CARDIAC ISCHEMIA.

Cardiac ischemia (Ischemic heart disease) is a chronic heart disease caused by a violation of the blood supply to the heart muscle to one degree or another due to damage to the coronary vessels that supply the heart muscle with blood.
Therefore, coronary artery disease is also called coronary heart disease.

At the heart of Ischemic heart disease lies the deposition in the walls of the coronary arteries of atherosclerotic plaques, which narrow the lumen of the vessel. The plaque gradually reduces the lumen of the arteries, which leads to inadequate nutrition of the heart muscle.
The process of formation of atherosclerotic plaques is called The rate of its development is different and depends on many factors.
The coronary arteries play a decisive role in the life of the heart muscle. The blood flowing through them brings oxygen and nutrients to all the cells of the heart. If the arteries of the heart are affected by atherosclerosis, then in conditions when there is an increased demand for the heart muscle for oxygen (physical or emotional stress), a state of myocardial ischemia may appear - insufficient blood supply to the heart muscle. As a result, Ischemic heart disease can lead to the development of angina pectoris and myocardial infarction.
Thus, Angina pectoris it is not an independent disease, it is a symptom Coronary artery disease. This state is called "angina pectoris".

Thus, ischemic heart disease - This is an acute or chronic myocardial disease caused by a decrease and cessation of blood flow to the myocardium as a result of damage to the coronary vessels.

IHD has several forms.

• Angina pectoris
• Myocardial infarction
• Chronic heart failure.

Classification Ischemic heart disease by WHO (70s).

• SUDDEN STOP OF BLOOD CIRCULATION(primary) that occurred before the provision of medical care.
• STENOCARDIA
• MYOCARDIAL INFARCTION (MI)
• NON-SPECIFIC MANIFESTATIONS Is (CH) and
  Development Heart Failure speaks of the emergence of a new disease --- the so-called. those. overgrowth of connective tissue in the heart muscle.

STENOCARDIA.

Angina pectoris (angina pectoris) --- a disease characterized by attacks of severe pain and a feeling of constriction behind the sternum or in the region of the heart. The immediate cause of an angina attack is a decrease in the supply of blood to the heart muscle.

Clinical symptoms of angina pectoris.

Angina pectoris is characterized by sensations of compression, heaviness, bursting, burning behind the breastbone, arising from physical exertion. The pain can spread to the left arm, under the left shoulder blade, into the neck. Less often, the pain radiates to the lower jaw, the right half of the chest, the right arm, to the upper abdomen.
The duration of an angina attack is usually several minutes. Since pain in the region of the heart often occurs when moving, the person is forced to stop, after a few minutes of rest, the pain usually goes away.
Pain attack with angina pectoris lasts more than one, but less than 15 minutes. The onset of pain is sudden, directly at the height of physical activity. Most often, walking is such a load, especially in a cold wind, after a heavy meal, when climbing stairs.
The end of pain, as a rule, occurs immediately after a decrease or complete cessation of physical activity or 2-3 minutes after taking Nitroglycerin under the tongue.

Symptoms associated with myocardial ischemia are a feeling of shortness of breath, difficulty breathing. Shortness of breath occurs in the same conditions as chest pain.
Angina pectoris in men usually presents with typical attacks of chest pain.
Women, the elderly and patients with diabetes mellitus during myocardial ischemia may not experience any pain, but feel rapid heartbeat, weakness, dizziness, nausea, and increased sweating.
Some people with coronary artery disease experience no symptoms at all during myocardial ischemia (and even myocardial infarction). This phenomenon is called painless, "silent" ischemia.
Pain in the region of the heart, not associated with coronary insufficiency-- this is cardialgia.

The risk of developing angina pectoris.

Risk factors - these are features that contribute to the development, progression and manifestation of the disease.
Many risk factors play a role in the development of angina pectoris. Some of them can be influenced, others cannot, that is, factors can be removable or irreparable.

