In addition, smoking affects the formation of blood clots and the development of atherosclerosis.

A sedentary lifestyle or excessive stress. Uneven motor activity creates an additional burden on the heart. The cause of the development of ischemia can be both physical inactivity and physical activity that exceeds the capabilities of the body. It is recommended to regularly engage in sports, individually determining the intensity, duration, frequency of training.

Obesity. Numerous studies have revealed a direct relationship between overweight and mortality from cardiovascular disease. Therefore, obesity is one of the factors contributing to the development of ischemia.

Diabetes. The threat of developing coronary heart disease is great for patients with type I and type II diabetes. They need to normalize carbohydrate metabolism to reduce risks.

Psychosocial causes. It is believed that people with a higher social status and with education are less likely to experience coronary disease.

IHD leads to the death and disability of people of working age around the world. WHO experts estimate that the disease causes the annual death of more than 7 million people. By 2020, mortality could double. It finds the greatest distribution among men 40 – 62 years old.

The combination of the processes discussed below increases the risk of morbidity.

The main causative factors:

  • Atherosclerosis A chronic ailment that affects the arteries that approach the heart muscle. Vascular walls become denser and less elastic. Plaques formed by a mixture of fats and calcium narrow the lumen, and the deterioration of the blood supply to the heart progresses.
  • Coronary spasm. The disease is caused by the development of atherosclerosis or is formed without it (under the influence of external negative factors, for example, stress). Spasm changes the activity of the arteries.
  • Hypertension – the heart is forced to fight high pressure in the aorta, which disrupts its blood circulation and causes angina pectoris and heart attack.
  • Thrombosis / thromboembolism. In the artery (coronary) as a result of the collapse of the atherosclerotic plaque, a blood clot forms. There is a high risk of clogging of the vessel with a thrombus, which formed in another part of the circulatory system and got into the bloodstream.
  • Acquired or congenital malformations.

Atherosclerosis is the main cause of the development of IHD.

Risk factors include:

  • hereditary factor – the disease is transmitted from parents to children;
  • steadily elevated “bad” cholesterol, causing the accumulation of HDL – high density lipoprotein;
  • tobacco smoking;
  • obesity of any degree, impaired fat metabolism;
  • arterial hypertension – high level of pressure;
  • diabetes (metabolic syndrome) – a disease caused by a violation of the production of pancreatic hormone – insulin, which leads to failure of carbohydrate metabolism;
  • devoid of physical activity lifestyle;
  • frequent psycho-emotional disorders, characteristics of character and personality;
  • adherence to unhealthy fatty foods;
  • age – risks increase after 40 years;
  • gender – men suffer from ischemic heart disease more often than women.

Coronary heart disease is often considered inevitable for people who have reached a certain age. Indeed, the highest incidence of disease is observed in people older than 50 years. However, not all people get coronary artery disease at the same time, for someone it occurs earlier, for someone later, and someone survives to advanced years without encountering this problem.

  • bad habits (smoking, alcoholism);
  • overweight, obesity;
  • lack of physical activity;
  • the wrong diet;
  • genetic predisposition;
  • some concomitant diseases, for example, diabetes mellitus, hypertension.

All these reasons can play a role, but the immediate precursor of coronary atherosclerosis is an imbalance in the various types of cholesterol in the blood and an extremely high concentration of so-called bad cholesterol (or low density lipoproteins). With a value of this concentration above a certain limit, a person with a high degree of probability has arteriosclerosis of the vessels, and as a result, coronary heart disease.

A certain negative factor is the male gender. Statistics say that coronary heart disease is much more likely to develop in men than in women. This is due to the fact that women in the body produce female hormones that protect blood vessels and prevent the deposition of cholesterol in them. However, after the onset of female menopause, the number of estrogen produced by the female body decreases, and therefore the number of women suffering from coronary heart disease increases sharply, almost comparing with the number of men suffering from this disease.

