CHD (coronary heart disease): what is it?

Coronary heart disease (abbreviated CAD) is a severe cardiac disease, which is based on the violation of the blood flow in the coronary arteries, leading to reduction or complete cessation of myocardial collateral blood blood. CHD is one of the leading places among the causes of death and permanent disability in most countries of the world.

Features of the blood supply to the myocardium

To more clearly understand what it is IBS, you need to understand how providing the myocardium with blood. The only source of arterial blood to the heart is a system of coronary arteries. Two main coronary arteries (right and left) away from the aortic root, they further divide into smaller vessels that cover the heart on the top and penetrate into the myocardium.

Feature of the system of coronary circulation is that it is capable of self-regulation aimed at ensuring myocardial blood depending on its needs in terms of emotional and physical stress the demand for oxygen increases, therefore, increases blood flow, alone, on the contrary, the blood flow decreases. If any of the coronary arteries becomes partially or completely impassable (due to spasm, occlusion of a major blood clot or atherosclerotic plaque) that develops in the acute or chronic coronary insufficiency pathogenetic basis for IBS.

Why developing coronary artery disease?

Myocardial ischemia is the result of a mismatch between the provision of blood and needs of the heart muscle. This condition occurs in the following cases:

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  • In atherosclerosis when the lumen of the coronary artery is narrowed by 70% or more.
  • When spasm of the coronary arteries (the walls may be unmodified).
  • In disorders of the microcirculation within the heart muscle.
  • When violations in the hemostatic system (the conditions for increased thrombogenesis).
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In addition to the reasons and allocate the risk factors for CAD:

  • Biological (immutable) – male gender, older age, genetic propensity.
  • Physiological and biochemical (variable) – arterial hypertension, violation of balance of lipids in the body, diabetes and obesity.
  • Behavioral – Smoking, alcohol abuse, inadequate dietary habits (the abundance in the diet meat fatty foods), inactivity.

Forms of ischemic heart disease

Forms of ischemic heart disease according to the commonly accepted classification:

  • Angina. Is stable, occurring in stress conditions, and unstable, occurring even at rest.
  • Myocardial infarction. Can be primary or secondary.
  • Postinfarction cardiosclerosis.
  • Sudden coronary death.
  • Heart failure.

IBS can have two types of the course: acute (myocardial infarction) and chronic (angina).

Symptoms of IBS

The classic manifestation of myocardial ischemia is pain in the heart (although there are cases when myocardial infarction occurs completely painless).
Features of pain in IBS:

  • Painful sensations arise in the chest, giving in left arm, neck, shoulder, back, stomach and lower jaw.
  • The intensity of the pain may be different, patients describe it as oppressive, baking, compressive.
  • There is pain usually on the background of physical exertion, emotional outbursts, alone the patient’s condition usually improves.
  • The pain lasts from a few seconds to 15 minutes.
  • Reduces soreness taking Nitroglycerin.

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Methods of diagnosis of CHD

Alone pain are not sufficient to diagnose IBS. The patient needs a comprehensive examination, which may include (depending on the equipment of medical institutions):

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  • ECG. In the electrocardiogram, the doctor can see signs of ischemia of the heart muscle that began or already coupled myocardial infarction, cardiosclerosis, arrhythmias, etc.
  • Echocardiography, which allows to assess the state of myocardial contractility.
  • Blood tests – a common clinical, biochemical (lipid profile), determination of markers of myocardial infarction.
  • Functional tests, which involve registration of parameters of heart function by ECG or Echocardiography after physical load on the treadmill or the Jogging path.
  • Instrumental assessment of coronary circulation – coronary angiography, intravascular ultrasound and other studies.
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Basic principles of treatment of IBS

The main challenge in the treatment of this disease is to restore blood flow to the myocardium, what is it used for different surgical and therapeutic methods. For each form of IBS has a Protocol of therapeutic measures, however, there are several General areas that are important for all forms:

  • Limitation of physical activity. In the acute period to reduce the load on the heart and prevent the progression of ischemia, patients prescribed a strict bed rest. In subsequent shows metered capacity loads and rehabilitation aimed at returning the patient to normal life.
  • A diet which involves limited consumption of salt and water, as well as the rejection of high-calorie food, animal fats, smoked meats, etc.
  • Pharmacotherapy, which according to the recommendations of cardiologists, the U.S. must be sure to include the 3 groups of drugs: antiplatelet agents (Aspirin), beta-blockers (Metoprolol, etc.) and statins (Lovastatin, Simvastatin, etc.). These drugs, first, improve the flow properties of blood by reducing platelet adhesion, and secondly, reduces the need of myocardium in oxygen by reducing the heart rate, thirdly, prevent the worsening of atherosclerotic vascular lesions.

As surgical treatment of coronary artery disease, the following methods:

  • Coronary artery bypass grafting – establishment of additional vessel (taken from the patient) between the aorta and the coronary artery below the blockage.
  • Mammary-coronary artery bypass graft overlaying anastomosis between the internal thoracic artery and one of coronary.
  • Coronary stenting – establishment of coronary artery stent (a hollow tube, which restores and maintains the patency of the vessel).
  • Transmyocardial laser revascularization – the creation in the myocardium of microscopic channels through which blood from the left ventricle enters into the heart muscle, bypassing the coronary system. Subsequently, in places these channels, the formation of new blood vessels.
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Operative treatment of CHD, in contrast to conservative methods, to more effectively restore coronary circulation. After such operations patients need some time to avoid physical activity, take certain medications and do other medical advice, but the overall quality of life is significantly improved.