Causes, symptoms and treatment of cardiac ischemia
The content of the article:
What is ischemia of the heart?
Ischemia of the heart is a disease, which is a violation of blood circulation of myocardium. It is caused by lack of oxygen which is transferred in the coronary arteries. Prevent receipt of atherosclerosis: narrowing of the lumen of the vessels and the formation of these plaques. In addition to hypoxia, i.e. lack of oxygen, tissues are deprived of the beneficial nutrients needed for normal functioning of the heart.
Coronary artery disease is one of the most common diseases, which causes sudden death. Among women it occurs much less frequently than among men. This is due to the presence in the body of the females of a number of hormones that hinder the development of atherosclerosis. With the onset of menopause is a change in hormonal levels, so the possibility of coronary disease increases dramatically.
In the classification of ischemic heart disease are the following forms:
Painless form. This myocardial ischemia is characteristic of people with a high pain threshold. It contributes to the development of hard physical labor, alcohol abuse. The risk group also includes the elderly and patients with diabetes. This form of ischemia is painless, which often it is called a mute. However, in some cases there may be discomfort in the chest. It occurs in the early stages of the disease. The characteristic symptoms of painless ischemia of the heart is tachycardia, angina, sudden drop in blood pressure. A possible weakness in the left arm, shortness of breath or heartburn.
- Primary cardiac arrest. It is understood as sudden coronary death. It occurs immediately after a heart attack or within a few hours after it. This manifestation of coronary heart disease contributes to overweight, Smoking, arterial hypertension, the cause is ventricular fibrillation. Emit a sudden coronary death with successful resuscitation or fatal. In the first case, qualified medical assistancemust be provided immediately. If defibrillation is not done in time, the patient dies.
Angina. Compressing or pressing pain, discomfort in the chest are the main symptoms that define this form of coronary disease. It often manifests itself in the form of heartburn, cramps or nausea. Pain from the chest can be given in the neck, left arm or shoulder on the same side, and sometimes the jaw and the back. Discomfort occurs during active physical exertion, after meals, especially when eating, a sharp increase in blood pressure. Angina causes stress and hypothermia. In all of these situations there is a need for more oxygen to the heart muscle, but because of the clogged artery plaques it is impossible. To cope with the pain, which can last up to 15 minutes, enough to stop physical activity if it was caused by them or take nitrates short-acting. Most popular among these drugs is the nitroglycerin.
Angina can be stable and unstable. In the first case it is caused by the action of environmental factors: Smoking, significant physical load. You can deal with it with nitroglycerin. If it becomes ineffective, it shows the development of unstable angina. It is more dangerous as it often causes myocardial infarction, or death of the patient. One type is unstable angina new-onset angina. The main distinguishing feature of this form of disease is the appearance of seizures did not begin until a few months ago. The reason new-onset angina can be a strong emotional or physical stress. Thus the coronary arteries can function normally. The second group of patients consists of patients who have had a myocardial infarction and having pathology of the coronary arteries. If the disease will occur unnoticed, it is likely that it will grow into a stable angina. But there is another option. Often the first symptoms will soon pass, the attacks stopped and for the next years angina in a patient does not appear. It is required to undergo regular examinations to prevent unexpected myocardial infarction.
Progressive angina, which is one kind of unstable, is characterized by the buildup of attacks. They happen more often, become more intense andlonger may be accompanied by dyspnea, shortness of breath and rapid pulse. The first attacks happen at high loads. When angina progresses to increase your heart rate and occurrence of shortness of breath becomes quite small exertion. The attacks occur at night, are more frequent in stressful situations. Nitroglycerin may not be effective in combating pain. Prognosis in progressive angina varies, but in most cases it precedes a myocardial infarction or is its beginning. Though perhaps a complete cessation of attacks and remission.
