Cardiac pathologies more often than other diseases cause disability and death. So, in Russia, more than a million people die from such diseases every year. About a third of deaths are accounted for by such a formidable disease as coronary heart disease (CHD). Hypertension, physical inactivity, constant stress have led mankind to an epidemic increase in the number of cardiovascular diseases.

The concept of coronary disease

The term "ischemia" is derived from two Greek words - ischo (delay) and haima (blood). Since blood delivers oxygen and nutrients to the muscles, its delay adversely affects the functioning of organs. This also applies to the heart muscle.

The human heart has a large margin of safety, but its work requires a full and uninterrupted blood supply. It is carried out through the so-called coronary arteries, left and right.

If the patency of these large vessels is good, the heart is working in the correct mode. The walls of healthy arteries are normally smooth and elastic. With physical or emotional stress, they stretch, passing the right amount of blood to the heart.

With atherosclerosis, the inner walls of blood vessels are overgrown with cholesterol plaques. The lumen of the arteries decreases, their walls thicken and lose their elasticity. The blood supply to the heart is insufficient.

Against the background of poor blood supply in the heart muscle, biochemical and tissue changes begin. There are symptoms of ischemia of the heart, requiring an urgent visit to the doctor.

Forms of coronary artery disease

The classification of ischemia in cardiology still does not have clear boundaries. A variety of clinical manifestations, a combination of different types of disease, the development of medicine are constantly changing the understanding of cardiologists about the mechanisms of the occurrence of coronary artery disease. Today, according to the WHO classification, cardiac ischemia is divided into several types.

Sudden coronary death

This is the most severe form of the disease.. It is characterized by an unexpected cardiac arrest that occurs against the background of a relatively stable condition.

Factors of sudden death:

• congestive heart failure;
• Ischemia of the heart with ventricular arrhythmias;
• Emotional and physical stress;
• The first hours after myocardial infarction;
• High blood pressure, smoking, abnormal fat and carbohydrate metabolism.

Often, cardiac arrest occurs under normal conditions, outside the hospital, which determines the high mortality of this category of coronary artery disease.

Painless myocardial ischemia

The form is dangerous because there are no signs of coronary heart disease, which is why the disease often ends in sudden death. Without manifesting itself, painless ischemia contributes to the development of arrhythmias and chronic heart failure.

You can determine the disease with the help of long-term, echocardiography with stress tests. If the diagnosis is made on time, the disease is treated according to the usual scheme.

angina pectoris

Other name - . Differs paroxysmal course. During an attack, there is an acute retrosternal pain that radiates to the arm, shoulder, under the left shoulder blade. A person experiences a lack of air and interruptions in the heart, turns pale, takes a forced pose.

Angina manifests itself in cases where the myocardium needs an increased blood flow:

• Nervous or physical tension;
• Abundant food intake;
• Running or walking against a strong wind;
• Weight lifting.

The attack passes spontaneously or under the influence of drugs. The patient usually carries with him pills that help him - nitroglycerin, nitromint, validol.

Over time, angina pectoris develops, passing into a severe phase. Pain appears for no reason, at rest. This is a dangerous sign that requires urgent medical attention.

myocardial infarction

A prolonged attack of angina pectoris, strong excitement, heavy physical exertion can lead to a heart attack. Increased blood flow is fraught with plaque rupture and blockage of the stenotic vessel. As a result of acute heart failure, necrosis of myocardial tissue occurs.

If the plaque has completely closed the lumen of the artery, a (large-focal) MI develops when a large area of ​​the myocardium dies. With partial blockage, necrosis is small-focal in nature. According to the indications, drug therapy, thrombolysis, emergency angioplasty with stenting are carried out.

Postinfarction cardiosclerosis

Pathology is a direct consequence of a heart attack. Scar tissue begins to grow in the heart muscle, replacing the dead areas of the myocardium. Cardiosclerosis is manifested by heart failure.

This is a condition in which the contractility of the heart weakens, and the main organ cannot provide the body with the right amount of blood. This form of coronary artery disease is diagnosed 3-4 months after MI, when the scarring process ends.

As a result, the patient develops various circulatory anomalies, hypertrophy of the heart chambers, atrial fibrillation,. Outwardly, this is manifested by shortness of breath, edema, attacks of cardiac asthma, tachycardia.

Arrhythmia and heart failure in cardiosclerosis are irreversible, treatment gives only a temporary effect.

Causes of ischemia of the heart

In the development of the pathological process, certain circumstances play a role that contribute to the onset and progression of the disease. Some of them can be influenced by a person (removable), others are not (unremovable).

Fatal Factors

• Gender identity. Cardiovascular pathologies in men develop much more often. The fact is that estrogens in the body of a woman of childbearing age perform a protective function - they inhibit the production of cholesterol.
• Heredity. If the patient's direct relatives on the paternal side suffered a myocardial infarction before the age of 55, and the direct relatives on the mother's side - before the age of 65, the risk of early development of coronary disease increases significantly.
• Race. According to the World Health Organization, Europeans (especially those living in the northern regions) are much more likely to suffer from coronary artery disease than representatives of the Negroid population.
• Age. Atherosclerotic changes in the vessels begin in childhood and gradually develop. If 35-year-old men die from coronary disease only in 10% of cases, then after 55 years of age, mortality from cardiac ischemia rises to an average of 56% (in women over 55 years old - 40%).

Removable Factors

A person can cope with some of the causes that cause cardiac ischemia. Often the elimination of one negative phenomenon entails subsequent positive changes.

For example, reducing the amount of fat in the diet leads to an improvement in blood counts, and at the same time to getting rid of extra pounds. The result of weight loss is the normalization of blood pressure, and all this together reduces the risk of coronary artery disease.

List of avoidable risk factors:

• Tobacco smoking. The risk of sudden coronary death in smokers is much higher than in those who do not smoke or quit this bad habit. Smokers are 20 times more likely to develop atherosclerosis. In men over 62 years of age, mortality from coronary artery disease is half as high as compared with non-smokers from the same age group). A pack of cigarettes a day doubles the risk of death from coronary artery disease.
• Obesity. Judging by the results of world studies, almost half of people of mature age are overweight. The reasons are mostly banal - passion for sweets and fatty foods, regular overeating, a sedentary lifestyle.
• chronic stress. With constant psycho-emotional stress, the heart works with overload, blood pressure rises, and the delivery of nutrients to internal organs worsens.
• Hypodynamia. Physical activity is an important condition for maintaining health. Men who work hard have a lower risk of coronary disease compared to office workers.

Diseases that increase the risk of coronary disease

Diabetes

It has been established that all patients suffering from diabetes for at least 10 years have pronounced atherosclerotic changes in the vessels. The risk of coronary artery disease in them increases by 2 times. The most common cause of death in diabetes mellitus is myocardial infarction.

Atherosclerosis of the coronary arteries

It has been proven that the vast majority of patients with coronary heart disease have 75% stenosis of one or more main arteries.

Simply put, the lumen of the vessel that carries blood to the heart is closed by three quarters of lipid (fatty) plaques.

In this situation, the heart muscle chronically suffers from oxygen starvation. In a person, even with a slight load, severe shortness of breath begins.

Hyperlipidemia is an abnormally high level of lipids in the blood. By itself, the syndrome does not manifest itself in any way, but is recognized as the most important prerequisite for the development of atherosclerosis.

Arterial hypertension (hypertension)

Under the influence of high pressure, the heart works with constant overload. This leads to enlargement of the left ventricle, which in itself is a high predictor of mortality.

The hypertrophied heart needs more and more oxygen, as a result of which the blood supply to the organ worsens.

Blood clotting disorders

Thrombosis of the great vessel, caused by increased erythrocyte clotting, is the most important mechanism for the development of myocardial infarction and coronary insufficiency.

Symptoms of IHD

Coronary disease proceeds in waves: periods of exacerbation are replaced by relative calm. The first symptoms of coronary heart disease are very subjective: painful sensations and monotonous pain behind the sternum with any significant exertion. At rest, the pain goes away.

The disease lasts for decades, its forms change, the symptoms too. Characteristic signs of ischemia of the heart:

Burning constrictive pain behind the sternum, often occurring against a background of complete rest (which is a poor clinical sign). The pain usually radiates to the shoulder girdle, but can also spread to the groin area.