Separately, one should stop such a premise of the disease as an improper diet. As you know, the largest percentage of the incidence of coronary heart disease is in developed countries. Specialists mainly associate this fact with the fact that in Europe and America, people consume more animal fats, as well as simple, easily digestible carbohydrates. And this, together with a sedentary lifestyle, leads to obesity, to an excess of cholesterol in the blood.

Doctors knowingly warn about products containing bad cholesterol. Such products include fatty meats, butter, cheese, eggs, caviar. The amount of these products in the diet of each person should be limited, they should not be consumed every day, or in small quantities.

Although, on the other hand, only a small fraction of bad cholesterol enters the body from the outside, the rest is produced in the liver. So the significance of this factor should not be exaggerated, not to mention the fact that harmful cholesterol can be called very conditionally, since it takes part in many metabolic processes.

Classification: forms of coronary heart disease

IHD is divided into several forms. Accepted acute and chronic conditions.

    Primary cardiac arrest. Rapid acute coronary insufficiency and death that occurs instantly or the death of the patient within one hour after the development of a heart attack.

Angina pectoris. One of the forms of ischemic heart disease, which is manifested by pressing and compressing discomfort, localized behind the sternum. Pain and discomfort can radiate to the epigastric zone, left arm, and jaw.

It develops after physical exertion and is divided into several forms – the first occurrence, progressive, vasospastic, etc. Diagnosis can show the presence of coronary syndrome X, when the examination does not reveal vascular disorders, but the patient experiences characteristic pain.

Angina pectoris. It is customary to distinguish several clinical forms of this type of coronary heart disease:

  • unstable – occurs for the first time, progresses, develops after a heart attack or surgery;
  • stable – develops against a background of different physical activity and is divided into IV class. As the class of the disease increases, the tolerance of physical exertion by the patient decreases.

Angina pectoris spontaneous. Doctors call this form of angina of Prinzmetal. Pain behind the sternum can develop at rest or with moderate physical activity that is normal for other people. Pain syndrome is pronounced, characterized by equivalent periods of decrease and increase. The attack lasts about 20 minutes.

  • Hidden form. Painless ischemia in which the vessels that feed the heart muscle, greatly narrow. The patient does not feel serious changes in health. Diagnosis is possible only after instrumental studies.
  • Myocardial infarction. The heart muscle experiences an acute circulatory disturbance, which causes the death of its site (this is noticeable on the ECG).
  • Cardiosclerosis postinfarction. One of the common myocardial lesions involving valves. Cardiosclerosis develops if healthy tissue is replaced by scar tissue. On the myocardium, pathological areas of various size and prevalence are formed. Postinfarction cardiosclerosis is the cause of the death of a large number of people.
  • Heart rhythm and conduction disorders. The patient feels obvious changes in the heartbeat, such as acceleration, deceleration, interruptions in cardiac activity.
  • Heart failure. If the myocardium lacks blood supply for a long period, serious insufficiency develops. The patient has edema, shortness of breath – initially with physical exertion, then at rest.
  • Cardiologists manipulate such a thing as acute coronary syndrome. It combines some forms of coronary heart disease: myocardial infarction, angina pectoris, etc. Sudden coronary death is sometimes referred to here.

    When diagnosing coronary heart disease, my colleagues still use the classification, which was adopted back in the 80s of the last century.

    • Sudden cardiac death. Refers to all fatalities within the first 60 minutes after the onset of the attack, which was preceded by loss of consciousness, acute symptoms of ischemia and cardiac arrest.
    • Angina pectoris.
      • Stresses. It arises as a result of physical or psychoemotional stress.
        • First emerged.
        • Stable
    1. The first class appears only with pronounced overloads and never happens during normal work;
    2. The second is set for those who can’t quickly walk 500 or more meters without pain, and also go up to the 6th floor and above;
    3. The third class characterizes the development of an attack with little stress (it is conditionally accepted that when walking up to 100 meters and climbing the first flight);
    4. The fourth class corresponds to the appearance of sternal pain under condition of complete rest, while a person can not make any movement without the development of acute cardiac ischemia with characteristic signs.
      • Progressive (unstable). With this form, there is a deterioration in the condition and a decrease in the effectiveness of treatment in the conduct of an ordinary lifestyle.
    • Spontaneous (Prinzmetalla). A special form of ischemia in which vasospasm occurs that causes pain. External causes do not play a role in this. It is severe, poorly stopped by nitroglycerin.
    • Painless ischemia. It was put on the general list much later. Detected by chance after an ECG and stress tests.
    • Myocardial infarction.

