Coronary heart disease (CHD)– organic and functional damage to the myocardium caused by a lack or cessation of blood supply to the heart muscle (ischemia). IHD can manifest itself in acute (myocardial infarction, cardiac arrest) and chronic (angina pectoris, post-infarction cardiosclerosis, heart failure) conditions. Clinical signs IHD is determined by the specific form of the disease. IHD is the most common cause of sudden death in the world, including in people of working age.

ICD-10

I20-I25

General information

Coronary heart disease is the most serious problem of modern cardiology and medicine in general. In Russia, about 700 thousand deaths caused by various forms of IHD are recorded annually; in the world, mortality from IHD is about 70%. Coronary heart disease affects men more active age(55 to 64 years), leading to disability or sudden death. The group of IHD includes acutely developing and chronic conditions of myocardial ischemia, accompanied by subsequent changes: dystrophy, necrosis, sclerosis. These conditions are considered, among other things, as independent nosological units.

Causes

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

Other causes of IHD are thromboembolism or spasm of the coronary arteries, which usually develop against the background of an existing atherosclerotic lesion. Cardiospasm aggravates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.

Factors contributing to the occurrence of IHD include:

hyperlipedemia

Promotes the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of coronary heart disease are hyperlipidemia types IIa, IIb, III, IV, as well as a decrease in the content of alpha-lipoproteins.

Arterial hypertension increases the likelihood of developing coronary artery disease by 2-6 times. In patients with systolic blood pressure = 180 mmHg. Art. and higher, coronary heart disease occurs up to 8 times more often than in hypotensive patients and people with normal blood pressure.

smoking

According to various data, cigarette smoking increases the incidence of coronary artery disease by 1.5-6 times. Mortality from coronary heart disease among men 35-64 years old who smoke 20-30 cigarettes daily is 2 times higher than among non-smokers of the same age category.

physical inactivity and obesity

Physically inactive people are 3 times more likely to develop coronary artery disease than people who lead an active lifestyle. When physical inactivity is combined with excess body weight, this risk increases significantly.

impaired carbohydrate tolerance

angina pectoris (stress):

stable (with determination of functional class I, II, III or IV);
unstable: new-onset, progressive, early postoperative or post-infarction angina;

spontaneous angina (syn. special, variant, vasospastic, Prinzmetal's angina)

large-focal (transmural, Q-infarction);
small-focal (not Q-infarction);

6. Cardiac conduction and rhythm disorders(form).

7. Heart failure(form and stages).

In cardiology, there is the concept of “acute coronary syndrome”, which combines various forms of coronary heart disease: unstable angina, myocardial infarction (with and without Q-wave). Sometimes sudden coronary death caused by ischemic heart disease is also included in this group.

Symptoms of IHD

Clinical manifestations of IHD are determined by the specific form of the disease (see myocardial infarction, angina pectoris). In general, coronary heart disease has a wave-like course: periods of stable normal health alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially with silent myocardial ischemia, do not feel the presence of coronary artery disease at all. The progression of coronary heart disease can develop slowly over decades; at the same time, the forms of the disease, and therefore the symptoms, may change.

Common manifestations of IHD include chest pain associated with physical activity or stress, pain in the back, arm, and lower jaw; shortness of breath, increased heartbeat or a feeling of irregularities; weakness, nausea, dizziness, clouding of consciousness and fainting, excessive sweating. Often, IHD is detected already at the stage of development of chronic heart failure when edema appears on the lower limbs, severe shortness of breath, forcing the patient to take a forced sitting position.

The listed symptoms of coronary heart disease usually do not occur simultaneously; with a certain form of the disease, a predominance of certain manifestations of ischemia is observed.

Precursors of primary cardiac arrest in coronary heart disease can be paroxysmal sensations of discomfort in the chest, fear of death, and psycho-emotional lability. In case of sudden coronary death, the patient loses consciousness, breathing stops, there is no pulse in the main arteries (femoral, carotid), heart sounds cannot be heard, the pupils dilate, and the skin becomes a pale grayish tint. Cases of primary cardiac arrest account for up to 60% of deaths from coronary artery disease, mainly in the prehospital stage.

Complications

Hemodynamic disturbances in the heart muscle and its ischemic damage cause numerous morpho-functional changes that determine the forms and prognosis of IHD. The result of myocardial ischemia is the following mechanisms of decompensation:

insufficiency of energy metabolism of myocardial cells – cardiomyocytes;
“stunned” and “sleeping” (or hibernating) myocardium – forms of impaired contractility of the left ventricle in patients with coronary artery disease, which are transient in nature;
development of diffuse atherosclerotic and focal post-infarction cardiosclerosis - a decrease in the number of functioning cardiomyocytes and the development of connective tissue in their place;
violation of systolic and diastolic myocardial functions;
disorder of the functions of excitability, conductivity, automaticity and contractility of the myocardium.

The listed morpho-functional changes in the myocardium in coronary artery disease lead to the development of a persistent decrease in coronary circulation, i.e., heart failure.

Diagnostics

Diagnosis of coronary artery disease is carried out by cardiologists in a cardiology hospital or dispensary using specific instrumental techniques. When interviewing the patient, complaints and the presence of symptoms characteristic of coronary heart disease are clarified. Upon examination, the presence of edema, cyanosis of the skin, heart murmurs, and rhythm disturbances are determined.

Laboratory diagnostic tests involve the study of specific enzymes that increase during unstable angina and heart attack (creatine phosphokinase (during the first 4-8 hours), troponin-I (on days 7-10), troponin-T (on days 10-14), aminotransferase , lactate dehydrogenase, myoglobin (on the first day)). These intracellular protein enzymes, when cardiomyocytes are destroyed, are released into the blood (resorption-necrotizing syndrome). A study of the level of total cholesterol, low (atherogenic) and high (antiatherogenic) density lipoproteins, triglycerides, blood sugar, ALT and AST (nonspecific markers of cytolysis) is also carried out.

