Coronary heart disease: symptoms, treatment. Prevention of coronary heart disease

Chronic ischemic heart disease is a special pathological condition in which there is a complete or partial disruption of the supply nutrients and oxygen of myocardial tissue, against the background of existing damage to the coronary arteries. Due to circulatory disorders in the coronary arteries, there is a gradual death of myocardial tissue that feeds from these blood vessels.

This pathological condition has a lot characteristic manifestations and without proper treatment ultimately leads to death due to heart attack or acute heart failure. In statistics of mortality from cardiovascular diseases, coronary disease accounts for more than 35% of all cases.

Common Causes

Considering that coronary heart disease is extremely common, all etiological factors appearance of this pathological condition already well studied. Most often, such damage to heart tissue is observed in men. Among other things, the main predisposing factors for the development of IHD include age. The thing is that most often people over the age of 40 suffer from coronary heart disease. In reality, the causes of chronic coronary heart disease are not always rooted in a person’s gender and age characteristics. There are many diseases and factors that contribute to the development of chronic coronary heart disease, including:

• excess weight;
• low physical activity;
• severe stress;
• smoking;
• alcoholism;
• diabetes;
• tachycardia;
• arterial hypertension;
• thrombosis;
• atherosclerosis;
• spasm of the coronary arteries.

As practice shows, chronic coronary heart disease is often the result of a combination of unfavorable factors. The thing is that the majority modern people lead a sedentary lifestyle, have a lot of extra pounds, eat food, rich in fat and easily digestible carbohydrates, and in addition, they have bad habits. This predisposes to the appearance of atherosclerotic plaques and pathological changes in the walls of blood vessels.

It is worth noting that it is modern living conditions that predispose to the appearance of such disorders of the coronary arteries, therefore residents of megacities develop this disease much more often and at an earlier age than those who live in the countryside and are engaged in agriculture. In addition, in residents of megacities, chronic coronary heart disease occurs in a more severe form than in people who live in rural areas.

Among other things, it should be taken into account that a separate role is assigned to genetic predisposition. Most people suffering from chronic coronary heart disease have close relatives who have the same disease. Currently, changes in genes have been established that may predispose to the appearance of coronary artery disease, but still, if a person active image life, it is quite possible to delay the occurrence of critical damage to the coronary vascular walls.

Symptomatic manifestations

Despite the fact that chronic cardiac ischemia is an extremely dangerous disease, such a disorder can occur with both severe symptoms and a painless scenario. Chronic coronary heart disease, which occurs without any pronounced symptomatic manifestations, is currently considered the most dangerous course, since a person suffering from this disease does not feel any discomfort and therefore cannot consult a doctor in a timely manner. With a painless course of the disease, existing pathologies of the coronary arteries are often detected when changes in the myocardium have already become irreversible and difficult to treat.

In most patients, chronic coronary heart disease develops according to the traditional scenario. Symptoms of chronic coronary heart disease increase gradually. Signs of development include:

• arrhythmia;
• decreased tolerance physical activity;
• dyspnea;
• weakness in the legs;
• swelling of the lower extremities;
• anxiety attacks;
• unreasonable fears;
• fast fatiguability.

In some cases, in the absence of targeted treatment, a condition such as sudden coronary death may develop. This condition can develop either instantly or within a day. Coronary death in HIHD is accompanied by loss of consciousness, dilated pupils, and in addition, respiratory arrest and disruption of the heart muscle. When coronary death develops, even with timely assistance, only 20% of patients have the opportunity to survive.

Diagnostic methods

When chronic coronary heart disease appears, it is very important to immediately consult a neurologist. Among other things, after a person reaches 40 years of age, it is necessary to undergo preventive examinations, since only in this case is it possible to identify heart pathologies on early stages their development. To make a diagnosis, anamnesis is taken and heart sounds are also listened to. The presence of edema and shortness of breath is indicative. To confirm the diagnosis, necessary measure is to conduct a number of studies, including:

• electrocardiography;
• myocardial scintigraphy with thallium;
• stress echocardiography;
• coronary angiography;
• echocardiography.

In some cases, they may be prescribed additional research, which allow you to assess the condition of blood vessels. Carrying out comprehensive examination blood vessels allows you to predict the course of the disease and select adequate treatment.

Treatment

Therapy methods are selected depending on the existing stage of neglect of pathological cardiac ischemia.

First of all, drugs are selected to stabilize the heart. Drugs are always selected individually, since only in this case it is possible to determine optimal treatment. Usually selected medicines belonging to the following groups:

• β-blockers;
• antiplatelet agents;
• cholesterol-lowering drugs;
• nitrates;
• natural lipid-lowering drugs;
• anticoagulants;
• diuretics;
• angiotensin-converting enzyme inhibitors;
• antiarrhythmic drugs;
• metabolic cytoprotectors.

Good day, dear readers!

In today's article we will look at a disease such as coronary heart disease (CHD), as well as its symptoms, causes, classification, diagnosis, treatment, folk remedies and prevention of ischemic heart disease. So…

What is coronary heart disease?

Coronary heart disease (CHD)– a pathological condition that is characterized by insufficient blood supply and, accordingly, oxygen to the heart muscle (myocardium).

Synonyms for IHD– Coronary heart disease (CHD).

