Coronary heart disease - Causes, Symptoms and Treatment .MF .
Diseases of the cardiovascular system are the leading cause of death and disability worldwide.According to researchers, 8 times higher in the Russian Federation mortality from cardiovascular disease than in France, and is approximately 58% of the overall mortality structure.Every year from cardiovascular in Russia kills more than 1.2 million people, while in Europe a little over 300 thousand leading role in the structure of mortality from cardiovascular disease belongs coronary heart disease ( CHD ) -. 35%.If this continues, and further, that the population of Russia in 2030 will be approximately 85 million. This is a frightening figure.But the situation can and must change, if each of us will know about it."You know - forearmed" - the ancients said.
Structure and function of the heart, coronary arteries
To understand coronary artery disease, let's look at what affects CHD - our heart.
The heart is a hollow muscular organ consisting of four chambers: 2 atria and 2 ventricles.In size it is equal to
heart can be divided into two halves: the left and right.In the left half (this is the left atrium and left ventricle) flowing arterial blood rich in oxygen from the lungs to all organs and tissues of the body.The myocardium, ie,heart muscle of the left ventricle is very powerful and capable of carrying heavy loads.Between the left atrium and the left ventricle is the mitral valve, which consists of 2 valves.The left ventricle opens into the aorta through the aortic (he has 3 leaf) valve.At the base of the aortic valve from the aorta are the mouth of the coronary or coronary arteries.
right half, consisting also of the atrium and ventricle pumps venous blood poor in oxygen and rich in carbon dioxide from all the organs and tissues to the lungs.Between the right atrium and ventricle is the tricuspid, ietricuspid valve and ventricle from the pulmonary artery of the same name separates the valve, the pulmonary artery.
Heart is located in the heart bag, performs a damper function.The heart bag is a fluid that lubricates the heart and prevent friction.Its volume can reach a rate of 50 ml.
Powered heart is the one and only law of "all or nothing".His work is done cyclically.Before the beginning of contraction of the heart is relaxed and passively filled with blood.Then cut the atria and the ventricles be sent to the additional portion of the blood.After that, relax atrium.
systole phase then begins, ie,contraction of the ventricles and blood ejected into the aorta to the organs and into the pulmonary artery to the lungs.After a strong contraction of the ventricles relax and comes diastole phase.
heart is reduced thanks to one unique property.It is called automatism, ie,This ability to self-generate nervous impulses, and under their influence decline.Such features not found in any organ.These impulses generates a special portion of the heart, located in the right atrium, called pacemaker.From his impulses are complicated by the conduction system to the myocardium.
As we said above, the heart supplied with blood by the coronary arteries, left and right, which are filled with blood only in diastolic phase.Coronary arteries play a crucial role in the life of the heart muscle.The blood flowing through it, brings oxygen and nutrients to all the cells of the heart.When the coronary arteries are passable heart is working properly and does not get tired.If the artery atherosclerosis and amazed because of this narrow, the myocardium can not operate at full capacity, it is not enough oxygen, and because of this biochemical begin, and then the tissue changes, developing CHD .
How are the coronary arteries?
Coronary arteries are composed of three layers, with a different structure (see Figure).
aorta depart from two major coronary arteries - the right and left.The left main coronary artery has two large branches:
- anterior descending artery, which supplies blood to the anterior and anterolateral wall of the left ventricle (Figure) and to the larger part of the wall separating the inside of the two ventricular ezhzheludochkovaya baffle - not shown in the figure);
- circumflex artery which runs between the left atrium and ventricle and delivers blood to the lateral wall of the left ventricle.Less circumflex artery supplies blood to the top and back of the left ventricle
right coronary artery delivering blood to the right ventricle to the bottom and back wall of the left ventricle.
main coronary arteries branch out into smaller blood vessels that form a network throughout the myocardium.These are small in diameter blood vessels called collaterals.If the heart is healthy, the role of collateral arteries in myocardial blood supply is not significant.In violation of coronary blood flow caused by an obstacle in the lumen of the coronary artery collaterals helps increase blood flow to the myocardium.It is thanks to this little "spare" vessels the size of myocardial damage at the termination of coronary blood flow in any major coronary artery is smaller than it could be.
