Signs and treatment of coronary heart disease

The concept of coronary heart disease

The term "ischemia" is derived from two Greek words ischo (to restrain) and haima (blood). Since the blood delivers to the muscles the oxygen and nutritional compounds that delay has a detrimental effect on the functioning of the organs. This applies to the heart muscle.

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

If the permeability of these larger vascular of good, heart is in the right mode. The walls of healthy arteries, normal smooth and elastic. When physical or emotional tension they stretch, flowing to the heart the right amount of blood.

In atherosclerosis the inner walls of the blood vascular acquire cholesterol plaques. The lumen of the artery decreases, their walls thicken and lose their elasticity. The blood reaches the heart in a sufficient amount.

On the background of poor blood supply in the heart muscle begin biochemical and tissue changes. Symptoms of cardiac ischemia requiring urgent visit to the doctor.

Forms of ischemic heart disease

Classification of ischemia in cardiology still has no clear boundaries. A variety of clinical manifestations, a combination of different types of the disease, the development of medicine is constantly changing the view of cardiologists on the mechanisms of occurrence of CHD. Today, according to the who classification, ischemia of the heart is divided into several types.

Sudden coronary death

This is the most severe form of the disease. Characterized by unexpected cardiac arrest that occur against the background of relatively stable state.

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 in normal conditions, outside the hospital, which determines the high mortality of this category of IBS.

Painless myocardial ischemia

Form threat the fact thatsigns of coronary heart disease are absent, and the disease often ends in sudden death. Not appearing, painless ischemia contributes to the development of arrhythmias and congestive heart failure.

Angina

Another name — angina pectoris. Different paroxysmal over. During the attack there is a sharp retrosternal pain that radiates to the arm, shoulder, under the left shoulder blade. The person experiences shortness of breath and interruptions in heart, pale, takes a forced position.

Angina manifests itself in cases when the heart needs increased blood flow:

• Nervous or physical stress;
• A rich meal;
• Running or walking against a strong wind;
• Lifting weights.

Attack resolves spontaneously or under the influence of drugs. The patient usually carries with him tablets that help him — nitroglycerin, nitromint, validol.

Over time, the angina develops, passing a difficult phase. Pain appear for no reason, at rest. This is a dangerous symptom that requires urgent medical measures.

Myocardial infarction

A heart attack may cause protracted angina, severe anxiety, heavy physical activity. Increased blood flow is fraught with separation of the plaque and blockage of the stenotic vessel. As a result of acute heart failure occurs necrosis of myocardial tissue.

If the plaque completely closed the lumen of the artery, evolving transmural (large-focal) THEM when a large area of the myocardium. In case of partial blockage of necrosis is small character. According to testimony carried drug therapy, thrombolysis, emergency angioplasty with stenting.

Postinfarction cardiosclerosis

Pathology is a direct consequence of suffering a heart attack. In the cardiac muscle begins to grow scar tissue, replacing dead areas of the myocardium. Cardio manifested heart failure.

This is a condition in which diminished heart contractility, and the main body cannot provide the body with necessary amount of blood. Diagnosed with this form of IBS in 3-4 months after mi when the scarring process ends.

As a result, patients have various abnormalities of blood circulation, hypertrophy of the heart chambers, atrial fibrillation,ventricular arrythmia. It is manifested by shortness of breath, edema, cardiac asthma, tachycardia.

Arrhythmia and heart failure if infarction is irreversible, the treatment gives only a temporary effect.

Causes of cardiac ischemia

In the development of the pathological process play a role in certain circumstances, contributing to the emergence and progression of the disease. Some of them people may be influenced (disposable), others are not (fatal).

Fatal factors

• Sex. Cardiovascular disease men develop more often. The fact that the estrogen in women of childbearing age perform a protective function - inhibit the production of cholesterol.
• Heredity. If direct relatives of the patient on the paternal side suffered a myocardial infarction before 55 years of age, and direct relatives on my mother's side — up to 65 years, the risk of early development of coronary artery disease increases significantly.
• Race. According to the world health organization, Europeans (especially in Northern regions) is much more common in IBS than Negroid populations.
• Age. Atherosclerotic changes in blood vascular begin in childhood and develop gradually. If 35-year-old man die from coronary disease only in 10% of cases, after 55 years, the mortality from cardiac ischemia increases to an average of 56 % (women over 55 years — 40%).