The main and most common cause of IHD is the appearance and development of atherosclerotic plaques in the coronary arteries, which narrow and sometimes block the blood vessels, thereby disrupting the normal flow of blood in them.

Now let's move on to the development of the IHD itself.

The heart, as you and I know, is the “engine” of a person, one of the main functions of which is pumping blood throughout the body. However, like a car engine, without sufficient quantity fuel, the heart stops functioning normally and may stop.

The function of fuel in the human body is performed by blood. Blood delivers oxygen, nutrients and other substances necessary for normal functioning and life to all organs and parts of the body of a living organism.

The blood supply to the myocardium (heart muscle) occurs through 2 coronary vessels that arise from the aorta. The coronary vessels, divided into a large number of small vessels, go around the entire heart muscle, feeding each section of it.

If there is a decrease in the lumen or blockage of one of the branches of the coronary vessels, that part of the heart muscle is left without nutrition and oxygen, and the development of coronary heart disease, or as it is also called, coronary heart disease (CHD), begins. How larger artery becomes clogged, the worse the consequences of the disease.

The onset of the disease usually manifests itself in the form of pain in the chest during severe physical exertion (running and others), but over time, if no action is taken, pain and other signs of IHD begin to haunt the person even during rest. Some signs of IHD are also shortness of breath, swelling, dizziness.

Of course, the above-described model of the development of coronary heart disease is very superficial, but it reflects the very essence of the pathology.

IHD - ICD

ICD-10: I20-I25;
ICD-9: 410-414.

The first signs of IHD are:

• Increased blood sugar levels;
• Increased cholesterol levels;

The main signs of IHD, depending on the form of the disease, are:

• Angina pectoris- characterized by pressing pain behind the sternum (which can radiate to left side neck, left shoulder blade or arm), shortness of breath during exercise ( fast walk, running, climbing stairs) or emotional stress(stress), increased blood pressure, ;
• Arrhythmic form- accompanied by shortness of breath, cardiac asthma, pulmonary edema;
• – a person develops an attack of severe pain in the chest, which is not relieved by conventional painkillers;
• Asymptomatic form– the person does not have any obvious signs indicating the development of coronary artery disease.
• , malaise;
• Edema, mainly;
• , clouding of consciousness;
• , sometimes with attacks;
• Heavy sweating;
• Feelings of fear, anxiety, panic;
• If you take nitroglycerin during painful attacks, the pain subsides.

The main and most common cause of the development of IHD is the mechanism of which we talked about at the beginning of the article, in the paragraph “Development of IHD”. In short, the essence is the presence of atherosclerotic plaques in the coronary blood vessels, narrowing or completely blocking the access of blood to one or another part of the heart muscle (myocardium).

Other causes of IHD include:

• Eating – fast foods, lemonades, alcoholic products and etc.;
• Hyperlipidemia ( increased level lipids and lipoproteins in the blood);
• Thrombosis and thromboembolism of the coronary arteries;
• Spasms of the coronary arteries;
• Dysfunction of the endothelium (the inner wall of blood vessels);
• Increased activity of the blood coagulation system;
• Damage to blood vessels - herpes virus, cytomegalovirus, chlamydia;
• Hormonal imbalance (with the onset of menopause, and other conditions);
• Metabolic disorders;
• Hereditary factor.

The following people are at increased risk of developing CHD:

• Age – the older a person is, the higher the risk of developing IHD;
• Bad habits – smoking, alcohol, drugs;
• Poor quality food;
• Sedentary lifestyle;
• Exposure to frequent ;
• Male gender;

Classification of IHD

Classification of IHD occurs in the form:
1. :
— Angina pectoris:
— — Primary;
— — Stable, with indication functional class
— Unstable angina (Braunwald classification)
- Vasospastic angina;
2. Arrhythmic form (characterized by cardiac arrhythmia);
3. Myocardial infarction;
4. Post-infarction cardiosclerosis;
5. Heart failure;
6. Sudden coronary death (primary cardiac arrest):
— Sudden coronary death with successful resuscitation;
— Sudden coronary death with fatal outcome;
7. Asymptomatic form of IHD.

Diagnosis of IHD

Diagnosis of coronary heart disease is carried out using the following examination methods:

• Anamnesis;
• Physical Research;
• Echocardiography (EchoECG);
• Angiography and CT angiography of the coronary arteries;

How to treat coronary heart disease? Treatment of IHD is carried out only after a thorough diagnosis of the disease and determination of its form, because The method of therapy and the means necessary for it depend on the form of ischemic heart disease.

Treatment of coronary heart disease usually includes the following therapies:

1. Limitation of physical activity;
2. Drug treatment:
2.1. Anti-atherosclerotic therapy;
2.2. Maintenance therapy;
3. Diet;
4. Surgical treatment.

1. Limiting physical activity

As you and I already know, dear readers, the main point of IHD is insufficient blood supply to the heart. Due to the insufficient amount of blood, of course, the heart does not receive enough oxygen, along with various substances, necessary for its normal functioning and vital activity. At the same time, you need to understand that with physical stress on the body, the load on the heart muscle also increases, which in due course wants to receive an additional portion of blood and oxygen. Naturally, because If there is already not enough blood in IHD, then under load this insufficiency becomes even more critical, which contributes to the worsening of the disease in the form of increased symptoms, up to sudden cardiac arrest.

