Coronary artery disease, symptoms and treatment

Coronary heart disease - a disease which is a breach of myocardial blood flow. It is caused by lack of oxygen, which is carried on the coronary arteries. Prevent its entry manifestations of atherosclerosis: narrowing of the blood vessels and the formation of plaques in them. In addition to hypoxia, ie oxygen deficiency, tissues are deprived of the beneficial nutrients necessary for normal heart function.

Ischemic heart disease - one of the most common diseases that cause sudden death. Among women, it is much rarer than among men. This is due to the presence in the body of the fairer sex a number of hormones that prevent the development of atherosclerosis. With the onset of menopause is a change in hormonal levels, so the possibility of coronary disease increases dramatically.

What it is?

Coronary heart disease - a deficiency of blood supply to the myocardium (heart muscle).

The disease is very dangerous - for example, in acute coronary heart disease immediately leads to myocardial infarction, that causes the death of the middle-aged and elderly people.

Causes and risk factors

The vast majority (97-98%) clinical cases of coronary artery disease caused by atherosclerosis of the coronary arteries of various severity from a slight narrowing of the lumen of the atherosclerotic plaque to complete vascular occlusion. At 75% strength koronarostenoze heart muscle cells react to the lack of oxygen, and patients develop angina.

Other causes of coronary heart disease, serve as a thromboembolism or spasm of the coronary arteries, usually develops on the background of existing atherosclerotic lesions. Cardiospasm aggravates obstruction of the coronary vessels and causes manifestations of coronary heart disease.

Factors contributing to the occurrence of coronary heart disease include:

1. Hyperlipidemia - contributes to the development of atherosclerosis and increase the risk of coronary heart disease is 2-5 times. The most dangerous in terms of risk of CHD are hyperlipidemia types IIa, IIb, III, IV, and a decrease in alpha-lipoprotein.
2. Arterial hypertension - increases the likelihood of developing coronary heart disease is 2-6 times. Patients with systolic blood pressure = 180 mm Hg. Art. and higher coronary heart disease occurs up to 8 times more than in hypotensive patients and people with normal blood pressure levels.
3. Smoking - according to various sources, cigarette smoking increases the incidence of CHD in 1.5-6 times. Mortality from coronary heart disease among men 35-64 years old who smoked 20-30 cigarettes daily, 2 times higher than among non-smokers in the same age category.
4. Physical inactivity and obesity - are physically less active people are at risk of coronary heart disease is 3 times more than a person, leading an active lifestyle. When combined with physical inactivity overweight increases the risk significantly.
5. Diabetes, including latent form, increases the incidence of the risk of coronary heart disease is 2-4 times.

Factors endangering CHD should also include family history, male gender and older age patients. With the combination of a number of predisposing factors, the degree of risk in the development of coronary heart disease increases significantly. Causes and speed the development of ischemia, the duration and severity, the initial state of the cardiovascular system of an individual determine the occurrence of some form of coronary heart disease.

Symptoms of coronary artery disease

The subject disease can occur quite discreetly, so it is advisable to pay attention to even minor changes in the heart. are alarming symptoms:

• periodically occurring feeling of lack of air;
• a feeling of anxiety for no apparent reason;
• general weakness;
• recurring chest pain, which can give (irradiate) in the arm, shoulder, or neck;
• a feeling of tightness in the chest;
• burning or tightness in the chest;
• nausea and vomiting of unknown etiology.

The symptoms of coronary heart disease

CHD is the most extensive heart disease and has many of its forms.

