Scientific editor: OA Strokina practicing therapist, doctor of functional diagnostics. Work experience since 2015.
August, 2018.
Coronary heart disease (CHD) - a disease caused by the mismatch between the demand of the heart muscle of oxygen and its delivery, leading to cardiac dysfunction. In Russia and many European countries, this disease is a major cause of premature mortality, and each year this figure is growing.
Risk factors
- male gender (in young and middle aged men suffer from coronary heart disease more frequently with age, the incidence becomes the same)
- age over 65 years, although currently CHD "younger"
- smoking
- alcohol abuse
- lack of exercise (low physical activity)
- heredity
- dyslipidemia - disturbance of blood lipid composition, in which the increased content "Bad" cholesterol - low density lipoprotein (LDL) and decreases the content of high density lipoprotein (HDL)
- diabetes
- arterial hypertension
- increased heart rate
- disturbances in the blood clotting system, such as elevated blood clots
- overweight (the most dangerous is the abdominal type of obesity, it may be indicative of the waist circumference> 88 cm in women and> 102 cm in men).
- severe or prolonged stress
- the use of combination oral contraceptives
Causes
- atherosclerosis coronary artery (up to 95% of cases)
- spasm unchanged coronary arteries (rare)
Types of coronary heart disease
- Sudden cardiac death (primary cardiac arrest)
-
angina
- angina
- Spontaneous angina rest
- Silent myocardial ischemia
- The cardiac syndrome X
- myocardial infarction
- myocardial infarction
- Cardiac arrhythmias
- Heart failure
Angina in ischemic heart disease and its symptoms
It is to elaborate on angina since is the most common manifestation of coronary heart disease.
Angina is manifested by the following symptoms:
- pain behind the sternum crushing or compressive nature,
- Pain may radiate to the left arm, shoulder, jaw,
- docked alone or nitroglycerine.
This clinic can occur in response to the following factors:
- often occurs after physical exertion,
- with an increase in blood pressure,
- cold,
- after a heavy meal,
- with strong emotional stress.
attack duration, usually a few minutes.
- With stable angina pressing pain occurs when some physical load (e.g., the patient goes to 200 m).
- Progressive angina diagnosed if the stress tolerance decreases with time (i.e., the patient can tolerate without attack smaller and smaller load). Progressive and new-onset angina are unstable and require immediate intervention of a physician, and sometimes hospitalization.
- At rest angina attacks often occur at night, in the early morning hours, may be accompanied by fear of death, feeling short of breath.
Diagnostics
For the diagnosis of coronary heart disease in the first place important patient complaints as coronary heart disease - is primarily a clinical diagnosis. To confirm it used laboratory and instrumental methods of research.
laboratory:
- complete blood count (leukocytosis possible; decrease in hemoglobin during non-vascular causes of pain)
- biochemical analysis of blood (increased cholesterol and LDL cholesterol, low HDL cholesterol, increasing performance glucose).
instrumental methods
invasive
- coronary angiography (X-rays of blood vessels using a contrast agent, is often combined with surgical treatment for coronary artery disease - stenting)
- intravascular ultrasound (imaging of atherosclerotic plaques in the coronary vessels, is rarely used because of the low accessibility of the art)
- transesophageal electrostimulation (for diagnosis of latent coronary insufficiency in the inability to use non-invasive examination methods).
These procedures are carried out only in a hospital.
noninvasive
- ECG (ischemic changes)
- daily monitoring ECG Holter
- ECG exercise (treadmill or bicycle ergometry test on a treadmill)
- Echocardiogram (echocardiography) alone
- Echocardiography with pharmacological or physical activity
- Radionuclide methods (substance is distributed in the myocardial tissue and clearly visualize areas with insufficient blood supply)
- MRI heart (with visualization problems using echocardiogram).
check with Federal standard primary care CHD during 2011.
differential diagnosis
CHD diagnosis is quite easy to put in a typical course of the disease, since it has the characteristic symptoms. However, it should be noted that many other diseases can replicate symptoms of myocardial ischemia. Difdiagnostiki requires a long list of diseases of the gastrointestinal tract, broncho-pulmonary, cardiovascular, nervous and musculoskeletal systems. In addition, the symptoms may be similar, and in a number of mental illnesses. In all this, unable to understand a specialist.