    How and why does pain occur in coronary heart disease

    The pathogenesis of the appearance of pain during an attack has been well studied. A decrease in blood flow or an increase in oxygen demand leads to the development of ischemia. An increased release of active substances (mediators) that cause irritation of pain receptors (histamine, bradykinin) begins in the focus. From the affected area, signals along nerve fibers begin to flow.

    What is dangerous ischemic heart disease

    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 indicates the presence of myocardial changes, which leads to the formation of progressive failure. Contractility weakens, the heart does not provide the body with the required amount of blood. People with coronary heart disease quickly become tired and experience constant weakness. Lack of treatment increases the risk of death.

    Symptoms

    In my practice, I constantly come across the fact that patients with coronary heart disease do not immediately seek help. This is because the first symptoms of coronary disease increase gradually.

    The most common complaint of a patient with angina pectoris or heart attack is pain in the sternum – in most it is accompanied by a feeling of fear and panic. Irradiation is usually observed under the scapula, in the arm, and part of the lower jaw on the virgin side. Some complain of numbness of the upper limb, aching in the wrist joint.

    When I ask to characterize the type of pain, a person indicates that it is:

    The appearance of a pain syndrome is associated with physical exertion – when a person was running, walking quickly, or climbing stairs. Sometimes an attack was observed after stress, strong emotional stress, going outside in cold weather. A sharp blood flow to the heart is also noted when rising from a prone position. All these factors lead to increased pressure, increased heart rate and increased oxygen demand of the myocardium.

    The pain with angina is short-term and does not last more than 5-15 minutes. As soon as a person stops, sits down, calms down, it subsides, since the causes of acute ischemia are eliminated. Patients with experience always carry nitroglycerin with them, which quickly relieves symptoms. If the intensity of the unpleasant sensation does not subside after taking the remedy, then this most often indicates an extracardiac pathology, or indicates the development of a heart attack.

    With vasospastic or spontaneous angina pectoris, pain and other signs of myocardial ischemia develop without any connection with physical activity, it is noted in the morning, often provoked by exposure to cold. Well removed only by calcium antagonists.

    Other signs of coronary heart disease do not always occur, in some patients during the attack period I observed the following symptoms:

    • nausea, vomiting;
    • fatigue;
    • severe shortness of breath with difficulty breathing;
    • sweating;
    • pallor of the skin;
    • increase or decrease in blood pressure;
    • palpitations (less commonly) heart rate, arrhythmia.

    In some cases, instead of a classic attack indicating the presence of coronary heart disease, one can see its equivalents: shortness of breath, fatigue after a minimal load.

    There are several main symptoms of cardiac ischemia:

    Pain in the chest and behind the chest. It can have a stabbing, baking or compressive character. Unpleasant sensations arise unexpectedly and disappear after 3-15 minutes. In the first stages of coronary disease, discomfort may be mild. Severe pain is given to the left arm and shoulder, less often to the jaw and right side. They appear during sports, or with strong emotional stress. To get rid of the discomfort caused by physical activity, it is enough to take a short break. When such measures do not help and the seizures become strong, they resort to the help of medications.

    Dyspnea. Like pain, it first appears during movement and is caused by a lack of oxygen in the body. As the disease develops, shortness of breath is accompanied by each attack. The patient experiences it even at rest.

    Palpitations. It becomes more frequent, and blows in this case are felt more strongly. There may also be interruptions at some points. The heartbeat is felt very weak.

