What is ischemia? Types, causes, symptoms, treatment and consequences of ischemia. Features of coronary heart disease: what is dangerous, symptoms, how to treat pathology Degrees of coronary heart disease

08 July 2019
5532
Cardiology. Diseases of the cardiovascular system.

The most common manifestation of coronary heart disease is angina, which is a clenching pain in the chest and usually affects the cervical region, lower jaw and back, left arm. This symptom indicates a lack of blood flow to the heart. For this reason, the heart is forced to work hard.

Angina can be caused by increased exercise or other physical activity, emotional surges, such as anger or irritability. Coronary heart disease can cause what usually happens when an artery blockage is formed due to a blood clot that makes it difficult or even interferes with blood flow to the heart.

In a heart attack or myocardial infarction, an area of the heart muscle is no longer supplied with oxygen and dies. This phenomenon causes pressing pain in the chest area. Other signs of a heart attack include vomiting and excessive sweating. It has been found that approximately 30% of all heart attacks are fatal, however, most people can be saved from death if timely assistance is provided. In this regard, every person should be aware of the symptoms of a heart attack, and how to provide emergency assistance to a person.

The reasons

Coronary heart disease can have many causes, including:

smoking;
hypodynamia;
diabetes;
high blood pressure;

The main factor in the occurrence of coronary heart disease is a high concentration of cholesterol in the blood, which occurs due to the abuse of fried foods or foods containing large amounts of cholesterol.

Until recently, doctors believed that coronary heart disease most often occurs in men. However, recent research has shown that this is not the case. Coronary heart disease affects both men and women equally, it just occurs in women at a later age.

Treatment

In fact, there are no cures for coronary heart disease. But the disease can be controlled by drugs that artificially reduce the concentration of cholesterol in the blood. In addition, lifestyle plays an important role in the control of coronary heart disease. As a rule, people suffering from coronary heart disease are advised to include regular exercise in their lives, exclude fatty cholesterol foods from the diet, replacing them with fresh vegetables and fruits. Naturally, it is better for patients to quit smoking.

Angina pectoris, the most common symptom of coronary heart disease, can be treated with a variety of drugs. Nitroglycerin has been used for a long time. But now in the fight against angina pectoris, calcium channel blockers are considered much more effective. People with angina pectoris are advised to take an aspirin every day to prevent blood clots from forming.

Operation - coronary artery bypass grafting

When drugs and a healthy lifestyle do not give positive changes in the fight against coronary heart disease, the patient can undergo coronary bypass surgery. During coronary artery bypass surgery, a different path is created around the area of the blocked coronary artery for blood to flow to an area of the heart muscle that could not previously be supplied with blood.

From the patient's own biomaterial - his veins and arteries - special shunts are created. The shunt is attached to the coronary artery on one side and to the aorta on the other. In other words, it turns out a bypass for blood flow. Most often, an artery from the chest area, located from the inside of the chest, is used to create a shunt. Thus, an extremely reliable and durable bypass for blood flow is achieved, reducing the likelihood of secondary surgical intervention.

For any cardiovascular diseases, it is advisable to use biologically active. It increases the effect of traditional therapy, reduces the likelihood of severe complications. Doctors also recommend using it during the rehabilitation period after surgery on the vessels or the heart, and rehabilitation after a myocardial infarction or stroke. Regular courses are effective for preventing the occurrence of these diseases, as well as their relapses.

IHD is one of the vascular diseases that directly affects the functioning of the heart. What is coronary heart disease, what practical recommendations and knowledge are needed to combat the disease, everyone suffering from ischemia should know. Exacerbation of ischemia poses a serious threat to the life of the patient. This condition is called acute coronary death and develops suddenly and like an avalanche. Breathing stops, the work of the heart stops, the person loses consciousness. Even with timely and qualified assistance, about 60% of cases end in death. Therefore, it is so important to diagnose the initial stage of the disease in time and undergo appropriate treatment.

