Treatment regimen for ischemic heart disease. Information and training

Treatment of coronary artery disease involves the joint work of the cardiologist and the patient in several directions at once. First of all, you need to take care of changing your lifestyle. In addition, drug treatment is prescribed, and, if necessary, surgical treatment methods are used.

Lifestyle changes and neutralization of risk factors include mandatory smoking cessation, correction of cholesterol levels (through diet or medications), and weight loss. For patients with coronary artery disease, the so-called “ Mediterranean diet", which includes vegetables, fruits, light poultry, fish and seafood dishes.

Very important point non-drug treatment IHD is the fight against a sedentary lifestyle by increasing the patient’s physical activity. Of course, an indispensable condition for successful treatment of IHD is preliminary treatment for hypertension or diabetes mellitus, if the development of IHD occurs against the background of these diseases.

The goals of treatment of coronary heart disease are defined as improving the patient’s quality of life, that is, reducing the severity of symptoms, preventing the development of forms of coronary artery disease such as myocardial infarction, unstable angina, sudden cardiac death, as well as increasing the patient’s life expectancy. The initial relief of an attack of angina is carried out with the help of nitroglycerin, which has a vasodilating effect. The rest of the drug treatment for coronary heart disease is prescribed only by a cardiologist, based on the objective picture of the disease. Among the drugs that are used in the treatment of coronary artery disease, one can highlight drugs that help reduce the myocardial oxygen demand, increase the volume of the coronary bed, etc. However, the main task in the treatment of coronary artery disease - freeing blocked vessels - is practically not solved with the help of medications (in particular, sclerotic plaques are practically not destroyed by medications). Severe cases will require surgery.

Aspirin has been considered a classic remedy for the treatment of coronary artery disease for many years; many cardiologists even recommend using it prophylactically in small quantities (half/one-fourth tablet per day).

The modern level of cardiology has a diverse arsenal of medications aimed at treating various forms of coronary artery disease. However, any medications can only be prescribed by a cardiologist and can only be used under the supervision of a doctor.

For more severe cases of coronary artery disease, they are used surgical methods treatment. Quite good results are shown by coronary bypass surgery, when an artery blocked by a plaque or thrombus is replaced by an “artificial vessel” that takes over the blood flow. These operations are almost always performed on a non-functioning heart with artificial circulation; after bypass surgery the patient has to recover for a long time from extensive surgical trauma. The bypass method has many contraindications, especially in patients with weakened bodies, but if the operation is successful, the results are usually good.

The most promising treatment method for ischemic heart disease is currently Endovascular surgery (X-ray surgery) is considered. The term “endovascular” translates as “inside the vessel.” This relatively young area of ​​medicine has already gained a strong position in the treatment of coronary artery disease. All interventions are carried out without incisions, through punctures in the skin, under X-ray observation; for the operation it is enough local anesthesia. All these features are most important for those patients for whom traditional surgical intervention is contraindicated due to concomitant diseases or general weakness of the body. Among the methods of endovascular surgery for coronary artery disease, balloon angioplasty and stenting are most often used, which make it possible to restore patency in arteries affected by ischemia. When using balloon angioplasty, a special balloon is inserted into the vessel, and then it is inflated and “pushes” atherosclerotic plaques or blood clots to the sides. After this, a so-called stent is inserted into the artery - a mesh tubular frame made of “medical” stainless steel or alloys of biologically inert metals, capable of independently expanding and maintaining the shape given to the vessel.

Treatment of coronary heart disease primarily depends on the clinical form. For example, although some general principles of treatment are used for angina and myocardial infarction, treatment tactics, selection of activity regimens and specific medications may differ radically. However, there are some general directions, important for all forms of IHD.

• 1. Limitation physical activity. During physical activity, the load on the myocardium increases, and as a result, the myocardium’s need for oxygen and nutrients. If the blood supply to the myocardium is disrupted, this need is unsatisfied, which actually leads to manifestations of coronary artery disease. Therefore, the most important component of the treatment of any form of coronary artery disease is limiting physical activity and gradually increasing it during rehabilitation.
• 2. Diet. In case of coronary artery disease, in order to reduce the load on the myocardium, the intake of water and sodium chloride (table salt) is limited in the diet. In addition, given the importance of atherosclerosis in the pathogenesis of coronary artery disease, much attention is paid to limiting foods that contribute to the progression of atherosclerosis. An important component of the treatment of coronary artery disease is the fight against obesity as a risk factor.

The following food groups should be limited, or if possible avoided.

• Animal fats (lard, butter, fatty meats)
• · Fried and smoked foods.
• · Products containing a large amount of salt (salted cabbage, salted fish, etc.)
• · Limit intake of high-calorie foods, especially quickly absorbed carbohydrates. (chocolate, candy, cakes, pastry).

To correct body weight, it is especially important to monitor the ratio of energy coming from the food eaten and energy expenditure as a result of the body’s activities. For sustainable weight loss, the deficit must be at least 300 kilocalories daily. The average person is not busy physical work spends 2000-2500 kilocalories per day.

3. Pharmacotherapy for ischemic heart disease. There are a number of groups of drugs that may be indicated for use in one form or another of coronary artery disease. In the USA there is a formula for the treatment of coronary artery disease: “A-B-C”. It involves the use of a triad of drugs, namely antiplatelet agents, beta-blockers and hypocholesterolemic drugs.

Also, in the presence of concomitant hypertension, it is necessary to ensure that target blood pressure levels are achieved.

• - Antiplatelet agents (A). Antiplatelet agents prevent the aggregation of platelets and red blood cells, reduce their ability to glue and adhere to the vascular endothelium. Antiplatelet agents facilitate the deformation of red blood cells when passing through capillaries and improve blood fluidity.
• · Aspirin - taken once a day in a dose of 100 mg; if myocardial infarction is suspected, a single dose can reach 500 mg.
• · Clopidogrel - taken once a day, 1 tablet of 75 mg. It is required to take it for 9 months after endovascular interventions and CABG.
• - β-blockers (B). Due to their effect on β-arenoceptors, adrenergic blockers reduce the heart rate and, as a result, myocardial oxygen consumption. Independent randomized studies confirm an increase in life expectancy when taking beta-blockers and a decrease in the incidence of cardiovascular events, including recurrent ones. Currently, it is not advisable to use the drug atenolol, since according to randomized studies it does not improve the prognosis. β-blockers are contraindicated in case of concomitant pulmonary pathology, bronchial asthma, COPD. Below are the most popular beta-blockers with proven properties of improving the prognosis of coronary artery disease.
• · Metoprolol (Betalok Zok, Betalok, Egilok, Metocard, Vasocardin);
• · bisoprolol (Concor, Coronal, Bisogamma, Biprol);
• Carvedilol (Dilatrend, Talliton, Coriol).
• - Statins and Fibrates (C). Cholesterol-lowering drugs are used to reduce the rate of development of existing atherosclerotic plaques and prevent the formation of new ones. Proven positive influence on life expectancy, these drugs also reduce the frequency and severity of cardiovascular events. The target cholesterol level in patients with coronary artery disease should be lower than in persons without coronary artery disease and equal to 4.5 mmol/l. The target LDL level in patients with coronary artery disease is 2.5 mmol/l.
• · lovastatin;
• · simvastatin;
• · atorvastatin;
• Rosuvastatin (the only drug that significantly reduces the size of atherosclerotic plaque);

Fibrates. They belong to a class of drugs that increase the antiatherogenic fraction of HDL, with a decrease in which the mortality rate from coronary artery disease increases. Used to treat dyslipidemia IIa, IIb, III, IV, V. They differ from statins in that they mainly reduce triglycerides (VLDL) and can increase the HDL fraction. Statins primarily reduce LDL and do not have a significant effect on VLDL and HDL. Therefore, for maximum effective treatment macrovascular complications require a combination of statins and fibrates. With the use of fenofibrate, mortality from coronary artery disease is reduced by 25%. Of the fibrates, only fenofibrate is safely combined with any class of statins (FDA).

fenofibrate

Other classes: omega-3 polyunsaturated fatty acids (Omacor). In case of ischemic heart disease, they are used to restore the phospholipid layer of the cardiomyocyte membrane. By restoring the structure of the cardiomyocyte membrane, Omacor restores the basic (vital) functions of cardiac cells - conductivity and contractility, which were impaired as a result of myocardial ischemia.

Nitrates. There are nitrates for injection.

Drugs in this group are derivatives of glycerol, triglycerides, diglycerides and monoglycerides. The mechanism of action is the influence of the nitro group (NO) on the contractile activity of vascular smooth muscles. Nitrates predominantly act on the venous wall, reducing the preload on the myocardium (by dilating the vessels of the venous bed and deposition of blood). A side effect of nitrates is a decrease in blood pressure and headaches. Nitrates are not recommended for use if blood pressure is below 100/60 mmHg. Art. In addition, it is now reliably known that taking nitrates does not improve the prognosis of patients with coronary artery disease, that is, it does not lead to an increase in survival, and are currently used as a drug to relieve the symptoms of angina pectoris. Intravenous drip administration of nitroglycerin can effectively combat the symptoms of angina pectoris, mainly against the background of high blood pressure numbers.

Nitrates exist in both injectable and tablet forms.

• · nitroglycerin;
• isosorbide mononitrate.

Anticoagulants. Anticoagulants inhibit the appearance of fibrin filaments, they prevent the formation of blood clots, help stop the growth of existing blood clots, and enhance the effect of endogenous enzymes that destroy fibrin on blood clots.

· Heparin (the mechanism of action is due to its ability to specifically bind to antithrombin III, which sharply increases the inhibitory effect of the latter in relation to thrombin. As a result, the blood clots more slowly).

Heparin is injected under the skin of the abdomen or using an infusion pump intravenously. Myocardial infarction is an indication for heparin prophylaxis of blood clots; heparin is prescribed at a dose of 12,500 IU, injected under the skin of the abdomen daily for 5-7 days. In the ICU, heparin is administered to the patient using an infusion pump. The instrumental criterion for prescribing heparin is the presence of depression S-T segment on the ECG, which indicates an acute process. This sign is important in terms of differential diagnosis, for example, in cases where the patient has ECG signs of previous heart attacks.

Diuretics. Diuretics are designed to reduce the load on the myocardium by reducing the volume of circulating blood due to the accelerated removal of fluid from the body.

Loopbacks. The drug "Furosemide" in tablet form.

Loop diuretics reduce the reabsorption of Na +, K +, Cl - in the thick ascending part of the loop of Henle, thereby reducing the reabsorption (reabsorption) of water. They have a fairly pronounced, rapid effect and are usually used as drugs. emergency assistance(for forced diuresis).

The most common drug in this group is furosemide (Lasix). Available in injection and tablet forms.

Thiazide. Thiazide diuretics are Ca 2+ sparing diuretics. By reducing the reabsorption of Na + and Cl - in the thick segment of the ascending limb of the loop of Henle and the initial part of the distal tubule of the nephron, thiazide drugs reduce urine reabsorption. With systematic use of drugs in this group, the risk of cardiovascular complications in the presence of concomitant hypertension is reduced.

