Under IBS( in the decoding definition - ischemic heart disease) a complex of diseases is grouped. They are characterized by unstable blood circulation in the arteries that provide the myocardium.
Ischemia - insufficient blood supply - is caused by narrowing of the coronary vessels. Pathogenesis is formed under the influence of external and internal factors.
- 1 Causes( pathogenesis) and risk factors
- 2 Classification: forms of coronary heart disease
- 3 Than dangerous, complications, consequences
- 4 Clinic: first signs and symptoms
- 5 Diagnostic methods
- 6 How and what to treat
- 6.1 Therapy without medications
- 6.2 Pharmacologicalsupport
- 6.3 Operations
- 7 Prognosis and prevention
Causes( pathogenesis) and risk factors
IHD leads to death and disability of people of working agethat's all over the world. WHO experts estimated that the disease becomes the cause of the annual death of more than 7 million people.
The combination of the processes discussed below increases the risk of morbidity.
Main causative factors:
- Atherosclerosis .Flowing in a chronic form of an ailment, affects the arteries that approach the heart muscle. Vascular walls are densified and lose elasticity. Plaques formed by a mixture of fats and calcium, narrow the lumen, deterioration of the blood supply of the heart progresses. Spasm of coronary vessels .The illness is caused by the development of atherosclerosis or formed without it( under the influence of external negative factors, for example, stress).Spasm changes the activity of the arteries.
- Hypertensive disease - the heart is forced to fight high pressure in the aorta, which disrupts its circulation and causes angina and heart attack.
- Thrombosis / thromboembolism .In the artery( coronary) as a result of the decay of the atherosclerotic plaque, a thrombus is formed. There is a high risk of clogging the blood vessel with a thrombus, which was formed in another part of the circulatory system and got into here with the bloodstream.
- Acquired or congenital malformations.
To risk factors it is customary to include:
- hereditary factor - the disease is transmitted from parents to children;
- stably increased "bad" cholesterol, which causes accumulation of HDLP - high-density lipoprotein;
- obesity of any degree, disorders of fat metabolism;
- arterial hypertension - high blood pressure;
- Diabetes( metabolic syndrome) is a disease caused by impaired hormone production of the pancreas - insulin, which leads to failure of carbohydrate metabolism;
- is an activity-free lifestyle;
- frequent psychoemotional disorders, characteristics of personality and personality;
- commitment to unhealthy fatty foods;
- age - risks increase after 40 years;
- sex - men suffer from CHD more often than women.
Classification: forms of ischemic heart disease
IHD is divided into several forms. It is customary to isolate acute and chronic conditions.
- Primary cardiac arrest. Rapid acute coronary insufficiency and death occurring instantaneously or death of the patient within one hour after the development of a heart attack. Angina pectoris .One of the forms of the course of IHD, which manifests itself by pressing and compressing uncomfortable sensations localized behind the sternum. Pain and discomfort can irradiate into the epigastric zone, the left arm, the jaw.
Develops after physical exertion and is divided into several forms - the first to arise, the progressive, the vasospastic, etc. Diagnosis can show the presence of coronary syndrome X, when the examination does not reveal vascular disorders, but the patient experiences characteristic pain.
Stenocardia of tension .It is accepted to distinguish several clinical forms of this type of ischemic heart disease:
- unstable - occurs for the first time, progresses, develops after a heart attack or surgical intervention;
- stable - develops against a background of different physical activity and is divided into IV class. As the class of the disease grows, the patient's tolerance of physical exertion is reduced. Angina spontaneous .Physicians call this form angina Prinzmetal. The pain behind the breastbone can develop at rest or at moderate, normal for other people's physical exertion. Pain syndrome is pronounced, characterized by equivalent periods of decline and growth. The attack lasts about 20 minutes.
- Hidden form. Pain-free ischemia in which the vessels supplying the heart muscle severely narrow. The patient does not feel any serious changes in his state of health. Diagnosis is possible only after instrumental research.
- Myocardial infarction. The heart muscle experiences an acute circulatory disturbance, which causes the death of its site( this is noticeable on the ECG).
- Cardiosclerosis is postinfarction. One of the most common lesions of the myocardium with the involvement of valves. Cardiosclerosis develops if the healthy tissues are replaced by scarring. On the myocardium, various pathological sites of different magnitude and prevalence are formed. Postinfarction cardiosclerosis is the cause of death of a large number of people.
- Heart rate and conduction disorders of .The patient feels obvious changes in the heart rate, such as acceleration, deceleration, interruptions in cardiac activity.
- Cardiac insufficiency .If the myocardium lacks blood supply for a long period, serious insufficiency develops. The patient has swelling, shortness of breath - initially with physical exertion, then at rest.
Than dangerous, complications, consequences
Ischemic heart disease suggests the presence of changes in the myocardium, which leads to the formation of progressive insufficiency. The contractility is weakening, the heart does not provide the body with the required amount of blood. People with Ids quickly get tired and experience the constant weakness of .Lack of treatment increases the risk of death.