What is coronary heart disease and what is its cause?

The disease leads to a systematic, constant lack of sufficient oxygen by the heart. The latter, as you know, enters the organs with blood. If, for some reason, blood circulation is disturbed, then an acute lack of oxygen (hypoxia) develops. In the case of the disease under consideration, the coronary arteries are responsible for the violations of the blood supply to the heart muscle. The following factors can lead to a violation of the performance of these vessels of their functions.

Aneurysm of the thoracic aorta. Violates the proper functioning of the valve between the aorta and the heart.
Inflammation of the coronary arteries occurring in systemic diseases of the connective tissue (arteritis). Inflammatory processes lead to a narrowing of the blood flow channel.
Cardiovascular syphilis. Damage to the coronary arteries and aorta, a complication against the background of a known venereal disease.
thrombosis and embolism. Changes in the composition of the blood often lead to the formation of blood clots and blockage of blood vessels.
Atherosclerosis of the arterial walls. The main cause of coronary heart disease. With this pathology, the lumen in the vessel is significantly narrowed, which makes it difficult for the passage of blood flow.
Congenital abnormalities in the structure of the coronary arteries. In utero, some heart defects can also form.
hereditary predisposition to the disease. Typically, most people with ischemia have one or more older direct relatives who are familiar with the problem.

Risk factors

Quite often, the diagnosis of "coronary heart disease" is received by active smokers with many years of experience. Tobacco smoke tends to constrict all blood vessels in the body, including those located in the heart area. Physical inactivity (lack of motor activity) can significantly worsen the condition of the vessels. The risk is also high in those suffering from diabetes mellitus, due to disturbances in the body's carbohydrate metabolism.

In adulthood, the vessels gradually lose their qualities, so the risk of the disease increases with age.

A special predisposition to the disease is noted in overweight people. As a rule, lovers of fried, fatty and salty foods fall into this category. Salt, as a chemical substance, in itself contributes to the occurrence of atherosclerosis. Saturated fats speed up the process. Since the main cause of coronary heart disease is vascular sclerosis, overweight people are most susceptible to this disease.

Types of disease

There are two main types of coronary heart disease by localization: external and internal. Accordingly, in the latter version, the inner wall of the myocardium (heart muscle) suffers from hypoxia, in the first case, the outer one. The lack of blood supply to the outer wall is called subepicardial ischemia, and the same process inside is called « subendocardial myocardial ischemia ».

As a rule, the outer layer of the myocardium receives a stronger blood flow, and its arteries have a greater opportunity for self-regulation. Subepicardial disorders occur, much less frequently, and often after internal myocardial damage. The greater damage to the inner walls is also explained by the fact that nutrition in this part of the heart muscle occurs due to thinner vessels, which, moreover, receive constant exposure from the contracting muscles of the heart.

Symptoms

The main symptom of ischemia is angina pectoris (pressive pain in the chest, often accompanied by a burning sensation). Pain occurs paroxysmal, at regular intervals. At first, such attacks do not occur often, and the patient may not pay attention to them. But over time, they become more frequent and stronger. The following signs may indicate the presence of ischemia:

dyspnea;
weakness
nausea;
radiating pain to the left arm, neck or between the shoulder blades.

Due to fatigue, increased sweating may occur. If these signs appear, you should visit the cardiologist's office. But sometimes there is a latent ischemia, the signs of which practically do not appear. This is a special type of pathology, which is classified into several types.

It is typical for patients with coronary stenosis, without symptoms of angina pectoris or arrhythmias.
It is diagnosed in the presence in the past of attacks of a heart attack without its main precursor - angina pectoris.
There are pain signs without characteristic additional symptoms (pain, shortness of breath, etc.).

Often the reason for the absence of pain is a high pain threshold, when a person is not sensitive to any kind of pain, including in the heart area. Painless ischemia is the most dangerous in terms of timely diagnosis, since the patient's lack of reasons for timely contacting a medical institution can lead to a significant progression of the disease. That's what is dangerous ischemic heart disease in a latent form.