• Shortness of breath, increased fatigue;
• Fainting and dizziness;
• Strong sweating;
• Paleness, cyanosis of the skin, a decrease in body temperature;
• Edema of the lower extremities and severe shortness of breath, forcing the patient to take a forced position of the body. This is typical for IHD in the stage of chronic heart failure;
• Increased palpitations or a feeling of sinking heart.

It is important not to leave these symptoms unattended. It is necessary to contact a cardiologist in time, and in case of threatening conditions, call an ambulance.

Features of the course of coronary disease in women

The first symptoms of coronary artery disease in the fairer sex appear later by about 15-20 years than in men. Doctors attribute this phenomenon to the hormonal status of women of childbearing age.

Estrogens in the female body increase the level of "good cholesterol" - high density lipoproteins, and reduce the amount of low and very low density lipoproteins - "bad cholesterol". Progesterone (a male hormone) does the opposite.

After menopause, this advantage is lost. The female body after 55 years is also susceptible to coronary artery disease to the same extent as the male body. Pain attacks mainly occur as a result of nervous tension or strong fear, so stress tests during the examination are not very informative. In women, atypical signs of the disease are more common: weakness, nausea, vomiting, heartburn, pain behind the sternum of an unclear nature.

Manifestations of coronary artery disease in children

In childhood, cardiac ischemia practically does not manifest itself, there are no chest pains. However, parents should be alert to the following symptoms:

• Shortness of breath and fatigue;
• unexplained pallor;
• Cyanosis of the lips and nasolabial triangle;
• Lagging behind in development and in weight;
• Frequent colds.

All of these can be symptoms of incipient coronary disease.

Diagnostics

The patient is examined by a cardiologist. First, the patient is interviewed, finding out the complaints and syndromes characteristic of ischemia. The doctor examines the patient and listens to the heartbeat, determining the presence of arrhythmias, heart murmurs, cyanosis of the skin. The following studies are assigned next:

Laboratory diagnostic blood test showing the level of glucose, cholesterol, triglycerides, atherogenic and anti-atherogenic lipoproteins.

Removal of an ECG at rest and with a stepwise increase in physical activity. The electrocardiogram shows disturbances in the normal functioning of the myocardium.

With coronary artery disease, Holter monitoring of the ECG is often prescribed. Its essence is that a portable device is attached to the patient's belt, which takes readings during the day. All this time, the patient needs to keep a self-observation diary, where his own actions and changes in well-being are indicated by the hour. The method reveals not only violations in the work of the myocardium, but also their causes.

Chest x-ray

Echocardiography (EchoCG, ultrasound of the heart) is performed to determine the size of the heart muscle, myocardial contractility, the condition of the cavities and valves. In some cases, stress echocardiography is prescribed - ultrasound with dosed physical activity.

If the results of the examination do not give a complete picture, a transesophageal ultrasound may be prescribed. The transducer is inserted into the esophagus and records the readings of the heart without interference from the chest, skin and subcutaneous tissue.

After collecting the data, the doctor may prescribe coronary angiography of the vessels. The procedure reveals the sites of stenoses in the coronary arteries.

Treatment strategy

IHD therapy has three main goals - to save the patient from heart attacks and prevent the onset of dangerous complications - sudden death and myocardial necrosis. Treatment of coronary heart disease is carried out in several main areas.

Non-drug therapy

This includes dietary and lifestyle changes. Restriction of physical activity is shown, since it is in this case that there is an insufficiency of the blood supply to the heart. With the improvement of the patient's condition, the load regime gradually expands. A low-calorie diet with the exception of fats and rapidly absorbed carbohydrates (pastries, sweets, cakes) is recommended.

Drug therapy

It is carried out according to the ABC formula (antiplatelet agents, beta-blockers and hypocholesterolemic agents).

Patients are prescribed the following drugs:

• To normalize cholesterol levels - statins and fibrins.
• To prevent thrombosis - anticoagulants, fibrolysin.
• To normalize blood pressure - ACE inhibitors and beta-blockers.
• For the relief of angina attacks - nitrates.

Medicines promote dilatation (expansion) of the coronary vessels, increasing the delivery of oxygen to the heart.

Surgery

If drug therapy is ineffective, and the disease progresses, the cardiologist raises the question of a surgical operation. Coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) is prescribed depending on the severity of IHD manifestations.

Angioplasty

This is a low-traumatic operation for the mechanical expansion of stenotic vessels. It is carried out through a small incision in the radial or femoral artery. A long flexible tube is inserted into the vessel and advanced to the narrowed area.

To prevent re-stenosis of the vessel, a metal mesh cylinder - a stent - is installed in the expanded place.

Angioplasty with stenting is prescribed for patients with ischemic disease not complicated by diabetes mellitus, severe forms of hypertension, or myocardial infarction.

Coronary artery bypass grafting

It is aimed at creating bypass routes for blood flow (anastomoses), which will be an equivalent replacement for the affected vessels. The operation is clearly indicated in the following cases:

• With angina pectoris of a high functional class - when it is difficult for the patient to walk, eat, serve himself.
• With stenosis of three or more coronary vessels that feed the heart muscle (detected on coronary angiography).
• In the presence of an aneurysm of the heart, complicated by atherosclerosis of the main arteries.

During the operation, the chest is completely opened or an incision is made in the intercostal space - this depends on the extent of the lesion. For a shunt, a segment of a vein in the leg or a fragment of the radial (or internal mammary) artery is taken. The option with arteries is preferable - 95% of such anastomoses successfully function for 20 years or more.

Next, the surgeon connects the shunt to the area of ​​the coronary artery below the narrowed area. The other end of the shunt is sutured to the aorta. This creates a bypass that provides sufficient blood supply to the myocardium.

Alternative methods of treatment of coronary artery disease

For the treatment of the heart, traditional healers made up a lot of different recipes:

• 10 lemons and 5 heads of garlic are taken per liter of honey. Lemons and garlic are crushed and mixed with honey. The composition is kept for a week in a dark, cool place, after insisting, take four teaspoons once a day.
• Mix 500 g of vodka and honey and heat until foam forms. Take a pinch of motherwort, marsh cudweed, valerian, knotweed, chamomile. Brew the grass, let it stand, strain and mix with honey and vodka. Take morning and evening, first a teaspoon, a week later - a tablespoon. The course of treatment is a year.
• Mix a spoonful of grated horseradish and a spoonful of honey. Take one hour before meals and drink water. The course of treatment is 2 months.

Traditional medicine will help if you follow two principles - regularity and strict adherence to the recipe.

Finally. The development of coronary disease largely depends on the patient himself. Particular attention should be paid to eliminated risk factors - quit smoking and other addictions, improve nutrition and exercise regimen.

It is extremely important to visit a cardiologist and follow his recommendations, treat concomitant diseases, take tests for glucose and lipid levels on time. The result will be improved heart function and improved quality of life.

Coronary heart disease has taken a leading place in the list of the main problems of medicine in the XXI century. Pathology has become the main cause of death among the population in many countries of the world, including developed European ones. A certain downward trend in the popularity of coronary artery disease was observed in the United States at the end of the last century, but in general, the spread of the disease is observed among people of different ages and sexes.

Ischemic heart disease (CHD) is a general concept that combines acute and chronic pathological processes with similar pathogenesis. The key role in the formation of coronary artery disease is assigned to a violation of the coronary circulation, as a result of which the metabolic exchange in the heart muscle changes. In other words, the myocardium requires more oxygen and nutrients than it receives from the existing blood flow.

The course of IHD is divided into acute, in the form of myocardial infarction, and chronic, when the patient is disturbed by periodic attacks of angina pectoris.

A special role in determining the type and nature of the course of IHD is given to modern diagnostic methods. The patient's complaints, objective examination, laboratory parameters and results of instrumental methods are taken into account. All this makes it possible to make an accurate diagnosis and subsequently prescribe effective treatment. Otherwise, a poor prognosis is given.

Video: Ischemic heart disease - causes, diagnosis, treatment

IHD classification

The disease is considered in various rubricators, classifiers and open databases. But the most commonly used is the International Classification of Diseases of the 9th and 10th revisions. According to ICD-10, IHD is under I20-I25 font, and in ICD-9 - under 410-414.

According to Wikipedia, the term "ischemic heart disease" comes from the Latin. morbus ischaemicus cordis from other Greek. ἴσχω - “I hold back, hold back” and αἷμα - “blood”.

