How does coronary heart disease develop? Coronary heart disease (CHD, CHD): how to recognize the danger and treat the disease in time. Treatment methods for coronary heart disease

IHD (in the deciphered definition - coronary heart disease) groups a complex of diseases. They are characterized by unstable blood circulation in the arteries supplying the myocardium.

Ischemia - insufficient blood supply - is caused by narrowing of the coronary vessels. Pathogenesis is formed under the influence of external and internal factors.

IHD leads to death and disability in working age people around the world. WHO experts estimate that the disease is becoming cause of the annual death of more than 7 million people. By 2020, mortality could double. It is most widespread among men 40–62 years old.

The combination of the processes discussed below increases the risk of morbidity.

Main causative factors:

Atherosclerosis. The disease, which occurs in a chronic form, affects the arteries that approach the heart muscle. Vascular walls thicken and lose elasticity. Plaques formed by a mixture of fats and calcium narrow the lumen, and the deterioration of blood supply to the heart progresses.
Spasm of coronary vessels. The disease is caused or formed without it (under the influence of external negative factors, for example, stress). The spasm changes the activity of the arteries.
Hypertonic disease- the heart is forced to fight high pressure in the aorta, which disrupts its blood circulation and causes angina pectoris and heart attack.
Thrombosis/thromboembolism. In the artery (coronary), a thrombus is formed as a result of the disintegration of an atherosclerotic plaque. There is a high risk of blockage of the vessel by a blood clot that has formed in another part circulatory system and got here through the bloodstream.
or .

Atherosclerosis is the main cause of the development of coronary artery disease.

Risk factors include:

hereditary factor - the disease is transmitted from parents to children;
persistently elevated “bad” cholesterol, causing the accumulation of HDL – high-density lipoprotein;
smoking;
obesity of any degree, fat metabolism disorders;
arterial hypertension – high level pressure;
diabetes (metabolic syndrome) - a disease caused by a disruption in the production of the pancreatic hormone - insulin, which leads to disruptions in carbohydrate metabolism;
deprived physical activity Lifestyle;
frequent psycho-emotional disorders, character and personality traits;
adherence to unhealthy fatty foods;
age – risks increase after 40 years;
gender – men suffer from ischemic heart disease more often than women.

Classification: forms of coronary heart disease

IHD is divided into several forms. It is customary to distinguish between acute and chronic conditions.

Cardiologists manipulate the concept of acute coronary syndrome. It combines some forms of coronary artery disease: myocardial infarction, angina pectoris, etc. Sometimes sudden coronary death is included here.

What is dangerous, complications, consequences

Coronary heart disease indicates the presence of changes in the myocardium, which leads to the formation of progressive failure. Contractility weakens, the heart does not provide the body with the required amount of blood. People with IHD get tired quickly and experience constant weakness. Lack of treatment increases the risk of death.

Clinic of the disease

Manifestations can appear complexly or separately, depending on the form of the disease. There is a clear relationship between the development pain localized in the heart area, and physical activity. There is a stereotype of their occurrence - after a rich meal, under unfavorable weather conditions.

Description of pain complaints:

character – pressing or squeezing, the patient feels a lack of air and a feeling of increasing heaviness in the chest;
localization - in the precordial zone (along the left edge of the sternum);
negative sensations can spread over the left shoulder, arm, shoulder blades or both arms, into the left prescapular area, into cervical region, jaw;
painful attacks last no more than ten minutes, after taking nitrates they subside within five minutes.

We talked in more detail about, including differences in symptoms between men and women and risk groups, in a separate article.

If the patient does not seek treatment and the disease progresses long time, the picture is complemented by the development of swelling in the legs. The patient suffers from severe shortness of breath, which forces him to take a sitting position.

A specialist who can help with the development of all the conditions discussed is a cardiologist. Prompt access to medical attention can save lives.

Diagnostic methods

Diagnosis of IHD is based on the following examinations:

To clarify the diagnosis and exclude the development of other diseases, a number of additional studies are carried out.