• · hypothiazide;
• · indapamide.

Angiotensin-converting enzyme inhibitors. By acting on the angiotensin-converting enzyme (ACE), this group of drugs blocks the formation of angiotensin II from angiotensin I, thus preventing the effects of angiotensin II, that is, leveling vasospasm. This ensures that target blood pressure levels are maintained. Drugs in this group have nephro- and cardioprotective effects.

• Enalapril;
• Lisinopril;
• captopril

Antiarrhythmic drugs. The drug "Amiodarone" is available in tablet form.

Amiodarone is a III group antiarrhythmic drugs, has a complex antiarrhythmic effect. This drug acts on the Na + and K + channels of cardiomyocytes, and also blocks b- and b-adrenergic receptors. Thus, amiodarone has antianginal and antiarrhythmic effects. According to randomized clinical trials, the drug increases the life expectancy of patients who regularly take it. When taking tablet forms of amiodarone clinical effect observed after approximately 2-3 days. The maximum effect is achieved after 8-12 weeks. This is due to long period half-life of the drug (2-3 months). Due to this this drug It is used for the prevention of arrhythmias and is not an emergency treatment.

Taking into account these properties of the drug, the following scheme of its use is recommended. During the saturation period (the first 7-15 days), amiodarone is prescribed at a daily dose of 10 mg/kg of the patient’s weight in 2-3 doses. With the onset of a persistent antiarrhythmic effect, confirmed by the results of daily ECG monitoring, the dose is gradually reduced by 200 mg every 5 days until a maintenance dose of 200 mg per day is reached.

Other groups of drugs.

Ethylmethylhydroxypyridine

The drug "Mexidol" in tablet form. Metabolic cytoprotector, antioxidant-antihypoxant, which has a complex effect on key links in pathogenesis cardiovascular diseases: anti-atherosclerotic, anti-ischemic, membrane-protective. Theoretically, ethylmethylhydroxypyridine succinate has significant beneficial effects, but at present there is no data on its clinical effectiveness based on independent randomized placebo-controlled studies.

• · Mexico;
• · coronator;
• · trimetazidine.
• 4. Use of antibiotics for ischemic heart disease. There are results of clinical observations of the comparative effectiveness of two different courses of antibiotics and placebo in patients admitted to the hospital with either acute myocardial infarction or unstable angina. Studies have shown the effectiveness of a number of antibiotics in the treatment of coronary artery disease. The effectiveness of this type of therapy is not pathogenetically substantiated, and this technique is not included in the standards of treatment for coronary artery disease.
• 5. Endovascular coronary angioplasty. The use of endovascular (transluminal, transluminal) interventions (coronary angioplasty) for various forms of coronary artery disease is developing. Such interventions include balloon angioplasty and stenting under the guidance of coronary angiography. In this case, instruments are inserted through one of the large arteries (in most cases the femoral artery is used), and the procedure is performed under fluoroscopic control. In many cases, such interventions help prevent the development or progression of myocardial infarction and avoid open surgery.

This area of ​​treatment of coronary artery disease is dealt with in a separate field of cardiology - interventional cardiology.

6. Surgery.

Aorto-coronary bypass surgery is performed.

Under certain conditions of coronary heart disease, indications for coronary artery bypass surgery arise - an operation in which the blood supply to the myocardium is improved by connecting the coronary vessels below the site of their lesion with external vessels. Best known coronary artery bypass surgery(CABG), in which the aorta is connected to segments coronary arteries. For this purpose, autografts (usually the great saphenous vein) are often used as shunts.

It is also possible to use balloon dilatation of blood vessels. In this operation, the manipulator is inserted into the coronary vessels through puncture of the artery (usually femoral or radial), and using a balloon filled contrast agent The lumen of the vessel is widened; the operation is essentially a bougienage of the coronary vessels. Currently, “pure” balloon angioplasty without subsequent stent implantation is practically not used, due to its low effectiveness in the long term.

• 7. Other non-drug treatments
• - Hirudotherapy. Hirudotherapy is a treatment method based on the use of the antiplatelet properties of leech saliva. This method is an alternative and has not been clinically tested to meet the requirements of evidence-based medicine. Currently, it is used relatively rarely in Russia, is not included in the standards of medical care for coronary artery disease, and is used, as a rule, at the request of patients. Potential beneficial effects of this method include the prevention of blood clots. It is worth noting that when treated according to approved standards, this task is performed using heparin prophylaxis.
• - Shock wave therapy method. Exposure to low power shock waves leads to myocardial revascularization.

An extracorporeal source of focused acoustic wave allows remote influence on the heart, causing “therapeutic angiogenesis” (vascular formation) in the zone of myocardial ischemia. The impact of UVT has double effect-- short-term and long-term. First, the vessels dilate and blood flow improves. But the most important thing begins later - new vessels appear in the affected area, which provide long-term improvement.

Low-intensity shock waves cause shear stress in the vascular wall. This stimulates the release of factors vascular growth, starting the process of growth of new vessels that nourish the heart, improving myocardial microcirculation and reducing angina. The results of such treatment are theoretically a decrease in the functional class of angina pectoris, an increase in exercise tolerance, a decrease in the frequency of attacks and the need for medicines.

However, it should be noted that at present there have been no adequate independent multicenter randomized studies evaluating the effectiveness of this technique. Studies cited as evidence of the effectiveness of this technique are usually carried out by the manufacturing companies themselves. Or do not meet the criteria of evidence-based medicine.

This method is not widely used in Russia due to questionable effectiveness, high cost of equipment, and lack of appropriate specialists. In 2008, this method was not included in the standard of medical care for coronary artery disease, and these manipulations were carried out on a contractual basis. on a commercial basis, or in some cases under voluntary health insurance contracts.

- Use of stem cells. When using stem cells, those performing the procedure expect that the pluripotent stem cells introduced into the patient’s body will differentiate into the missing cells of the myocardium or vascular adventitia. It should be noted that stem cells actually have this ability, but at present the level of modern technology does not allow us to differentiate a pluripotent cell into the tissue we need. The cell itself makes the choice of differentiation path - and often not the one needed for the treatment of coronary artery disease.

This treatment method is promising, but has not yet been clinically tested and does not meet the criteria of evidence-based medicine. It takes years of scientific research to achieve the effect that patients expect from the introduction of pluripotent stem cells.

Currently, this treatment method is not used in official medicine and is not included in the standard of care for IHD.

- Quantum therapy for ischemic heart disease. It is a therapy using laser radiation. The effectiveness of this method has not been proven, independent clinical trial was not carried out.

Treatment of coronary heart disease involves a wide range of different measures, part of which is drug therapy. Diseases are treated according to special principles, which involve actions in several directions. For ischemic heart disease, many drugs are used, each group of which is necessary to achieve specific purpose.

General principles of drug treatment of coronary artery disease

At drug treatment Coronary heart disease requires an integrated approach. This allows you to achieve results in several directions at once.

Drug therapy for IHD is based on the following principles:

• relief of manifestations of an already developed disease;
• preventing disease progression;
• prevention of complications;
• normalization of lipid metabolism;
• normalization of blood clotting;
• improvement of myocardial condition;
• normalization of pressure;
• increasing tolerance to physical activity;
• taking into account the form of the disease and the patient’s response to drugs of the same group;
• taking into account developed complications: this usually refers to circulatory failure;
• taking into account concomitant diseases: most often this applies to diabetes mellitus, systemic atherosclerosis.

The approach to drug treatment for each patient must be individual. When prescribing medications, it is necessary to take into account many factors, including the nuances of the course of the disease and individual characteristics sick.

Statins

This group of drugs is cholesterol-lowering. Their inclusion in the treatment of coronary artery disease is necessary, since thanks to them, atherosclerotic plaques develop more slowly, are reduced in size, and new ones are no longer formed.

The use of statins has a positive effect on the patient's life expectancy and the frequency and severity of cardiovascular attacks. Such drugs allow you to achieve a target cholesterol level of 4.5 mmol/l, while it is necessary to reduce the level of low-density lipoproteins to 2.5 mmol/l.

The effectiveness of statins is due to their interaction with the liver, where the production of an enzyme necessary for the production of cholesterol is inhibited. When decreasing general level cholesterol, its forward and reverse transport returns to normal.

For coronary artery disease, the following drugs from the statin group are usually used:

• Atorvastatin;
• Lovastatin;
• Rosuvastatin;
• Simvastatin.

In the treatment of coronary heart disease, statins are usually prescribed in high dosages. For example, Rosuvastin is taken at 40 mg, and Atorvastatin at 80 mg.

Antiplatelet agents

Such drugs are necessary to prevent blood clots. Under the influence of these medications, the aggregation of platelets and red blood cells is inhibited. As a result, their ability to stick together and adhere to the vascular endothelium is reduced.

By reducing the surface tension of red blood cell membranes, their damage during passage through the capillaries is reduced. As a result, blood flow improves.

In the treatment of ischemic heart disease, acetylsalicylic acid is often used, which is the basis of Aspirin, Acecardol, and Thrombolol. Take such drugs once a day in a dosage of at least 75 mg.

Another effective antiplatelet agent is Clopidogrel. Drugs such as Plavix and Clopidogrel are based on this substance. It is also taken once a day, 75 mg.

Antiplatelet agents provide not only the prevention of aggregation, but are also capable of disaggregating aggregated platelets.

Antagonists of the renin-angiotensin-aldosterone system (ACE inhibitors)

Drugs in this group act on the angiotensin-converting enzyme, triggering a whole chain of reactions. The breakdown of bradykinin slows down, afterload and the production of angiotensin II, which constricts blood vessels, decreases.

Thanks to this, ACE inhibitors provide several actions at once:

• hypotensive;
• nephroprotective;
• cardioprotective.

The use of ACE inhibitors for coronary heart disease allows you to achieve target blood pressure readings. When choosing a suitable drug is based on the ability active substance to penetrate tissue. When treating coronary artery disease, a drug is selected that needs to be used once a day. At the same time, it must be excreted in different ways in order to allow treatment against the background of renal or liver failure.

Of the ACE inhibitors, Captopril is most often used. Only such drugs provide a direct effect, when other representatives of this group are prodrugs. The latter include, which is also often included in the treatment of coronary artery disease.

ACE inhibitors are prescribed with caution for myocardial infarction, especially in the first hours of its development. In this case, hemodynamic instability is observed, therefore the risk of development or aggravation increases. In such a situation, drugs are included in treatment with a minimum dosage, which is increased only after stabilization of hemodynamics under conditions of pressure control.

Angiotensin receptor blockers

Drugs in this group are usually prescribed for ischemic heart disease when ACE inhibitors cannot be used due to the patient’s individual intolerance to them. These medications block angiotensin II receptors and are known by another name - sartans or angiotensin receptor antagonists.

The main purpose of angiotensin receptor blockers is hypotensive effect. Single dose the drug ensures its effectiveness throughout the day. In addition to the antihypertensive effect, medications in this group have a positive effect on lipid metabolism, reducing the level of low-density lipoproteins and triglycerides.