Physical activity is necessary, but only at the rehabilitation stage after acute stage diseases, and only as prescribed by the attending physician.

2. Drug treatment (medicines for ischemic heart disease)

Important! Before using medications, be sure to consult your doctor!

2.1. Anti-atherosclerotic therapy

Recently, for the treatment of coronary artery disease, many doctors use the following 3 groups of drugs - antiplatelet agents, β-blockers and hypocholesterolemic (cholesterol-lowering) drugs:

Antiplatelet agents. By preventing the aggregation of red blood cells and platelets, antiplatelet agents minimize their gluing and settling on the internal walls of blood vessels (endothelium), and improve blood flow.

Among the antiplatelet drugs, the following drugs can be distinguished: acetylsalicylic acid(“Aspirin”, “Acecardol”, “Thrombol”), “Clopidogrel”.

β-blockers. Beta blockers help lower the heart rate (HR), thereby reducing the load on the heart. In addition, with a decrease in heart rate, oxygen consumption also decreases, due to the lack of which coronary heart disease mainly develops. Doctors note that when regular useβ-blockers improve the quality and life expectancy of the patient, because This group of drugs relieves many symptoms of coronary artery disease. However, you should be aware that contraindications to taking β-blockers are the presence of such concomitant diseases, like – , pulmonary pathologies and chronic obstructive pulmonary disease (COPD).

Among the β-blockers, the following drugs can be distinguished: bisoprolol (Biprol, Cordinorm, Niperten), carvedilol (Dilatrend, Coriol, Talliton), metoprolol (Betalok, Vasocardin, " Metokard", "Egilok").

Statins and fibrates- hypocholesterolemic (cholesterol-lowering) drugs. These groups of drugs lower the amount of “bad” cholesterol in the blood, reduce the number of atherosclerotic plaques on the walls of blood vessels, and also prevent the appearance of new plaques. The combined use of statins and fibrates is the maximum effective way fight cholesterol deposits.

Fibrates help increase the amount of lipoproteins high density(HDL), which actually counteract low-density lipoproteins (LDL), and as you and I know, it is LDL that forms atherosclerotic plaques. In addition, fibrates are used in the treatment of dyslipidemia (IIa, IIb, III, IV, V), lower triglyceride levels and, most importantly, minimize the percentage of deaths from coronary artery disease.

Among the fibrates, the following drugs can be distinguished: Fenofibrate.

Statins, unlike fibrates, have direct action on LDL, lowering its amount in the blood.

Among the statins, the following drugs can be distinguished: Atorvastin, Lovastatin, Rosuvastin, Simvastatin.

The level of cholesterol in the blood in case of coronary artery disease should be 2.5 mmol/l.

2.2. Maintenance therapy

Nitrates. They are used to reduce the preload on the heart by dilating the blood vessels of the venous bed and depositing blood, thereby stopping one of the main symptoms of coronary heart disease - angina pectoris, manifested in the form of shortness of breath, heaviness and pressing pain behind the sternum. Especially for cupping severe attacks Recently, intravenous drip administration of nitroglycerin has been successfully used for angina pectoris.

Among the nitrates, the following drugs can be distinguished: Nitroglycerin, Isosorbide mononitrate.

Contraindications to the use of nitrates are below 100/60 mmHg. Art. From side effects A decrease in blood pressure can also be noted.

Anticoagulants. They prevent the formation of blood clots, slow down the development of existing blood clots, and inhibit the formation of fibrin threads.

Among the anticoagulants, the following drugs can be distinguished: Heparin.

Diuretics (diuretics). Promotes accelerated elimination from the body excess liquid, due to a decrease in the volume of circulating blood, thereby reducing the load on the heart muscle. Among diuretics, two groups of drugs can be distinguished: loop and thiazide.

Loop diuretics are used in emergency situations when fluid needs to be removed from the body as quickly as possible. A group of loop diuretics reduce the reabsorption of Na+, K+, Cl- in the thick part of the loop of Henle.

Among loop diuretics, the following drugs can be distinguished: Furosemide.

Thiazide diuretics reduce the reabsorption of Na+, Cl- in the thick part of the loop of Henle and primary department distal tubule of the nephron, as well as reabsorption of urine, are retained in the body. Thiazide diuretics, in the presence of hypertension, minimize the development of complications of coronary heart disease from of cardio-vascular system.

Among the thiazide diuretics, the following drugs can be distinguished: Hypothiazide, Indapamide.

Antiarrhythmic drugs. Helps normalize heart rate (HR), thereby improving respiratory function, the course of ischemic heart disease is facilitated.

Among antiarrhythmic drugs The following drugs can be distinguished: “Aymalin”, “Amiodarone”, “Lidocaine”, “Novocainamide”.

Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors, by blocking the conversion of angiotensin II from angiotensin I, prevent spasms of blood vessels. ACE inhibitors also normalize and protect the heart and kidneys from pathological processes.

Among the ACE inhibitors, the following drugs can be distinguished: Captopril, Lisinopril, Enalapril.

Sedatives. They are used as a calming agent for the nervous system when the cause of an increase in heart rate is emotional experiences or stress.

Among sedatives can be distinguished: “Valerian”, “Persen”, “Tenoten”.

