The consequence of ischemia. Adverse consequences of ischemia. By origin

Ischemia is a pathological condition that occurs with a sharp weakening of blood circulation in a certain part of the organ, or in the entire organ. Pathology develops due to a decrease in blood flow. Deficiency of blood circulation becomes the cause of metabolic disorders, and also leads to disruption of the functioning of certain organs. It is worth noting that all tissues and organs in the human body have different sensitivity to lack of blood supply. Less susceptible are cartilage and bone structures. More vulnerable are the brain, heart.

Etiology

The causes of ischemia are as follows:

blood diseases;
severe stress;
injuries of varying severity;
large blood loss;
mechanical compression of the vessel by a tumor of a benign or malignant nature;
spasm of blood vessels;
(blockage of the vessel with an embolus);
poisoning with biological and chemical poisons.

Also the cause of the progression of heart ischemia, lower limbs, the intestine may become a thickening of blood vessel walls, increased pressure on the artery.

Classification

Acute form

This process is characterized by a sudden malnutrition of tissues and organs, which occurs due to a slowdown or cessation of blood flow. Acute ischemia of the myocardium, lower limbs, brain is divided into 3 degrees:

1 - absolute. This is the most severe form of the disease, which leads to disruption of the normal functioning of organs and tissues. If ischemia is observed for a long time, then the changes in the affected organs may become irreversible.

2 - subcompensated. The blood flow rate is critical, so there is no way to fully preserve the functionality of the affected organs.

3 - compensated. This degree of pathology is the mildest.

Chronic form

In this case, blood circulation is disrupted gradually. It should be noted that the term "chronic ischemia" combines a large number of pathologies, each of which has its own clinical picture. The most common pathology of these is cerebral ischemia of the brain. The main reasons for its progression are: atherosclerosis, hypertension, and heart disease.

Forms

The mechanism of development of circulatory disorders has several forms, depending on which the classification of this pathology is carried out. The disease comes in 4 forms:

obstructive. This form of pathology begins to progress due to the formation of blood clots, emboli and atherosclerotic plaques in the artery. These elements interfere with the normal outflow of blood;
angiopathic. The main reason is a spasm of a blood vessel;
compression. It progresses due to mechanical compression of the blood vessels;
redistributive. The reason for the progression of ischemia is the interorgan redistribution of blood flow.

Symptoms

The symptoms of ischemia directly depend on the organ in which the progression of the pathological process is observed.

With the development of chronic cerebral ischemia, the patient's memory is impaired, there is a feeling of lack of air and coordination of movements is significantly impaired. The ability to focus on certain actions also decreases.

Signs of cerebral ischemia occur sharply and are similar in nature to the symptoms of a pre-stroke state. Transient cerebral ischemia is characterized by the following symptoms:

noise in ears;
weakness of the upper and lower extremities;
disorders of the speech apparatus is one of the main symptoms of transient cerebral ischemia. The patient's speech becomes incoherent, words are indistinct, etc.
violation of visual function;
headache;
dizziness;
numbness of the face. This sign of transient ischemia is very important for subsequent diagnosis.

Transient cerebral ischemia is very dangerous, as it can lead to irreversible changes in the organ. Therefore, it is necessary to hospitalize the patient as soon as possible so that the doctors provide him with qualified assistance. Transient ischemia is treated only in an inpatient setting, so that doctors can constantly monitor the general condition of the patient and prevent the progression of complications.

It should be noted that transient ischemic brain disease is a rather unpredictable condition. The manifested neurological symptoms may completely disappear even before the patient is taken to the hospital.

Violation of blood circulation in the intestine

Intestinal ischemia manifests itself as the appearance of a strong pain syndrome localized in the navel region, as well as in the upper right abdomen. Intestinal motility increases, and the patient has frequent urge to defecate. At the first stages of the progression of intestinal ischemia, the following symptoms are observed:

upset stool;
nausea and vomiting;
streaks of blood appear in the excreted excrement.

Body temperature during the first stage of intestinal ischemia is within normal limits. As the disease develops, the following is observed:

hypovolemia;
metabolic acidosis;
hyperamilasemia.

Lack of blood circulation in the limbs

Ischemia of the lower extremities is diagnosed very often. As a rule, the symptomatology of the pathology is pronounced. Due to circulatory disorders in the lower extremities, the following symptoms occur:

pain syndrome in the muscle structures of the lower extremities. Tends to increase at night;
due to inadequate supply of blood and nutrients, trophic ulcers form on the skin of the legs. The main localization is the feet and toes;
intermittent claudication. A person with ischemic disease of the lower extremities cannot move fully. Due to circulatory disorders and severe pain in calf muscles, he is forced to periodically stop and rest.

If you don't pay attention to specified symptoms, then the progression of critical lower limb ischemia is possible. Pain syndrome is constantly observed and its intensity does not decrease at rest. Along with trophic ulcers, necrosis develops on the skin of the lower extremities. If ischemia is not treated, then a person may lose part of a limb.

Violation of blood circulation in the heart muscle

The main symptom of coronary heart disease is the appearance. The patient notes that he had severe pain behind the breastbone, as well as a feeling of lack of oxygen. It should be noted that the pain syndrome usually manifests itself with physical overload, strong psycho-emotional shock.

Myocardial ischemia can occur without severe pain. It is possible to identify the progression of the pathology during a heart examination. Indirect signs of the disease:

dyspnea. With myocardial ischemia, shortness of breath is usually observed with exercise. The patient becomes much easier when he sits down;
weakness and pain in the left hand;
decrease in blood pressure;
cyanosis skin;
increased frequency of extrasystoles;
heartburn.

Myocardial ischemia - extremely dangerous condition, which can be fatal if a heart attack develops in the affected area.

Diagnostics

The standard plan for the diagnosis of coronary heart disease, brain and other organs includes the following methods:

ECG is one of the most informative methods for diagnosing heart ischemia;
coronary angiography - allows you to assess the state of the coronary vessels of the heart;
stress testing;
ultrasound cardiography.

