Modern treatment tactics for ischemic heart disease. Decoctions

• Lipid-lowering drugs
• Antiplatelet drugs
• Antianginal drugs
• Metabolic drugs
• Other medicines
• Antihypertensive drugs

Modern medical science in the treatment of coronary artery disease with drugs cannot boast of complete or even partial relief of the patient from the disease. But medications can still stop the progression of the disease, improve the patient’s life, and prolong it.

1. Aspirin and antianginal drugs.
2. β-blockers and normalizing blood pressure.
3. Refusal bad habits(especially smoking) and normalization of blood cholesterol levels.
4. Dietary nutrition and bringing blood sugar levels to recommended levels using medication.
5. Therapeutic physical education and educational work.

Pharmaceuticals offers for the treatment of chronic use:

1. Lipid-lowering (antiatherosclerotic) drugs.
2. Antiplatelet drugs.
3. Antianginal drugs that affect hemodynamics.
4. Metabolic drugs.

Lipid-lowering drugs

Their goal is to normalize blood cholesterol levels, the indicators of which for the majority of patients are:

1. Basic cholesterol - no more than 5 mmol/l.
2. Low density (“bad” cholesterol) - no more than 3 mmol/l.
3. High density (“good”) - no less than 1 mmol/l.

Normal cholesterol levels are achieved by patients by taking medications from the group of statins (lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin), fibrates (bezalip, grofibrate, lipanor, lipantil 200 M, trilipix, fenofibrate, exlip), nicotinic acid, resins , preparations of omega-3 polyunsaturated fatty acids (PUFAs), with mandatory adherence to the diet. Taking lipid-lowering drugs for diabetes is especially important.

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Antiplatelet drugs

These medications act to thin the blood and prevent the formation of blood clots. To reduce blood viscosity, the doctor may prescribe tablets containing acetylsalicylic acid, clopidogrel, ticlopidine, warfarin, drugs that block IIβ/IIα receptors, dipyridamole, indobufen.

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Antianginal drugs

Facilitate the work of the heart and prevent attacks of angina pectoris. These include:

1. β-blockers, which reduce the frequency and strength of heart contractions, they also reduce arterial pressure and have a beneficial effect on the heart muscle during arrhythmias. Not prescribed for diabetes. Representatives: propranolol (anaprilin, inderal), metoprolol, pindolol, etc.
2. Nitrates (nitroglycerin, isosorbide mono- and dihydrate, etc.) are used for angina attacks. Due to the rapid expansion of the coronary vessels and deep veins, the work of the myocardium is facilitated, its need for oxygen is reduced, as a result of which the attack is stopped. Long-term use nitrates are now rarely practiced.
3. Calcium channel blockers (nifedipine and verapamil). Both drugs block calcium channels in cell membranes. But their mechanism of action is different. Verapamil reduces heart rate, and nifedipine dilates coronary vessels. In both cases, the work of the myocardium is facilitated.
4. Drugs that increase the flow of oxygen to the heart during cardiac ischemia include β-adrenergic agonists (dipyridamole, lidoflazin, papaverine, carbocromene, etc.) and validol. But the coronary-dilating effect of myotropic drugs is weakly expressed; they are rarely used as a treatment for coronary artery disease. The mechanism of action of validol is not fully understood; it is believed that, acting irritatingly on the oral mucosa, it reflexively affects the heart muscles. Used to eliminate mild attacks of coronary artery disease.
5. Cardiac glycosides (digoxin, corglycon), due to the manifestation of multiple side effects, are rarely used for atrial fibrillation and edema.

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Metabolic drugs

They are classified into:

1. Antihypoxants (actovegin, hypoxen, cytochrome C), they improve the tolerance of oxygen deficiency by enhancing cellular respiration;
2. Antioxidants (ubiquinone, emoxipine, mexidol) destroy peroxide molecules, interrupt the reactions of free radical lipid peroxidation, and compact membranes, which prevents the penetration of oxygen to lipids.
3. The cytoprotector trimetazidine, by maintaining the required amount of ATP (adenosine triphosphoric acid), reducing acidosis and improving intracellular metabolism, increases the efficiency of oxygen uptake by the myocardium.

Treatment of cardiac ischemia depends on the clinical manifestations of the disease.

Treatment tactics, taking certain medications and selecting a physical activity regimen may vary greatly for each patient.

The course of treatment for cardiac ischemia includes the following complex:

• therapy without application medications;
• drug therapy;
• endovascular coronary angioplasty;
• treatment with surgery;
• other treatment methods.

Drug treatment of cardiac ischemia involves the patient taking nitroglycerin, which, due to its vasodilating effect, can short term stop attacks of angina.

This also includes taking a number of other medications that are prescribed exclusively by the treating specialist. To prescribe them, the doctor is based on the data obtained during the diagnosis of the disease.

Drugs used in treatment

Theoapia for coronary heart disease involves taking the following medications:

The following medications are also used: lisinopril, captopril, enalaprin, antiarrhythmic drugs (amiodarone), antibacterial agents and other drugs (Mexicor, ethylmethylhydroxypyridine, trimetazidine, mildronate, coronatera).

Video

The video describes what medications can be taken for ischemic heart disease:

Exercise restriction and diet

During physical activity, the load on the heart muscle increases, as a result of which the need of the heart myocardium for oxygen and necessary substances also increases.

The need does not correspond to the opportunity, which is why manifestations of the disease occur. Therefore, an integral part of the treatment of IHD is the limitation physical activity and its gradual increase during rehabilitation.

Diet for cardiac ischemia also plays an important role. In order to reduce the load on the heart, the patient is limited in intake of water and table salt.

Also, much attention is paid to limiting those foods that contribute to the progression of atherosclerosis. Fight with overweight, as one of the main risk factors, is also an integral component.