Another important quality angiotensin receptor antagonists - reducing the amount of uric acid in the blood. This factor is important when the patient is prescribed long-term diuretic therapy.

One of the most effective sartans is Valsartan. This is the only drug in this group that can be used after myocardial infarction.

The advantage of sartans is the minimal risk of side effects. This especially applies to dry cough, which often occurs while taking ACE inhibitors.

Beta blockers

Drugs in this group act on β-adrenergic receptors. As a result, the heart rate decreases, which reduces the heart muscle's need for oxygen.

The inclusion of β-blockers has a positive effect on the patient’s life expectancy and also reduces the likelihood of cardiovascular events, including recurrent ones.

β-blockers are one of the main directions in the treatment of coronary heart disease. They allow you to get rid of angina pectoris, improve the quality of life and prognosis after myocardial infarction and chronic heart failure.

For angina pectoris, treatment begins with a minimum dosage, adjusting it if necessary. In case of side effects, the drug may be discontinued.

When treating IHD, they usually resort to Carvedilol, Metoprolol. If the selected β-blocker is ineffective or increasing its dosage is impossible, then it is combined with a nitrate or calcium antagonist. In some cases, a combination of all three is required. Additionally, an antianginal agent may be prescribed.

Nitrates

This group is represented by derivatives of glycerol, diglycerides, monoglycerides and triglycerides. As a result of exposure to nitrates, the contractile activity of vascular smooth muscles changes and the preload on the myocardium decreases. This is ensured by the dilation of blood vessels in the venous bed and the deposition of blood.

The use of nitrates causes a decrease in blood pressure. Such drugs are not prescribed if the pressure is not higher than 100/60 mm Hg. Art.

In case of IHD, nitrates are mainly used to... There is no increase in survival rate with this treatment.

With high blood pressure, attacks are stopped by intravenous drip administration of the drug. There is also a tablet and inhalation form.

Among nitrates, in the treatment of coronary heart disease, they usually resort to Nitroglycerin or isosorbide mononitrate. The patient is advised to carry the prescribed medication with him at all times. It should be taken during an attack of angina if eliminating the provoking factor does not help. Repeated administration of Nitroglycerin is allowed, but if there is no effect after this, you should call ambulance.

Cardiac glycosides

For ischemic heart disease, drug therapy includes various antiarrhythmic drugs, one of the groups of which are cardiac glycosides. Their distinctive feature– plant origin.

The main purpose of cardiac glycosides is the treatment of heart failure. Taking this drug leads to an increase in the performance of the myocardium and an improvement in its blood supply. The heart rate decreases, but their strength increases.

Cardiac glycosides can normalize arterial and lower venous pressure. Such drugs are prescribed infrequently for coronary heart disease due to the high risk adverse reactions.

Of the cardiac glycosides, Digoxin or Corglicon are most often used. The first preparation is based on woolly foxglove, the second on lily of the valley.

Calcium antagonists

Drugs in this group block calcium channels (L-type). Due to inhibition of the penetration of calcium ions, their concentration in cardiomyocytes and smooth vascular muscle cells decreases. This ensures expansion of the coronary and peripheral arteries, so a pronounced vasodilator effect is observed.

The main purpose of slow calcium channel blockers for coronary artery disease is the prevention of angina attacks. The antianginal properties of this drug group resemble those of beta-blockers. Such drugs also lower the heart rate, provide an antiarrhythmic effect and inhibit the contractility of the heart muscle.

For ischemic heart disease, slow calcium channel blockers are usually used if high blood pressure combined with stable angina, as well as for the prevention of ischemia in patients with vasospastic angina.

The advantage of calcium antagonists over beta-blockers is the possibility of use in a wide range of people, as well as use in cases of contraindications or individual intolerance to beta-blockers.

Among the calcium antagonists in the treatment of coronary artery disease, they usually resort to Verapamil, Nifedipine, Diltiazem, Amlodipine, Felodipine.

Diuretics

Drugs in this group are diuretics. When used, the excretion of water and salts in the urine increases, and the rate of urine formation increases. This leads to a decrease in the amount of fluid in the tissues.

This action allows the use of diuretics to lower blood pressure, as well as for edema due to cardiovascular pathologies.

For ischemic heart disease, thiazide or loop diuretics are used. In the first case, the drugs are potassium-sparing. Systematic therapy with medications of this group reduces the risk of complications affecting the cardiovascular system due to hypertension. Among thiazide diuretics, Indapamide or Hypothiazide are most often used. These drugs are intended for long-term treatment– the necessary therapeutic effect is achieved after a month of continuous use of the drug.

Loop diuretics provide quick and pronounced results. Usually they serve as an ambulance and help to carry out forced diuresis. From this group, Furosemide is usually used. It has tablet form and injection form– the appropriate option is selected according to the circumstances.

Antihypoxants

Currently, such drugs are used quite rarely. Under their influence, the utilization of oxygen that circulates in the body improves. As a result, resistance to oxygen starvation increases.

One of effective drugs Among the antihypoxants is Actovegin. Its action is to activate the metabolism of glucose and oxygen. The medication also provides an antioxidant effect. Actovegin is used in high doses for acute myocardial infarction, as it provides prevention of reperfusion syndrome. A similar effect is required when the patient has chronic heart failure, has undergone thrombolytic therapy or balloon angioplasty.

Another effective antihypoxant is Hypoxen. When taking such a drug, the tolerance to hypoxia increases, since mitochondria begin to consume oxygen faster, and the conjugacy of oxidative phosphorylation increases. This drug is suitable for any type of oxygen deprivation.

Cytochrome C is also used. This enzyme agent catalyzes cellular respiration. The drug contains iron, which goes into a reducing form and accelerates oxidative processes. The disadvantage of the drug is the risk of allergic reactions.

Trimetazidine is classified as a hypoxanth. This antianginal medication does not belong to standard regimens for the treatment of coronary heart disease, but can be used as additional means. Its action is to normalize energy cellular metabolism against the background of hypoxia and ischemia. This drug is included in drug treatment for coronary artery disease as a prophylaxis for angina attacks. It is also indicated for patients with dizziness and tinnitus due to impaired cerebral circulation.

Anticoagulants

Medicines of this group affect the blood coagulation system, inhibiting its activity. As a result, the drug prevents thrombus formation.

For ischemic heart disease, heparin is usually used, which is an anticoagulant. direct action. The anticoagulant activity of the drug is ensured by the activation of antithrombin III. Due to certain reactions that are provided by heparin, antithrombin III becomes capable of inactivating coagulation factors, kallikrein, and serine proteases.

For coronary heart disease, the drug can be administered subcutaneously (abdominal area) or intravenously through an infusion pump. In case of myocardial infarction, this drug is prescribed to prevent the formation of blood clots. In this case, they resort to subcutaneous injection funds in the amount of 12500 IU. This procedure is repeated every day for a week. If the patient is in the intensive care unit and intensive care, then heparin is administered by an infusion pump.

Warfarin is also used for ischemic heart disease. This drug is an anticoagulant indirect action. It is usually prescribed if the patient is diagnosed with a permanent form of atrial fibrillation. The dosage of the medication is selected in such a way that blood clotting is maintained at a level of 2-3.

Warfarin actively dissolves blood clots, but can lead to bleeding. This drug can only be used when prescribed by a doctor. Be sure to monitor blood tests during treatment.

Antiplatelet

Antithrombotic therapy for coronary heart disease is prescribed for both acute and chronic cases. Drugs in this group can inhibit platelet function. They affect the hemocoagulation system, restore vascular patency against the background of their thrombolysis.

One of the effective antiplatelet agents is Dipyridamole, which is a pyrimido-pyrimidine derivative. It has vasodilating and antiplatelet properties. This medication is usually prescribed to be taken twice daily. Against the background of ischemic brain disease, the medication is combined with small doses of aspirin.

The main representatives of antiplatelet drugs are Aspirin and Clopidogrel. In the background, Aspirin is prescribed, and if there are contraindications to it, they resort to the second option.

Nonsteroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs differ wide range applications and complex action. These drugs have analgesic, anti-inflammatory and antipyretic properties.

The advantage of non-steroidal anti-inflammatory drugs is their high safety and low toxicity. The risk of complications is low even when taking high doses of such drugs.

The effect of non-steroidal anti-inflammatory drugs is due to blocking the formation of prostaglandins. It is because of these substances that inflammation, pain, fever, muscle spasms.

Anti-inflammatory non-steroidal drugs reduce vascular permeability and increase microcirculation in them.

One of the most famous drugs in this group is Aspirin. In case of coronary heart disease, the patient is prescribed lifelong use of this medication if there are no contraindications to such treatment.

Well-known representatives of the non-steroidal anti-inflammatory group are Diclofenac and Ibuprofen. The use of such drugs for myocardial infarction is not recommended, as it negatively affects the prognosis. The approach is similar for conditions equivalent to a heart attack.

Drug therapy for coronary heart disease involves the use of a whole range of drugs. Each of them provides a specific result. The correct combination of different medications for a particular patient must be determined in individually. Only a specialist can do this.

Treatment of coronary artery disease consists of tactical and strategic measures. The tactical task includes providing emergency care the patient and stopping an attack of angina pectoris (MI will be discussed in a separate chapter), and strategic measures are, in essence, the treatment of coronary artery disease. Let's not forget about the strategy for managing patients with ACS.

I. Treatment of angina. Since in the vast majority of cases the patient consults a doctor due to pain (the presence of angina), eliminating the latter should be the main tactical task.

The drugs of choice are nitrates ( nitroglycerin, isosorbide dinitrate ). Nitroglycerine (anhibid, anhydride, nitrangin, nitroglin, nitrostat, trinitrol etc.), tablets for sublingual administration at 0.0005, the relief effect occurs in 1-1.5 minutes and lasts 23-30 minutes. It is advisable to take it in a sitting position, i.e. with your legs down. If there is no effect from one tablet after 5 minutes, you can take a second, then a third, but no more than 3 tablets within 15 minutes. In severe cases nitroglycerine administered intravenously. You can use buccal forms - plates trinitrolonga , which are applied to the mucous membrane of the upper gum above the canines and small molars. Trinitrolong is able to both quickly stop an attack of angina and prevent it. If trinitrolong taken before going outside, walking, commuting to work or before other physical activity, it can prevent angina attacks. If nitro drugs are poorly tolerated, they are replaced with Molsidomine (corvaton ).

If the pain cannot be relieved, then this is most likely not a normal attack of angina. We will discuss the provision of assistance during an intractable angina attack below (see “Strategy for the management of patients with ACS”).

Treatment regimens for patients with angina pectoris

Standard for emergency care for angina pectoris.

1. During an anginal attack:

It is convenient to sit the patient with his legs down;

- nitroglycerine - tablets or aerosol 0.4-0.5 mg sublingually three times every 3 minutes (if intolerant nitroglycerin - Valsalva maneuver or carotid sinus massage);

Physical and emotional peace;

Correction of blood pressure and heart rate.