Disposable factors

People can cope with some reasons causing ischemia of the heart. Often the removal of one negative phenomenon entails the subsequent positive developments.

For example, reducing the amount of fat in the diet leads to improvement in blood and at the same time to get rid of extra pounds. As a result of lower body weight becomes the normalization of blood pressure, and all this together reduces the risk of coronary artery disease.

The list of avoidable risk factors:

• Smoking. The risk of sudden coronary death in smokers is much higher than those who do not smoke or quit this harmful habit. Smokers are 20 times more likely to develop atherosclerosis. In men over 62 years, mortality from CHD increases by half, when compared with non-smokers of the same age group). A pack of cigarettes a day doubles the risk of death from CHD.
• Obesity. Judging by the results of world studies, almost half of middle-aged people are overweight. The reasons are mostly banal — the fascination with sweets and fatty foods, regular overeating, sedentary lifestyle.
• Chronic stress. At constantemotional tension the heart is overloaded, raised HELL, deteriorating delivery of nutrients to the internal organs.
• Lack of exercise. Physical activity is essential to the preservation of health. In men engaged in heavy labor, the risk of coronary disease is lower when compared with office workers.

Diseases that increase the risk of coronary artery disease

Diabetes

Found that all patients with diabetes for at least 10 years, have expressed atherosclerotic changes in vascular. The risk of IHD is increasing in 2 times. The most common cause of death in diabetes myocardial infarction.

Atherosclerosis of the coronary arteries

It is proved that the overwhelming majority of patients with coronary heart disease have a 75 percent stenosis of one or more of the major arteries.

Simply put, the lumen of the vessel carrying blood to the heart, three quarters closed lipid (fat) plaques.

In this situation the heart muscle is chronically suffering from oxygen starvation. In humans, even at low load starts dyspnea.

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

Arterial hypertension (hypertension)

Under high pressure the heart works with a constant overload. This leads to the growth of the left ventricle, which in itself is a high predictive factor of mortality.

Clotting of blood

Thrombosis of major vessel caused by clotting of red blood cells, is an essential mechanism of development of myocardial infarction and coronary insufficiency.

Symptoms of IBS

Coronary heart disease occurs in waves: periods of exacerbation followed by relative calm. The first symptoms of coronary heart disease is very subjective: painful sensations and dull pain behind the breastbone at any significant voltage. At rest the pain goes away.

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

A burning gripping pain behind the sternum, often occurring on the background of complete rest (which is a poor clinical sign). The pain usually radiates to the shoulder girdle, but can spread to the groin area.

• Shortness of breath, fatigue;
• Fainting and dizziness;
• Severe sweating;
• Pallor, cyanosis, low body temperature;
• Lower extremity swelling and dyspnea, forcing patient to take a forced posture. It is typical for ischemic heart disease in stage chronic heart failure;
• Palpitations or feeling of heart-stopping.

It is important not to leave these symptoms unattended. You need time to go to a cardiologist, and when threatening conditions to call an ambulance.

The peculiarities of coronary heart disease in women

The first symptoms of CHD in women appear later about 15-20 years than men. Doctors attribute this phenomenon to the hormonal status of women of childbearing age.

Estrogens in the female body increases the level of "good cholesterol" - high density lipoproteins and reduces the amount of lipoproteins of low and very-low-density — "bad cholesterol". Progesterone (male hormone) acts on the contrary.

After menopause this advantage is lost. Female body after the age of 55 years are also susceptible to ischemic heart disease to the same extent as men. Pain attacks mostly happen as a result of nervous tension or strong fear, so the stress tests during the examination is uninformative. Women are more common atypical signs of illness: weakness, nausea, vomiting, heartburn, chest pain of uncertain nature.

Symptoms of IBS in children

In childhood heart disease practically does not manifest with chest pain do not exist. However, parents should worry the following symptoms

• Shortness of breath and fatigue;
• Unexplained pallor;
• Cyanosis of the lips and nasolabial triangle;
• Underdevelopment and weight;
• Frequent colds.

All of these can be symptoms of incipient coronary disease.

Diagnosis

Examination of the patient performed by the physician-a cardiologist. First, patient interviewing, figuring out complaints and syndromes, characteristic for ischemia. The doctor examines the patient and listens to the heartbeat, identifying the presence of arrhythmias, a heart murmur, cyanosis of the skin. Further assigned the following studies:

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

ECG at rest and during stepwise increasing exercise. The EKG shows an abnormal myocardium.