Diagnostics

Preliminary conclusions about the disease are made on the basis of the initial examination of the patient, which consists of several stages.

Recording patient complaints in order to identify areas for further research.
A detailed survey of the patient allows you to determine whether he belongs to any risk group for the disease.
Physical examination includes a visual examination of the patient, palpation and listening with a phonendoscope.

If the data obtained are positive and there are suspicions of a pathology of the heart, then the research continues.

For a more accurate diagnosis, echocardiography is used, which is able to assess the state of the myocardium using ultrasound cardiography, as well as the well-known ultrasound. No less reliable is Holter monitoring, the essence of which is the collection of ECG data at different times during the day. Ischemia on the ECG is diagnosed using a special portable device that takes readings and saves it for decoding. Electrocardiogram readings give an idea of what type of disease is bothering the patient.

If the symmetrical T wave is below the zero line, then we can talk about ischemia of the subepicardial type, the anterior region.
If the positive T wave is wide, this indicates the presence of subepicardial ischemia in the lower region of the myocardium.
Subendocardial ischemia on the ECG looks like a sharp T wave, symmetrical and with a significant height above the zero line.

Treatment

For effective treatment, it is necessary not only to restore the blood supply to the myocardium, but also to prevent the occurrence of possible complications. Therefore, therapy involves the use of drugs of various directions.

Nitrates

Drugs from this group are able to quickly dilate blood vessels and relieve symptoms of angina pectoris. They have a high hypotensive effect, so they need to be taken strictly dosed. These include:

Nitroglycerine;
Nitrogranulong;
Corvalment;
Corvaltab.

Nitroglycerin can cause a headache, therefore, immediately after taking it, it is better to put a validol tablet under the tongue.

B - blockers

They are one of the most important components of the complex treatment of ischemia, due to their properties to effectively promote the supply of oxygen to the heart muscle. More often than others, bisoprolol and metoprolol are prescribed. They are prescribed only by prescription, since they have a lot of contraindications, especially for those suffering from certain diseases of the lungs and respiratory tract.

Antiplatelet agents

Normalize blood circulation due to blood thinning, prevent thrombosis. Their use allows you to avoid such terrible complications as myocardial infarction and acute coronary insufficiency. These include:

Aspirin;
Ticlopidin;
Pentoxifylline.

The effectiveness of the treatment of coronary heart disease largely depends on the timely removal of fluid from the body, which allows you to more effectively reduce blood pressure. Diuretics are used for this purpose:

Hypothiazide;
Dibazol.

General cardiac preparations

This type of medication is used in complex treatment and is prescribed to increase the functionality of the cardiovascular system. One of their advantages is the supply of the heart muscle with the microelements necessary for its work. For example:

Asparkam;
Digoxin;
Verapamil.

Vitamins are also necessary for the work of the heart, especially during the period of treatment and recovery. The vitamin complex improves heart function, improves immunity and overall metabolism. The one most used here is Riboxin, which is often referred to as the heart vitamin.

Medications may have contraindications or be incompatible, so they should be prescribed by the attending physician. Only he can always be sure that such a drug is applicable in coronary heart disease and can give recommendations on its use.

If drug therapy does not bring the desired result, then one of the surgical methods of treatment is prescribed.

Stenting.
Coronary bypass.
Coronary artery bypass grafting.

Also, if necessary, an operation to remove blood clots can be prescribed.

Treatment of cardiac ischemia with folk methods

Like traditional drugs, traditional medicine has a different focus in the treatment of one disease.