2. If an attack of angina persists:

oxygen therapy;

with angina pectoris - anaprilin 10-40 mg sublingually, for variant angina - nifedipine 10 mg sublingually or in drops orally;

heparin 10,000 units i.v.;

let chew 0.25 g acetylsalicylic acid .

3. Depending on the severity of pain, age, condition (without prolonging the attack!):

- fentanyl (0.05-0.1 mg) or promedol (10-20 mg), or butorphanol (1-2 mg), or analgin (2.5 g) with 2.5-5 mg droperidol intravenously slowly or fractionally.

4. With ventricular extrasystoles of 3-5 degrees:

- lidocaine IV slowly 1 - 1.5 mg/kg and every 5 minutes 0.5-0.75 mg/kg until an effect is achieved or a total dose of 3 mg/kg is achieved. To prolong the effect obtained - lidocaine up to 5 mg/kg IM.

In cases of unstable angina or suspected myocardial infarction, patients are considered to have ACS. The approach to managing such patients is outlined below.

Management strategy for patients with ACS .

The course and prognosis of the disease largely depend on several factors: the volume of the lesion, the presence of aggravating factors such as diabetes mellitus, arterial hypertension, heart failure, old age, and to a large extent on the speed and completeness of medical care. Therefore, if ACS is suspected, treatment should begin at the prehospital stage. The term “acute coronary syndrome” (ACS) was introduced into clinical practice when it became clear that the issue of using certain active treatment methods, in particular thrombolytic therapy, should be decided before establishing the final diagnosis - the presence or absence of large-focal myocardial infarction.

At the first contact of a doctor with a patient, if there is a suspicion of ACS, based on clinical and ECG signs it can be classified as one of its two main forms.

Acute coronary syndrome with ST segment elevations. These are patients with pain or other unpleasant sensations (discomfort) in chest and persistent ST segment elevations or “new” (new or suspected new) left bundle branch block on the ECG. Persistent ST segment elevations reflect the presence of acute complete occlusion of the coronary artery. The goal of treatment in this situation is rapid and lasting restoration of the lumen of the vessel. For this purpose, thrombolytic agents are used (in the absence of contraindications) or direct angioplasty (if technically possible).

Acute coronary syndrome without ST segment elevations. Patients with chest pain and ECG changes indicating acute myocardial ischemia, but without ST segment elevations. These patients may experience persistent or transient ST depression, inversion, flattening or pseudo-normalization of the T wave. The ECG on admission may be normal. The management strategy for such patients consists of eliminating ischemia and symptoms, monitoring with repeated (serial) recording of electrocardiograms and determining markers of myocardial necrosis (cardiac troponins and/or creatine phosphokinase MB-CPK). Thrombolytic agents are not effective and are not used in the treatment of such patients. Therapeutic tactics depend on the degree of risk (severity of the condition) of the patient.

In each specific case, deviations from the recommendations are permissible depending on the individual characteristics of the patient. The doctor makes a decision taking into account the medical history, clinical manifestations, data obtained during observation of the patient and examination during hospitalization, as well as based on the capabilities of the medical institution. In general terms, the strategy for managing a patient with ACS is presented in Fig.

LMWH – low molecular weight heparins. PCI – percutaneous coronary intervention. UFH – unfractionated heparin.

The initial evaluation of a patient complaining of chest pain or other symptoms suggestive of myocardial ischemia includes a thorough history, physical examination, with particular attention to the possible presence of valvular heart disease (aortic stenosis), hypertrophic cardiomyopathy, heart failure, and lung diseases.

An ECG should be recorded and ECG monitoring should be started to monitor the heart rhythm (multi-channel ECG monitoring is recommended to monitor myocardial ischemia).

Patients with persistent ST segment elevation on the ECG or “new” left atrioventricular bundle branch block are candidates for immediate treatment to restore blood flow through the occluded artery (thrombolytic, PC).

Drug treatment of patients with suspected ACS (with the presence of ST segment depression/T wave inversion, false positive T wave dynamics or a normal ECG with a clear clinical picture of ACS) should begin with oral administration aspirin 250-500 mg (first dose - chew the uncoated tablet); then 75-325 mg, 1 time/day; heparin (UFH or LMWH); beta blockers. For ongoing or recurring chest pain, nitrates are added orally or intravenously.

The administration of UFH is carried out under the control of APTT (activated partial thromboplastin time) (it is not recommended to use determination of blood clotting time to monitor heparin therapy) so that 6 hours after the start of administration it is 1.5-2.5 times higher than the control (normal) indicator for the laboratory of a particular medical institution and then staunchly maintained at this therapeutic level. Initial dose NFG : bolus 60-80 units/kg (but not more than 5,000 units), then infusion 12-18 units/kg/h (but not more than 1250 units/kg/h) and determination of aPTT after 6 hours, after which the rate is adjusted drug infusion.

APTT determinations should be performed 6 hours after any dose change. heparin . Depending on the result obtained, the infusion rate (dose) should be adjusted in order to maintain the aPTT at a therapeutic level. If the aPTT is within therapeutic limits with 2 consecutive measurements, then it can be determined every 24 hours. In addition, the determination of the aPTT (and adjustment of the dose of UFH depending on its result) should be carried out if there is a significant change (deterioration) in the patient’s condition - the occurrence of repeated attacks myocardial ischemia, bleeding, arterial hypotension.

Myocardial revascularization. In case of atherosclerotic damage to the coronary arteries, which allows for a revascularization procedure, the type of intervention is selected based on the characteristics and extent of the stenoses. In general, recommendations for choosing a revascularization method for NST are similar to the general recommendations for this treatment method. If selected balloon angioplasty with or without stent placement, it can be performed immediately after angiography, within the same procedure. In patients with single vessel disease, PCI is the main intervention. CABG is recommended for patients with left main coronary artery disease and three-vessel disease, especially in the presence of LV dysfunction, except in cases with serious concomitant diseases that are contraindications to surgery. For two-vessel and in some cases three-vessel disease, both CABG and PTCA are acceptable.

If it is impossible to perform revascularization of patients, it is recommended to treat heparin (low molecular weight heparins - LMWH) until the second week of the disease (in combination with maximum anti-ischemic therapy, aspirin and if possible - clopidogrel ). Once the patient's condition has been stabilized, invasive treatment should be considered in another hospital with appropriate capabilities.

II. Treatment of chronic coronary disease. So, the acute period is over. Strategic management of chronic coronary insufficiency comes into effect. It should be comprehensive and aimed at restoring or improving coronary circulation, curbing the progression of atherosclerosis, eliminating arrhythmia and heart failure. The most important component of the strategy is resolving the issue of myocardial revascularization.

Let's start with catering. The diet of such patients should be low-energy. The amount of fat is limited to 60-75 g/day, and 1/3 of it should be of plant origin. Carbohydrates - 300-400 g. Exclude fatty meats, fish, refractory fats, lard, combined fats.

Application medicines is aimed at relieving or preventing an attack of angina, maintaining adequate coronary circulation, influencing metabolism in the myocardium to increase its contractility. For this purpose, nitro compounds, beta-adrenergic receptor blockers, CCBs, antiadrenergic drugs, potassium channel activators, and disaggregants are used.

Anti-ischemic drugs reduce myocardial oxygen consumption (lowering heart rate, blood pressure, suppressing left ventricular contractility) or cause vasodilation. Information on the mechanism of action of the drugs discussed below is given in the appendix.

Nitrates have a relaxing effect on the smooth muscles of blood vessels, causing the expansion of large coronary arteries. According to the duration of action, short-acting nitrates are distinguished ( nitroglycerine for sublingual use, spray), medium duration of action (tablets sustaka, nitrong, trinitrolong ) and long-acting ( Isosorbitol dinitrate -20 mg each; patches containing nitroglycerine , erinite 10-20 mg). The dose of nitrates should be gradually increased (titrated) until symptoms disappear or side effects (headache or hypotension) appear. Long-term use of nitrates can lead to addiction. As symptom control is achieved, IV nitrates should be replaced with non-parenteral forms, while maintaining some nitrate-free interval.

Beta blockers. The goal of taking β-blockers orally should be to achieve a heart rate of 50-60 per minute. β-blockers should not be prescribed to patients with severe atrioventricular conduction disorders (RV block of the first degree with PQ > 0.24 s, second or third degree) without a working artificial pacemaker, a history of asthma, severe acute LV dysfunction with signs of HF. The following drugs are widely used - anaprilin, obzidan, inderal 10-40 mg each, daily dose up to 240 mg; Trazicore 30 mg each, daily dose - up to 240 mg; cordanum (talinolol ) 50 mg, per day up to 150 mg.

Contraindications for the use of β-blockers: severe heart failure, sinus bradycardia, peptic ulcer, spontaneous angina.

Calcium channel blockers divided into direct-acting drugs that bind calcium on membranes ( verapamil, finoptin, diltiazem ), and indirect action, having the ability of membrane and intracellular effects on calcium flow ( nifedipine, corinfar, felodipine, amlodipine ). Verapamil, isoptin, finoptin Available in tablets of 40 mg, daily dose - 120-480 mg; nifedipine, corinfar, pheninidine 10 mg each, daily dose - 30-80 mg; amlodipine - 5 mg, per day - 10 mg. Verapamil can be combined with diuretics and nitrates, and drugs from the group Corinthara - also with β-blockers.

Antiadrenergic drugs of mixed action - amiodarone (cordarone ) - have antiangial and antiarrhythmic effects.

Potassium channel activators (nicorandil ) cause hyperpolarization of the cell membrane, give a nitrate-like effect due to an increase in the content of cGMP inside the cell. As a result, the SMC relaxes and the “cellular protection of the myocardium” increases during ischemia, as well as coronary arteriolar and venular vasodilation. Nikorandil reduces the size of MI during irreversible ischemia and significantly improves post-ischemic myocardial stress with transient episodes of ischemia. Potassium channel activators increase myocardial tolerance to repeated ischemic injury. Single dose nicorandil - 40 mg, course of treatment - approximately 8 weeks.

Lowering Heart Rate: A New Approach to Treating Angina. Heart rate, along with left ventricular contractility and load, are key factors determining myocardial oxygen consumption. Tachycardia caused by exercise or pacing can induce the development of myocardial ischemia and, apparently, is the cause of the majority of coronary complications in clinical practice. The channels through which sodium/potassium ions enter the cells of the sinus node were discovered in 1979. They are activated during the period of hyperpolarization of the cell membrane, are modified under the influence of cyclic nucleotides and belong to the family of HCN channels. Catecholamines stimulate the activity of adenylate cyclase and the formation of cAMP, which promotes the opening of f-channels and an increase in heart rate. Acetylcholine has the opposite effect. The first drug that selectively interacts with f-channels is ivabradine (coraxan , "Servier"), which selectively reduces heart rate, but does not affect other electrophysiological properties of the heart and its contractility. It significantly slows down diastolic membrane depolarization without changing the overall duration of the action potential. Dosage regimen: 2.5, 5 or 10 mg twice a day for 2 weeks, then 10 mg twice a day for 2-3 months.

Antithrombotic drugs.

