In terms of frequency of occurrence, coronary heart disease occupies a leading position among all diseases of the cardiovascular system. The mortality rate from this disease is at least 60% of the total mortality caused by pathologies of the heart and blood vessels.
What is Coronary Heart Disease?
Coronary or ischemic disease is characterized by the development of atherosclerotic changes in the coronary arteries of the heart. A similar problem can occur as a result of complete or partial blockage of the lumen of the arteries. 
As a result of poor blood supply, the myocardium ceases to receive the required amount of oxygen, which entails the development of oxygen starvation (hypoxia).
The most common coronary heart disease occurs in men after 40 years of age. However, after 50 years, this pathology occurs with the same frequency in males and females.
The danger of this condition lies in the fact that the areas of the heart muscle, deprived of normal blood supply, are reborn into connective (scar tissue), and this, in turn, leads to a violation of the contractility of the myocardium.
The most vulnerable spot in coronary heart disease is the area of the left ventricle from the anterior wall and apex of the heart. The reason for this is the peculiarity of the blood supply to this area. The base of the heart and the posterior wall of the left ventricle are in second place in terms of frequency of occurrence.
What led to the development of pathology?
In world medical practice, new theories about the occurrence of this disease appear every year. To arise coronary heart disease may be influenced by the following factors:
- Narrowing of the lumen of the arteries feeding the myocardial tissue. Atherosclerotic changes in the coronary arteries can contribute to this phenomenon. Diseases such as diabetes mellitus, hypertension, physical inactivity and obesity can serve as the cause of the development of atherosclerosis.
- Viruses (adenoviruses, influenza, cytomegaloviruses) are another theory of the onset of atherosclerosis, and as a consequence of coronary artery disease. Timely prevention of acute respiratory viral infections and influenza significantly reduces the incidence of coronary heart disease.
- Stress factor. The constant impact of stressful situations on the human psyche is accompanied by the release of adrenaline, which provokes a spasm of the coronary arteries of the heart.
- Individual predisposition. This factor plays a key role in the development of coronary heart disease. The propensity to develop this disease is inherited.
- Drinking alcohol and smoking. Nicotine and ethyl alcohol are one of the reasons for the development of this pathology, since, entering the body, they cause a spasm of the vessels that feed the myocardium.
How can coronary heart disease manifest itself?
Any discomfort in the heart and chest area is an absolute indication for visiting a cardiologist. Symptoms of coronary heart disease can be different for each person. In some situations, a person may not feel any failures in the work of the heart.
Complete blockage of the lumen of the coronary vessel can lead to such a consequence as rupture of the myocardial wall (infarction). The main symptom of coronary artery disease is chest or chest pain.
If the vessel was completely blocked, a person may feel the following symptoms:
- there are short-term bouts of pain;
- the intensity of the pain gradually increases;
- after 30-40 minutes, the pain becomes severe, and the person is not able to endure it.
If there is a partial overlap of the coronary vessel, then the person may experience the following symptoms: 
- pain sensations increase when expressing emotions, as well as during physical activity (walking, running, lifting weights);
- the patient develops a feeling of fear associated with the appearance of a new attack of pain;
- shortness of breath and shortness of breath is observed;
- intense pain often radiates (gives) to the area of the lower jaw, cheekbones, left shoulder and hand.
In some situations, coronary heart disease can proceed without characteristic symptoms. Instead of pain, a person may be disturbed by the following symptoms:
- weakness and general malaise;
- increased fatigue;
- asthma attacks;
- increased heart rate;
- dyspnea;
- burning sensation and discomfort behind the breastbone.
Each of these symptoms appears even with minimal physical and emotional stress. The most dangerous type of coronary heart disease is a latent form that does not have any manifestations.
In this case, the diagnosis is made only after the development of a spontaneous attack of pain.
Effective diagnostic methods
Diagnostic measures for coronary heart disease are carried out in order to:
- determining the exact localization of pain;
- detecting factors contributing to increased pain;
- determining the duration of a painful attack;
- evaluating the effectiveness of nitroglycerin during an attack.
The symptoms of coronary heart disease are similar to many non-cardiac diseases and heart diseases. Additional research methods are used to make an accurate diagnosis. These methods include:
What treatments are there?
The key point in the treatment of this disease is to reduce the need for oxygen in the heart muscle, as well as to create conditions for its full delivery to the myocardium. Depending on the degree of damage and the severity of the course, both conservative (medication) and surgical methods of treatment can be used.
Drug therapy
For the treatment of this disease, the following groups of drugs are used:
- Nitroglycerins. The purpose of their use is to eliminate acute attacks of the disease;
- Acetylsalicylic acid (aspirin) and statins. These drugs are prescribed to prevent the formation of fatty and blood clots in the lumen of blood vessels.
- Beta blockers. The purpose of their use is to normalize the heart rate and prevent tachycardia.
- Calcium antagonists. Their main function is to reduce the heart rate, as well as to expand the lumen of blood vessels.
The dosage and frequency of taking each drug is calculated by the attending physician on an individual basis. Before starting the calculation, the doctor evaluates the diagnostic data, as well as information about the severity of the course of the disease.
Surgical restoration of blood supply
If drug therapy has not yielded a significant result, then the patient is recommended to undergo surgery. Other indications for surgical treatment include neglect of the pathological process, rapid progression of the disease, as well as extensive vascular lesions by atherosclerosis.
Coronary artery bypass grafting is used as the most effective method. The essence of this procedure is to create an additional channel for blood flow, bypassing pathological areas. A patient's vessel taken from the area of the lower limb is used as a shunt.
Another method of surgical treatment is coronary angioplasty, during which the lumen of the affected vessel is expanded. The result of the operation is a complete restoration of the blood supply to the heart.
If the patency in the artery has not been restored, then doctors may use a stent placement technique. Once in the narrowed area, the stent expands and straightens the narrowed artery. This method is an effective prevention of myocardial infarction.
Proper nutrition is the key to recovery
The organization of the daily diet is the most important aspect of all treatment for coronary heart disease. Nutritional therapy contributes to the normalization of fat and carbohydrate metabolism in the body, and is a good prevention of the formation of new atherosclerotic plaques in the body. 
The basic principles of dietary nutrition for this disease include:
- First of all, it is recommended to limit the consumption of high-calorie foods. The daily diet should contain no more than 300 g of complex carbohydrates. Sources of complex carbohydrates are cereals, as well as fresh fruits and vegetables. Eating simple carbohydrates can exacerbate the disease.