1. Angina. The patient appears pain or discomfort in the chest, in the left side of the chest, feeling of heaviness and pressure in the region of the heart - as if put something heavy on his chest. The old saying, man "angina pectoris." The pain may be different in nature: pressing, compressing, stitching. It can give (radiate) in his left hand under the left shoulder, the jaw, the stomach, and accompanied by the appearance of pronounced weakness, cold sweat, fear of death. Sometimes the pain is not there with a load, and a feeling of lack of air, passing alone. Duration of angina attack normally a few minutes. Since the pain in the heart area often occurs when driving, a person is forced to stop. In this regard, angina figuratively called "disease reviewers windows" - after a few minutes of rest pain usually goes away.
2. Myocardial infarction. Formidable and often disabling form of CHD. Myocardial infarction causes severe, often tearing, pain in the heart or in the sternum, extending to the left shoulder, arm, jaw. Pain lasting longer than 30 minutes, when receiving the nitroglycerin is not fully reversible and not only decreases permanently. There is a sense of lack of air, there may be a cold sweat, severe weakness, decrease in blood pressure, nausea, vomiting, anxiety. Admission nitropreparatov does not help. Portion of the heart muscle deprived of food necrotize, loses its strength, flexibility and ability to contract. A healthy portion of the heart continues to work with a maximum voltage and cutting, can break the lifeless land. No accident that in common parlance is called a myocardial rupture of the heart! Is only in this state, a person to take the slightest physical effort, as it is on the verge of death. Thus, the meaning of the treatment is to break the place and healed the heart has been able to function properly in the future. It is achieved with the help of medication, and with the help of specially selected physical exercises.
3. Sudden cardiac or coronary death - this is the most difficult of all forms of ischemic heart disease. It is characterized by a high mortality rate. Death occurs almost instantaneously, or 6 hours of symptom onset severe pain behind the breastbone, but usually within an hour. The reasons for such cardiac events are different kinds of arrhythmias, complete blockage of the coronary arteries, severe myocardial electric instability. Provoking factor is the use of alcohol. As a rule, patients do not even know if they have coronary artery disease, but have a number of risk factors.
4. Heart failure. Heart failure is manifest inability of the heart to provide adequate blood flow to organs by reducing the contractile activity. The basis of heart failure is a violation of the contractile function of the myocardium both because of his death in myocardial and in violation of rhythm and conduction of the heart. In any case, the heart contracts and inadequate function of its poor. It appears heart failure breathlessness, weakness at loadings and at rest, leg edema, liver enlargement and swelling of the cervical vein. The doctor may hear crackles in the lungs.
5. Cardiac arrhythmias and conduction. Another form of CHD. It has a large number of different species. They are based on a violation of the pulse of the cardiac conduction system. It is manifested feelings of disruption of the heart, a sense of "fading", "gurgling" in the chest. Cardiac arrhythmias and conduction can occur under the influence of endocrine, metabolic disorders, and drug intoxications influences. In some cases, arrhythmias may occur when the structural changes of the cardiac conduction system and myocardial disease.

Diagnostics

The first diagnosis of coronary artery disease is based on the patient's feelings. Most often complain of a burning sensation and pain in the chest, shortness of breath, excessive sweating, edema, is a vivid sign of heart failure. The patient experiences weakness, heart disorders and rhythm. Required for suspected ischemia performing electrocardiography.

Echocardiography - research method to assess the state of the myocardium, to determine the contractile activity of muscles and blood flow. Performed blood tests. Biochemical changes can detect coronary artery disease. Carrying out functional tests involves the physical strain on the body, such as climbing stairs or doing the exercises on the simulator. Thus it is possible to identify heart disease in the early stages.

How to treat coronary artery disease?

First of all, the treatment of coronary heart disease depends on the clinical form. For example, although in angina pectoris and myocardial infarction used some general principles of treatment, yet less treatment strategy, selection of the mode of activity and specific drugs may be dramatically differ. However it is possible to identify some general trends that are important for all forms of ischemic heart disease.

medication

There are several groups of drugs that may be indicated for use with some form of coronary heart disease. In the United States there exists a formula CHD treatment: «A-B-C». It involves use of the triad of drugs, namely, antiplatelet agents, β-blockers and hypocholesterolemic agents.