• Fatal risk factors Is age, gender, race and heredity.
  Men are more likely to develop angina pectoris than women. This trend persists until about 50–55 years of age, that is, before the onset of menopause in women. After 55 years, the incidence of angina pectoris in men and women is approximately the same. African blacks rarely get atherosclerosis.
• Removable reasons.
  • Smoking – one of the most important factors in the development of angina pectoris. Smoking is highly likely to contribute to the development of coronary artery disease, especially when combined with an increase in total cholesterol levels. On average, smoking shortens life by 7 years. Smokers also have increased levels of carbon monoxide in the blood, which reduces the amount of oxygen that can enter the cells of the body. In addition, the nicotine in tobacco smoke causes the arteries to spasm, thereby increasing blood pressure.
  • An important risk factor for angina pectoris isdiabetes. In the presence of diabetes, the risk of angina pectoris and coronary artery disease increases on average more than 2 times.
  • Emotional stress may play a role in the development of angina pectoris, myocardial infarction, or sudden death. With chronic stress, the heart begins to work with increased stress, blood pressure rises, and the delivery of oxygen and nutrients to the organs worsens.
  • Physical inactivity or lack of physical activity. It is another removable factor.
  • is well known as a risk factor for angina pectoris and coronary artery disease. Hypertrophy (enlargement) of the left ventricle asa consequence of arterial hypertension is an independent strong predictor of mortality from coronary heart disease.
  • Increased blood clotting , can lead to thrombosis.

VARIETIES OF STENOCARDIA.

There are several options for angina pectoris:

Exertional angina .

• Stable angina, which includes 4 functional classes depending on the transferred load.
• Unstable angina stability or instability of angina pectoris is determined by the presence or absence of a connection between the load and the manifestation of angina pectoris
• Progressive angina pectoris. The attacks take on an increasing character.

Rest angina.

• Variant angina, or Prinzmetall's angina. This type of angina is also called vasospastic. This is a vasospasm that occurs in a patient who does not have coronary artery disease, there may be 1 affected artery.
  Since it is based on a spasm, the attacks do not depend on physical activity, occur more often at night (n.vagus). Patients wake up, there may be a series of attacks every 5-10-15 minutes. In the interictal period, the patient feels normal.
  ECG outside the attack is normal. During an attack, the picture Any of these attacks can lead to myocardial infarction.
• X - a form of Angina pectoris. It develops in humans as a result of spasm of capillaries, small arterioles. Rarely leads to a heart attack, develops in neurotics (more in women).

Stable angina.

It is believed that for the occurrence of angina pectoris, the arteries of the heart must be narrowed due to atherosclerosis by 50 - 75%. If treatment is not carried out, then atherosclerosis progresses, plaques on the walls of the arteries are damaged. Blood clots form on them, the lumen of the vessel narrows even more, blood flow slows down, and angina attacks become more frequent and occur with light physical exertion and even at rest.

Stable angina pectoris (exertion), depending on the severity, is usually divided into Functional Classes:

• I functional class- attacks of chest pain are rare. Pain occurs when an unusually large, quickly performed load NS
• II functional class- attacks develop with rapid climbing stairs, brisk walking, especially in frosty weather, in a cold wind, sometimes after eating.
• III functional class- a pronounced restriction of physical activity, seizures appear during normal walking up to 100 meters, sometimes immediately when going outside in cold weather, when climbing to the first floor, they can be provoked by unrest.
• VI functional class- there is a sharp restriction of physical activity, the patient becomes unable to perform any physical work without manifestation of angina attacks; it is characteristic that attacks of angina pectoris at rest can develop - without prior physical and emotional stress.

Allocation of functional classes allows the attending physician to choose the right drugs and the amount of physical activity in each case.

Unstable angina.

If habitual angina pectoris changes its behavior, it is called unstable or pre-infarction condition. Unstable angina refers to the following conditions:
For the first time in life, angina pectoris not more than one month old;

• Progressive angina pectoris when there is a sudden increase in the frequency, severity or duration of attacks, the appearance of nocturnal attacks;
• Rest angina- the appearance of angina attacks at rest;
• Postinfarction angina- the appearance of rest angina in the early postinfarction period (10-14 days after the onset of myocardial infarction).

In any case, unstable angina is an absolute indication for hospitalization in the intensive care unit.

Variant angina.

Symptoms of variant angina occur as a result of sudden contraction (spasm) of the coronary arteries. Therefore, doctors call this type of angina pectoris vasospastic angina.
With this angina pectoris, the coronary arteries can be affected by atherosclerotic plaques, but sometimes they are absent.
Variant angina occurs at rest, at night or in the early morning. Duration of symptoms 2-5 minutes, works well Nitroglycerin and calcium channel blockers,nifedipine.