The most important method for diagnosing cardiac diseases, including coronary heart disease, is an ECG - recording the electrical activity of the heart, which makes it possible to detect disturbances in the normal functioning of the myocardium. EchoCG is a cardiac ultrasound method that allows you to visualize the size of the heart, the condition of the cavities and valves, and evaluate myocardial contractility and acoustic noise. In some cases, in case of coronary artery disease, stress echocardiography is performed - ultrasound diagnostics using dosed physical activity, recording myocardial ischemia.

Functional stress testing is widely used in the diagnosis of coronary heart disease. They are used to identify the early stages of coronary artery disease, when disorders cannot yet be determined at rest. Walking, climbing stairs, exercise on exercise machines (an exercise bike, a treadmill), accompanied by ECG recording of heart function indicators, are used as stress tests. The limited use of functional tests in some cases is caused by the inability of patients to perform the required amount of load.

Treatment of coronary artery disease

The treatment tactics for various clinical forms of coronary heart disease have their own characteristics. However, it is possible to identify the main directions used for the treatment of coronary artery disease:

non-drug therapy;
drug therapy;
performing surgical revascularization of the myocardium (coronary artery bypass grafting);
use of endovascular techniques (coronary angioplasty).

Non-drug therapy includes measures to correct lifestyle and nutrition. For various manifestations of coronary artery disease, a limitation of the activity regime is indicated, since during physical activity the myocardial need for blood supply and oxygen increases. Failure to satisfy this need of the heart muscle actually causes manifestations of IHD. Therefore, in any form of coronary heart disease, the patient’s activity regimen is limited, followed by a gradual expansion during rehabilitation.

The diet for coronary artery disease involves limiting the intake of water and salt with food to reduce the load on the heart muscle. In order to slow the progression of atherosclerosis and combat obesity, a low-fat diet is also prescribed. The following food groups are limited and, if possible, excluded: fats of animal origin (butter, lard, fatty meat), smoked and fried foods, quickly absorbed carbohydrates (baked goods, chocolate, cakes, candies). To maintain a normal weight, it is necessary to maintain a balance between energy consumed and energy expended. If it is necessary to lose weight, the deficit between consumed and expended energy reserves should be at least 300 kC daily, taking into account that a person spends about 2000-2500 kC per day during normal physical activity.

Drug therapy for ischemic heart disease is prescribed according to the “A-B-C” formula: antiplatelet agents, β-blockers and cholesterol-lowering drugs. In the absence of contraindications, it is possible to prescribe nitrates, diuretics, antiarrhythmic drugs, etc. The lack of effect of drug therapy for coronary heart disease and the threat of myocardial infarction are an indication for consultation with a cardiac surgeon to resolve the issue of surgical treatment.

Surgical revascularization of the myocardium (coronary artery bypass grafting - CABG) is resorted to in order to restore blood supply to the ischemic area (revascularization) in case of resistance to pharmacological therapy (for example, with stable angina pectoris of class III and IV). The essence of the CABG method is to create an autovenous anastomosis between the aorta and the affected artery of the heart below the area of its narrowing or occlusion. This creates a bypass vascular bed that delivers blood to the site of myocardial ischemia. CABG operations can be performed using cardiopulmonary bypass or on a beating heart. Minimally invasive surgical techniques for ischemic heart disease include percutaneous transluminal coronary angioplasty (PTCA) – balloon “expansion” of a stenotic vessel with subsequent implantation of a stent frame that holds the vessel lumen sufficient for blood flow.

Prognosis and prevention

Determining the prognosis for ischemic heart disease depends on the interrelation of various factors. The combination of coronary heart disease and arterial hypertension, severe lipid metabolism disorders and diabetes mellitus has an unfavorable effect on the prognosis. Treatment can only slow down the steady progression of IHD, but not stop its development.

Most effective prevention IHD is a reduction in the adverse effects of threat factors: avoiding alcohol and smoking, psycho-emotional overload, maintaining optimal body weight, exercising, controlling blood pressure, healthy eating.

Coronary heart disease (CHD) is a disease that develops against the background of insufficient oxygen supply to the heart muscle (myocardium).

Narrowing of the lumen and atherosclerosis of the coronary arteries disrupt the blood circulation process, which is the cause of oxygen starvation of the heart. In this article we will look at how IHD is treated, what type of drugs are used and what role they play.

hidden (asymptomatic);
angina pectoris;
arrhythmic.

Basic methods of treatment of ischemic heart disease

medication (treatment of coronary artery disease with drugs);
non-drug (surgical) treatment;
elimination of risk factors contributing to the development of the disease.

Drug treatment of coronary artery disease - general principles

Complex drug treatment IHD is aimed at stopping the development of pathology, mitigating negative symptoms, increasing the duration and quality of life of the patient.

Drugs for cardiac ischemia are prescribed by a cardiologist.

As drugs for the treatment of coronary artery disease that improve the prognosis:

antiplatelet agents - block the formation of blood clots in blood vessels;
statins - help reduce blood cholesterol levels;
blockers of the renin-angiotensin-aldosterone system - prevent an increase in blood pressure.

Medicines for cardiac ischemia to relieve symptoms:

sinus node inhibitors;
calcium antagonists;
potassium channel activators;
nitrates;
antihypertensive drugs.

Taking medications for the treatment of coronary heart disease prescribed by a cardiologist is permanent. Replacement of medications or changes in dosage for ischemic heart disease is carried out exclusively by the attending physician.

Drugs for the treatment of IHD are not a panacea: recovery is impossible without following a diet, reasonable physical activity, normalizing sleep patterns, giving up cigarettes and other bad habits.