According to the plan, the patient receives a set of stress tests (physical, radioisotope, pharmacological), undergoes examinations using the X-ray contrast method, computed tomography heart, electrophysiological study, Dopplerography.

How and with what to treat

Tactics complex therapy IHD is developed based on the patient’s condition and an accurate diagnosis.

Therapy without drugs

Principles of treatment of ischemic heart disease:

daily dynamic cardio training (swimming, walking, gymnastics), the degree and duration of the load is determined by the cardiologist;
emotional peace;
formation of a healthy diet (ban on salty, fatty foods).

Pharmacological support

The treatment plan may include the following drugs:

Anti-ischemic– reduce myocardial oxygen demand:

Calcium antagonists are effective in the presence of contraindications to beta blockers and are used when the effectiveness of therapy with their participation is low.
beta blockers - relieve pain, improve rhythm, dilate blood vessels.
nitrates – stop attacks of angina pectoris.

Antiplatelet agents– pharmacological preparations, reducing blood clotting.
ACE inhibitors– complex action drugs to lower blood pressure.
Hypocholesterolemic medications (fibrators, statins) – eliminate bad cholesterol.

As additional support and as indicated, the treatment plan may include:

diuretics– diuretics to relieve swelling in patients with coronary artery disease.
antiarrhythmics– maintain a healthy rhythm.

Find out more in a separate publication.

Operations

Regulation of blood supply to the myocardium surgically. A new vascular bed is brought to the ischemic site. The intervention is implemented in case of multiple vascular lesions, low effectiveness of pharmacotherapy and a number of concomitant diseases.

Coronary angioplasty. Wherein surgical treatment IHD, a special stent is introduced into the affected vessel, which keeps the lumen normal. Heart blood flow is restored.

Prognosis and prevention

Cardiologists note that IHD has a poor prognosis. If the patient follows all the instructions, the course of the disease becomes less severe, but it does not disappear completely. Among preventive measures effective management healthy image life ( proper nutrition, absence of bad habits, physical activity).

All persons who are predisposed to developing the disease are recommended to regularly visit a cardiologist. This will allow you to maintain a full quality of life and improve your prognosis.

A useful video about what kind of diagnosis is “coronary heart disease”; all the details about the causes, symptoms and treatment of coronary artery disease are described:

Coronary heart disease (CHD)- This 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;
violation heart rate(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. Hereditary factor It 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 in early stage 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 due to dysfunction digestive organs due to hypoxia (oxygen deficiency in tissues) and reflex influences. Also due to the change in structure muscle tissue myocardium and decreased cardiac function, intracardiac pressure increases, tissue swelling appears in the chest and peritoneum, which also contributes to 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.

Risk factors for coronary heart disease
Symptoms
Angina pectoris
Diagnostics
Treatment
Unstable angina and myocardial infarction
Symptoms
Diagnosis and treatment

Cost of admission
For adults
For children
Doctors treating
Make an appointment

Coronary heart disease (CHD) is the most common reason deaths of people in developed countries. Russia is no exception here. The cause of IHD is coronary atherosclerosis, that is, partial or complete blockage of one or more coronary arteries (arteries that supply blood to the heart itself) with atherosclerotic plaques. However, IHD and coronary atherosclerosis are not synonymous. In order to make a diagnosis of coronary artery disease, it is necessary to prove the presence of myocardial ischemia using functional diagnostic methods. Often the diagnosis of IHD is made unreasonably, especially in old age. IHD and elderly age- these are also not synonyms. There are several forms of IHD. The most common of them will be discussed below - exertional angina, unstable angina, myocardial infarction. Other forms of IHD include ischemic cardiomyopathy, silent myocardial ischemia, microcirculatory angina (cardiac syndrome X).

Risk factors for coronary heart disease

The risk factors for IHD are the same as for atherosclerosis in general. These include arterial hypertension(persistent increase in level blood pressure above 140/90), diabetes mellitus, smoking, heredity (myocardial infarction or sudden death one or both parents under the age of 55), sedentary lifestyle, obesity, excess blood cholesterol. The most important part of the prevention and treatment of coronary artery disease is the impact on risk factors.