Treatment

Treatment of coronary heart disease or other organs is carried out only after a thorough diagnosis, identifying the true cause of the pathology, and assessing the severity of the disease. The treatment of ischemia is carried out using physiotherapy, medication and surgical techniques. In the case of choosing drug treatment, the patient is injected intravenously with prostaglandins, thrombolytics, as well as drugs to improve blood flow.

It is possible to completely eliminate the cause of vessel occlusion and normalize its patency by stenting the anterior vessel wall. Also, doctors often resort to coronary angioplasty.

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Diseases with similar symptoms:

Pulmonary insufficiency is a condition characterized by the inability of the pulmonary system to maintain a normal blood gas composition, or it is stabilized due to a strong overstrain of the compensatory mechanisms of the external respiration apparatus. The basis of this pathological process is a violation of gas exchange in the pulmonary system. Because of this, the required amount of oxygen does not enter the human body, and the level of carbon dioxide is constantly increasing. All this becomes the cause of oxygen starvation of organs.

The reasons for the increase in resistance to blood flow in the arteries:

Compression (external compression) of the bringing vessels (tumor, scar, ligature, foreign body). This ischemia is called compression.

Obturation of the bringing vessels - as a result of complete or partial closure from the inside of the lumen of the artery by a thrombus or embolus.

Angiospasm of the bringing arteries - as a result of vasoconstriction of vascular smooth muscles. Arterial spasm mechanisms: a) extracellular - associated with prolonged circulation of vasoconstrictor substances in the blood. These are: catecholamines, serotonin; b) membrane - associated with a violation of the process of repolarization of membranes of smooth muscle cells; c) intracellular - the intracellular transport of calcium ions is disturbed, hence the non-weakening contraction of smooth muscle cells.

Microcirculation during ischemia:

The arterio-venous pressure difference is reduced due to a decrease in the hydrostatic pressure in the arterial part of the bed.

The resistance to blood flow in the arterial part of the bed is increased due to the obstruction of blood flow in the adducting arteries.

The volumetric blood flow rate is reduced by reducing the arteriovenous pressure difference and increasing the resistance to blood flow.

The linear blood flow velocity is reduced due to a decrease in the arteriovenous pressure difference and an increased resistance to blood flow.

The total cross-sectional area of \u200b\u200bthe capillary bed is reduced due to the closure of a part of the functioning capillaries.

Reduction of the diameter and number of visible arterial vessels due to their narrowing and decreased blood circulation.

Blanching of tissues or organs due to a decrease in blood supply and a decrease in the number of functioning capillaries.

Reducing the amount of pulsation of the arteries as a result of filling them with blood.

Lowering the temperature of the ischemic tissue or organ due to a decrease in the flow of warm arterial blood, further decrease in metabolism.

Decrease in lymph formation as a result of a decrease in perfusion pressure in tissue microvessels.

A decrease in the volume and turgor of tissues and organs due to insufficient blood and lymph filling.

Decrease in specific functions.

Decrease in non-specific functions and processes: local defense reactions, lymph formation, plastic processes.

Development of dystrophic processes, tissue hypotrophy and atrophy.

Necrosis and heart attacks.

The value of the level of tissue and organ functioning, shunting and collateral circulation in the outcome of ischemia. Heart attack as a consequence of ischemia.

29. Emboli: etiology, classification by type of emboli, consequences. Embolism of the large and pulmonary circulation. Paradoxical and retrograde embolism.

Embolism - pathological process, which is caused by various substrates (emboli) circulating in the blood / lymph, which do not occur normally, but are capable of causing acute occlusion with impaired blood supply to the organ / tissue.

From the venous system of a large circle of blood circulation and the right heart in a small circle.

From small to systemic circulation

From the portal system to the portal vein

Thromboembolism is a blockage by a thrombus that breaks away from the place of its formation and gets into the circulating blood, as a result of which ischemia and necrosis develops.

Fatty - blood transfer and occlusion of small vessels

Tissue - vascular occlusion by decay products of their own tissues

Microbial - occlusion of blood vessels with MOI or fragments of an infected thromboembolus that undergoes purulent inflammation

Air - the entry of air bubbles into the bloodstream

Gas - the release of gases dissolved in the blood (usually nitrogen)

Foreign body embolism: shot, bullet, shrapnel

Embolism of the pulmonary circulation. Emboli close the lumen pulmonary arteries... In the pulmonary arteries, foreign particles come from the venous vessels of the systemic circulation and the right half of the heart. The consequences depend on the composition, size of the emboli, and their total mass. Multiple embolism of small pulmonary arteries is especially dangerous. Blood flow is impaired. The blood pressure in the vessels of the pulmonary circulation rises, the flow of blood into the left atrium and ventricle is limited, the stroke and minute volumes of the heart decrease, and blood pressure sharply decreases. Hypotension - characteristic feature massive embolism of the vessels of the pulmonary circulation. Decline blood pressure negatively affects the functional activity of the heart itself due to myocardial hypoxia. A drop in blood pressure is combined with a significant increase in systemic venous pressure with the development of acute right ventricular failure (acute pulmonary heart syndrome).

Pulmonary embolism is accompanied by changes in the blood gas composition. Shortness of breath occurs as a reflex reaction to irritation of the chemoreceptors of the reflexogenic zones of the systemic circulation and as a reaction from the receptor fields of the pulmonary circulation system. Shortness of breath helps to increase blood oxygenation and release it from CO 2.

Most often, mesenteric arteries, arteries of the kidneys, spleen, brain, and heart muscle are exposed to embolism.

Retrograde embolism, in which the movement of the embolus occurs against the natural blood flow. As a rule, this is typical for vertically oriented venous vessels, in which the embolus has a greater density than blood plasma, and its movement is subject to gravity to a greater extent than to hemodynamics. Also, retrograde embolism from the distal artery can be caused by an abnormal blood pressure gradient.

Also known paradoxical embolism... In case of paradoxical embolism, the particle freely penetrates from the venous system of the great circle into the arterial, bypassing the small circle, due to the existing heart defect. This happens with a defect of the interventricular or interatrial septum or with another defect with a right-left shunt.