The disease is often prescribed Holter ECG monitoring. Its essence is that the belt of the patient is attached to a portable device, taking the readings during the day. All this time the patient must keep a diary of self-observation where hourly indicates their own actions andchanges in well-being. The method detects not only violations in the work of the myocardium, but also their causes.

Chest x-ray

Echocardiography (cardiac ultrasound) is performed to determine the size of the heart muscle, myocardial contractility, the state of the cavities and valves. In some cases, prescribe stress echocardiography — ultrasound study with dosed physical load.

If the results of the survey do not give the full picture, perhaps the appointment of transesophageal ultrasound. The sensor is inserted into the esophagus and records the readings of the heart without interference from the chest wall, skin and subcutaneous tissue.

Treatment strategy

Therapy IBS has three main goals — to relieve the patient from heart attacks and to prevent the occurrence of dangerous complications of sudden death and myocardial necrosis. Treatment of coronary heart disease is carried out in several directions.

Non-drug therapy

This includes correction of diet and lifestyle. Shows the limitation of physical activity, since in this case there is a failure of blood supply to the heart. With the improvement of the condition of the patient mode of the load is gradually expanding. Recommended low-calorie diet with the exception of fats and rapidly absorbed carbohydrates (pastries, sweets, cakes).

Drug therapy

Is carried out according to the formula ABC (antiplatelet agents, beta-blockers and cholesterol-lowering drugs).

Patients are assigned to the following drugs:

• To normalize cholesterol levels — statins and fibrin.
• To prevent thrombosis — anticoagulants, fibrolysin.
• Blood pressure — ACE inhibitors and beta-blockers.
• For the relief of stenokardicheskie seizures nitrates.

Surgery

If drug therapy is ineffective and the disease progresses, a cardiologist raises the question of surgery. Depending on the severity of the CHD is assigned to coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG).

Angioplasty

This is a less traumatic surgery for mechanical dilatation of stenotic vascular. It is done through a small incision in the radial or femoral artery. In a vessel having a long flexible tube and advance it to the narrowed area.

Further down the tubehold the catheter with a balloon. When they reached the place of the stenosis, the balloon is gently inflated. A fatty plaque that covers the lumen of the artery, severed, and blood flow is restored.

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

Angioplasty with stenting is assigned to patients with coronary artery disease, uncomplicated diabetes mellitus, severe hypertension, and old myocardial infarction.

Coronary artery bypass grafting

aimed at creating detours for blood flow (anastomosis), which will be an equivalent replacement of the affected vascular. The operation is clearly shown in the following cases:

• Angina, high functional class of the patient when it is difficult to walk, eat, care for himself.
• Stenosis of three coronary vascular feeding the heart muscle (detected at coronary angiography).
• In the presence of an aneurysm of the heart, complicated by atherosclerosis of the major arteries.

During surgery the chest open all the way or make the incision in the intercostal space, depending on the extensiveness of the lesion. For shunt take a cut vein in the leg or a fragment of a radiation (or internal thoracic) artery. The option of the arteries is preferable to 95% of such anastomoses successfully operating for 20 years or more.

Next, the surgeon connects the shunt section of the coronary artery below the narrowed space. The other end of the shunt is sutured to the aorta. So created a workaround that ensures adequate blood supply to the myocardium.

Traditional treatment of IBS

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

• Per liter of honey, 10 lemons and 5 heads of garlic. Lemons and garlic are crushed and mixed with honey. The composition kept a week in a cool dark place, after insisting take a teaspoon four times a day.
• 500 g of vodka and honey mix and heat to form a foam. Take a pinch of motherwort, cudweed, Valerian, knotweed, chamomile. Grass boil, let settle, strain and mix with honey and vodka. Take morning and evening, first on a teaspoon, after a week in the dining room. The course of treatment.
• Mix a spoonful of grated horseradish and a spoonful of honey. Taken one hour before meals and drink water. The course of treatment — 2 months.

Traditional medicines will help, if you follow two principles — regularity and exact adherence to the recipe.

In conclusion. The development of coronary disease depends on the patient. Special attention must be paid to eliminate the risk factors — stop Smoking and other addictions, to establishthe diet and regimen of physical activity.

It is essential to visit a cardiologist and follow his recommendations to treat the underlying disease, time to take the test on glucose level and lipids. The result will be the improvement of cardiac function and improved quality of life.