- The daily rate of fats is no more than 80 g. At least 40% of fats must be of vegetable origin. The daily protein intake is 100 g.
- It is recommended to exclude foods rich in nitrogenous substances (fried meat, smoked meats, red wine) from the diet.
- Substances such as magnesium, phosphorus, potassium, iodine will help improve the general condition in coronary heart disease.
- Boiled meat and fish are recommended.
- Meals should be fractional, in small portions 4-5 times a day. The last meal should be taken at least 3 hours before bedtime.
- Fish and fish products. It is better to eat those types of fish that contain a minimum amount of fat (pike perch, perch, cod). It is recommended to cook fish dishes in the oven or steamed.
- Bread and bakery products. It is better to refuse freshly baked bread, preferring rye and yesterday's white bread.
- Meat and meat products. As with fish, it is recommended to consume lean meats (beef, chicken, lamb, turkey). Before eating, it is better to bake the meat in the oven or boil it.
- Dairy products. It is better to give preference to sour cream and cream, which contain substances that contribute to the normalization of lipid metabolism in the body.
- Cereals and cereals. It is permissible for people with coronary heart disease to eat semolina and rice cereals.
- Eggs. The diet for this disease allows the use of no more than 2 chicken eggs per week. This product cannot be completely excluded, since it contains the phosphorus necessary for the body.
- Vegetable oil. There are no restrictions on the use of vegetable oils, since they contain fatty acids that help to normalize cholesterol metabolism.
- Vegetables and fruits. Fresh vegetables and fruits saturate the body with vitamins and microelements. Their use is permissible in unlimited quantities. Only the use of radish, spinach and radish should be limited.
It is important to remember that coronary heart disease is a serious medical condition that must be treated under the strict supervision of a specialist cardiologist.
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Coronary artery disease (CHD) Is a pathological condition in which the heart muscle (myocardium) receives insufficient blood supply. The heart, like all other organs, must receive the substances necessary for normal functioning, which are delivered by the blood stream. The flow of fresh blood into the myocardium occurs through the heart's own arteries; they're called coronary arteries... Narrowing of the lumen of the coronary arteries leads to ischemia (local decrease in blood supply) of the heart muscle. Therefore, ischemic heart disease is sometimes called coronary heart disease.
Forms of ischemic heart disease
The main forms of coronary heart disease are:
- ... The main manifestation is chest pain, shortness of breath, sweating, severe fatigue may also occur;
- violation of the heart rhythm (arrhythmic form). Atrial fibrillation is most often observed;
- myocardial infarction is an acute form of ischemic heart disease. With a heart attack, part of the heart muscle tissue dies off (limited necrosis). The reason is the complete closure of the lumen of the artery;
- sudden cardiac arrest (coronary death).
IHD leads to the development of conditions such as postinfarction cardiosclerosis (proliferation of connective scar tissue at the site of necrotic lesion) and heart failure (when the heart is unable to provide its "motor" function at the proper level and provide sufficient blood supply). These conditions are also included in the concept of ischemic heart disease.
Causes of ischemic heart disease
In the overwhelming majority of cases, the cause of the development of ischemic heart disease is. Atherosclerosis is characterized by the formation of plaques (fatty deposits) on the walls of the arteries, which gradually block the lumen of the vessel. Such plaques can also appear on the walls of the coronary arteries. Gradually increasing disturbance of blood flow in the coronary arteries leads to the development of chronic forms of coronary artery disease. Acute forms of ischemic heart disease, as a rule, are caused by blockage of the vessel by a thrombus or a detached part of an atherosclerotic plaque.
Other causes of coronary artery disease are:
- spasm of the coronary arteries;
- increased blood clotting. In this case, the risk of blood clots increases;
- an increase in the size of the heart (a consequence of some diseases). At the same time, the growth of the vascular network lags behind. The result is a lack of blood supply to the enlarged heart muscle;
- persistent low or high blood pressure (hypotension or hypertension);
- (thyrotoxicosis) and some others.
Factors contributing to the development of ischemic heart disease
The risk of developing coronary heart disease is increased by:
- smoking;
- high blood cholesterol;
- (overweight);
- arterial hypertension;
- hypodynamia (low physical activity).
At risk are people over the age of 50. Moreover, men suffer from coronary heart disease more often than women. The hereditary factor also matters: the likelihood of developing coronary artery disease increases if it was detected in one of the close relatives.
Symptoms of ischemic heart disease
The symptoms of coronary artery disease depend on the specific form of the disease. There is also an asymptomatic course of coronary heart disease, which can be observed at an early stage of the development of this disease.
In some cases, you should immediately call an ambulance:
- if the symptoms of ischemic heart disease (listed below) are observed for the first time;
- if chest pain is not relieved by nitroglycerin and lasts more than 15 minutes;
- If the pain is unusually severe or is accompanied by other, previously absent symptoms (for example, it radiates to the shoulder, arm, or lower jaw);
- with episodes of suffocation or loss of consciousness in a patient.
The main symptoms of coronary heart disease are as follows:
Nausea may be accompanied.
The occurrence of nausea in heart failure is due to dysfunction of the digestive organs due to hypoxia (oxygen deficiency in tissues) and reflex influences. Also, due to changes in the structure of myocardial muscle tissue and a decrease in heart function, intracardiac pressure increases, tissue edema appears in the chest and peritoneum, which also contributes to the occurrence of nausea.
Dizziness
Dizziness in coronary artery disease occurs due to the fact that the brain does not receive the required amount of oxygen. Episodes of loss of consciousness (fainting) may occur.
Diagnostic methods for ischemic heart disease
When examining a patient, the doctor determines which diagnostic methods are necessary in this particular case.
Diagnosis of ischemic heart disease is carried out. To determine the state of the heart, the following are used:
Inactive diagnostic method
It can be used to detect changes that cannot be detected during examination at rest (at a doctor's appointment). Sensors are attached to the patient's body, the information from which is sent to a portable device. The patient leads his usual way of life. The received data is then processed. Thus, violations of cardiac activity are detected.
Methods for the treatment of coronary artery disease
IHD treatment aims to normalize the blood supply to the heart muscle, reduce the risk of myocardial infarction, and reduce the frequency and intensity of angina attacks. Adequate treatment of coronary heart disease, started in time, will improve the patient's quality of life and save life for many years.