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The consequences of ischemia

1. With short-term ischemia or with well-developed collaterals, the tissue may practically not be damaged.

2. With shallow but prolonged ischemia, atrophic changes in parenchymal cells develop with the proliferation of connective tissue.

3. If the blood flow in the ischemic tissue is not restored, then a heart attack occurs. Heart attack - ischemic necrosis of an organ or tissue site due to a sudden cessation of blood flow. In rare cases, a heart attack can develop due to a violation of venous outflow - with venous hyperemia.

The color of the damaged tissue distinguishes between white and red infarction. White infarction is formed in the process of necrosis (necrosis) of ischemic tissue containing a small amount of blood due to the absence or very weak development of collateral vessels (functionally absolutely insufficient collaterals). The blood vessels in the ischemic tissue are filled mainly with blood plasma and contain almost no red blood cells. White heart attacks develop, for example, in the spleen, heart, and kidneys. The formation of a red infarction is the result of ischemic necrosis of tissue that has a small collateral blood supply (functionally relatively sufficient collaterals), but sufficient for the accumulation of a significant amount of blood in this tissue. In the process of ischemic damage to the vascular walls, their permeability increases. Erythrocytes enter the extravascular space by diapedesis. In the future, the walls of blood vessels are destroyed and erythrocytes with their decay products "stuff the tissue." The fabric turns red.

Ischemic heart disease consequences

Consequences of ischemic heart disease

Coronary artery disease, if not treated promptly, can lead to irreversible consequences. What are the most dangerous consequences Ischemic heart disease?

The patient develops chronic heart failure over time. But even in the initial stages of the disease with ischemic heart disease, sudden cardiac arrest or myocardial infarction may occur.

In addition, according to statistics, 1/3 of deaths occur precisely due to ischemic heart disease.

If the disease has just made itself felt, it is possible to stop its development with the help of conservative therapy, including physiotherapy procedures and taking medications.

The goal of pharmacotherapy is to block angina attacks. and also prevent the development of myocardial infarction.

At home, if you feel the onset of an attack, you should take a nitroglycerin tablet. This drug dilates blood vessels and improves the nutrition of the heart muscle.

In no case should you take other medications without a doctor's prescription.

Depending on the condition of the body and taking into account the current pathology, the doctor will prescribe certain medications and vasodilators for you.

At a later stage of the disease, surgery may be required. Its task is to expand the vessel, which is blocked by a plaque or thrombus.

One of the most effective surgical interventions for coronary artery disease is coronary artery bypass grafting and stenting of the coronary arteries.

For such an operation, local anesthesia is sufficient. However, in the future, during the rehabilitation period, it is necessary to strictly follow all the doctor's recommendations.

The most important thing is to reconsider your lifestyle and diet.

The basis of the diet should be vegetables and lean meats and fish. Mandatory exercise stress.

It is also necessary to quit smoking and drinking alcoholic beverages. It is advisable to normalize blood cholesterol levels and blood pressure.

Treatment of coronary heart disease has been successfully carried out for a long time in the city clinical hospital №57.

When choosing a drug treatment, only drugs that have successfully passed clinical trials and have proven their high efficiency are used.

Coronary artery disease treatment and its consequences

Don't be negligent about your heart! Did you know that in economically developed countries one third of deaths occur from coronary heart disease. This disease, if left untreated, can lead to serious consequences. The patient develops chronic heart failure over time. The quality of life drops sharply. With coronary artery disease, patients often experience sudden cardiac arrest. Therefore, be sure to contact a specialist at the first signs of heart problems. Doctors have a sufficient arsenal of tools to help you.

Most often, if the disease is not too advanced, coronary heart disease is treated with drugs. Medications are given mostly to keep heart attacks from recurring and to prevent myocardial infarction from developing.

If you feel the onset of an attack of coronary heart disease, you should take a nitroglycerin tablet. This drug dilates blood vessels and improves the nutrition of the heart muscle. You should not drink any more drugs without a doctor's prescription.

What can a doctor prescribe? These are medicines that reduce the need for your myocardium for oxygen, vasodilators.

It should be remembered that the cause of coronary heart disease is that the vessel is blocked by a plaque or thrombus. This situation cannot be changed with the help of conservative treatment. To cleanse the vessel bed, it is necessary to perform surgical intervention. But this is an extreme measure, which is not always resorted to. One of the types of surgical interventions for coronary heart disease is bypass surgery. In this operation, a piece of the vessel is cut out and an artificial site is inserted in its place. The operation is difficult because the patient is connected to a heart-lung machine during it, because the heart should not beat. After bypass surgery, the body recovers for a long time. Such operations have a fairly large number of contraindications.

For many years, acetylsalicylic acid has been used for the prevention and treatment of coronary heart disease. Today, drugs have been created that replace aspirin and at the same time affect the body more gently and sparingly.

Don't try to self-medicate. Pharmacies really have a ton of remedies for the treatment of coronary heart disease. Each of these agents has a very strong effect on the body, therefore, it can significantly disrupt the work of the heart. Coronary heart disease can only be treated under medical supervision.

Most modern way The treatment of coronary artery disease is endovascular surgery. The lumen of the vessel is cleaned using micro-instruments inserted through a small opening in the skin. The surgeon monitors the progress of the operation using an X-ray. The patient is not even given general anesthesia. For such an operation, local anesthesia is sufficient.

According to doctors, all surgical methods for treating coronary heart disease are very effective. In addition, after them, the patient practically does not develop any complications.

After treating coronary heart disease, you will need to reconsider your lifestyle and diet. The basis of the diet should now be vegetables and lean meats and fish. A feasible physical activity is required. You will have to quit smoking and drinking alcohol. It is also advisable to normalize blood cholesterol levels and blood pressure.

To improve blood circulation, the tiensmed.ru medical board (www.tiensmed.ru) advises to purchase a circulatory stimulator. produced by Tianshi Corporation. The action of the device is based on the effect on biologically active points of your body. The method is completely safe. The device comes with detailed instructions for use. You can easily find the necessary areas on your body for exposure. With the help of the Blood Circulation Stimulator, you will not only improve blood circulation, but also heal the body as a whole.