In the IHD group, the following clinical forms are distinguished:

1. Angina, which in turn is divided into unstable and stable, or exertional angina.
2. Myocardial infarction (primary).
3. Myocardial infarction (repeated).
4. Previously transferred myocardial infarction, expressed in postinfarction cardiosclerosis.
5. Sudden coronary death, which can result in successful resuscitation and death.
6. Heart failure.

When making a diagnosis, the clinical form of the disease must be indicated, for example: “CHD: stable angina II FC”. Some clinical forms are considered in separate classifications, according to which the required designation is necessarily indicated in the final diagnosis.

Braunwald's classification of unstable angina

	A - there is an external cause that increases ischemia. Secondary unstable angina	B - no external cause of angina. Primary unstable angina	C - occurs within 2 weeks after myocardial infarction. Postinfarction angina pectoris
I - new onset, progressive angina pectoris, without rest angina	IA	IB	IC
II - angina at rest within a month, but not within the next 48 hours	IIA	IIB	IIC
III - rest angina pectoris in the next	IIIA	IIIB	IIIC

A - there is an external cause that increases ischemia. Secondary unstable angina B - there is no external cause of angina pectoris. Primary unstable angina C - occurs within 2 weeks after myocardial infarction. Post-infarction angina pectoris
I - new onset, progressive angina pectoris, without rest angina pectoris IA IB IC
II - angina at rest within a month, but not within the next 48 hours IIA IIB IIC
III - rest angina in the next 48 hours IIIA IIIB IIIC

In addition to the above classification, in the group of unstable angina, early post-infarction KS, progressive and first-time, as well as Prinzmetal, or variant, are distinguished.

The classification of myocardial infarction is very voluminous and is considered according to the stages of development, the scale and anatomy of the lesion, the location of the necrotic focus, and the course of the disease. In addition, there are more modern classifications developed on the basis of general considerations of European, American and worldwide cardiology communities.

Causes of coronary artery disease

The development of the disease is directly related to the insufficient amount of oxygen that enters the heart muscle. Due to oxygen starvation, the myocardium begins to lose the ability to perform its functions, and the larger the affected area, the more pronounced the clinic of the disease. In some cases, blood circulation in the coronary vessels stops so abruptly that an acute oxygen deficiency occurs with all the ensuing consequences.

Why does blood flow stop in the coronary vessels? One or more pathological mechanisms may be involved in this:

1. atherosclerosis and thrombosis.
2. Atherosclerosis of the coronary vessels.
3. Spasm of blood vessels.

There are also so-called extravascular etiological factors that contribute to the development of coronary artery disease. In some cases, an important role is played by risk factors that contribute to the manifestation of the clinical picture of a sluggish process.

Development factors

The key etiological factor in the development of coronary artery disease is atherosclerosis. With this pathology, there is a narrowing of the lumen of the coronary arteries, due to which the needs of the myocardium for blood supply do not coincide with the real possibilities of the bloodstream.

With atherosclerosis, specific plaques are formed, which in some cases block the lumen of the vessel by 80%. Then myocardial infarction develops, or, as a “lighter” option, angina pectoris.

The formation of an atherosclerotic plaque does not occur all at once. This can take months or even years. At the beginning, low-density lipoproteins are deposited on the walls of the coronary vessels, which begin to gradually affect the epithelium located nearby.

Platelets and other blood cells accumulate at the site of the lesion, due to which the lumen of the vessel is blocked by an increasingly protruding part of the plaque. If the pathological formation occupies up to 50% of the lumen of the vessel, then the clinic of the disease is sluggish or not at all expressed. Otherwise, IHD develops in one clinical form or another.

Each coronary artery supplies blood to a specific area of ​​the myocardium. The farther from its distal end is the area of ​​the vessel affected by atherosclerosis, the more extensive ischemia or necrosis can be. If the mouth of the left coronary artery or the main trunk is involved in the pathological process, then the most severe ischemia of the heart muscle develops.

In addition to the developmental factors that lie inside the vessel, there are also extravasal causes. First of all, it is arterial hypertension, which most often provokes a spasm of the coronary vessels. The formation of IHD is promoted by frequent and severe tachycardia, as well as myocardial hypertrophy. In the last two cases, the need of the heart muscle for oxygen increases sharply and, if they are not satisfied, ischemia develops.

Risk factors

Modern scientists and leading clinicians attach great importance to the formation of IHD to predisposing circumstances. Against their background, with the highest probability, a pathological condition can develop with all the ensuing consequences. Risk factors for coronary artery disease are in many ways similar to those in atherosclerosis, which is associated with the direct involvement of atherosclerotic plaque in partial or complete blockage of the vessel lumen.

Coronary heart disease is associated with many risk factors (RF), so a kind of classification was required to streamline them for better understanding.

1. Biological risk factors:

• Men get sick more often than women.
• In older people, atherosclerosis is more often determined, which means that the likelihood of myocardial ischemia is higher.
• Hereditary predispositions that contribute to the development of diabetes mellitus, hypertension, dyslipidemia, and hence coronary artery disease.

2. Anatomical, physiological and metabolic risk factors:

• Diabetes mellitus, mainly of the insulin-dependent type.
• Overweight and obesity.
• Arterial hypertension.
• An increased amount of lipids in the blood (hyperlipidemia) or a violation of the percentage of different types of lipids (dyslipidemia).

3. Behavioral risk factors:

• Wrong nutrition.
• Having bad habits, especially smoking and drinking alcohol.
• Hypodynamia or excessive physical activity.

Muscular-elastic hyperplasia of the intima of arteries, including coronary arteries, is another possible risk factor for the occurrence of coronary artery disease, but today it is under study. Changes in the vessels according to the type of hyperplasia are already determined among children, so there are assumptions about the contribution of such RF to the development of coronary artery disease at an older age. In addition, the role of the CDH13 gene and its mutation in the formation of ischemia is being studied, but so far this assumption has not been fully proven.

Types of IHD

In patients with coronary artery disease, such clinical forms as myocardial infarction and angina pectoris are most often determined. Other varieties are not so common, and they are more difficult to diagnose. Based on this, the clinic and course of myocardial infarction, angina pectoris, sudden coronary death and postinfarction cardiosclerosis will be considered.

myocardial infarction

Such a diagnosis can be established when there is myocardial necrosis confirmed by clinical, laboratory and instrumental methods. It can be small or large, but regardless of this, the patient should be sent to the intensive care unit as soon as possible.

• Large-focal myocardial infarction is characterized by pathognomonic changes that are determined on the ECG and in the course of laboratory diagnostics. Of particular importance is the increase in serum lactate dehydrogenase, creatine kinase and a number of other proteins.

Such enzymes indicate the activity of the redox reaction taking place in the body. If normally these components are found only in cells, then when they are destroyed, proteins pass into the blood, therefore, by their quantity, one can indirectly judge the scale of necrosis.

• Small-focal myocardial infarction is often endured by patients “on their feet”, since the clinic may not be pronounced, and changes in the ECG and in the analyzes are also not as critical as in the case of large-focal MI.

angina pectoris

The disease has a characteristic clinical sign - retrosternal pain, which can occur from any stress (physical or emotional). Pain can be felt as a burning sensation, heaviness, or severe discomfort, and often spreads along the nerve fibers to other parts of the body (scapula, lower jaw, left arm.

The duration of an angina attack is most often 1-10 minutes, much less often - up to half an hour.

Another feature characteristic of angina pectoris is the relief of pain with nitroglycerin, which practically does not help with myocardial infarction. Also, painful sensations can go away on their own if the emotional or physical stimulus has been eliminated.

Characteristics of individual forms of angina pectoris:

• For the first time, angina pectoris is quite variable in its course, so it is not immediately possible to make an accurate diagnosis. This usually takes up to three months. During this period, the patient's condition is monitored, the development of the disease, which can go into a progressive or stable form.
• Stable angina - characterized by the occurrence of pain with a certain pattern. The severity of stable angina pectoris is determined by functional classes, the corresponding FC must be indicated in the final diagnosis.
• Progressive angina pectoris - the intensity of pain attacks increases rather quickly, while the patient's resistance to physical and emotional stress decreases. This form of angina pectoris is poorly controlled by nitroglycerin and, in severe cases, narcotic analgesics may be required.

Angina occurs spontaneously and is not associated with any physical or emotional stimuli. This form of angina is often determined at rest, at night or in the morning. This pathology is defined as spontaneous angina pectoris.