Cardiac ischemia or Ischemic heart disease - one of the most common and serious cardiac ailments, characterized by unpredictability and severity of manifestations. The victims of this disease are most often men of active age - 45 years and older.
Disability or sudden death is a very likely outcome in coronary artery disease. In our country alone, about 700 thousand deaths are annually recorded, caused by various forms of ischemia. In the world, mortality from this disease is almost 70%. That is why regular observation is so important!
Blood test for ischemia
Analyzes for ischemia of the heart
Diagnosis of ischemic heart disease in "Mediccity"
The development of ischemic heart disease is provoked by an imbalance between the need for myocardial blood supply and the actual coronary blood flow.
The main cause of insufficient blood supply and oxygen starvation of the heart muscle is narrowing of the coronary arteries due to (atherosclerotic plaques in the lumen of blood vessels), atherothrombosis and / or spasm.
The pathological process can affect both one and several arteries at once (multivessel lesion). Significant narrowing of the coronary arteries impedes the normal delivery of blood to the fibers of the myocardium and causes pain in the heart.
Without proper treatment and medical supervision, coronary artery disease, caused by oxygen and nutrient deficiencies, can lead to cardiac arrest and sudden cardiac death.
Factors contributing to the development of ischemic heart disease
The main reasons for the development of coronary heart disease can be identified:
- (increases the likelihood of ischemia by 2-6 times);
- smoking (tobacco addicts have a 1.5-6 times higher risk of developing coronary artery disease than nonsmokers);
- violation of lipid and lipoprotein metabolism (promotes the development and increases the risk of ischemia by 2-5 times);
- hypodynamia and obesity (obese inactive people get sick at least 3 times more often than thin and athletic people);
- disorders of carbohydrate metabolism, (with diabetes of both types, the threat of developing coronary heart disease increases by 2-4 times).
Risk factors also include burdened heredity, belonging to the stronger sex and old age. When two or more of the listed positions are combined, the degree of risk of developing coronary artery disease increases significantly.
ECG for ischemia of the heart
ABPM in the diagnosis of ischemia
ECHO-KG with ischemic heart disease
Detection of myocardial ischemia
Symptoms in coronary heart disease can be either pronounced or subtle.
Among the most characteristic symptoms of coronary artery disease are the following:
- Pressing pain and burning sensation behind the sternum and in the region of the heart during exercise;
- shortness of breath on exertion.
But sometimes IHD does not reveal itself until the very myocardial infarction! In this case, the classic symptoms of coronary heart disease may be noticed too late.
Classification of ischemic heart disease
Depending on the symptoms, the following main forms of the disease are distinguished:
Coronary death ... Symptoms develop rapidly: loss of consciousness, pupils are dilated and do not respond to light. No pulse, no breathing.
Postinfarction cardiosclerosis ... Among the characteristic signs: cardiac arrhythmias, acute manifestations (asthma attack - "cardiac asthma", pulmonary edema) and chronic (leg edema, shortness of breath). The patient complains of a feeling of lack of air, shortness of breath, his legs and feet swell.
Acute coronary syndrome. Newly-onset angina pectoris, progressive angina pectoris, myocardial infarction, etc.
Myocardial infarction ... Often there is severe pressing and burning pain behind the sternum, radiating to the jaw, left shoulder blade and arm. Lasts up to half an hour or more, does not go away when taking nitroglycerin under the tongue. Also, the patient has cold sweat, blood pressure decreases, weakness, vomiting and fear of death may appear.
Angina pectoris ... A person complains of chest pain - squeezing, squeezing, burning behind the breastbone during physical exertion and sometimes at rest. Possible symptoms of angina pectoris are pain in the neck, left shoulder blade, lower jaw, or left arm. The pain is usually short-lived.
Angina pectoris is one of the most striking manifestations of coronary heart disease. Self-treatment of angina pectoris with folk remedies is unacceptable! Only a doctor, on the basis of his professional experience and diagnostic techniques, can draw conclusions about a person's condition and the necessary therapeutic measures!
Ultrasound of the heart with angina pectoris
Ultrasound of the heart in MedicCity
Blood tests for ischemic heart disease
If angina pectoris occurred for the first time, if angina attacks began to occur more often, last a longer time and become more pronounced, we are talking about acute coronary syndrome and a high risk of developing myocardial infarction. Such patients should be urgently hospitalized by ambulance in a hospital, where coronary angiography will be performed urgently and blood flow in the artery of the heart will be restored, which will avoid the occurrence of myocardial infarction and, as a result, disability.
Painless myocardial ischemia
IHD may not be accompanied by pain. This ischemia is called painless.
The manifestation of the disease in the case of painless myocardial ischemia often becomes direct or sudden coronary death. Therefore, it is very important to be regularly examined by a cardiologist, especially for people at risk (diabetics, hypertensive patients, smokers, obese people, the elderly, etc.).
Such latent ischemia can be detected using some instrumental techniques, for example, treadmill). It is during the stress test that the changes that are specific to IHD are especially pronounced.
Diagnosis of ischemic heart disease
The success of preventive and therapeutic measures depends on the timely detection of the disease and the correct diagnosis.
Of course, the initial stage in the diagnosis of coronary artery disease is the collection and analysis of patient complaints. This is followed by an examination, during which the cardiologist measures the patient's blood pressure, visually assesses his condition (degree of swelling, skin tone, sweating, behavioral features, etc.), listens with a stethoscope to his heart for noises, rhythm disturbances, etc.
- clinical and biochemical blood tests;
- blood test for markers of myocardial infarction;
- coronary angiography (radiopaque examination of the coronary arteries).
Ultrasound of the heart with ischemic heart disease
Diagnosis of ischemic heart disease in "Mediccity"
ABPM for ischemic heart disease
Coronary artery disease treatment. Prophylaxis
The success of coronary artery disease treatment depends on many factors. So, the combination of ischemia with and can significantly burden the situation. While the patient's adherence to a healthy lifestyle and focus on recovery can be of great help to the doctor and his chosen treatment regimen.
The tactics of treating coronary artery disease for each specific patient is individual and is determined by the attending physician based on the results of studies and analyzes. However, you can list the main types of treatment for coronary heart disease used in modern cardiology.
As a rule, patients with coronary artery disease are assigned:
1. Non-drug therapy , which includes the maximum possible elimination of the threats of coronary artery disease (identification and treatment of concomitant diseases, diet, adherence to work and rest, the fight against excess weight, blood pressure control, feasible physical activity, lifestyle changes).