Before use, you must consult a specialist.

Coronary artery disease: causes and consequences

Causes of ischemic heart disease (CHD)

Ischemic heart disease occurs as a result of insufficient blood supply to the myocardium. As a result - the death of a portion of the heart muscle, or myocardial infarction. The imbalance between the heart's need for oxygen and the ability of the vessels to provide this need can be caused by a number of reasons. In general, they can be divided into two groups:

1. Intravascular changes.

atherosclerosis - narrowing of the lumen of the coronary arteries due to the growth of cholesterol plaques;
thrombosis - blockage of blood vessels by blood clots (thrombi), can occur against the background of atherosclerosis;
spasm of the coronary arteries (vasospasm) - narrowing of the vascular lumen due to contraction of arthritic smooth muscles;

tachycardia - increased heart rate (HR);
arterial hypertension - increased blood pressure;
myocardial hypertrophy - an increase in the volume of the heart muscle, arises from a high load on the myocardium.

Some of the above causes of ischemia are reversible (tachycardia) or are easily treatable, if detected early (arterial hypertension), some - appear suddenly (thrombosis) and pose a great danger to life.

Risk factors for ischemia

Causal changes in the cardiovascular vascular systemsthey do not appear spontaneously; they usually take years to develop. And if you pay attention to your own well-being in time and exclude possible risk factors - ischemia, in most cases, can be avoided. The main risk factors for the development of coronary artery disease can be roughly divided into reversible and irreversible.

Irreversible risk factors:

Heredity is of great importance in the development of coronary heart disease. According to various sources, a hereditary predisposition occurs in 80-90% of cases of thrombophilia, common reason thrombosis of the coronary arteries.

Diabetes mellitus - In addition to the danger of hyperglycemia, diabetes mellitus can significantly accelerate the risk of ischemia. Elevated level blood glucose contributes to damage vascular wall, including the coronary vessels. In addition to the direct danger to blood vessels, diabetes mellitus contributes to the accumulation of fat, thereby exacerbating the negative effect on the heart arteries.

Hypothyroidism - inadequate hormone production thyroid gland... As with diabetes mellitus, hypothyroidism, in addition to its negative impact on the condition of the coronary arteries, contributes to obesity, which, in turn, is an additional risk factor for the development of ischemia and associated complications.

Physical inactivity - low physical activity, or hypotension, also poses a serious threat to the health of the coronary arteries. Negative consequences hypodynamia manifests itself in a state of activity, when the heart, weaned from exertion, is forced to pump an unexpectedly large amount of blood.

Obesity is a fairly common cause of heart disease, in particular ischemic heart disease. In addition, excess fat deposition further increases the risk of complications during the course of cardiac ischemia. Despite its danger, obesity, in most cases, is a reversible risk factor - the load on the heart decreases in direct proportion to the decrease in body weight.

Smoking is another reversible, but rather dangerous factor in the development of coronary artery disease. According to the data of various studies, the risk of ischemia in a smoking part of the world's population is 2-7 times higher than in a nonsmoker. Despite the spread in numbers, bad influence tobacco addiction on heart health is unequivocally supported by numerous studies.

Alcoholism - those who still did not know about it or had doubts should be warned: alcohol has a detrimental effect on the health of your heart, as well as on health in general. Despite the periodic statements of some "luminaries" about the harmlessness and even benefits of alcohol, the statistics are relentless - about 20% of deaths from cardiovascular diseases are caused by excessive alcohol consumption. Besides clear signs development of ischemic heart disease on the basis of alcohol abuse, there are so-called "sober" cases, when the consequences of harmful effects are manifested after years of life without alcohol. The negative effect of ethylene on the cardiovascular system goes along several lines:

Acting on the distribution of electrolytes, alcohol causes disturbances in the work of the coronary vessels.
Once in the blood, alcohol causes hemolysis (breakdown of red blood cells, the very ones that are carried).
Alcohol disrupts the mechanisms of blood sugar regulation, changing its level up to the state of hypoglycemia.

In most cases of ischemia, several factors take place at once. At the same time, the presence of reversible risk factors, unfortunately, is usually promoted by trivial human disorder. With a responsible attitude to one's own health, the risk of developing coronary artery disease can be significantly reduced by getting rid of bad habits, keeping food in moderation and maintaining physical activity.

Consequences of myocardial ischemia

Structural and ultrastructural changes

Metabolic changes

Dysfunction of the heart

Arrhythmias

Reflex sympathetic activation

Anginal pain

Ischemic cascade

a decrease in pH and an increase in the concentration of K + ions in venous blood flowing from the ischemic area;
regional abnormal movement of the LV walls and signs of global diastolic and systolic LV dysfunction;
the appearance of changes in the ST segment.

Acute coronary syndrome - acute phase of ischemic heart disease. Atherosclerosis, the underlying ischemic heart disease, is not a linearly progressive, stable process. Atherosclerosis of the coronary arteries is characterized by a change in the phases of a stable course and exacerbation of the disease.

Ischemic heart disease - inconsistency coronary blood flow metabolic needs of the myocardium, i.e. the volume of oxygen consumption by the myocardium (PMO2).

In some cases clinical picture chronic stable coronary artery disease is caused by symptoms and signs of LV dysfunction. This condition is defined as ischemic cardiomyopathy. Ischemic cardiomyopathy is the most common form of HF in developed countries, reaching a level of 2/3 to 3/4 of cases of dil.

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Consequences of chronic coronary heart disease

Ischemic heart disease, depending on the nature of the disease, is divided into two clinical forms - acute and chronic. Chronic ischemic heart disease is one of the most important problems of humanity. The disease is characterized by a high mortality rate due to cardiac arrest. More than 70% of people around the world die from this disease every year. Elderly people are more susceptible to hibs, of whom most are men aged 50-60.