Sudden coronary death

The second clinical designation is primary cardiac arrest. Its formation is associated with electrical instability of the myocardium. Such a diagnosis is made only if there is no evidence for the definition of another specific form of coronary artery disease. For example, the heart may stop due to a myocardial infarction, and then the diagnosis is indicated as death from myocardial infarction.

A high risk of sudden coronary death is observed in those patients who have signs of narrowing of a large number of coronary vessels on coronary angiography. An unfavorable condition is the expansion of the left ventricle. Significantly increases the likelihood of sudden coronary death after a heart attack. Also, any myocardial ischemia, including without pronounced painful sensations, can be considered as a danger due to a sudden cessation of cardiac activity.

Postinfarction cardiosclerosis

In clinical practice, this disease is considered a complication of a previous myocardial infarction. To make such a diagnosis, at least 2 months are allotted. In some cases, postinfarction cardiosclerosis is considered as an independent disease, but for this, the presence of angina pectoris, heart failure, etc. should not be confirmed. In addition, signs of focal or diffuse cardiosclerosis should be present on the ECG.

In relatively mild cases, patients feel interruptions in the rhythm of the heart. The severe course of the disease is accompanied by shortness of breath, edema, heart pain, inability to endure the load, etc. The complexity of the pathology lies in the fact that there is a more or less noticeable progression of the process, which only a well-chosen therapy can hold for a while.

Video: Types and forms of coronary heart disease

Diagnostics

Patients with coronary heart disease are dealt with by a cardiologist who, during the initial appointment, pays attention to clinical symptoms. With IHD, the following characteristic complaints are distinguished:

• Pain behind the sternum, which in most cases is associated with emotional and physical stress.
• Incorrect work of the heart, which is accompanied by weakness and arrhythmia.
• Swelling in the legs, indicating heart failure.
• Feeling short of breath.

The history of the disease is of great importance during the examination. This is when the doctor asks clarifying questions about the nature of the pain, its duration, etc. The amount of physical activity that the patient can withstand relatively calmly also matters. For a correct diagnosis, information must be obtained on the effectiveness of various pharmacological agents, including nitroglycerin. Additionally, risk factors are specified.

All patients with suspected coronary artery disease undergo electrocardiography. This indirect diagnostic method cannot accurately indicate how many cardiomyocytes have died, but it can be used to determine myocardial functions such as automatism and conduction capacity.

The following signs of myocardial infarction are clearly visible on the ECG:

• The appearance of a pathological Q wave, which in some leads is combined with a negative T wave.
• In acute myocardial infarction, the ST segment rises high and manifests itself in the form of a "sailboat" or "cat's back".
• With myocardial ischemia, ST segment depression is noted.
• If there is a scar in the myocardium on the ECG for two days or more, a negative T wave of weak severity and a pathological Q wave are determined.

An ECG is necessarily supplemented by an ultrasound of the heart. Using this modern method of research, it is possible to assess in real time the condition of the heart muscle, how much the contractility of the heart has suffered from a heart attack, and whether there are disturbances in the operation of the valvular apparatus. If necessary, echocardiography is combined with dopplerography, which makes it possible to assess the possibilities of blood flow.

Laboratory research are relevant for the diagnosis of myocardial infarction, since various biochemical parameters change during the development of the pathological process. First of all, protein fractions are determined, which are normally found only inside the cell, and after the destruction of cardiomyocytes they enter the blood. For example, in the first 8 hours after a heart attack, the level of creatine kinase increases, and in the first day - myoglobin. Up to 10 days, troponins are determined, the amount of lactate dehydrogenase and aminotransferase also matters.

In violation of the structure of the myocardium, a nonspecific reaction is observed in the form of an increase in the concentration of AST and ALT, the erythrocyte sedimentation rate (ESR) and the appearance of neutrophilic leukocytosis.

In patients with coronary artery disease, the lipid profile must be examined. For this, indicators such as total cholesterol, triglycerides, high and low density lipoproteins, apolipoproteins and an atherogenic index are determined.

Functional trials in combination with ECG registration, it is possible to assess the capabilities of the heart muscle under the influence of physical exertion. For early diagnosis of the disease, this is extremely important, since not all patients at rest have clinical changes. A person can be stressed in a variety of ways. The most common is the exercise bike. It is also often used a treadmill, walking up the stairs, etc.

Additional instrumental studies:

• CT angiography (or angiography of the coronary vessels) is carried out in order to obtain x-ray images with vessels contrasting with a special substance. The resulting images show blockage of the arteries, their occlusion, and the degree of patency is also assessed.
• Monitoring according to the Holter method - consists in recording an ECG for a day or two, for which the patient carries a special device with him all the time. The study allows you to determine not pronounced and hidden changes in cardiac activity, when a standard ECG cannot fix changes due to the rare occurrence of an attack.
• Intraesophageal ECG - is performed in cases where no changes are recorded on the standard ECG, but there are clinical signs of the presence of additional foci of excitation. To conduct a study, an active electrode is inserted into the esophagus, which studies the electrical activity of the atria and atrioventricular node.

IHD treatment

The tactics of treatment is based on the classification of coronary heart disease, since each clinical form is suitable for its own specific method of therapy. Despite this, there are general guidelines for managing patients with coronary artery disease, which are as follows:

• Moderate physical stress is important in stabilizing patients with coronary artery disease, since the higher the physical activity, the greater the need for oxygen, and due to impaired blood supply to the heart muscle, this only aggravates the course of the disease by provoking new attacks. If the patient is on the mend, then gradually physical activity increases.
• Diet food - should be as sparing as possible for the myocardium, therefore the amount of salt and the volume of water are reduced. When determining atherosclerosis, foods such as smoked meats, pickles, animal fats are excluded from the diet. High-calorie and fatty foods are also not recommended for use. If the patient is obese, then the issue of counting calories is especially carefully approached, since energy expenditure should be related to the energy coming from food.

Medical therapy

US cardiologists proposed a treatment regimen under the abbreviation "A-B-C". It is based on the use of drugs from three pharmacological groups: antiplatelet agents, beta-blockers, statins (considered hypocholesterolemic drugs). If a concomitant disease is determined in the form of hypertension, then drugs are added to treat this pathology.

• Antiplatelet agents - prevent erythrocytes and platelets from sticking together, as well as their further adhesion to the inner wall of the vessel. As a result, blood rheology improves, and the risk of developing blood clots decreases. Of the drugs in this group, acecardol, aspirin are most often used, and clopidogrel is also prescribed.
• Beta-blockers - according to the mechanism of action, stimulate adrenoreceptors in myocardial cells, which leads to a decrease in heart contractility. This, in turn, has a beneficial effect on the condition and performance of the body. Drugs from this group are contraindicated in certain pulmonary diseases. Today, metoprolol, carvedilol, bisoprolol are most often used.
• Statins and fibrates are anticholesterolemic drugs, as they help slow down the growth of existing atherosclerotic plaques and prevent the formation of new ones. To some extent, they can alleviate the severity of an attack of coronary artery disease. Of this group, lovastatin, simvastatin, rosuvastatin, atorvastatin are most often prescribed. Fibrates can increase the level of high-density lipoproteins, which have anti-atherogenic value, among which fenofibrate is the most famous.

Depending on the indications and comorbidity, the patient may be prescribed nitrates (they expand the venous bed and thereby relieve the load on the heart), anticoagulants (do not allow blood clots to form), diuretics (loop or thiazide). Antiarrhythmic agents in the form of amiodarone may also be prescribed for the treatment and prevention of rhythm disorders.

Video: What drugs are used to treat coronary heart disease (CHD)?

Natural lipid-lowering agents

In complex therapy, lipid-lowering agents such as aspirin and policosanol can be used. The latter name is a general term for long-chain alcohols that are made from vegetable waxes. Today, they are often found in various nutritional supplements.

In the process of application, policosanol does not have a negative effect on coagulation, while it helps to increase the concentration of high-density lipoproteins and reduce the fraction of “harmful” low-density lipoproteins. Additionally, the substance has an antiplatelet effect.

Endovascular coronary angioplasty

It is an alternative to open surgery. It is used in various forms of coronary artery disease, even in the case of progression of the pathology and in order to prevent complications. This method combines coronary angioplasty and endovascular technologies, often represented by transluminal and transluminal instrumentation.

To expand spasmodic vessels, due to which myocardial ischemia occurs, stenting is most often used, less often balloon angioplasty. All manipulations are performed under the control of coronary angiography and fluoroscopy. For the introduction of the required instrumentation, a large vessel is selected, mainly the femoral artery is preferred.

