Ischemia, accompanied by a violation of the normal blood supply to the heart muscle, is today considered a very serious problem. It is this pathology that is the most common cause of sudden death. Moreover, as a rule, patients of working age suffer from the disease. Diagnosis of coronary heart disease is sometimes fraught with difficulty. That is why it is worth familiarizing yourself with the basic information about this disease.
What is coronary heart disease? Symptoms, diagnosis, treatment, possible complications are those moments that are worth exploring in more detail. After all, the sooner a person notices symptoms and consults a doctor, the higher the likelihood of a favorable outcome.
What is an ailment? general information
What is coronary heart disease? Symptoms, diagnosis, therapy - this is what interests many patients. But first, it’s worth it to deal with the basic facts.
Coronary heart disease (CHD) is a pathology that is accompanied by functional and / or organic lesions of the heart muscle. Disorders of the myocardium with such an ailment are associated with insufficient blood supply to the organ or its complete cessation.
It is worth noting that such a diagnosis of "coronary heart disease" is most often made to men of active age (from 55 to 64 years). Of course, the development of the disease in female patients or in boys of a younger age is not excluded.
This pathology is associated with an imbalance between the need for myocardial blood supply and actual blood flow. If the heart muscle for one reason or another does not receive enough oxygen and nutrients, which is inevitably observed with a violation of blood supply, then pathological changes are possible, including sclerosis, dystrophy and necrosis.
According to statistics, in about 60-70% of cases, the acute form of coronary heart disease leads to a sudden death of the patient. That is why the correct and, most importantly, modern diagnosis of coronary heart disease is so important.
The causes of the development of the disease. Description of risk factors
How and why does coronary heart disease develop? Diagnosis, treatment, rehabilitation are important issues. But to begin with, it is worth learning more about the causes of the development of pathology.
In approximately 97-98% of cases, this disease is associated with atherosclerosis of the coronary arteries. It is these vessels that provide myocardial nutrition. Accordingly, even a small narrowing of the lumen of the coronary arteries adversely affects the state of the heart muscles. Complete vessel occlusion leads to the development of acute ischemia, angina pectoris, heart attack, and sometimes sudden death. Other causes include thromboembolism (clogging of the lumen of a vessel with a blood clot).
Of course, the above pathologies themselves do not develop. The occurrence of certain risk factors leads to their appearance. Diagnosis of coronary heart disease should also be aimed at determining the causes of the development of the disease.
- First of all, it is worth mentioning hyperlipidemia . This condition is accompanied by a sharp increase in the level of lipids and lipoproteins in the blood. An abnormal increase in the amount of fat in the blood contributes to the development of atherosclerosis. It is proved that the risk of developing coronary heart disease in people with hyperlipidemia increases 2-5 times.
- One of the main risk factors is arterial hypertension . According to research results, the risk of developing coronary disease in patients with high blood pressure (it is a chronic pathology, and not about random, temporary pressure surges) is 2-8 times higher.
- It is impossible not to mention heredity . If among relatives of a person there are people suffering from coronary heart disease, then the likelihood of developing pathology is much greater.
- According to statistics, coronary heart disease (symptoms, diagnosis of the disease will be described below) is much more often diagnosed in older men. Therefore, the risk factors include the gender and age of the patient.
- Patients with diabetes mellitus (including in the latent form of the disease) are more likely to suffer from coronary heart disease.
- Risk factors include physical inactivity and obesity . It is proved that cases of coronary disease are three times more likely to be diagnosed in people who lead an inactive lifestyle. As you know, physical inactivity is often combined with obesity. Being overweight also increases the chances of developing an ailment.
- Smoking has a negative effect on the cardiovascular system, since nicotine causes a spasm of small vessels, including coronary arteries.
Correctly performed diagnosis of coronary heart disease allows you to determine not only the stage and severity of the disease, but also its causes. Already on the basis of these data, the doctor will be able to draw up an effective treatment regimen. It should be understood that in most cases, coronary heart disease develops under the influence of several factors.
Coronary heart disease: classification
The term IHD combines various pathological conditions associated with impaired myocardial blood supply:
- Sudden coronary death. In this case, we are talking about primary cardiac arrest, which occurred as a result of electrical instability of the heart muscle. A person in this condition can be successfully resuscitated (naturally, if the patient receives timely help).