Myocardial infarction. This acute form of coronary disease can be triggered by strong emotional experiences, physical overexertion, resulting in stops the flow of blood to one of the chambers of the heart. Poor circulation can last from several minutes to several hours. Located in the blood vessels of an atherosclerotic plaque can rupture, leading to thrombus formation. It becomes the reason of impaired circulation. Deprived of oxygen and nutrients, cells die.
Myocardial infarction is accompanied by severe pain behind the breastbone. Unlike angina to deal with it with pills of nitroglycerin fail. And not necessarily by the heart attack causes the external influence, for example, stress. Sometimes necrosis of the tissues occurs without any apparent cause during sleep or early in the morning. Symptoms of myocardial infarction include also the nausea and vomiting, difficulty breathing and abdominal pain. The complete absence of signs of disease are common in patients with diabetes. In the absence of necessary research a heart attack goes unnoticed. To determine any changes is only possible with an electrocardiogram or echocardiography.
If you suspect a myocardial infarction requires urgent hospitalization. The doctor prescribes medication and bed rest. Early recovery after a heart attack took months, but modern drugs and methods of treatment allowed to reduce this period to a few days. The patient undergoing such an attack of coronary artery disease, is contraindicated in active exercise, you need to do physical therapy, gradually increasing the intensity of exercise. Take medications prescribed by the doctor is necessary throughout life, even in the absence of pain and discomfort.
Cardiosclerosis. In this form of ischemic disease of heart, the dead heart cells are replaced by scarfabric. She is not involved in the myocardial contractility and induces hypertrophy areas of the heart, as well as deformation of its valves. As a result of impaired pumping of blood, and develops heart failure.
Cardio can be diffuse and focal. In the first case, scar tissue replaces heart cells uniformly distributed throughout the muscle. In focal cardiosclerosis connective tissue affects only a few areas. It is usually caused by myocardial infarction.
Plaque in the arteries cause the development of atherosclerotic cardiosclerosis. Development miotaticheskogo of infarction promotes inflammation directly to the heart muscle. Increases the risk of illness overeating, Smoking, sedentary lifestyle. For a long time, the infarction may be asymptomatic, especially in the case of atherosclerotic forms. Patients during rehabilitation and maintenance should follow a diet which involves a minimal use of salt, fats and liquids.
Symptoms of cardiac ischemia
There are several basic symptoms of cardiac ischemia:
- Pain in chest and behind the breast part. It can be stabbing, baking, or compressive in nature. Discomfort appear suddenly and pass through 3-15 minutes. In the early stages of ischemic discomfort may be very pronounced. Severe pain felt in left arm and shoulder, rarely in the jaw and the right side. They appear during sports, or during a strong emotional stress. To get rid of the discomfort resulting from physical activity, enough to make a short breather. When these measures do not help and the attacks have become strong, have resorted to the use of drugs.
- Shortness of breath. Like pain, it first appears during movement and caused by lack of oxygen in the body. With the development of the disease is shortness of breath accompanied each attack. The patient has it even at rest.
- Disorders of the heartbeat. It quickens and strikes in this case, it felt stronger. It is also possible in some moments of disruption. Palpitations thus felt very weak.
Angina. In the old days it was called "angina pectoris". This phrase is not accidental, because angina is not a pain, and strong squeezing and burning in the chest and esophagus. Can be felt in the form of pain in shoulder, arm or wrist, but such cases are less common. Angina can easily be confused with heartburn. It is not surprising that some people try to cope with it and use soda. In cardiology angina is considered to be the most prominent symptom, indicating the presence of ischemic heart disease and preventing a heart attack. It is much worse when the disease occurs without external manifestations. Asymptomatic in most cases leads to death.
When infarction there is complete overlap of the lumen of the artery plaques. The pain increases while gradually, and half an hour later it becomes unbearable. Discomfort can take place in a few hours. In the chronic form of ischemic heart disease the lumen of the vessel not overlap completely, the pain is less prolonged.
- Psychological symptoms. When a heart attack patient may experience unexplained fear and anxiety.