Symptoms

The main manifestation of myocardial ischemia is chest pain. The severity of pain can vary - from mild discomfort, a feeling of pressure, burning in the chest to severe pain during myocardial infarction. Pain or discomfort most often occurs behind the sternum, in the middle chest, inside her. The pain often radiates to left hand, under the shoulder blade or down into the solar plexus area. May get sick lower jaw, shoulder. In a typical case, an angina attack is caused by physical (less often emotional) stress, cold, rich food - everything that causes an increase in the work of the heart. Pain is a manifestation of the fact that the heart muscle does not have enough oxygen: the blood flow provided by the narrowed coronary artery becomes insufficient under load. In typical cases, the attack is eliminated (stopped) with rest on its own or after taking nitroglycerin (or other fast-acting nitrates - in the form of sublingual tablets or spray). It must be borne in mind that nitroglycerin can cause headache and a decrease in blood pressure are direct manifestations of its action. You should not take more than two nitroglycerin tablets on your own: this is fraught with complications. There may be no complaints (this is the so-called silent myocardial ischemia), sometimes the first manifestation of IHD is myocardial infarction or sudden death. In this regard, everyone who has risk factors for atherosclerosis and who is going to engage in physical exercise needs to undergo a stress test (see below) to make sure that myocardial ischemia does not occur during exercise. Interruptions in the heart (extrasystoles) in themselves are not a sign of coronary artery disease. The cause of extrasystoles most often remains unclear, and extrasystole itself does not require treatment. Nevertheless, in patients with coronary artery disease, extrasystole often occurs during physical activity: if you conduct a stress test and make sure that the extrasystole disappears during exercise, this indicates its benign nature, that it is not life-threatening. Complaints ischemic cardiomyopathy characteristic of heart failure of any other origin. First of all, it is shortness of breath, that is, a feeling of lack of air during exertion, and in severe cases, at rest.

Angina pectoris

Angina pectoris is otherwise called stable angina. Angina is considered stable if its severity remains constant for several weeks. The severity of stable angina may vary somewhat depending on the patient's activity level and ambient temperature. New-onset angina is called angina that occurred a few weeks ago. This is a borderline state between stable and unstable angina. The severity of angina pectoris is characterized by its functional class: from the first (mildest), when attacks occur only during heavy physical work, to the fourth, most severe (attacks with little physical activity and even at rest).

Diagnostics

An electrocardiogram (or echocardiography) at rest is NOT a method for diagnosing coronary artery disease. Sometimes these methods, however, make it possible to diagnose or detect coronary artery disease, for example, if signs of a previous myocardial infarction can be detected, or if they are performed against the background of chest pain. Holter monitoring (ECG monitoring) also does not serve as a method for diagnosing coronary artery disease, although this method is used unreasonably widely for this purpose. ST segment depressions that are detected by Holter ECG monitoring are often nonspecific (i.e., false), especially in women. Holter monitoring only allows one to identify the main method for diagnosing ischemic heart disease. stress tests. The main types of stress tests are: ECG tests with exercise and stress echocardiography, that is, echocardiography performed during exercise (or immediately after its completion) or against the background of the administration of drugs that increase heart function (for example, dobutamine). Myocardial scintigraphy ( isotope study heart surgery) in Russia is performed in only a few centers and is practically inaccessible. Based on the results of stress tests, a decision is made whether to refer the patient for coronary angiography. It is almost never necessary to begin the examination with coronary angiography. This best method visualize (look at) lesions of the coronary arteries (atherosclerotic plaques), but evaluate them functional significance(whether they cause myocardial ischemia or not) coronary angiography often cannot.