Antiplatelet agents

Antiplatelet drugs (antiplatelet agents) are a class of drugs that thin the blood (affecting clotting). They prevent platelets or red blood cells from coming together (aggregation) and reduce the risk of blood clots. Antiplatelet agents for the treatment of coronary artery disease are an important component of complex treatment of the disease.

Aspirin (acetylsalicylic acid) - in the absence of contraindications (stomach ulcers, diseases of the hematopoietic system) is the main means of preventing thrombosis. Aspirin is effective for ischemic heart disease and has a balanced combination beneficial properties And side effects, differs in budget cost.
Clopidogrel is a medicine with a similar effect, which is prescribed for patients intolerant to aspirin.
Warfarin - has a more intense effect, promotes the dissolution of blood clots, and maintains the level of blood clotting. Warfarin for the treatment of coronary artery disease is prescribed after a comprehensive examination with regular blood monitoring for the INR (may cause bleeding).

Lipid-lowering drugs (statins)

Statins, which actively lower cholesterol levels in the blood, in combination with a special diet, are a mandatory element of therapy for coronary artery disease. Lipid-lowering drugs for the treatment of coronary heart disease are effective if taken continuously:

Rosuvastatin;
Atorvastatin;
Simvastatin.

Narrowing of the coronary arteries in coronary artery disease

Blockers of the renin-angiotensin-aldosterone system

The list of methods for treating the disease necessarily includes tablets for cardiac ischemia that normalize blood pressure. Its increase negatively affects the condition of the coronary vessels. Possible result- progression of coronary artery disease, risk of stroke, as well as chronic heart failure.

Angiotensin receptor blockers (inhibitors) - medications, used in the treatment of ischemia, blocking receptors of the enzyme angiotensin-2 (located in the structure of cardiac tissue). Therapeutic effect - reduction blood pressure, eliminating the risk of growth of tissue and heart muscles (hypertrophy) or reducing it.

Drugs in this group are taken strictly under medical supervision over a long period.

ACE inhibitors - act as blockers of the activity of the enzyme angiotensin-2, which is the cause of increased blood pressure. A negative effect of the enzyme on cardiac tissue and blood vessels was revealed. Positive dynamics are observed with the use of the following drugs belonging to the ACE group:

Treatment of coronary artery disease with ARBs (angiotensin-II receptor blockers):

Losartan (, Cozaar, Lorista);
Candesartan (Atacand);
Telmisartan (Micardis).

Groups of drugs for the symptomatic treatment of ischemic heart disease

As part of a complex of therapeutic measures, drugs for cardiac ischemia are prescribed to relieve the symptoms of the disease. In patients at risk of an unfavorable course of the disease, the drugs discussed in the article are prescribed for cardiac ischemia intravenously (intravenously).

Beta blockers

Beta-blockers (BAB) are a central group of drugs that help improve heart function. Their action is aimed at reducing heart rate and regulating average daily blood pressure. Indicated for use as inhibitors of stress hormone receptors. Beta-blockers eliminate the symptoms of angina pectoris and are recommended for use by patients who have suffered. The list of drugs for the treatment of coronary artery disease, such as beta blockers, includes:

Oxprenolol;
Nadolol;
Metoprolol;
Carvedilol;
Nebivolol.

Calcium antagonists

Calcium antagonists are drugs that prevent angina attacks. The feasibility of their use is comparable to beta-blockers: they help reduce the number of heart contractions, neutralize the manifestation of arrhythmia, and reduce the number of myocardial contractions. They are effective in the prevention of coronary artery disease, as well as in the vasospastic form of angina. You can also get acquainted with the treatment of atrial fibrillation.

The most effective medications for cardiac ischemia:

Verapamil;
Parnavel Amlo;

Nitrates and nitrate-like agents

They relieve attacks of angina and prevent complications in acute myocardial ischemia. Nitrates relieve pain, dilate coronary arteries, and reduce blood flow to the heart, which reduces its need for oxygen.

Drugs for cardiac ischemia (nitrates):

Nitroglycerin (Nitromint) - inhalation or by tongue;
Nitroglycerin in the form of ointment, discs or patches;
Isosorbide dinitrate (Isosorbide dinitrate long acting);
Isosorbide mononitrate (long-acting isosorbide mononitrate);
Mononitrate (Monocinque);
Molsidomine (long-acting molsidomine) - prescribed for nitrate intolerance.

Sinus node inhibitor

Sinus node inhibitor (Ivabradine) - reduces the heart rate, but does not affect myocardial contractility and blood pressure. Ivabradine is effective when treating stable sinus angina who are intolerant to beta blockers. In some cases, taking ivabradine in combination with beta blockers has a beneficial effect on the prognosis of the disease.

Potassium channel activator

Potassium channel activator - Nicorandil (anti-ischemic drug). The drug dilates the coronary vessels and counteracts the deposition of platelets on the walls of the arteries (the formation of atherosclerotic plaques). The action of Nicorandil does not affect the number of heartbeats or blood pressure. The drug is indicated in the treatment of microvascular angina, prevents and relieves attacks of the disease.

Antihypertensive drugs

Antihypertensive drugs are drugs that have the property of lowering high blood pressure. This group includes medications belonging to different pharmacological classes and different mechanisms of action.

Antihypertensive drugs for coronary artery disease include diuretics. Diuretics (diuretics) - in small dosages reduce blood pressure, in larger dosages they remove excess fluid from the body. Diuretics include:

Furosemide;
Lasix.

The previously described beta-blockers, calcium antagonists, ACE inhibitors (angiotensin-converting enzyme inhibitors) help lower blood pressure:

Cilazapril;
Coexipril;
Quinapril;
Perindopril;
Cilazapril.

Treatment of vasospastic angina

Vasospastic form of angina is special shape diseases with characteristic painful sensations and discomfort in the chest area, even in a calm state. The cause is spastic pathologies of the vessels supplying the heart muscle, narrowing of the lumen of the right coronary artery, and obstructed blood flow to the myocardium.