The diet for coronary artery disease is aimed at reducing the load on the heart muscle (myocardium). To do this, limit the amount of water and salt in the diet. Also excluded from the daily diet are foods that contribute to the development of atherosclerosis, which can be found in the article -.

The main points of the diet for ischemic heart disease include:

• The calorie content of food is 10-15%, and in case of obesity, 20% less than your daily diet;
• The amount of fat is no more than 60-80 g/day;
• The amount of protein is no more than 1.5 g per 1 kg of human body weight/day;
• The amount of carbohydrates is no more than 350-400 g/day;
• Quantity table salt– no more than 8 g/day.

What not to eat if you have ischemic heart disease

• Fatty, fried, smoked, spicy and salty foods - sausages, sausages, ham, fatty dairy products, mayonnaise, sauces, ketchups, etc.;
• Animal fats, which are large quantities contained in lard fatty varieties meat (pork, domestic duck, goose, carp and others), butter, margarine;
• High-calorie foods, as well as foods rich in easily digestible carbohydrates - chocolate, cakes, pastry, sweets, marshmallows, marmalade, preserves and jams.

What can you eat if you have ischemic heart disease?

• Food of animal origin - low-fat varieties meat (low-fat chicken, turkey, fish), low-fat cottage cheese, egg white;
• Cereals – buckwheat, oatmeal;
• Vegetables and fruits – mainly green vegetables and orange fruits;
• Bakery products – rye or bran bread;
• Drinking – mineral water, low-fat milk or kefir, unsweetened tea, and juices.

In addition, the diet for ischemic heart disease should be aimed at eliminating excessive amounts of extra pounds (), if present.

For the treatment of coronary heart disease, M.I. Pevzner developed a therapeutic nutrition system - diet No. 10c (table No. 10c)

Ascorbic acid also promotes the rapid breakdown of “bad” cholesterol and its removal from the body.

Horseradish, carrots and honey. Grate the horseradish root to make 2 tbsp. spoons and pour a glass of boiled water over it. Afterwards, mix the horseradish infusion with 1 glass of freshly squeezed carrot juice and 1 glass of honey, mix everything thoroughly. You need to drink 1 tbsp. spoon, 3 times a day, 60 minutes before meals.

The condition of the entire organism depends on the proper functioning of the cardiovascular system. Pathologies associated with the heart sometimes develop for decades without pronounced symptoms. But one day, deviations in the full functioning of the cardiac and vascular sphere can lead to a crisis, the consequence of which is often disability or death. One of these pathologies is coronary heart disease. Let us consider in detail what cardiac ischemia is.

What is IHD?

Coronary heart disease (CHD) what is it? The first letters of the definition of pathology are usually used when abbreviating the concept, that is IHD ischemic heart disease. Coronary heart disease is a condition in which the blood supply to the middle muscular layer of the heart (myocardium) is disrupted. The main cause of coronary artery disease, which causes disruption of blood circulation in the myocardium, is damage to the coronary arteries. As a result, there is an imbalance between the metabolic needs of the heart muscle and its adequate supply of oxygen and nutrients. Delivery of all necessary resources to the myocardium is carried out through blood flow through the coronary arteries.

What exactly is cardiac ischemia? This is a condition when less oxygen enters the bloodstream than is required by the myocardium for normal functioning. Essentially, myocardial ischemia is caused by its oxygen starvation. The pathology can be acute, leading to myocardial infarction (transmural or small focal), and chronic ischemic heart disease, when periodic angina can be observed. At the same time, it can manifest itself as painful attacks in the heart area, caused by insufficient supply of the main cardiac muscle with blood substance.

Chronic condition of ischemic heart disease

Chronic coronary heart disease develops with age and as a result of lack of treatment or non-compliance with the prescribed course of therapy. Chronic ischemia may be present in the patient long time and in a form that is not always manifested painful sensations, which lulls vigilance. Therefore, persons at risk of developing chronic form IHD, it is necessary to completely abandon bad habits, change the diet towards the predominance of products plant origin. And also increase physical activity, at least take daily walks.

And above all, with a disease such as chronic ischemia, it is necessary to periodically conduct blood tests for cholesterol levels and other necessary examinations.

Complications of HIBS (chronic ischemia):

• Post-infarction or diffuse cardiosclerosis.
• Heart rhythm disturbances due to narrowing of the lumens in the arteries.
• Death of heart muscle cells (myocardial necrosis).
• Myocardial infarction.
• Sudden stoppage of heart contractions.

Based on the list of complications, it becomes clear how chronic ischemia is a dangerous cardiac disease. It is also insidious because one drug therapy in any case it will not be enough. To maintain normal myocardial tone, you will need to strictly adhere to healthy image life. And the fulfillment of this condition will fall entirely on the patient and will require him to systematically observe the correct daily routine, diet and physical activity. This is precisely where the danger lies, since not every person is ready to radically change their usual life, especially if the signs of coronary heart disease are still only slightly noticeable.

Causes of development of coronary heart disease

Among cardiovascular pathologies Myocardial ischemia is one of the most common. According to statistical data provided by scientists in the field of medicine, ischemic syndrome and, in addition, cerebral stroke are characterized by the highest mortality or disability rate in almost 90% of cases. The culprits of such a huge mortality rate are often the people themselves who are at risk. But, despite individual predisposition, due to heredity or wrong image existence. They neglect the warnings and recommendations of doctors to eliminate the factors that cause chronic ischemia.