The likelihood of thrombosis is reduced by thrombin inhibitors - direct ( hirudin ) or indirect (unfractionated heparin or low molecular weight heparins) and antiplatelet agents ( aspirin , thienopyridines, blockers of glycoprotein IIb/IIIa platelet receptors).

Heparins (unfractionated and low molecular weight). The use of unfractionated heparin (UFH) is recommended. Heparin is ineffective against platelet thrombus and has little effect on thrombin, which is part of the thrombus.

Low molecular weight heparins (LMWH) can be administered subcutaneously, dosing them according to the patient’s weight and without laboratory monitoring.

Direct thrombin inhibitors. Application hirudin recommended for the treatment of patients with thrombocytopenia caused by heparin.

When treated with antithrombins, hemorrhagic complications may develop. Minor bleeding usually requires simply stopping treatment. Major gastrointestinal bleeding manifested by hematemesis, melena, or intracranial hemorrhage may require the use of heparin antagonists. This increases the risk of thrombotic withdrawal phenomenon. The anticoagulant and hemorrhagic effects of UFH are blocked by administering protamine sulfate , which neutralizes the anti-IIa activity of the drug. Protamine sulfate only partially neutralizes the anti-Xa activity of LMWH.

Antiplatelet agents. Aspirin (acetylsalicylic acid) inhibits cyclooxygenase-1 and blocks the formation of thromboxane A2. Thus, platelet aggregation induced through this pathway is inhibited.

Adenosine diphosphate receptor antagonists (thienopyridines). Thienopyridine derivatives ticlopidine And clopidogrel - adenosine diphosphate antagonists, leading to inhibition of platelet aggregation. Their effect occurs more slowly than the effect of aspirin. Clopidogrel has significantly fewer side effects than ticlopidine . Long-term use of a combination of clopidogrel and aspirin, started in the first 24 hours of ACS, is effective.

Warfarin . Effective as a drug for the prevention of thrombosis and embolism warfarin . This drug is prescribed to patients with heart rhythm disorders, patients who have had a myocardial infarction, suffering from chronic heart failure after surgery for prosthetics of large vessels and heart valves, and in many other cases.

Dosing warfarin - a very responsible medical manipulation. On the one hand, insufficient hypocoagulation (due to a low dose) does not relieve the patient from vascular thrombosis and embolism, and on the other hand, a significant decrease in the activity of the blood coagulation system increases the risk of spontaneous bleeding.

To monitor the state of the blood coagulation system, MHO (International normalized ratio, derived from the prothrombin index) is determined. In accordance with the IHO values, 3 levels of hypocoagulation intensity are distinguished: high (from 2.5 to 3.5), medium (from 2.0 to 3.0) and low (from 1.6 to 2.0). In 95% of patients, the MHO value is between 2.0 and 3.0. Periodic monitoring of MHO allows timely adjustment of the dose of the drug taken.

Upon appointment warfarin selection of an individual dose usually begins with 5 mg/day. After three days, the attending physician, focusing on the INR results, reduces or increases the amount of the drug taken and re-prescribes the INR. This procedure can continue 3-5 times before the required effective and safe dose is selected. So, with an MHO of less than 2, the dose of warfarin is increased, and with an MHO of more than 3, it is decreased. Therapeutic breadth warfarin - from 1.25 mg/day to 10 mg/day.

Blockers of glycoprotein IIb/IIIa platelet receptors. Drugs in this group (in particular, abciximab ) are highly effective when given short-term intravenously in patients with ACS undergoing percutaneous coronary intervention (PCI) procedures.

Cytoprotective drugs.

A new approach in the treatment of coronary artery disease - myocardial cytoprotection, is to counteract the metabolic manifestations of ischemia. A new class of cytoprotectors - a drug with metabolic action trimetazidine , on the one hand, reduces the oxidation of fatty acids, and on the other, enhances oxidative reactions in mitochondria. As a result, a metabolic shift towards activation of glucose oxidation is observed.

Unlike drugs of the “hemodynamic” type (nitrates, beta blockers, calcium antagonists), there are no restrictions for use in elderly patients with stable angina. Addition trimetazidine to any traditional antianginal therapy can improve the clinical course of the disease, the tolerability of exercise tests and the quality of life in elderly patients with stable angina pectoris, while the use of trimetazidine was not accompanied by a significant effect on the main hemodynamic parameters and was well tolerated by the patients.

Trimetazidine is produced in a new dosage form - trimetazidine MBi, 2 tablets per day, 35 mg, which is fundamentally no different in its mechanism of action from the 20 mg form of trimetazidine, but has a number of valuable additional features. Trimetazidine MB , the first 3-CAT inhibitor, causes effective and selective inhibition of the last enzyme in the beta-oxidation chain. The drug provides better protection myocardium from ischemia within 24 hours, especially in the early morning hours, since the new dosage form allows you to increase the minimum concentration by 31% while maintaining the maximum concentration at the same level. The new dosage form allows you to increase the time during which the concentration of trimetazidine in the blood remains at a level not lower than 75% of the maximum, i.e. significantly increase the concentration plateau.

Another drug from the group of cytoprotectors is mildronate . It is a structural synthetic analogue of gamma-butyrobetaine, a precursor of carnitine. Inhibits the enzyme gamma-butyrobetaine hydroxylase, reduces the synthesis of carnitine and the transport of long-chain fatty acids through cell membranes, and prevents the accumulation of activated forms of unoxidized fatty acids in cells (including acylcarnitine, which blocks the delivery of ATP to cell organelles). It has cardioprotective, antianginal, antihypoxic, angioprotective effects. Improves myocardial contractility, increases exercise tolerance. In acute and chronic circulatory disorders, it promotes the redistribution of blood flow to ischemic areas, thereby improving blood circulation in the ischemic area. For angina pectoris, 250 mg is prescribed orally 3 times a day for 3-4 weeks, the dose can be increased to 1000 mg/day. For myocardial infarction, 500 mg - 1 g IV bolus is prescribed once a day, after which they switch to oral administration at a dose of 250 -500 mg 2 times a day for 3-4 weeks.

Coronaroplasty.

Coronary revascularization. PCI or coronary artery bypass grafting (CABG) for CAD is performed to treat recurrent ischemia and to prevent MI and death. Indications and choice of method for myocardial revascularization are determined by the degree and prevalence of arterial stenosis and angiographic characteristics of stenoses. In addition, it is necessary to take into account the facility's capabilities and experience in performing both elective and emergency procedures.

Balloon angioplasty causes plaque rupture and may increase plaque thrombogenicity. This problem has been largely solved by the use of stents and blockers of glycoprotein IIb/IIIa platelet receptors. Mortality associated with PCI procedures is low in high volume facilities. Stent implantation for CAD can help mechanically stabilize the ruptured plaque at the site of narrowing, especially in the presence of a plaque with a high risk of complications. After stent implantation, patients should take aspirin and within a month ticlopidine or clopidogrel . The combination of aspirin + clopidogrel is better tolerated and safer.

Coronary bypass surgery. Surgical mortality and the risk of infarction with CABG are currently low. These rates are higher in patients with severe unstable angina.

Atherectomy (rotational and laser) - removal of atherosclerotic plaques from a stenotic vessel by “drilling” them or destroying them with a laser. Survival rates differ between transluminal balloon angioplasty and rotational atherectomy across studies, but without statistically significant differences.

Indications for percutaneous and surgical interventions.

Patients with single-vessel disease should generally undergo percutaneous angioplasty, preferably with stent placement, along with the administration of glycoprotein IIb/IIIa receptor blockers. Surgical intervention in such patients is advisable if the anatomy of the coronary arteries (severe vascular tortuosity or curvature) does not allow for safe PCI.

In all patients with secondary prevention Aggressive and broad targeting of risk factors is warranted. Stabilization of the patient's clinical condition does not mean stabilization of the underlying pathological process. Data on the duration of the healing process of a ruptured plaque are ambiguous. According to some studies, despite clinical stabilization during drug treatment, the stenosis, “responsible” for exacerbation of coronary artery disease, retains a pronounced ability to progress.

Patients should stop smoking. When a diagnosis of IHD is made, lipid-lowering treatment should be started without delay (see section “Atheroxlerosis”) with HMG-CoA reductase inhibitors ( statins ), which significantly reduce mortality and the incidence of complications in patients with high and moderate levels of low-density lipoprotein cholesterol (LDL). It is advisable to prescribe statins during the patient's first visit, using lipid levels in blood samples taken upon admission as a guide for dose selection. The target levels of total cholesterol and LDL cholesterol should be 5.0 and 3.0 mmol/L, respectively, but there is a view that a greater reduction in LDL cholesterol should be aimed for. There is reason to believe that ACE inhibitors can play a certain role in the secondary prevention of coronary artery disease. Since atherosclerosis and its complications are caused by many factors, to reduce the incidence of cardiovascular complications, special attention should be paid to addressing all modifiable risk factors.

Prevention . Patients with risk factors for the development of coronary artery disease require constant monitoring, systematic monitoring of lipid mirrors, periodic ECGs, and timely and adequate treatment of concomitant diseases.

According to the modern classification, coronary artery disease includes sudden death, angina pectoris and myocardial infarction. But in this section only IHD in the manifestations of angina will be considered. This is a group of heart diseases (especially ischemic and coronary insufficiency) resulting from impaired blood flow to the myocardium due to narrowing of the coronary arteries.

Term "ischemia" came from a combination of the Greek words lh/yu, which means “to delay, stop,” and Nta - “blood.” In this condition, the blood supply to any part of the heart is disrupted, and a discrepancy appears between the needs of the heart (myocardium) for oxygen and the level of cardiac blood flow and incoming oxygen. This condition can be acute or chronic, temporary (reversible) or irreversible.

As a result of long-term, irreversible changes in the myocardium, heart cells are damaged and die. IHD manifests itself when the narrowing of the coronary vessels reaches 50%. If the narrowing approaches 70-80%, then severe attacks of angina occur. In addition to atherosclerosis of the coronary arteries, a number of factors are important in the occurrence of IHD - the condition of the vessels and the number chemical substances, which is produced by the inner walls of blood vessels.

Atherosclerosis- This chronic illness, in which arterial damage occurs. It is expressed in the fact that fats and calcium salts are deposited on the inner wall of the vessel, and degeneration develops muscle tissue into the connecting room. As a result, the wall of the vessel becomes denser, its lumen narrows, and blood flow is disrupted. This causes adverse changes in organs, leading to various diseases. Atherosclerosis is one of the most common modern diseases. Its prevalence is high among Europeans, North America, and in the countries of the East, Africa, and South America it is much less common.

Men get sick more often than women, and atherosclerosis occurs about 10 years earlier in them. This difference is due to lifestyle, genetic characteristics, and hormonal factors. Behind last decades Mortality from coronary artery disease caused by atherosclerosis has increased significantly. The occurrence of atherosclerosis is caused by a combination of many factors called risk factors. These include: arterial hypertension, smoking, prolonged emotional stress, metabolic characteristics in the body.

