Diseases of the cardiovascular system occupy first place in the frequency of occurrence throughout the world. In one of the first places is coronary heart disease and its complications.
What is ischemic heart disease?
Coronary heart disease is understood as a condition that develops as a result of a decrease in blood flow in the coronary arteries, the main system of blood vessels in the heart. As a result of this, the myocardium of the heart lacks oxygen and experiences oxygen starvation. For this reason, the heart cannot properly perform its function, as it works at the limit of its own capabilities. Because of this, there is a thickening of the walls of the heart and its increase in size. At some point, in conditions of lack of blood and oxygen, excessive muscle tension appears, and as a result, either myocardial rupture or damage to the vessel with the development of hemorrhage (myocardial infarction) develops. Most often, this condition is fixed against the background of atherosclerotic lesions of the coronary vessels, but there can be many reasons for its appearance. It is worthwhile to understand why the most important and frequent condition develops in IHD - atherosclerotic cardiosclerosis.
What kind of disease is cardiosclerosis?
Usually, cardiosclerosis is understood to mean an irreversible process taking place in the thickness of the heart muscle. With it, there is a replacement of normal cardiomyocytes with connective tissue, which significantly worsens heart function.
There are two main forms into which cardiosclerosis is divided - atherosclerotic and post-infarction.
As the name implies, postinfarction cardiosclerosis develops at the site of a former cardiomyocyte necrosis - a heart attack. With it, the replacement of damaged tissues is a physiological process, an attempt by the body to restore the affected organ. Its activation contains complex mechanisms of interaction between myocardial cells, connective tissue and cells of the immune system.
In atherosclerotic cardiosclerosis, the process is usually pathological and proceeds somewhat differently than postinfarction sclerosis. It is based on complex reactions of the accumulation and expenditure of fat molecules.
This disease is also mentioned in the international classification of diseases. If there is atherosclerotic cardiosclerosis, the ICD code, which is diagnosed with I24. By the way. This diagnosis is made to all patients without exception 55 years old. What is characteristic of him?
Atherosclerosis as the basis of heart disease
How does atherosclerotic cardiosclerosis develop? The causes of this pathology are metabolic disorders, primarily associated with fat metabolism.
It all starts with an imbalance of lipoproteins in the body. An important role is played by low density lipoproteins (recognized as the most atherogenic - capable of forming atherosclerotic plaques). Another, no less important factor is the local damage to the vascular endothelium. Normally, the endothelium is covered with special substances that prevent lipoproteins and blood clots from settling on them. Since it is affected, conditions are created for the accumulation of lipoproteins at the site of the violation. As a result, an atherosclerotic plaque develops at the site of the vascular defect. As it grows, a gradual narrowing of the coronary vessel occurs, which creates the conditions for oxygen starvation. As a result of an almost total decrease in the lumen of the vessel, the blood stops passing to the myocardium, and its heart attack develops.
Atherosclerotic change in the walls of the heart
This form of coronary heart disease - atherosclerotic cardiosclerosis - is the main cause of heart failure. As a result of a violation of the supply of myocardium with oxygen and the development of sclerosis of the coronary vessels, the process goes to the heart muscles. Because of this, it becomes total and captures the entire thickness of the organ. The diagnosis of atherosclerotic cardiosclerosis is valid for all persons over 55-60 years of age. Be sure to have an increased amount of lipoproteins. An extremely small percentage of people can avoid the development of this disease, because of which you should be aware of the features of this pathology.
It develops over a long period of time. Violations increase gradually, which is why it is impossible to establish a diagnosis of atherosclerotic lesion without appropriate studies. What are the manifestations of this disease and how do they manifest themselves in different people?
Clinic of the disease
Any clinical signs do not manifest themselves until the whole myocardium, as well as other heart membranes , are involved in the process . Especially important is the narrowing of the lumen of the coronary vessels. The clinic does not appear until the diameter of the cardiac arteries is reduced by at least 70 percent and atherosclerotic cardiosclerosis of the heart develops.
The initial manifestations of the disease are shortness of breath, pain in the heart, periodic rises in blood pressure.
Shortness of breath manifests itself gradually. At first, its development is characteristic of excessive physical exertion, but over time, its appearance may be at rest.
As for heartaches, they are aching in nature and usually appear when the heart is overloaded. This is not to say that they have an angina pectoris (constricting pain that extends into the arms or back). With progression, the pains become constant and do not respond well to vasodilators.
If such a patient comes to you and the clinic and medical history described above are observed, atherosclerotic cardiosclerosis is what a competent specialist should think about
Diagnosis of the disease
In order to reach a verdict and answer the question of what happened to the person and why he makes such complaints, it is necessary to conduct an additional examination of the patient. A diagnosis of atherosclerotic cardiosclerosis can be detected if all of these symptoms and risk factors are present. Additional components of the latter, affecting the development of the process, are the age of patients older than 55 years, the male sex, a sedentary lifestyle, and poor nutrition.
To clarify the diagnosis, some additional studies should be carried out. Among them, a biochemical blood test for cholesterol, an electrocardiogram and coronarography come first.
Changes in the cardiogram characteristic of atherosclerosis of the heart - a decrease in the voltage of the teeth (a decrease in their normal size) when the teeth are quite normal in width and nature.
Coronarography reveals a narrowing of the lumen of the coronary vessels and suggests a lack of oxygen in the myocardium.
Treatment
Given the complexity of the pathogenesis of the disease, it should be understood that therapy should be comprehensive. The balance of non-drug measures, as well as drug and surgical interventions can achieve significant success in the treatment of coronary heart disease.