To relieve pain, tincture is perfect. For its preparation, you will need valerian root, yarrow grass, hop cones and hawthorn flowers in a ratio of 2: 2: 1: 3. Brew a tablespoon of the mixture with 200 g of boiling water, cover and let it brew for 15-20 minutes. Consume the contents during the day in three equal portions, half an hour before meals.
To relieve the symptoms of arrhythmia, you can prepare an infusion of dry powder of lovage pharmacy. One tsp powder pour a glass of boiling water and leave for 4 hours. Take before meals throughout the day.
As a diuretic, cardiac glycosides, which are contained in sufficient quantities in adonis and spring adonis, will be useful. An infusion based on them also has a calming effect.
To calm down and sleep well, a collection of lemon balm, rosehip, oregano, chamomile and linden flowers helps a lot. Tincture of these components is consumed half a glass, 3 times a day before meals.

With coronary heart disease, folk remedies cannot be used as an independent treatment, but only as an addition to the main therapy. It is possible and necessary to be treated with herbal infusions and decoctions, but only after consultation with your doctor. This is also important because a person, in addition to ischemia, may have another disease in which there are contraindications to the use of one or another remedy.

Nutrition Features

Nutrition for angina pectoris and coronary heart disease involves the exclusion from the diet of excessive consumption of sugars and saturated fats of animal origin. Salt has a negative effect on blood vessels and retains water in the body. This leads to an increase in blood pressure, and hypertension is one of the most frequent companions of ischemia. You should also reduce the amount of fried foods.

With ischemia, it is much preferable to eat boiled or steamed dishes. Food should contain iron, zinc and vitamins. It is useful to add foods such as:

cereals;
nuts;
legumes;
fruits and vegetables.

During the course of treatment, the consumption of bread during the day should not exceed 250 g. Preferably rye bread and bran. Eggs only use the protein because the yolk contains high levels of cholesterol. You need to eat small meals, if possible every 3 hours.

Successful treatment of coronary disease is possible only if all conditions are met and depends on various circumstances. This includes the correctness of the selected treatment, and the degree of neglect of the disease. But there is a factor that depends only on the patient himself - this is a responsible attitude to one's health. The body has enormous abilities for self-healing, you just need not interfere with it. If you set aside enough time for rest and sleep, do not poison the body with cigarettes and do not take everything to heart, then it will respond with great gratitude.

Definition: what is meant by IHD?

Ischemic heart disease is one of the most common diseases in industrialized countries. Ischemic heart disease is a narrowing of one or more coronary vessels, which causes a violation of the blood supply to the heart muscle. This leads to insufficient supply of oxygen to the heart. As a result, the heart stops working properly. This leads to pain and a feeling of heaviness in the heart area. In the worst case, CAD can lead to a heart attack.

Causes: how does coronary heart disease occur?

The main cause of coronary heart disease is considered atherosclerosis (calcification of the arteries). When influenced by risk factors such as high blood pressure and cholesterol levels, diabetes, being overweight and smoking, this condition can lead to myocardial infarction.

Symptoms: how is coronary artery disease manifested?

Coronary heart disease in the early stages, as a rule, is asymptomatic, however, with the progression of the disease, it manifests itself mainly through the main symptom - angina pectoris. The blood flow coming through the narrowed arteries cannot provide the heart with enough oxygen, especially during physical activity (for example, climbing stairs), as a result, the patient experiences shortness of breath, a burning sensation, and pressure pain in the chest.

How is CAD diagnosed?

A variety of invasive and non-invasive methods are available for diagnosing coronary artery disease, and the latter are usually used for initial diagnosis. They include:

Resting, exercise and Holter ECG monitoring
echocardiography
scintography of the heart
MRI of the heart
CT of the heart

If the diagnosis needs to be clarified or non-invasive methods of research have not provided convincing results, it is used coronary angiography (heart catheterization) . In this case, cardiac catheterization is performed through the femoral or brachial artery and a contrast agent is injected. Thus, the narrowing in the coronary arteries becomes visible with the help of x-rays.

Treatment of coronary artery disease: drugs or surgery?

In the treatment of IHD, drug therapy is of great importance. Drugs such as aspirin (to thin the blood), beta-blockers (to decrease the heart rate and therefore the oxygen consumption of the heart) and nitrates (also to reduce the oxygen consumption) may be used.

