What is ischemic heart disease, we will consider in this article.
Coronary heart disease is characterized by organic and functional myocardial lesions, which are caused by a deficiency or complete cessation of blood supply to the heart muscle (ischemia). IHD is manifested in both acute (cardiac arrest, heart muscle infarction) and chronic (post-infarction cardiosclerosis, angina pectoris, heart failure) conditions. The clinical symptoms of this pathology are determined by its specific form. CHD is the most common cause of sudden death, including among people of working age.
Symptoms and treatment of coronary heart disease are presented below.
Pathology Description
Coronary heart disease is a very serious problem in modern cardiology and medical science in general. At the present stage, about 600 thousand deaths are recorded in our country as a result of various forms of coronary heart disease (ICD 10 I24.9 - acute, I25.9 - chronic) annually, and worldwide mortality from this disease is about 75%. This pathology in most cases occurs in men from 50 to 70 years and can lead to disability and rapid death.
What is ischemic heart disease, many are interested.
What is the basis of the formation?
At the heart of the formation of the disease is an imbalance between the need for tissue of the heart muscle in the blood supply and coronary blood flow. This phenomenon can develop due to the high demand of the myocardium for oxygen and its insufficient intake, or during normal demand, but a decrease in coronary blood supply.
Deficiency of blood flow to the cells of the heart muscle is especially pronounced when there is a decrease in coronary blood flow, and the need for myocardium in blood flow increases. The lack of blood supply to the heart tissues, their hypoxia is manifested by various forms of coronary heart disease.
The group of similar diseases includes myocardial ischemia in acute and chronic form, which are accompanied by its subsequent changes: necrosis, dystrophy, sclerosis. Similar pathologies of the condition are considered in cardiology, as well as as nosological independent units.
Why do coronary heart disease and angina pectoris occur?
Causes and factors of occurrence
In the vast majority (96%) of clinical cases, the occurrence of such a disease is due to atherosclerotic changes in the coronary arteries of varying severity: from an insignificant narrowing of the arterial lumen by an atherosclerotic plaque to absolute vascular occlusion. With 80% coronary stenosis, the tissues of the heart muscle begin to respond to a lack of oxygen, and patients develop the so-called angina pectoris.
Other prerequisites
Other conditions that can trigger the development of symptoms of coronary artery disease in people are spasm or thromboembolism of coronary arteries, which develops, as a rule, against the background of already present atherosclerotic lesions of arteries. Cardiospasm enhances obstruction in the coronary vessels and causes the main symptoms of coronary artery disease.
Provocative factors
Factors that, in addition to vascular atherosclerosis, contribute to the occurrence of coronary heart disease, include:
- Hyperlipidemia, which contributes to the formation of atherosclerotic changes and increases the risk of coronary heart disease several times. The most dangerous in terms of risk are type II, III, IV hyperlipidemia, and a decrease in the content of alpha-lipoproteins.
- Arterial hypertension, which increases the likelihood of coronary heart disease by 6 times. In people with systolic blood pressure of 180 mm Hg. Art. and higher, a similar pathology occurs up to 9 times more often than in people with normal or low blood pressure.
- Smoking. According to statistics, smoking dramatically increases the incidence of this pathology by 4 times. Mortality from coronary disease among smokers 30-55 years old, who smoke 20-30 cigarettes daily, is two times higher than non-smokers of the same age category. What else increases the risk of coronary heart disease?
- Obesity and physical inactivity. Physically inactive people risk 3 times more death from heart ischemia than those who lead a more mobile lifestyle. With concomitant obesity, such risks increase at times.
- Violation of tolerance to carbohydrates.
- In the presence of diabetes mellitus, including in latent form, the risk of morbidity with pathology increases by about 3 times.
Factors that create a threat to the formation of this pathology should also include hereditary predisposition, elderly age and male gender of patients. In the presence of several predisposing factors at once, the likelihood of occurrence increases.
The speed and causes of the development of ischemia, as well as its severity, duration and initial state of the cardiac and vascular systems of a person determine the occurrence of a particular type of ischemic disease.
What is coronary heart disease is now clear. Consider further the classification of the disease.
Pathology classification
In clinical cardiology, the following systematization of forms of ischemic pathology is accepted:
1. Primary cardiac arrest (coronary death) is a rapidly developing condition based on, presumably, electrical instability of myocardial functioning. Sudden coronary death is considered occurring no later than 6 hours after the occurrence of a heart attack or instant death. There is a sudden coronary death with positive resuscitation and such, which ended in a fatal outcome.
2. Angina pectoris in coronary heart disease, which is divided, in turn, into:
- stable (functional class I, II, III or IV);
- unstable: arising for the first time, early postoperative, progressive, or post-infarction;
- spontaneous - Prinzmetal angina, vasospastic.
3. Painless forms of ischemic myocardial disturbance.
4. Myocardial infarction:
- Q-infarction, transmural (large focal);
- no Q-infarction (small focal).