Laboratory research.
The minimum list of biochemical parameters for suspected coronary heart disease and angina pectoris includes the determination of blood levels:

• total cholesterol;
• high density lipoprotein cholesterol;
• low density lipoprotein cholesterol;
• triglycerides;
• hemoglobin
• glucose;
• AST and ALT.

The main instrumental methods for diagnosing stable angina pectoris include the following studies:

• electrocardiography,
• exercise test (bicycle ergometry, treadmill),
• echocardiography,
• coronary angiography.

If it is impossible to carry out a test with physical activity, as well as to identify the so-called bose-pain ischemia and variant angina pectoris, it is shown daily (Holter) ECG monitoring.

Differential diagnosis.
It should be remembered that chest pain can occur not only with angina pectoris, but also with many other diseases. In addition, there may be several causes of chest pain at the same time.
Under angina pectoris can be masked:

• Myocardial infarction;
• Diseases of the gastrointestinal tract (peptic ulcer, diseases of the esophagus);
• Diseases of the chest and spine (osteochondrosis of the thoracic spine, shingles);
• Lung disease (pneumonia pleurisy).

Typical angina pectoris:
Retrosternal ---- pain or discomfort characteristic quality and duration
Occurs with physical exertion or emotional stress
It passes at rest or after taking nitroglycerin.

Atypical angina pectoris:
Two of the above signs. Non-heart pain. One or none of the above.

Prevention of angina pectoris.
Methods for the prevention of angina pectoris are similar to the prevention of coronary heart disease,

EMERGENCY HELP FOR SENOCARDIA!

An ambulance should be called if this is the first attack of angina pectoris in life, as well as if: pain behind the sternum or its equivalents increases or lasts more than 5 minutes, especially if all this is accompanied by worsening breathing, weakness, vomiting; chest pain did not stop or worsened within 5 minutes after resorption of 1 nitroglycerin tablet.

Help with pain before the arrival of an ambulance for angina pectoris!

Sit down the patient comfortably with lowered legs, calm him down, do not let him get up.
Let me chew 1/2 or 1 large tablet aspirin(250-500 mg).
For pain relief, give nitroglycerine 1 tablet under the tongue or nitrolingual, isoket in an aerosol can (one dose under the tongue, without inhaling). If there is no effect, use these drugs again. Nitroglycerin tablets can be reused at intervals of 3 minutes, aerosols at intervals of 1 minute.Drugs can be reused no more than three times due to the danger of a sharp drop in blood pressure.
A sip of cognac often helps relieve the spasm, which must be held in the mouth for 1-2 minutes before swallowing.

TREATMENT Ischemic heart disease and stenocardia.

Drug therapy.

1. Medicines that improve the prognosis (recommended for all patients with angina pectoris in the absence of contraindications):

• it Antiplatelet drugs (Acetylsalicylic acid, Clopidogrel). They prevent platelet aggregation, that is, they prevent thrombus formation at its earliest stage.
  Long-term regular intake of acetylsalicylic acid (aspirin) by patients with angina pectoris, especially those who have had myocardial infarction, reduces the risk of developing a second heart attack by an average of 30%.
• it Beta-blockers By blocking the effect of stress hormones on the heart muscle, they reduce myocardial oxygen demand, thereby leveling the imbalance between myocardial oxygen demand and its delivery through narrowed coronary arteries.
• it Statins (Simvastatin, Atorvastatin and others)... They lower total and low-density lipoprotein cholesterol levels, reduce cardiovascular mortality and
• it Angiotensin Converting Enzyme Inhibitors - ACE (Perindopril, Enalapril, Lisinopril and others). Taking these drugs significantly reduces the risk of death from cardiovascular disease, as well as the likelihood of developing heart failure. ACE inhibitors should not be prescribed when 1st type.

