Cardiology

Coronary heart disease


Coronary heart disease - causes, symptoms and treatment

Ischemic heart disease – a disease that develops when there is insufficient oxygen to the heart muscle through the coronary arteries. The most common cause is atherosclerosis of the coronary arteries with plaque formation and narrowing of their lumen. Can occur acutely and chronically (long-term). Manifestations of coronary artery disease may include: angina, myocardial infarction, arrhythmias, and sudden cardiac death.

In developed countries, coronary heart disease was the most frequent cause of death and disability – it accounts for about 30 percent mortality. It is much ahead of other diseases as a cause of sudden death and occurs in about one-third of women and half men. This difference is due to the fact that female sex hormones are one of the means of protection against atherosclerotic vascular lesions. Due to changes in hormonal levels during menopause the risk of myocardial infarction in women after menopause increases significantly.

Types of ischemic heart disease

Types of ischemic heart diseaseDepending on how pronounced oxygen starvation of the heart, how long it lasts and how quickly emerged, there are several forms of coronary artery disease heart.

Asymptomatic ischemic heart disease – does not cause complaints from the patient.
Angina is a chronic form, is manifested by shortness of breath and pain in the chest during physical activity and stress, under the influence of some other factors.
Unstable angina – any angina markedly superior in strength to the previous or accompanied by new symptoms. These increasing attacks indicate worsening of the disease and may be predictive of myocardial infarction.
Arrhythmic form – is manifested by cardiac arrhythmias, most commonly atrial fibrillation. Occurs acutely and can become chronic.
myocardial infarction – the acute form, the death of part of the heart muscle, caused most often by removing the plaque from the wall of the coronary artery or a blood clot and complete occlusion of its lumen.
Sudden cardiac death – cardiac arrest, in most cases, caused by a sharp decrease in the number delivered to him the blood as a result of complete occlusion of a large artery.
These forms can be combined and superimposed one on another. For example, to angina often joins the arrhythmia, then a heart attack.

Causes of coronary heart disease

Despite the fact that heart in the body, pumping blood, it needs a blood supply. The heart muscle (myocardium) receives blood through two arteries that branch off from the root of the aorta and are called coronary (due to the fact that they bypass the heart like a crown). Further, these arteries divide into smaller branches, each of which feeds her a piece of his heart.

More of the arteries that bring blood to the heart, no. Therefore, when the narrowing or blockage of one of them, the area of the heart muscle suffers from the lack of oxygen and nutrients, the disease develops.

The main cause of CHD is currently considered a coronary artery disease with deposition in them of plaque and narrowing of the arteries (coronary artery disease). As a result, the blood cannot sufficiently flow to the heart.

At first, the lack of oxygen only during high load, such as when running or walking fast with shipping. Appearing with pain in the chest called angina voltage. As narrowing of the lumen of coronary arteries and degradation metabolism of cardiac muscle pains start to appear at lower load, and in the end, and alone.

Simultaneously with angina may develop chronic heart failure, manifested by swelling and shortness of breath.

With a sudden rupture of plaque may come full closing of the lumen of the artery, myocardial infarction, cardiac arrest and death. The degree of the damage of the heart muscle depends on which artery or the bifurcation occurred corking the larger the artery, the worse the consequences.

In order to myocardial infarction, the artery should be reduced to not less than 75%. The slower and postepenno this happens, the heart is easier to adapt. Sudden blockage of the most dangerous and often leads to death.

Symptoms of coronary artery disease

Depending on the type of disease the symptoms may be:
Asymptomatic form – manifestations of the disease there is, detected only by screening.
Angina
– pain in the chest and pressing nature (as if laid brick), give in left arm and neck. Shortness of breath when walking, climbing stairs.
Arrhythmic form – shortness of breath, palpitations, interruptions in heart work.
myocardial infarction
– severe pain in the chest, resembling angina, but more intense and not removable by conventional means.

Ischemic heart disease

Ischemic heart diseaseFor coronary heart disease is irreversible. This means that there are no tools that completely cures her. All modern methods of treatment allow to some extent to monitor the progress of the disease and slow its progression, but reversing course, they can’t.

Heart damage is continuous and in parallel with other organs: kidneys, brain, pancreas. This process is called “cardiovascular continuum”, it includes such diseases as coronary heart disease, atherosclerosis, hypertension, stroke, atrial fibrillation, metabolic syndrome, and others. All these diseases are interrelated and are due to common causes.

Stages of the cardiovascular continuum can be described as follows:

Asymptomatic stage – the risk factors have had a negative impact, in the heart vessels appear cholesterol deposits, but their clearance is still quite broad.
First symptoms – high blood pressure, blood sugar, cholesterol. At this stage of cholesterol plaques in the blood vessels proliferate and can already close to 50% of the lumen. In the heart muscle begin the remodeling processes, i.e. changes its structure, which lead to heart failure.
Emergence and progression of symptoms – shortness of breath, disruption of the heart, pain in the sternum. On ultrasound of the heart to this moment becomes visible enlargement of heart, thinning of the heart muscle. The lumen of the arteries even more narrowed.
Finish symptoms – the appearance of congestive heart failure, a sharp deterioration of the heart, edema, congestion of the lungs, a sharp increase in pressure, atrial fibrillation. Chest pain at the slightest load and even at rest.

At any of these stages, but usually on the third or fourth, there may be myocardial infarction or sudden cardiac arrest. A heart attack does not necessarily lead to death, but after ischemic always accelerates its course.