5. Post-infarction cardiosclerosis.
6. Violations of the rhythm and cardiac conduction.
7. Heart failure.
In cardiological practice, the term “acute coronary syndrome” exists, in which various types of ischemic disease are combined: myocardial infarction, unstable angina pectoris, etc. Sudden coronary death caused by coronary heart disease is sometimes included in this category.
FC angina pectoris
With this pathological process, several stages are distinguished.
The first functional class, when an attack develops with increased physical activity.
The second functional class, which is a state that occurs against the background of an average load.
The third functional class, the clinical manifestations of which arise in the form of a response to minor activity, for example, in the form of walking or during psycho-emotional stress.
The fourth functional class, which is characterized by the fact that attacks bother the patient even at rest.
Symptoms of the disease
The clinical symptoms of coronary heart disease (ICD-10 code I20 – I25) are determined, as a rule, by the form of this disease. In general, such a pathology has a wave-like course: the patient’s stable normal state of health alternates with moments of exacerbation of ischemia. About a third of all patients do not at all feel the presence of ischemic disease, the progression of which can develop slowly, sometimes even for decades, and not only the forms of the pathological process, but also the symptoms of coronary heart disease can change.
Common signs of ischemia
Common signs of ischemia include pain in the sternum, which is associated with physical exertion or severe stress, pain in the back, arms, lower jaw, shortness of breath, increased palpitations or a feeling of interruptions in the rhythm of the heart, weakness, nausea, blurred consciousness, etc. Often, coronary disease is detected already at the chronic stage of heart failure with the appearance of edema of the lower extremities, shortness of breath, which often causes the patient to consult a specialist.
The above symptoms of coronary heart disease (ICD code I20 – I25), as a rule, do not occur simultaneously, and with a specific form of pathology, certain manifestations of ischemia predominate.
Harbingers
The harbingers of the primary form of cardiac arrest in cardiac ischemia may be a paroxysmal feeling of discomfort behind the sternum, a panic attack, fear of death, as well as psycho-emotional instability. In a sudden form of coronary death, the patient faints, he has a respiratory arrest, lack of pulse on the main arteries (carotid and femoral), heart sounds are not heard, the pupils expand, the skin becomes pale grayish in color. Cases of this pathology account for up to 63% of deaths in coronary heart disease (ICD code: I20 – I25), mainly even before the patient is hospitalized.
Diagnostics
Diagnosis of the disease is carried out in a hospital or clinic using specific instrumental methods. Laboratory studies usually indicate the presence of specific enzymes that increase with heart attack and angina (creatine phosphokinase, troponin-I, troponin-T, aminotransferase myoglobin, etc.) In addition, cholesterol, atherogenic and anti-atherogenic lipoproteins are determined. triglycerides, as well as markers of cytolysis.
Symptoms and treatment of coronary heart disease are interrelated.
Important methods for diagnosing such diseases are ECG, echocardiography, cardiac ultrasound, stress echocardiography , etc. In the diagnosis of coronary heart disease, functional tests are also widely used during exercise to detect the early stages of ischemia.
Holter ECG monitoring is another diagnostic method involving ECG recording within 24 hours.
Transesophageal electrocardiography is a technique that allows you to evaluate the conductivity, electrical excitability of the myocardium.
Coronary angiography in determining coronary heart disease allows you to visualize the vessels of the heart muscle by introducing a contrast medium into the blood and determine violations of their patency, the presence of stenosis or occlusion. The history of coronary heart disease may vary individually.
IHD treatment
The tactics of treatment of certain forms of this pathology has some features. However, there are main conservative areas that are used to treat ischemia. These include:
- Drug therapy.
- Carrying out operative revascularization of the heart muscle (coronary artery bypass grafting).
- Use of endovascular methods (coronary angioplasty).
Non-drug therapy includes measures to correct nutrition and lifestyle. With various forms of ischemia, a restriction of activity is shown, since during physical exertion, the myocardial oxygen demand increases, the dissatisfaction of which causes manifestations of coronary artery disease. Therefore, with any form of coronary heart disease, the patient's activity mode is limited.
Medications
Drug therapy for coronary heart disease (ICD-10 code I20 – I25) involves the use of the following medications:
- antiplatelet agents;
- hypocholesterolemic drugs;
- β-blockers
- diuretics
- antiarrhythmic drugs.
In cases of lack of effect in the implementation of drug and other therapy of pathology, various methods of surgical intervention are used.
We examined what is coronary heart disease.
Forecast and Prevention
The prognosis for coronary heart disease depends on various factors. So, the combination of coronary heart disease and arterial hypertension, severe lipid metabolism disorders and diabetes mellitus will be unfavorable. Therapeutic measures can only slow down the progression of coronary heart disease, but not completely stop it.
The most effective prevention of coronary heart disease is to reduce risk factors: it is necessary to exclude alcohol and tobacco smoking, psycho-emotional overload, maintain optimal body weight, exercise, control blood pressure, eat right.