Calcium antagonists are recommended to prevent attacks; during exacerbations, Nitroglycerin and long-acting nitrates are recommended. Sometimes, a combination of calcium antagonist drugs with small doses of beta-blockers is indicated. In addition, unfavorable factors such as stress, smoking, and hypothermia should be avoided.

Cardiac vessels during an attack of angina

Treatment of microvascular angina

Symptoms of the disease are manifested by pain in the chest, characteristic of angina, without changes in the coronary vessels. Patients with this diagnosis include those with diabetes mellitus or those suffering from arterial hypertension. In case of pathological changes in the microvessels of the heart, the following is prescribed:

statins;
antiplatelet agents;
ACE inhibitors;
ranolazine.

beta blockers;
calcium antagonists;
long-term nitrates.

First aid drugs

Providing first aid for coronary artery disease involves relieving or stopping pain.

Actions and medications for first aid for ischemic heart disease:

Nitroglycerin is the main first aid treatment for patients with characteristic chest pain. Instead of nitroglycerin, you can use a single dose of Isoket or Nitrolingval. It is advisable to take the drug in a sitting position to avoid fainting (with a decrease in blood pressure).
If the condition does not improve, you should give the patient a crushed tablet of Aspirin, Baralgin or Analgin before the medical team arrives.
Medicines can be taken no more than 3 times in a row with a short interval, since most of them reduce blood pressure.

If symptoms of IHD appear, it is advisable to take potassium supplements (Panangin and analogues).

Useful video

About the causes of coronary heart disease and modern methods Find out about diagnosis and treatment in the following video:

Conclusion

Medications for coronary heart disease should be taken only under the supervision of a cardiologist.
The course of treatment for IHD is prescribed on the basis of a full examination in a hospital setting and laboratory diagnostics.
For a disease such as cardiac ischemia, treatment: tablets, capsules, aerosols - dosage of all drugs, duration of administration and compatibility with others medicines determined exclusively by a cardiologist.
Drug treatment of coronary artery disease as a component of treatment continues indefinitely. Even if you feel better, it is strictly not recommended to stop treatment - this can provoke angina attacks, the development of myocardial infarction or cardiac arrest.

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What is the danger of IHD: what is it and what diseases are included in this concept

Not every person knows why IHD develops, what it is and how to treat it. This abbreviation stands for coronary heart disease. This pathology is very common among the adult population. The development is based on a violation of the blood supply to the myocardium. Such a diagnosis worsens the health prognosis and shortens the life expectancy of the sick person.

Development of coronary heart disease

The human circulatory system is very complex. It consists of the heart and blood vessels. The myocardium itself constantly needs oxygen and nutrients. They enter there through the coronary (coronary) arteries. The latter nourish the heart itself, maintaining its functions at the proper level. Ischemic disease is a pathological condition in which the blood supply to the myocardium is disrupted or completely stopped.

This pathology can be organic or functional. IHD has a high mortality rate. A poor prognosis is most often associated with an acute form of ischemia (myocardial infarction). IHD is the most common cause of sudden death. This is serious medical and social problem. In Russia, more than 1 million people die every year from vascular diseases. Most of- working population. IHD is increasingly developing in young people.

The incidence rate is higher in men. This is due to active smoking, alcoholism and addiction to fatty foods. Many people become disabled. This happens as a result of heart attacks and development. Modern healthcare cannot yet cope with such a problem and change the situation. The only way to reduce mortality and morbidity is to change lifestyle.

Types of coronary disease

WHO (World Health Organization) considers IHD as a general concept. It combines several diseases. The IHD group includes:

sudden coronary death (with and without fatal outcome);
angina pectoris (strain and spontaneous);
painless variant of IHD;
rhythm and conduction disorder;
heart failure;
post-infarction cardiosclerosis.

Painful forms of ischemic disease are more common. The most common pathology is angina pectoris. It can be stable and unstable. Prinzmetal's angina is identified separately. Many experts use the concept of acute coronary syndrome. It includes a heart attack. This also includes unstable angina. There is no need to confuse coronary heart disease with. These are different concepts. Stroke is an acute disorder of cerebral circulation.

Etiological factors

Risk factors for coronary artery disease are known to every cardiologist. The development of this cardiac pathology is based on a lack of oxygen. The cause may be damage to the coronary arteries. The following factors are of greatest importance in the development of IHD:

atherosclerosis of coronary vessels;
smoking;
thrombosis;
hyperlipidemia;
diabetes;
high blood pressure;
alcoholism;
poor nutrition;
physical inactivity.

Ischemic disease often develops against the background. The reason is a violation of lipid metabolism.

Cholesterol is formed in the body of every person. It is bound to blood proteins. There are low, high and very low density lipoproteins. With atherosclerosis, the content of LDL and VLDL increases. Over many years, lipids are deposited on the walls of the coronary arteries.

Atherosclerosis

At first there are no symptoms. Gradually, the lumen of the vessels decreases and at a certain point the blood flow becomes difficult. Dense plaques form. The situation is aggravated by smoking, poor diet and physical inactivity. Risk factor for developing coronary artery disease - . It increases the likelihood of myocardial ischemia several times.

IHD often develops in people suffering from endocrine pathologies (obesity, diabetes, hypothyroidism). This form of ischemic disease, such as a heart attack, can be caused by acute thrombosis (blockage) of the coronary arteries. Causes of CAD include smoking. This is very serious problem, which is almost impossible to solve.

Active and passive smoking is dangerous. Substances contained in smoke contribute to arterial spasm, which leads to. Carbon monoxide helps reduce oxygen levels in the blood. All tissues of smokers experience oxygen starvation. Another risk factor that can be eliminated is stress. It leads to an increase in blood pressure due to the production of catecholamines (adrenaline and norepinephrine) and oxygen deficiency.