    General malaise. The patient is dizzy, may faint, and quickly become tired. There is increased sweating and nausea, turning into vomiting.

    Angina pectoris. In ancient times it was called “angina pectoris”. This phrase is not accidental, because angina pectoris is not pain, but strong squeezing and burning in the chest and esophagus. It can be felt in the form of pain in the shoulder, arm or wrist, but such cases are less common. Angina pectoris is easily confused with heartburn. It is not surprising that some try to cope with it and use soda for this. In cardiology, angina pectoris is considered the most striking symptom, indicating the presence of coronary heart disease and to prevent myocardial infarction. It is much worse when the disease proceeds without external manifestations. An asymptomatic form in most cases leads to death.

    With a heart attack, there is complete overlap of the lumen of the arteries with plaques. The pain increases gradually and after half an hour becomes unbearable. Unpleasant sensations may not pass within a few hours. In the chronic form of coronary heart disease, the lumen of the vessel is not completely blocked, the attacks of pain are less long.

    Psychological symptoms. With a heart attack, the patient may experience inexplicable fear and anxiety.

    Clinic of the disease

    Manifestations can emerge in a complex or separate, depending on the form of the disease. There is a clear correlation between the development of pain localized in the region of the heart and physical activity. There is a stereotype of their occurrence – after plentiful food, under adverse weather conditions.

    Description of pain complaints:

    • character – pressing or compressing, the patient feels a lack of air and a feeling of increasing heaviness in the chest;
    • localization – in the atrial zone (along the left edge of the sternum);
    • negative feelings can spread along the left shoulder, arm, shoulder blades or in both hands, in the left prepopular zone, in the cervical region, jaw;
    • pain attacks last no more than ten minutes, after taking nitrates, they subside within five minutes.

    In more detail about the symptoms of coronary heart disease, including the differences in signs between men and women and risk groups, we talked about in a separate article.

    If the patient does not seek treatment and the disease proceeds for a long time, the picture is supplemented by the development of swelling on the legs. The patient suffers from severe shortness of breath, which makes him assume a sitting position.

    A specialist who can help with the development of all the conditions considered is a cardiologist. Appealing to doctors in a timely manner can save lives.

    Methods of diagnosis

    Diagnosis of coronary heart disease is based on the following examinations:

      History taking (life, family, illness, and complaints). The doctor conducts a detailed survey of the patient: when, how long ago the pain, discomfort, their duration, localization, character began. Find out if there is an interruption in the rhythm, shortness of breath, weakness. The patient should tell what drugs he took and what are the results of taking. Risk factors are >

  • ECG – electrocardiography – the study reveals hypertrophy (oversize) of the left ventricle and a number of other specific signs. Norms and interpretation of ECG indicators in the table can be found in another article.
  • EchoECG – echocardiography – assesses the size and structure of the organ, examines the intracardiac blood flow, the degree of vascular lesions, and valve function.
  • Daily Holter ECG monitoring – an electrocardiogram is recorded within 24–72 hours. An effective assessment of the patient’s condition, which allows to identify the conditions and causes of the development of IHD.
  • Chest x-ray – necessary to identify potential dilatation (expansion) of the left ventricle. If the ventricle has expanded dramatically, this may indicate aortic dissection. Possible complications, changes in the lung tissue are determined.
  • To clarify the diagnosis and exclude the development of other diseases, a number of additional studies are being carried out.

    According to the plan, the patient receives a set of stress tests (physical, radioisotope, pharmacological), undergoes examinations using the radiopaque method, computed tomography of the heart, electrophysiological examination, dopplerography.

    Diagnosis of coronary heart disease includes laboratory and instrumental techniques.

