Painless myocardial ischemia is a special form of coronary heart disease with detectable symptoms of insufficient blood supply to the heart muscle, which is not manifested by pain. Such a disease is not accompanied by symptoms characteristic of ischemia in the form of shortness of breath, arrhythmia, and pain.
At the same time, objective research methods (we are talking about electrocardiography, Holter monitoring and coronary angiography) can record myocardial changes characteristic of angina pectoris. Despite the absence of symptoms, mute ischemia has poor prognoses, requiring timely therapy in the form of lifestyle correction, drug treatment, and sometimes cardiac surgery. Next, we will talk in detail about a disease such as painless myocardial ischemia, find out what are the factors of its development and symptoms, and in addition, we will understand its diagnosis and treatment.
Description
BBIM in cardiology is one of the variants of ischemia, in which there is objective evidence of myocardial disease, but there are no clinical manifestations. This pathology is observed in patients suffering from various forms of ischemia, and even in individuals without previously diagnosed coronary pathologies. The prevalence of this disease is about five percent among the population.
There is an increased chance of getting painless myocardial ischemia in patients with burdened heredity, the presence of essential hypertension, obesity, physical inactivity, diabetes and bad habits. Signs of BBIM can be detected on an electrocardiogram in every eighth subject who is older than fifty-five. Next, we proceed to consider the causes of the described pathology and find out what are the provoking factors.
Causes
Episodes of painless myocardial ischemia, like typical pain attacks of angina pectoris, can occur under the influence of various factors in the form of physical exertion, stress, cold, smoking, and in addition, high temperature and alcohol consumption in large quantities. In this case, the reasons that underlie the BBIM and arise from the action of the above factors are:
- The presence of coronary stenosis. In most situations, stenosis is caused by atherosclerotic lesions of the arteries of the heart. With a varying severity, this condition is diagnosed among more than half of patients with episodes of painless ischemia. Clinically important, doctors consider a decrease in the lumen of the coronary arteries to seventy percent. In addition to atherosclerosis, stenosis is caused by systemic vasculitis and the tumor process.
- The development of angiospasm of the coronary arteries. This condition occurs due to stress and stress. What are the other causes of painless myocardial ischemia?
- The presence of coronary artery thrombosis. This is often caused by the process of ulceration of atherosclerotic plaques in the vessels, and at the same time, blood clots from other areas of the circulatory system and blood clotting functions fail. A thrombus may overlap the lumen of the vessel in whole or in part. Thus, episodes of ischemia or myocardial infarction may occur.
Risk groups
There are some risk groups, among which the likelihood of an MND is very high. We are talking about people who have had a heart attack, and in addition, about patients who have risks of developing ischemia. Also, those who have hypertension or chronic obstructive pulmonary disease can also suffer from painless myocardial ischemia. This category includes representatives of professions with an extremely high level of stress, we are talking about pilots, air traffic controllers, drivers, surgeons, and so on.
Below we consider the classification of painless myocardial ischemia.
Classification
In order to correctly assess the severity of the patient’s well-being at the time of treatment and to monitor the dynamics of the pathology in cardiology, a classification is used based on anamnesis and, moreover, episodes of ischemia and the clinical picture. According to it, three types of painless type of ischemia are distinguished:
- First type. The development of painless ischemia among patients with proven coronary artery stenosis with coronary angiography. Such patients do not have bouts of angina pectoris, heart rhythm pathology and congestive heart failure.
- With the second type in the patient’s medical history, ischemia without angina pectoris, but with myocardial infarction is recorded.
- Against the background of the third type, silent ischemia occurs in patients with angina pectoris. Every day in such patients there are cases of painless and painful attacks of ischemia.
In practical medical activities, specialists widely use the classification, which includes two types of the disease: the first is marked by BBI, which occurs without obvious symptoms that are characteristic of myocardial ischemia, and the second type is when mute ischemia is combined with painful angina pectoris and other forms of coronary heart disease.
Are there any symptoms of painless myocardial ischemia?
Symptoms
The insidiousness of painless ischemia consists in the complete painlessness of its episodes. There are only two indicators according to which the patient or doctor may suspect the development of pathology: the presence of diagnosed angina pectoris and ischemia in the anamnesis and direct detection of BBIM as part of a preventive study of heart functions with the fixation of a characteristic change on the cardiogram. In seventy percent of cases, one can argue about the existence of painless ischemia among patients who have had a heart attack or have coronary artery disease. Almost all such patients have four painless attacks for each new deterioration in well-being.
How does a heart ache? Symptoms in women and men that form the clinical picture of the disease can occur typically and atypically.
In women with heart diseases, attacks are less acute, pain often gives to the neck, arms, back. Often against the background of this, nausea and vomiting are observed, and much more often than men there is coughing and shortness of breath.
Common signs of cardiac pathologies can be considered:
- shortness of breath, severe fatigue from normal activities;
- nausea, pain in the upper stomach;
- swelling of the lower extremities in the evening;
- frequent urination at night;
- throbbing headache;
- pain in the elbow joints and wrist;
- chest pain.
Now we know how heart hurts. Symptoms in women and men are important to recognize in a timely manner.
Complications
The presence of this pathology in patients is an extremely unfavorable sign, indicating high risks of developing complications with painless myocardial ischemia. In these patients, the frequency of sudden cardiac mortality is three times higher than in people with pain attacks. Myocardial infarction in the presence of this ailment has less pronounced, and at the same time, implicit symptoms, whose intensity is not enough to alert the patient and force him to take all precautions. And for this, you usually need to stop or reduce physical activity, use certain medications and consult a doctor for help. Obvious clinical symptoms occur even when there is an extensive myocardial damage, and the risk of death increases at times.