Every doctor should know the etiology of ischemic heart disease. Risk factors for the development of this pathology include elderly age, genetic predisposition, nutritional errors and male gender. Symptoms of IHD often occur in people who abuse animal fats (they are found in meat, fish, butter, mayonnaise, sausage) and simple carbohydrates.

Development of angina in humans

Of all forms of coronary artery disease, angina pectoris is the most common. This pathology is characterized by the occurrence of acute pain in the heart area against the background of impaired blood supply. There are angina pectoris and spontaneous (variant). They have fundamental differences from each other.

Angina pectoris is detected mainly in people of mature age. The risk of developing this pathology in a person under 30 years of age is less than 1%.

The prevalence of angina pectoris among adults reaches 15-20%. The incidence rate increases with age. Most common cause is atherosclerosis. Symptoms appear when the lumen of the arteries narrows by 60-70%.

With angina pectoris (stress), the following clinical manifestations are observed:

chest pain;
dyspnea;
pale skin;
increased sweating;
change in behavior (feelings of fear, anxiety).

The main symptom of this form of IHD is pain. It occurs as a result of the release of mediators and irritation of receptors. The pain is paroxysmal. It occurs during physical activity, quickly intensifies, is eliminated by nitrates, is pressing or squeezing and is felt in the chest on the left. The attack lasts several seconds or minutes. If it drags on for 20 minutes or more, then myocardial infarction must be ruled out.

The pain radiates to left side torso. Angina pectoris can be stable or unstable. The first differs in that attacks occur during the same physical activity. The pain syndrome is felt for less than 15 minutes. The attack disappears after taking 1 tablet of nitrates. Pain with unstable angina is longer lasting.

Each subsequent attack is provoked by a lesser load. Often it occurs at rest. Signs of CAD include shortness of breath. Such patients feel short of breath. It often occurs during an attack of angina. Its appearance is due to a decrease in heart function, stagnation of blood in the pulmonary circulation and increased pressure in the pulmonary vessels.

The breathing of patients becomes deep and frequent. With angina, the heart rhythm is often disturbed. This manifests itself as frequent or rare heartbeat, dizziness and even loss of consciousness.

With angina pectoris, a person’s behavior changes: he freezes, bends over, and tries to take a relieving position. The fear of death often appears.

Variant and rest angina

The classification of coronary artery disease distinguishes angina that occurs at rest. This form of cardiac ischemia is characterized by the occurrence of a painful attack, regardless of physical activity. This is one of the types of unstable angina. This pathology occurs in acute, subacute and chronic forms. It often develops 1-2 weeks after a myocardial infarction.

Causes of rest include atherosclerosis, narrowing of the aorta, inflammation of the coronary arteries, hypertension, cardiomyopathy with left ventricular hypertrophy. This form of IHD is characterized by the appearance of pain at rest, when a person is in a supine position. This often happens during sleep. The attack lasts up to 15 minutes and is severe. This is different from exertional angina. The pain is eliminated after taking 2-3 nitrate tablets.

Autonomic symptoms include sweating, redness or paleness of the face, nausea, dizziness, and increased blood pressure. A variant of this pathology is Prinzmetal's angina. This is a rare form of coronary heart disease. It is detected in 2-5% of patients with coronary artery disease. Prinzmetal's angina most often develops in people aged 30 to 50 years. The risk group includes smokers.

Attacks occur against a background of stress, hyperventilation, and cooling of the body. Triggering factors may be absent. Prinzmetal's angina pectoris is manifested by intense pain in the chest of a burning or pressing nature, lability of blood pressure, rapid heartbeat, rhythm disturbances, headache, and nausea. Some people lose consciousness. The attacks are severe and often occur several times a day.

Heart attack

The diagnosis of coronary artery disease may include an indication of myocardial infarction. This is an acute form of coronary heart disease that kills thousands of people every year. This condition requires emergency assistance. Sometimes patients need surgical intervention. The definition of a heart attack is known to every cardiologist. The difference between this pathology is that a focus of necrosis (tissue death) forms in the heart muscle.

In the future, a scar will form at this location. Before the age of 60, this condition is more often diagnosed in men. Death from a heart attack occurs in 30-40% of cases. Tissue necrosis can develop against the background of a prolonged attack of angina if the patient is not given proper assistance. During a heart attack, irreversible changes occur within 15-20 minutes from the moment of the attack.

The causes of acute circulatory disorders are thrombosis. The risk of developing a heart attack is higher in people suffering from hypertension and crises. Most often the left ventricle is involved in the process. Myocardial infarction can be large-focal or small-focal. There are acute, acute, subacute and post-infarction periods.

With this form of IHD the following symptoms are observed:

chest pain lasting more than 30 minutes;
numbness;
feeling of fear;
severe weakness;
excitation;
dyspnea;
an increase in blood pressure followed by a fall;
tachycardia;
increase in body temperature.

The main symptom is pain. It has the following characteristics:

piercing (dagger) or burning;
varying intensity;
felt in the left chest;
lasts more than 30 minutes;
radiates to the left shoulder, jaw, arm;
appears spontaneously at night or in the morning;
wavy;
does not change after taking nitrates and at rest.

Complications such as heart failure, atrial fibrillation, shock and pulmonary edema often develop. Help for the patient should be provided early stage IHD. In some cases, a heart attack occurs in an atypical form (painless, abdominal). This makes it difficult to make a diagnosis. more common among older people.

Development of post-infarction cardiosclerosis

The World List of Diseases (ICD) identifies a form of IHD as post-infarction cardiosclerosis. This disease is the outcome of AMI. Post-infarction cardiosclerosis is a pathological condition in which myocardial muscle fibers are replaced connective tissue. The latter is not able to excite and contract.