Coronary Heart Disease Coronary heart disease - is myocardial damage caused by the violation of blood flow in the coronary arteries.That is why in medical practice often use the term coronary heart disease.
What are the symptoms of coronary heart disease?
Usually in people suffering from coronary artery disease, the symptoms appear after 50 years.They occur only during physical exertion.Typical manifestations of the disease are:
- pain in the middle of the chest (angina pectoris);
- feeling short of breath and labored breath;
- circulatory arrest due to too frequent contractions of the heart (300 or more in a minute).This is often the first and last manifestation of the disease.
Some patients suffering from ischemic heart disease, do not feel any pain, and feeling short of breath, even during myocardial infarction.
order to know the likelihood of myocardial infarction in the next 10 years, use a special tool: "Know your risk»
How do you know if you have coronary heart disease?
Consult your cardiologist.The doctor will ask you questions to help you identify the symptoms and risk factors of the disease.The more risk factors a person, the more likely the presence of disease.The impact of most risk factors can be reduced, thereby preventing the development of disease and the occurrence of its complications.These risk factors include smoking, high cholesterol and blood pressure, diabetes.
In addition, the doctor will examine you and prescribe specific methods of examination, that will help to confirm or deny that you have a disease.These methods include: an electrocardiogram at rest and check with a stepped increase in exercise (stress test), chest X-ray, blood chemistry (with the definition of the level of cholesterol and blood glucose).If your doctor as a result of the conversation, inspection, testing and received for instrumental methods of examination suspect severe coronary artery disease requiring surgery, you will be assigned coronary angiography.Depending on the status of your coronary arteries and the number of affected vessels, as a treatment, in addition to drugs, you will be offered either angioplasty or coronary artery bypass grafting.If you asked the doctor in time, you will be assigned medication to help reduce the impact of risk factors, improve the quality of life and prevent the development of myocardial infarction and other complications:
- statins for lowering cholesterol;
- beta blockers and angiotensin converting enzyme inhibitors to lower blood pressure;
- aspirin to prevent blood clots;
- nitrates to facilitate the cessation of pain in angina attack
Remember that the success of treatment depends on your lifestyle:
- smoke.It's the most important.In non-smokers the risk of myocardial infarction and death is much lower than in smokers;
- eat foods low in cholesterol;
- regularly, every day for 30 minutes engaged in physical activity (walking at an average pace);
- Reduce your level of stress.
In the style of life are given detailed recommendations for each item.
What else should I do?
- regularly visit a cardiologist.The doctor will monitor your risk factors, treatment, and will make changes as necessary;
- regularly take prescribed you medication doses prescribed by your doctor.Do not change your medication without consulting your doctor;
- if the doctor has appointed you nitroglycerin to relieve pain associated with angina, always carry it with you;
- tell your doctor about all the episodes of pain in the chest, if they occur again;
- change your lifestyle in accordance with these recommendations.
Coronary artery atherosclerosis and
People having a predisposition, cholesterol and other fats which form the atherosclerotic plaque (Figure) accumulates in the walls of the coronary arteries.
why atherosclerosis is a problem for the coronary arteries?
Healthy coronary artery like a rubber tube.It is smooth and flexible, and blood flows through it freely.If the body need more oxygen, for example, during physical exercise, healthy coronary artery stretch and go to the heart more blood.If a coronary artery affected by atherosclerosis, it becomes like a clogged pipe.Atherosclerotic plaque narrows the arteries and makes it tough.This leads to a restriction of blood flow to the myocardium.When the heart begins to work harder, this artery can not relax and deliver more blood and oxygen to the myocardium.When atherosclerotic plaque is so big that completely blocks the artery or plaque that ruptures and forms a blood clot overlying the artery, then to the myocardium does not enter the blood and its land is dying.