2. Pharmacotherapy (depending on the form of ischemia, may be prescribed: aspirin, nitroglycerin, nitrates, calcium antagonists, statins and / or other cholesterol-lowering drugs, beta-blockers, angiotensin-converting enzyme inhibitors, trimetazidine, etc.).
3. Surgery ... The most common operations for coronary artery disease today are endovascular techniques (stenting of the coronary vessels of the heart and angioplasty), as well as myocardial revascularization (coronary artery bypass grafting).
In operations of the first type, a catheter is inserted into the artery, through which a super-thin guidewire is passed with a deflated air balloon and a folded stent - a tube made of the finest medical wire. The balloon is inflated as soon as it reaches the site of narrowing of the lumen - this is necessary to expand the walls of the artery, then the stent is straightened. Next, the balloon is deflated and removed along with the catheter, while the expanded stent remains in the artery, preventing its re-narrowing and ensuring normal blood flow. Coronary artery bypass grafting is a method in which the surgeon bypasses blocked coronary vessels using a graft - a vein taken from the patient's arm or leg. The operation is done for very serious reasons, since it is performed on an open heart.
As for the prevention of the disease, the most effective prevention of coronary heart disease, like most CVDs, is blood pressure control, healthy eating, maintaining physical fitness, and quitting tobacco.
Diagnostics and treatment at MedicCity is the right choice for every person who cares about their health! Our people know how to help you maintain good health for years to come! We work on equipment from leading manufacturers and carry out all the necessary types of diagnostics and other organs and systems with high quality.
This is the middle muscle layer of the organ, which makes up the bulk of its mass. As a result of the development of symptoms of pathology without their treatment, various complications may appear.
Ischemic heart disease (symptoms and treatment are taken into account in the diagnosis) is a pathology in which the blood supply to the myocardium is disrupted. The abbreviated disease is called ischemic heart disease. Coronary vessels are affected, blood flows limitedly to the heart or does not flow to the organ at all.
The myocardium is the thickest muscle in the heart and is located in the middle. She is involved in pumping blood.
Thanks to the myocardium, the heart has the following properties:
- automatic work without external stimulation - the heart beats rhythmically;
- impulse conductivity;
- response to external and internal factors.
Forms of ischemia of the heart
Ischemic disease has a classification. The table shows the forms of ischemic heart disease.
| Name | Description |
| Sudden coronary death | Other names are primary cardiac arrest, VKS. A lethal outcome that occurs as a result of the termination of the activity of the organ. A type of ischemic heart disease occurs in adults aged 45 - 75 years. Sudden death is the cessation of the body's vital activity, which occurs within 6 hours from the onset of the manifestation of cardiac disorders. A variety of ischemic heart disease always appears unexpectedly and does not depend on the presence of CVS pathologies. The condition is not always fatal. It is possible to normalize the functioning of the heart if resuscitation measures are provided in a timely manner. |
| Angina pectoris | Another name is angina pectoris. A person has paroxysmal pain in the region of the heart. Unpleasant sensations arise as a result of insufficient blood supply to the myocardium. Angina pectoris is of several types: |
| Myocardial infarction | Muscle necrosis that develops as a result of acute impaired circulation. Stages of a heart attack: 1. Initial. Another name is the period of damage. The stage lasts up to 3 days. The fibers are damaged, resulting in impaired circulation. 2. Sharp. The duration of the stage is from 1 to 21 days. Gradually, the area of damage decreases, as one section of the fibers dies, and the other tries to recover and reduces blood circulation. 3. Subacute. The duration of the stage is from 3 to 12 months. Deeply damaged fibers die off. And others - recover, go into the zone of ischemia (reduced blood circulation). 4. Cicatricial. Another name is the final stage. Fibers are scarred throughout a person's life. Healthy areas are joined at the site of necrosis. |
| Postinfarction cardiosclerosis | Scarring of dead tissue occurs. A variety of ischemic heart disease appears not only as a result of myocardial infarction, but also in infectious diseases. |
| Abnormal heart rhythm | Another name is arrhythmia. This is a type of ischemic heart disease, in which the frequency, rhythm, sequence of contraction and excitation of the heart is disturbed. Classification:
|
| Heart failure | A condition that develops as a result of a weakened contractile activity of the myocardium. Heart failure is not a disease in its own right. The disorder appears as a result of ischemic heart disease, arterial hypertension. Heart failure is of several types:  |
| Painless ischemia of the heart | The blood supply to the myocardium is temporarily disrupted. Pain does not appear as symptoms, but abnormalities in the work of the heart can be seen on the cardiogram. A variety of ischemic heart disease is manifested in the form of an independent deviation or combined with other forms of ischemia. |
In addition to international qualifications, new varieties of coronary artery disease have appeared.
Namely:
- Hibernating myocardium. Another name is sleeping. The condition is a long-term impairment of myocardial functionality due to chronic coronary artery disease or repeated episodes of ischemia.
- Deafened myocardium. Decrease in myocardial contractility, which occurs against the background of impaired blood flow. The muscle is affected, but its cells do not die.
- Syndrome H. Arteries change, their lumen decreases. In terms of symptoms, the disease is similar to atherosclerosis of the coronary vessels.
Causes of ischemic heart disease
Ischemic heart disease (symptoms and treatment are interrelated in the choice of therapy tactics) occurs for various reasons.
These include the following factors:
Ischemic heart disease is an inadequate supply of blood, oxygen and nutrients to the myocardium.
This develops for the following reasons:
- damage to the coronary vessels;
- heart disease is associated with impaired metabolism.
Risk factors
Coronary artery disease can occur when there are risk factors. That is, the likelihood of the appearance of the disease increases. This must be considered when symptoms occur and when treatment is prescribed.