Diagnostics
In view of the absolute painlessness of the course of the disease in question, the basis for the diagnosis of painless myocardial ischemia are instrumental research methods that can provide objective information about the presence and degree of heart ischemia. The most significant markers of such ischemia are considered to have no clinical manifestations, but changes registered in the work of the heart, recorded by means of equipment. In addition, it is possible to suggest the development of painless ischemia when assessing myocardial blood supply. These and other data are obtained using the following diagnostic methods:
- An electrocardiogram at rest is one of the most common and elementary in the execution of diagnostic methods. This method allows you to obtain information about characteristic changes in the work of the heart. Its disadvantage is the ability to register information only in a state of physical rest, while painless attacks can sometimes occur only during exercise.
- ECG on Holter. This diagnostic technique is more informative than the usual electrocardiogram. This method provides much more complete information, since it is carried out in a natural, and in addition, in a daily environment familiar to the patient. Thanks to this method, the number of episodes of BBIM is revealed, their total duration is determined along with the dependence on emotional and physical activity throughout the day.
- In addition to the Holter ECG, it is advisable to carry out bicycle ergometry. The essence of this method is to register an electrocardiogram and pressure level with a dosed increase in physical activity. Due to the increasing heart rate, myocardial oxygen demand increases. In the presence of painless ischemia in the patient, an increase in blood supply is simply impossible due to pathologies of the coronary vessels, thus, the heart muscle suffers from ischemia, which is recorded by electrocardiography.
- Coronary angiography This method is considered one of the basic diagnostic methods due to the presence of a proven connection between pathology and stenosis of the coronary arteries. The technique allows you to determine the nature along with the degree of narrowing of the cardiac arteries. It is also possible to establish how many vessels are affected and what is the total extent of stenosis. The data from this study significantly affect the choice of patient therapy.
Next, let's talk about what methods of treatment for painless myocardial ischemia exist.
Treatment
Algorithms for the treatment of the described disease correspond to those for other forms of ischemia. The goal of therapy is to eliminate the pathogenetic and etiological foundations of the disease. They begin therapy with the exclusion of all kinds of risk factors, for example, physical inactivity, smoking, an irrational diet with excessive amounts of animal fat, salt, alcohol, and so on. A special role is given to correcting disorders in lipid and carbohydrate metabolism, controlling pressure and maintaining satisfactory glycemia in the presence of diabetes. Drug therapy is aimed at supporting the myocardium, and at the same time at increasing its performance and normalizing the rhythm. As part of the treatment, doctors provide for the use of the following types of drugs:
- Adrenergic blockers have the ability to lower the heart rate, exerting a pronounced antianginal effect and improving exercise tolerance. Thanks to the pronounced antiarrhythmic effect, the prognosis of life improves.
- Calcium antagonists reduce the heart rate by expanding the coronary and peripheral arteries and normalizing the heart rhythm. Due to the ability to inhibit the metabolic processes in cardiomyocytes, their oxygen demand is reduced and tolerance to any loads is increased. The occurrence of episodes of the disease is less effectively prevented compared with adrenergic blockers.
- The use of nitrates reduces resistance within the coronary arteries, which stimulates collateral blood flow. Thanks to nitrates, blood flow is redistributed towards the ischemic areas of the myocardium, whereby the number of active collaterals increases. Also, thanks to such drugs, the lumen of the coronary vessels expands in areas of atherosclerotic lesions and a cardioprotective effect occurs.
- Through the use of nitrate-like vasodilators, stimulation of the release of peripheral arteries is achieved. Due to this, the blood supply to the myocardium is significantly improved, and in addition, the need for myocytes in oxygen is reduced. Such drugs do not eliminate the causes of the painless form of ischemia, but the frequency of its episodes decreases.
- The use of statins. These drugs act on one of the very important links in the pathogenesis, namely, atherosclerotic processes. Thanks to such drugs, the level of lipoproteins with a low density is effectively reduced. Due to this effect, the formation of atherosclerotic plaques in the body, which occur, as a rule, on the walls of coronary arteries, prevents the narrowing of the lumen and impaired perfusion of the heart muscle.
Mild heart failure
The main function of the heart is the supply of oxygen to the body and all kinds of nutrients, and in addition, the withdrawal of their metabolic products. Depending on whether people are resting or working actively, the body needs a different amount of blood. To adequately meet the needs of the human body, the heart rate along with the size of the vascular lumen can vary significantly.
The diagnosis of “mild heart failure” indicates that the heart stopped supplying organs and tissues with oxygen and nutritious ingredients to a sufficient extent. This disease usually has a chronic course, and the patient can live with it for a long time before learning about this diagnosis.
Holter Electrocardiogram
Holter monitoring is a functional study of the cardiovascular system and is named after the founder of Holter. This research technique makes it possible to continuously record cardiac dynamics during ECG using a special portable device. Holter diagnostic technique makes it possible to monitor changes in the work of the heart and monitor blood pressure during the day under the conditions of natural activity of the patient.
Such monitoring is necessary to prevent painless myocardial ischemia. In addition, Holter monitoring is recommended in cases where the electrocardiogram parameters are normal, but the person experiences pain symptoms along with temporary cardiac arrhythmias that occur sporadically and do not always manifest themselves at the doctor’s appointment. The Holter technique helps to detect any cardiac abnormalities during the day, which is simply impossible when diagnosed with other methods. Thus, it is possible to analyze information about heart health during sleep or during periods of patient activity while awake.