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    Assays

    Biochemical methods for detecting a number of enzymes in the blood help in determining the acute phase of a heart attack, since they are released as a result of the destruction of cardiomyocytes. The first day after the attack, when acute myocardial ischemia and necrosis are observed, an increase in LDH and myoglobin occurs. An increase in CPK occurs in the first 8 hours from the start, troponins are detected after 1-2 weeks

    Cardiogram

    Without fail, the patient arrived with complaints and signs of a heart attack, I send for an urgent cardiogram. It allows you to detect the presence of an increase in the left ventricle, rhythm disturbance and the severity of the lesion in a certain area of ​​the heart.

    Signs of acute ischemia in the myocardium on the ECG are as follows:

    1. The appearance of a high and sharp T wave. Although I observed an ECG in tall asthenic people, in whom such signs are a variant of the norm. Subendocardial ischemia of the anterior wall of the heart can be characterized by negative T, and a biphasic tooth appears at the border of the lesion zone and the normal myocardial region.
    2. Another typical sign of acute ischemia is the displacement of the ST segment by a distance of more than 0,5 mm from the isoline. Its rise in the chest leads indicates damage to the left ventricle, and depression in the same areas indicates a violation of the blood flow of the posterior wall.
    3. Necrosis with the development of a heart attack manifests itself in the form of the appearance of a pathological Q wave or a whole QRS complex in the corresponding leads.

    In more detail, and about changes in the film in patients with ischemia, we described in the article by the link here.

    Other methods

    In order to determine IHD, the following methods are also widely used:

    1. Stress tests. They are recommended at the initial stage of ischemia, help determine the disease with an atypical manifestation and implicit deviations on the electrocardiogram. The principle is to artificially create an increased myocardial oxygen demand and record changes. For this, bicycle ergometry, transesophageal electrocardiostimulation and pharmacological tests with Isoprotenol and Dipyridamole preparations are most often used. If there is a violation of the passage of blood through the arteries of the heart, myocardial ischemia is recorded on the ECG.
    2. Coronarography Refers to the most informative methods for identifying coronary pathology. It allows you to conduct research without provoking or waiting for an attack. A contrast agent is introduced into the right and left arteries of the heart, and a full-fledged picture of the state of the vascular bed is obtained on the angiograph.
    3. Echocardiography. In this case, it is an auxiliary diagnostic method. It allows you to assess local and global myocardial contractility, shows the usefulness of the heart in systole and diastole, to determine the presence of complications in coronary artery disease.

    Treatment

    Treatment of coronary heart disease begins with the correction of lifestyle and the appointment of a diet. I have repeatedly had to deal with the fact that patients did not take this important part of therapy seriously enough, and then wondered why the improvement did not take so long.

    So, before you go to the pharmacy for medicines, you need to remember two important things:

    • Sparing mode. Exclusion of physical activity, leading to increased oxygen consumption by the myocardium.
    • Diet with the exception of animal fats, foods high in salt and easily digestible carbohydrates. With excess body weight, the total calorie content of food should be reduced.

    Medicines

    Of course, one correction of nutrition and lifestyle will not be enough, therefore, it is necessary to support the body and medication.

    1. Disaggregants to prevent blood clots. I usually recommend Aspirin or Clopidogrel (Plavix).
    2. Beta-adrenergic blocking agents (Nebivolol, Bisoprolol). Numerous and lengthy studies prove an increase in the life expectancy of patients with coronary heart disease who constantly use this group of drugs.
    3. Statins, they help to even out the level of “bad” cholesterol. If coronary heart disease is treated with their help, the patient’s life is significantly extended. For rapid and strong reduction, “Rosuvastatin” is used, and in patients with diabetes mellitus and high triglycerides, it is better to take “Atorvastatin”.
    4. For the relief of an acute attack, Nitroglycerin is used sublingually, or Isosorbide Mononitrate for internal use. Expanding the venous bed, drugs of this series reduce the preload on the heart and quickly relieve an attack of angina pectoris.
    5. Diuretics reduce the volume of the vascular bed and thereby facilitate the work of the heart. For the rapid removal of edema, Furosemide is used. For the purpose of continuous administration, I recommend Indapamide or Torasemide.