1. β-blockers. Due to the action on the β-blockers arenoretseptory reduce the heart rate and, consequently, myocardial oxygen consumption. Independent randomized studies confirm the increase in life span when taking beta-blockers, and reduction in the incidence of cardiovascular events, including repeated. Currently, inappropriate use of the drug atenolol, since according to randomized trials it does not improve the prognosis. β-blockers are contraindicated for concomitant pulmonary disease, asthma, COPD. Below are the most popular with β-blockers proved properties improve the prognosis of ischemic heart disease.
2. Antiplatelet agents. Antiplatelet agents inhibit platelet aggregation and red blood cells, reducing their ability to stick together and adhere to the vascular endothelium. Antiplatelet agents facilitate deformation of the erythrocytes during the passage through capillaries, improve blood flow.
3. Fibrates. It refers to a class of drugs that enhance the antiatherogenic fraction lipoproteins - HDL, which increases with a decrease in mortality from coronary heart disease. Used to treat dyslipidemia IIa, IIb, III, IV, V. It differs from a statin that mainly reduce triglycerides and can increase HDL fraction. Statins reduce LDL and preferably okazyvyut no significant effect on VLDL and HDL. Therefore, to maximize treatment of macrovascular complications requires a combination of statins and fibrates.
4. Statins. Holesterinsnizhayuschie drugs are used to reduce the rate of development of existing atherosclerotic lesions and the appearance of new prevention. The positive impact on life expectancy, as these drugs reduce the frequency and severity of cardiovascular events. Target cholesterol levels in patients with coronary artery disease should be lower than in individuals without coronary artery disease, and is equal to 4.5 mmol / l. The target level of LDL in patients with coronary heart disease - 2.5 mmol / l.
5. Nitrates. Drugs in this group are derivatives of glycerol, triglycerides, diglycerides and monoglycerides. [18] The mechanism of action is the influence of the nitro group (NO) on the contractile activity vascular smooth muscle. Nitrates advantageously act on the venous wall, reducing the preload on the myocardium (by vasodilatation and venous blood deposit). A side effect of nitrates is to reduce blood pressure and headaches. Nitrates are not recommended for blood pressure below 100/60 mmHg. Art. Also now it is known that the nitrates reception does not improve the prognosis of patients with coronary artery disease, that is not It leads to increased survival, and is currently used as a drug for relief of anginal symptoms. Intravenous drip administration of nitroglycerin can effectively deal with angina phenomena, mainly due to high blood pressure numbers.
6. Lipid-lowering drugs. The efficacy of combination therapy of patients suffering from ischemic heart disease, with the use of policosanol (20 mg daily) and aspirin (125 mg daily). As a result of therapy was noted sustained reduction in LDL cholesterol, decrease blood pressure, weight normalization.
7. Diuretics. Diuretics are designed to reduce the load on the myocardium by reducing the circulating blood volume due to the accelerated withdrawal of fluid from the body.
8. Anticoagulants. Anticoagulants inhibit the appearance of fibrin strands, they prevent the formation of thrombi, contribute cessation of growth of blood clots that have already arisen, to enhance the impact of endogenous clot-degrading enzymes fibrin.
9. Loop diuretics. Reduce reabsorption of Na +, K +, Cl- in thick ascending part of Henle's loop, thereby reducing the reabsorption (reuptake) of water. Have a sufficiently rapid pronounced effect usually used as formulations emergency (for forced diuresis).
10. Antiarrhythmic drugs. Amiodarone relates to a group III antiarrhythmic drugs has complex antiarrhythmic activity. This drug acts on the Na + and K + channels cardiomyocytes, and blocks α- and β-adrenergic receptors. Thus, amiodarone possesses antianginal and antiarrhythmic action. According to randomized clinical trials the drug increases the life expectancy of patients, regularly receiving. When receiving amiodarone tablet forms clinical effect occurs in approximately 2-3 days. The maximum effect is achieved after 8-12 weeks. This is due to long half-life of the drug (2-3 months). In this connection, the drug used in the prophylaxis of arrhythmia and is not an emergency vehicle.
11. Inhibitors of angiotensin converting enzyme. By acting on the angiotensin converting enzyme (ACE), this group of drugs blocking the formation of angiotensin II of angiotensin I, thus hindering the implementation of angiotensin II effects, i.e. leveling spasm vessels. This ensures maintaining target blood pressure numbers. Drugs in this group have a cardioprotective effect and nephrotoxicity.

Other ways to treat coronary artery disease

Other non-drug treatments:

1. Hirudotherapy. It is a method of treatment based on the use of antiplatelet agents properties leech saliva. This method is an alternative and has not been clinically tested for compliance with the requirements of evidence-based medicine. It is currently used is relatively rare in Russia, is not included in the standards of care for coronary artery disease, it is usually applied on the patient. The potential beneficial effects of this method consist in preventing thrombus formation. It is worth noting that in the treatment of an approved standard, this task is performed using heparin prophylaxis.
2. Stem cell therapy. When administered into the organism of stem cells is calculated that trapped in the body of the patient, the pluripotent stem cells differentiate into cells lacking infarction or vascular adventitia. Stem cells are in fact possess this ability, but they can turn in any other human cells. Despite numerous statements by proponents of this method of therapy, it is still far from practical applications in medicine and There are no clinical studies of the appropriate standards of evidence-based medicine, which would have confirmed the effectiveness of this techniques. WHO says this method as a promising, but not yet recommend it to practical application. In the vast majority of countries, this technique is experimental and is not included in the standards of care to patients with coronary artery disease.
3. The method of shock wave therapy. Exposure to low power shock waves leads to myocardial revascularization. Extracorporeal source of focused acoustic waves can remotely work on the heart, causing a "therapeutic angiogenesis" (sosudoobrazovanie) in the zone of myocardial ischemia. Impact UHT has a double effect - a short-term and long-term. First vessels dilate, and blood flow is improved. But the most important thing then begins - in the affected area there are new vessels that provide longer lasting improvement. Low-intensity shock waves cause shear stress in the vascular wall. It stimulates the release of vascular growth factors, launching the process of the growth of new blood vessels that feed the heart, improve microcirculation and reduce infarction angina phenomena. The results of this treatment is theoretically reduced functional class of angina, increasing exercise tolerance, reducing the frequency of attacks and medicinal needs preparations.
4. Quantum therapy. It represents treatment by laser irradiation. The effectiveness of this method has not been proven, independent clinical studies have been conducted. equipment manufacturers claim that quantum therapy is effective for almost all patients. Manufacturers of drugs report conducted studies proving low efficiency of quantum therapy. In 2008, this method is not included in the standards of care for CHD patients conducted primarily in funds. Argue about the effectiveness of this method without an independent open randomized study impossible.