The heart muscle (myocardium), thanks to the blood flow, consumes a lot of oxygen. With lesions of the heart muscle, its blood supply is disrupted or stopped. The cause of this condition is cholesterol plaques that form on the walls of the coronary vessels of the myocardium. They interfere with the delivery of oxygen and other nutrients to the heart. As a result, a state of oxygen starvation develops - ischemia.

CHD symptoms

Chronic ischemic heart disease is characterized by gradual development, in which the symptoms of the disease appear and disappear. If the disease is not treated at this stage, it will progress and can be fatal.

In chronic ischemia, the following symptoms are expressed:

increased blood pressure;
severity or paroxysmal pain behind the sternum with a return to the left arm, shoulder, sometimes to the scapula, back, abdomen;
pain that occurs against the background of any stress and passes at rest;
interruptions in the work of the myocardium (change heart rate);
swelling of the lower extremities;
shortness of breath, difficulty breathing;
severe weakness with light exertion;
pronounced pallor of the skin;
anxiety, anxiety.

Due to stagnation of blood in the vessels, work worsens internal organs: stomach, liver and kidneys.

Diagnosis of the disease

For the diagnosis of chronic ischemic heart disease on early stage there are a number of modern informative methods... With their help, the clinical diagnosis is clarified and the method of subsequent treatment is determined.

First of all, the doctor conducts a detailed survey of the patient, auscultation, analyzes the complaints, and finds out the family history.

The next stage is laboratory tests to identify various inflammatory processes in the patient's body and other disorders. For this, it is carried out:

biochemical and general blood test;
coagulogram;
lipid profile.

Instrumental research methods

The use of specific instrumental techniques in diagnostics gives a fairly accurate picture of the disease.

ECG is a diagnostic method that records the electrical activity of the myocardium. It detects various changes in heart rate, and is also able to detect myocardial infarction or its consequences. Various options ischemic disease have long been studied, and using electrocardiography, you can get enough information on ECG changes during the examination.

The echocardiogram method can measure the size of the heart muscle, examine the contractility of the heart, heart cavities and valves, and acoustic noise. The combination of ultrasound diagnostics with physical activity (stress echocardiography) allows you to register ischemic disorders in the myocardium.

Bicycle ergometry is a common functional test. With its help, changes in the activity of the heart are revealed, which are invisible at rest, but only during physical exertion - in particular, in the form of exercise on a stationary bike.

To fix violations in the activity of the myocardium, a special apparatus is used - a Holter monitor. It is fixed on the patient's belt or shoulder, and the device takes readings for a full day. For a more accurate study, the patient should keep a diary of observation of well-being.

Such close monitoring enables specialists to find out and study:

under what conditions does the patient develop manifestations of chronic coronary artery disease;
the nature of violations in the work of the myocardium, the degree of their severity;
study the frequency of interruptions in the heart rate;
catch heart interruptions.

Transoesophageal electrocardiography (PEECG) is very exact method studies using a sensor inserted into the esophagus, where it records the performance of the myocardium without the interference created outward manifestations human life.

The coronary angiography method is used in severe cases. Coronary angiography examines the vessels of the heart muscle, determines the violation of their patency, the degree of stenosis, localization of the affected arteries by introducing a specific substance. This research method allows you to diagnose CHD, to distinguish it from any similar disease. Coronary angiography helps in deciding the need for surgery on myocardial vessels.

Left ventriculography is performed at the same time as coronary angiography. This method is also used to clarify the indications for surgery.

Radionuclide research helps to conduct a more accurate diagnosis of the myocardium, its functional state, on the basis of which one can judge the effectiveness surgical operation for the patient.

To diagnose the symptoms of complications of ischemic disease - myocardial aneurysm, some manifestations of heart failure, an X-ray examination is prescribed.

After a complete diagnosis of the disease, the doctor prescribes proper treatment for the patient.

CHD treatment methods

Depending on the clinical forms diseases, treatment of ischemia of the heart is carried out in the main areas:

drug-free therapy;
drug therapy;
surgical intervention.

Non-drug therapy

Non-drug therapy is aimed at correcting the patient's lifestyle. Physical activity requires an increased supply of oxygen to the heart, but during an illness the body cannot meet this need due to the affected heart arteries. Therefore, in the course of treatment, the patient's activity is minimized.

The patient is prescribed physiotherapy exercises and short walks - such loads help the heart to adapt to the limited blood supply during the period of illness.

The patient's diet influences the healing process. Limiting the amount of salt in food and water intake to reduce stress on the heart. To improve the state of blood vessels and normalize weight in obesity, the patient is prescribed a low-fat diet, which includes fiber, fruits, vegetables and fish products. Excluded from the diet:

Drug therapy

Drug therapy for chronic forms of ischemic heart disease is carried out according to the formula "A-B-C" and consists of antiplatelet agents, β-blockers and cholesterol-lowering drugs. And also the patients are prescribed:

diuretics;
antiarrhythmic, antianginal drugs;
nitrites;
aCE inhibitors;
calcium channel blockers;
anticoagulants;
statins;
fibrates.

Medicines are prescribed to each patient individually. The age, features of the course of the disease and the absence of pathologies in the patient are taken into account. Self-medication, taking medications without the advice of a specialist doctor is life-threatening.

Surgical intervention

Surgery is necessary if drug therapy does not bring required result... Before prescribing it, the cardiac surgeon conducts a thorough diagnosis to determine:

contractile function of the myocardium;
conditions of the coronary arteries;
the level and localization of the narrowing of the coronary arteries;
the severity of the disease;
resistance of the disease to drug therapy.

Surgical intervention is aimed at restoring the patency of clogged vessels and improving blood flow in them. The operation is assigned in the following conditions:

unstable angina pectoris resistant to drug therapy;
narrowing of the trunk of the left coronary artery by 70%, the defeat of three coronary arteries;
damaged coronary bed with artery narrowing by 75%;
ischemic myocardial dysfunction;
intolerance to minimal physical exertion on the heart;

The main surgical methods for chronic coronary artery disease:

coronary artery bypass grafting;
coronary angioplasty;
stenting.

