Update: October 2018
Coronary heart disease (CHD) – a group of cardiac pathologies,
the basis of which, above all, lies the mismatch between
how much oxygen does the heart muscle need for trouble free
full work and how much oxygen is delivered to it. With
All forms of coronary disease
myocardium on the background of spasm or changes in the lumen of the coronary
Ischemic heart disease in the world today suffers order
6% to 15% of the population in different countries. This pathology is the first in the list.
causes of death of the inhabitants of the planet. It accounts for about 35%
deaths from cardiovascular disease.
Risk factors for CHD
To get sick with ischemic disease, it is enough to have this type
blood flow to the heart that will not provide it
metabolic needs at which will accumulate
oxidized oxidation products or significantly weakened
сократительная способность myocardium. Risks to get such
the state is the higher, the narrower the lumen of the heart arteries and the less
cardiac output is productive.
- Men (due to hormonal characteristics) are more likely to get sick
IHD than women, the elderly are more likely to suffer from this disease.
After menopause, the risks of men and women equalize
after the last menopause.
- Disturbance in lipid metabolism (accumulation of LDL, decrease in HDL),
leading to atherosclerosis of the coronary arteries – the main risk in the development
- Arterial hypertension, metabolic syndrome, sugar
diabetes, abdominal obesity increase the risk of coronary artery disease.
- Smokers and alcohol abusers are more likely to suffer from ischemia.
- A sedentary lifestyle is also considered a risk factor.
Options for the development of coronary artery disease
- Angina pectoris – exertion angina pectoris (first developed
or stable), unstable angina, vasospastic
- Sudden coronary death
- Myocardial infarction
- Postinfarction cardiosclerosis
- Heart rhythm disorders
- Heart failure
What are the pains in ischemic heart disease?
This is the most characteristic manifestation of the entire group of diseases.
Pain occurs as the response of tissues to the accumulation of oxidized
metabolic products and the launch of a cascade of inflammatory mediators.
The classic version of pain in IHD is an attack of angina.
The duration of painful attack with stable angina
voltage does not exceed fifteen minutes. Pain squeezing, less
oppressive nature occurs in the projection of the heart (pain in the left
half of the chest) or behind the sternum (see the causes of pain in
Стабильная angina pectoris
Onset of pain with stable exertional angina associated
- exercise, that is, pain occurs during exercise and
after its termination gradually fades
- pain can be triggered by smoking
- psycho-emotional stress
- alcoholic episode
- sometimes even a rise in temperature
- or overeating
The intensity of pain in angina varies between moderate and
quite intense, but does not reach the degree of unbearable. Pain
may give to the left shoulder area and under it, to the left hand or
a few fingers of the left hand, Also found a reflection of the heart
pain in the left half of the lower jaw. Rare irradiation – to the right
Pain можно устранить либо прекращением физической нагрузки, либо
taking Nitroglycerin tablets, drops or spray (with
intolerance to nitrates can use Sidnofarm –
Molsidomine in a dose of 2 mg, that is, one tablet). Sometimes
full pain is replaced by a feeling of numbness in the chest or
numbness of the little finger and the ring finger of the left hand.
For stable angina use a classification that
depends on the frequency of attacks and the conditions of their occurrence. AT
depending on the class is chosen tactics of disease management and
- 1 functional class – seizures with loads exceeding
intensity or duration of the usual. Load resistance
- Class 2 – Pains at average normal loads (when walking farther
500 m, when climbing above one floor). ATысоки риски приступа на
- Class 3 – Restricted physical activity is limited. Pains
appear when walking further 500 m, when climbing one floor.
- 4 класс – Withступы провоцируются любой минимальной нагрузкой,
limited daily activities and self-service. Typical
angina pectoris покоя и приступы болей при перемене положения тела (при
bedding). It is impossible to pass even 100 m.
Нестабильная angina pectoris
Прогрессирующая angina pectoris — Для нестабильной стенокардии
characterized by a constant decrease in resistance to stress and
constant reduction of the load threshold that provokes pain
syndrome. With этом увеличивается число приступов болей за неделю,
сутки и нарастает их тяжесть и длительность.
Стенокардия покоя — Также нестабильной считается angina pectoris
rest when there is no clear relationship between the occurrence of an attack
pain and physical activity, an attack of pain lasts longer 15
minutes but does not lead to necrosis cardiac muscle. This also includes
and angina pectoris for the first time or after a long
mezhpristupnogo gap. During the month this option
angina pectoris will be considered the first-time angina pectoris. Because
unstable angina – intermediate between stable
angina pectoris and myocardial infarction, then every episode of it
requires immediate treatment for qualified medical
help, additional diagnostics (ECG) and adequate therapy.