Causes of cardiac ischemia
The main reasons because of which can occur ischemia of the heart, the following:
Atherosclerosis. Myocardium bordered the two main arteries which carry blood flow to the heart. They are called coronary and branch out into many smaller vessels. If the lumen of at least one of them is partially or completely closed, some areas of the heart muscle do not receive the necessary nutrients and most importantly oxygen. The arteries supplying the heart with blood, is no more, so his work is disturbed, and the developing coronary disease.
Clogging of arteries is due to atherosclerosisaffecting the arteries. It implies the formation of cholesterol plaques in the arteries that impede the movement of blood. The implementation of active movements in the lack of oxygen in the heart muscle accompanied by pain.
At this stage coronary artery disease is expressed in the form of angina. Gradually the metabolism of a myocardium worsens, the pain intensified,become longer and appear dormant. Developing heart failure, the patient suffers from shortness of breath. If the lumen of the coronary artery suddenly is blocked in the result of plaque rupture, the blood supply to the heart, there is a heart attack. In the end, it may be fatal. The patient's condition after a heart attack and its consequences largely depend on the blockage of an artery. The larger the affected vessel, the worse the prognosis.
An improper diet. The reason for the formation of plaques on the walls of the receptacles is an excess of cholesterol coming from food. In General this substance is necessary as it's used to create cell membranes and production of several hormones. On the walls of blood vessels cholesterol is deposited under the influence of stress.
Emotional stress becomes the reason for the development of specific substances. It, in turn, promotes the deposition of cholesterol in arteries. To reduce the amount in the body allows a properly composed diet. Should limit eating foods that have saturated fats: butter, sausages, fatty cheeses and meat. It is recommended to give preference to fats contained in fish, nuts, corn. Contributes to the development of cardiac ischemia and high-calorie food.
Bad habits. Alcohol abuse and Smoking affects the heart muscle. Cigarette smoke contains a large number of chemicals, among which are carbon monoxide, impairing the transport of oxygen, and nicotine, increases the arrhythmia. In addition, Smoking affects the formation of blood clots and atherosclerosis.
- Sedentary lifestyle or excessive load. Uneven locomotor activity creates an additional burden on the heart. The reason for the development of ischemia may be a lack of exercise and physical activity that exceed the capabilities of the body. It is recommended to exercise regularly, individually defining the intensity, duration and frequency of training.
Obesity. During numerous studies, a direct correlation between excess weight and mortality from cardiovascular disease. Therefore, obesity is one of the factors contributing to the development of ischemia.
- Diabetes. The threat of coronary heart disease a large for patients with diabetes type I and II. They need to normalize carbohydrate metabolism, to reduce the risks.
- Psychosocial reasons. There is a perception that people with higher social status and education have less risk of coronary heart disease.
How to treat heart disease?
Diagnosis of coronary artery disease is made primarily on the basis of the patient's sensations. Most often complain of burning and pain in the chest, shortness of breath, excessive sweating, swelling, is a prominent symptom of cardiac failure. The patient experiences weakness, disturbances of heart rate and rhythm. Definitely for suspected ischemia execute electrocardiography. Echocardiography – a method of research, allowing to assess the state of the myocardium, to determine the contractile activity of the muscles and the bloodstream. Performed blood tests. Biochemical changes allow to detect ischemic heart disease. Functional tests imply physical strain on the body, for example, walking up the stairs or performing exercises on the simulator. Thus it is possible to identify pathology of the heart in the early stages.
For the treatment of ischemia in the complex preparations of the following groups: antiplatelet agents, antagonists, fibrates and statins. Specific funds are selected by the doctor depending on the form of the disease. Antiplatelet agents improves blood flow, using blockers can reduce the frequency of contractions of the heart muscle and reduce the oxygen consumption. The effect of fibrates and statins is directed at atherosclerotic plaque. Drugs reduce their rate of occurrence and prevent the new formation on the walls of blood vessels.
Struggle with angina pectoris is using nitrates. Widely used to treat coronary heart disease and natural lipid-lowering drugs. The formation of blood clots affect anticoagulants and withdraw excess fluid from the body diuretics help.