The following food groups should be limited or avoided:

• animal fats (lard, butter, fatty meats);
• fried and smoked foods;
• products containing a large number of salt (salted cabbage, fish, etc.).

You should limit your intake of high-calorie foods, especially quickly absorbed carbohydrates. These include chocolate, cakes, sweets, and baked goods.

In order to maintain a normal weight, you should monitor the energy and its amount that comes from the food you eat and the actual energy expenditure in the body. At least 300 kilocalories should enter the body daily. A common person who is not busy physical work, spends about 2000 kilocalories per day.

Surgery

In special cases surgical intervention- the only chance to save the life of a sick person. The so-called coronary bypass surgery is an operation in which the coronary vessels are combined with external ones. Moreover, the connection is made in a place where the vessels are not damaged. This operation significantly improves blood supply to the heart muscle.

Coronary artery bypass grafting is a surgical procedure in which the aorta is connected to the coronary artery.

Balloon vascular dilatation is an operation in which balloons containing a special substance are inserted into the coronary vessels. Such a balloon expands the damaged vessel to the required size. It is introduced into the coronary vessel through another large artery using a manipulator.

The method of endovascular coronary angioplasty is another method of treating cardiac ischemia. Balloon angioplasty and stenting are used. This operation is carried out under local anesthesia, auxiliary instruments are often inserted into the femoral artery, piercing the skin.

The operation is monitored by an X-ray machine. This is an excellent alternative to direct surgery, especially when the patient has certain contraindications to it.

In the treatment of cardiac ischemia, other methods that do not involve the use of medications can be used. This quantum therapy, stem cell treatment, hirudotherapy, shock wave therapy methods, enhanced external counterpulsation method.

Treatment at home

How can you get rid of cardiac ischemia and prevent it at home? There are a number of methods that only require the patience and desire of the patient.

These methods predetermine activities that are aimed at improving the quality of life, that is, minimizing negative factors.

This treatment involves:

• quitting smoking, including passive smoking;
• giving up alcohol;
• diet and balanced nutrition, which includes products of plant origin, lean meat, seafood and fish;
• mandatory consumption of foods rich in magnesium and potassium;
• refusal of fatty, fried, smoked, pickled and too salty foods;
• consumption of food with low content cholesterol;
• normalization of physical activity (walking in the fresh air, swimming, jogging; exercise on an exercise bike is required);
• gradual hardening of the body, including wiping and dousing with cool water;
• getting enough sleep at night.

The degree and type of load should be determined by a medical specialist. Monitoring and constant consultation with your doctor are also necessary. It all depends on the phase of exacerbation and the degree of the disease.

Not drug treatment includes measures to normalize blood pressure and treatment of existing chronic diseases, if any.

Video

You can also find out what foods you should include in your diet to maintain of cardio-vascular system:

Treatment with folk remedies

Herbal medicine plays an important role in the treatment of coronary heart disease, as it helps to increase the effectiveness of pharmacological drugs and improve the patient’s quality of life. Among the plants that best help in curing this disease, hawthorn should be highlighted.

Experts advise regularly drinking tea brewed from its leaves, fruits and flowers. In this case, it is recommended not to chop the fruits, but to add a few pieces per cup of boiling water.

To improve blood supply to the heart muscle, you can add herbs to tea medicinal clover, linden leaves with flowers or meadowsweet flowers.

Horseradish is a fairly effective folk remedy for the treatment of coronary heart disease. Five grams of the root of this plant should be grated and poured with a glass of boiling water. The decoction should be left in a thermos for two hours and then used for inhalation. You can also mix one teaspoon of grated horseradish with one teaspoon of honey and eat it once a day with water. The duration of the course of taking this medicine should be one and a half months.

The most famous traditional medicine for combating coronary heart disease is garlic. It can be used for cooking healing tincture, chopping fifty grams of vegetables and pouring a glass of vodka. After three days, you should start using the tincture, diluting eight drops in a teaspoon of cold water.

You need to take the medicine three times a day. It is impossible not to mention the importance of such medicinal plants, such as woodlice, capitol, horsetail, raspberry leaves, lemon balm, oregano and other herbs that are used to prepare various medicinal infusions.

Prevention

As preventive measures to prevent the occurrence of cardiac ischemia, the following should be highlighted:

• Don’t overload yourself with work and rest more often;
• get rid of nicotine addiction;
• do not abuse alcohol;
• eliminate the consumption of animal fats;
• limit foods high in calories;
• 2500 kilocalories per day is the limit;
• The diet should include foods high in protein: cottage cheese, fish, lean meat, vegetables and fruits;
• engage in moderate physical activity, go for walks.

What's the prognosis?

The prognosis is generally unfavorable. The disease progresses steadily and is chronic. Treatment only stops the disease process and slows down its development.

Timely consultation with a doctor and proper treatment improve the prognosis. Healthy image life and good nutrition also helps strengthen cardiac function and improve quality of life.

Cardiologist, Functional diagnostics doctor

For many years, Dr. Zhuravlev has been helping patients with cardiopathology get rid of problems in the functioning of the heart and blood vessels, so the specialist provides comprehensive therapy for hypertension, ischemia, and arrhythmia.

Coronary heart disease is a pathological condition caused by a lack of nutrition of the heart muscle due to narrowing of the lumen of the coronary vessels or their spasm. It combines several diagnoses, such as angina pectoris, myocardial infarction, cardiosclerosis, sudden coronary death and others.

Today it is the most common disease in its category in the world and ranks first among the causes of death and disability in all developed countries.

Predisposing factors

To date, criteria have been developed that can be used to predict the development of a particular disease. was no exception. There is not just a list, but a classification of risk factors, grouped according to a specific characteristic, that can contribute to the occurrence of this disease.