Video: Stenting of the coronary arteries

Surgery

Under some circumstances, coronary heart disease is not amenable to medical treatment. Then the option of surgical intervention is considered, in particular, coronary artery bypass grafting. The purpose of this technique is to connect the coronary vessels to the aorta by means of an autograft (represented mainly by the great saphenous vein).

The main indications for surgical intervention in coronary artery disease:

• multiple lesions of the coronary vessels;
• determination of stem stenosis in the region of the left coronary vessel;
• determination of ostial stenoses in the region of the right or left coronary vessel;
• stenosis of the anterior coronary vessel, which is not amenable to angioplasty.

Surgical treatment cannot be carried out in the case when the patient has multiple lesions of peripheral coronary vessels, located diffusely. Also, a contraindication is low myocardial contractility, the presence of heart failure in the stage of decompensation and a post-infarction state, which is not more than 4 months old.

Non-drug treatment

Conservative therapy, if necessary, can be supplemented with non-drug methods of exposure, which also help to improve the condition of the myocardium.

The main methods of treatment of non-drug direction:

• Hirudotherapy is known as leech therapy. In the saliva of these creatures there are components with an antiplatelet effect, as a result of which thrombosis is prevented. It is difficult to judge the effectiveness of the method, since it does not have approval from the field of evidence-based medicine.
• Shock wave therapy of the heart - for the implementation of the technique, low power of shock waves is used. Under their action, new vessels begin to form in the myocardium, which significantly improves blood supply to the tissues. This is exactly what is needed to reduce the ischemic zone. The non-invasive method is most often used in the absence of effectiveness from conservative and surgical treatment. According to some researchers, improvement in myocardial perfusion is observed in almost 60% of patients.
• Enhanced external counterpulsation - in terms of the method of conduction, it is similar to internal counterpulsation. Refers to non-surgical methods and is based on the work of special air cuffs that are worn on the legs. Due to the sharp pumping out of air from the cuffs during systole, the pressure in the vascular bed decreases, which means that the load on the heart is removed. At the same time, during the period of diastole, the bloodstream, on the contrary, is intensively filled with blood, which improves the condition of the myocardium. After a large study in the USA, the method was approved and is now widely used in clinics.

Forecast

The conclusion on the development of the disease largely depends on the severity of the clinic and the severity of structural changes in the myocardium. In most cases, a relatively unfavorable prognosis is given, since, regardless of the treatment, it is impossible to reverse the disease. The only thing is that therapy helps to improve the patient's well-being, make attacks less frequent, in some cases it is possible to significantly improve the quality of life. Without treatment, the disease progresses very quickly and is fatal.

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Why is coronary artery disease dangerous: what is it and what diseases are included in this concept

Not every person knows why IHD develops, what it is and how to treat it. This abbreviation stands for coronary heart disease. This pathology is very common among the adult population. The development is based on a violation of the blood supply to the myocardium. Such a diagnosis worsens the prognosis for health and shortens the life expectancy of a sick person.

Development of coronary heart disease

The human circulatory system is very complex. It consists of the heart and blood vessels. The myocardium itself constantly needs oxygen and nutrients. They enter there through the coronary (coronary) arteries. The latter nourish the heart itself, maintaining its functions at the proper level. Ischemic disease is a pathological condition in which the blood supply to the myocardium is disturbed or completely stopped.

This pathology can be organic or functional. With IHD, the percentage of deaths is high. An unfavorable prognosis is most often associated with an acute form of ischemia (myocardial infarction). IHD is the most common cause of sudden death. This is a serious medical and social problem. In Russia, more than 1 million people die every year from vascular diseases. Most of the working population. Increasingly, IHD develops in young people.

The incidence rate is higher in men. This is due to active smoking, alcoholism and addiction to fatty foods. Many people become disabled. This happens as a result of myocardial infarction and development. Modern health care cannot yet cope with such a problem and change the situation. The only way to reduce mortality and morbidity is to change lifestyles.

Varieties of ischemic disease

WHO (World Health Organization) considers CAD as a general concept. It combines several diseases. The IBS group includes:

• sudden coronary death (with and without fatal outcome);
• angina (tension and spontaneous);
• painless variant of IHD;
• disorder of rhythm and conduction;
• heart failure;
• postinfarction cardiosclerosis.

Painful forms of ischemic disease are more common. The most common pathology is angina pectoris. It is stable and unstable. Separately, Prinzmetal's angina pectoris was singled out. Many specialists use the concept of acute coronary syndrome. It includes a heart attack. This includes unstable angina. Do not confuse coronary heart disease and. These are different concepts. A stroke is an acute cerebrovascular accident.

Etiological factors

Risk factors for coronary artery disease are known to every cardiologist. The development of this cardiac pathology is based on a lack of oxygen. The cause may be damage to the coronary arteries. The following factors are of greatest importance in the development of IHD:

• atherosclerosis of the coronary vessels;
• smoking;
• thrombosis;
• hyperlipidemia;
• diabetes;
• high blood pressure;
• alcoholism;
• malnutrition;
• physical inactivity.

Ischemic disease often develops against the background. The reason is a violation of lipid metabolism.

Cholesterol is produced in the human body. It is associated with blood proteins. There are low, high and very low density lipoproteins. Atherosclerosis increases the content of LDL and VLDL. Over the years, lipids are deposited on the walls of the coronary arteries.

Atherosclerosis

Initially, there are no symptoms. Gradually, the lumen of the vessels decreases and at a certain moment the blood flow becomes difficult. Dense plaques are formed. The situation is aggravated by smoking, unhealthy diet and physical inactivity. Risk factor for the development of coronary artery disease -. It increases the likelihood of myocardial ischemia several times.

IHD often develops in people suffering from endocrine pathology (obesity, diabetes, hypothyroidism). This form of coronary disease, such as a heart attack, may be due to acute thrombosis (blockage) of the coronary arteries. Causes of CHD include smoking. This is a very serious problem that is almost impossible to solve.

Active and passive smoking is dangerous. The substances contained in the smoke contribute to spasm of the arteries, which leads to. Carbon monoxide helps to reduce the level of oxygen in the blood. All tissues of smokers experience oxygen starvation. Another risk factor that can be eliminated is stress. It leads to an increase in blood pressure due to the production of catecholamines (adrenaline and norepinephrine) and oxygen deficiency.

With IHD, every doctor should know the etiology. Risk factors for the development of this pathology include advanced age, genetic predisposition, dietary errors, and male gender. IHD symptoms often occur in people who abuse animal fats (they are found in meat, fish, butter, mayonnaise, sausage) and simple carbohydrates.

The development of angina pectoris in humans

Of all forms of coronary artery disease, angina pectoris is the most common. This pathology is characterized by the occurrence of acute pain in the region of the heart against the background of impaired blood supply. There are angina pectoris and spontaneous (variant). They have fundamental differences from each other.

Angina pectoris is detected mainly in people of mature age. The risk of developing this pathology in a person under 30 years of age is less than 1%.

The prevalence of angina among adults reaches 15-20%. The incidence rate increases with age. The most common cause is atherosclerosis. Symptoms appear when the lumen of the arteries narrows by 60-70%.

With angina pectoris (stress), the following clinical manifestations are observed:

• chest pain;
• dyspnea;
• pale skin;
• increased sweating;
• change in behavior (feelings of fear, anxiety).

The main symptom of this form of IHD is pain. It occurs as a result of the release of mediators and irritation of receptors. The pain is paroxysmal. It occurs during physical exertion, increases rapidly, is eliminated by nitrates, pressing or squeezing and is felt in the chest on the left. The attack lasts a few seconds or minutes. If it is delayed for 20 minutes or more, then myocardial infarction must be excluded.

The pain radiates to the left side of the body. Angina pectoris can be stable or unstable. The first is different in that the attacks occur with the same physical activity. The pain syndrome is felt for less than 15 minutes. The attack disappears after taking 1 tablet of nitrates. Pain in unstable angina is longer.

Each subsequent attack is provoked by a smaller load. Often it occurs at rest. Signs of CAD include shortness of breath. Such patients feel short of breath. Often it occurs during an attack of angina pectoris. Its appearance is due to a decrease in heart function, stagnation of blood in the small circle and an increase in pressure in the pulmonary vessels.