In some cases, these operations are contraindicated in some groups of patients:

suffering from concomitant serious illnesses;
in cases with constantly high blood pressure;
being overweight;
with certain lesions in the myocardium.

Complications of chronic coronary artery disease

Ischemic heart disease provokes extremely negative consequences for the whole human body, if it is not treated.

Angina pectoris is the main manifestation of ischemic myocardial disease. The causes of its occurrence are blood clots that close the passage in the arteries, which are formed when hyperaggregation (increased adhesion) of platelets occurs due to spasms in the vessels.

Treatments for angina pectoris are widely known and available, but the disease is difficult to respond to. This disease can be caused not only by ischemic heart disease, there are many other causes of cardiac arrhythmias.

In chronic coronary artery disease, these disorders occur precisely because of the presence of foci of ischemia in the heart muscle.

Stable, or exertional angina, occurs under the influence of physical or emotional stress. It is manifested by pain that can be relieved by taking nitroglycerin. Sometimes they leave on their own if they lie quietly in a well-ventilated area.

With unstable angina pectoris (rest and tension), pain occurs regardless of physical or emotional stress, more often at rest. In fact, this is an intermediate stage between chronic heart ischemia and heart attack. The occurrence of such attacks means that the disease is progressing and the heart lacks oxygen even at rest. If the attacks of pain become more frequent and more intense, this indicates the possible development of acute myocardial infarction.

Heart failure is also a complication of chronic coronary artery disease. It is formed under the influence of various functional disorders in the work of the heart muscle.

A frequent complication of myocardial ischemia is the formation of congestive heart failure (CHF). In CHF, the heart muscle contracts weakly and therefore does not pump enough blood to normal work internal organs. For this reason, various violations occur in them. Acquiring a chronic form, congestive heart failure dramatically reduces the patient's chances of survival.

Complication of CHD in the form of chronic heart failure is expressed by such symptoms as:

swelling;
dyspnea;
inability to exercise;
irreversible changes in internal organs.

Acute heart failure (AHF) most often develops with various heart diseases. AHF syndrome affects the left ventricle of the myocardium, the patient has signs of pulmonary edema in the form of shortness of breath, separation of pink sputum during coughing. Acute heart failure often progresses to heart attack or stroke.

Arrhythmia is also a complication of chronic coronary artery disease. This is a fairly common pathology. The most common types of arrhythmias are:

sinus tachycardia;
bradycardia;
extrasystoles;
violation of the conduction of the heart (blockade).

Arrhythmia sometimes goes unnoticed and patients do not attach serious importance to it. This attitude is dangerous, as any form of arrhythmia can be fatal.

The chronic form of ischemia of the heart is a rather dangerous disease. Almost any of the listed complications of CHD lead to the death of the patient without timely and correct treatment.

Acute ischemic disease

Acute ischemic heart disease is another form of myocardial disease, expressed by complications such as:

myocardial infarction;
cardiogenic shock;
sudden coronary death (primary cardiac arrest).

Myocardial infarction is a very common complication of acute cardiac ischemia. The reason for its occurrence lies in the blockage of one of the cardiac arteries by the formed plaque. The heart attack is large-focal and small-focal.

Sharp pain on the left behind the sternum, radiating to the left side of the body (arm, shoulder blade, lower jaw). It occurs suddenly or increases rapidly in a short period of time. Within half an hour from the moment of the attack, in the absence of medical care, the pain intensifies.
Severe shortness of breath. When you try to take a deep breath, soreness increases behind the sternum, which prevents the patient from breathing normally. Lack of oxygen is noticeably manifested, suffocation may occur.
A sharp drop in blood pressure, leading to loss of consciousness. The reasons are a spontaneous change in heart rate, a decrease in the contractile function of the heart.
Taking nitroglycerin for a heart attack does not eliminate pain due to a serious violation of the viability of cardiomyocytes (myocardial cells responsible for the contractile ability of the heart).

Acute complications

Another of the most severe manifestations of the acute form of coronary heart disease is cardiogenic shock. Its signs:

a rapid drop in blood pressure;
unconsciousness;
extremely weak pulse;
shallow breathing.

Lack of blood supply leads to serious complications in the work of internal organs:

acute renal and hepatic failure develops;
pulmonary edema;
there are malfunctions in the central nervous system.

In this condition, a person needs urgent medical attention in order to prevent death.

Sudden coronary death is also a complication of acute coronary artery disease. Death can overtake a person in an instant or within six hours from the onset of the attack. The approximation of the videoconferencing can be determined by several signs:

the emerging and increasing feeling of suffocation;
strong pressure behind the sternum;
heaviness in the shoulders;
dilated pupils;
loss of consciousness;
cessation of breathing;
cessation of cardiac activity.

Most often, she overtakes active men who do not complain about their health. The cause of VKS is a violation of the heart rhythm: the contraction of myocardial fibers occurs chaotically, out of order, the heart rate per minute is more than three hundred.

It is rarely possible to save a person in such a state. Even with the timely implementation of all possible resuscitation procedures, death occurs in four cases out of five.

If heart failure syndrome occurs against the background of acute myocardial ischemia, it is manifested by cardiac asthma or pulmonary edema.

A person with any acute form of ischemic disease needs emergency assistance... For resuscitation, such means are used as:

pain medications;
thrombolytics;
plasma-substituting drugs;
defibrillation.

VKS prevention measures

People who die suddenly sometimes do not have clear signs of an approaching death. But you should know that it is extremely rare for a person to instantly die without any pathology in the cardiovascular system. This means that you can and should carefully focus on your unhealthy feelings. First of all, this applies to those who have suffered a myocardial infarction.

In the process of studying cases of VS, it was found that almost half of the patients had clear signs of its approach several hours before death. This means that they had the opportunity to avoid tragedy with timely examination and treatment.

Another risk group is patients with myocardial ischemia who do not have pain or other symptoms of the disease, or they are extremely weak. For this reason, people do not undergo the necessary examination and treatment. Death in this case occurs due to a serious violation of the heart rhythm.