Clinical causes of ischemia:

Factors provoking ischemic pathologies of the heart muscle:

• Genetic predisposition.
• Increased blood pressure.
• Excessive amount of cholesterol.
• Insulin deficiency.
• Lack of physical mobility (physical inactivity), sedentary image life.
• Frequent consumption of fatty foods of animal origin.
• Regular stressful situations.
• Large body weight.
• Elderly age.

The male part of the population has a greater tendency to heart pathologies. Thus, according to some information, at 35–45 years of age the ratio of mortality among men and women from coronary heart disease is 5:1. Among the older age category of both sexes, this figure is already 2:1.

Cases of coronary heart disease in women are observed during menopause, when monthly blood renewal ceases. Signs of coronary heart disease in men are detected more often due to poor lifestyle, systematic consumption of heavy foods, addiction to smoking and alcohol, as well as frequent exposure to stress during the process. labor activity. After reviewing what coronary artery disease is, symptoms and treatment, these are the next steps to take to restore the health of your heart muscle.

Signs of ischemic heart pathology

What are the main alarming symptoms of coronary heart disease that indicate the presence of pathology? Myocardial ischemia is often characterized by an abnormal pulse. Typically, a person may feel that their heartbeat is too fast or intermittent. Signs of ischemia are often expressed by chest pain in the left hypochondrium. Painful signs IHD sometimes manifests itself during physical activity, not necessarily related to sports exercises. It happens that discomfort in the heart area is felt when climbing stairs or any other elevation. By nature, such sensations resemble pressing or squeezing pain and can radiate to the left or both arms, neck, lower jaw, or to the shoulder on the side of the heart.

The most common symptoms of cardiac ischemia include:

• Painful symptoms in the heart area that last longer than 5–10 minutes.
• Difficulty breathing, feeling of lack of air, shortness of breath.
• Nausea, accompanied by weakness and sweating.
• Dizziness with clouding of consciousness, sometimes leading to fainting.
• Noticeable interruptions in the functioning of the heart.

Symptoms of cardiac ischemia, which are more likely related to the consequences, are expressed in cardiac arrest or cessation of blood circulation due to rapid heart rate, reaching up to 300 heart beats per minute. This pathology usually cannot be restored and leads to fatal consequences.

Therefore, one should not underestimate the slightest manifestations of tachycardia and eliminate the source of deviation in time.

The presence of IHD symptoms can be detected several simultaneously. With this development of events, it is urgent to take appropriate measures, including a visit to a cardiologist or, at a minimum, initially giving up bad habits and fatty foods. If coronary heart disease is suspected, it will most likely be necessary to eliminate the symptoms and carry out treatment in full.

Therapy for coronary heart disease

How to treat coronary heart disease? Many people who are worried about their health ask the question: “Is it possible to cure coronary heart disease completely?” The answer to whether it is possible to cure a pathology such as myocardial ischemia will be optimistic - it is possible. But only if the patient’s condition is not brought to an extreme degree pathological process. The success of IHD treatment depends on the stage of the disease than formerly man starts treatment for cardiac ischemia, then treatment will be much more effective. With the development of irreversible processes, treatment of coronary heart disease is carried out using mechanical manipulations.

Treatment of myocardial ischemia by surgical methods:

• Arterial coronary bypass surgery, which involves excision of a damaged segment of the circulatory system, in particular a deformed vessel, and replacing it with an artificial analogue.
• Endovascular surgical method- a complex operation performed in the cavity of the vessel, but without dissecting it.
• Angioplasty is used to expand the lumen of the vascular area by blowing it out.

In non-advanced cases, treatment of cardiac ischemia may be limited to the use of one or a combination of the following drugs:

1. Aspirin for blood thinning.
2. Drugs that eliminate excess cholesterol.
3. Medicines that lower blood pressure.
4. Nitroglycerin and other nitrates to eliminate pain syndrome during an angina attack.

How to treat cardiac ischemia at home? In addition to surgical or drug treatment of coronary heart disease, the patient will be prescribed a special diet consisting of food with moderate cholesterol content and minimizing animal products.

The severity of the diet and the degree of physical activity for coronary heart disease will directly depend on the stage of the patient’s pathological condition. The greater the degree of damage to blood vessels, coronary arteries and myocardium, the easier cardio training should be, which is better to start with long hiking definitely in clean air. It is strictly forbidden to walk near highways, near hazardous enterprises and other industrial and gas-polluted objects in order to restore the myocardium; the purest possible ozone is required.

Diagnosis of coronary artery disease is possible only after the conclusion of a cardiologist. The doctor, as a result of examining the totality of all the information received, will confirm the presence of coronary heart disease or establish other reasons that affect the patient’s state of malaise. Diagnostic methods include: elucidation of disturbing symptoms, interpretation of blood test results (cholesterol, blood sugar, AST and ALT, triglycerides and other substances), the use of instrumental diagnostic methods (ECG, EchoCG, cardiac ultrasound, coronary angiography, stress tests and other procedures ). If a diagnosis of coronary heart disease is made, the patient will be prescribed individual therapy. But even if suspicions of IHD are not confirmed, every person should remember that normal condition The cardiovascular system directly depends on a healthy lifestyle.