- Angina pectoris. In this case, the pathology can take various forms. There are stable, unstable, spontaneous and some other types of angina pectoris. Pathology is accompanied by pain behind the sternum, which often extends to the left shoulder and shoulder blade.
- Myocardial infarction. A condition that is accompanied by necrosis of a certain section of the heart muscle that occurs against a background of insufficient blood supply.
- Cardiosclerosis In most cases, a similar pathology develops as a result of a previous heart attack. Areas of heart muscle that underwent necrosis begin to change - muscle fibers are replaced by connective tissue, as a result of which the myocardium loses contractile properties.
- Heart rhythm disturbances. These pathologies almost inevitably arise with narrowing of blood vessels, because blood begins to pass through “jerks”.
- Heart failure. Chronic violation of myocardial trophism may be accompanied by a violation of the physiological activity and anatomical structure of the heart.
What symptoms should I look for?
What is coronary heart disease? Diagnosis, treatment is, of course, important information. However, many patients are interested in symptoms. What are the first signs of CHD? What violations should I look for?
- Disorders of the heart are often accompanied by shortness of breath. At first, breathing problems appear during physical activity, for example, when walking fast, climbing stairs, etc. But as the disease progresses, shortness of breath appears even at rest.
- Arrhythmias are also included in the list of symptoms. Patients complain of an increased and rapid heartbeat.
- CHD is often accompanied by changes in blood pressure - patients are diagnosed with hypo- or hypertension.
- Angina pectoris is accompanied by pain in the chest. Some patients note a feeling of squeezing and burning behind the sternum. Pain can be given to the shoulder, neck, shoulder blade. Sometimes the pain syndrome is very intense and can not be stopped by drugs.
Unfortunately, the diagnosis and treatment of chronic coronary heart disease is often difficult, because in most cases people ignore a small shortness of breath and weak, periodic tingling in the heart. A doctor is contacted already in the late stages of the development of the disease.
Suspected Ischemia Tests
If the patient turns to a specialist with complaints of recurring chest pain and shortness of breath, the doctor first of all collects a complete medical history. It is important to find out exactly when the symptoms occurred, whether there are heart diseases in close relatives, whether the patient has bad habits, etc.
Further laboratory studies are carried out. For example, the level of troponins, myoglobin and aminotransferases in the blood is determined - it is these protein compounds that are released during the destruction of cardiomyocytes.
In addition, the patient’s blood is checked for the presence of an increased amount of glucose, lipoproteins and cholesterol - this helps to diagnose concomitant diseases, and sometimes to determine the cause of ischemic disease (for example, atherosclerosis).
Instrumental diagnostics
Decisive in the diagnosis of coronary heart disease is such a simple and affordable study as an electrocardiogram. During the procedure, the doctor can check the electrical activity of the heart, detect certain violations of the myocardial rhythm.
EchoCG is also mandatory. This study allows you to determine the size of the heart, evaluate its contractile activity, visualize the state of the valves and myocardial cavities, and study specific acoustic noises. Additionally, stress echocardiography is performed, since the symptoms of ischemia can sometimes be detected only during physical activity.
Informative is the daily monitoring of the ECG. A special device is attached to the patient’s shoulder, which measures cardiac activity during the day. In addition, the patient should write down in a special diary his actions, changes in health.
Often performed transesophageal electrocardiography. A special sensor is inserted into the patient's esophagus, which records the performance of the heart. Thus, the doctor can evaluate the conductivity and electrical excitability of the myocardium.
Quite often, doctors prescribe positron emission tomography (PET) for patients. Diagnosis of coronary heart disease involves the study of myocardial blood flow. This technique also allows you to measure the rate of utilization of glucose in a particular area of the myocardium, evaluate the activity of the metabolism of fatty acids, measure the amount of oxygen consumed. A PET diagnosis of coronary heart disease is carried out if any segment of the heart muscle looks like a scar.
A lot of useful information can be obtained after coronary angiography. Contrast is introduced into the coronary vessels, and then its movements are traced. Using this procedure, a specialist can determine the presence of vascular obstruction, as well as the degree of occlusion and stenosis.
The differential diagnosis of coronary heart disease is also important, because symptoms such as pain behind the sternum and shoulder, as well as shortness of breath develop against other diseases, including autonomic neurosis, pathologies of the peripheral nervous system, paraneoplastic syndrome, pleural lesions, etc.
How to treat coronary heart disease?