This pathology develops several months after a heart attack. The growth of scar tissue during sclerosis leads to disturbances in the rhythm and contractility of the heart. The outcome is the development of heart failure. More rare causes of cardiosclerosis include myocardial dystrophy. This form of IHD is characterized by the following symptoms:

If right ventricular failure develops, edema appears. Complications of post-infarction cardiosclerosis include the development of atrial fibrillation, partial or complete blockade. The most unfavorable prognosis is observed in the case of left ventricular aneurysm.

Development of heart failure

An independent form of coronary disease is heart failure. It can be acute and chronic. The development of this pathology is based on a decrease in the contractile function of the myocardium due to ischemia. This is a complication of other diseases. The prevalence of chronic heart failure is 0.5-2%. Over the age of 75, every tenth person is sick.

Every year the number of people with this pathology increases. With this form of coronary heart disease, symptoms include cyanosis of the extremities, ears and nose, swelling, heaviness in the right hypochondrium, swelling of the veins in the neck, tachycardia, shortness of breath, cough, fatigue. Stagnation of blood leads to dysfunction of many organs. Gastritis, pneumonia, bronchitis, and pyelonephritis often develop. The functioning of the central nervous system is disrupted.

How to detect IHD in a person

Patients are treated after examination. The diagnosis is made by a cardiologist or therapist. The following studies are required:

Blood analysis

analysis for the presence of intracellular protein enzymes in the blood (troponin, aminotransferase, lactate dehydrogenase, myoglobin);
biochemical research;
electrocardiography;
Ultrasound of the heart;
lipid spectrum research;
coronary angiography;
daily monitoring;
physical examination;
general clinical tests.

The level of blood pressure, respiratory rate and heartbeat must be assessed. The attending physician must collect a detailed history of life and illness. If angina is suspected, stress tests (treadmill test and bicycle ergometry) are performed. The method for diagnosing ischemic heart disease is electrocardiography. In case of a heart attack, the ECG shows a negative T wave and an abnormal QRS complex. With extensive damage, a pathological Q wave is determined. It may not exist.

Decoding the results allows you to evaluate the work of the organ. Each tooth and complex reflects the state of individual chambers in systole and diastole. Using ultrasound, you can evaluate the function of the ventricles and atria, myocardial contractility, and the functioning of the valve apparatus. To determine the patency of the coronary arteries and the degree of their obstruction, coronary angiography is performed.

Therapeutic tactics for ischemic heart disease

In acute forms of ischemic disease, emergency care is required. If you suspect a heart attack, do the following:

call an ambulance;
put a person down;
raise the head end of the bed or place a cushion under your neck;
give a nitroglycerin tablet under the tongue;
remove clothing that restricts movement;
ensure a flow of clean air;
calm the patient;
give painkillers;
make mustard plaster on the chest.

Emergency care includes the use of . This is an antiplatelet agent. It prevents the formation of blood clots. In case of lack of breathing and cardiac arrest, resuscitation measures are carried out. Treatment of ischemic heart disease after clarification of the diagnosis is determined by the form of ischemia. If angina is detected, long-acting antianginal drugs are prescribed.

Verapamil

These include nitrates (Sustak, Nitrong), calcium channel blockers (Verapamil), peripheral vasodilators (Corvaton), beta-blockers (Anaprilin). Angina therapy involves the use of statins, antiplatelet agents and antioxidants. In severe cases, angioplasty or coronary artery bypass surgery is required. These are radical methods of treatment.

Standards for the treatment of coronary artery disease are known to any cardiologist. Patients with myocardial infarction are hospitalized on an emergency basis. Therapy includes the use of antiplatelet agents (Aspirin, Clopidogrel), anticoagulants (Fraxiparine), thrombolytics (Urokinase, Streptokinase). Stenting and angioplasty are often required. It is completely impossible to cure patients with heart attacks.

In case of heart rhythm disturbances, therapy involves the use of medications such as Amiodarone, Lidocaine and Atropine. If necessary, a pacemaker is installed. Not everyone knows how to treat heart failure. Therapy is aimed at the main cause of its occurrence.

Digoxin

In case of acute deficiency, rest is required. Reduce fluid intake to 500 ml. Symptoms and treatment are related. If there are signs of thrombosis, anticoagulants and antiplatelet agents are prescribed. For heart failure, glycosides (Digoxin, Strophanthin, Korglykon), nitrates, ACE inhibitors (for high blood pressure), beta-blockers, and diuretics are indicated.

Methods for preventing coronary heart disease

You need to know not only what coronary heart disease is, but also what its prevention should be. To reduce the risk of developing CHD, you need to:

get rid of bad habits (smoking, drinking alcohol and drugs);
move more;
exercise;
promptly treat arterial hypertension;
limit consumption of foods rich in animal fats;
treat endocrine diseases;
eliminate stress;
increase immunity.

There is no specific prevention. There are risk factors for the development of coronary artery disease that cannot be eliminated (, old age). Prevention of myocardial infarction comes down to controlled treatment of hypertension. People who regularly take ACE inhibitors have a significantly lower risk of developing a heart attack.

If various clinical syndromes (pain, swelling) appear, you should immediately consult a doctor.

Prevention of coronary artery disease includes periodic examination. Electrocardiography and fluorography should be performed at least once a year.

Prevention of coronary disease includes normalization of nutrition.

Almost always the cause of angina and heart attack is atherosclerosis. To prevent it, you need to eat more fruits and vegetables. Additionally, it is recommended to include in the diet foods that have anti-atherosclerotic effects. These include sunflower and olive oils, fish, and nuts. Seafood is very healthy. Ischemic syndrome can be prevented by following all these rules. Normalizing weight is of great importance, since obesity is a risk factor for the development of coronary artery disease.

Thus, the presence of symptoms of coronary heart disease is a reason to contact a cardiologist and undergo a comprehensive examination. When identifying IHD, taking medication alone is not enough. must be combined with diet and management healthy image life. In the case of the development of a large infarction and acute heart failure, the prognosis is relatively unfavorable.