The patient's breathing becomes deep and frequent. With angina pectoris, the heart rhythm is often disturbed. This is manifested by frequent or rare palpitations, dizziness and even loss of consciousness.

With angina pectoris, a person's behavior changes: he freezes, bends down, tries to take a relieving position. Often there is a fear of death.

Variant and rest angina

Classification of coronary artery disease highlights angina that occurs at rest. This form of cardiac ischemia is characterized by the occurrence of a pain attack, regardless of physical activity. This is one of the varieties of unstable angina. This pathology occurs in acute, subacute and chronic forms. Often it develops 1-2 weeks after myocardial infarction.

Causes of rest include atherosclerosis, narrowing of the aortic orifice, inflammation of the coronary arteries, hypertension, cardiomyopathy with left ventricular hypertrophy. This form of coronary artery disease is characterized by the appearance of pain at rest, when a person is in a prone position. Often this happens during sleep. The attack lasts up to 15 minutes and is severe. This is different from exertional angina. The pain is eliminated after taking 2-3 tablets of nitrates.

Autonomic symptoms include sweating, redness or pallor of the face, nausea, dizziness, and increased pressure. A variant of this pathology is Prinzmetal's angina. This is a rare form of coronary heart disease. It is detected in 2-5% of patients with coronary artery disease. Most often, Prinzmetal's angina develops in people aged 30 to 50 years. The risk group includes smokers.

Attacks occur against the background of stress, hyperventilation, cooling of the body. Triggers may not be present. Prinzmetal's angina is manifested by intense pain in the chest of a burning or pressing nature, lability of blood pressure, palpitations, rhythm disturbance, headache, nausea. Some people lose consciousness. Attacks are severe and often occur several times a day.

myocardial infarction

The diagnosis of CAD may include an indication of myocardial infarction. This is an acute form of coronary heart disease, from which thousands of people die every year. This condition requires emergency care. Sometimes patients need surgery. The definition of a heart attack is known to every cardiologist. The difference of this pathology is that a focus of necrosis (tissue necrosis) is formed in the heart muscle.

In the future, a scar is formed at this place. Before the age of 60, this condition is more often diagnosed in men. A lethal outcome in a heart attack is observed in 30-40% of cases. Tissue necrosis can develop against the background of a prolonged attack of angina pectoris, if the patient is not provided with proper assistance. With a heart attack, irreversible changes occur within 15-20 minutes from the moment of the attack.

Causes of acute circulatory disorders - and thrombosis. The risk of developing a heart attack is higher in people suffering from hypertension and crises. Most often, the left ventricle is involved in the process. Myocardial infarction is large-focal and small-focal. There are acute, acute, subacute and postinfarction periods.

With this form of IHD, the following symptoms are observed:

• chest pain lasting more than 30 minutes;
• numbness;
• feeling of fear;
• severe weakness;
• excitation;
• dyspnea;
• increase in blood pressure, followed by its fall;
• tachycardia;
• increase in body temperature.

The main symptom is pain. It has the following features:

• stabbing (dagger) or burning;
• different intensity;
• felt in the chest on the left;
• lasts more than 30 minutes;
• gives to the left shoulder, jaw, arm;
• appears spontaneously at night or in the morning;
• wavy;
• does not change after taking nitrates and at rest.

Complications often develop in the form of heart failure, atrial fibrillation, shock and pulmonary edema. Assistance to the patient should be provided at an early stage of coronary artery disease. In some cases, a heart attack occurs in an atypical form (painless, abdominal). This makes it difficult to make a diagnosis. more common among older people.

Development of postinfarction cardiosclerosis

The World List of Diseases (ICD) identifies such a form of coronary artery disease as postinfarction cardiosclerosis. This disease is the outcome of AMI. Postinfarction cardiosclerosis is a pathological condition in which myocardial muscle fibers are replaced by connective tissue. The latter is not able to be excited and contract.

This pathology develops a few months after a heart attack. The growth of scar tissue in sclerosis leads to a violation of the rhythm and contractility of the heart. The outcome is the development of heart failure. More rare causes of cardiosclerosis include myocardial dystrophy. The following symptoms are characteristic of this form of IHD:

If right ventricular failure develops, then edema appears. Complications of postinfarction cardiosclerosis include the development of atrial fibrillation, partial or complete blockade. The most unfavorable prognosis is observed in the case of left ventricular aneurysm.

Development of heart failure

An independent form of ischemic disease is heart failure. It is acute and chronic. The development of this pathology is based on a decrease in the contractile function of the myocardium due to ischemia. This is a complication of other diseases. The prevalence of chronic heart failure is 0.5-2%. At the age of more than 75 years, every tenth person is sick.

The number of people with this pathology is increasing every year. With this form of coronary heart disease, symptoms include cyanosis of the extremities, ears and nose, swelling, heaviness in the right hypochondrium, swelling of the veins in the neck, tachycardia, shortness of breath, cough, fatigue. Stagnation of blood leads to dysfunction of many organs. Gastritis, pneumonia, bronchitis, pyelonephritis often develop. The work of the central nervous system is disrupted.

How to identify a person with coronary artery disease

Therapy of patients is carried out after the examination. The diagnosis is made by a cardiologist or therapist. The following studies are required:

Blood test

• analysis for the presence in the blood of intracellular protein enzymes (troponin, aminotransferase, lactate dehydrogenase, myoglobin);
• biochemical research;
• electrocardiography;
• Ultrasound of the heart;
• lipid spectrum study;
• coronary angiography;
• daily monitoring;
• physical examination;
• general clinical examinations.

Be sure to assess the level of blood pressure, respiratory rate and heartbeat. The attending physician should collect a detailed history of life and disease. If angina pectoris is suspected, exercise tests are performed (treadmill test and bicycle ergometry). The method of diagnosing IHD is electrocardiography. In a heart attack, the ECG shows a negative T wave and an abnormal QRS complex. With an extensive lesion, a pathological Q wave is determined. It may not be.

Deciphering the results allows you to evaluate the work of the body. Each tooth and complex reflect the state of individual chambers in systole and diastole. With the help of ultrasound, it is possible to assess the function of the ventricles and atria, myocardial contractility, the work of the valvular apparatus. To determine the patency of the coronary arteries and the degree of their obstruction, coronary angiography is performed.

Therapeutic tactics for IHD

In acute forms of ischemic disease, emergency care is required. If you suspect a heart attack, do the following:

• call an ambulance;
• lay down a person;
• raise the head end of the bed or put a cushion under the neck;
• give a nitroglycerin tablet under the tongue;
• remove clothing that restricts movement;
• ensure the flow of clean air;
• calm the patient;
• give an anesthetic;
• make a mustard plaster on the chest.

Emergency care includes the use of . It's an antiplatelet agent. It prevents the formation of blood clots. In the absence of breathing and cardiac arrest, resuscitation is carried out. Treatment of coronary artery disease after clarifying the diagnosis is determined by the form of ischemia. If angina pectoris is detected, long-acting antianginal drugs are prescribed.

Verapamil

These include nitrates (Sustak, Nitrong), calcium channel blockers (Verapamil), peripheral vasodilators (Corvaton), beta-blockers (Inderal). Therapy for angina pectoris involves the use of statins, antiplatelet agents, and antioxidants. In severe cases, angioplasty or coronary artery bypass grafting is required. These are radical treatments.

Standards for the treatment of coronary artery disease are known to any cardiologist. Patients with myocardial infarction are hospitalized on an emergency basis. Therapy includes the use of antiplatelet agents (Aspirin, Clopidogrel), anticoagulants (Fraxiparine), thrombolytics (Urokinase, Streptokinase). Often, stenting and angioplasty are required. It is completely impossible to cure patients with a heart attack.

In case of heart rhythm disturbance, therapy involves the use of medications such as Amiodarone, Lidocaine and Atropine. If necessary, a pacemaker is installed. How to treat heart failure, not everyone knows. Therapy is aimed at the underlying cause of its occurrence.

Digoxin

In acute insufficiency, rest is required. Reduce fluid intake to 500 ml. Symptoms and treatment are related. If there are signs of thrombosis, anticoagulants and antiplatelet agents are prescribed. In heart failure, glycosides (Digoxin, Strofantin, Korglikon), nitrates, ACE inhibitors (with high blood pressure), beta-blockers, diuretics are indicated.