1. Biological:
   - age over 50 years;
   - gender - men get sick more often;
   - genetic predisposition to dysmetabolic diseases.
2. Anatomy:
   - high blood pressure;
   - obesity;
   - presence of diabetes mellitus.
3. Lifestyle:
   - diet violation;
   - smoking;
   - physical inactivity or excessive physical activity;
   - alcohol consumption.

Development of the disease

Pathogenetic causes of the development of the disease can be both extra- and intravascular problems, such as narrowing of the lumen of the coronary arteries due to atherosclerosis, thrombosis or spasm, or severe tachycardia with hypertension. But still, atherosclerosis is in first place for the reasons for the development of a heart attack. Initially, a person develops a metabolic disorder, which is expressed in a persistent increase in lipid levels in the blood.

The next stage is the fixation of lipid complexes in the walls of blood vessels and their sweating into the endothelial cells. Atherosclerotic plaques form. They destroy the wall of blood vessels, making it more fragile. U this state There can be two outcomes - either a blood clot breaks off from the plaque and clogs the artery upstream of the blood, or the diameter of the vessel becomes so small that blood can no longer circulate freely and nourish a certain area. In this place, a focus of ischemia and then necrosis is formed. If this entire process occurs in the heart, then the disease will be called IHD.

There are several clinical forms and corresponding to them treatment of ischemic heart disease. Drugs are selected based on the pathophysiological component.

Sudden coronary death

Otherwise called cardiac arrest. It can have two outcomes: the person dies or ends up in intensive care. It is associated with sudden instability of the myocardium. This diagnosis is an exception when there is no reason to suspect another form of IHD. Treatment and drugs of choice for healthcare workers remain the same as for resuscitation. Another condition is that death must occur instantly and in the presence of witnesses or no later than six hours from the moment it began. heart attack. Otherwise, it already falls under a different classification.

Angina pectoris

This is one of the forms of IHD. It also has its own additional classification. So:

1. Stable exertional angina.
2. Vasospastic angina.
3. Unstable angina, which, in turn, is divided into:
   - progressive;
   - first arisen;
   - early post-infarction.
4. Prinzmetal's angina.

The most common is the first type. The Association of Cardiologists has long developed the treatment of ischemic heart disease (IHD). The drugs must be taken regularly and for a long time, sometimes throughout life. If you follow the recommendations, you can postpone the unpleasant health consequences for some time.

Myocardial infarction

It is established taking into account electrocardiogram data, laboratory and anamnestic indicators. The most informative are considered to be increases in enzymes such as LDH (lactate dehydrogenase), ALaT (alanine aminotransferase), which are normally contained within the cell and appear in the blood only when it is destroyed.

A heart attack is one of the outcomes that uncontrolled coronary heart disease can lead to. Treatment, medications, help - all this may be late, because during an acute attack very little time is given to reverse the damage.

Diagnostics

Naturally, any examination begins with a survey and examination. Collect medical history data. The doctor is interested in such complaints as chest pain after physical activity, shortness of breath, fatigue, weakness, and palpitations. It will be important to note evening swelling that is warm to the touch. And also how IHD is treated. Medicines can tell a doctor a lot. For example, "Nitroglycerin". If it helps relieve an attack, then this almost always speaks in favor of angina pectoris.

A physical examination includes measuring blood pressure, respiratory and pulse rates, and listening to the heart and lungs. The doctor tries to hear pathological noises, increased heart sounds, as well as wheezing and bubbles in the lungs, which would indicate congestive processes.

Treatment

So we moved on to the most basic thing. We are interested in the treatment of ischemic heart disease. Drugs play a leading role in it, but they are not the only ones that help improve well-being. First of all, it is necessary to explain to the patient that they will have to completely change their lifestyle. Eliminate excessive physical activity, balance your sleep and rest patterns, and eat well. Diet should be given Special attention. It should contain potassium, calcium and sodium necessary for the heart, but at the same time limit the consumption of salt, water, foods with excessive quantity animal fats and carbohydrates. If a person has excess weight, then it is necessary to correct it.

But in addition, methods have been developed to pharmacologically eliminate such a problem as coronary heart disease. Treatment - drugs in the form of tablets, capsules, powders and solutions. With proper selection and regular use, you can achieve excellent results.

Antiplatelet agents

Groups of drugs for the treatment of coronary artery disease are divided into several classifications, but the most common is by mechanism of action. This is what we will use. Antiplatelet agents help improve blood flow. They act on the coagulation and anticoagulation systems, somewhat disconnecting them, and thus achieve liquefaction. These include Aspirin, Clopidogrel, Warfarin and others. When prescribing them, it is always necessary to monitor the INR (international normalized ratio) to prevent bleeding in a person.

Beta blockers

They act on receptors in the walls of blood vessels, slowing down the heartbeat. As a result, it consumes less oxygen and needs less blood, which is very useful when it is narrowed. These are one of the most common medications for ischemic heart disease. Treatment, drugs of choice and dose depend on the underlying conditions. There are selective and non-selective beta blockers. Some of them act more softly, others a little harsher, but absolute contraindication is the patient's history of bronchial asthma or other obstructive pulmonary disease. Among the most common drugs are Biprolol, Visken, Carvedilol.

Statins

Doctors spend a lot of effort on treating coronary artery disease. Drugs are being improved, new approaches are being developed, and research is being conducted into the causes of the disease. One such advanced approach is to target triggers, namely dyslipidemia, or blood fat imbalances. It has been proven that lowering cholesterol levels leads to a slowdown in the formation of atherosclerosis. And this is the main cause of IHD. Signs, treatment, medications - all this has already been identified and developed; you just need to be able to use the available information to benefit the patient. Examples of effective drugs include Lovastatin, Atorvastatin, Simvastatin and others.