Risk factors that increase the likelihood of coronary artery disease:
Pain with ischemic heart disease
Pain in IHD depends on the type of disease. Details are shown in the table.
| IHD type | Pain description |
| Sudden coronary death | Unpleasant sensations arise behind the breastbone. The nature of the pain is pressing or squeezing. |
| Angina pectoris | Angina pain has special features. First, there is chest discomfort. Then pain appears, which has the following features:  |
| Myocardial infarction | Most often, myocardial infarction can be judged by the appearance of pain behind the sternum, which has a sharp, burning, pressing character. Discomfort can be localized in the upper limb, neck, back. And also the pain radiates to the lower jaw. But the discomfort is not always typical. With myocardial infarction, pain can be masked. Distinguish between abdominal discomfort. Unpleasant sensations in the abdominal cavity, which are atypical for a heart attack. Acute discomfort, localized in the right side, but then can spread throughout the abdomen. |
| Postinfarction cardiosclerosis | The condition is characterized by chest pain, it has a burning and pressing character. Discomfort radiates to the shoulder or upper limb. |
| Irregular heart rhythm | With arrhythmias, pain in the region of the heart can be observed, which are aching or stabbing in nature. Sometimes the discomfort is so intense that it makes you faint. If the heart rhythm is abnormal, there may be back pain. |
| Heart failure | Pain in the heart squeezes, squeezes. Additionally, it can manifest itself as stabbing and cutting. |
| Painless ischemia | There are no painful sensations. |
Signs of illness
Coronary artery disease presents with various symptoms. Signs depend on the classification of coronary artery disease. Details are shown in the table.
| Name of the type of ischemic heart disease | Symptoms |
| Sudden coronary death | A symptom that a person himself can notice is a sudden decrease in previously tolerated loads. For example, if before that it was possible to climb the 5th floor without problems, now it is difficult to walk 200 m.Further symptoms of coronary death:
Harbingers may appear before this type of ischemic heart disease. For example, increased heart rate, dizziness. |
| Angina pectoris | In addition to pain, with angina pectoris, the emotional background is disturbed. A person is afraid of death, constantly nervous. In addition, there is shortness of breath and fatigue with minimal exertion.  |
| Myocardial infarction | In addition to pain, the following symptoms appear with myocardial infarction:
|
| Postinfarction cardiosclerosis | Symptoms:
|
| Abnormal heart rhythm | Status signs:
If the case is severe, then fainting is additionally added. |
| Heart failure | Symptoms of acute insufficiency in the right ventricle:
Signs of acute failure in the left ventricle:  With chronic insufficiency, the following symptoms appear:
|
| Painless ischemia | In terms of symptoms, the disease may be similar to other pathologies - diabetes mellitus, thrombosis. Signs:
|
But a heart attack can be masked. Additional symptoms:Complications
Coronary artery disease (symptoms and treatment are interrelated factors) provokes complications. The most serious consequences of ischemic heart disease are coma and death.
When should you see a doctor? Diagnostics
The treatment of ischemic heart disease is in the competence of the doctor - cardiologist. Therefore, if you suspect a disease, you must visit a doctor. He will conduct a survey, study the medical history. Additionally, you will need to inspect the human body. After that, you may need to consult with a heart surgeon.
Symptoms for which you need to call your doctor or ambulance:
To clarify the diagnosis, a complete examination of the body is necessary. It includes:
- delivery of a general analysis of blood and urine - according to the results, the value of important indicators (erythrocytes, hemoglobin and others) is determined;
- delivery of biochemical analysis - determine the value of glucose, cholesterol and other indicators;
- electrocardiogram (ECG) - the procedure helps to identify abnormalities in the work of the heart;
- ultrasound examination (ultrasound) - according to the results, it is possible to identify the size of the heart, deviations in the development of the organ;
- magnetic resonance imaging (MRI) is a highly informative study, according to the results of which it is possible to determine the size of an organ, to assess its functionality;
- heart biopsy - small tissue of the myocardium is taken, sent to the laboratory;
- load test;
- Holter research;
- Echocardiography;
- coronary angiography.
Load tests
Another name for exercise techniques is stress test. They are of several types. But the principle is the same - the heart is examined during physical activity. This helps to fully view the organ. At rest, there may not be a complete picture of the disturbance in the activity of the heart.
Positive qualities of stress tests:
- identification of abnormalities in the work of the heart at the initial stage;
- the ability to study abnormalities in the work of the heart that are not visible at rest;
- you can identify the tolerance of the organism.
Therefore, stress tests are often used in people whose professions are associated with increased stress - firefighters, drivers. And also this diagnostic method is used by athletes in order to calculate the permissible load and conduct training more efficiently.
Popular tests:
Load test combined with imaging techniques
As stress tests with imaging techniques, the following procedures are used:
- Single-photon emission computed tomography (SPECT). The drug is injected into the human body. Then computed tomography is done. If myocardial blood flow is normal, the drug is evenly distributed. When the blood supply to the muscle is reduced, defects can be noticed.
- Positron Emission Tomography (PET). A radioactive isotope is injected into the body. With the help of tomography, the nutrition of the myocardium is monitored. Based on the results, we can conclude about the supply of the heart.
- Perfusion magnetic resonance imaging of the coronary bed (PMRI)... A substance is introduced into the human body that stains the vessels. After PMRI, a conclusion can be drawn about the work of the myocardium.
Holter monitoring
The abbreviated name that cardiologists use is Holter.
Based on the results of the procedure, we can conclude about the following points:
The skin in the chest area is defatted using a special alcohol solution. A small device is attached to the human body, the weight of which does not exceed 500 g. Next, the electrodes are attached.
The standard time for the procedure is 24 hours. But, if a longer diagnosis is needed, the duration can be increased to 2 - 7 days.
When setting a Holter, the doctor will tell you what actions are best not to do. For example, too much physical activity is prohibited, since the device may turn off or the result will be incorrect. And also from increased sweating, the electrodes will not stick. Otherwise, you need to adhere to your usual lifestyle.
When the required period of time has passed, the device is removed, the device is connected to the computer. The digital system analyzes the received data.
Echocardiography
The full name of the procedure is echocardiography. For carrying out, a special apparatus is used that emits ultrasound. Passing through the heart, the waves are reflected by the tissues of the organ.
The duration of the procedure varies from 30 to 40 minutes. The probe is applied to multiple areas of the skin. In the process of echocardiography, attention is paid to myocardial contractility, valve activity, and heart function.
Coronary angiography
Based on the results of the procedure, it is possible to identify the structural features of the circulatory system. Coronary angiography is an operative diagnostic intervention. Therefore, the procedure is carried out only in the clinic. 
An incision is made in the skin through which a probe (long and thin tube) is inserted. The process of advancing the catheter to the heart is monitored by a camera. A contrast agent is injected through the probe. Next, an x-ray is taken. Throughout the procedure, the person's pulse is monitored.
Drug treatment
Coronary artery disease (symptoms and treatment are interrelated factors) is a pathology in which drug therapy can be used. Medicines reduce the manifestation of negative symptoms and make a person feel better.