Methods for the prevention of coronary artery disease

It is necessary to know not only what coronary heart disease is, but also what its prevention should be. To reduce the risk of developing coronary artery disease, you need:

• get rid of bad habits (smoking, drinking alcohol and drugs);
• move more;
• exercise;
• treat arterial hypertension in a timely manner;
• limit the consumption of food rich in animal fats;
• treat endocrine diseases;
• eliminate stress;
• boost immunity.

There is no specific prophylaxis. There are risk factors for developing coronary artery disease that cannot be eliminated (advanced age). Prevention of myocardial infarction is reduced to controlled treatment of hypertension. People who regularly take ACE inhibitors have a much lower risk of having a heart attack.

If there are various clinical syndromes (pain, swelling), then you should immediately consult a doctor.

Prevention of coronary artery disease includes periodic examination. Electrocardiography and fluorography should be carried out at least once a year.

Prevention of coronary disease includes the normalization of nutrition.

Atherosclerosis is almost always the cause of angina pectoris and heart attack. To prevent it, you need to eat more fruits and vegetables. Additionally, it is recommended to include in the diet products that have anti-atherosclerotic effects. These include sunflower and olive oils, fish, nuts. Very useful seafood. Ischemic syndrome can be prevented by observing all these rules. Of great importance is the normalization of weight, since obesity is a risk factor for the development of coronary artery disease.

Thus, the presence of symptoms of coronary heart disease is the reason for contacting a cardiologist and a comprehensive examination. When IHD is detected, one medication is not enough. must be combined with a diet and a healthy lifestyle. In the case of the development of an extensive heart attack and acute heart failure, the prognosis is relatively unfavorable.

Video

Coronary artery disease is the most common heart disease, resulting in over 10 million premature deaths each year and is manifested by chest pain during exercise. IHD develops with a decrease in blood flow to the heart muscle due to the growth of atherosclerotic plaques in the arteries of the heart involved in the blood supply to the myocardium. A common symptom of cardiac ischemia in most cases is chest pain or discomfort that may radiate to the shoulder, arm, back, neck, or jaw. Sometimes angina can feel like heartburn. Typically, symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may be the only symptom of CAD without pain. Often the first sign of coronary artery disease is a heart attack.

To understand how coronary heart disease manifests itself, we will use the WHO definition:

• Sudden coronary death (primary cardiac arrest)
• Sudden coronary death with successful resuscitation
• Sudden coronary death (fatal)
• angina pectoris
• angina pectoris
• New onset angina pectoris
• Stable exertional angina with indication of functional class
• Unstable angina
• Vasospastic angina
• myocardial infarction
• Postinfarction cardiosclerosis
• Heart rhythm disorders
• Heart failure

Risk factors

Coronary artery disease has a number of well-defined risk factors:

• High blood pressure.
• Smoking - is associated with 36% of cases of coronary artery disease, you need to know that smoking even one cigarette a day doubles the risk of heart attack.
• Diabetes - Up to 40% of patients are diabetic.
• Obesity - noted in 20% of cases of coronary artery disease
• High blood cholesterol is a predictor of the disease in 60% of patients
• Family history - about half of the cases are related to genetics.
• Excessive alcohol consumption is a risk factor for acute coronary syndrome.

What is coronary heart disease (CHD)?

The heart is a muscular organ that must constantly work to provide the body with blood, without which it dies. The heart does not stop for a minute, throughout life. For this reason, the heart must constantly receive oxygen and nutrients through the blood. The blood supply to the heart occurs through a powerful network of coronary arteries. If narrowing or blockage develops in these arteries, then the heart cannot cope with its work. In acute cases, part of the muscle tissue of the heart dies and myocardial infarction develops.

With age, many people begin to develop atherosclerotic plaques in their arteries. The plaque gradually narrows the lumen of the artery, as a result of which the delivery of oxygen to the heart muscle decreases and pain develops in the region of the heart (angina pectoris). Narrowing of the lumen and inflammation around the plaque can lead to arterial thrombosis and complete cessation of blood flow in a certain area of ​​the myocardium. The muscle tissue of the heart may die. This is accompanied by pain and decreased contractile function of the heart. Myocardial infarction develops, which in almost 50% of cases is accompanied by a fatal outcome.

As plaque develops in the coronary vessels, the degree of narrowing of their lumen of the coronary arteries also increases, which largely determines the severity of clinical manifestations and prognosis. The narrowing of the lumen of the artery up to 50% is often asymptomatic. Clinical manifestations of the disease usually occur when the lumen is narrowed to 70% or more. The closer the stenosis is to the mouth of the coronary artery, the greater the mass of the myocardium undergoes ischemia in accordance with the area of ​​blood supply. The most severe manifestations of myocardial ischemia are observed with narrowing of the main trunk or mouth of the left coronary artery.

In the origin of myocardial ischemia, a sharp increase in its oxygen demand, angiospasm or thrombosis of the arteries of the heart plays an important role. The prerequisites for thrombosis may arise already in the early stages of the development of an atherosclerotic plaque, due to the increased activity of the thrombus formation system, so it is important to prescribe antiplatelet therapy in a timely manner. Platelet microthrombi and microembolism can exacerbate blood flow disorders in the affected vessel.

Forms of coronary heart disease

Stable angina pectoris is a classic symptom of coronary artery disease, meaning pain in the region of the heart and behind the sternum that develops after exercise. Depending on this load, the functional class of angina pectoris is determined.

Stable angina develops when:

• Physical exercise or other activities
• Eating
• Anxiety or stress
• freezing

Unstable angina

Ischemic heart disease can develop to such an extent that pain in the heart occurs even at complete rest. This is a medical emergency (unstable angina) and can lead to a heart attack.

myocardial infarction

A form of coronary heart disease in which there is a sudden cessation of blood flow through any coronary artery with the development of a limited area of ​​\u200b\u200bdeath of the heart muscle. Heart attack without urgent surgery leads to mortality in half of patients. Heart attack and sudden coronary death are the main arguments in understanding why coronary heart disease is dangerous. Every patient should be aware that a prolonged attack of angina pectoris can be a sign of the onset of a heart attack.

Prognosis for coronary heart disease

Without timely myocardial revascularization, CAD has a poor prognosis. Sudden coronary death develops in 10% of patients, myocardial infarction in almost 50% of patients. Life expectancy in patients who are not treated with diagnosed CAD is no more than 5 years. Timely revascularization (stenting of the coronary arteries or coronary artery bypass grafting) significantly improves the quality and duration of life in these patients, reducing the risk of heart attack and sudden coronary death tenfold.

Treatment is carried out in clinics:

Make an appointment

Advantages of treatment in the clinic

Experienced cardiologists with extensive experience

Stress echocardiography for diagnosing difficult cases

Safe coronary angiography with a CT scanner

Angioplasty and vascular stenting with the best stents

Diagnostics

Examination by a competent cardiologist is the most important method for diagnosing coronary artery disease. The doctor will carefully collect an anamnesis, listen to complaints and determine an examination plan.
Timely diagnosis of coronary heart disease and the correct interpretation of symptoms allow you to prescribe adequate treatment.

Symptoms of coronary heart disease

The most common symptom is angina or chest pain. On this basis, functional classes of the disease are determined. Typically, patients describe the following symptoms:

• Heaviness in the chest
• Feeling of pressure in the heart
• Aches in the chest
• Burning
• squeezing
• Painful sensations
• Dyspnea
• Palpitations (irregular heartbeat, missed beats)
• fast heartbeat
• Weakness or dizziness
• Nausea
• sweating

Angina pectoris is usually felt as pain behind the sternum, but can be given to the left arm, neck, under the shoulder blade, to the lower jaw.

A cardiologist can determine the diagnosis after:

• careful questioning
• Physical examination.
• Electrocardiography
• Echocardiography (ultrasound of the heart)
• 24-hour ECG monitoring (Holter study)
• Contrast coronary angiography (X-ray examination of the vessels of the heart)

Which patients are diagnosed with stress tests?

• With multiple risk factors for atherosclerosis and cardiovascular disease
• With diabetes
• With complete blockade of the right bundle branch of His of unknown origin
• With ST segment depression less than 1 mm on resting ECG
• Suspicion of vasospastic angina

When should a stress test be performed in combination with imaging techniques?

• in the presence of changes in the resting ECG (blockade of the left bundle branch block, WPW phenomenon, permanent artificial pacemaker, intraventricular conduction disturbances),
• if there is a decrease in the segment by 1 mm or more on the ECG at rest, caused by any reasons,
• determine the viability of the affected area of ​​the heart muscle in order to resolve the issue of the appropriateness of surgical intervention on the coronary vessels (stenting, coronary artery bypass grafting).