Treatment

There are three main treatment options for exertional angina: medication, coronary stenting (angioplasty with stent placement) and coronary artery bypass grafting. In any case, treatment begins with active influence on risk factors: with a low-cholesterol diet, with smoking cessation, with normalization of blood pressure, etc. Each patient diagnosed with coronary artery disease must, in the absence of contraindications, take at least three drugs: beta- an adrenergic blocker (for example, metoprolol, bisoprolol, nadolol), an antiplatelet agent (most often aspirin) and a statin (for example, atorvastatin, rosuvastatin). It must be borne in mind that neither coronary stenting nor coronary bypass surgery in general prolongs life. There are only select groups of patients for whom this is not true. Thus, bypass surgery prolongs life in patients with damage to several vessels in combination with diabetes mellitus, with severely reduced overall contractile function of the heart, and with damage to the proximal (initial) parts of the left coronary artery. Stenting for stable angina also has a limited scope vital signs, and generally serves to improve the quality of life (that is, the elimination of symptoms), rather than its duration. It must be borne in mind that the stented artery, although it looks like normal on the pictures, in reality it is not. Stents (expanded metal springs) are susceptible to thrombosis and other complications. Therefore, after stenting for a long time, it is necessary to take not only aspirin, but also another antiplatelet agent - clopidogrel, and this, in turn, increases the risk of bleeding. In any case, the decision on the treatment method must be made together with the attending physician, therapist or cardiologist, and not with the angiographer or cardiac surgeon - those who perform stenting or bypass surgery.

Unstable angina and myocardial infarction

These two life-threatening conditions are caused by the fact that at some point the atherosclerotic plaque in the coronary artery becomes unstable (its lining is damaged, it ulcerates). Unstable angina and myocardial infarction constitute the so-called acute coronary syndrome, which requires immediate hospitalization. In almost half of the cases, acute coronary syndrome is not preceded by angina, that is, it develops against the background of apparent health.

Symptoms

Most often, acute coronary syndrome is manifested by severe unbearable pain in the chest (behind the sternum or below - in the solar plexus, “in the pit of the stomach”).

Diagnosis and treatment

The modern tactics of treating such patients is to immediately transport them to a hospital, where it is possible to perform emergency stenting of the coronary artery in which the catastrophe occurred. We must act immediately: about half of those who die from myocardial infarction die within the first hour after the first signs appear. Unstable angina is distinguished from myocardial infarction by the reversibility of myocardial damage: during a heart attack, part of the myocardium supplied with blood from the affected artery dies and is replaced by scar tissue; with unstable angina, this does not happen. With myocardial infarction, there are characteristic changes in the electrocardiogram, an increase and then a decrease in the level of several proteins - markers of myocardial necrosis, and impaired contractility of several segments of the left ventricle according to echocardiography. The anterior myocardial infarction has its own complications, while the lower one has its own. Thus, with anterior myocardial infarction it is much more common cardiogenic shock, pericarditis (so-called epistenocardial pericarditis), left ventricular rupture, false and true left ventricular aneurysms, dynamic left ventricular obstruction, left bundle branch block. Inferior infarction is characterized by transient disturbances atrioventricular conduction, mitral insufficiency, rupture of the interventricular septum, damage to the right ventricle. After a period of hospitalization, rehabilitation is carried out: a regimen of physical activity is developed, medications are prescribed for constant use. Anyone who has had a myocardial infarction should, unless contraindicated, take at least four medications continuously: a beta blocker (eg, metoprolol, bisoprolol, nadolol), an antiplatelet agent (most often aspirin), a statin (eg, atorvastatin, rosuvastatin) and an ACE inhibitor ( enalapril, lisinopril and others). Before discharge from the hospital or immediately after it, it is necessary to conduct a stress test (preferably stress echocardiography) and decide on the advisability of coronary angiography.

Ischemia, the symptoms of which are not limited to chest pain, is a disorder coronary circulation, which leads to insufficient blood supply to the myocardium, metabolic disorders and inadequate oxygen supply to the heart muscle. IN Lately quite common disease cordially- vascular system, which leads to severe irreparable deterioration in health and even fatal outcome. The risk group includes mainly men, women during and also after menopause, which, with changes in hormonal levels, brings with it a weakening of the body and provokes many diseases.