Β-blockers
A group of drugs reduces myocardial oxygen demand, reduces heart rate and blood pressure. When taking B-blockers, the life expectancy of a person with ischemic heart disease increases.
The mechanism of action of beta-blockers The most commonly prescribed drugs are:
- Metoprolol.
- Atenolol.
- Bisoprolol.
- Concor.
- Betalok.
Antiplatelet agents
Drugs that reduce the likelihood of blood clots.
With ischemic heart disease, it is often prescribed:
- Acetylsalicylic acid.
- Cardiomagnet.
- Thrombotic ACC.
- Acecardol.
Statins and fibrates
Statins accelerate the elimination of bad cholesterol. As a result, the general condition of the vessels improves, the elasticity of their walls improves. Additionally, drugs eliminate the symptoms of high cholesterol.
With ischemic heart disease, the following medications are prescribed:
- Atorvastatin.
- Atoris.
- Crestor.
- Rosuvastatin.
Fibrates reduce the production of triglycerides, high and low density lipoproteins. And also drugs increase the synthesis of good cholesterol.
Medicines:
- Clofibrate.
- Fenofibrate.
- Lipantil.
Anticoagulants
Medication helps to thin the blood. As a result, the likelihood of blood clots is reduced. The group includes Heparin, Warfarin, Ksarelto.
Nitrates
Medicines eliminate an attack of angina pectoris. And also nitrates are used to prevent complications in the case of acute myocardial infarction. A group of drugs dilates blood vessels, blood flows faster to the myocardium and supplies it with oxygen. 
As a result, you can get rid of chest pain. Additionally, nitrates improve blood flow and prevent thrombus formation. The group includes Nitroglycerin, Nitrosprey, Nitromint.
Antiarrhythmics
The drugs normalize the heart rate. The group includes Verapamil, Digoxin, Amiodarone.
Diuretics
Medicines speed up the elimination of excess fluid from the body. As a result, the swelling decreases, the load on the heart decreases. The group includes Veroshpiron, Diuver, Hydrochlorothiazide.
Other methods
In addition to drugs, other methods of therapy can be used for coronary artery disease. The most commonly used coronary angioplasty and stenting, coronary artery bypass grafting.
Coronary angioplasty and stenting
The operation is used to open a vessel (if it is blocked by a plaque of cholesterol) and restore blood flow. Before the procedure, the person is given local anesthesia.
A puncture is made in the femoral (near the groin) or radial (on the wrist) artery. Preliminarily, the skin is worked off with an alcohol solution. Next, a catheter is inserted into the artery, at the end of which there is a balloon. 
The tube is advanced to the site of the blockage. The balloon is slowly inflated, pressing the plaque into the walls of the artery. Then deflation occurs. Actions with the balloon are repeated several times. Further, all instruments are removed from the vessel.
If the diameter of the artery is more than 3 mm, stenting should be performed. A special device (stent) is inserted into the vessel. Thanks to the lattice structure, the artery expands. Thus, the effect is more lasting. After the procedure, the stand remains in the vessel forever.
Coronary artery bypass grafting
During the operation, a new vascular pathway is created for the movement of blood. The surgeon lays it around the artery, which is clogged with cholesterol plaque. According to the results of the procedure, the blood supply to the myocardium can be improved. For shunting, the patient's vessels are used. It can be part of the upper limb radial artery, saphenous vein of the leg.
On one side, the shunt connects to the aorta, and on the other, to the heart branch, which is blocked by a blood clot. During the operation, a person is connected to a cardiopulmonary bypass system. The device will carry blood through the body instead of the heart. But intervention is possible without fulfilling this point, the main body will work.
The value of nutrition with ischemic heart disease
With ischemic heart disease, you need to eat properly. This can reduce the stress on the heart and improve the person's well-being. 
Nutrition principles:
- Frequent meals - up to 6 times a day. It is necessary to observe breaks between meals - from 3 to 4 hours. Serving size - up to 300 g.
- Remove fatty, fried, smoked foods from the diet.
- Reduce the amount of sweet, starchy foods.
- Replace fatty meat with low-calorie meat - instead of pork and lamb, it is better to buy chicken, turkey;
- Dairy products should be low in calories.
- The diet should be dominated by vegetable soups, cereals.
- Better to steam, boil or bake in the oven.
- It is necessary to remember about the drinking regime - at least 1 liter of clean non-carbonated water per day. It is recommended to exclude sugary drinks, strong coffee and tea.
The importance of physical activity
Exercise with coronary heart disease helps to reduce the manifestation of symptoms and make a person feel better. But you don't need to go in for professional sports or load the body heavily. At first, exercise in the morning is enough. Then you can increase the load and choose your favorite activity - cycling, walking.
Forecast
The prognosis for ischemic heart disease depends on the type of disease and stage. And also take into account concomitant pathologies. But IHD is an incurable condition. You cannot completely get rid of the disease.
But with such a pathology, a person's life can be increased by another 20-50 years, if you adhere to all the recommendations of a specialist. With the help of therapeutic measures, it is allowed to stop the progression of the disease.
Ischemic heart disease is understood as a violation of myocardial circulation. It is a muscle that is involved in pumping blood. There are different forms of ischemic heart disease - myocardial infarction, angina pectoris, cardiosclerosis. Each species has its own symptoms.
As a treatment, drugs and surgery (angioplasty, bypass surgery) are used. The most important thing is to visit a cardiologist in a timely manner or call an ambulance. If you follow all the doctor's recommendations, you can stop the progression of the disease, reduce the likelihood of complications.
Article design: Vladimir the Great
Ischemic Heart Disease Videos
What is the danger of cardiac ischemia:
Is a disease that is a violation of myocardial circulation. It is caused by a lack of oxygen, which is carried through the coronary arteries. Manifestations of atherosclerosis prevent it from entering: narrowing of the lumens of blood vessels and the formation of plaques in them. In addition to hypoxia, that is, lack of oxygen, tissues are deprived of some of the beneficial nutrients necessary for the normal functioning of the heart.Coronary artery disease is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of the fairer sex of a number of hormones that prevent the development of vascular atherosclerosis. With the onset of menopause, the hormonal background changes, so the possibility of developing coronary artery disease increases dramatically.
