GENERAL
Underestimate the coronary heart disease is not necessary, since it is the leading cause of death in men under 35 years of age and in both sexes after the age of 45 years. The incidence of coronary heart disease is constantly increasing, in spite of the ongoing efforts for the prevention and treatment of this pathological condition, which demonstrates the shortcomings of modern medicine. Current data show a significant effect of disease on the life expectancy of patients with coronary heart disease - it is reduced by an average of 16 years compared with life expectancy peers.
Angina may debut as a myocardial infarction or other acute circulatory disorders, but more often it just takes a chronic form.
CAUSES
The main cause of coronary heart disease considered atherosclerosis. It is the deposition of cholesterol and certain lipoprotein fractions form the so-called plaques, preventing the normal coronary blood flow. They are found in almost 97% of patients.
Estimated pathogenesis of the disease more fully described in the Ross Harlera hypothesis and at the end of the last century. It is called "response to injury".
The pathogenesis of coronary heart disease:
- Under the effect of various factors is damage to endothelial cells - the inner vessel shell. In these areas due to the vigorous activity of platelets formed microthrombuses.
- Platelet-secreted biologically active substances act on the smooth muscle fiber within the vessel wall, which leads to their proliferation and expansion. Muscular frame created for accumulation thereon lipids.
- Repeated damaged endothelial layer of cells contribute to slow blood thickening inner shell vessel and trophic disorders of the heart tissue, which in turn, provokes the development of the pathological process capillaries.
The specialists of the European Society of Cardiology were identified risk factors that trigger the development of atherosclerosis. A combination of several of them greatly increases the likelihood of disease.
Risk factors:
- especially food (food with a high cholesterol);
- smoking;
- consumption of alcoholic beverages;
- passive lifestyle;
- a change in lipid profile with increasing concentrations of low-density molecules;
- improving glucose tolerance;
- overweight;
- factors that contribute to thrombosis;
- the presence of the disease in close relatives;
- elderly age.
The narrowed coronary vessels can not fully provide the myocardium with oxygen and nutrients. This is especially noticeable during physical activity, when metabolic needs increase significantly cardiomyocytes, manifested the characteristic clinical symptoms.
CLASSIFICATION
Uniform classification of coronary heart disease has not yet been developed. This is due to the fact that the constantly changing and updated data on the mechanisms of failure of the coronary arteries. As some scholars have pointed out the lack of clear distinction between the different forms of the disease, which prevents the release of them in separate disease entities.
Among domestic cardiologists greatest recognition of the classification in 1984, developed by an expert Commission of the World Health Organization, according to which the heart ischemic disease are separated by length disease.
Acute process:
- myocardial infarction;
- sudden cardiac death.
Chronic process:
- angina (four classes);
- myocardial infarction;
- abnormal heart rhythm;
- heart failure.
Acute pathology examined in the relevant sections. This article will focus in more detail on the chronic process, namely, the most common form - angina.
SYMPTOMS
Angina - state short-term violation of the coronary circulation, in which the patient has a characteristic clinical picture with a dominating pain syndrome.
Characteristics of pain:
- associated with physical or emotional stress;
- accompanied by a feeling of anxiety or anxiety;
- It has a clear localization of the sternum;
- It may radiate to the left side of the body;
- passes after the reception of nitroglycerin;
- time does not exceed a quarter of an hour;
- the intensity of the pain often high, paroxysmal character.
Depending on the amount of exercise, which provoked the occurrence of pain, IBS divided into four class, where the first - the most easy, does not affect the patient's quality of life, and may occur when the pain even in the fourth alone.
DIAGNOSTICS
Examination of the patient always begin with a careful anamnesis data collection followed by the application of physical, instrumental and laboratory methods for diagnosis.
Anamnesis
Often questioning possible to find out the possible risk factors for atherosclerosis, which allows suspected coronary vessels. In favor of angina indicates the gradual development of pain with shortening of remission periods. With the progression of disease in a patient is reduced exercise tolerance that seen the emergence of discomfort behind the breastbone in the performance of all kinds of lighter activity.
examination of the patient
Coronary heart disease has no specific symptoms, seen during a patient examination. Allow to suspect disease symptoms disorders of lipid metabolism, which include:
- cutaneous xanthoma - Lots of cells on the lower eyelids, dyed cholesterol;
- xanthelasma - the accumulation of cholesterol in the skin layers over the joint;
- corneal clouding of the eye.
Auscultation
Auscultation of the heart can identify emphasis heart tones of the aorta, the appearance of additional heart sounds. Auscultation of large vessels to determine the rough systolic murmur over them.
Laboratory research:
- lipid examinee showing an increase in the concentration of low density lipoproteins and decrease in high density fractions;
- may increase the level of glucose in the blood or urine;
- in the overall analysis of blood platelet count increased, neutrophil white blood cells.
electrocardiography
This method is the gold standard for the diagnosis of patients with coronary heart disease. Electrocardiography is performed both at rest and during exercise stress dosage.
Major changes:
- reducing or-segment elevation ST, which indicates the pathological changes in the ventricular myocardium;
- pathological appearance of teeth, which may be an indication of myocardial infarction.
The silent period, the patient may be completely absent electrocardiographic signs of the disease, so research should be carried out during an attack of pain.
To evaluate the risks and disease prognosis perform the registration of electrical activity of the heart at dosage exertion. This method is considered to be highly specific and highly sensitive. In the technique using a special exercise bike or treadmill stair certain height.
ECG monitoring
An important method for registering changes in the electrical activity of the heart during the day. Daily monitoring reveals evidence of myocardial ischemia provoked by psycho congestion.
Doppler
- Features of blood flow in coronary vessels;
- zone of local ischemia in the myocardium;
- early signs of heart failure.
coronary Angiography
When ambiguity results from the above methods, perform coronary angiography. This technique applies to invasive, so there may be complications. Their frequency is 0.1-0.2%, which testifies to the relative safety of the procedure.
TREATMENT
In the treatment of coronary artery disease adhere to these principles:
- elimination of symptoms of the disease;
- the prevention of heart attack and sudden death.
Treatment of the disease should be comprehensive and include several directions. The main treatment medical pathology, in some cases, perhaps even surgery. In addition, it is necessary to eliminate the risk factors and to review the way of life.
The elimination of risk factors:
- Treatment of chronic diseases (diabetes, arterial hypertension).
- Weight loss.
- Refusal of bad habits (alcohol, alcoholic beverages, fatty foods).
- Control lipidemicheskogo profile and lowering cholesterol.
- Adequate hormone replacement therapy during menopause.
- Elimination of psycho-emotional overload.
Drug therapy:
- In order to prevent the progression of myocardial ischemia pathogenetically justified it is to conduct gipolipedimicheskoy therapy. Used drugs that reduce cholesterol in blood fractions, namely low-density lipoproteins.
- To eliminate the symptoms of the disease using several groups of drugs - calcium channel blockers, beta-blockers, nitrates. These drugs reduce the need of the heart muscle of oxygen and enhance myocardial vessels.
- Drugs that improve myocardial metabolism, are assigned to the support and the rapid restoration of the myocardium.
- Antiplatelet therapy is used for the prevention of thrombosis of atherosclerotic changes of vessels.
Surgery
In severe forms of coronary disease, as well as extensive myocardial damage blood vessels, recommended surgery. Apply operations with different access and progress of. In moderately severe ischemic lesions and blood vessels that feed the heart muscle, the deposition of atherosclerotic plaques, and narrowing lumen, conduct surgery with minimal operational access - mounted stents and balloon carried plastic.
In severe situations, carry out more complex operations - coronary artery bypass grafting. The goal of surgery - to create additional connections between healthy blood vessels for nourishment and blood supply of the heart muscle.
Spa treatment and physical therapy
For the rehabilitation of patients with severe ischemia, especially after suffering a surgery requires a gradual myocardial load through physical therapy exercises. Specialist will select the necessary complex given the state of the patient. The first exercises are performed under medical supervision, with a gradual increase in load as the adaptation of the organism. For a quick recovery of patients with severe ischemia is a water aerobics in the pool.
Patients with coronary heart disease is recommended spa treatment in specialized health centers. A change of scenery, tranquility and a wide range of wellness treatments contribute to a speedy recovery.
COMPLICATIONS
Coronary heart disease at untimely and incorrect treatment is almost always complicated by severe pathologies, in some cases leading to death of the patient.
The most dangerous complication of coronary heart disease are:
- acute impairment of blood flow in the coronary arteries;
- development failure of the left myocardial departments;
- cerebrovascular accident;
- sudden death;
- occurrence of abnormal heart rhythm.
PREVENTION
For the prevention of coronary heart disease by the World Health Organization experts general recommendations developed:
- sufficient physical activity, which should include walking, swimming, special cardio;
- weight management through diet;
- rejection of bad habits;
- Annual pass routine inspections;
- systematic control of blood pressure, cholesterol, glucose;
- minimization of psycho-emotional stress;
- the normalization process of the labor and leisure.
FORECAST FOR RECOVERY
Coronary heart disease refers to the ever-progressive disease, even against the background of the therapy, the prognosis - conventionally unfavorable.
State, weighting forecast:
- diabetes;
- obesity;
- hypertonic disease.
Found a bug? Select it and press Ctrl + Enter