The mechanism of occurrence of atherosclerosis: the inner lining of the vessel is damaged, platelets rush to the site of damage, settle there, become covered with connective tissue, followed by the addition of lipids. Cholesterol is one of several fat-like compounds found in human blood and tissues. It is produced by liver cells. Cholesterol exists in the body in several forms. One of them is high-density connections. This part is very important as it protects the body from atherosclerosis, removes cholesterol from body tissues and artery walls, and returns it to the liver for reuse or elimination from the body. Another part of cholesterol is low-density compounds. It plays a role in the formation of plaques and the development of atherosclerosis.

Gradually, the process progresses, cracks and ulcers form on the plaques, and blood clots form on their surface with the help of platelets. They close the lumen of the artery. Thrombosis occurs. The most dangerous complication in this is the detachment of a blood clot. There are more than 30 factors contributing to the occurrence of coronary artery disease. The main ones are increased blood pressure, increased cholesterol levels in the blood, smoking, a sedentary lifestyle, frequent use alcohol, heredity (presence of diseases of cardio-vascular system close relatives), being male, objective process aging of the body, overwork, irrational work and rest, poor nutrition, stressful situations.

Stress these days greatly increases the risk of coronary artery disease. Under stress, the human body produces so-called stress hormones. In this process, a large amount of vitamins and nutrients is consumed. It is also very important to change the composition of the blood - accelerating blood clotting, which leads to platelet aggregation and ultimately to the formation of plaques and blood clots.

Clinical manifestations

Angina pectoris- the most important and common manifestation of ischemic heart disease. This is a common disease, the main symptom of which is pain behind the sternum of a pressing or squeezing nature. The pain spreads, radiates to left hand, shoulder, shoulder blade, often in the neck and lower jaw. An attack of angina pectoris can manifest itself in the form of discomfort in the chest - burning, heaviness, fullness. A characteristic symptom of angina is the appearance of pain in the chest when the patient leaves a warm room into a cold one. Deterioration is often observed in the autumn-winter period, with changes in atmospheric pressure. Pain occurs during physical activity (in the initial stages of the disease - so-called angina pectoris) and stops with rest or after taking nitroglycerin. With excitement, pain appears without connection with physical stress.

Attacks of pain can occur at night, after eating, with bloating and a high position of the diaphragm. The duration of an angina attack is almost always more than 1 minute and less than 15 minutes. Its duration also depends on the patient’s behavior. If you stop exercising and take nitroglycerin, the attack will be shorter and less intense. One of the signs of angina is that the pain increases when lying down and decreases when the patient sits or stands. This occurs because the supine position increases the flow of venous blood to the heart and the myocardium requires more oxygen. The strength of the attack varies. At this time, the pulse is usually slow and rhythmic, but sometimes it can be accelerated (tachycardia). Blood pressure may also increase. Attacks may be rare (once a week or less), may not recur for several months, or, conversely, become more frequent and prolonged.

In diagnostics IHD Questioning the patient, finding out the causes of the disease, electrocardiographic examination, which is carried out repeatedly, tests with dosed physical activity (veloergometry), and drug tests are very important. One of the modern methods carried out in cardiology hospitals is radiographic examination of the vessels of the heart, i.e. the introduction of a substance into the blood, thanks to which it is possible to see the heart and large vessels and determine the nature, location of the lesion, and the extent of the process. This method is called "coronary angiography".

Treatment

Traditional

Treatment IHD- This is a comprehensive program. It includes methods of traditional therapy prescribed by therapists and cardiologists, and methods of non-traditional, traditional medicine. A mandatory component of treatment is the fight against risk factors. It is necessary to normalize the patient’s lifestyle, eliminate physical inactivity, eliminate bad habits, adhere to a certain diet, and try to avoid worries and emotional overload.

Medical nutrition

The list of products needed by patients with this disease must include raisins, honey, nuts of any kind, raw pumpkin, pumpkin seeds, seaweed, cottage cheese, strawberries. peas, soybeans, soybean oil and flour, eggplants, lemons and oranges with zest, rose hips in the form of a drink, gooseberries, cranberries. The content of proteins, fats and carbohydrates should be in a ratio of 1:1:4. If you are overweight, it is important to reduce the calorie content of your food. It is necessary to exclude fatty meat (especially lamb and pork), hard margarine, and butter from the diet, replacing it with vegetable oil, i.e., it is necessary to reduce the content of saturated fatty acids in the foods consumed, which are rich in animal fats that contribute to the formation of cholesterol, and to increase amount of fat plant origin. In addition, you need to provide the body with an increased amount of vitamins and microelements.

Drug therapy includes two main groups of drugs. This is, firstly, nitroglycerin and its derivatives, more long acting(they relieve spasm and dilate coronary vessels, making it easier for blood and oxygen to reach the heart). Another group is drugs that help improve blood composition (in this case, reducing coagulation and preventing the formation of blood clots). The simplest drug among them is aspirin (acetylsalicylic acid), prescribed according to a specific regimen. In addition, in some cases, medications are recommended that reduce the formation of cholesterol in the blood and inhibit its absorption in the intestines. Drugs that accelerate metabolism and remove lipids from the body are also used.

The administration of vitamins E and P is very useful. It is more advisable to combine them with ascorbic acid. It must be remembered that everything pharmacological preparations must be prescribed by a doctor. Self-medication with these drugs is unacceptable. In addition to the above remedies, in the treatment and rehabilitation of patients with coronary artery disease, it is very important physical training. At the initial manifestations of the disease, running, swimming, skiing, cycling, i.e., cyclic physical activity, are indicated.

They should be carried out during periods outside of exacerbation of the disease. With more severe forms IHD physical activity is recommended in the form of therapeutic exercises. The physical therapy complex should be selected by a physical therapy doctor based on the patient’s condition. Classes are requested by a physical therapy instructor in a group method in a hospital or clinic setting under the supervision of a physician. It is necessary to measure your pulse before, during and after exercise. Typically, these complexes include exercises in the initial position of standing, sitting (for patients over 50 years of age), walking, exercises for the upper and lower extremities using a gymnastic stick, breathing exercises and stretching. Exercises are performed at a slow pace, smoothly, with a small range of movements.

To “unload” the work of the heart, you need to use self-massage of the limbs. This is carried out with the aim of facilitating 01 flow of blood from the periphery to the center. The simplest massage techniques: stroking, rubbing, kneading. After a certain course therapeutic exercise In health care facilities, the patient can independently perform these exercises at home. When treating patients with coronary artery disease, we must not forget about the use of physical factors (methods of hardware physiotherapy). The type of physiotherapeutic treatment is selected by a physiotherapist.

In the absence of contraindications (such as progressive angina, persistent pain, rest angina, increased blood pressure, the presence of arrhythmias), balneotherapy sessions are used - carbon dioxide, radon, chloride and iodine-bromine medicinal baths. In patients with more severe angina, these effects are used sparingly - in the form of four-chamber baths. Electrosleep, galvanic collar, electrophoresis of painkillers and sedatives give a good calming effect.

In the absence of contraindications, combinations of therapeutic baths and hardware physiotherapy can be used. Laser therapy is widely used in specialized cardiology clinics and hospital departments. various types laser radiation.

Phytotherapy

Required: 2 tbsp. l. rose hips, 350 ml vodka.

Cooking method.

Finely crush the rose hips, pour into a 0.5 liter glass bottle, and fill with vodka. Infuse in a place protected from light for 2 weeks, shake daily.

Mode of application.

Take 20 drops on a piece of sugar 3 times a day, regardless of meals.

Required: 5 g fresh horseradish roots.

Cooking method.

Pour crushed horseradish roots into a thermos with 1 cup of boiling water, leave for 2 hours. You don’t need to strain.

Mode of application.

Use the infusion for inhalation.

Required: 1 tsp. nettle flowers.

Cooking method.

Pour 1 cup of boiling water over nettle flowers.

Mode of application.

Take 0.5 cups 2 times a day: in the morning on an empty stomach and in the evening before bed.

Required: 1 part coltsfoot leaves, 2 parts dill fruits. jaundice herb, reed sunflower flowers, 1 liter of boiling water.

Cooking method.

Mix all components thoroughly and grind. 1 tbsp. l. Pour boiling water over the resulting mixture and leave for 1 hour. Strain the resulting infusion and squeeze out the raw materials.

Mode of application.

Take 1/2 cup 5-6 times a day for a month, regardless of meals.

Required: 40 g of lovage herb, chopped corn roots, 1 l boiled water.

Cooking method.

Mix the ingredients and chop. 2 tbsp. l. pour boiled water over the resulting mixture, bring to a boil, boil for 7-8 minutes, pour into a thermos and leave for 40 minutes. Strain the resulting broth and squeeze out the raw materials.

Mode of application.

Take 1/2 cup 3 times a day, 30 minutes after eating. Conduct 3 courses of 7 days at a five-day interval.

Required: 1 part of kelp thallus, 2 parts of corn silk, horsetail herb, sundew herb, 1 liter of boiling water.

Cooking method.

Mix the ingredients thoroughly and chop. 3 tbsp. l. Place the resulting mixture in an enamel bowl and pour 1 liter of boiling water. Place in a water bath and bring to a boil. Boil for 1 minute. Pour into a thermos and leave for 1 hour. Strain the resulting infusion and squeeze out the raw materials.

Mode of application.

Take 1/2 cup 6 times a day, preferably after meals, for 2 weeks.

Required: 20 g each of blue cornflower flowers, birch buds, chopped rhizomes with roots of elecampane, corn silk, bearberry leaves, buckwheat flowers. 1 cup of boiling water.

Cooking method.

Mix all ingredients thoroughly and chop. 2 tbsp. l, pour the collection into an enamel bowl, pour 1 cup of boiling water, put in a water bath, bring to a boil. Leave until cool. Strain the resulting broth, squeeze out the raw materials, and bring to the original volume with boiled water.

Mode of application.

Take 1/2 cup 2 times a day 30 minutes before meals. It is not recommended to use at night.

Required: 1 part each of tea kopeck root and linden flowers. raspberry fruits, ground flaxseed, 2 cups of boiling water.

Cooking method.

Mix all ingredients thoroughly and chop. 4 tbsp. l. Place the resulting collection in an enamel bowl, pour boiling water, place in a water bath and keep for 30 minutes. Leave until cool. Strain the resulting broth, squeeze out the raw materials, and bring with boiled water to the original volume.

Mode of application.

Take 1 glass 2 times a day immediately 5-7 minutes before eating. Use within a month. If the effectiveness is insufficient, repeat the course after a two-week break.

Required: 20 g horsetail herb, 30 g knotweed herb, 50 g hawthorn flowers, 1 glass of boiling water.

Cooking method.

Mix the crushed raw materials. 2 tbsp. l. pour boiling water over the collection. Stir and leave until cool. Strain the resulting infusion and squeeze out the raw materials.

Mode of application.

Drink during the day.

Required: 2 tbsp. l. chopped horseradish root, 1 glass of honey, 1 glass of freshly prepared carrot juice, 1 glass of boiled water.

Cooking method.