Variant angina on the background of spasm of coronary vessels
(Prinzmetal’s stenocardia) is also not related to physical activity.
and often gives pain in the early morning hours.
Postinfarction – Another option unstable angina,
characterized by the resumption or occurrence of seizures
angina pain in the period from days to 8 weeks after
myocardial infarction. It can provoke early
physical activity or lack of medication
Acute myocardial infarction
The main and most frequent manifestation also has pain
angina-like syndrome, but characterized by a greater
severity of pain (from pressing and compressing to burning),
as well as the duration and lack of relief while taking
nitrates. Quite often, the pain while complemented by:
- fear of death
- vegetative symptoms in the form of sweating,
- nausea, vomiting, pain in the stomach.
The latter are characteristic of abdominal infarction, which
may occur under the guise of gastrointestinal problems. Often
the heart attack is complemented by collapse or painful shock in which
the patient turns pale, turns gray and loses consciousness.
In cerebral infarction, it is cerebral disorders.
loss of blood circulation precedes chest pain
Mention should also be made of the painless form of myocardial infarction, with
which the patient does not feel pain and sometimes suffers necrosis
heart muscle “on the feet”. This type of heart attack is often characteristic of
elderly with spontaneous sharp sclerosing of heart vessels and for
drinking patients. At the same time come to the fore disorders
heart rhythm or vascular collapse.
Differential diagnosis of a heart attack:
- The basis of the differential diagnosis of acute myocardial infarction
and prolonged angina pectoris (duration 20-30
minutes) ECG remains.
- In domestic conditions, one should focus on efficiency.
Nitroglycerin. So with compressive pain in the heart with
Irradiation or without it, you can put a pill under the tongue
Nitroglycerin or spray once (Nitromint) or
take advantage of Molsidomin (Korvaton, Sidnofarm). If in
within five minutes the pain does not pass, the procedure is repeated. After waiting
another five minutes, take the third pill and call the brigade
fast, as it is already a matter of a prolonged attack of angina and
possibly about a heart attack.
A heart attack is the death of the heart muscle against the background of a thrombosis (or
constriction) of the coronary vessel. Therefore, for the location of the thrombus
blood does not flow and the pain cannot stop completely from
redistribution of blood between the layers of the myocardium, which give nitrates.
In case of myocardial pain, only neuroleptoanalgesia removes pain.
(combination of painkiller and neuroleptic).
Heart rhythm pain
They are largely due to the nature of the violations and
the severity of circulatory disorders in the coronary vessels (and
means providing oxygen to the heart muscle).
- Rare solitary extrasystoles are felt as an extraordinary blow.
hearts followed by his sinking and further
restoration of habitual palpitations.
- Frequent extrasystoles, double (bigymenii) or tripled
(trigimenii) may already give piercing, pulling, aching, or even
constricting pains. The latter are always talking about eating disorders.
- Paroxysmal tachycardia not only increases heart palpitations
and pulse is more than 100, but also unpleasant pressing pain in the chest or in
areas of the heart.
- Atrial fibrillation produces an uneven, abrupt change.
heartbeats. Feeling of lack of air, pain in the chest
oppressive or constricting nature, fear of death, dizziness,
may be accompanied by loss of consciousness.
Often, arrhythmias accompany myocardial infarction and
are its complication. Therefore, any prolonged angina pectoris
an attack accompanied by heart rhythm disorders requires
call an ambulance.
In addition to rhythm disturbances in the CHD program, they can occur when
myocardiopathies, myocarditis, endocrine diseases,
dehydration. If the patient is less than 30 years old, it is always worth looking
alternative CHD causes of rhythm disturbances. Therefore, in the presence of
rhythm disorders are always shown Holter ECG monitoring,
ECHO-KS. Those over the age of 45 are often prescribed a fancy MRI today.