2. Antianginal (anti-ischemic) therapy , aimed at reducing the frequency and intensity of angina attacks:

• it Beta-blockers (Metaprolol, Atenolol, Bisaprolol and others). Taking these drugs decreases heart rate, systolic blood pressure, cardiovascular response to exercise and emotional stress. This leads to a decrease in oxygen consumption by the myocardium.
• it Calcium antagonists (Verapamil, Diltiazem). They reduce myocardial oxygen consumption. However, they should not be prescribed for sick sinus syndrome and atrioventricular conduction disorder.
• it Nitrates (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, Kardiket, Oligard, etc.). They expand (dilate) the veins, thereby reducing the preload on the heart and, as a result, myocardial oxygen demand. Nitrates relieve spasm of the coronary arteries. Since nitrates can cause headaches, especially at the beginning of treatment, you need to take small doses of caffeine at the same time (it dilates cerebral vessels, improves outflow, prevents stroke; 0.01-0.05 g simultaneously with nitrate).
• it Cytoprotectors (Pre-dictated).It normalizes myocardial metabolism, does not dilate the coronary vessels. The drug of choice for the X-form of angina pectoris. Do not administer for more than 1 month.

Coronary artery bypass grafting.

Coronary artery bypass grafting- This is a surgical intervention performed to restore the blood supply to the myocardium below the site of atherosclerotic vasoconstriction. This creates a different path for blood flow (shunt) to the area of ​​the heart muscle, the blood supply to which has been impaired.

Surgical intervention is performed in severe angina pectoris (III-IV functional class) and narrowing of the lumen of the coronary arteries> 70% (according to the results of coronary angiography). The main coronary arteries and their large branches are subject to bypass grafting. Previous myocardial infarction is not a contraindication to this operation. The volume of the operation is determined by the number of affected arteries supplying blood to the viable myocardium. As a result of the operation, blood flow should be restored in all areas of the myocardium where blood circulation is impaired. In 20-25% of patients who underwent coronary artery bypass grafting, angina pectoris recurs within 8-10 years. In these cases, the issue of reoperation is considered.

Ischemic heart disease is a pathological condition caused by a lack of nutrition of the heart muscle due to narrowing of the lumen of the coronary vessels or their spasm. It combines several diagnoses, such as angina pectoris, myocardial infarction, cardiosclerosis, sudden coronary death and others.

Today it is the most common disease in its category in the world and ranks first among the causes of death and disability in all developed countries.

Predisposing factors

To date, criteria have been derived by which one can predict the development of a particular disease. Ischemic heart disease is no exception. There is not just a list, but a classification of risk factors, grouped according to a specific criterion, that can contribute to the onset of this disease.

1. Biological:
   - age over 50;
   - gender - men are more likely to get sick;
   - genetic predisposition to dysmetabolic diseases.
2. Anatomy:
   - high blood pressure;
   - obesity;
   - the presence of diabetes mellitus.
3. Lifestyle:
   - violation of the diet;
   - smoking;
   - physical inactivity or excessive physical activity;
   - alcohol consumption.

Disease development

The pathogenetic causes of the development of the disease can be both extra- and intravascular problems, such as narrowing of the lumen of the coronary arteries due to atherosclerosis, thrombosis or spasm, or severe tachycardia with hypertension. But still, atherosclerosis is in the first place for the reasons for the development of a heart attack. Initially, a person develops a metabolic disorder, which is expressed in a persistent increase in blood lipids.

The next stage is the fixation of lipid complexes in the walls of blood vessels and their sweating into the endothelial cells. Atherosclerotic plaques are formed. They destroy the vascular wall, make it more fragile. This condition can have two outcomes - either a blood clot comes off the plaque and clogs the artery upstream of the bloodstream, or the diameter of the vessel becomes so small that the blood can no longer freely circulate and feed a specific area. In this place, a focus of ischemia is formed, and then necrosis. If this whole process takes place in the heart, then the disease will be called IHD.

There are several clinical forms and the corresponding treatment for coronary artery disease. The drugs are selected based on the pathophysiological component.

Sudden coronary death

It is also called cardiac arrest. It can have two outcomes: a person dies or ends up in intensive care. It is associated with sudden myocardial instability. This diagnosis is an exception when there is no reason to suspect another form of ischemic heart disease. Treatment, drugs of choice for medical workers remain the same as in resuscitation. Another condition is that death must occur instantly and with witnesses or no later than six hours after the onset of a heart attack. Otherwise, it already falls under a different classification.