Pour horseradish with water and leave for a day. Add honey and carrot juice. Mix. Store in a cool place.

Mode of application.

Take 1 tbsp. l. on an empty stomach 1 hour before meals or 1.5-2 hours after meals.

Required: 2 tbsp. l. crushed blue cyanosis roots.

Cooking method.

Pour 100 ml of boiling water over the raw material and keep it on low heat for 10 minutes. Leave for 15 minutes, then strain and bring to the original volume with boiled water.

Mode of application.

Take 1 tbsp, l. 5 times a day after meals. Last time take at night.

Required: 20 g strawberry leaves.

Cooking method.

Pour the raw material with 1 cup of boiling water, boil for 10 minutes, then leave for 2 hours, strain, squeeze out the leaves, bring to the original volume with boiled water.

Mode of application.

Take 1 tbsp. l. 3-4 times a day, regardless of meals.

Required: 50 g garlic, 1 glass of vodka.

Cooking method.

Chop the garlic, add vodka, leave in a warm place for 3 days.

Mode of application.

Take 3 times a day, 8-10 drops in 1 tsp. cold boiled water 3 times a day, regardless of meals.

Required: 350 g of garlic, 200 ml of medical alcohol with a strength of 96%.

Cooking method.

Finely chop the peeled garlic and grind in a container with a wooden spoon. Take 200 g of this mass from below along with the resulting juice, place it in a glass vessel, fill it with alcohol, and seal tightly. Store the resulting tincture in the refrigerator for no more than 12 days.

Mode of application.

Take 20 minutes before meals, after mixing with 1/4 glass of cold milk, for 10 days according to the following scheme: on the 1st day, 1 drop in the morning, 2 drops at lunch, 3 drops before dinner. On the 2nd, 3rd, 4th and 5th day, add 3 drops per dose. From the 6th to the 10th day, reduce by 3 drops per dose.

Required: 1 tsp. mistletoe leaves, 2 tbsp. l, buckwheat flowers, 1 cup boiling water.

Cooking method.

1 tsp. pour boiling water over the collection, put in a warm place overnight, strain in the morning.

Mode of application.

Take 2 tbsp. l. 20 minutes before meals 3 times a day.

Treatment of ischemic heart disease with folk remedies: features of the disease and methods of its treatment

Today, cases of heart disease are increasingly being reported. And one of the most common is coronary heart disease, which, if treated inadequately and if not detected in a timely manner, can lead to fatal outcome. And the treatment of this disease is usually carried out comprehensively, using both standard medications and traditional medicine.

Causes and factors contributing to the development of ischemic heart disease

Before moving on to the main methods of treating coronary artery disease with folk remedies, it is necessary to find out why it occurs and what factors provoke it.

But main reason The occurrence of IHD is the deposition of fatty plaques that interfere with the normal flow of blood into the heart, as well as its further transportation throughout the body.

Also, factors such as:

• Frequent increase in blood pressure, which occurs most often due to stress, as well as due to a weak nervous system, and, of course, due to other problems with the heart and blood vessels
• Not active image life, due to which the body loses a lot, including becoming unadapted to any changes. The body does not expend as much energy as it needs to function normally. And besides, a sedentary lifestyle leads to weakness of all muscles, which has a very negative effect on the functioning of the heart.
• Poor nutrition. This usually includes the abuse of spicy foods, as well as very fatty and sweet foods. Few people think when eating a hamburger that it could cause heart problems.
• Overweight and obesity. Since the main reason for the development of ischemic heart disease is the deposition of fatty plaques, in the case of very obese people this process occurs much faster, since the body is practically composed of fat. And the load on the heart when overweight increases many times
• Smoking. Everyone knows that tobacco (nicotine) has a detrimental effect on the body, namely, it pollutes the lungs. And if an insufficient amount of oxygen enters the lungs, and besides, it is poisoned by nicotine, then the heart suffers from this
• Heredity. Heredity plays a major role in the development of the disease. It is generally accepted that if one of your close relatives has this disease, then the chances that it will develop are significantly increased
• Diabetes. With diabetes, the blood becomes much thicker than the body requires. And that's why people with diabetes develop many other diseases.
• Frequent stress that leads to heart failure constant unrest and begins to work faster, since even with weak emotional stress much more oxygen and nutrients are required to support the normal functioning of all organs
• Blood diseases
• A busy work schedule, as well as constant non-compliance with the work and rest regime, which leads to overload of the whole body

Despite the fact that the population's awareness of coronary heart disease is high, few people still adhere to a healthy lifestyle in order to avoid the development of the problem.

Symptoms of the disease

Every person should know the main symptoms of this disease, since the earlier it was detected and steps were taken to improve the condition, the better it will be for the person himself.

So, the main symptoms of IBS include:

• Painful sensations behind the sternum, which can be either pressing or squeezing. Mostly they are not strong, but still force a person, for example, to stop while walking
• Burning sensation in the heart area
• Painful sensations that appear at the moment when a person leaves the room in the cold
• Attacks of pain can happen at any time; there is no clear dependence on day and night. True, many patients note that pain most often appears in autumn or winter, when the weather is very unstable and atmospheric pressure is constantly changing
• The pain usually gets worse if the person wants to lie down. But if he sits down or stands up, the pain will either subside or go away altogether

It should also be said that attacks can occur either once a week or once every six months. But with a severe stage of the disease, they can occur every day, forcing a person to change his lifestyle.

Treatment of the disease. Nutrition

Quite often, many problems can be solved by changing your diet. And IBS is no exception. Of course, adding some products will not completely get rid of the disease, but it will significantly improve the condition and reduce the number of painful attacks quite possibly.

Those people who suffer from coronary heart disease are recommended to add to their diet:

• Cheremsha
• Onion. It is famous for its healing properties. True, this does not mean that you need to eat kilograms of it. A small piece once a day will be enough
• Blackberry. It can and should be eaten in any form. True, they sell it fresh only in the summer, but frozen, from which you can cook compotes, you can find it in any large supermarket
• Black currant. This berry is not only tasty, but also very healthy. It should also be consumed in any form (compotes, jam, etc.)
• Cabbage, which can be eaten fresh, added to salads, or boiled or stewed
• Apples and pears. They can also be eaten in absolutely any form, since beneficial features are always saved
• Watermelon. This is a very healthy berry, although natural, without additives, watermelon can only be bought for two months a year. But even at this time you need to eat at least two kilograms a day
• Corn, which you can simply boil, or buy corn grits and cook porridge from it
• Apricots
• Hawthorn. which needs to be dried and brewed

Of course, adding all these foods to your diet will not heal, but will significantly improve the condition of the heart and blood vessels. In addition, those who want to get rid of the disease or at least reduce the number of attacks need to completely eliminate fatty foods, since they are most often the cause great content cholesterol in the blood. A high cholesterol leads to the deposition of plaques.

Folk remedies. Decoctions

Most often, people resort to decoctions:

1. Recipe 1. You need to take 150 grams of mulberry roots and fill them with 2 liters of cold water, then mix well. After this, put it on the fire and let it boil. The broth should be kept in the refrigerator, as it can quickly spoil
2. Recipe 2. You need to take fennel, about ten grams. You only need to take the fruits. Then pour boiling water (one glass) and strain. All fruit particles must be removed. After which a little water is added to the broth to form a glass. Then take before meals
3. Recipe 3. For this decoction you need to take ten grams of dried dried fruit, pour boiling water over it and heat it in a water bath for about fifteen minutes. After time has passed, the broth must be strained, allowed to cool and diluted with boiled water to make exactly a glass. After the decoction is ready, it should be taken half a glass after each meal.
4. Recipe 4. You need to take either dill seeds or chopped dill itself. Take about a tablespoon. Pour it into a glass and pour boiling water over it. After the decoction has infused, it should be drunk throughout the day when the attack occurred
5. Recipe 5. You need to take five grams of nettle flowers, pour 200 milliliters of boiling water over it. After the broth has cooled, you need to take half a glass twice a day

There are many recipes for decoctions, thanks to which a person can significantly improve their well-being. In addition, each of them is very easy to prepare; you don’t need to run to all the pharmacies and look for the necessary herb. Everything is within walking distance, and you can buy it at any pharmacy.

Folk remedies. Horseradish

There are several of the most effective folk remedies for the treatment of ischemic heart disease. Horseradish is one of these. Many may wonder what the benefits of this plant are, because it is customary to add it to twists or eat it, seasoning dishes with it.

But in fact, horseradish has a lot healing properties, thanks to which it is used in the treatment of ischemic heart disease.

There are three most popular recipes, which contain horseradish:

1. Recipe 1. You need to take horseradish root, about five grams, and grind it as finely as fashionable. After which the resulting mixture is poured with a quarter liters of boiling water and poured into a thermos. The broth must stand for at least three hours in order for it to brew better. After it is ready, it is necessary to inhale
2. Recipe 2. You need to take horseradish and grind it. Every day take a teaspoon and mix it with a teaspoon of honey. In order for the effect to be most positive, you need to take the mixture for at least one and a half months
3. Recipe 3. You need to take grated horseradish (two tablespoons), pour boiling water over it and leave overnight. Then mix with a glass of carrot juice and a glass of honey. You need to take a tablespoon of the mixture every day an hour before meals.

Eating horseradish in this form can significantly improve your heart rate, as well as alleviate the condition during attacks of ischemic heart disease.

Folk remedies. Hawthorn

Many people associate hawthorn only with the tincture that is sold in pharmacies. This is why this berry is mistakenly not considered healthy. This is a huge misconception, since hawthorn is recommended for use in various diseases hearts, and not only with ischemic heart disease.

There are three ways to prepare hawthorn:

• Decoction. You need to take six tablespoons of hawthorn berries and the same amount of motherwort. Pour all this over one and a half liters of boiling water, wrap it in a blanket and leave for the whole day. After this time, filter the broth well so that not a single particle of hawthorn or motherwort remains, and drink one glass three times a day
• Infusion. You need to take dry hawthorn fruits (a tablespoon) and pour boiling water over them. It is better to do this in a thermos, as you need to let it brew for at least two hours. After time has passed, you need to take three spoons three times a day
• Tea. For tea drinkers, this recipe will be to their taste, since hawthorn tea is not only healthy, but also quite pleasant to the taste. You need to take enough berries so that the color of the tea is dark, but not black. For those who like tea with sugar, you can add it there

You can buy hawthorn at the market from grandmothers, or in the autumn you can simply pick it from the bushes, which are often located next to the entrances of high-rise buildings built around the 70s.

