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 mortality and disability in all developed countries.
Predisposing factors
To date, criteria have been derived by which it is possible to predict the development of a disease.
Coronary heart disease was no exception. There is not just a list, but a classification of risk factors grouped by a certain attribute that can contribute to the occurrence of this disease.
- Biological:
- age older than 50 years;
- gender - men are more often ill;
- a genetic predisposition to dysmetabolic diseases. - Anatomy:
- high blood pressure;
- obesity;
- the presence of diabetes. - Lifestyle:
- violation of the diet;
- smoking;
- physical inactivity or excessive physical activity;
- alcohol consumption.
Disease development
Pathogenetic causes of the development of the disease can be either extra- or intravascular problems, such as narrowing of the lumen of the coronary arteries due to atherosclerosis, thrombosis or spasm, or severe tachycardia with hypertension. But nevertheless, atherosclerosis is in the first place for reasons of the development of a heart attack. Initially, a person develops a metabolic disorder, which is expressed in a persistent increase in blood lipids.
The next step is the fixation of lipid complexes in the walls of blood vessels and their sweating inside the endothelial cells. Atherosclerotic plaques form. They destroy the wall of blood vessels, make it more fragile. This condition can have two outcomes: either a blood clot comes off a plaque and clogs an artery upstream of the blood, or the diameter of the vessel becomes so small that the blood can no longer circulate freely and nourish a certain area. In this place, a focus of ischemia is formed, and then necrosis. If the whole process takes place in the heart, then the disease will be called coronary heart disease.
There are several clinical forms and the corresponding treatment of coronary artery disease. Drugs are selected based on the pathophysiological component.
Sudden coronary death
Otherwise called cardiac arrest. It can have two outcomes: a person dies or ends up in intensive care. It is associated with sudden myocardial instability. This diagnosis is an exception when there is no reason to suspect another form of coronary artery disease. Treatment, drugs of choice for medical workers remain the same as during resuscitation. Another condition is that death should occur instantly and with witnesses or no later than six hours after the onset of a heart attack. Otherwise, it already falls under another classification.
Angina pectoris
This is a form of coronary heart disease. It also has its own additional classification. So:
- Stable angina pectoris.
- Vasospastic angina pectoris.
- Unstable angina pectoris, which, in turn, is divided into:
- progressive;
- first arising;
- early post-infarction. - Prinzmetall's angina pectoris.
The most common is the first type. The Association of Cardiology has long developed a treatment for coronary artery disease. Drugs must be taken regularly and for a long time, sometimes all their lives. If you follow the recommendations, you can for some time postpone unpleasant health consequences.
Myocardial infarction
It is established taking into account the data of the electrocardiogram, laboratory and anamnestic indicators. The most informative are the increases in enzymes such as LDH (lactate dehydrogenase), ALaT (alanine aminotransferase) and ACaT (aspartate aminotransferase), which are normally enclosed within the cell and appear in the blood only when it is destroyed.
A heart attack is one of the finals that uncontrolled coronary heart disease can lead to. Treatment, drugs, help - all this can be late, because with an acute attack, very little time is devoted to reversing the damage.
Diagnostics
Naturally, any examination begins with a survey and examination. History data is collected. Doctors are interested in such complaints as pain behind the sternum after exercise, the presence of shortness of breath, fatigue, weakness, and a feeling of palpitations. It will be important to note the evening swelling, warm to the touch. And also how the treatment of coronary heart disease is carried out. Drugs can say a lot to the doctor. For example, Nitroglycerin. If it helps to relieve an attack, then this almost always speaks in favor of angina pectoris.
A physical examination includes measuring pressure, respiratory rate and heart rate, and listening to the heart and lungs. The doctor is trying to hear pathological noises, an increase in heart sounds, as well as wheezing and blisters in the lungs, which would speak of stagnant processes.
Next, the doctor sends the patient for laboratory and physical examination. We have already talked about the analyzes, and of the studies, the most common are ECG, echocardiography, and ultrasound of the heart.
Treatment
So we moved on to the most basic. We are interested in the treatment of coronary heart disease. Drugs play a leading role in it, but not only they contribute to improving well-being. First of all, the patient needs to clarify that he will have to completely change his lifestyle. Remove excessive physical exertion, balance sleep and rest 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 intake of salt, water, foods with excess animal fats and carbohydrates. If a person is overweight, then it is necessary to carry out its correction.
But besides this, methods have been developed for the pharmacological elimination of 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 heart disease are divided into several classifications, but the most common - according to the mechanism of action. We will use it. Antiplatelet agents help improve blood flow. They act on coagulation and anticoagulation systems, somewhat separating them, and thus achieve liquefaction. These include Aspirin, Clopidogrel, Warfarin and others. When assigning them, it is always necessary to control the INR indicator (international normalized ratio) in order to prevent a person from bleeding.
Beta blockers
They have an effect on receptors in the walls of blood vessels, slowing the heartbeat. As a result, it consumes less oxygen and needs less blood, which is very useful with narrowed coronary arteries . This is one of the most common drugs for coronary heart disease. Treatment, drugs of choice, and dose depend on concomitant conditions. There are selective and non-selective beta-blockers. Some of them act more gently, others a little tougher, but an absolute contraindication is the presence in the patient a 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 the treatment of coronary artery disease. The drugs are being improved, new approaches are being developed, and the causes of the disease are being studied. One of such advanced approaches is to influence provocative factors, namely dyslipidemia or imbalance in blood fats. It has been proven that lowering cholesterol levels slows the formation of atherosclerosis. And this is the main cause of coronary heart disease. Signs, treatment, drugs - all this has already been identified and developed, you only need to be able to use the available information to the benefit of 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 needed as part of the program, which is part of the treatment of coronary heart disease. Medications and drugs are carefully selected, the dose is adjusted, the frequency of administration. They affect the smooth muscles in the walls of blood vessels. Relaxing, these muscles increase the diameter of the lumen, thus increasing the amount of blood received. This helps relieve ischemia and pain. But, unfortunately, nitrates can not prevent a heart attack from developing in the global sense of the word, and does not increase life expectancy, therefore, they are recommended to take these drugs only during an attack ("Dinibor", "Isoket"), and choose something else on an ongoing basis .
Anticoagulants
If, in addition to angina pectoris, the patient has a risk of thrombosis, then these are the drugs prescribed for coronary heart disease. Symptoms and treatment, drugs depend on how much this or that link of the pathological process prevails. One of the most famous means of this series is Heparin. It is administered in a large dose once in acute myocardial infarction, and then maintain the level in the blood plasma for several days. It is necessary to carefully monitor the time of blood coagulation.
Diuretics
Drugs for the treatment of coronary heart disease are not only pathogenetic, but also symptomatic. They affect such a link as high blood pressure. If you increase the amount of fluid that the body will lose, then you can artificially lower the pressure to normal numbers and eliminate the threat of a second heart attack. But do not do it too quickly so as not to provoke a collapse. There are several types of these drugs, depending on which part of the Henle loop (nephron site) they affect. A competent doctor will select the medicine necessary in this situation. One that does not exacerbate the condition of the patient. Be healthy!