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Cardiovascular diseases are the leading cause of disability and mortality worldwide. According to medical and scientific data, 1.2 million people die annually in Russia, 35% of which are diagnosed with coronary heart disease (CHD). The situation can be improved if people know more about this disease.

Causes of IHD

Insufficient blood supply to the heart muscle is the main cause of IHD. It does not pass through the coronary arteries of the heart in the required quantity due to their blockage or narrowing. Depending on the severity of cardiac “starvation”, several forms of coronary artery disease are distinguished. 98% clinical cases associated with atherosclerosis of the coronary vessels. Other causes of IHD are:

• thromboembolism, which develops against the background of atherosclerotic lesions;
• hyperlipidemia and decrease in alpha lipoproteins;
• arterial hypertension;
• stable angina pectoris;
• smoking;
• obesity;
• high cholesterol;
• physical inactivity;
• diabetes.

Classification of IHD

It is customary to distinguish between chronic and acute form IHD. The first category includes heart failure, arrhythmia, and cardiosclerosis. Acute ischemia includes sudden death, unstable angina, heart attack. There are also several classes of the disease, which are characterized by certain features:

1. Walking or climbing stairs does not cause attacks. Symptoms of the pathology appear during prolonged or intense exercise.
2. There is a slight limitation in motor activity. An attack sometimes develops after waking up, eating, stressful situation.
3. Significant restriction of activity. The attack occurs after 200 meters of habitual walking.
4. The ability to perform any task is completely lost. physical work. Anginal pain appears even in calm state.

Sudden coronary death

This term refers to natural death. Heart failure is much more common in men than in women by a ratio of 10:1. This form of the disease in most cases is associated with ventricular fibrillation, when chaotic contraction of different cardiac fibers occurs at a heart rate of 300-600 beats/minute. This condition is not adequate for normal blood circulation, therefore it is not compatible with life. Less commonly, this form of ischemic heart disease may be associated with asystole or bradycardia.

IHD - angina pectoris

This condition is understood as ischemic syndrome, which is manifested by chest pain radiating to the epigastrium, jaw, upper limbs, neck. The immediate cause of the pathology is insufficient blood supply to the heart muscle. Stable angina pectoris is easily treated with medications because it has stereotypical attacks. Unstable disorder sometimes leads to myocardial infarction or death. The spontaneous form (chronic heart failure) manifests itself even in a calm state and is of vasospastic origin.

IHD - cardiosclerosis

When connective scar tissue grows in the myocardium and the valves become deformed, this pathology is called cardiosclerosis. This condition is a manifestation of chronic ischemic heart disease. The atherosclerotic form of the disease has Long procces development, and its progression disrupts the heart rhythm, which provokes necrotic changes and scarring of myocardial tissue. Sclerotic changes lead to the development of acquired heart disease or bradycardia.

IHD - myocardial infarction

Necrosis of an area of ​​the muscle layer caused by insufficient blood supply is called myocardial infarction. This form of IHD - what is it? The disease in its clinical manifestation has three stages: pain (1-2 days), fever (7-15 days), scarring (2-6 months). A heart attack is usually preceded by an exacerbation of coronary artery disease, which manifests itself in increased attacks of angina, a feeling of cardiac arrhythmia, and initial signs of heart failure. This condition is called pre-infarction.

Arrhythmic form of ischemic heart disease

In medicine, arrhythmia is an interruption in the functioning of the heart when the regularity and frequency of contractions changes. The arrhythmic form of IHD is the most common, since it is often the only symptom of the disease. Arrhythmia can be provoked not only by chronic ischemic heart disease, but also by bad habits, long-term stress, drug abuse, other diseases. This form of IHD is characterized by a slow or rapid heartbeat due to impaired functionality of electrical impulses.

Painless form of ischemic heart disease

This is a temporary disruption of the blood supply to the myocardium, not accompanied by a painful attack, but recorded on the cardiogram. The silent form of IHD can manifest itself independently or be combined with other forms of myocardial ischemia. According to classification, it is divided into several types:

1. First. Diagnosed in patients with coronary angiography, but only if other forms of coronary artery disease have not previously been identified.
2. Second. Appears in people who have had a heart attack, but without angina attacks.
3. Third. Diagnosed in patients diagnosed with progressive angina.

IHD - symptoms

Cardiac ischemia has symptoms of physical and mental manifestations. The first include arrhythmia, weakness, shortness of breath, and increased sweating. The patient experiences spontaneous chest pains that do not stop even after taking nitroglycerin, and he becomes very pale. Mental symptoms IHD:

• severe lack of oxygen;
• apathy, sad mood;
• panic fear of death;
• causeless anxiety.