There are several forms of cardiac ischemia:

Initial - manifests itself painlessly. There is a decrease in blood pressure, discomfort in the chest, shortness of breath.
Primary arrest - characterized by cardiac arrest. IN in this case without immediate professional help it can be fatal.
Angina pectoris. There is a blockage of the coronary arteries with plaques, causing painful sensations in the chest, arm, neck, face.
Heart attack. Stopping the full flow of blood to the parts of the heart.
Heart failure or cardiosclerosis. Scarring of areas of the heart, abnormal shape of the valves.

If you fail to apply in a timely manner medical care serious complications are possible. At the first signs, you should immediately consult a doctor. The cardiovascular system is involved in the process of blood circulation throughout the body, and the heart, as its independent organ, also needs blood supply. Coronary vessels or arteries supply the myocardium and heart muscle.

But there are reasons that lead to disruption of this process and the development of coronary artery disease:

Atherosclerosis. The formation of cholesterol on the walls of blood vessels.
Arterial hypertension. Due to the constant increase in blood pressure, the left ventricle enlarges and the proper blood supply is impaired.
Diabetes. Leads to the formation of cholesterol plaques, which impede blood circulation.
Thrombosis. The mechanism of rapid blood clotting makes it impossible for it to flow through the vessels into the organs.

These diseases often not only provoke ischemia, but are subsequently concomitant diseases. They make the treatment and recovery of patients much more difficult.

Not only diseases, but also the characteristics of the body and the life activity of the person himself can provoke disturbances and improper functioning of the organs of the cardiovascular system:

Stress, nervous tension. Lead to constant arrhythmia, disruption of flow nutrients and oxygen to the organs.
Genetic predisposition. It is inherited along with the genetic code.
Gender. Ischemia occurs more often in men.
Excess weight. Exceeding normal body weight increases the volume of blood that the heart must pump out per beat. The tone of the walls gradually deteriorates, and the load on the vessels increases.
Having bad habits. Smoking causes excessive amounts of carbon monoxide and a lack of oxygen in the blood.

Gradually and with age, blood vessels lose their elasticity, so after 45-50 years there is a high probability that ischemia will appear. Symptoms in the stronger sex are more pronounced, as they are more vulnerable to ischemia. This is not only due to physiological characteristics. The reasons are difficult working conditions, bad habits and stressful situations.

Failure to consult a doctor in a timely manner when there are complaints of coronary artery disease leads to coronary heart disease, which manifests itself in men with characteristic symptoms:

severe pain in the chest;
lack of air, shortness of breath;
fainting, darkening of the eyes;
dizziness and migraines;
attacks of nausea;
increased sweating;
attacks of arrhythmia.

The prerequisites for the occurrence of cardiac ischemia in this case are atherosclerosis, the formation of blood clots in the vessels, increased level cholesterol and spasms of coronary vessels. All this contributes to a lack of nutrients in the body and disruption of the proper blood circulation process.

Signs of cardiac ischemia in women and children

Signs of cardiac ischemia in women are not as clear as in men, since for a long time Only men were susceptible to cardiac ischemia. In women, this disease was observed quite rarely. Now it is considered age-related and manifests itself during menopause. Changes occurring in the body, lack of estrogen affects the functioning of the cardiovascular system in 20% of women.

Women still have individual signs of cardiac ischemia:

attacks of acute sharp pain in the back;
short-term angina - lasts no more than 15 minutes;
dyspnea;
indigestion;
In the evening, swelling of the limbs may appear;
loss of consciousness or frequent dizziness.

In women, the cause of cardiac ischemia can be stress, heavy mental work, and age over 55 years. Then, as in men, the disease begins at the age of 40.

Diseases of the cardiovascular system affect even children younger age. There are several reasons for their occurrence. These include heredity, overwork during educational process, congenital pathologies.

In a child, ischemia exhibits its characteristic symptoms:

Pain, feeling of compression of the chest. Duration reaches 30 minutes.
Numbness and sharp pain left side of the face, hand and forearm.
Lack of oxygen, shortness of breath, signs of suffocation.

In most cases, even the drug Nitroglycerin is not able to alleviate the condition. IN childhood Mortality from coronary disease is much higher. Therefore, at the first even the slightest suspicion of cardiac dysfunction, it is urgent to call an ambulance.