Folk remedies. Fees

Another very good remedy during the treatment of ischemic heart disease is the use of fees. These preparations are based on all the herbs that can have a positive effect not only on the heart, but also on the blood vessels, and also get rid of cholesterol plaques:

1. Recipe 1. You need to take white mistletoe and buckwheat flowers. The proportion is two to one. After everything is mixed, you need to take a teaspoon from there and pour a glass of boiling water over it. Then you need to wrap it in a woolen blanket and leave it overnight. Before drinking the infusion, you need to strain it well.
2. Recipe 2. Mix corn root and lovage in a ratio of one to one (take about forty grams each). After everything has been mixed, you need to add water and put on fire. Boil for about eight minutes, then pour into a thermos, wrap and leave for a while. Before use, you need to strain the decoction
3. Recipe 3. You need to take two tablespoons of horsetail, three tablespoons of knotweed, five tablespoons of hawthorn. Mix all this and pour a quarter liter of boiling water. Then let it sit for about three hours. Strain before use

Many people resort to folk remedies after medications have not given the desired effect. True, despite the fact that there are many positive feedback about the use of infusions, decoctions and teas for coronary heart disease, they must be treated very carefully, since some people may have an individual intolerance to some herb, and as a result will develop a severe allergic reaction.

Physical exercise

As mentioned above, one of the reasons for the development of IHD is a lack of physical activity, namely a stationary or sedentary lifestyle. Most often this happens to people who spend the whole day sitting at computer monitors or driving a car.

For people suffering from coronary heart disease, cyclic sports are recommended, that is, swimming, running, cycling. In addition, you can resort to them only when there is no period of exacerbation. Otherwise, it can only make the situation worse.

For those who are not in the initial stage of the disease, therapeutic exercises are recommended, and then only under the supervision of a physiotherapist who can accurately calculate the load that will bring benefit and not harm.

Forecast

Regardless of whether the patient is treated with folk remedies or resorts only to medications, there is a certain prognosis that depends on the stage of the disease.

If a person is diagnosed with the initial stage, then there is every chance of correcting the situation and preserving the lifestyle that the person lives.

If the disease was detected at the third or fourth stage, then the risk of a heart attack increases, which, at best, may not affect the entire area of ​​the myocardium.

But in the fourth stage, most often patients die from an extensive myocardial infarction, since even completely changing the diet and following all the recommendations, the disease affects a large area of ​​the heart.

Treatment IBS folk means are not uncommon today. And besides, many cardiologists themselves suggest taking one or another decoction to maintain good health and provide additional assistance to medications.

Modern methods of treating coronary heart disease

Coronary heart disease (CHD) is one of the main causes of temporary and permanent disability in the developed countries of the world. In this regard, the problem of IHD occupies one of the leading places among the most important medical problems XXI century.

The fate of patients with coronary artery disease largely depends on the adequacy of the treatment outpatient treatment, quality and timeliness of diagnosis of those clinical forms of the disease that require emergency care or urgent hospitalization for the patient.

Alexander Gorkov, head of the department of X-ray surgical methods of diagnosis and treatment of the District Cardiological Dispensary (Surgut, Khanty-Mansi Autonomous Okrug - Yugra), spoke about modern methods of treating coronary heart disease.

V. Alexander Igorevich, what is IHD?

– Coronary heart disease is characterized by an absolute or relative disruption of the blood supply to the myocardium due to damage to the coronary arteries of the heart. In other words, the myocardium needs more oxygen than is supplied by the blood. If IHD were manifested only by symptoms of ischemia, then it would be enough to constantly take nitroglycerin and not worry about the work of the heart. The term coronary heart disease includes a number of diseases (arterial hypertension, heart rhythm disturbances, heart failure, etc.) that are based on one cause - vascular atherosclerosis.

Q. Are heart pain and nitroglycerin the lot of older people?

– It used to be thought so, but now coronary heart disease does not bypass the younger generation either. Many factors of modern reality play a role in this development of IHD: ecology, hereditary predisposition, lifestyle associated with smoking, physical inactivity and rich in fats diet.

Q. What effective methods of treating coronary heart disease have appeared in the arsenal of cardiologists over the past decades?

– Modern development The technology is accompanied by the improvement of treatment methods, but its basic principle remains the same - restoration of blood flow through a narrowed or blocked coronary artery for normal nutrition of the myocardium. This can be achieved in two ways: medication and surgery.

Drug therapy modern drugs with a proven level of effectiveness today it is the basic basis for the treatment of chronic ischemic heart disease. Treatment is aimed at improving the patient’s quality of life, that is, reducing the severity of symptoms, preventing the development of forms of coronary artery disease such as myocardial infarction, unstable angina, and sudden cardiac death.

For this purpose, cardiologists have in their arsenal various drugs, which reduce the content of “bad” cholesterol in the blood, which is responsible for the formation of plaques on the walls of blood vessels. In addition, in the treatment of coronary heart disease, drugs are used that need to be taken once a day: these are antiplatelet agents (thin the blood), antiarrhythmics, antihypertensives and others. It should be noted that only a cardiologist can prescribe these medications based on the objective picture of the disease.

In more severe cases of coronary artery disease, surgical treatment methods are used. Endovascular surgery is considered the most effective method of treating coronary heart disease. This relatively young area of ​​medicine has already gained a strong position in the treatment of coronary artery disease. All interventions are performed without incisions, through a puncture under X-ray observation. These features are important for those patients who are contraindicated (due to concomitant diseases or general weakening of the body) to traditional surgical intervention.

Among the methods of endovascular surgery for coronary artery disease, balloon angioplasty and stenting are used, which make it possible to restore patency in arteries affected by ischemia. The essence of the method is that a special balloon is inserted into the vessel, then it is inflated and “pushes” atherosclerotic plaques or blood clots to the sides. After this, a cylindrical stent (a wire structure made of a special alloy) is installed in the artery, which is able to maintain the shape given to the vessel.

A generally accepted and effective method of surgical blood flow in a narrowed or blocked artery is coronary artery bypass surgery, when the artery blocked by a plaque or thrombus is replaced by an “artificial vessel” that takes over the blood flow. These operations are almost always performed on a non-functioning heart under conditions of artificial circulation, for which there are clear indications.

However, the positive effect after surgical and endovascular treatment is stable and long-lasting.

V. Alexander Igorevich, what is the reason for choosing the method used?

– The state of a person’s health, the degree of damage to the coronary arteries by atherosclerotic plaques or blood clots, and one of the important indicators is time! As part of the effective work in the Khanty-Mansi Autonomous Okrug - Ugra of the Yugra-Kor project, patients from all over the district in the first hours from the beginning pain syndrome end up in one of three Interventional Cardiology Centers, including the District Cardiology Clinic, and doctors manage to provide assistance using low-traumatic surgical methods. In 2012, the cardiac center performed about 1,100 angioplasty operations, of which about 300 were performed on patients with acute coronary syndrome as part of the Ugra-Kor project.

V. Alexander Igorevich, tell us how the life of a person diagnosed with coronary heart disease should change?

– Treatment of coronary artery disease involves joint work between the cardiologist and the patient in several areas. First of all, care must be taken to change lifestyle and address the risk factors for coronary heart disease. This includes quitting smoking and correcting cholesterol levels through diet or medication. A very important point in non-drug treatment of IHD is the fight against a sedentary lifestyle by increasing the patient’s physical activity. And, of course, preliminary treatment of concomitant diseases, if the development of IHD occurs against their background.

Modern methods of treating coronary heart disease are quite effective in helping people live a better and longer life. But health is the daily result of a person’s work on himself. Focus your energy on maintaining your own health and take care of the health of your heart!

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I’ll say right away about the abbreviation IBS used later in the text. This is the short name for coronary heart disease. This dangerous disease represents acute or chronic cardiac dysfunction. The disease occurs due to a violation of the patency of blood vessels, which should allow the flow of blood and oxygen directly to the heart muscle.

However, if blood clots (atherosclerotic plaques) form in the vascular cavity, they become narrowed, blocked, and blood flow is disrupted. This narrowing and blockage of the vessel cavity by a thrombus is called ischemia.

In addition to sclerotic plaques, vascular spasm can also disrupt blood flow. This happens with severe, sudden stress, pathological change psycho-emotional state sick.

Modern medicine has many methods of treating this pathology, which are widely used with varying degrees efficiency. Let's talk today about the signs of coronary artery disease, modern treatment, and briefly consider treatment methods:

Symptoms of ischemia

IHD usually develops in the second half of life, most often after 50 years. Symptoms usually appear after physical activity and are as follows:

There are signs of angina pectoris (pain in the chest area).
- There is a feeling of insufficiency of inhaled air, the inhalation itself is difficult.
- Sudden cessation of blood circulation due to pathologically frequent contractions of the heart muscle (more than 300 contractions per minute), with all the ensuing consequences.

Even after familiarizing yourself with the symptoms of coronary artery disease, you need to know that some patients do not feel any signs of this dangerous disease at all, even if they have a heart attack.

Modern treatment of coronary disease

IHD therapy is carried out in several areas:

Drug treatment: Special medications are used to reduce attacks of the disease, its intensity and frequency. Medicines are intended to strengthen the heart and increase the patency of the coronary vessels. Typically, drug therapy is used to treat ischemia in the early stages, when drugs are most effective.

Surgery: With the help of surgical intervention, ischemic heart disease is treated in acute cases, when it is necessary and most effective. Before the operation, the patient’s condition is stabilized, examined, tested, prepared for surgical intervention. The operation is stenting or coronary artery bypass grafting, which involves expanding the lumen of blood vessels, removing the obstruction and stimulating the necessary blood flow to the heart muscle.

Non-surgical treatment of the heart and blood vessels:

Unfortunately, drug therapy is not always effective, and coronary artery bypass grafting (surgical operation) cannot be performed for some reason. Therefore, patients should know that modern non-invasive treatment methods have been developed that help combat ischemia without undergoing major surgery. Here are some non-surgical treatment methods:

Shock wave therapy . The modern method treatment of IHD involves the use of a shock wave generator, which is specially designed taking into account the clinical and anatomical features of the chest. Shock wave therapy is carried out in several courses. As a result of treatment, angina pectoris decreases, the frequency and pain of attacks decreases, and there is no need for frequent use medicines.

EECP (external counterpulsation). This modern method is intended for the treatment of coronary artery disease, angina pectoris, and heart failure. Often performed when drug therapy is insufficiently effective. EECP is recommended for patients with severe concomitant diseases, for example, diabetes mellitus. Treatment can be carried out on an outpatient basis.

The result of treatment is a decrease in the class of angina pectoris, a decrease in the frequency and severity of attacks, and a decrease in the need for medications. After treatment there are practically no side effects and complications.

Gravitational. This method involves the use of a physiotherapeutic factor of increased gravity. The treatment is indicated for therapeutic, orthopedic and surgical profiles; it is the latest medical technique. In the process of treatment, it turns out that muscle load on lower limbs.

As a result, increased blood flow is achieved, collateral circulation is enhanced, the development of ischemia is stopped, and metabolism is improved. This method is very well tolerated by patients, is effective and improves the quality of drug treatment.

Stem cells. A new method of treating coronary artery disease is the use of the patient’s own stem cells. This treatment is prescribed after a thorough examination, which will confirm the effectiveness of cellular treatment in each specific case.

The need to use a particular treatment method is determined by the attending physician, taking into account the data of the examinations performed, the severity of the patient’s condition, his age and other indicators.

Remember that IHD is a very dangerous disease, the treatment of which does not require delay. Therefore, if symptoms are present, painful sensations in the chest, consult a cardiologist immediately. Be healthy!