Forms of IHD

In case of myocardial ischemia, for successful treatment of pathology, doctors distinguish between: clinical symptoms by forms of IHD:

1. Coronary death. Symptoms develop rapidly: the pupils do not react to light, there is no consciousness, no pulse, no breathing.
2. Angina pectoris. Pressing, cutting, squeezing and burning pain is localized in the epigastrium or behind the sternum. An attack of angina pectoris lasts from 2 to 5 minutes and is quickly relieved medicines. Vasospastic angina is characterized by a feeling of discomfort in the chest at rest. When angina occurs for the first time, there is an increase in blood pressure and spontaneous attacks for up to 15 minutes during physical exertion. Early post-infarction angina occurs after myocardial infarction.
3. Cardiosclerosis. Pulmonary edema, diffuse or focal myocardial damage, aneurysm rupture, and persistent cardiac arrhythmia are observed. The patient develops swelling of the feet, lack of air, dizziness, and over time – pain in the hypochondrium, enlargement of the abdomen. Post-infarction cardiosclerosis is characterized by attacks nocturnal asthma, tachycardia, progressive shortness of breath.
4. Heart attack. Strong pain behind the sternum, extending into the jaw, left shoulder blade and arm. Lasts up to half an hour, does not go away when taking nitroglycerin. The patient appears cold sweat, a sharp decline Blood pressure, weakness, vomiting, fear of death.
5. Coronary syndrome X. Pressing or squeezing pain in the precordial region or behind the sternum, which lasts up to 10 minutes.

Diagnosis of IHD

Determining the form of myocardial ischemia is an important and difficult process. The successful prescription of pharmacotherapy depends on the correct diagnosis. The main diagnosis of IHD is a survey of the patient and physical examinations. After establishing the cause and degree of the disorder, the specialist prescribes the following diagnostic methods:

• urine and blood tests (general, biochemical);
• Holter monitoring;
• electrocardiography (ECG);
• echocardiography (EchoCG)
• functional tests;
• Ultrasound of the heart;
• angiography;
• intraesophageal electrocardiography.

IHD - treatment

Also, based on laboratory indicators, the doctor prescribes, in addition to diet and a gentle regime, treatment of IHD with drugs from the following pharmacological groups:

1. β-blockers. Atenol, Prinorm.
2. Antiarrhythmic drugs. Amiodarone, Lorcainide.
3. Antiplatelet agents and anticoagulants. Verapamil, Warfarin.
4. Antioxidants. Mexicor, Ethylmethylhydroxypyridine.
5. Angiotensin-converting enzyme inhibitors. Captopril, Lisinopril, Enalapril.
6. Nitrates. Nitroglycerin, Isosorbide mononitrate.
7. Diuretics. Hypothiazide, Indapamide.
8. Natural lipid-lowering drugs. Atorvastatin, Mildronate, Rosuvastatin, Trimetazidine.
9. Statins. Lovastatin, Simvastatin.
10. Fibrates. Fenofibrate, Miscleron.

Prevention of coronary artery disease

There are several measures to prevent cardiac ischemia. In the painless form of IHD, they are aimed at inhibiting atherosclerotic phenomena. The main directions for the prevention of ischemia of any degree:

• organizing the correct alternation of rest and work;
• complete cessation of smoking;
• reducing alcohol consumption to a minimum (20 g/day)
• recreational aerobic exercise (running, swimming, aerobics, tennis and others);
• lowering blood sugar and cholesterol levels;
• normalization of eating habits through healthy eating:
• Calculation of daily calories for weight loss.

Video: what is IHD

The chronic form of coronary heart disease (CHD) refers to the most dangerous pathologies of cardio-vascular system. About 70% of the population dies every year with this diagnosis. Men are more often affected by pathology; among women, the disease is 2 times less common. Prevention will help avoid the development of the disease.

General characteristics, ICD code, forms

HIHD is characterized by impaired blood supply to the myocardium. The heart muscle needs oxygen, which is provided by the blood flow. With atherosclerotic deposits on the walls of the coronary vessels and the formation of plaques, the lumens inside the vessels narrow. As a result, the heart has to pump blood harder to deliver vital oxygen to the myocardium.

With increased functioning of the heart muscle, it expands. This can lead to a number of complications and death.

According to the international classification, HIHD is classified as a disease of the circulatory system. According to ICD-10, these are classes 100-199. HIBS has a separate class – 125.

Depending on the clinical picture HIBS can be classified into the following pathologies:

• cardiosclerosis;
• heart failure;
• sudden coronary death;
• painless form.

Angina pectoris can be new, early, coronary, vasospastic. Arrhythmia can be expressed either, that is, an accelerated or slowed heart rate.

Causes

Chronic coronary heart disease begins against the background of atherosclerosis of the arteries. It is usually caused by a lipid metabolism disorder. Other possible reason– spasm of the coronary arteries.

HIBS with more likely develops in people against the background of:

• obesity;
• genetic predisposition;
• smoking;
• low physical activity;
• diabetes mellitus;
• constant stress;
• alcohol abuse;
• high blood pressure;
• constant consumption of fried and fatty foods.

Symptoms

The clinical picture of HIHD can be different. More often the disease is accompanied the following symptoms:

• increased blood pressure;
• changes in heart rhythm;
• heaviness or paroxysmal pain behind the sternum (can be felt in the shoulder, left arm, less often in the shoulder blade, abdomen or back);
• weakness even with minor exertion;
• shortness of breath, difficulty breathing;
• swollen limbs;
• pronounced pallor of the skin;
• anxiety, panic attacks.

In the painless form of the pathology, a person is not bothered by symptoms. In this case, the disease is detected only during diagnosis.