The third group of persons at risk of VKS is patients in whom it is not possible to detect acute myocardial disturbance in any way. Here we can only hope for an emergency medical assistance, since predicting sudden death in in this case does not seem possible.

Death with coronary heart disease occurs quite often due to insufficient seriousness in the treatment of the disease. For the prevention of VS, doctors are obliged to inform patients about the possible threatening consequences of their illness. In general, the signs of sudden death appear quite often. It is important not to leave them unattended so as not to become a victim of your own indifference to your health.

Prevention of disease recurrence

To prevent a relapse of the disease, after discharge from the hospital, the patient should follow all the recommendations of the attending physician and follow certain rules:

do not stop taking medications prescribed by your doctor;
engage in physiotherapy;
in stressful situations, go to an appointment with a psychotherapist;
to undergo spa treatment;
regularly monitor blood pressure;
maintain a healthy weight;
stick to a healthy diet;
avoid conditions of prolonged stress (driving a car, long flights by plane, being in a poorly ventilated room);
sports only under the supervision of a physiotherapy specialist.

You should not get involved in alternative medicine without the advice of a doctor. Folk remedies are quite effective in treatment various diseases, but which of them and how to use should be prescribed by a specialist.

Preventive measures to prevent coronary artery disease are almost the same as the recommendations for maintaining health after hospital treatment of CHD.

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Depending on the nature of the disease, it is divided into two clinical forms - acute and chronic. Chronic ischemic heart disease is one of the most important problems of humanity. The disease is characterized by a high mortality rate due to cardiac arrest. More than 70% of people around the world die from this disease every year. Elderly people are more susceptible to hibs, of whom most are men aged 50-60.

CHD symptoms

In chronic ischemia, the following symptoms are expressed:

increased blood pressure;
severity or paroxysmal pain behind the sternum with a return to the left arm, shoulder, sometimes to the scapula, back, abdomen;
pain that occurs against the background of any stress and passes at rest;
interruptions in the work of the myocardium (change in heart rate);
swelling of the lower extremities;
shortness of breath, difficulty breathing;
severe weakness with light exertion;
pronounced pallor of the skin;
anxiety, anxiety.

Due to stagnation of blood in the vessels, the work of the internal organs worsens: the stomach, liver and kidneys.

Diagnosis of the disease

For the diagnosis of chronic coronary artery disease at an early stage, there are a number of modern informative methods. With their help, the clinical diagnosis is clarified and the method of subsequent treatment is determined.

First of all, the doctor conducts a detailed survey of the patient, auscultation, analyzes the complaints, and finds out the family history.

The next stage is laboratory tests to identify various inflammatory processes in the patient's body and other disorders. For this, it is carried out:

biochemical and general blood test;
lipid profile.

Instrumental research methods

The use of specific instrumental techniques in diagnostics gives a fairly accurate picture of the disease.

- a diagnostic method that records the electrical activity of the myocardium. It detects various changes in heart rate, and is also able to detect or its consequences. Various variants of coronary artery disease have been studied for a long time, and the electrocardiography method can provide enough information on the ECG changes during the examination.

You can measure the size of the heart muscle, examine the contractility of the heart, heart cavities and valves, and acoustic noises. The combination of ultrasound diagnostics with physical activity (stress echocardiography) allows registering ischemic disorders in the myocardium.

Such close monitoring enables specialists to find out and study:

under what conditions does the patient develop manifestations of chronic coronary artery disease;
the nature of violations in the work of the myocardium, the degree of their severity;
study the frequency of interruptions in the heart rate;
catch heart interruptions.

Transesophageal electrocardiography (TEEKG) is a very accurate research method using a sensor inserted into the esophagus, where it records the performance of the myocardium without interference caused by external manifestations of human activity.

Left ventriculography is performed at the same time as coronary angiography. This method is also used to clarify the indications for surgery.

Radionuclide research helps to make a more accurate diagnosis of the myocardium, its functional state, on the basis of which one can judge the effectiveness of the surgical operation for the patient.

To diagnose the symptoms of complications of ischemic disease - myocardial aneurysm, some manifestations of heart failure, an X-ray examination is prescribed.

After a complete diagnosis of the disease, the doctor prescribes proper treatment for the patient.

CHD treatment methods

Depending on the clinical forms of the disease, the treatment of cardiac ischemia is carried out in the main directions:

drug-free therapy;
drug therapy;
surgical intervention.

Non-drug therapy

The patient is prescribed physiotherapy exercises and short walks - such loads help the heart to adapt to the limited blood supply during the period of illness.

animal fats;
roast;
smoked;
baking;
alcoholic drinks.

Drug therapy

In chronic forms of ischemic heart disease is according to the formula "A-B-C" and consists of antiplatelet agents, β-blockers and hypocholesterolemic drugs. And also the patients are prescribed:

diuretics;
antiarrhythmic, antianginal drugs;
nitrites;
aCE inhibitors;
calcium channel blockers;
anticoagulants;
statins;
fibrates.

Surgical intervention

Surgery is necessary if drug therapy does not bring the desired result. Before prescribing it, the cardiac surgeon conducts a thorough diagnosis to determine:

contractile function of the myocardium;
conditions of the coronary arteries;
the level and localization of the narrowing of the coronary arteries;
the severity of the disease;
resistance of the disease to drug therapy.

Surgical intervention is aimed at restoring the patency of clogged vessels and improving blood flow in them. The operation is assigned in the following conditions:

unstable angina pectoris resistant to drug therapy;
narrowing of the trunk of the left coronary artery by 70%, the defeat of three coronary arteries;
damaged coronary bed with artery narrowing by 75%;
ischemic myocardial dysfunction;
intolerance to minimal physical exertion on the heart;

The main surgical methods for chronic coronary artery disease:

coronary angioplasty;
stenting.

In some cases, these operations are contraindicated in some groups of patients:

suffering from concomitant serious illnesses;
in cases with constantly high blood pressure;
being overweight;
with certain lesions in the myocardium.

Complications of chronic coronary artery disease

Ischemic heart disease provokes extremely negative consequences for the whole human body, if it is not treated.