Nitrates

The work of these drugs is one of the diagnostic signs that help confirm the presence of the disease. But they are also needed as part of the program that is included in the treatment of coronary artery disease. Medicines and preparations are carefully selected, the dose and frequency of administration are adjusted. They affect the smooth muscles in the walls of blood vessels. By relaxing, these muscles increase the diameter of the lumen, thus increasing the amount of blood supplied. This helps relieve ischemia and pain. But, unfortunately, nitrates cannot prevent the development of a heart attack in the global sense of the word, and do not increase life expectancy, therefore it is recommended to take these medications only during an attack (Dinisorb, Isoket), and choose something else on a permanent basis .

Anticoagulants

If, in addition to angina pectoris, the patient is at risk of thrombosis, then he is prescribed these medications for coronary artery disease. Symptoms and treatment, drugs depend on how dominant one or another link is pathological process. One of the most famous drugs in this series is Heparin. It is administered in a large dose once for acute myocardial infarction, and then the plasma level is maintained for several days. It is necessary to carefully monitor blood clotting times.

Diuretics

Drugs for the treatment of coronary artery disease are not only pathogenetic, but also symptomatic. They influence such a link as high blood pressure. If you increase the amount of fluid that the body loses, you can artificially reduce the pressure to normal levels and eliminate the threat of a second heart attack. But you shouldn’t do this too quickly, so as not to provoke a collapse. There are several types of these drugs, depending on which part of the loop of Henle (part of the nephron) they act on. A competent doctor will select the medicine necessary in this situation. One that will not worsen the patient's condition. Be healthy!

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INconducting

The heart is one of the main human organs. This is our engine, which works without rest, and if earlier, malfunctions in its operation were observed in older people, then recently heart disease has become much younger and is at the top of the list of life-threatening diseases.

Relevance.Despite modern advances in medicine, the last decade has been characterized by a steady increase in cardiovascular diseases in the population. Atherosclerosis, coronary heart disease, hypertension and their complications have taken first place among the causes of morbidity, disability, disability and mortality in economically developed countries. In Russia, annual mortality from cardiovascular causes exceeds one million people. Myocardial infarction develops in 0.9-1.4% of men aged 40-59 years, in men of the older age group - 2.1% per year. There has been a steady increase in incidence among young and middle-aged people. Despite the decrease in hospital mortality, the overall mortality from this disease remains high, reaching 40-60%. It should be noted that most deaths occur in the prehospital stage.

Numerous epidemiological studies revealed a significant prevalence of arterial hypertension among the adult population. In European Union countries, the number of patients with high blood pressure reaches 20-30%, in Russia - 30-40%. Arterial hypertension is one of the main risk factors for the formation of coronary heart disease, cerebral stroke, and heart failure. These circumstances determine the great importance of introducing new advances in cardiology into practical healthcare.

Targetwork- study the basic modern principles of treatment of coronary heart disease.

1. IshamAndcheskayamoreeknowWitheheart

(IHD; lat. morbus ischaemicus cordis from ancient Greek ?uchch - “delay, restrain” and b?mb - “blood”) is a pathological condition characterized by an absolute or relative disruption of the blood supply to the myocardium due to damage to the coronary arteries.

Coronary heart disease is a myocardial lesion caused by a disorder of coronary circulation, resulting from an imbalance between coronary blood flow and the metabolic needs of the heart muscle. In other words, the myocardium needs more oxygen than is supplied by the blood. IHD can occur acutely (in the form of myocardial infarction), as well as chronically ( periodic attacks angina).

IHD is a very common disease, one of the main causes of mortality, as well as 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 of the 21st century.

In the 80s There was a tendency towards a decrease in mortality from IHD, but nevertheless, in developed European countries it accounted for about half of the total mortality of the population, while maintaining a significant uneven distribution among groups of people of different sexes and ages. In the USA in the 80s. The mortality rate for men aged 35-44 was about 60 per 100,000 population, with the ratio of men to women dying at this age being approximately 5:1. By the age of 65-74 years, the overall mortality from ischemic heart disease in both sexes reached more than 1,600 per 100,000 population, and the ratio between deceased men and women in this age group decreased to 2:1.

The fate of patients with ischemic heart disease, components a significant part contingent observed by doctors largely depends on the adequacy of the outpatient treatment, on the quality and timeliness of diagnosis of those clinical forms of the disease that require providing the patient emergency care or urgent hospitalization.

According to statistics, in Europe, IHD and cerebral stroke account for 90% of all diseases of the cardiovascular system, which characterizes IHD as one of the most common diseases.

1.1 EtiologyAndpathogenesis

A number of factors contribute to the occurrence of CAD. Among them, hypertension should be placed in first place, which is detected in 70% of patients with coronary artery disease. Hypertension contributes to a more rapid development of atherosclerosis and spasm of the coronary arteries of the heart. Diabetes mellitus, which contributes to the development of atherosclerosis due to impaired protein and lipid metabolism, is also a predisposing factor for the occurrence of coronary artery disease. When smoking, spasm of the coronary vessels develops, and blood clotting also increases, which contributes to the occurrence of thrombosis of altered coronary vessels. Genetic factors are of a certain importance. It has been established that if parents suffer from coronary artery disease, then in their children it occurs 4 times more often than in persons whose parents are healthy. Hypercholesterolemia significantly increases the likelihood of ischemic heart disease, since it is one of the important factors, contributing to the development of atherosclerosis in general and coronary vessels in particular. In obesity, coronary artery disease occurs several times more often than in people with normal body weight. In obese patients, the amount of cholesterol in the blood is increased; in addition, these patients lead a sedentary lifestyle, which also contributes to the development of atherosclerosis and coronary artery disease.

IHD is one of the most common diseases in industrialized countries. Over the past 30 years, the incidence of coronary artery disease has doubled, which is associated with mental stress. In men, IHD appears approximately 10 years earlier than in women. People who work physically get sick less often than people who work mentally.