    Case study

    A patient came to me with complaints of frequent pain behind the sternum, pressing and compressing, giving to the left arm and under the shoulder blade. She appeared after a quick walk, at the same time shortness of breath and fear of death. On examination, the skin is pale, the borders of the heart are enlarged on the left. On an ECG with a load: inhibition of the ST segment in leads II, III, aVF, signs of left ventricular hypertrophy. The patient had a history of myocardial infarction of the back wall, long-term experience of smoking and drinking alcohol.

    Diagnosis: ischemic heart disease. Postinfarction cardiosclerosis, angina pectoris FCII. Life-long administration of Atorvastatin, Aspirin Cardio, Bisoprolol was prescribed. During the development of pain, the intake of “Nitroglycerin” under the tongue. Two weeks after the start of treatment, the frequency of seizures decreased, the general condition is relatively satisfactory. Secondary prophylaxis of coronary heart disease (use of the above drugs), doctor’s supervision is recommended.

    Advice of a specialist

    Many patients ask whether heart ischemia can be cured. In fact, you can completely get rid of the problem only in the case of an operation to restore blood flow. But keep in mind that any intervention can result in complications.

    Therefore, prevention of coronary heart disease is necessary. I recommend switching to a healthy lifestyle, abandoning bad habits, monitor weight. It is especially important to follow the rules for those who already have close relatives in the family with coronary heart disease or those who have had a heart attack. It is necessary to pay attention to diseases associated with vascular abnormalities (diabetes mellitus, systemic diseases) and take adequate treatment.

    The treatment of coronary heart disease is a long and complex process, in which sometimes the leading role is played not so much by the art and knowledge of the attending physician as by the patient’s desire to cope with the disease. In this case, it is necessary to be prepared for the fact that a complete cure for coronary heart disease is usually impossible, since the processes in the vessels of the heart in most cases are irreversible.

    Treatment in the first stage of the disease usually involves only conservative methods. They are divided into drug and non-drug. Currently, in medicine, the most considered is the treatment regimen of the disease, called A-B-C. It includes three main components:

    • antiplatelet agents and anticoagulants,
    • beta blockers,
    • statins.

    What are these classes of drugs for? Antiplatelet agents prevent platelet aggregation, thereby reducing the likelihood of intravascular thrombus formation. The most effective antiplatelet agent with the greatest evidence base is acetylsalicylic acid. This is the very Aspirin that our grandfathers and grandmothers used to treat colds and flu.

    However, conventional Aspirin tablets are not suitable as a continuous drug in case of coronary heart disease. The thing is that taking acetylsalicylic acid carries the risk of irritation of the stomach, the occurrence of peptic ulcer and intragastric bleeding.

    Anticoagulants also prevent blood clots, but have a completely different mechanism of action than antiplatelet agents. The most common drug of this type is heparin.

    Beta-blockers block the effects of adrenaline on specific receptors located in the heart – beta-type adrenaline receptors. As a result, the patient’s heart rate decreases, the load on the heart muscle, and as a result, its oxygen demand. Examples of modern beta-blockers are metoprolol, propranolol.

    The third class of first-line drugs for the treatment of coronary heart disease are drugs to reduce bad cholesterol in the blood (statins). The most effective statin is atorvastatin. For half a year of therapy with this drug, atherosclerotic plaques in patients decrease by an average of 12%. However, other types of statins can be prescribed by the doctor – lovastatin, simvastatin, rosuvastatin.

    Fibrate drugs are also designed to reduce bad glycerol. However, their mechanism of action is not direct, but indirect – thanks to them, the ability of high density lipoproteins to process “bad” cholesterol increases. Both types of drugs – fibrates and statins can be prescribed together.

    Also, with IHD, other drugs can be used:

    • antihypertensive drugs (if hypertension is accompanied by coronary heart disease),
    • diuretics (with poor kidney function),
    • hypoglycemic drugs (with concomitant diabetes mellitus),
    • metabolic agents (improving metabolic processes in the heart, for example, mildronate),
    • sedatives and tranquilizers (to reduce stress and relieve anxiety).