- the main manifestation of ischemic myocardial disease. The causes of its occurrence are blood clots that close the passage in the arteries, which are formed when hyperaggregation (increased adhesion) of platelets occurs due to spasms in the vessels.

Widely known and available, but the disease does not respond well to them. This disease can be caused not only by ischemic heart disease, there are many other causes of cardiac arrhythmias.

In chronic coronary artery disease, these disorders occur precisely because of the presence of foci of ischemia in the heart muscle.

Or, it occurs under the influence of physical or emotional stress. It is manifested by pain that can be relieved by taking nitroglycerin. Sometimes they leave on their own if they lie quietly in a well-ventilated area.

When (and stress), pain occurs regardless of physical or emotional stress, more often at rest. In fact, this is an intermediate stage between chronic heart ischemia and heart attack. The occurrence of such attacks means that the disease is progressing and the heart lacks oxygen even at rest. If the attacks of pain become more frequent and more intense, this indicates the possible development of acute myocardial infarction.

Heart failure is also a complication of chronic coronary artery disease. It is formed under the influence of various functional disorders in the work of the heart muscle.

A frequent complication of myocardial ischemia is education. In CHF, the heart muscle contracts weakly and therefore does not pump enough blood for the internal organs to function normally. For this reason, various violations occur in them. When acquired, congestive heart failure drastically reduces the patient's chances of survival.

Complication of CHD in the form of chronic heart failure is expressed by such symptoms as:

swelling;
dyspnea;
inability to exercise;
irreversible changes in internal organs.

Most often it develops with various heart diseases. AHF syndrome affects the left ventricle of the myocardium, the patient has signs of pulmonary edema in the form of shortness of breath, separation of pink sputum during coughing. Acute heart failure often progresses to heart attack or stroke.

It is also a complication of chronic coronary artery disease. This is a fairly common pathology. The most common types of arrhythmias are:

extrasystoles;

Arrhythmia sometimes goes unnoticed and patients do not attach serious importance to it. This attitude is dangerous, as any form of arrhythmia can be fatal.

The chronic form of ischemia of the heart is a rather dangerous disease. Almost any of the listed complications of CHD lead to the death of the patient without timely and correct treatment.

Acute ischemic disease

Acute ischemic heart disease is another form of myocardial disease, expressed by complications such as:

myocardial infarction;
cardiogenic shock;
sudden coronary death (primary cardiac arrest).

Myocardial infarction is a very common complication of acute cardiac ischemia. The reason for its occurrence lies in the blockage of one of the cardiac arteries by the formed plaque. The heart attack is large-focal and small-focal.

Heart attack symptoms:

Sharp pain on the left behind the sternum, radiating to the left side of the body (arm, shoulder blade, lower jaw). It occurs suddenly or increases rapidly in a short period of time. Within half an hour from the moment of the attack, in the absence of medical care, the pain intensifies.
Severe shortness of breath. When you try to take a deep breath, soreness increases behind the sternum, which prevents the patient from breathing normally. Lack of oxygen is noticeably manifested, suffocation may occur.
A sharp drop in blood pressure, leading to loss of consciousness. The reasons are a spontaneous change in heart rate, a decrease in the contractile function of the heart.
Taking nitroglycerin for a heart attack does not eliminate pain due to a serious violation of the viability of cardiomyocytes (myocardial cells responsible for the contractile ability of the heart).

Acute complications

Another of the most severe manifestations of the acute form of coronary heart disease is cardiogenic shock. Its signs:

a rapid drop in blood pressure;
unconsciousness;
extremely weak pulse;
shallow breathing.

Lack of blood supply leads to serious complications in the work of internal organs:

acute renal and hepatic failure develops;
pulmonary edema;
there are malfunctions in the central nervous system.

In this condition, a person needs urgent medical attention in order to prevent death.

the emerging and increasing feeling of suffocation;
strong pressure behind the sternum;
heaviness in the shoulders;
dilated pupils;
loss of consciousness;
cessation of breathing;
cessation of cardiac activity.

Most often, she overtakes active men who do not complain about their health. The cause of VKS is a violation of the heart rhythm: the contraction of myocardial fibers occurs chaotically, out of order, the heart rate per minute is more than three hundred.

It is rarely possible to save a person in such a state. Even with the timely implementation of all possible resuscitation procedures, death occurs in four cases out of five.

If heart failure syndrome occurs against the background of acute myocardial ischemia, it is manifested by cardiac asthma or pulmonary edema.

A person with any acute form of ischemic disease needs emergency help. For resuscitation, such means are used as:

pain medications;
thrombolytics;
plasma-substituting drugs;
defibrillation.

VKS prevention measures

The third group of persons at risk of VKS is patients in whom it is not possible to detect acute myocardial disturbance in any way. Here we can only hope for emergency medical assistance, since it is not possible to predict sudden death in this case.

Prevention of disease recurrence

To prevent a relapse of the disease, after discharge from the hospital, the patient should follow all the recommendations of the attending physician and follow certain rules:

do not stop taking medications prescribed by your doctor;
engage in physiotherapy;
in stressful situations, go to an appointment with a psychotherapist;
to undergo spa treatment;
regularly monitor blood pressure;
maintain a healthy weight;
stick to a healthy diet;
avoid conditions of prolonged stress (driving a car, long flights by plane, being in a poorly ventilated room);
sports only under the supervision of a physiotherapy specialist.

You should not get involved in alternative medicine without the advice of a doctor. Folk remedies are quite effective in treating various diseases, but which of them and how to use should be prescribed by a specialist.

For the prevention of coronary artery disease are almost the same as the recommendations for maintaining health after hospital treatment for CHD.

Coronary artery disease with untimely treatment can lead to irreversible consequences. What are the most dangerous consequences of ischemic heart disease?

The patient develops chronic heart failure over time. But even in the initial stages of the disease with ischemic heart disease, sudden cardiac arrest or myocardial infarction may occur.

Moreover, according to statistics, 1/3 of deaths occur precisely due to coronary heart disease.