First of all, a healthy lifestyle should be promoted. As you know, a violation of proper nutrition is the main cause of damage to the heart vessels and heart. In addition, competent physical activity allows you to properly prepare the heart for subsequent stress in the work.
Compliance with these simple rules (good nutrition and physical education) makes it possible to delay the development of coronary disease for some time. The use of medications will eliminate the cause of the disease and restore normal metabolism.
The main thing that you should pay attention to if you need to cure atherosclerotic cardiosclerosis is the pathogenesis of the disease. By acting on its main links, you can achieve significant success in the treatment of the disease.
Drug therapy
Treatment of atherosclerotic cardiosclerosis with medications should only begin if there is a reliable and confirmed presence of heart failure and vascular damage. For this purpose, such groups of drugs as antihypertensive drugs, anti-heart failure drugs, statins, fibrates and metabolites are used.
Antihypertensive therapy includes the use of angiotensin converting enzyme inhibitors (Enalapril, Captopril), diuretics (Indap, Furosemide). Diuretics are also used in the presence of heart failure and are one of those drugs that are prescribed in the first place.
To improve heart function, it is recommended to use metabolic preparations (Mildronate, Cardiomagnyl). They can improve the blood supply to the heart muscle, and also contribute to the launch of regenerative processes.
In addition, with increased heart rate and impaired functioning, it is best to use cardiac glycosides (Digoxin, Strofantin).
The use of statins and fibrates
Statins are the main drugs in the treatment of atherosclerosis. The essence of their action is to reduce the level of atherogenic lipoproteins in blood plasma, their breakdown and excretion, as well as to saturate the blood with antiatherogenic lipoproteins (HDL - high density proteins). Increasing their concentration, the protective properties of the vascular endothelium are improved, its strengthening occurs, which prevents the development of new plaques.
Fibrates have a similar effect, but using them together with statins is strictly prohibited due to the development of side effects.
For treatment, drugs such as Lovastatin, Simvastatin, and Rosuvastatin are used. Of fibrates, clofibrate, bezafibrat, and gemfibrozil were widely used.
These drugs should be used only as prescribed by the doctor and with mandatory monitoring of the state of health, since not all patients tolerate these drugs well.
Surgery
With the ineffectiveness of non-drug methods and prescribed drug therapy, they resort to the use of surgical intervention. The spectrum of operations performed for this pathology is small, and all of them are aimed mainly at the expansion of narrowed coronary vessels and restoration of blood flow. The most widespread are shunting, stenting and balloon angioplasty.
Bypass surgery is usually performed on an open heart and is a rather complicated and dangerous operation.
Stenting is the introduction of a metal structure into the cavity of the vessel, the purpose of which is the mechanical expansion of the narrowed vessels.
Balloon angioplasty formally is the initial stage of stenting, but can sometimes be used independently. It is carried out under the control of x-rays. A balloon catheter is placed in the vessel. Upon reaching the site of narrowing, the balloon inflates, thereby flattening the plaque and expanding the vessel.
Physiotherapy
Physiotherapeutic methods have not been found to be of particular use in the treatment of cardiovascular diseases, however, they can be used to alleviate the condition of patients and to stop the pathological process.
Typically, local electrophoresis is applied to the heart region using drugs. Most often, statins are delivered directly to the heart by current. At the same time, it is possible to create a local concentration of a substance that will act directly on the heart and, with a blood stream, spread through all the vessels.
Sanatorium treatment in the mountains will not interfere with patients. It is there that the transport function of blood is significantly improved, the saturation of the myocardium and other organs with oxygen-enriched blood.
Physical therapy helps to normalize blood pressure, partially reduce, due to exercise, cholesterol and carbohydrate levels and bring yourself and your body into tone.
Atherosclerotic cardiosclerosis - complications
Like all diseases, coronary heart disease has its negative outcomes, or complications.
First of all, disruption of the heart as a result of its defeat atherosclerosis affect the patient's lifestyle. Severe shortness of breath may develop when doing any work.
Often, if atherosclerotic cardiosclerosis develops, complications can occur in the form of a violation of heart contractions and the appearance of rhythm disruptions. Usually there are fibrillation of the ventricles and atria, the development of blockades, weak sinus syndrome. In rare cases, asystole and sudden cardiac death are observed.
If a person has atherosclerotic cardiosclerosis, complications often develop outside the heart. Perhaps a violation of sensitivity on the limbs, especially on the hands and feet, cooling of these parts of the body, the development of atrophy. The vessels of the brain, eyes, and other organ systems can also suffer.
Over time, vascular damage spreads throughout the body. In this case, the treatment is not particularly effective and acts purely symptomatically. With the process running, the only outcome that a person can count on who has atherosclerotic cardiosclerosis is death.
Prevention of atherosclerosis
As you know, any ailment is easier to prevent than to treat. Heart disease is also suitable for this formulation. That is why you should be aware of the main measures and methods to prevent atherosclerotic cardiosclerosis. Complications in this case, if done correctly, may never manifest themselves.
First of all, attention should be paid to the daily routine and diet. You should not eat after six in the evening, and if you’re completely unbearable, it’s better to drink a glass of low-fat milk or kefir.
Be sure to take time and physical education. Heart training will never be superfluous. For her, brisk walking, swimming are perfect.
Do not neglect and preventive examinations. Usually during them one or another problem is revealed, and therefore it is better to devote a couple of days to studying the state of your health than then treat yourself for the rest of your life.
If you have the first symptoms of the disease, it is best to immediately consult a doctor to determine a further plan of action.