Coronary heart disease in women
In women, the risk of coronary heart disease increases by 2-3 times after menopause.During this period, it increases cholesterol and increased blood pressure.The reasons for this phenomenon are not well understood.Women suffering from ischemic heart disease, symptoms of the disease are sometimes different from symptoms in men.So in addition to the typical pain women may experience shortness of breath, heartburn, nausea or weakness.Women more likely to develop myocardial infarction during a mental stress or intense fear, during sleep, while "masculine" myocardial infarction often occurs during exercise.
As women to prevent the development of coronary heart disease?
Refer to the cardiologist.The doctor will give you advice on lifestyle changes, prescribe medicines.In addition, please refer to the gynecologist to determine the need for hormone replacement therapy after menopause.
How should we change the style of life?
- stop smoking and avoid places where other people smoke;
- daily for a 30-minute walk around the average rate;
- limit the intake of saturated fat to 10% of the diet, cholesterol, and 300 mg / day;
- maintain a BMI in the range 18.5-24.9 kg / m 2 and waist circumference within 88 cm;
- if you are already ill with coronary heart disease, watch the symptoms of depression
- consume moderate amounts of alcohol, if you do not drink alcohol, do not start;
- follow a special diet to reduce blood pressure
- if, despite lifestyle changes blood pressure above 139/89 mm Hg.Art.- Refer to the cardiologist.
What medications you need to take?
not take any action without consulting with the doctor!
- at intermediate and high risk of coronary heart disease need to follow a diet and taking statin drugs to lower cholesterol;
- if you have diabetes, every 2-3 months, check the level of glycated hemoglobin.It should be less than 7%;
- if you have a high risk of developing coronary heart disease , daily aspirin at low doses;
than a dozen years for the prevention of thrombosis and ischemic disease used aspirin, however long it may cause reception problems with the gastrointestinal tract, such as heartburn, gastritis, nausea, stomach pain, etc.To avoid these undesirable effects, it is necessary to make money in a special enteric coating.For example, one can use the drug Thrombotic ACC each tablet is coated with a special film coating resistant to gastric acid and dissolves only in the intestine.Thus, the substances that make up the drug, do not harm the stomach.For best results, this tool is recommended to take every day, not courses.
- if you transferred a myocardial infarction or have angina, take beta-blockers;
- if you have a high risk of myocardial infarction, have diabetes or heart failure, take angiotensin-converting enzyme.This drug lowers blood pressure and reduces the strain on your heart;
- If you do not carry the angiotensin-converting enzyme, the drug can be replaced by angiotensin II.
Hormone replacement therapy and coronary heart disease
combination of estrogen and progestin or estrogen alone is not recommended for the prevention of coronary heart disease for women in menopause.Although hormone replacement therapy does not prevent the development of coronary heart disease after menopause, some women take these drugs to reduce the symptoms of menopause.Most doctors recommend to weigh the pros and cons of receiving such drugs.Before taking hormonal drugs consult a gynecologist.
symptoms of coronary heart disease
CHD is the most extensive heart disease and has many of its forms.
Let's start from the beginning.
- Sudden cardiac or coronary death - this is the most difficult of all forms of CHD .It is characterized by a high mortality rate.Death comes almost immediately or in the next 6 hours from the start of the attack, severe chest pain, but usually within an hour.The reasons for such cardiac catastrophes are different kinds of arrhythmias, complete blockage of the coronary arteries, severe electrical instability of the myocardium.Provoking factor is the use of alcohol.As a rule, patients do not even know if they have CHD , but have a number of risk factors.
- Myocardial infarction. Terrible and often disabling form of CHD .Myocardial infarction causes severe, often tearing, pain in the heart or in the sternum, radiating to the left shoulder, arm, jaw.The pain lasts for more than 30 minutes, while taking nitroglycerin is not fully reversible, and not only a long time reduced.There is a feeling of lack of air, it can appear cold sweats, severe weakness, decreased blood pressure, nausea, vomiting, feeling of fear.Admission nitropreparatov does not help.The plot of the heart muscle, deprived of food, necrotizing, loses strength, elasticity and ability to contract.A healthy portion of the heart continues to work with a maximum voltage and cutting, can break the lifeless land.It is no accident in the common parlance is called a myocardial rupture of the heart!As soon as a person in this state to take the slightest physical effort, as it is on the verge of death.