Stopping on rhythm disturbances, it is worth noting that
single extrasystoles or rare extrasystoles (up to 200 per day
according to the results of daily ECG monitoring), despite the abundance
unpleasant sensations that accompany them, do not require medication
treatments and not threaten disorders of blood flow and nutrition of organs and
Dyspnea – симптом, ощущающийся, как нехватка воздуха,
the inability to make a deep enough full breath. Such
The type of dyspnea is called inspiratory (unlike pulmonary
expiratory dyspnea with difficulty exhaling). Dyspnea всегда
indicative of varying degrees of cardiac
- Dyspnea как эквивалент стенокардитических болей часто путают с
manifestations of circulatory failure. Such shortness of breath is not
accompanied by this shortening of the respiratory act. She is
stoped with the elimination of factors provoking
angina pectoris attack and is susceptible to
- Dyspnea при инфаркте миокарда – следствие острого расстройства
blood circulation. The dead portion of the heart muscle is reduced
the ability of the myocardium to contract and push through the blood that
stagnates in the lungs. Plasma sweats in the lung tissue,
pulmonary edema develops through interstitial or alveolar
to type. In addition to feeling short of breath and shortness of breath appear hoarse
a breath that is bubbling and audible from a distance, on a heartbeat,
cold sweat. With alveolar edema, a significant number appears
pinkish foam from the mouth.
- Acute heart failure – if on the background of prolonged
attack of chest pains intense in addition to shortness of breath and feeling
lack of air in a person inflates veins of the neck, nasolabial turns blue
the triangle and the limbs, a ripple appears in the upper womb –
probably a complication of heart attack, such as acute failure
right ventricle of the heart.
- Chronic heart failure manifests by shortness of breath with
weakness of the right heart. This dyspnea is combined with
episodes of cough with scanty sputum. The patient has to sleep on
a higher cushion, or even occupy a forced sitting position
position. Patients have pale bluish skin, bluish tips.
fingers, nasolabial triangle. Dyspnea может смениться эпизодом
Также признак острой или хронической сердечной failure.
Acutely they occur with heart attack, chronically – with violations
heart rhythm, postinfarction cardiosclerosis. Most typical
swelling with stagnation in the great circle of blood circulation on the background of weakness
left ventricle of the heart.
- First, there is pastos foot, which is replaced by edema.
hundred and shins, and with the progression of the process and hips.
- Subsequently, the genitals and the anterior abdominal wall swell.
A massive edema, called anasarca, may also develop.
- The rapid increase in body weight (daily) talks about the hidden
edema, located in the fatty tissue of internal organs.
- Edema of the kidneys leads to a decrease in urine discharge.
- The liver on the background of edema becomes large and dense, acts
from under the costal arch and can hurt under loads.
- Edema increases in the afternoon, difficult
amenable to isolated diuretic treatment.
- Increasing blood stasis can create brain problems
blood circulation, which leads to impaired memory, thinking,
Heart failure is divided into functional classes,
allow us to assess the resistance to stress, to choose the therapy and
make a prediction for the future.
- 1 functional class allows you to transfer the full volume
habitual loads, increased load manifests shortness of breath.
- Grade 2 gives shortness of breath or palpitations only in the load (at rest
- Grade 3 – the appearance of manifestations with minimal loads and
lack of them alone.
- Grade 4 gives symptoms alone.
Consciousness Disorders in IHD
They range from:
- легких dizziness и потемнения в глазах (различные формы
arrhythmias and prolonged heart attacks)
- up to severe cerebrovascular accidents (cardiac
failure and myocardial infarction) with loss of consciousness.
The smaller the left ventricular ejection fraction, the longer
oxygen starvation of the brain, the worse his condition, and
unfavorable prognosis. With a systolic pressure below 60
mmHg. normal oxygen supply to the brain ceases and
man loses consciousness.
Various rhythm disorders (sick sinus syndrome,
atrioventricular block, ventricular tachycardia, fibrillation
ventricular (Wolff-Parkinson-White syndrome) can cause
Of the interesting facts worth noting that the passion
nitroglycerin without indications and use it with any piercing
chest pains can lead to medication-related
fainting, and also cause severe headaches (which are real
“Cores” are removed with validol).
In addition to disorders of consciousness, ischemia of the cortex is accompanied by:
- sleep disturbances (difficulty in falling asleep, inadequate
deep sleep. early awakenings)
- learning problems
- mental disorders, the most striking of which is
an overwhelming sense of fear that is observed during acute
myocardial infarction or attack of atrial fibrillation.
Clinical Terminal Disorder
death with sudden coronary death, which, if unsuccessful
resuscitation, may lead to biological
Thus, manifestations of coronary heart disease
diverse, but not unique to its different forms. Therefore, it is so important
during their development refer for more detailed diagnostics to
cardiologist, and with the development of life-threatening conditions
promptly call an ambulance.