If medical treatment does not bring the desired results, they resort to procedures such as balloon angioplasty (TBCA = percutaneous transluminal coronary angioplasty) or bypass surgery.

In balloon angioplasty, immediately after coronography, a balloon catheter is advanced to the site of narrowing of the vessel. The balloon reaches the point of constriction and begins to expand it. A stent (flexible metal tube) is placed to prevent re-constriction of the vessels.

In especially severe cases of ischemic disease, surgery is performed shunting . By transplanting a vein or artery taken from the patient's limb, a "workaround" is made for the site of narrowing. The operation can be performed either on a beating heart or using minimally invasive techniques.

What is the life expectancy for coronary heart disease?

The prognosis for coronary artery disease depends on many factors, the decisive of which are the number of coronary arteries affected, the location of the narrowing, the severity of the disease, and the presence of other diseases, such as diabetes or circulatory disorders in other organs.

Early diagnosis and treatment of the disease is the key to a favorable prognosis, since neglected disease can lead to a heart attack.

Also, the long-term favorable prognosis depends on whether the patient can fundamentally change his lifestyle. It is important to adhere to the following rules:

enough exercise
healthy eating
to give up smoking
obesity prevention
regular medication

Existing treatment options for coronary artery disease generally lead to good outcomes. For patients, this means a long life without complaints.

Which doctors and clinics are specialists in the treatment of coronary heart disease in Germany and Switzerland?

A person who suffers from coronary heart disease wishes to receive the best medical care. Thus, the patient wonders where to find the best clinic for the treatment of coronary artery disease or the best cardiology clinic in Germany, Switzerland or Austria ?

Since this question is difficult to answer objectively, and a real doctor will never claim to be the best, one can only rely on the experience of a specialist. These are cardiologists and cardiac surgeons who specialize in the treatment of coronary artery disease and have many years of experience.

PRIMO MEDICO will help you find an experienced specialist or clinic for the treatment of narrowed coronary arteries. All doctors and clinics have been accepted into the PRIMO MEDICO database based on their experience and reputation. They are waiting for your requests for an additional opinion, cost estimate or duration of treatment.

Who among us has not experienced pain in the heart at least once in our lives? Unfortunately, there are very few such people. For some, pain in the heart occurs at a time, for others - quite often. There are many reasons for such sensations, one of them is coronary heart disease. IHD - what it is, how it manifests itself and how this article will deal with it.

Ischemic heart disease is a disease in which there is a discrepancy between the need of the heart muscle for oxygen and its delivery to it. It can be both an acute process and a chronic one.

Causes

IHD is a disease that occurs when there is insufficient blood flow to the heart. This leads to damage to the coronary arteries. This can happen in the following cases:

atherosclerotic lesion is the main cause of the disease. An atherosclerotic plaque growing in a vessel closes its lumen, as a result of which a smaller volume of blood passes through the coronary artery;
congenital genetic anomalies of the coronary arteries - a malformation that was formed in utero;
inflammatory diseases of the coronary arteries (coronaritis) arising from systemic connective tissue diseases or periarteritis nodosa;
aortic aneurysm, which is in the process of dissection;
syphilitic damage to the walls of the coronary vessels;
thromboembolism and embolism of the coronary arteries;
congenital and acquired heart defects.

Risk group

Etiological factors include risk factors that are divided into 2 groups - those that change and do not change (that is, those that depend on the person and those that the person cannot change).

Unchangeable risk factors:

Age - 61 years and older (according to some sources and 51 years).
Burdened heredity - the presence of atherosclerosis, coronary heart disease in the immediate family (parents, grandparents).
Gender - predominantly occurs in men, coronary artery disease in women is much less common.