In fact, therapy for this disease must necessarily be comprehensive.
Only a doctor selects the means of treating coronary heart disease, since a lot depends on the general condition of the patient, the presence of other diseases, etc. Sometimes, experts prescribe beta-blockers that help lower blood pressure. Preparations containing nitroglycerin help dilate blood vessels, including coronary arteries. Proper administration of ACE inhibitors improves blood flow. With atherosclerosis, patients are prescribed medications that contain statin, as they help to adjust the level of cholesterol in the blood. Acetylsalicylic acid can be used to prevent thrombosis. In the presence of edema, diuretics are sometimes used.
It is also worth noting that the patient needs to change his lifestyle a bit, in particular, to eat right. The restriction of physical activity is also shown. If the severity of coronary disease is small, then patients are recommended feasible loads, for example, swimming, walking, cycling. Such exercises help strengthen blood vessels. But if we are talking about a severe form of the disease and severe shortness of breath, then you will have to give up sports activities and physical activity for a while.
Proper nutrition for ischemia
Diet for coronary heart disease is extremely important. Doctors recommend that patients adhere to certain rules:
- It is necessary to sharply limit the amount of salt. In addition, do not recommend drinking too much fluid. This will help relieve stress from the heart muscle.
- In order to slow the development of atherosclerosis, it is important to limit the amount of foods containing animal fats and cholesterol. The list of prohibited include lard, fatty meats, butter. Doctors recommend giving up fried, too spicy and smoked foods. Foods rich in simple, easily digestible carbohydrates have a negative effect on health. That is why it is important to limit the amount of sweets, pastries, chocolate and other sweets in the diet.
- If a patient develops coronary heart disease amid obesity, it is important to begin the fight against overweight. Of course, you need to lose weight slowly and carefully, since too strict a diet is stressful for the body. Doctors recommend eating properly, doing physical labor (in the absence of contraindications), and maintaining the correct energy balance (energy consumption should be greater than the amount of calories consumed with food by about 300).
Surgical intervention
Unfortunately, in most cases it is difficult to do without surgical intervention, since drug treatment only helps to relieve symptoms and prevent the development of complications.
- Coronary artery bypass grafting is an operation during which the surgeon takes the patient’s own vessel and hem it to the coronary artery in such a way as to create a workaround for blood flow. The myocardium again begins to receive oxygen and nutrients in sufficient quantities, which leads to the elimination of ischemia.
- At one time, such a technique as balloon angioplasty was widely used. During the procedure, a special balloon is introduced into the lumen of the vessel, with the help of which the surgeon literally inflates the artery, returning it to its normal size and normalizing the blood flow. Unfortunately, the procedure gives only a temporary effect.
- More effective is stenting. The meaning of the operation is the same - to expand the vessel. But during the procedure, a metal mesh frame (stent) is introduced into the lumen of the affected artery - this way the vessel retains its natural shape constantly.
Possible complications
Unfortunately, many patients face a problem such as coronary heart disease. Therapy helps inhibit the development of the disease and prevent the occurrence of complications. But with improper treatment or its absence, the following are possible:
- insufficiency of energy metabolism of cardiomyocytes;
- various forms of disorders of contractility of the left ventricle;
- the development of cardiosclerosis (the number of functioning cardiomyocytes is significantly reduced, they are replaced by connective tissue elements that are not able to contract);
- violations of diastolic and systolic myocardial function;
- impaired conduction, contractility and excitability of the myocardium, partial loss of autoregulation.
Preventive measures and forecasts
It should immediately be said that the prognoses for patients with a similar diagnosis depend on the general condition of the body, the degree of damage to the coronary vessels, and the presence of other diseases. If it is a mild degree of ischemia, then it responds quite well to therapy. The prognosis is not so favorable for patients who, along with coronary heart disease, suffer from diabetes mellitus and hypertension.
As for prevention, there are no specific remedies. People at risk should maintain a healthy lifestyle. It is important to eat right, limiting the amount of fatty, fried and too spicy dishes, foods rich in bad cholesterol.
Negatively affects the state of blood vessels smoking. It is important to keep fit by regularly doing all kinds of exercise, such as training in the gym and walking in the fresh air. Patients with hypertension need to constantly monitor blood pressure indicators.
These simple rules will help not only prevent the development of ischemia, but also significantly improve the functioning of the whole organism.