An ischemic attack usually begins after heavy physical exertion or severe emotional shock. A person feels a squeezing pain in the chest, and there is profuse sweating.

In such cases, it is necessary to know exactly the rules of how to provide first aid for angina pectoris:

call an ambulance immediately emergency assistance;
it is convenient to place the patient on the bed, raising his head and loosening the belt and collar of his clothes;
try to calm and distract;
open the windows, turn on the fan or air conditioner in the summer;
pour into a heating pad warm water and place it at the patient’s feet.

You can also give the drug “Nitroglycerin”; depending on the severity, you can give from 1 to 4 tablets. The person should put them under the tongue and suck them.

If you have angina, you should not cause excitement, give unfamiliar drugs, or force the person to move. Until the ambulance arrives, it is better to remain quiet and, in case of severe anxiety, use valerian tincture.

Most The best way avoiding ischemia means constantly monitoring your health and undergoing medical examination. If symptoms suddenly appear in the chest area or left side of the body, contact a specialist.

The main measures to prevent coronary disease are simple daily rules that must be followed:

Eat a healthy, nutritious diet. Control your weight and avoid obesity.
Move more and accustom your body to walks in the fresh air.
Don't forget about physical activity.
Get rid of bad habits.
If you have a hereditary predisposition, spend more time visiting doctors.
Take, on the advice of a specialist, medications that strengthen the heart and blood vessels, for example, Entresto (you can read about the drug) or the medicine Cordanum.

Many diseases are the result of the wrong lifestyle of the person himself. We must also take into account environmental problems, which also play a big role in deteriorating health. Avoid stressful situations and unnecessary stress in every possible way.

IHD is a group of acute and chronic diseases of the heart muscle, the morphological basis of which is atherosclerosis of the coronary arteries. The pathophysiological basis of the disease lies in the discrepancy between the heart's need for blood supply and the actual delivery of blood to the heart. This discrepancy arises not only due to atherosclerotic narrowing of the lumen of the coronary vessels, but also due to the development of platelet aggregates in these vessels, periodic spasm (narrowing) of the vessels.

Classification of coronary heart disease

(VKSC Amn USSR, 1983. Based on suggestions from WHO experts (1979).

Sudden coronary death (primary cardiac arrest).

Angina pectoris.

Angina pectoris.
1. new-onset angina pectoris,
  stable angina pectoris (indicating the functional class from I to IV),
  progressive exertional angina.

Spontaneous, or variant angina(Prinzmetal).

Myocardial infarction:

large-focal (transmural),

fine focal (non-transmural),

Post-infarction cardiosclerosis (indicating the date of the infarction).

Heart rhythm disturbances (indicating the form).

Heart failure (indicating stage and form).

“Silent” form of IHD.

ANGINA

Angina pectoris is a peculiar attack-like pain syndrome, most often occurring behind the sternum or to the left of the sternum against the background of atherosclerosis or vasospasm of the coronary arteries. The pathophysiological basis of the pain syndrome is myocardial ischemia.

As can be seen from the presented classification of coronary heart disease (Table 9), angina is divided into angina pectoris And spontaneous angina. In turn, angina pectoris is divided into new-onset angina pectoris, stable angina pectoris and progressive angina pectoris. Clinically, the most common is stable angina pectoris.

About new-onset angina pectoris they say in cases where no more than one month has passed since the onset of the first attack.

Stable exertional angina

Complaints: Chief complaint – typical pain behind the sternum or to the left of it. It is paroxysmal, most often pressing or compressive , accompanied by a feeling of fear of death. Duration of pain 3-5 minutes , less often 15-20 minutes, often radiates to the left shoulder, left arm, scapula, less often to the neck, lower jaw, interscapular space, sometimes to the epigastric region (Fig. 55), associated with physical activity , increased blood pressure, psycho-emotional agitation. It stops (decreases) when you stop exercising or immediately after taking nitroglycerin. A distinctive diagnostic feature of stable angina pectoris is the stereotypic nature of its course; all attacks are similar to each other and occur only during a certain physical activity. In this regard, patients, knowing all these nuances, adapt to their condition and, by adjusting the level of physical activity or taking preventive nitroglycerin before such exercise, prevent angina attacks.