Modifiable risk factors:

Insufficient physical activity.
Prolonged increase in blood pressure, then blood pressure (arterial hypertension or hypertension).
Overweight and metabolic syndrome.
Dyslipidemia is an imbalance between “good” (high density lipoproteins) and “bad” (low density lipoproteins) lipids towards the latter.
Long history of smoking.
Concomitant disorders of carbohydrate metabolism - diabetes mellitus or prolonged hyperglycemia.
Eating disorders - eating fatty foods rich in simple carbohydrates, eating large amounts of food, non-compliance with its intake regimen.

Development mechanisms

IHD is what is defined as a mismatch between myocardial oxygen demand and oxygen delivery. Consequently, the mechanisms of development are associated precisely with these two indicators.

The heart's need for the amount of oxygen it needs is determined by the following indicators:

the size of the heart muscle;
contractility of the left and right ventricles;
the value of blood pressure;
heart rate (HR).

Failure in the delivery of oxygen occurs mainly due to the narrowing of the lumen of the coronary vessels by atherosclerotic plaques. In the affected vessels, their inner membrane is damaged, as a result of which the endothelium stops secreting vasodilators and begins to produce vasoconstrictors, which further reduces the lumen of the vessels.

Another mechanism of development is the rupture of an atherosclerotic plaque, as a result of which platelets adhere to the site of damage to the vascular wall, forming platelet masses that close the lumen of the vessels, reducing the flow of blood passing through.

Types of IHD

Ischemic heart disease is classified as follows:

SCD is sudden cardiac death.
Angina:

at rest;
in tension (unstable, stable and first appeared);
spontaneous.

painless ischemia.
Myocardial infarction (small and large focal).
Cardiosclerosis after a heart attack.

Sometimes two more items are included in this classification, such as heart failure and heart rhythm disturbance. This classification of coronary artery disease was proposed by the WHO and has not changed much to date. The above diseases are clinical forms of IHD.

Clinical picture

Symptoms of coronary artery disease depend on its clinical form. They can vary in strength, duration and nature of pain, in the presence or absence of certain symptoms.

Sudden cardiac death

This is death that occurs within one hour of the onset of cardiac symptoms, associated with cardiac causes, natural, preceded by loss of consciousness.

The causes of sudden death are directly IHD, congenital heart defects, cardiomyopathies, anomalies of the coronary arteries and Wolff-Parkinson-White syndrome (ventricular preexcitation).

Symptoms of this (clinical) CAD may begin with vague chest pain, followed by shortness of breath, palpitations, and weakness after a few weeks. After the onset of these symptoms, a sudden loss of consciousness occurs (as a result of cardiac arrest, cerebral circulation stops). On examination, dilation of the pupils, the absence of all reflexes and pulse, respiratory arrest is revealed.

Stable exertional angina

This form is characterized by the occurrence of pain behind the sternum, which appear during exercise and / or strong emotions, when in the cold, and can also appear in a calm state, when eating a large amount of food.

In this clinical form, you can understand a little more about what it is, called coronary disease. As a result of the various causes that have been described above, myocardial ischemia occurs, and at first the layers that are located under the endocardium suffer. As a result, the contractile function and biochemical processes in cells are disrupted: since there is no oxygen, the cells switch to an anaerobic type of oxidation, as a result of which glucose decomposes to lactate, which reduces intracellular pH. A decrease in the intracellular acidity index leads to the fact that the energy in cardiomyocytes is gradually depleted.

In addition, angina leads to the fact that the concentration of potassium inside the cell decreases, while the concentration of sodium increases. Because of this, there is a failure in the process of relaxation of the heart muscle, and the contractile function suffers for the second time.

Depending on the tolerance of cardiac stress, the Canadian Society of Cardiology has identified the following functional classes of angina pectoris:

Functional class (FC) I - an attack of angina pectoris is not caused by normal physical exertion, but occurs only with very strong or prolonged stress.
FC II equates to mild limitation of physical activity. In this case, the attack is provoked by walking more than 200 m on level ground or climbing more than one flight of stairs.
FC III - a significant limitation of physical activity, in which pain behind the sternum occurs already when walking on level ground or climbing one flight of stairs.
With IV FC angina pectoris, any physical activity without discomfort and pain behind the sternum is impossible, and seizures can also occur at rest.