Who Should Have an ECG Holter Monitor?

With the development of compact recording devices in the 1970s and 1980s, it became possible to record ECG data over a long period of time in daily activities. This is how Holter ECG monitoring was born, named after its inventor, Dr. Norman D. Holter.

The main indication for its implementation is the examination of patients with fainting and palpitations, especially non-rhythmic, it is also possible to detect myocardial ischemia, both in the presence and in the absence of clinical manifestations of coronary artery disease, that is, the so-called "silent ischemia" of the myocardium. Angina attacks that occur once a day or not every day are best detected by changes on the holter. The study can be carried out in a hospital and at home.

When should echocardiography be performed in patients with coronary artery disease?

• In patients with myocardial infarction
• With symptoms of worsening heart function - peripheral edema, shortness of breath
• Patients with suspected chronic heart failure
• Determine the presence of pathology of the valvular apparatus of the heart

Indications for coronary angiography:

severe stable angina (class III or greater) despite optimal treatment
patients who have experienced cardiac arrest
life-threatening ventricular arrhythmias
patients who have previously undergone surgical treatment of coronary artery disease (stenting of the coronary arteries, or coronary artery bypass grafting), who develop early relapse of moderate or severe angina pectoris

General principles

Lifestyle changes: If you smoke, stop smoking, take more walks in the fresh air, reduce excess body weight. Avoid the dangers of eating fatty foods and eat a diet low in salt and sugar. Monitor your sugar levels carefully if you have diabetes. IHD is not treated with nitroglycerin alone. To continue an active life, it is necessary to establish contact with a cardiologist and follow his instructions.

Medications for coronary artery disease

The cardiologist may recommend drug therapy if lifestyle changes are not enough. Drugs are prescribed only by the attending physician. The most commonly prescribed drugs that reduce the risk of thrombosis (aspirin, Plavix). Statins may be prescribed to lower cholesterol for a long time. Heart failure should be treated with drugs that improve the function of the heart muscle (cardiac glycosides).

• Aspirin

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

• Antiplatelet therapy

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

• β-blockers

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

• β-blockers with proven properties to improve prognosis in coronary artery disease:
• Carvedilol (Dilatrend, Acridilol, Talliton, Coriol).
• Metoprolol (Betaloc Zok, Betaloc, Egiloc, Metocard, Vasocardin);
• bisoprolol (Concor, Niperten, Coronal, Bisogamma, Biprol, Cordinorm);

• Statins

Preparations of this group reduce the level of cholesterol in the blood by reducing its synthesis in the liver, or inhibit the absorption of cholesterol from food, affecting the causes of atherosclerosis. Medicines are used to reduce the rate of development of existing atherosclerotic plaques in the vessel wall and prevent the emergence of new ones. There is a positive effect on the degree of progression and development of symptoms of coronary artery disease, on life expectancy, and these drugs also reduce the frequency and severity of cardiovascular events, possibly contributing to the restoration of the lumen of the vessel. The target cholesterol level in patients with coronary heart disease should be lower than in those without coronary artery disease, and equal to 4.5 mmol/l. In blood tests, the target level of LDL in patients with coronary artery disease should be no more than 2.5 mmol / l. Determination of lipid levels should be carried out every month. Main drugs: lovastatin, simvastatin, atorvastatin, rosuvastatin.

• Fibrates

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

• Nitroglycerin preparations

Nitroglycerin is the main drug that relieves retrosternal pain in the heart. Nitrates mainly act on the venous wall, reducing the preload on the myocardium (by expanding the vessels of the venous bed and depositing blood). An unpleasant effect of nitrates is a decrease in blood pressure and headaches. Nitrates are not recommended for use with blood pressure below 100/60 mm Hg. Art. Modern studies have shown that taking nitrates does not improve the prognosis of patients with IHD, that is, it does not lead to an increase in survival, and therefore they are used as a drug to relieve symptoms of IHD. Intravenous drip of nitroglycerin allows you to effectively deal with the symptoms of angina pectoris, mainly against the background of high blood pressure. Every patient with coronary artery disease should know that if taking nitroglycerin at home did not relieve chest pain, then an ambulance should be called, as a heart attack may have developed.

Coronary angioplasty and stenting

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

Coronary artery bypass grafting

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

Prevention

Up to 90% of cardiovascular disease can be prevented by avoiding established risk factors. Prevention includes adequate exercise, reducing obesity, treating high blood pressure, eating healthy, lowering cholesterol, and stopping smoking. Medicines and exercise are about equally effective. A high level of physical activity reduces the likelihood of coronary heart disease by about 25%.

In diabetes, tight blood sugar control reduces heart risk and other problems such as kidney failure and blindness.
The World Health Organization (WHO) recommends "low to moderate alcohol consumption" to reduce the chances of developing coronary heart disease, while alcohol abuse is very dangerous for the heart.

Diet

A diet high in fruits and vegetables reduces the risk of heart disease and death. Vegetarians have a lower risk of heart disease due to their higher consumption of fruits and vegetables. Consumption of trans fats (commonly found in hydrogenated foods such as margarine) has been shown to cause atherosclerosis and increase the risk of coronary heart disease.

Secondary prevention

Secondary prevention is the prevention of further complications of pre-existing diseases. Effective lifestyle changes include:

• Weight control at home
• Giving up bad habits - smoking cessation
• Avoid consumption of trans fats (in partially hydrogenated oils)
• Reducing psychosocial stress
• Regular determination of blood cholesterol levels

Physical activity

Aerobic exercise such as walking, jogging, or swimming may reduce the risk of death from coronary heart disease. They lower blood pressure and blood cholesterol (LDL), and increase HDL cholesterol, which is the "good cholesterol". It is better to be treated with physical education than to expose yourself to the danger of surgical interventions on the heart.

More about treatment in our clinic

Price

Estimated cost of treatment standards

Expert advice

Ultrasound diagnostics

Laboratory diagnostics

Electrophysiological studies

Radiation diagnostics

Angiography of coronary artery bypass grafts (in addition to coronary angiography) Coronary artery bypass angiography is performed in addition to standard coronary angiography if the patient has previously undergone coronary artery bypass surgery. Allows assessing the patency of coronary bypass grafts and the condition of the coronary arteries below the anastomosis between the graft and the coronary artery.
Coronary angiography Examination of the vessels of the heart. It is carried out through a puncture in the arm. The duration of the diagnosis is about 20 minutes.
Femoral coronary angiography using a stapling device (AngioSeal) - outpatient Examination of the vessels of the heart on an x-ray unit with the introduction of contrast. Access on the thigh is used. After the examination, the puncture hole is closed with a special stapling device.
X-ray of the lungs Plain radiography of the lungs - a general x-ray examination of the chest organs in a direct projection. It allows you to assess the state of the respiratory system, heart, diaphragm. It is a screening method to rule out serious lung and heart problems in preparation for major surgery. If any pathology is suspected, additional projections for x-rays are assigned.

Hospital services

The cost of endovascular interventions on the heart

Angioplasty of one coronary artery for type A lesion according to the ACC / AHA classification (excluding the cost of stent implantation) Angioplasty and stenting of the coronary artery is performed for coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Type A lesion is the least difficult for angioplasty. The opening of the balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents, drug-coated or resorbable stents can be placed. The cost of the stent is paid separately.
Angioplasty of coronary arteries in bifurcation lesions Angioplasty and stenting of the coronary artery is performed for coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Bifurcation lesion implies angioplasty of the main artery and its large branch. The opening of this balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents, drug-coated or resorbable stents can be placed.
Angioplasty of one coronary artery for type B lesion according to the ACC/AHA classification (excluding the cost of stent implantation) Angioplasty and stenting of the coronary artery is performed for coronary heart disease, myocardial infarction to restore the patency of the narrowed artery of the heart. The intervention is performed through a puncture on the wrist or in the groin area. A special conductor is passed through the narrowed vessel, through which a balloon with a stent is passed under X-ray control. Type B lesions are moderately difficult to angioplasty. The opening of the balloon leads to the elimination of the narrowing, and the stent maintains the lumen of the artery in a passable state. Depending on the clinical situation, metal alloy stents, drug-coated or resorbable stents can be placed. The cost of the stent is paid separately.