Video

Having felt pain in the heart or regular malaise associated with unpleasant sensations in the chest, we go to a cardiologist and, after undergoing a series of examinations, we see in the line with the inscription “diagnosis” three mysterious letters - IHD. What it is? Let's figure it out.

Diagnosis: IHD

Coronary heart disease is a lesion of the myocardial walls caused by impaired circulatory function, which can manifest itself in both chronic and acute forms.

The history of coronary artery disease is the occurrence of an imbalance between the required level of blood supply to the heart muscle and the actual coronary blood supply. This condition can occur if the need for blood supply increases sharply, but it does not happen, or if normal conditions the level of blood flow decreases. Then various changes occur in the myocardium due to oxygen starvation of tissues, which are characterized by the presence of: dystrophy, sclerosis or necrosis. Such conditions can be considered as an independent disease or a component of more severe forms: myocardial infarction, angina pectoris, heart failure, cardiac arrest or post-infarction cardiosclerosis.

Thus, answering the question “IHD: what is it,” we can say that it is a deficiency of blood supply to myocardial tissue, leading to its physiological changes, that is, the development of ischemia.

Causes and risk factors

In most cases, the causes of ischemia are atherosclerosis of the arteries of varying degrees of complexity, from the presence of plaques to complete blockage of the lumens. In this case, a disease called “angina pectoris” develops.

Also, against the background of atherosclerotic changes, spasms of the coronary arteries may occur, as a result of which the most common forms of coronary heart disease occur - angina pectoris, arrhythmia, hypertension.

Factors contributing to the development of this disease include:

Arterial hypertension, which increases the chances of ischemia by 5 times.
Hyperlipidemia causes the development of atherosclerosis and, as a consequence, ischemia.
Smoking. Nicotine causes a steady contraction of vascular muscle tissue, impairing blood circulation throughout the body.
Impaired carbohydrate tolerance as a result of diabetes mellitus.
Obesity and physical inactivity become prerequisites for the development of ischemia.
Heredity and old age.

Classification

"IHD: what is it?" - a question arises for a person and his relatives if a doctor makes such a diagnosis. To understand what risks a patient faces, it is necessary to refer to WHO recommendations for identifying and systematizing forms of the disease:

Coronary death or cardiac arrest usually develops suddenly and is an unexpected condition. If such a patient is away from other people and is unable to call for help, sudden death may occur after a heart attack.
Angina pectoris, which can be stable, post-infarction, spontaneous.
Painless form of ischemia.
Myocardial infarction.
Cardiosclerosis post-infarction.
Arrhythmia.
Heart failure.

IHD: symptoms

Depending on the form in which ischemia develops, clinical manifestations may be different. However, as a rule, the disease is not permanent, but periodic in nature, when states of exacerbation and complete absence of symptoms can alternate. Most often, patients who are diagnosed with coronary artery disease do not suspect the presence of any heart disease, since they do not feel constant ailments or any regular pain in the heart area. Therefore, the disease can develop over several years and be aggravated by other more severe conditions.

With IHD, symptoms may manifest as follows:

Pain in the area of the heart muscle, especially during physical activity and stress.
Pain occurring on the left side of the body: in the back, arm, left side of the jaw.
Shortness of breath, rapid heart rhythms, sensations of rhythmic disturbance.
A state of general weakness, nausea, dizziness, increased sweating.
Swelling in the lower extremities.

It is quite rare for all of these symptoms to occur at the same time to give a complete picture of what is happening. However, any feeling of discomfort in the sternum or the presence of the symptoms described above, especially with a stable or frequently recurring occurrence, should be a signal to be examined for the presence of coronary artery disease in any form.

Progression of the disease

Possible complications of coronary artery disease are damage or functional changes in the state of the myocardium, which cause:

Violations of diastolic and systolic functions.
Development of atherosclerotic foci.
Disorders of the contractile function of the left ventricle of the heart.
Disorders of automatic contractility and excitability of myocardial tissue.
Insufficient level of ergonomics and metabolism of myocardial cells.

Such changes can lead to a significant and prolonged deterioration of coronary circulation and can progress to heart failure.

Diagnosis of IHD

Ischemia can be detected through the combined use of various methods of instrumental observation and analysis, as well as during the initial examination of the patient and collection of anamnesis.

When conducting an oral interview, the cardiologist pays attention to the patient’s complaints, the presence of some discomfort in the heart area, regular descending edema in the lower extremities, as well as cyanosis of the skin tissue.

Laboratory diagnostic analysis is used to study the presence of specific enzymes, the level of which increases when IHD occurs, these are: creatine phosphokinase, aminotransferase, myoglobin.

Additionally, a study of the level of blood sugar, cholesterol, lipoproteins, triglycerides, the level of androgenic and antiandrogenic densities, and nonspecific markers of cytolysis is prescribed.

The most informative and mandatory are ECG and EchoCG studies. They allow you to detect the slightest changes in the work of the myocardium, as well as visually assess the size and condition of the heart muscle, its valves, the presence of murmurs in the work of the heart and its ability to contract.

In the early stages of development, when there are no pronounced symptoms that could be recorded during a survey or standard studies, ECG studies are used when a special load is given to the heart muscle in the form of physical exercises that help identify the most minor changes in the condition of the myocardium.

Also, when the symptoms are inconsistent, Holter 24-hour ECG monitoring can be used, the essence of which is to monitor the work and condition of the heart on a portable device for one day in order to record changes in the work of the heart. This study is most often used in the development of angina pectoris.

Based on the diagnosis of IHD, treatment and prevention can be prescribed both preventively, in order to prevent more severe forms, and as restorative therapy. Methods can cover both traditional and traditional medicine.

Treatment

In the course of diagnosing and identifying the diagnosis of coronary artery disease, treatment consists of using various approaches aimed at achieving the best result, these are:

Drug therapy.
Non-drug treatment.
Carrying out coronary artery bypass surgery.
Application of methods of angioplasty of coronary vessels.