Symptoms of coronary disease include pain and its equivalents (shortness of breath and severe fatigue). The pain is localized behind the sternum, lasts from 1 to 15 minutes, has an increasing character. If the duration of discomfort is more than 14 minutes, there is a danger that this is no longer angina pectoris, but a myocardial infarction. There are two conditions for the cessation of unpleasant sensations: the abolition of physical. loading or taking nitroglycerin under the tongue.

The pain can be compressive, pressing or bursting in nature, while there is a fear of death. Irradiation occurs both in the left and right parts of the chest, in the neck. Irradiation to the left arm, shoulder and shoulder blade is considered classic.

Signs of coronary heart disease include accompanying symptoms: nausea, vomiting, excessive sweating, tachycardia, and increased blood pressure. The patient is pale, freezes in one position, as the slightest movement increases the pain.

Unstable angina (UA)

NS is an acute myocardial ischemia, the severity and duration of which is insufficient for the occurrence of myocardial infarction.

This type of IHD occurs due to the following reasons:

a sharp spasm, thrombosis or embolization of the coronary arteries;
inflammation of the coronary vessels;
rupture or erosion of an atherosclerotic plaque with further formation of a thrombus on the damaged vessel surface.

Symptoms of coronary heart disease include typical and atypical complaints. Typical complaints include prolonged pain syndrome (more than 15 minutes), the presence of pain at rest, as well as nocturnal attacks. With atypical complaints, pain occurs in the epigastric region, indigestion, which develops acutely, and increased shortness of breath.

Unlike myocardial infarction, there are no markers of necrosis in the blood. This is the main difference in the differential diagnosis.

Prinzmetal's angina

This type belongs to the variant, in which discomfort behind the sternum appears at rest, while the transient rise of the ST segment is determined on the electrocardiogram. It occurs due to a temporary, transient spasm of the coronary arteries; variant angina pectoris is in no way connected with physical activity. The pain attack can stop both independently and after taking nitroglycerin.

Ischemic heart disease of this type is characterized by the occurrence of typical senocardiotic pain behind the sternum, more often at night or early in the morning, lasting more than 15 minutes. A concomitant symptom is the appearance of migraine and, and also in the presence of this type of angina pectoris, the presence of aspirin asthma is very often detected.

A diagnostic sign is sudden onset of fainting, due to ventricular arrhythmias that appear at the peak of pain.

The cause of myocardial ischemia in this case is not its increased need for oxygen, but simply a decrease in oxygen delivery to the heart muscle.

Diagnosis of coronary heart disease

Diagnosis of coronary artery disease includes anamnesis, physical examination data (described above), as well as additional research methods:

ECG - is one of the main diagnostic methods, one of the first reflects the changes occurring during an attack in the myocardium: rhythm and conduction disturbances are possible. In unclear diagnostic cases, 24-hour ECG monitoring (Holter) is performed.
Laboratory studies - complete blood count (no specific changes), biochemical blood test (increase in biochemical markers of myocardial necrosis: troponins, CPK, myoglobin).
Stress tests are used for differential diagnosis of clinical forms of coronary heart disease among themselves, as well as coronary artery disease with other diseases, to determine individual exercise tolerance, examination of working capacity or to evaluate the effectiveness of treatment.

Cases when stress tests cannot be done: fresh myocardial infarction (less than 7 days), the presence of unstable angina pectoris, acute cerebrovascular accident, thrombophlebitis, fever, or the presence of severe pulmonary insufficiency.

The essence of this technique is a stepwise dosed increase in physical. load, at which simultaneous recording of an electrocardiogram and registration of blood pressure is carried out.

A test is considered positive, in which typical pain behind the sternum appears, without a change in the ECG. If signs of ischemia occur, the test should be stopped immediately.