Within the framework of the classification of coronary heart disease, the following forms are distinguished:
Painless form. This myocardial ischemia is typical for people with a high pain threshold. Hard physical labor and alcohol abuse contribute to its development. The elderly, as well as the sick, are at risk. This form of ischemia is painless, which is why it is often called dumb. However, in some cases, there may be chest discomfort. It occurs in the early stages of the development of the disease. The characteristic symptoms of painless ischemia of the heart are tachycardia, angina pectoris, sharp. Possible weakness in the left arm, shortness of breath or.
Primary cardiac arrest. It refers to sudden coronary death. It occurs immediately after a heart attack or within a few hours after it. Overweight, smoking, arterial hypertension contribute to this manifestation of coronary heart disease, and ventricular fibrillation becomes the cause. Allocate sudden coronary death with successful resuscitation or resulting in death. In the first case, qualified medical care should be provided immediately. If defibrillation is not done in time, the patient dies.
Compressing or pressing pain, discomfort in the chest area - these are the main symptoms by which this form of coronary artery disease is determined. It often manifests itself in the form of heartburn, colic, or nausea. Chest pains can radiate to the neck, left arm or shoulder on the same side, sometimes to the jaw and back. Discomfort occurs during active physical activity, after eating, especially when overeating, a sharp increase in blood pressure. Angina is caused by stress and hypothermia. In all these situations, there is a need for more oxygen for the heart muscle, but due to clogged arteries with plaque, this is not possible. To cope with pain, which can last up to 15 minutes, it is enough to stop physical activity, if it was caused by it, or to take short-acting nitrates. The most popular of these drugs is nitroglycerin.
Angina pectoris can be stable and unstable. In the first case, it is caused by the action of environmental factors: smoking, significant physical activity. You can deal with it with nitroglycerin. If it becomes ineffective, this indicates the development of unstable angina. It is more dangerous, as it often becomes the cause of myocardial infarction or death of the patient. One of the types of unstable angina pectoris is the first-onset angina pectoris. The main distinguishing feature of this form of the disease is that the onset of seizures began no later than a few months ago. The cause of the first-onset angina pectoris can be strong emotional or physical stress. In this case, the coronary arteries can function normally. The second group of patients is formed by patients who have undergone and have pathology of the coronary arteries. If the development of the disease proceeds imperceptibly, it is highly likely that it will develop into stable angina pectoris. But another option is also possible. Often, the first symptoms soon disappear, the attacks stop, and over the next years, the patient's angina does not appear in any way. This requires regular examinations to prevent unexpected myocardial infarction.
Cardiosclerosis can be diffuse and focal. In the first case, scar tissue replaces heart cells evenly, being distributed throughout the muscle. With focal cardiosclerosis, the connective tissue affects only certain areas. It is usually caused by myocardial infarction.
Plaques in the arteries cause the development of atherosclerotic cardiosclerosis. The development of myocarditis cardiosclerosis is promoted by the inflammatory process of the heart muscle itself. Overeating, smoking, a sedentary lifestyle increases the risk of the disease. For a long time, cardiosclerosis can be asymptomatic, especially in the case of atherosclerotic form. Patients during rehabilitation and prevention should follow a diet that involves the minimum intake of salt, fats and liquids.
There are several main symptoms of heart ischemia:
Pain in the chest and behind the chest. It can have a stabbing, baking or squeezing character. Unpleasant sensations arise unexpectedly and disappear after 3-15 minutes. In the early stages of coronary artery disease, discomfort may be mild. Severe pains radiate to the left arm and shoulder, less often to the jaw and right side. They appear during sports, or with strong emotional stress. To get rid of the discomfort caused by physical activity, it is enough to take a short break. When such measures do not help and the attacks become severe, they resort to the help of medications.
Dyspnea. Like pain, it first appears during movement and is caused by a lack of oxygen in the body. As the disease progresses, shortness of breath is accompanied by each attack. The patient experiences it even at rest.
Heartbeat disorders. It becomes more frequent, and the blows are felt stronger in this case. There may also be interruptions at some moments. At the same time, the heartbeat is felt very weak.
General malaise. The patient experiences, may fall into, gets tired quickly. There is increased sweating and nausea, turning into vomiting.
In the old days it was called "angina pectoris". This phrase is not accidental, because angina pectoris is not pain, but severe squeezing and burning in the chest and esophagus. May feel in the form of pain in the shoulder, arm, or wrist, but this is less common. Angina pectoris can be easily confused with heartburn. Unsurprisingly, some people try to deal with it and use baking soda to do it. In cardiology, angina pectoris is considered the most striking symptom, indicating the presence of ischemic and preventing myocardial infarction. It is much worse when the disease proceeds without external manifestations. The asymptomatic form is fatal in most cases.
With a heart attack, there is a complete overlap of the lumen of the arteries with plaques. The pain increases gradually and after half an hour it becomes unbearable. The unpleasant sensations may not go away for several hours. In the chronic form of coronary heart disease, the lumen of the vessel does not completely overlap, the attacks of pain are less prolonged.
Psychological symptoms. With a heart attack, the patient may experience unexplained fear and anxiety.
The main reasons due to which cardiac ischemia can occur are as follows:
Atherosclerosis. The myocardium is bent around by two main arteries, through which blood flows to the heart. They are called coronary and branch into many small vessels. If the lumen of at least one of them is partially or completely closed, certain parts of the heart muscle do not receive the necessary nutrients, and most importantly, oxygen. The arteries supplying the heart with blood no longer exist, so its work is disrupted, and coronary artery disease develops.
The clogging of the arteries is due to the damaging arteries. It involves the formation of cholesterol plaques in the arteries that impede the movement of blood. Performing active movements with a lack of oxygen in the heart muscle is accompanied by pain.
At this stage, ischemic disease is expressed in the form of exertional angina. Gradually, myocardial metabolism worsens, pain intensifies, becomes longer and appears at rest. Heart failure develops, the patient suffers from shortness of breath. If the lumen of a coronary artery is suddenly blocked as a result of plaque rupture, blood stops flowing to the heart, and a heart attack occurs. As a result, a lethal outcome is possible. The patient's condition after a heart attack and its consequences largely depend on the blockage of the artery. The larger the affected vessel, the worse the prognosis.
Improper nutrition. The reason for the formation of plaques on the walls of blood vessels is an excess of cholesterol in the body that comes with food. In general, this substance is necessary, as it is used to create cell membranes and the production of a number of hormones. It is deposited on the walls of blood vessels under the influence of stressful situations.