Meals at IBS

patient menu diagnosed with coronary heart disease should be based on the principle of a balanced diet, balanced eating foods with a low content of cholesterol, fat and salt.

It is important to include the following foods in the menu:

• caviar, but not in large quantities - up to 100 grams per week;
• seafood;
• any vegetable salad with oil;
• lean meats - turkey, veal, rabbit;
• lean varieties of fish - perch, cod, perch;
• dairy products - yogurt, sour cream, cottage cheese, fermented baked milk, low-fat;
• any hard and soft cheeses, but unsalted, non-sharp;
• any fruit, berries and dishes from them;
• egg yolks - no more than 4 units per week;
• quail eggs - no more than 5 units per week;
• any porridge except semolina and rice.

It is necessary to eliminate or significantly reduce the use of:

• meat and fish dishes, including soups and broths;
• buns and pastry products;
• Sahara;
• dishes semolina and rice;
• animal offal (brains, kidneys, etc.);
• acute and salty snacks;
• chocolate;
• cocoa;
• coffee.

Eat with diagnosed coronary heart disease should be fractional - 5-7 times a day, but in small portions. If there is excess weight, then from him it is necessary to get rid of - it is a heavy burden on the kidneys, liver and heart.

Traditional methods of treatment of coronary artery disease

For the treatment of heart healers have made a lot of different recipes:

1. Per liter of honey lemon taken 10 and 5 garlic cloves. Lemon and garlic are crushed and mixed with honey. Composition hold a week in a cool dark place, after insisting take four teaspoons per day.
2. Hawthorn and motherwort (1 tbsp. l.) are placed in a thermos filled with boiling water (250 ml). After a couple of hours agent filtered. How to treat cardiac ischemia? It is necessary to half an hour before breakfast, lunch and dinner drink 2 tbsp. spoon infusion. Desirably further brewing broth from the hips.
3. 500 g of vodka and honey mixed and heated to form a foam. Take a pinch of motherwort, Cudweed, valerian, knotweed, and chamomile. Grass boil, let stand, drain and mix with honey and vodka. Taken in the morning and in the evening, first a teaspoon, a week later - on the table. The course of treatment - a year.
4. Mix a spoonful of grated horseradish and honey. Take one hour before meals and drink water. The course of treatment - 2 months.

Traditional medicines can help, if you follow two principles - the regularity and strict adherence to the recipe.

Surgery

Under certain parameters of coronary heart disease occur indications for coronary artery bypass surgery - operations at which improves blood supply to the myocardium by the compound of the coronary vessels below their place of lesions with external vessels. Most known coronary artery bypass grafting (CABG) where the aorta is connected to the segments of the coronary arteries. For this purpose, as shunts autografts often used (typically greater saphenous vein).

It is also possible to use balloon dilatation of vessels. With this operation, the manipulator is inserted into the coronary artery through a puncture vessels (typically the femoral or radiation), and by a cylinder be filled with contrast medium is performed expansion vessel lumen, the operation is, in fact, coronary bougienage vessels. Currently, "clean" without subsequent balloon angioplasty stent implantation is practically not used, because of the low efficiency in the long term. If not true movement of the medical device, possibly fatal.

Prevention and lifestyle

To prevent the development of the most severe forms of coronary heart disease, you need to stick to just three rules:

1. Leave your bad habits in the past. Smoking and drinking alcohol - this is a blow that will necessarily lead to a deterioration. Even a perfectly healthy person does not receive any good in smoking and alcohol consumption, to say nothing about a sick heart.
2. Move more. Nobody says that you need to set Olympic records, but to give up the car, public transport and the elevator in favor of walking necessary. You can not just load your body kilometers traveled road - let it be within reason. To physical activity does not cause deterioration of the served (and this happens when ischemia!), be sure to consult a physician about the validity of the classes.
3. Take care of your nerves. Try to avoid stressful situations and learn to calmly respond to the trouble, do not give in to emotional outbursts. Yes, it's hard, but it was such a tactic can save lives. Talk to your doctor about the use of sedative drugs or decoctions of medicinal plants with a calming effect.

Coronary heart disease - not only the recurring pain, prolonged violation of the coronary circulation leads to irreversible changes in the myocardium, and the internal organs and sometimes even death. Treatment long illness, sometimes requires lifelong medication. Therefore, heart disease is easier to prevent entering into their lives some limitations and optimizing lifestyle.