1.2 Pathologicalanatomy

Pathological changes depend on the degree of damage to the coronary vessels by atherosclerosis. With angina pectoris, when there is no myocardial infarction, only small foci of cardiosclerosis are noted. Defeat is necessary at least 50% of the lumen area of ​​one of the coronary vessels for angina to develop. Angina pectoris is especially severe if two or three coronary vessels are affected simultaneously. With myocardial infarction, necrosis occurs already in the first 5-6 hours after a painful attack muscle fibers. 8-10 days after myocardial infarction, a large number of newly formed capillaries appear. From this time on, connective tissue rapidly develops in areas of necrosis. From this moment, scarring begins in areas of necrosis. In 3-4 months.

1.3 SymptomsAndsignsischemicillnesseshearts

The first signs of IHD, as a rule, are painful sensations - that is, the signs are purely subjective. The reason for contacting a doctor should be any unpleasant sensation in the heart area, especially if it is unfamiliar to the patient. The patient should also be suspected of ischemic heart disease if pain in the chest area occurs during physical or emotional stress and goes away with rest and has the character of an attack.

The development of IHD lasts for decades; during the progression of the disease, its forms and, accordingly, clinical manifestations and symptoms may change. Therefore, we will look at the most common symptoms of IHD. However, it should be noted that about one third of patients with coronary artery disease may not experience any symptoms of the disease at all, and may not even know about its existence. Others may be bothered by symptoms of ischemic heart disease such as pain in the chest, in the left arm, in lower jaw, in the back, shortness of breath, nausea, excessive sweating, palpitations or irregular heart rhythms.

As for the symptoms of such a form of IHD as sudden cardiac death: a few days before the attack, a person develops paroxysmal discomfort behind the sternum, psycho-emotional disorders and fear of imminent death are often observed. Symptoms sudden cardiac death: loss of consciousness, respiratory arrest, absence of pulse in large arteries (carotid and femoral); absence of heart sounds; dilated pupils; appearance of a pale gray skin tone. During an attack, which often occurs at night during sleep, brain cells begin to die 120 seconds after it begins. After 4-6 minutes, irreversible changes in the central nervous system occur. After about 8-20 minutes the heart stops and death occurs.

2. Classificationcoronary heart disease

1.Sudden cardiac death(primary cardiac arrest, coronary death) is the most severe, lightning-fast clinical variant of IHD. IHD is the cause of 85-90% of all cases of sudden death. Sudden cardiac death includes only those cases of sudden cessation of cardiac activity when death occurs in the presence of witnesses within an hour after the onset of the first threatening symptoms. Moreover, before death, the condition of the patients was assessed as stable and not causing concern.

Sudden cardiac death can be provoked by excessive physical or neuropsychic stress, but it can also occur at rest, for example, in sleep. Immediately before the onset of sudden cardiac death, approximately half of the patients experience a pain attack, which is often accompanied by the fear of imminent death. Most often, sudden cardiac death occurs in out-of-hospital conditions, which determines the most common fatal outcome of this form of coronary artery disease.

2.Angina pectoris(angina pectoris) is the most common form of ischemic heart disease. Angina pectoris is attacks of sudden onset and usually quickly disappearing chest pain. The duration of an angina attack ranges from a few seconds to 10-15 minutes. Pain most often occurs during physical stress, for example, when walking. This is the so-called angina pectoris. Less commonly, it occurs during mental work, after emotional overload, during cooling, after a heavy meal, etc. Depending on the stage of the disease, angina pectoris is divided into new-onset angina pectoris, stable angina(indicating functional class from I to IV), progressive angina. With the further development of coronary artery disease, angina pectoris is supplemented by rest angina pectoris, in which painful attacks occur not only during stress, but also at rest, sometimes at night.

3.Heart attack myocardium- a serious disease that can develop into a prolonged attack of angina pectoris. This form of IHD is caused by acute insufficiency of blood supply to the myocardium, which causes a focus of necrosis, that is, tissue necrosis, to appear in it. The main reason for the development of myocardial infarction is complete or almost complete blockage of the arteries by a thrombus or swollen atherosclerotic plaque. When an artery is completely blocked by a thrombus, a so-called large-focal (transmural) myocardial infarction occurs. If the blockage of the artery is partial, then several smaller foci of necrosis develop in the myocardium, then they speak of small focal infarction myocardium.

Another form of manifestation of ischemic heart disease is called post-infarction cardiosclerosis. Post-infarction cardiosclerosis occurs as a direct consequence of myocardial infarction.

Post-infarction cardiosclerosis- this is damage to the heart muscle, and often to the heart valves, due to the development of scar tissue in them in the form of areas of varying size and extent that replace the myocardium. Post-infarction cardiosclerosis develops because dead areas of the heart muscle are not restored, but are replaced by scar tissue. Manifestations of cardiosclerosis often include conditions such as heart failure and various arrhythmias.

The main manifestations of cardiosclerosis are signs of heart failure and arrhythmia. The most noticeable symptom of heart failure is pathological shortness of breath, which occurs with minimal physical activity, and sometimes even at rest. In addition, signs of heart failure may include increased heart rate, fatigue, and swelling caused by excess fluid retention in the body. The symptom that unites different types of arrhythmias is unpleasant sensations associated with the fact that the patient feels his heart beating. In this case, the heartbeat can be rapid (tachycardia), slow (bradycardia), the heart can beat intermittently, etc.

It should be recalled once again that coronary disease develops in a patient over many years, and the earlier the correct diagnosis is made and appropriate treatment is started, the greater the patient’s chances for full life further.