Clinic: the first signs and symptoms of
Physicians identify several symptoms that are characteristic of coronary insufficiency and IHD.They can manifest themselves complexly or separately, depending on the form of the disease.
There is a clear correlation between the development of pain, localized in the heart area of , and physical activity. There is a stereotype of their occurrence - after abundant food, under adverse weather conditions.
Description of complaints of pain in IHD:
- character - pressing or compressing, the patient feels a lack of air and a feeling of increasing gravity in the chest;
- localization - in the atrial zone( on the left side of the sternum);
- negative sensations can spread along the left shoulder, arm, shoulder blades or both hands, to the left pre-inflammatory zone, to the cervical region, jaw;
- pain attacks last no more than ten minutes, after taking nitrates they subsided for five minutes.
Other symptomatology is indicated as follows:
- dizziness, fainting, blurred vision;
- nausea, weakness;
- shortness of breath;
- sensation of unstable heart function, tachycardia;
- excessive sweating.
A specialist who is able to help with the development of all considered conditions is a cardiologist. Timely appeal to doctors can save lives.
Diagnosis in coronary heart disease is based on the following examinations:
- Collecting an anamnesis of ( life, family, disease and complaints).The doctor conducts a detailed questioning of the patient: when, for a long time, the pain, discomfort, duration, localization, character began. Find out whether there are irregularities in the rhythm, shortness of breath, weakness. The patient should tell what preparations he took and what the results of the reception. Risk factors are identified.
- Cardiologist examination .The doctor measures the level of pressure, listens to the heart for the presence of noise, wheezing. Identifies signs of hypertrophy - increasing the size and mass of the right and left ventricles, insufficiency of its contractility, atherosclerosis of various sites.
- General blood test( + biochemistry) and urine - allows to identify the possible cause of ischemia, complications, actual cholesterol, triglycerides, which is important for assessing the risk caused by arteriosclerosis of the vessels.
- The study for troponins in the blood - is necessary for suspected infarction or acute coronary syndrome. When the heart cells are destroyed, specific enzymes are released into the blood.
- Coagulogram - with CHD coagulability increases.
- ECG - electrocardiography - the study reveals hypertrophy( excess of dimensions) of the left ventricle and a number of other specific signs. The norms and decoding of the ECG parameters in the table can be found in another article.
- Echo ECG - echocardiography - the size and structure of the organ are assessed, intracardiac blood flow is studied, the degree of vascular lesions, the work of the valves.
- Daily monitoring of ECG on Holter - electrocardiogram is recorded within 24-72 hours. An effective assessment of the patient's condition, which allows to identify the conditions and causes of IHD.
- Radiography of the chest - is necessary to detect potential dilatation( expansion) of the left ventricle. If the ventricle sharply expanded, this may indicate aortic dissection. Possible complications, changes in lung tissue are determined.
According to the plan, the patient receives a complex of exercise tests( physical, radioisotope, pharmacological), undergoes X-ray contrast examination, computed tomography of the heart, electrophysiological study, dopplerography.
How and what to treat
The tactics of complex therapy for IHD are developed based on the patient's condition and an accurate diagnosis.
Therapy without medicines
Principles of treatment of IHD:
- daily cardio in dynamics( swimming, walking, gymnastics), the degree and duration of the load is determined by the cardiologist;
- emotional rest;
- formation of a healthy diet( ban on salted, fatty).
Pharmacological support of
The following drugs may be included in the therapy plan:
Anti-ischemic - reduce myocardial oxygen demand:
- calcium antagonists - are effective in the presence of contraindications to beta-blockers and are used with low effectiveness of therapy with their participation.
- beta-blockers - relieve pain, improve rhythm, dilate blood vessels.
- nitrates - stop angina attacks.
- Antiagreganty - pharmacological drugs that reduce blood clotting.
- ACE inhibitors are complex agents for reducing pressure.
- Hypocholesterolemic medications( fibrators, statins) - eliminate harmful cholesterol.
As additional support and as indicated in the therapy plan, the
- diuretics can be used as a diuretic to relieve swelling in patients with ischemic heart disease.
- antiarrhythmics - maintain a healthy rhythm.
Learn more about the treatment of IHD with drugs from a separate publication.
Coronary artery bypass graft .Regulation of blood supply to the myocardium surgically. A new vascular bed is brought to the site of ischemia. Intervention is realized with multiple vascular lesions, with low effectiveness of pharmacotherapy and in a number of concomitant diseases.
Coronary angioplasty .In this surgical treatment of IHD, a special stent is introduced into the affected vessel, which keeps the lumen normal. The blood flow of the heart is restored.
Prognosis and prevention of
Cardiologists note that has an unfavorable prognosis for .If the patient complies with all the prescriptions, the course of the disease becomes less severe, but it does not disappear completely. Among preventive measures, the effective conduct of a healthy lifestyle( proper nutrition, lack of bad habits, physical activity).
A useful video of what kind of diagnosis is "ischemic heart disease", all the details of the causes, symptoms and treatment of IHD are told: