Ischemic heart disease

Cardiovascular disease is the leading cause of death and disability worldwide. According to the researchers, in the Russian Federation the mortality from cardiovascular diseases is 8 times higher than in France, and makes up about 58% of the total mortality structure. More than 1.2 million people die of cardiovascular diseases each year in our country, while in Europe there are just over 300,000. The leading role in the structure of cardiovascular mortality belongs to of ischemic heart disease ( IBS ) - 35%.If this continues, then the population of Russia by 2030 will be approximately 85 million. These are frightening figures. But the situation can be changed and needed if everyone of us knows about it."You know - armed" - said the ancients.

Structure and function of the heart, coronary arteries

To understand the history of coronary artery disease, let's first look at what affects CHD - our heart.

The heart is a hollow muscular organ consisting of four chambers: 2 atria and 2 ventricles. In size, it is equal to a clenched fist and is located in the chest immediately behind the sternum. The heart mass is approximately 1/175 -1/200 of the body weight and is from 200 to 400 grams.

instagram viewer

Conditionally it is possible to divide the heart into two halves: the left and the right. In the left half( this is the left auricle and the left ventricle) arterial blood flows rich in oxygen, from the lungs to all organs and tissues of the body. Myocardium, i.e.muscle of the heart, the left ventricle is very powerful and able to withstand high loads. Between the left atrium and the left ventricle is a mitral valve consisting of 2 valves. The left ventricle opens into the aorta through the aortic valve( it has 3 valves).At the base of the aortic valve, from the aortic side, are the mouths of the coronary or coronary arteries of the heart.

The right half, which also consists of the atrium and the ventricle, pumps venous blood, poor in oxygen and rich in carbon dioxide from all organs and tissues of the body to the lungs. Between the right atrium and the ventricle is the tricuspid;tricuspid valve, and the ventricle from the pulmonary artery separates the eponymous valve, the valve of the pulmonary artery.

The heart is in the heart bag, performing a cushioning function. In the heart bag is a liquid that lubricates the heart and prevents friction. Its volume can reach a normal 50 ml.

The heart works on one and only law "All or Nothing".His work is done cyclically. Before the contraction begins, the heart is in a relaxed state and passively filled with blood. Then, the atria contract and the additional portion of blood is sent to the ventricles. After this, the atria relax.

Then comes the systole phase, i.e.contractions of the ventricles and blood is discharged into the aorta to the organs and into the pulmonary artery to the lungs. After a powerful contraction, the ventricles relax and the diastole phase begins.

The heart is shortened due to one unique property. It is called automatism, i.e.it is the ability to independently create nerve impulses and under their influence to contract. There is no such feature in any organ. Generates these impulses a special area of the heart, located in the right atrium, the so-called pacemaker. From it, impulses follow a complex conducting system to the myocardium.

As we said above, the heart is supplied with blood from the coronary arteries, left and right, which fill with blood only in the diastole phase. Coronary arteries play a crucial role in the vital activity of the heart muscle. The blood flowing through them, brings oxygen and nutrients to all cells of the heart. When the coronary arteries are passable the heart works adequately and does not get tired. If the arteries are affected by atherosclerosis and because of this narrow, the myocardium can not work at full capacity, it lacks oxygen, and because of this biochemical, and then tissue changes begin, the is developing .

How do coronary arteries look?

Coronary arteries consist of three membranes, with different structures( Figure).

Two large coronary arteries from the aorta - right and left. The left main coronary artery has two large branches:

Anterior descending artery, which delivers blood to the anterior and anterior-lateral wall of the left ventricle( Figure) and to the greater part of the wall dividing the ventricular septum from inside the ventricle - not shown in the figure);
The envelope artery that passes between the left atrium and the ventricle and delivers blood to the side wall of the left ventricle. More rarely, the envelope artery supplies the upper and the back of the left ventricle with blood.

The right coronary artery delivers blood to the right ventricle, to the lower and posterior wall of the left ventricle.

What is collaterals?

The main coronary arteries branch into smaller blood vessels that form a network throughout the myocardium. These small blood vessels are called collaterals. If the heart is healthy, the role of the collateral arteries in supplying the myocardium with blood is not significant. When the coronary blood flow is disturbed, caused by an obstruction in the lumen of the coronary artery, collaterals help to increase the flow of blood to the myocardium. It is thanks to these small "spare" vessels that the size of myocardial damage with the cessation of coronary blood flow in some major coronary artery is smaller than it could be.

Ischemic heart disease - is a myocardial lesion caused by a violation of the blood flow in the coronary arteries. That is why medical practice often uses the term coronary heart disease.

What are the symptoms of ischemic heart disease?

Usually in people with coronary artery disease, symptoms appear after 50 years. They occur only with physical activity. Typical manifestations of the disease are:

pain in the middle of the chest( angina);
a sense of lack of air and a shortness of breath;
cardiac arrest due to too frequent contractions of the heart( 300 or more per minute).This is often the first and last manifestation of the disease.

Some patients with ischemic heart disease do not experience any pain or feeling of lack of air even during myocardial infarction.

To find out the probability of myocardial infarction in the next 10 years, use the special tool: "Know your risk"

How do you know if you have coronary heart disease?

Get help from a cardiologist. The doctor will ask you questions that will help to identify the symptoms and risk factors of the disease. The more human risk factors, the more likely the presence of the disease. The effect of most of the risk factors can be reduced, thus preventing the development of the disease and the occurrence of its complications. These risk factors include smoking, high cholesterol and blood pressure, diabetes mellitus.

In addition, the doctor will examine you and prescribe special methods of examination that will help confirm or deny the presence of your illness. These methods include: recording an electrocardiogram at rest and with a stepped increase in physical activity( stress test), chest x-ray, biochemical blood test( with determination of cholesterol and blood glucose level).If your doctor, by results of a conversation, examination, received tests and carried out instrumental methods of examination, suspects a serious lesion of the coronary arteries, requiring surgery, you will be given coronary angiography. Depending on the state of your coronary arteries and the number of affected vessels, as treatment, in addition to drugs, you will be offered either angioplasty or aortocoronary bypass surgery. If you turn to the doctor on time, you will be prescribed medications that help reduce the impact of risk factors, improve quality of life and prevent the development of myocardial infarction and other complications:

statins for lowering cholesterol;
beta-blockers and angiotensin-converting enzyme inhibitors to lower blood pressure;
aspirin to prevent the formation of blood clots;
nitrates to ease the cessation of pain with an attack of angina

Remember that the success of treatment depends largely on your lifestyle:

do not smoke. It's the most important. In non-smokers, the risk of developing myocardial infarction and death is significantly lower than that of smokers;
eat low cholesterol foods;
regularly, exercise every day for 30 minutes( walking at an average pace);
reduce your stress levels.

The life style section provides detailed recommendations for each item.

What else should I do?

visit the cardiologist regularly. The doctor will monitor your risk factors, treatment and will make changes as necessary;
take your prescribed medications regularly at doses prescribed by your doctor. Do not change your medication without consulting a doctor;
if the doctor has given you nitroglycerin to relieve pain with angina pectoris, always carry it with you;
tell your doctor about all episodes of chest pain if they occur again;
change your lifestyle in accordance with these recommendations.

Coronary arteries and atherosclerosis

People with predisposition in the walls of the coronary arteries accumulate cholesterol and other fats that form an atherosclerotic plaque( Figure).

Why is atherosclerosis a problem for the coronary arteries?

A healthy coronary artery is similar to a rubber tube. It is smooth and flexible and blood flows freely over it. If the body needs more oxygen, for example, during physical exertion, a healthy coronary artery will stretch and more blood will flow to the heart. If the coronary artery is affected by atherosclerosis, it becomes like a clogged tube. Atherosclerotic plaque narrows the artery and makes it stiff. This leads to a restriction of blood flow to the myocardium. When the heart begins to work harder, such an artery can not relax and deliver more blood and oxygen to the myocardium. If the atherosclerotic plaque is so large that it completely blocks the lumen of the artery or that this plaque breaks and a blood clot forms overlapping the artery lumen, then the blood does not enter the myocardium and its site dies.

Ischemic heart disease in women

In women, the risk of developing coronary heart disease increases 2-3 times after menopause. During this period, the level of cholesterol increases and blood pressure rises. The reasons for this phenomenon are not entirely clear. In women suffering from ischemic heart disease, the manifestations of the disease sometimes differ from the symptoms of the disease in men. So in addition to the typical pain, women may experience shortness of breath, heartburn, nausea, or weakness. In women, myocardial infarction often develops during mental stress or severe fear, during sleep, while "male" myocardial infarction often occurs during exercise.

How can a woman prevent the development of coronary heart disease?

Contact your cardiologist. The doctor will give you advice on how to change your lifestyle, prescribe medications. In addition, consult a gynecologist to determine the need for hormone replacement therapy after menopause.

How do I change my lifestyle?

stop smoking and avoid places where other people smoke;
daily for 30 minutes stroll at an average pace;
limit the intake of saturated fats to 10% of the diet, cholesterol to 300 mg / day;
maintain a body mass index of between 18.5-24.9 kg / m2 and a waistline within 88 cm;
if you are already ill with coronary heart disease, monitor the manifestations of depression
consume moderate amounts of alcohol; if you do not drink alcohol, do not start;
adhere to a special diet to reduce the blood pressure level of
if, despite lifestyle changes, the blood pressure level is above 139/89 mm Hg. Art.- consult a cardiologist.

What medications should I take?

Do not take any action without consulting a doctor!

at intermediate and high risk of ischemic heart disease you need to follow a diet and take statins to lower cholesterol;
if you have diabetes mellitus, check the level of glycated hemoglobin every 2-3 months. It should be less than 7%;
if you have a high risk of developing ischemic heart disease , take aspirin daily at low doses;
Aspirin has been used for several years to prevent thrombosis and ischemic disease, but prolonged use may lead to gastrointestinal problems, such as heartburn, gastritis, nausea, stomach pain, etc. To avoid such undesirable consequences, it is necessary to take the drugs in a special enteric coating. For example, you can use the drug Trombo ACC, each tablet is covered with a special film shell, resistant to the action of hydrochloric acid in the stomach and dissolving only in the intestine. Thus, the substances that make up the drug do not harm the stomach. For better effect this tool is recommended to take every day, not courses.
if you have had a myocardial infarction or have angina, take beta blockers;
if you have a high risk of myocardial infarction, have diabetes mellitus or heart failure, take angiotensin-converting enzyme inhibitors. This drug reduces blood pressure and reduces the burden on your heart;
If you do not tolerate angiotensin-converting enzyme inhibitors, this medication can be substituted for angiotensin II blockers.

Replacement hormone therapy and coronary heart disease

The combination of estrogens and progestins or only estrogens is not recommended for preventing ischemic heart disease in women during menopause. Although hormone replacement therapy does not prevent the development of coronary heart disease after menopause, some women take these medications to reduce the symptoms of menopause. Most doctors recommend weighing all the pros and cons of taking such drugs. Before taking hormonal medications, consult a gynecologist.

Symptoms of coronary heart disease

IHD is the most extensive heart pathology and counts many of its forms.

Let's start in order.

Sudden cardiac or coronary death is the most severe of all forms of CAD .It is characterized by high lethality. Death occurs almost immediately or within the next 6 hours from the onset of an attack of severe pain behind the sternum, but usually within an hour. The causes of such a cardiac catastrophe are various arrhythmias, complete blockage of the coronary arteries, marked electrical instability of the myocardium. The provoking factor is the intake of alcohol. As a rule, patients do not even know they have , but they have many risk factors.
Myocardial infarction. Terrible and often disabling form IHD .With myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the breastbone, giving to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, while taking nitroglycerin does not completely go away and only does not decrease for a long time. There is a feeling of lack of air, cold sweat, severe weakness, lowering of blood pressure, nausea, vomiting, fear can appear. Taking nitro drugs does not help. A segment of the heart muscle, devoid of nutrition, necrotic, loses strength, elasticity and the ability to contract. A healthy part of the heart continues to work with maximum stress and, cutting, can break the deadened area. It is no accident that in common speech the heart attack is called a heart rupture! It is only in this state that a person should take even the slightest physical effort, as he is on the verge of destruction. Thus, the meaning of the treatment is that the place of the rift be healed and the heart be able to work normally further. This is achieved both with the help of medications, and with the help of specially selected physical exercises.
Angina pectoris. The patient has pain or discomfort behind the sternum, in the left half of the chest, heaviness and pressure in the heart area - as if they put something heavy on the chest. In the old days people said that a person had a "pectoral toad".Pain can be of different nature: pressing, compressive, stitching. It can give( irradiate) to the left arm, under the left scapula, the lower jaw, the stomach area and is accompanied by the appearance of severe weakness, cold sweat, a sense of fear of death. Sometimes with the load there is not pain, but a sense of lack of air, passing at rest. The duration of an attack of angina is usually several minutes. Since pain in the heart often occurs during movement, a person is forced to stop. In connection with this, angina is figuratively called the "disease of the shop window reviewers", after a few minutes of rest the pain usually passes.
Heart rhythm and conduction disorders. Another form of is the ischemic heart disease .It has a large number of different species. They are based on the violation of the pulse on the conduction system of the heart. It manifests itself as sensations of interruptions in the work of the heart, a sense of "fading", "bubbling" in the chest. Disorders of heart rhythm and conduction can occur under the influence of endocrine, metabolic disorders, intoxication and drug effects. In some cases, arrhythmias can occur with structural changes in the conduction system of the heart and myocardial diseases.
Heart failure. Heart failure is manifested by the inability of the heart to provide sufficient blood flow to the organs by reducing the contractile activity. At the heart of heart failure is a breach of contractile function of the myocardium because of his death in a heart attack, and in violation of the rhythm and conductivity of the heart. In any case, the heart is reduced inadequately and its function is unsatisfactory. There is heart failure with shortness of breath, weakness with exertion and at rest, swelling of the legs, enlargement of the liver and swelling of the cervical veins. The doctor can hear wheezing in the lungs.

Factors of development of coronary heart disease

Risk factors are characteristics that contribute to the development, progression and manifestation of the disease.

Many risk factors play a role in the development of IHD.Some of them can be influenced, others can not. Those factors that we can influence are called removable or modifiable, to which we can not - irremovable or unmodifiable.

Unmodified. Unavoidable risk factors are age, gender, race and heredity. Thus, men are more likely to develop IHD than women. This trend persists to approximately 50-55 years, that is, before the onset of menopause in women, when the production of female sex hormones( estrogens), which have a pronounced "protective" effect on the heart and coronary arteries, is significantly reduced. After 55 years, the incidence of IHD in men and women is approximately the same. There is nothing to be done with such a distinct tendency as the increase and burden of diseases of the heart and blood vessels with age. In addition, as already noted, the incidence is affected by race: Europeans, or rather those living in the Scandinavian countries, suffer from coronary artery disease and arterial hypertension several times more often than those of the Negroid race. Early development of IHD often occurs when the ancestors of a patient in the male line underwent myocardial infarction or died from a sudden cardiac disease to 55 years, and direct female relatives had a myocardial infarction or sudden cardiac death of up to 65 years.
Modifiable. Despite the impossibility to change neither his age nor his gender, a person is able to influence his condition in the future, eliminating removable risk factors. Many of the removable risk factors are interrelated, therefore, eliminating or decreasing one of them, you can eliminate the other. Thus, lowering the fat content in food leads not only to lowering blood cholesterol levels, but also to weight loss, which, in turn, leads to lower blood pressure. Together, this helps reduce the risk of coronary heart disease. And so we list them.

Obesity is an excessive accumulation of adipose tissue in the body. Over half of the people in the world over the age of 45 are overweight. What are the causes of excess weight? In the overwhelming majority of cases, obesity is of alimentary origin. This means that overweight causes overeating with excessive consumption of high-calorie, especially fatty foods. The second most important cause of obesity is insufficient physical activity.
Smoking is one of the most important factors in the development of IHD .Smoking with a high degree of probability contributes to the development of IHD , especially if combined with an increase in the level of total cholesterol. On average, smoking shortens life by 7 years. Smokers also increase the carbon monoxide content in the blood, which leads to a decrease in the amount of oxygen that can enter the cells of the body. In addition, nicotine, contained in tobacco smoke, leads to spasm of the arteries, thereby leading to an increase in blood pressure.
An important risk factor for is the diabetes mellitus. In the presence of diabetes, risk of CAD increases on average by more than 2 times. Patients with diabetes often suffer from coronary heart disease and have a worse prognosis, especially with the development of myocardial infarction. It is believed that with the duration of overt diabetes for 10 years and more, regardless of its type, all patients have a fairly pronounced atherosclerosis. Myocardial infarction is the most common cause of death in diabetic patients.
Emotional stress can play a role in the development of of the ischemic heart disease, myocardial infarction or lead to sudden death. With chronic stress, the heart begins to work with increased workload, blood pressure rises, oxygen and nutrient delivery to organs worsens. To reduce the risk of cardiovascular disease from stress, it is necessary to identify the causes of its occurrence and try to reduce its impact.
Hypodinamy or lack of physical activity is rightly called a disease of the XX, and now the XXI century. It is another disposable risk factor for cardiovascular disease, so it is important to be physically active in order to maintain and improve health. In our time in many spheres of life there is no need for physical labor. It is known that IHD is 4-5 times more common in men under the age of 40-50 years who were engaged in easy labor( compared to those who do heavy physical work);in athletes, the low risk of CHD persists only if they remain physically active after leaving the big sport.
Arterial hypertension is well known as a risk factor for IHD.Hypertrophy( increase in size) of the left ventricle as a consequence of arterial hypertension is an independent strong prognostic factor of mortality from coronary disease.
Increased blood clotting. Coronary artery thrombosis is the most important mechanism of myocardial infarction formation and circulatory insufficiency. It also promotes the growth of atherosclerotic plaques in the coronary arteries. Disturbances predisposing to increased formation of blood clots are risk factors for the development of complications of IHD.
metabolic syndrome.
Stresses.

Metabolic Syndrome

Metabolic syndrome is a pathological process that contributes to the increase in the incidence of diabetes and diseases, based on atherosclerosis - ischemic heart disease, myocardial infarction, stroke.

Obligatory sign of metabolic syndrome is the presence of abdominal obesity( waist circumference more than 94 cm for men and more than 80 cm for women) combined with at least two of the following:

increase in the level of triglycerides of blood more than 1.7 mmol / l;
decrease in high-density lipoproteins of less than 1.03 mmol / L in men and less than 1.29 mmol / L in women;
increase in blood pressure: systolic more than 130 mm Hg.or diastolic more than 85 mm Hg;
increased plasma glucose of venous plasma fasting more than 5.6 mmol / l or previously identified type II diabetes mellitus.

Prophylaxis of coronary heart disease

All prevention of Ischemic Heart Disease is reduced to a simple "IBS" rule.

I. We get rid of smoking.
B. We are moving more.
S. We watch the weight.

I. Get rid of smoking
Smoking is one of the most important factors in the development of CHD , especially if it is combined with an increase in the level of total cholesterol. On average, smoking shortens life by 7 years.

The changes consist in reducing the time of blood clotting and increasing its density, increasing the ability of platelets to stick together and reduce their viability. Smokers increase the carbon monoxide content in the blood, which leads to a decrease in the amount of oxygen that can enter the cells of the body. In addition, nicotine, contained in tobacco smoke, leads to spasm of the arteries, thereby contributing to increased blood pressure.
In people who smoke, the risk of myocardial infarction is 2 times higher, and the risk of sudden death is 4 times that of non-smokers. When smoking a pack of cigarettes per day, the death rate increases by 100%, compared with non-smokers of the same age, and mortality from coronary heart disease - by 200%.
The relationship of smoking with heart disease is dose-dependent, that is, the more cigarettes you smoke, the higher the risk of IBS .
Smoking cigarettes with low tar and nicotine or smoking tubing does not provide a reduction in the risk of cardiovascular disease. Passive smoking( when smoking near you) also increases the risk of death from CHD .It was found that passive smoking increases the incidence of coronary heart disease by 25% among those working in a group of smokers.

B. We move more.
Hypodinamy or insufficient physical activity, by right, is called a disease of the 21st century. It is another disposable risk factor for cardiovascular disease, so it is important to be physically active in order to maintain and improve health. In our time in many spheres of life there is no need for physical labor.
It is known that IHD is 4-5 times more common in men under the age of 40-50 years who were engaged in easy labor( in comparison with those who perform heavy physical work);in athletes low risk IHD is retained only if they remain physically active after leaving the big sport. It is useful to exercise for 30-45 minutes at least three times a week. Physical load should be increased gradually.

S. We watch the weight.
Obesity is an excessive accumulation of adipose tissue in the body. Over half of the people in the world over the age of 45 are overweight. In a person with a normal weight of up to 50% of fat reserves lie directly under the skin. An important criterion of health is the ratio of fat tissues and muscle mass. In fatless muscles, the metabolism proceeds 17-25 times more actively than in fatty deposits.
The location of fat deposits is largely determined by the sex of the person: in women, fat is deposited mainly on the hips and buttocks, and in men around the waist in the abdomen: this abdomen is also called a "bundle of nerves".
Obesity is one of the risk factors IBS .With excess body weight, the heart rate at rest increases, which increases the heart's need for oxygen and nutrients. In addition, obese individuals generally have a metabolic disorder: high cholesterol and other lipids. Among those with overweight, arterial hypertension and diabetes are significantly more common, which in turn are also risk factors CHD .

What are the causes of excess weight?

In the vast majority of cases, obesity has an alimentary origin. This means that overweight causes overeating with excessive consumption of high-calorie, especially fatty foods.
The second most important cause of obesity is insufficient physical activity.

The most unfavorable is the abdominal type, in which the fatty tissue accumulates mainly in the abdomen. This type of obesity can be recognized around the waist circumference( & gt; 94 cm in men and> 80 cm in women).

What should I do if I have excess weight? The program for effective weight loss is based on improving nutrition and increasing physical activity. More effective and physiological are dynamic loads, for example, walking. The food regime should be based on products with a low content of fats and carbohydrates, rich in plant proteins, trace elements, fiber. In addition, it is necessary to reduce the amount of food consumed.

Small fluctuations in weight during the week are completely natural. For example, women during menstruation can gain weight up to two kilograms due to the accumulation of water in the tissues.

Complications of Ischemic Heart Disease

Complications of IHD follow the following mnemonic "IBS" rule.

I. Myocardial infarction.
B. Blockades and arrhythmias of the heart.
C. Heart failure.

Myocardial infarction

So, about the infarction. Myocardial infarction is one of the complications of IHD.Most often the infarct affects people suffering from a lack of motor activity against the background of psycho-emotional overload. But the "scourge of the twentieth century" can also hit people with good physical training, even young ones.
The heart is a muscular sack that, like a pump, drives the blood through itself. But the heart muscle itself is supplied with oxygen through the blood vessels that approach it from the outside. And now, as a result of various reasons, some of these vessels are affected by atherosclerosis and can not already pass enough blood. There is coronary heart disease. With myocardial infarction, the blood supply of a part of the heart muscle stops suddenly and completely because of a complete blockage of the coronary artery. Usually this leads to the development of a thrombus on an atherosclerotic plaque, less often - a spasm of the coronary artery. A segment of the heart muscle, devoid of nutrition, perishes. In Latin, dead tissue is a heart attack.

What are the signs of myocardial infarction?
With myocardial infarction, there is a strong, often tearing, pain in the region of the heart or behind the breastbone, giving to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, while taking nitroglycerin does not completely go away and only does not decrease for a long time. There is a feeling of lack of air, cold sweat, severe weakness, lowering of blood pressure, nausea, vomiting, fear can appear.
Prolonged pain in the heart, which lasts more than 20-30 minutes and does not pass after taking nitroglycerin, may be a sign of the development of myocardial infarction. Refer to "03".
Myocardial infarction is very life-threatening condition. Treatment of myocardial infarction should be performed only in a hospital. Hospitalization of the patient should be carried out only by the ambulance brigade.

Blockades and arrhythmias of the heart

Our heart works under one single law: "All or Nothing."It should work with a frequency of 60 to 90 beats per minute. If below 60, then it is a bradycardia, if the heart rate exceeds 90, in this case they speak of tachycardia. And of course, our health depends on how it works. Violation of the heart is manifested in the form of blockades and arrhythmias. Their main mechanism is the electrical instability of the heart muscle cells.

At the heart of the blockades is the principle of disconnection, it's like a telephone line: if the wire is not damaged, then the connection will be, if there is a gap, then it will not be possible to talk. But the heart is a very successful "communicator," and in the event of a disconnection, it finds a circuitous pathway for the signal, thanks to a developed conductive system. And as a result, the heart muscle continues to shrink even when "some transmission lines are broken", and doctors take an electrocardiogram and register a blockade.
With arrhythmias a little bit different. There, too, there is a "gap on the line," but the signal is reflected from the "break spot" and begins to circulate continuously. This causes chaotic contractions of the heart muscle, which affects its overall work, causing hemodynamic disorders( blood pressure, dizziness and other symptoms).This is why arrhythmias are more dangerous than blockades.

Main symptoms:

Heart palpitations and breasts;
Very rapid heartbeat or slow heartbeat;
Sometimes chest pain;
Shortness of breath;
Dizziness;
Loss of consciousness or feeling close to him;

Therapy of blockades and arrhythmias includes surgical and therapeutic methods. Surgical is the installation of artificial pacemakers or pacemakers. Therapeutic: with the help of various groups of drugs called antiarrhythmics, and electropulse therapy. Indications and contraindications in all cases are determined only by the doctor.

Heart failure

Cardiac failure is a condition in which the ability of the heart to supply blood supply to organs and tissues is impaired in accordance with their needs, which is most often a consequence of the IHD .As a result of defeat, the heart muscle weakens and can not satisfactorily perform its pump function, resulting in decreased blood supply to the body.

Heart failure is often characterized depending on the severity of clinical symptoms. In recent years, the classification that assesses the severity of heart failure, developed by the New York Heart Association, has gained international recognition. Light, moderate, severe heart failure is distinguished depending on the severity of symptoms, especially shortness of breath:

I functional class: only a sufficiently strong load provokes the appearance of weakness, palpitations, dyspnea;
II functional class: moderate restriction of physical exertion;the exercise of ordinary physical activity causes weakness, palpitations, dyspnea, attacks of angina pectoris;
III functional class: marked restriction of physical activity;comfortable only at rest;with minimal physical exertion - weakness, shortness of breath, palpitation, chest pain;
IV functional class: inability to perform any load without the appearance of discomfort;symptoms of heart failure appear at rest.

Non-drug therapy is aimed at reducing the severity of symptoms and thereby improving the quality of life of patients with moderate or severe heart failure. The main activities include normalization of body weight, treatment of hypertension, diabetes mellitus, discontinuation of alcohol intake, restriction of consumption of table salt and liquid, control of hyperlipidemia.
Scientific studies of recent decades have shown that moderate physical training in patients with chronic heart failure reduces the symptoms of heart failure, but the physical load must be dosed and monitored and supervised by a doctor.
But, despite the progress of medical therapy for heart failure, now the problem of treating this serious condition, unfortunately, is far from being resolved. Over the past 15 years there have been significant changes in the evaluation of the effectiveness of drugs used in heart failure.
Previously, the leading drugs were cardiac glycosides and diuretics, currently ACE inhibitors are the most promising, which improve symptoms, increase physical performance and increase the survival of patients with heart failure, so their appointment is considered mandatory in all cases of heart failure, regardless ofage of the patient.
Finally, it is now believed that the most important factor determining the survival of patients with chronic heart failure, in addition to adequate medical treatment, is the tactic of managing the patient, providing regular and continuous( without breaks) long-term therapy under strict medical supervision.

How to identify angina without additional tests

It is necessary to evaluate the clinical manifestations of the disease( complaints).Pain sensations in angina have the following characteristics:

character of pain: sensation of compression, severity, raspiraniya, burning behind the sternum;
their localization and irradiation: painful sensations are concentrated in the sternum, often pain radiates to the inner surface of the left hand, to the left shoulder, scapula, neck. Less often the pain is "given" to the lower jaw, the right half of the thorax, the right arm, to the upper abdomen;
duration of pain: pain attack with angina persists more than one, but less than 15 minutes;
conditions for the onset of a pain attack: the onset of pain is sudden, immediately at the height of physical activity. Most often, such a load is walking, especially against the cold wind, after a plentiful meal, while climbing the stairs;
factors facilitating and / or arresting pain: the reduction or disappearance of pain occurs almost immediately after the reduction or complete cessation of exercise or 2-3 minutes after taking nitroglycerin under the tongue.

Typical Angina:

Injured pain or discomfort of characteristic quality and duration
Occurs during physical exertion or emotional stress
Passes at rest or after taking nitroglycerin.

Atypical angina:

Two of the above signs.

Non-cardiac pain:

One or none of the above symptoms.

Laboratory tests for coronary heart disease

The minimum list of biochemical indicators for suspected ischemic heart disease and angina includes the determination of blood levels:

total cholesterol;
high-density lipoprotein cholesterol;
low-density lipoprotein cholesterol;
triglycerides;
of hemoglobin;
glucose;
AST and ALT.

Diagnosis of coronary heart disease

The following studies are the main instrumental methods for the diagnosis of stable angina:

electrocardiography,
exercise test( bicycle ergometry, treadmill),
echocardiography,
coronary angiography.

Note. If it is not possible to conduct a sample with physical exertion, as well as to identify so-called Bozboleva ischemia and variant angina, a daily Holter monitoring of the ECG is indicated.

Coronarography

Coronary angiography( or coronary angiography) is a method of diagnosing the state of the coronary bed. It allows to determine the localization and degree of narrowing of the coronary arteries.

The degree of constriction of the vessel is determined by the reduction in the diameter of its lumen in comparison with the proper one and is expressed in%.To date, a visual assessment has been used with the following characteristic: normal coronary artery, modified arterial contour without stenosis, narrowing & lt;50%, narrowing by 51-75%, 76-95%, 95-99%( subtotal), 100%( occlusion).Essential is the narrowing of the artery & gt;50%.Hemodynamically insignificant is the narrowing of the lumen of the vessel & lt;50%.

In addition to the localization of the lesion and its degree, coronary angiography may reveal other characteristics of artery involvement, such as thrombus, tearing( dissection), spasm, or myocardial bridge.

Absolute contraindications for coronary angiography at present does not exist.

The main tasks of coronary angiography:

specification of the diagnosis in cases of insufficient informative value of the results of non-invasive examination methods( electrocardiography, 24-hour ECG monitoring, physical stress tests and others);
determination of the possibility of restoration of adequate blood supply( revascularization) of the myocardium and the nature of the intervention - coronary artery bypass grafting or angioplasty with coronary stenting.

Coronarography is performed to resolve the issue of the possibility of myocardial revascularization in the following cases:

severe angina pectoris III-IV functional class, persisting with optimal therapy;
signs of severe myocardial ischemia based on non-invasive methods( electrocardiography, 24-hour ECG monitoring, bicycle ergometry and others);
presence in a patient of an anamnesis of episodes of sudden cardiac death or dangerous ventricular rhythm disturbances;
progression of the disease( according to the dynamics of non-invasive tests);
questionable results of non-invasive tests in persons with socially significant occupations( public transport drivers, pilots, etc.).

Treatment of coronary heart disease

See treatment of angina and myocardial infarction

Ischemic heart disease - Causes, symptoms and treatment. MF.