Painless ischemia myocardium is the most unpleasant and dangerous type of coronary artery disease, since, unlike attacks of angina, episodes of silent ischemia occur unnoticed by the patient. Therefore, 70% of cases of sudden cardiac death occur in patients with silent myocardial ischemia. In addition, silent ischemia increases the risk of arrhythmias and congestive heart failure. Only a cardiologist can detect silent ischemia in a patient using research methods such as long-term Holter monitoring, functional stress tests, and echocardiography. In case of timely examination and correct diagnosis, silent myocardial ischemia can be successfully treated

3. Diagnosticsischemicillnesseshearts

coronary heart disease stroke

Only a cardiologist can make a correct diagnosis of coronary heart disease using modern diagnostic methods. Such a high percentage of mortality from ischemic heart disease in the 20th century is partly explained by the fact that due to the abundance of various symptoms and frequent cases of asymptomatic course of ischemic heart disease, the diagnosis correct diagnosis was difficult. Nowadays, medicine has made a huge step forward in the methods of diagnosing coronary artery disease.

Survey patient

Of course, any diagnosis begins with interviewing the patient. The patient needs to remember as accurately as possible all the sensations in the heart area that he experiences and has experienced before, determine whether they have changed or remained unchanged for a long time, whether he has symptoms such as shortness of breath, dizziness, increased heartbeat, etc. In addition, the doctor should be interested in what diseases the patient has suffered during his life, what medications he usually takes, and much more.

Inspection patient

During the examination, the cardiologist listens possible noise in the heart, determines whether the patient has swelling or cyanosis (symptoms of heart failure)

Laboratory research

During laboratory tests, cholesterol and blood sugar levels are determined, as well as enzymes that appear in the blood during a heart attack and unstable angina.

Electrocardiogram

One of the main methods for diagnosing all cardiovascular diseases, including ischemic heart disease, is electrocardiography. The method of recording an electrocardiogram is widely used in cardiac diagnostics and is a mandatory step in the examination of a patient, regardless of the preliminary diagnosis. An ECG is also used during clinical examinations, during preventive medical examinations, and during tests with physical activity (for example, on a bicycle ergometer). Regarding the role of the ECG in recognizing ischemic heart disease, this examination helps to detect deviations in the functioning of the heart muscle, which can be crucial for diagnosing ischemic heart disease.

Holterovskoe monitoring ECG

Holter monitoring of the electrocardiogram is a long-term, often daily, ECG recording, which is carried out offline in a hospital or outpatient setting. In this case, the conditions for conducting the examination should be as close as possible to Everyday life the patient, both at rest and during various physical and psychological stress. This allows you to register not only the symptoms of IHD, but also the conditions and causes of their occurrence (at rest, during exercise). Holter monitoring helps the cardiologist determine the level of load at which the attack begins, after what rest period it ends, and also identify attacks of angina at rest, which often occur at night. In this way, a reliable picture of a person’s condition is created over a more or less long period of time, episodes of ischemia and heart rhythm disturbances are identified.

Load tests

Electrocardiographic stress tests are also an indispensable method for diagnosing angina pectoris. The essence of the method is to record an ECG while the patient is performing dosed physical activity. With physical activity, selected individually for each patient, conditions are created that require a high supply of oxygen to the myocardium: these are the conditions that will help identify the discrepancy between the metabolic needs of the myocardium and the ability of the coronary arteries to provide sufficient blood supply to the heart. In addition, ECG tests with physical activity can also be used to identify coronary insufficiency in persons who do not present any complaints, for example, with silent myocardial ischemia. The most popular of them and the most frequently used can be considered the bicycle ergometer test, which allows you to accurately dose muscle work over a wide power range.

Functional samples

In addition, to diagnose ischemic heart disease, they are sometimes used functional tests which provoke spasms coronary artery. This is a cold test and a test with ergometrine. However, the first of them gives reliable results only in 15-20% of cases, and the second can be dangerous in the development of severe complications and therefore these methods are used only in specialized research institutions.

Ultrasonic study hearts. EchoCG

In recent years it has become very common ultrasonography heart - echocardiography. EchoCG makes it possible to interpret the acoustic phenomena of the beating heart and obtain important diagnostic signs with a majority cardiac diseases, including with ischemic heart disease. For example, echocardiography reveals the degree of dysfunction of the heart, changes in the size of cavities, and the condition of the heart valves. In some patients, disturbances in myocardial contractility are not detected at rest, but arise only under conditions increased load to the myocardium. In these cases, stress echocardiography is used - a cardiac ultrasound technique that records myocardial ischemia induced by various stress agents (for example, dosed physical activity).

4. Modernmethodstreatmentischemicillnesseshearts

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” is recommended, which includes vegetables, fruits, light poultry, fish and seafood dishes.

A very important point in non-drug treatment of 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 ischemic heart disease 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.

In more severe cases of coronary artery disease, surgical treatment methods are used. Enough good results shows 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.

Endovascular surgery (x-ray surgery) is currently considered the most promising method of treating coronary artery disease. 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 performed without incisions, through punctures in the skin, under X-ray observation; local anesthesia is sufficient for the operation. 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 loads. 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 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 varieties meat)

· Fried and smoked foods.

Products containing large amounts of salt ( salted cabbage, salty fish and so on)

· 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. On average, a person not engaged in physical work spends 2000-2500 kilocalories per day.

3. Pharmacotherapy at IHD. 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.

B-blockers (B). Due to their action 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 acid(Omakor). 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 important in terms of differential diagnosis, for example, in cases where the patient has ECG signs 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 quite pronounced quick action, as a rule, are used as emergency drugs (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 loop of Henle and primary department 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.

Inhibitorsangiotensin-convertingenzyme. 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

Antiarrhythmicdrugs. 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, the clinical effect is 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). In this regard, this drug 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 daily dose 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.

Othergroupsdrugs.

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 a significant positive effect, but currently, data on its clinical effectiveness There are no independent randomized placebo-controlled studies based on them.

· Mexico;

· coronator;

· trimetazidine.