Inspection: with intense pain, the skin is pale, sweating is noted, especially on the forehead. Patients behave calmly, try to “lay low,” and are characterized by forced adynamia. On the street, patients stop and, in order to hide their condition, pretend to look at shop windows (“window display symptom”). Often during an attack, patients place a clenched fist on the heart area (“fist symptom”). With chronic ischemic heart disease, patients constantly feel pain in the area of the pectoralis major muscle on the left (“the sign of the medal block”).

Palpation: increased pain sensitivity in the Zakharyin-Ged zones, which can persist for several hours after the pain attack disappears.

Heart percussion: the borders of the heart are not changed (if there is no arterial hypertension and severe cardiosclerosis), the vascular bundle in the 2nd intercostal space is often enlarged. Auscultation of the heart: at the time of an angina attack - muting the first tone at the apex, often accent II tone on the aorta, the appearance of arrhythmias (usually extrasystoles). A decrease in heart rate and an increase in blood pressure are often observed.

Fig.55. Zones of localization and irradiation of pain in angina and myocardial infarction.

Electrocardiography. On ECG , taken during an attack of angina, signs of coronary circulatory disorders can be determined: ST interval offset more often down, less often up from the isoline by more than 1 mm. Less specific is the reduction, smoothing or appearance of a negative T wave. In a number of patients, the T wave becomes high and pointed. These changes not in all leads, but more often only in leads 1, II, V 4-6 or III, IIAVF, disappear a few minutes (less often - hours) after the cessation of the attack.

Outside of an attack, there may be no changes on the ECG at rest. Therefore, in order to make a diagnosis, a test with physical activity (bicycle ergometer), drug tests (dipyridamole, ergometrine test) are used. , Holter monitoring (continuous ECG recording for 24 hours). Depending on the severity of the course, stable angina pectoris is divided into 4 functional classes. The functional class reflects the intensity (magnitude) of physical activity at which an attack of pain occurs.

IClass. The patient tolerates normal physical activity well. Angina attacks occur only during high-intensity exercise. The threshold loading power is 125 W or more, determined using a VEP.

IIClass. Slight limitation of usual physical activity. Angina attacks occur when walking on level ground for a distance of more than 500 meters, or when climbing more than one floor. The threshold load power is 75-100 W.

IIIClass. Marked limitation of physical activity. Seizures occur when walking at a normal pace on level ground for a distance of 100 to 500 meters and when climbing one floor. The threshold load power is 50 W.

IVClass. Angina pectoris occurs with small physical activity, walking on level ground for a distance of less than 100 meters. The occurrence of angina attacks is also typical at rest, due to an increase in the metabolic needs of the myocardium. The threshold load power is 25 W or less.

The criteria for diagnosing progressive angina are an increase in frequency and severity of angina attacks, an increase in the frequency of nitroglycerin intake and a decrease in its effectiveness, a deterioration in the general condition of the patient, significant and long-term changes in the ECG (focal depression of the ST segment, the appearance of negative T waves, various heart rhythm disturbances).

Stress echocardiography. This method is more accurate for detecting coronary artery insufficiency. Its essence lies in the echocardiographic assessment of the mobility of the segments of the left ventricle with an increase in heart rate as a result of the administration of dobutamic, transesophageal pacing, or under the influence of physical activity. When the heart rate increases, the myocardial need for oxygen increases and an imbalance occurs between the delivery of oxygen through the narrowed coronary arteries and the need for it in a certain area of the myocardium. In this case, local disturbances in myocardial contractility occur, and the mobility of the ischemic area decreases. Changes in local myocardial contractility precede other manifestations of ischemia (pain, ECG changes).

For the purpose of the most accurate verification of coronary atherosclerosis, one of the most reliable methods is coronary angiography . This method is considered the “gold standard” in the diagnosis of coronary artery disease, since it allows us to identify the presence, location and degree of narrowing of the coronary arteries.