As plaque in the blood vessels causing their contraction, perhaps by artificial means to carry out widening of the lumen in the coronary arteries. This is done by stenting and balloon angioplasty. During these bloodless surgeries expands the lumen of the vessels and normalizes the blood flow. These methods have replaced the traditional bypass surgery, which today is carried out only in some forms of coronary disease. During such operation the coronary arteries are connected with other receptacles below the place of infringement of blood flow in them.
Apart from drug therapy and overall therapy, the patient required moderate physical activity. Depending on the form of ischemia, a set of exercises developsdoctor. After all, excessive physical activity increases the oxygen demand of the heart muscle and has a negative impact on the development of the disease.
In case of an unexpected attack while walking or exercising should stop and rest, drink a sedative and get some fresh air. Then you should take a nitroglycerin tablet.
This drug has an effect within 5 minutes. If the pain persists, you should drink 2 tablets. Ineffectiveness of nitroglycerin is indicative of serious problems, so the lack of improvement in condition of an urgent need to go to the hospital. Prevention of coronary heart disease involves the rejection of alcohol, Smoking, well-balanced diet and regular exercise. You must monitor their weight and control blood pressure. The importance of the presence of positive emotions and lack of stress.
Nutrition for ischemic heart
The basic principles of diet during ischemia following:
- Patients with coronary artery disease have to minimize in the diet, salt, sugar, candy and sweets, confectionery, i.e., all sources of simple carbohydrates, fatty meats, caviar, spicy and salty meals, chocolate, coffee and cocoa.
- The most important thing is to limit the use of products containing large amounts of cholesterol and fats. There need little but often.
Be sure to consume foods that contain ascorbic acid, vitamins A, B, C, potassium, calcium.
Vegetable oil used for cooking, should be replaced by corn, olive. It is much more useful; moreover, it contains omega-3 fatty acids, which have a positive effect on blood circulation.
- In the diet should prevail dairy products, except butter, cereals, seafood, vegetable soups, low-fat sea fish like cod, an egg-white omelette, Turkey, chicken.
- Meals it is recommended to cook for a couple. In addition, the products can be boiled or stewed.
Below are the usual menu for 7 days for patients with ischemiaheart:
Breakfast – slice of whole-wheat bread, oatmeal, a Cup of weak tea without sugar
- Lunch – natural yoghurt
- Lunch – vegetable salad, a piece of boiled chicken without skin, rice, a glass of fruit juice
- Dinner cottage cheese casserole without sugar, a Cup of yogurt
- Breakfast – omelet of several proteins, Apple, tea
- Second Breakfast – a Cup of yogurt
- Lunch – baked potato, cod, steamed, a piece of rye bread, tea
- Dinner – vegetable stew, unsweetened yogurt
- Breakfast – oatmeal, fruit juice
- Second Breakfast – cottage cheese with fruit
- Lunch – vegetable salad, seasoned with olive oil, roast Turkey, tea
- Dinner – milk soup, tea
- Breakfast – boiled egg, a piece tselnozernovym bread, natural yoghurt
- The second Breakfast – Apple
- Lunch – baked chicken, buckwheat, tea
- Dinner – vegetable soup, a Cup of yogurt
Breakfast – oatmeal, Apple, carrot juice
- Second Breakfast – a Cup of yogurt
Lunch – soaked herring, baked potatoes, tea
- Dinner – vegetable salad, seasoned with olive oil, a glass of milk
- Breakfast – cottage cheese casserole with fruit, tea
- Lunch – natural yoghurt
- Lunch: boiled sea bass, salad, glass of milk
- Dinner – milk soup, tea
- Breakfast – millet porridge, natural yoghurt
- Second Breakfast – egg white omelet
- Lunch – Turkey and baked potatoes, tea
- Dinner –vegetable soup, a Cup of yogurt
okov, Andrey Vladimirovich, doctor-neurologist