4. Usage antibiotics at IHD. There are results of clinical observations of the comparative effectiveness of two different courses of antibiotics and placebo in patients admitted to the hospital or with acute heart attack myocardium, or with unstable angina. Studies have shown the effectiveness of a number of antibiotics in the treatment of coronary artery disease. Efficiency of this type therapy is not pathogenetically justified, 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) is developing for various forms IHD. Such interventions include balloon angioplasty and stenting under the guidance of coronary angiography. In this case, the instruments are introduced through one of the large arteries(in most cases the femoral artery is used), and the procedure is performed under fluoroscopic guidance. 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. Surgical treatment.

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. The best known is coronary artery bypass grafting (CABG), in which the aorta is connected to segments of the 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. During this operation, a manipulator is inserted into the coronary vessels through a puncture of an artery (usually the femoral or radial), and using a balloon filled with a contrast agent, the lumen of the vessel is expanded; the operation is, in essence, 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-medicinal methods treatment

- 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 evidence-based medicine. Currently used relatively rarely in Russia, it is not included in the standards of provision medical care for ischemic heart disease, it 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.

- Methodshock wavetherapy. 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. Exposure to UVT has a 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 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, an increase in exercise tolerance, a decrease in the frequency of attacks and the need for medications.

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 commercial basis, or in some cases under voluntary health insurance contracts.

- Usagestemcells. 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 modern technologies does not allow differentiation of 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.

- QuantumtherapyIHD. It is a therapy through exposure laser radiation. The effectiveness of this method has not been proven, and no independent clinical study has been conducted.

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Symptoms of coronary heart disease (CHD). Traditional instrumental methods for diagnosing ischemic heart disease. Electrocardiography (ECG) at rest, daily monitoring Holter ECG. Diagnostic capabilities of echocardiography. Stress tests, coronary angiography.

Coronary heart disease (CHD) is a disease that develops against the background of insufficient oxygen supply to the heart muscle (myocardium).

Narrowing of the lumen and atherosclerosis of the coronary arteries disrupt the blood circulation process, which is the cause of oxygen starvation of the heart. In this article we will look at how IHD is treated, what type of drugs are used and what role they play.

• hidden (asymptomatic);
• angina pectoris;
• arrhythmic.

Basic methods of treatment of ischemic heart disease

• medication (treatment of coronary artery disease with drugs);
• non-drug (surgical) treatment;
• elimination of risk factors contributing to the development of the disease.

Drug treatment of coronary artery disease - general principles

Complex drug treatment of IHD is aimed at stopping the development of the pathology, mitigating negative symptoms, and increasing the duration and quality of life of the patient.

Drugs for cardiac ischemia are prescribed by a cardiologist.

As drugs for the treatment of coronary artery disease that improve the prognosis:

• antiplatelet agents - block the formation of blood clots in blood vessels;
• statins - help reduce blood cholesterol levels;
• blockers of the renin-angiotensin-aldosterone system - prevent an increase in blood pressure.

Medicines for cardiac ischemia to relieve symptoms:

• sinus node inhibitors;
• calcium antagonists;
• activators potassium channels;
• nitrates;
• antihypertensive drugs.

Taking medications for the treatment of coronary heart disease prescribed by a cardiologist is permanent. Replacement of medications or changes in dosage for ischemic heart disease is carried out exclusively by the attending physician.

Drugs for the treatment of IHD are not a panacea: recovery is impossible without following a diet, reasonable physical activity, normalizing sleep patterns, giving up cigarettes and other bad habits.

Antiplatelet agents

Antiplatelet drugs (antiplatelet agents) are a class of drugs that thin the blood (affecting clotting). They prevent platelets or red blood cells from coming together (aggregation) and reduce the risk of blood clots. Antiplatelet agents for the treatment of coronary artery disease are an important component of complex treatment of the disease.

• Aspirin ( acetylsalicylic acid) - in the absence of contraindications (stomach ulcers, diseases of the hematopoietic system) is the main means of preventing thrombosis. Aspirin is effective for ischemic heart disease, has a balanced combination of beneficial properties and side effects, and is inexpensive.
• Clopidogrel is a medicine with a similar effect, which is prescribed for patients intolerant to aspirin.
• Warfarin - has a more intense effect, promotes the dissolution of blood clots, and maintains the level of blood clotting. Warfarin for the treatment of coronary artery disease is prescribed after a comprehensive examination with regular blood monitoring for the INR (may cause bleeding).

Lipid-lowering drugs (statins)

Statins, which actively lower cholesterol levels in the blood, in combination with a special diet, are a mandatory element of therapy for coronary artery disease. Lipid-lowering drugs for the treatment of coronary heart disease are effective if taken continuously:

• Rosuvastatin;
• Atorvastatin;
• Simvastatin.

Narrowing of the coronary arteries in coronary artery disease

Blockers of the renin-angiotensin-aldosterone system

The list of methods for treating the disease necessarily includes tablets for cardiac ischemia that normalize blood pressure. Its increase negatively affects the condition of the coronary vessels. Possible result- progression of coronary artery disease, risk of stroke, as well as chronic form heart failure.

Angiotensin receptor blockers (inhibitors) - medications, used in the treatment of ischemia, blocking receptors of the enzyme angiotensin-2 (located in the structure of cardiac tissue). Therapeutic effect- lowering blood pressure, eliminating the risk of tissue and muscle growth of the heart (hypertrophy) or reducing it.

Drugs in this group are taken strictly under medical supervision over a long period.

ACE inhibitors - act as blockers of the activity of the enzyme angiotensin-2, which is the cause of increased blood pressure. The enzyme has been found to have a negative effect on cardiac tissue and blood vessels. Positive dynamics are observed with the use of the following drugs belonging to the ACE group:

Treatment of coronary artery disease with ARBs (angiotensin-II receptor blockers):

• Losartan (, Cozaar, Lorista);
• Candesartan (Atacand);
• Telmisartan (Mikardis).