Emotional stress causes the production of a special substance. It, in turn, promotes the deposition of cholesterol in the arteries. A properly formulated diet allows you to reduce its amount in the body. It is worth limiting the use of foods that contain saturated fats: butter, sausage, fatty cheeses and meats. It is recommended to give preference to fats contained in fish, nuts, corn. Fast-digesting and high-calorie food contributes to the development of heart ischemia.
Bad habits. Alcohol abuse and smoking affect the work of the heart muscle. Cigarette smoke contains a large number of chemicals, including carbon monoxide, which makes it difficult to transport oxygen, and nicotine, which increases. In addition, smoking affects the formation of blood clots and the development of atherosclerosis.
Sedentary lifestyle or excessive exertion. Uneven physical activity puts additional stress on the heart. The reason for the development of ischemia can be both physical inactivity and physical activity that exceeds the capabilities of the body. It is recommended to exercise regularly, individually determining the intensity, duration, frequency of training.
Obesity. Numerous studies have found a direct relationship between overweight and mortality from cardiovascular disease. Therefore, it is one of the factors contributing to the development of ischemia.
Diabetes. The risk of developing coronary heart disease is great for patients with type I and II diabetes. They need to normalize their carbohydrate metabolism to reduce their risks.
Psychosocial reasons. There is an opinion that people with a higher social status and education are less exposed to coronary artery disease.
Diagnosis of coronary artery disease is carried out primarily on the basis of the patient's feelings. Most often they complain of burning and chest pain, shortness of breath, increased sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, irregular heartbeat and rhythm. If ischemia is suspected, electrocardiography is mandatory. Echocardiography is a research method that allows you to assess the state of the myocardium, to determine the contractile activity of the muscle and blood flow. Blood tests are performed. Biochemical changes can detect coronary heart disease. Functional tests involve exercising the body, such as walking up stairs or exercising on a simulator. Thus, it is possible to identify pathologies of the heart in the early stages.
For the treatment of ischemia in the complex, drugs of the following groups are used: antiplatelet agents, adrenergic blockers, fibrates and statins. Specific remedies are selected by the doctor depending on the form of the disease. Antiplatelet agents improve blood flow, with the help of adrenergic blockers, it is possible to reduce the frequency of contractions of the heart muscle and reduce oxygen consumption. The action of fibrates and statins is directed at atherosclerotic plaques. The drugs reduce the rate of their appearance and prevent new formations on the walls of blood vessels.
The fight against angina pectoris is carried out with the help of nitrates. Natural lipid-lowering drugs are also widely used for the treatment of coronary artery disease. Anticoagulants affect the formation of blood clots, and diuretics help to remove excess fluid from the body.
Since plaques in the vessels cause their narrowing, it is possible to artificially increase the lumen in the coronary arteries. For this, stenting and balloon angioplasty are performed. During these bloodless surgical interventions, the lumen in the vessels expands, and the blood flow is normalized. These methods have replaced the traditional bypass surgery, which today is performed only for some forms of coronary artery disease. In the course of such an operation, the coronary arteries are connected to other vessels below the site of the violation of blood flow in them.
In addition to drug treatment and general therapy, the patient needs moderate physical activity. Depending on the form of ischemia, a set of exercises is developed by a doctor. Indeed, excessive physical activity increases the oxygen demand of the heart muscle and has a negative effect on the development of the disease.
If you have an unexpected attack while walking or playing sports, you should stop and rest, take a sedative and go out into the fresh air. Then you should take a nitroglycerin tablet.
This medication works within 5 minutes. If the pain persists, you need to drink 2 more tablets. The ineffectiveness of nitroglycerin indicates serious problems, therefore, in the absence of improvements in the condition, an urgent need to go to the hospital. Prevention of coronary heart disease involves avoiding alcohol, smoking, proper balanced nutrition and regular exercise. You need to monitor your weight and control. The presence of positive emotions and the absence of stress is important.
The basic principles of ischemic diet are as follows:
Patients with coronary artery disease will have to minimize salt, sugar, sweets and sweets, confectionery, that is, all sources of simple carbohydrates, fatty meats, caviar, spicy and salty foods, chocolate, coffee and cocoa in their diet.
The most important thing is to limit your intake of foods high in cholesterol and fat. You need to eat a little, but often.
It is imperative to eat foods that contain ascorbic acid, A, B, C, potassium, calcium.
Vegetable oil used for cooking should be replaced with corn oil, olive oil. It is much healthier, and it also contains fatty acids that have a positive effect on blood circulation.
The diet should be dominated by dairy products, with the exception of butter, cereals, seafood, vegetable soups, lean sea fish, for example, cod, protein omelet, turkey, chicken.
- It is recommended to steam the dishes. In addition, food can be boiled or stewed.
Below is a typical 7-day menu for patients with ischemia of the heart:
Monday
Breakfast - a slice of whole grain bread, a glass of weak tea without sugar
Lunch - vegetable salad, a slice of boiled skinless chicken, rice, a glass of fruit juice
Dinner - sugar-free cottage cheese casserole, a glass of kefir
Tuesday
Breakfast - scrambled eggs from several proteins, apple, tea
Lunch - baked potatoes, steamed cod, a slice of rye bread, tea
Dinner - vegetable stew, unsweetened yogurt
Wednesday
Breakfast - oatmeal, fruit juice
Second breakfast - cottage cheese with fruit
Lunch - vegetable salad dressed with olive oil, baked turkey, tea
Dinner - milk soup, tea
Thursday
Breakfast - boiled egg, a slice of whole grain bread, natural yogurt
Second breakfast - apple
Lunch - baked chicken, buckwheat, tea
Dinner - vegetable soup, a glass of kefir
Friday
Breakfast - oatmeal, apple, juice
Second breakfast - a glass of kefir
Lunch - soaked herring, baked, tea
Dinner - vegetable salad dressed with olive oil, a glass of milk
Saturday
Breakfast - cottage cheese casserole with fruit, tea
Second breakfast - natural yogurt
Lunch - boiled sea bass, vegetable salad, a glass of milk
Dinner - milk soup, tea
Sunday
Breakfast - millet porridge, natural yogurt
Second breakfast - protein omelet
Lunch - turkey and baked potatoes, tea
Dinner - vegetable soup, a glass of kefir
Education: In 2005 he completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in neurology. In 2009 completed postgraduate studies in the specialty "Nervous Diseases".
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