What is it - myocardial ischemia, not everyone knows. This term is used to indicate a condition in which an organ or part of an organ receives insufficient oxygen. As a result, oxygen starvation occurs.
Ischemia can occur for a variety of reasons, it can be a symptom of very serious diseases, in particular, such as a heart attack. With a prolonged course, it becomes chronic and requires serious treatment.
Disease feature
Despite the fact that the heart muscle constantly has contact with the blood, it does not receive oxygen and nutrients from it. This can be provoked by the fact that the inside of the heart is covered with the endocardium, that is, the inner membrane that prevents the absorption of blood in the heart.
Myocardium works around the clock, and the demand for energy raw materials and it is quite high. Ensure the delivery of nutrients and oxygen to the heart muscle coronary arteries, enveloping the organ from all sides. Their value is very large, since the health of the whole organism depends on the normal functioning of the heart. Therefore, during the course of the disease, the functioning of internal organs can be disrupted.
Many are interested in what it is - myocardial ischemia, for what reasons the disease occurs, what signs it has. This is a condition in which there is a strong oxygen starvation of the heart muscle. It occurs for a number of different reasons and can lead to serious complications over time.
Quite often there is painless myocardial ischemia (ICD-10 - I25.6), which is almost asymptomatic, but can cause serious complications. There is a direct correlation between the incidence rate and the patient's age. The maximum level is observed in people after 50 years.
In women, a painless form of ischemia is mainly observed, at the same time as acute ischemia is more characteristic of the male part of the population. For women, the main factor in the increased risk of the disease is the onset of a menopause, during which there is an increase in cholesterol and a tendency to increase pressure.
Types of Ischemia
It is important not only to know what myocardial ischemia is, but also what types of diseases can occur. These include such as:
- painless;
- acute coronary death;
- angina pectoris;
- cardiosclerosis;
- myocardial infarction.
A painless form is a type of ischemic heart disease that has characteristic manifestations in an instrumental or laboratory examination of the heart. A distinctive feature is the absence of pain or other signs of ischemia. Also, this type is found in patients with impaired pain sensitivity or in those who have previously had a heart attack.
Acute coronary death is myocardial ischemia, which leads to cardiac arrest and patient death. There is a similar violation with the blockage of the arteries. Angina pectoris is a recurrent myocardial ischemia, the attack of which is accompanied by very sharp pain behind the sternum, a sensation of heat, shortness of breath and increased heart rate.
Myocardial infarction - acute ischemia, which leads to the death of part of the heart muscle and impaired functioning. Cardiosclerosis is a complicated form of the disease when, as a result of oxygen starvation, part of the heart muscle is replaced by connective tissue, which cannot normally perform its functions.
Painless ischemia
What is myocardial ischemia? The symptoms and treatment of this disease is very important for those who are diagnosed with this disease. Quite often there is a painless form of the disease. An accurate diagnosis can only be made with additional instrumental techniques.
For painless myocardial ischemia, the same development mechanisms are inherent as in other clinical forms, only with the difference that they are episodic in nature and are not accompanied by the development of a characteristic clinical picture.
A painless form of myocardial ischemia can be equally common in people with a previously unknown diagnosis, and in patients who have long been suffering from other clinical forms of pathology, such as angina pectoris.
The occurrence of painless ischemia is facilitated by a decrease in the general pain threshold for various kinds of stimuli. The pathogenetic basis is mainly the oxygen demand of the heart muscle.
A comprehensive examination using instrumental techniques is required to make a diagnosis.
Causes of occurrence
Among the main causes of myocardial ischemia, it is necessary to distinguish such as:
- atherosclerosis;
- lack of potassium;
- coronary artery spasm;
- clogged arteries;
- excess weight;
- endocrine system diseases;
- sedentary lifestyle.
Each of the arteries nourishes a certain part of the heart muscle, therefore, when one of the vessels is blocked, they remain without power. With hypokalemia, much more fluid and sodium becomes, which leads to tissue edema. The edematous cell is not able to fully absorb nutrients and function normally.
Main symptoms
Signs of myocardial ischemia in each case can manifest themselves in completely different ways. However, there are a number of symptoms that are characteristic of almost all forms of coronary heart disease. Among the external signs, it is necessary to distinguish such as:
- the occurrence of burning, paroxysmal pain behind the sternum;
- feeling of great weakness;
- periodic nausea may occur;
- patients complain of shortness of breath or shortness of breath at rest.
The primary symptoms of myocardial ischemia can be distant when discomfort occurs, and then disappears on its own. It makes a person think that it’s just a malaise or fatigue.
In addition, with some types of myocardial ischemia, there are absolutely no signs. In this case, the pathology is detected only when conducting echocardiography or ECG.
Diagnostics
It is very important to timely diagnose myocardial ischemia and treatment to prevent the development of complications. In some cases, it so happens that the external signs of pathology are completely absent. Diagnosis implies:
- examination of the patient;
- history collection and analysis;
- conducting instrumental and laboratory studies.
The most effective are the instrumental examination methods, in particular, such as:
- electrocardiography;
- coronarography;
- echocardiography;
- tomography;
- ultrasound diagnostics;
- arterial dopplerography;
- angiography;
- intraesophageal electrocardiography;
- Holter monitoring.
In addition, laboratory diagnosis is very important for the detection of the disease, since ischemia is characterized by a change in such indicators as:
- troponins;
- creatine phosphokinase;
- myoglobin;
- aminotransferase.