Drug therapy for ischemic heart disease consists of prescribing drugs: beta-blockers, antiplatelet agents, hypocholesterolemic drugs. Diuretics, nitrates, and antiarrhythmic drugs may also be prescribed.

The influence of non-drug correction on the condition consists of prescribing a special diet and dosage physical activity, herbal remedies and contrasting water procedures can also be used.

When coronary heart disease does not respond well to drug treatment, the question may be raised about the need for coronary artery bypass surgery or coronary angioplasty.

The method of coronary artery bypass grafting involves the application of an autovenous anastomosis, bypassing the narrowing of the arteries, and thereby ensuring normal blood supply to the damaged area of the myocardium. Coronary angioplasty is the dilation of blood vessels by placing special balloons in them and applying frame structures that ensure normal blood flow through the lumen of the vessel.

Forecast

When a diagnosis of IHD is made, treatment is prescribed to stop further development and prevention of its more severe forms. However, changes in the condition of the myocardium are irreversible, and therefore any type of treatment will not lead to complete healing.

Prevention of coronary artery disease

The most effective preventative measures are the elimination of threat factors that provoke the development of the disease and adherence to a special dietary regimen, as well as moderate physical activity.

Having received an answer to the question: “Diagnosis of IHD, what is it?” - first of all, you need to seek advice from a cardiologist and follow all his recommendations, and also take seriously possible consequences in the absence of treatment and preventive measures.

Coronary heart disease (CHD) is a pathological condition in which the heart muscle (myocardium) receives insufficient blood supply. The heart, like all other organs, must receive the substances necessary for normal functioning, which are delivered by the bloodstream. Fresh blood enters the myocardium through the heart’s own arteries; they're called coronary arteries. Narrowing of the lumen of the coronary arteries leads to ischemia (local decrease in blood supply) of the heart muscle. Therefore, coronary heart disease is sometimes called coronary disease.

Forms of IHD

The main forms of coronary heart disease are:

. The main manifestation is pain behind the sternum; shortness of breath, sweating, and severe fatigue may also be observed;
heart rhythm disturbance (arrhythmic form). The most common is atrial fibrillation;
Myocardial infarction is an acute form of ischemic heart disease. During a heart attack, part of the heart muscle tissue dies (limited necrosis). The reason is complete closure of the artery lumen;
sudden cardiac arrest (coronary death).

IHD leads to the development of conditions such as post-infarction cardiosclerosis (the growth of connective scar tissue at the site of necrotic lesions) and heart failure (when the heart is unable to provide its “motor” function at the proper level and provide sufficient blood supply). These conditions are also included in the concept of coronary artery disease.

Causes of coronary heart disease

In the vast majority of cases, the cause of the development of IHD is. Atherosclerosis is characterized by the formation of plaques (fatty deposits) on the walls of the arteries, which gradually block the lumen of the vessel. Such plaques can also appear on the walls of the coronary arteries. Gradually increasing disruption of blood flow in the coronary arteries leads to the development chronic forms IHD. Acute forms IHD is usually caused by blockage of a vessel with a thrombus or a detached part of an atherosclerotic plaque.
Other causes of IHD are:

spasm of the coronary arteries;
increased blood clotting. In this case, the risk of blood clots increases;
an increase in heart size (a consequence of some diseases). At the same time, the growth of the vascular network lags behind. The result is a lack of blood supply to the enlarged heart muscle;
persistent low or high blood pressure (hypotension or hypertension);
(thyrotoxicosis) and some others.

Factors contributing to the development of ischemic heart disease

The risk of developing coronary heart disease increases:

smoking;
increased cholesterol levels in the blood;
(overweight);
arterial hypertension;
physical inactivity (low physical activity).

People over 50 years of age are at risk. Moreover, men suffer from coronary heart disease more often than women. The hereditary factor is also important: the likelihood of developing IHD increases if it was detected in one of your close relatives.

Symptoms of coronary heart disease

Symptoms of IHD depend on the specific form of the disease. There is also an asymptomatic course of coronary heart disease, which can be observed at an early stage of the development of this disease.

In some cases, you should immediately call an ambulance:

if symptoms of IHD (listed below) are observed for the first time;
if chest pain is not relieved by nitroglycerin and lasts more than 15 minutes;
if the pain is unusually strong or is accompanied by other previously absent symptoms (for example, it radiates to the shoulder, arm or lower jaw);
during episodes of suffocation or loss of consciousness in the patient.

The main symptoms of coronary heart disease are as follows:

Nausea may be accompanied.

The occurrence of nausea in heart failure is caused by dysfunction of the digestive organs due to hypoxia (oxygen deficiency in tissues) and reflex influences. Also, due to changes in the structure of myocardial muscle tissue and a decrease in heart function, intracardiac pressure increases, tissue swelling appears in the chest and peritoneum, which also contributes to the occurrence of nausea.

Dizziness

Dizziness with ischemic heart disease occurs due to the fact that the brain does not receive the required amount of oxygen. Episodes of loss of consciousness (fainting) may occur.

Methods for diagnosing coronary heart disease

When examining a patient, the doctor determines which diagnostic methods are necessary in this particular case.

Diagnosis of IHD is carried out. To determine the condition of the heart, the following are used:

Inactive diagnostic method

To identify changes that cannot be detected during examination at rest (at a doctor’s appointment), it can be used. Sensors are attached to the patient’s body, the information from which is sent to a portable device. The patient leads his usual lifestyle. The received data is then processed. In this way, cardiac abnormalities are detected.

Treatment methods for coronary heart disease

Treatment of coronary artery disease is aimed at normalizing the blood supply to the heart muscle, reducing the risk of myocardial infarction, and reducing the frequency and intensity of angina attacks. Timely and adequate treatment of coronary heart disease will improve the patient’s quality of life and save life for many years.