Treatment of coronary heart disease
The main principle of treatment of coronary heart disease - the restoration of blood flow to the damaged areas of the myocardium and prevention of complications.
We can distinguish two main directions in the treatment of coronary artery disease:
1. Relief of angina:
- you need to stop physical activity,
- provide fresh air,
- take nitroglycerin under the tongue, or the use of nitrate in the form of a spray.
2. Basic therapy.
non-pharmacological means
To give up smoking
Dieting.
- reduction in the consumption of animal fats up to 30% of the total energy value of food,
- reduction in consumption of saturated fat to 30% of the total fat,
- cholesterol consumption to 300 mg / day
- increased consumption of fresh fruits, plant foods, cereals,
- limit the total number of calorie intake in overweight,
- reducing the consumption of alcohol and salt at elevated blood pressure.
Increased physical activity.
Recommendations for physical activity should be given a strictly individual basis, depending on the diagnosis. The following exercise:
- fast walk,
- jogging,
- swimming,
- cycling and skiing,
- tennis,
- volleyball,
- dance with aerobic exercise.
The frequency of the heart rate should be no more than 60-70% of the maximum for a given age.
The duration of exercise should be 30-40 minutes:
- 5-10 min workout
- 20-30 min aerobic phase,
- 5-10 min final phase.
Regularity 4-5 p / week (at longer sessions - 2.3 p / week).
When a body mass index greater than 25 kg / m2 is necessary to decrease the body weight through diet and regular exercise. This leads to lower blood pressure, reduce the concentration of cholesterol in the blood.
drug therapy
When high blood pressure is prescribed antihypertensive therapy with no effect on non-drug treatment (see. hypertension). The optimum blood pressure less than 140/90 mm Hg
Treatment of diabetes It is the right choice of antidiabetic therapy and careful monitoring of indicators of blood glucose.
Treatment atherosclerosis - a required component in the treatment of coronary artery disease. The most common for this purpose statins:
- rosuvastatin,
- atorvastatin,
- simvastatin.
While receiving these drugs need to control lipid and liver counts (ALT, AST, CPK, LDH) 1 time in 3 months.
Less commonly used fibrates, such as fenofibrate.
Antiplatelet therapy:
- acetylsalicylic acid (better to use than the usual aspirin and more modern drugs such as Cardiomagnyl or Thrombotic-Ass since they are less aggressive effect on the gastric mucosa)
- in some cases shown clopidogrel.
Beta blockers reduce myocardial oxygen demand. Currently preferred is the use of selective drugs:
- bisoprolol,
- metoprolol,
- nebivolol,
- carvedilol.
Calcium antagonists:
- amlodipine,
- nitrendipine and others.
Long-acting nitrates (it should be noted that when receiving this group of drugs is a frequent complication of headache, perhaps also a pronounced decrease in blood pressure).
- isosorbide dinitrate,
- isosorbide mononitrate.
Other anti-ischemic drugs:
- trimetazidine,
- ranolazine,
- ivabradine.
Surgery
A role now played by the surgical treatment of coronary heart disease. For this purpose methods revascularization (reperfusion) infarction. These include:
- CABG - complicated surgery on the heart vessels to bypass the constriction via vascular prostheses.
- percutaneous intervention - stenting (lumen recovery vessel by posing a stent within a vessel or carcass).
sources:
- Coronary heart disease and atherosclerotic lesions of the carotid arteries. - National Clinical Guidelines, 2016
- Stable coronary artery disease. - National Clinical Guidelines, 2016.
- Acute coronary syndromes without ST-segment elevation in the electrocardiogram adults. - National Clinical Guidelines, 2016.