The chronic course of the pathology means that it manifests itself in periods. Between individual episodes of exacerbations, the clinical picture may be blurred.

Diagnostics

To identify the chronic form of coronary heart disease today there are many laboratory and instrumental studies. The specialist determines the techniques necessary in this case individually, after examining the patient and listening to his complaints.

The following tests are effective in identifying CHD:

• General blood test and biochemistry test. This procedure is standard for most diseases.
• Coagulogram.
• Lipidogram.
• Electrocardiogram. This study allows you to detect deviations in heart rhythm. Using an ECG, you can establish the form of pathology and detect myocardial infarction. To accurately assess the clinical picture, Holter monitoring is performed, when readings are taken during the day using a special device (attached to the shoulder or belt).
• Echocardiography. This ultrasound technique is important for determining the size of the myocardium, assessing the contractility of the organ, and identifying acoustic noise. EchoCG can detect ischemic disorders in the heart muscle if stress tests are additionally used.
• Bicycle ergometry. like this functional test carried out to identify changes in the functioning of the heart muscle that do not appear in a calm state.
• Transesophageal electrocardiography. This study is carried out to record myocardial performance indicators. Its essence lies in the introduction of a special sensor into the patient’s esophagus.
• Coronography.
• Left ventriculography.
• Radionuclide research.
• X-ray. This technique is usually used when an aneurysm is suspected.

To identify HIHD, several of these studies are sufficient. Advanced diagnostics may be required to identify concomitant diseases, as well as to obtain accurate information if surgical intervention is necessary.

Treatment of chronic coronary heart disease

In the treatment of HIHD, both drug therapy and surgery are used. The approach is individual for each patient and depends on the characteristics of the clinical picture, the presence of concomitant diseases and a number of other factors.

Regardless of the method of treatment, the patient must adhere to general recommendations:

• reduce physical activity;
• decrease drinking regime;
• reduce the amount of salt or avoid it altogether;
• reduce the consumption of fats, especially animal origin;
• to refuse from bad habits;
• normalize your daily routine.

The need to reduce physical activity does not mean completely abandoning it. You should walk and do physical therapy.

Drug therapy

Patients with HIHD need complex treatment. Drug therapy includes the following groups of drugs:

• Angiotensin-converting enzyme inhibitors. From this group they usually resort to Enalapril, Lisinopril, Ramipril, Fasinopril. Perindopril.
• Angiotensin II type AT receptor antagonists These drugs are antihypertensive. It is possible to use Losartan, Irbesartan, Valsartan, Telmisartan, Eprosartan.
• β-blockers. Among these medications, they resort to Bisoprolol, Metoprolol or Nebivolol.
• Diuretics. Furosemide is usually used. Hydrochlorothiazide or Spironolactone may also be used.
• Slow calcium channel blockers. In this group, preference is given to Amlodipine, Nifedipine, Verapamil.

Treatment with medications may also involve the use of statins, nitrites, fibrates, antianginal drugs, and anticoagulants.

Drug treatment is prescribed individually. In this case, it is necessary to take into account the patient’s age, the characteristics of the clinical picture, the presence of complications and concomitant pathologies.

Surgery

In some cases, drug therapy for CHD is not enough. We have to resort to surgical treatment. It is prescribed only after a certain diagnosis has been carried out, clarifying the severity of the disease, features of its course, condition and functionality heart and its individual elements.

The operation is indicated for following conditions:

• angina pectoris is unstable and resistant to drug treatment;
• left trunk coronary artery narrowed by 70%, 3 coronary arteries are affected;
• the coronary bed is damaged, the artery is narrowed by 75%;
• the patient cannot tolerate even minimal stress on the heart;
• diagnosed with ischemic myocardial dysfunction.

There are many options surgical treatment. The technique is selected individually. Surgical intervention can be done through:

• coronary artery bypass grafting;
• stenting;
• coronary angioplasty.

These techniques are the most common, but are not the only treatment option. The patient may require a pacemaker.

Forecast

In most cases (more than 80%) HIHD ends with sudden cardiac arrest. This outcome is more typical for men.

In the absence of the correct and timely treatment high risk of various complications. One of the most common is heart failure. With its stagnant form, the risk of death increases significantly.

HIHD often leads to angina pectoris and myocardial infarction. Such pathologies are fraught fatal.

Prevention

Main preventative measure To avoid the development of chronic coronary heart disease - a healthy lifestyle. It means:

• maintaining body weight normal level;
• healthy diet with a limit on fatty, sweet and other harmful products;
• giving up cigarettes and alcohol;
• moderate physical activity.

Must be taken regularly medical examinations. This will allow timely identification of various disorders in the body that can lead to coronary artery disease.

At high blood pressure or high level sugar levels, it is necessary to monitor these indicators and, if necessary, carry out appropriate treatment.

To prevent relapse of the disease, you must adhere to proper nutrition, healthy lifestyle, regularly take prescribed medications, monitor blood pressure readings. Should go Spa treatment and repeat it periodically for preventive purposes.

Primary prevention should be observed at any age. Cardiovascular diseases They become “younger” every year, and many diseases begin in childhood.

Chronic coronary heart disease is a serious disease. It is fraught with serious complications and a high risk of death. Treatment may be medication or surgery. In any case, it can only be prescribed by a specialist after appropriate diagnosis.