    However, the most commonly used type of drugs taken directly during an attack of angina pectoris are nitrates. They have a pronounced vasodilating effect, help relieve pain and prevent such a formidable consequence of coronary heart disease as myocardial infarction. The most famous drug of this type, used since the century before last, is nitroglycerin.

    The second group of non-drug methods of combating coronary heart disease is exercise. Of course, during an exacerbation of the disease, with unstable angina, any serious load is prohibited, since they can lead to death. However, during the rehabilitation period, patients are shown therapeutic exercises and various physical exercises, as prescribed by the doctor. Such a dosed load trains the heart, makes it more resistant to oxygen deficiency, and also helps to control body weight.

    In the event that the use of medications and other types of conservative therapy do not lead to improvement, then more radical methods are used, including surgical ones. The most advanced treatment for coronary heart disease is balloon angioplasty, often combined with subsequent stenting.

    The essence of this method is that a miniature balloon is introduced into the lumen of a narrowed vessel, which is then inflated with air and then blown away. As a result, the lumen of the vessel expands significantly. However, after some time, the lumen may narrow again. In order to prevent this from happening inside, the walls of the artery are strengthened with the help of a special frame. This operation is called stenting.

    However, in some cases, angioplasty is also powerless to help the patient. Then the coronary artery bypass grafting operation becomes the only way out. The essence of the operation is to bypass the affected area of ​​the vessel and connect two segments of the artery between themselves, in which atherosclerosis is not observed.

    How to treat heart ischemia?

    Diagnosis of coronary disease is carried out primarily on the basis of the patient’s sensations. Most often they complain of burning and chest pain, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, palpitations and rhythm disturbances. Be sure to suspect ischemia electrocardiography.

    Echocardiography is a research method that allows you to assess the condition of the myocardium, determine the contractile activity of the muscle and blood flow. Blood tests are performed. Biochemical changes reveal coronary heart disease. Conducting functional tests involves physical exertion on the body, for example, walking up stairs or performing exercises on the simulator. Thus, it is possible to identify pathologies of the heart in the early stages.

    For the treatment of ischemia, the complex uses drugs of the following groups: antiplatelet agents, adrenergic blockers, fibrates and statins. Specific funds are selected by the doctor depending on the form of the disease. Antiplatelet agents improve blood flow, with the help of adrenergic blockers it is possible to reduce the frequency of contractions of the heart muscle and reduce oxygen consumption.

    The fight against angina pectoris is carried out with the help of nitrates. Widely used to treat coronary disease and natural lipid-lowering drugs. Anticoagulants influence the formation of blood clots, and diuretics help to remove excess fluid from the body.

    Since plaques in the vessels cause their narrowing, it is possible to artificially increase the lumen in the coronary arteries. For this, stenting and balloon angioplasty are performed. During these bloodless surgical interventions, the lumen in the vessels widens and the blood flow normalizes. These methods have replaced the traditional bypass surgery, which today is carried out only with some forms of coronary artery disease. During such an operation, the coronary arteries connect to other vessels below the site of disruption of blood flow in them.

    In addition to drug treatment and general therapy, the patient needs moderate physical activity. Depending on the form of ischemia, a set of exercises is developed by a doctor. Indeed, excessive motor activity increases the oxygen demand of the heart muscle and has a negative effect on the development of the disease.

    In case of an unexpected attack while walking or playing sports, you should stop and relax, drink a sedative medicine and go out into the fresh air. Then you should take a tablet of nitroglycerin.

    This drug has an effect for 5 minutes. If the pain persists, you need to drink 2 more tablets. The inefficiency of nitroglycerin indicates serious problems, therefore, in the absence of improvements in the condition, you must urgently go to the hospital. Prevention of coronary heart disease involves the abandonment of alcohol, smoking, proper balanced nutrition and regular exercise. You need to monitor your weight and control blood pressure. The presence of positive emotions and the absence of stress are important.