Echocardiographic study - conducting, in order to assess its contractility. It is possible to conduct a stress ultrasound, in which the mobility of the structures and segments of the left ventricle is assessed during: after the administration of dobutamine or physical activity. It is used to diagnose atypical forms of angina pectoris or when it is impossible to carry out stress tests.
Coronary angiography is the gold standard for diagnosing coronary heart disease. It is carried out with severe types of angina pectoris or severe myocardial ischemia.
Scintigraphy - visualization of the heart muscle, in which it is possible to identify areas of ischemia (if any).

IHD treatment

Treatment of coronary heart disease is complex and can be both medical (conservative and surgical) and non-drug.

Non-drug treatment of coronary artery disease includes the impact on risk factors: elimination of malnutrition, reduction of excessive body weight, normalization of physical activity and blood pressure, as well as correction of carbohydrate metabolism disorders (diabetes mellitus).

Drug treatment is based on the appointment of various groups of drugs for the most complete and comprehensive treatment. The following main groups of drugs are distinguished:

Nitrates

Short-acting - used to stop an attack and are not suitable for treatment. These include nitroglycerin, the effect of which occurs within a few minutes (from one to five).
Long-acting - these include isosorbide mono- and dinitrate, are used to prevent seizures.

Beta-blockers - to reduce myocardial contractility:

Selective (block only one type of receptor) - metoprolol and atenolol.
Non-selective (block all sympathetic receptors that are located both in the heart and in other organs and tissues) - propranolol.

Antiplatelet agents (aspirin, clopidogrel) - reduce blood clotting by affecting platelet aggregation.
Statins - simvastatin, nystatin (reduce the concentration of cholesterol in low-density lipoproteins, that is, they affect risk factors).
Metabolic agents - preductal, increases the delivery of oxygen to the heart muscle.
Angiotensin-converting enzyme inhibitors (lisinopril, ramipril) or angiotensin receptor blockers (losartan, valsartan).

It is possible to use combinations of these drugs.

Surgery

Surgical treatment of coronary heart disease consists of two main methods: percutaneous transluminal coronary angioplasty (balloon dilatation) and coronary bypass grafting.

Balloon dilatation is the treatment of choice for single- or dual-vessel disease with normal left ventricular ejection fraction. A balloon is inserted under high pressure into the narrowed area of the coronary artery, which is inflated and fixed. A stent can be implanted to prevent re-stenosis.
Coronary artery bypass grafting is an operation in which an anastomosis is created between the internal mammary artery or aorta and the coronary artery below the site of narrowing. As a result, the blood supply to the myocardium is restored. It is the method of choice for two- or three-vessel disease, a decrease in the left ventricular ejection fraction of less than 45%, and in the presence of concomitant pathology (for example, diabetes mellitus).

Coronary bypass surgery should be used in the following cases:

narrowing of the left coronary artery by more than 50%;
IHD III and IV functional classes, which is not amenable to active therapy;
severe ischemia in combination with narrowing of two or more coronary arteries.

Complications after the procedure are divided into early and late. The early ones include death and the occurrence of myocardial infarction. To late - the recurrence of stenosis in the coronary arteries.

Ischemic disease is a formidable disease, but many people do not understand this and try to be treated on their own, with folk remedies. This can lead to severe consequences, even death.

Doctors recommend the use of folk remedies not instead of, but together with medical treatment or as a preventive measure in the presence of risk factors. Some of these remedies include hawthorn, wild rose, motherwort and buckwheat. In general, in medicine one cannot self-medicate, especially in the presence of this pathology, and even the use of folk remedies should be discussed with the doctor.

In the presence of cardiac ischemia, the treatment and symptoms of the disease differ somewhat depending on what clinical form the patient has.

Thus, coronary artery disease is a dangerous disease both in itself and in the development of complications. With timely diagnosis and treatment, the disease has a favorable outcome. The main thing is not to delay going to the doctor, especially if you have symptoms or at least one of the risk factors.