Groups of drugs for the symptomatic treatment of ischemic heart disease

As part of the complex therapeutic measures Prescribe medications for cardiac ischemia that relieve symptoms of the disease. In patients at risk of an unfavorable course of the disease, the drugs discussed in the article are prescribed for cardiac ischemia intravenously (intravenously).

Beta blockers

Beta-blockers (BAB) are a central group of drugs that help improve heart function. Their action is aimed at reducing heart rate and regulating average daily blood pressure. Indicated for use as inhibitors of stress hormone receptors. Beta-blockers eliminate the symptoms of angina pectoris and are recommended for use by patients who have suffered. The list of drugs for the treatment of coronary artery disease, such as beta blockers, includes:

• Oxprenolol;
• Nadolol;
• Metoprolol;
• Carvedilol;
• Nebivolol.

Calcium antagonists

Calcium antagonists are drugs that prevent angina attacks. The feasibility of their use is comparable to beta-blockers: they help reduce the number of heart contractions, neutralize the manifestation of arrhythmia, and reduce the number of myocardial contractions. They are effective in the prevention of coronary artery disease, as well as in the vasospastic form of angina. You can also get acquainted with the treatment of atrial fibrillation.

The most effective medications for cardiac ischemia:

• Verapamil;
• Parnavel Amlo;

Nitrates and nitrate-like agents

They relieve attacks of angina and prevent complications in acute myocardial ischemia. Nitrates relieve pain, dilate coronary arteries, and reduce blood flow to the heart, which reduces its need for oxygen.

Drugs for cardiac ischemia (nitrates):

• Nitroglycerin (Nitromint) - inhalation or by tongue;
• Nitroglycerin in the form of ointment, discs or patches;
• Isosorbide dinitrate (long-acting isosorbide dinitrate);
• Isosorbide mononitrate (long-acting isosorbide mononitrate);
• Mononitrate (Monocinque);
• Molsidomine (long-acting molsidomine) - prescribed for nitrate intolerance.

Sinus node inhibitor

Sinus node inhibitor (Ivabradine) - reduces the heart rate, but does not affect myocardial contractility and blood pressure. Ivabradine is effective when treating stable sinus angina who are intolerant to beta blockers. In some cases, taking ivabradine in combination with beta blockers has a beneficial effect on the prognosis of the disease.

Potassium channel activator

Potassium channel activator - Nicorandil (anti-ischemic drug). The drug dilates the coronary vessels and counteracts the deposition of platelets on the walls of the arteries (the formation of atherosclerotic plaques). The action of Nicorandil does not affect the number of heartbeats or blood pressure. The drug is indicated in the treatment of microvascular angina, prevents and relieves attacks of the disease.

Antihypertensive drugs

Antihypertensive drugs are drugs that have the property of lowering high blood pressure. This group includes medications belonging to different pharmacological classes and different mechanisms of action.

Antihypertensive drugs for coronary artery disease include diuretics. Diuretics (diuretics) - in small dosages reduce blood pressure, in larger dosages they remove excess fluid from the body. Diuretics include:

• Furosemide;
• Lasix.

The previously described beta-blockers, calcium antagonists, ACE inhibitors (angiotensin-converting enzyme inhibitors) help lower blood pressure:

• Cilazapril;
• Coexipril;
• Quinapril;
• Perindopril;
• Cilazapril.

Treatment of vasospastic angina

Vasospastic form of angina is special shape diseases with characteristic painful sensations and discomfort in the chest area, even in a calm state. The cause is spastic pathologies of the vessels supplying the heart muscle, narrowing of the lumen of the right coronary artery, and obstructed blood flow to the myocardium.

Calcium antagonists are recommended to prevent attacks; during exacerbations, Nitroglycerin and long-acting nitrates are recommended. Sometimes, a combination of calcium antagonist drugs with small doses of beta-blockers is indicated. In addition, unfavorable factors such as stress, smoking, and hypothermia should be avoided.

Cardiac vessels during an attack of angina

Treatment of microvascular angina

Symptoms of the disease appear characteristic of angina pectoris painful sensations behind the sternum without changes in coronary vessels. Patients with this diagnosis include those with diabetes mellitus or those suffering from arterial hypertension. At pathological changes in the microvessels of the heart, the following is prescribed:

• statins;
• antiplatelet agents;
• ACE inhibitors;
• ranolazine.

• beta blockers;
• calcium antagonists;
• long-term nitrates.

First aid medications

Providing first aid for coronary artery disease involves relieving or stopping pain.

Actions and medications for first aid for ischemic heart disease:

1. Nitroglycerin is the main first aid treatment for patients with characteristic chest pain. Instead of nitroglycerin, you can use a single dose of Isoket or Nitrolingval. It is advisable to take the drug in a sitting position to avoid fainting (with a decrease in blood pressure).
2. If the condition does not improve, you should give the patient a crushed tablet of Aspirin, Baralgin or Analgin before the medical team arrives.
3. Medicines can be taken no more than 3 times in a row with a short interval, since most of them reduce blood pressure.

If symptoms of IHD appear, it is advisable to take potassium supplements (Panangin and analogues).

Useful video

About the causes of coronary heart disease and modern methods Find out about diagnosis and treatment in the following video:

Conclusion

1. Medications for coronary heart disease should be taken only under the supervision of a cardiologist.
2. The course of treatment for IHD is prescribed on the basis of a full examination in a hospital setting and laboratory diagnostics.
3. For a disease such as cardiac ischemia, treatment: tablets, capsules, aerosols - dosage of all drugs, duration of administration and compatibility with others medicines determined exclusively by a cardiologist.
4. Drug treatment of coronary artery disease as an integral part therapeutic measures continues indefinitely. Even if you feel better, it is strictly not recommended to stop treatment - this can provoke angina attacks, the development of myocardial infarction or cardiac arrest.