In this case, the ECG is considered the most common method for detecting such pathologies. It is an indirect study that makes it possible to identify changes in the functioning of the myocardium. All diagnostic methods used allow us to assess the nature of the pathology and choose the required therapy.
Treatment features
Therapy is prescribed according to the results of diagnosis. All patients with signs of insufficient blood supply should abandon bad habits, normalize their diet, and minimize stress.
To stabilize the cardiovascular system and coronary circulation, patients are prescribed such groups of drugs as:
- ACE inhibitors;
- antiplatelet agents;
- statins
- beta blockers;
- diuretics;
- antiarrhythmic drugs;
- organic nitrates.
The choice of drug and its dosage is determined separately for each patient. In this case, the diagnosis of pathology and the presence of contraindications of the selected medication are of great importance. In some cases, episodes of myocardial ischemia are very rare and are almost asymptomatic, so the disease can be detected already in advanced stages.
Normalization of blood circulation in this case cannot be achieved by using only conservative therapy. With a similar course of the disease, the patient is recommended to undergo cardiosurgical correction of changes occurring in the coronary vessels. This may require radical and endovascular surgery. The choice of cardiac correction technique is determined strictly individually, depending on each specific case.
If it is possible to restore normal blood circulation in the area of ischemia, such minimally invasive intervention as angioplasty with stenting can be performed. With massive lesions, larger operations are performed.
Medications
In acute and chronic myocardial ischemia, medication is required. The choice of certain means is determined for each patient separately, depending on the diagnostic study.
Basically, doctors prescribe antiplatelet agents, in particular, such as Cardiomagnyl, Aspirin Cardio, and Thrombo Ass. They normalize the blood circulation process, and also reduce the load on the myocardium.
Beta-blockers such as Nebivolol, Carvedilol and Bisoprolol will help reduce heart rate and myocardial oxygen demand. Statins and fibrates lower cholesterol, prevent the progression of atherosclerosis. Such drugs include Lovastatin and Fenofibrate.
ACE inhibitors such as Captopril and Enap normalize blood pressure and also eliminate arterial spasms. Diuretics are required to eliminate excess fluid, which creates an additional burden on the heart. Such drugs include Lasix, Indapamide.
Antiarrhythmic drugs are required to detect heart rhythm disturbances. Very often, doctors prescribe Amiadron and Cordaron. Organic nitrates, in particular, such as Isoket and Nitroglycerin, are used for pain in the heart. With ischemia and myocardial infarction, the doctor may additionally prescribe other medications.
Operation
Treatment of myocardial ischemia in advanced stages is carried out with the help of surgery, since simply taking medications is no longer enough. Cardiac surgery may be required to restore vascular changes.
Depending on the nature of the lesion of the coronary vessels, surgery can be performed using endovascular intervention or radical intervention to eliminate the pathology. With minor damage to the coronary vessels, balloon angioplasty can be performed with the subsequent installation of a metal stent. A similar technique consists in introducing into the lumen of the affected vessel a balloon made of polymeric material. Under the control of the x-ray, it is inflated in the required place, in the area of narrowing of the vessels, a special cylindrical metal frame is installed, which will support the vessel in the expanded state. As a result, myocardial ischemia is eliminated in the affected area.
With a more extensive lesion of the coronary arteries, minimally invasive intervention cannot be effective. In this case, a more radical operation is performed to eliminate circulatory failure, namely, coronary artery bypass grafting.
Intervention can be performed on an open heart or using a minimally invasive technique. The essence of such an intervention is to create a shunt from transplanted vessels, ensuring the normal flow of blood to a particular site of the myocardium. As a result of this, coronary circulation becomes complete, and the risk of myocardium or sudden death is significantly reduced.
Possible complications
If acute myocardial ischemia has not been diagnosed in a timely manner, then the disease can lead to the onset of sudden coronary death. In addition, it is worth noting that this may be the main cause of myocardial infarction.
With an asymptomatic course of ischemia, the patient can for a long time really assess the severity of his condition and take the necessary measures. Obvious manifestations of myocardial necrosis in such patients are usually noticed even when there is an extensive damage to the heart muscle, and the risk of death increases significantly.
Forecast
The prognosis for ischemia is always unfavorable. In the absence of timely treatment, this pathology can lead to disability of the patient and result in the onset of sudden death. According to statistics, painless ischemia increases the risk of heart failure and arrhythmia by 2 times, and the likelihood of sudden death can increase by 5 times.
That is why the solution to this problem remains relevant for modern cardiology, timely detection of such circulatory disorders and their prevention is of great importance. Myocardial ischemia can lead to the development of severe arrhythmia, angina pectoris, heart failure, myocardial infarction. To prevent the occurrence of such complications, it is necessary to undergo preventive examinations and strictly follow all the recommendations of the treating doctor.
Prophylaxis
It is important not only to know what it is - myocardial ischemia, and how treatment is carried out, but also how to prevent the occurrence of the disease. The main preventive measures include such as:
- refusal of bad habits that lead to narrowing of blood vessels;
- dietary cholesterol restriction;
- treatment of concomitant diseases (diabetes, hypertension, obesity);
- adequate physical activity;
- restoration of mineral balance;
- blood thinning for the prevention of thrombosis.
The amount of physical exertion must be selected taking into account the weight of the patient and blood pressure indicators. Sometimes sports are strictly contraindicated for people with obesity.