    The tactics of complex treatment of coronary heart disease is developed based on the patient’s condition and an accurate diagnosis.

    Principles of treatment of coronary heart disease:

    • daily cardiotraining in dynamics (swimming, walking, gymnastics), the degree and duration of the load is determined by the cardiologist;
    • emotional peace;
    • the formation of a healthy diet (ban on salty, fatty).

    The following drugs may be included in the treatment plan:

    Anti-ischemic – reduce myocardial oxygen demand:

    • calcium antagonists are effective in the presence of contraindications to beta-blockers and are used in case of low effectiveness of therapy with their participation.
    • beta-blockers – relieve pain, improve rhythm, dilate blood vessels.
    • nitrates – stop attacks of angina pectoris.
  • Antiplatelet agents are pharmacological drugs that reduce blood coagulation.
  • ACE inhibitors are complex-acting drugs to lower blood pressure.
  • Hypocholesterolemic medicines (fibrators, statins) – eliminate harmful cholesterol.
  • As additional support and according to indications, the treatment plan may include:

    • diuretics – diuretics that can remove swelling in patients with coronary artery disease.
    • antiarrhythmics – maintain a healthy rhythm.

    Case study

    A patient came to me with complaints of frequent pain behind the sternum, pressing and compressing, giving to the left arm and under the shoulder blade. She appeared after a quick walk, at the same time shortness of breath and fear of death. On examination, the skin is pale, the borders of the heart are enlarged on the left. On an ECG with a load: inhibition of the ST segment in leads II, III, aVF, signs of left ventricular hypertrophy. The patient had a history of myocardial infarction of the back wall, long-term experience of smoking and drinking alcohol.

    Diagnosis: ischemic heart disease. Postinfarction cardiosclerosis, angina pectoris FCII. Life-long administration of Atorvastatin, Aspirin Cardio, Bisoprolol was prescribed. During the development of pain, the intake of “Nitroglycerin” under the tongue. Two weeks after the start of treatment, the frequency of seizures decreased, the general condition is relatively satisfactory. Secondary prophylaxis of coronary heart disease (use of the above drugs), doctor’s supervision is recommended.

    Prevention

    Cardiologists note that coronary heart disease has a poor prognosis. If the patient complies with all prescriptions, the course of the disease does not become so severe, but it does not disappear completely. Among preventive measures, maintaining a healthy lifestyle is effective (proper nutrition, lack of bad habits, physical activity).

    All persons who are predisposed to the development of the disease are recommended to visit a cardiologist regularly. This will maintain a full quality of life and improve the prognosis.

    It is well known that treatment is always more difficult than avoiding the disease. This is especially true for such a serious and sometimes incurable ailment as ischemic heart disease. Millions of people around the world and in our country suffer from this heart disease. But in most cases, the occurrence of the disease is not to blame for an unfavorable combination of circumstances, hereditary or external factors, but the person himself, his wrong lifestyle and behavior.

    Recall again the factors that often lead to an early incidence of coronary heart disease:

    • sedentary lifestyle;
    • a diet containing a large amount of bad cholesterol and simple carbohydrates;
    • constant stress and fatigue;
    • uncontrolled hypertension and diabetes;
    • alcoholism;
    • smoking.

    To change something on this list, making sure that this problem goes away from our lives and we would not have to be treated for coronary artery disease, most of us can do it.

    Advice of a specialist

    Many patients ask whether heart ischemia can be cured. In fact, you can completely get rid of the problem only in the case of an operation to restore blood flow. But keep in mind that any intervention can result in complications.

    Therefore, prevention of coronary heart disease is necessary. I recommend switching to a healthy lifestyle, abandoning bad habits, monitor weight. It is especially important to follow the rules for those who already have close relatives in the family with coronary heart disease or those who have had a heart attack. It is necessary to pay attention to diseases associated with vascular abnormalities (diabetes mellitus, systemic diseases) and take adequate treatment.

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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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