Angina pectoris

This is one of the forms of ischemic heart disease. It also has its own additional classification. So:

1. Stable exertional angina.
2. Vasospastic angina.
3. Unstable angina pectoris, which in turn is divided into:
   - progressive;
   - emerged for the first time;
   - early postinfarction.
4. Prinzmetal angina.

The first type is the most common. The Association of Cardiologists has long developed the treatment of ischemic heart disease of exertional angina. The drugs must be taken regularly and for a long time, sometimes for a lifetime. If you follow the recommendations, then you can postpone unpleasant health consequences for a while.

It is established taking into account the data of the electrocardiogram, laboratory and anamnestic indicators. The most informative are the increases in enzymes such as LDH (lactate dehydrogenase), ALaT (alanine aminotransferase) and ASaT (aspartate aminotransferase), which are normally contained within the cell and appear in the blood only when it is destroyed.

A heart attack is one of the endings to which uncontrolled coronary heart disease can lead. Treatment, drugs, help - all this can be late, because in an acute attack, very little time is allotted to reverse the damage.

Diagnostics

Naturally, any examination begins with a survey and examination. Anamnesis data is collected. The doctor is interested in such complaints as chest pain after exercise, shortness of breath, fatigue, weakness, palpitations. It will be important to note the evening swelling, warm to the touch. And also how is the treatment of ischemic heart disease carried out. Drugs can tell a doctor a lot. For example, "Nitroglycerin". If it helps to relieve an attack, then this almost always speaks in favor of angina pectoris.

The physical examination includes measuring blood pressure, breathing and pulse rate, and listening to the heart and lungs. The doctor tries to hear pathological noises, increased heart sounds, as well as wheezing and blisters in the lungs, which would indicate stagnant processes.

Treatment

So we got down to the basics. We are interested in the treatment of ischemic heart disease. The drugs play a leading role in it, but not only they contribute to the improvement of well-being. First of all, the patient needs to be explained that he will have to completely change his lifestyle. Remove excessive physical activity, balance sleep and rest, and eat well. Diet should be given special attention. It should contain potassium, calcium and sodium necessary for the heart, but at the same time limit the intake of salt, water, foods with excessive amounts of animal fats and carbohydrates. If a person is overweight, then it is necessary to correct it.

But besides this, methods have been developed for the pharmacological elimination of such a problem as coronary heart disease. Treatment - drugs in the form of tablets, capsules, powders and solutions. With proper selection and regular use, excellent results can be achieved.

Antiplatelet agents

Groups of drugs for the treatment of coronary artery disease are divided into several classifications, but the most common - according to the mechanism of action. We will use it. Antiplatelet agents help improve blood flow. They act on the coagulation and anticoagulant systems, somewhat uncoupling them, and thus achieve liquefaction. These include Aspirin, Clopidogrel, Warfarin and others. When prescribing them, it is always necessary to monitor the INR (international normalized ratio) indicator in order to prevent bleeding in a person.

Beta-blockers

They have an effect on receptors in the walls of blood vessels, slowing down the heartbeat. As a result, it consumes less oxygen and needs less blood, which is very useful with narrowed coronary arteries. These are some of the most common medications for coronary artery disease. Treatment, drugs of choice, and dose depend on the underlying conditions. There are selective and non-selective beta-blockers. Some of them act more gently, others - a little harder, but an absolute contraindication is the patient's history of bronchial asthma or other obstructive pulmonary disease. Among the most common drugs are Biprolol, Visken, Carvedilol.

Statins

Doctors spend a lot of effort on the treatment of coronary artery disease. The drugs are being improved, new approaches are being developed, and the causes of the development of the disease are being investigated. One of these advanced approaches is to influence the provoking factors, namely dyslipidemia or imbalance of blood fats. It has been proven that a decrease in cholesterol levels leads to a slowdown in the formation of atherosclerosis. And this is the main cause of ischemic heart disease. Signs, treatment, drugs - all this has already been identified and developed, you just need to be able to use the available information to the benefit of the patient. Examples of effective agents include Lovastatin, Atorvastatin, Simvastatin and others.

Nitrates

The work of these drugs is one of the diagnostic signs that help to confirm the presence of the disease. But they are also needed as part of the program that is included in the treatment of coronary artery disease. Medicines and drugs are carefully selected, the dose and frequency of administration are adjusted.

and affect smooth muscles in the walls of blood vessels. When these muscles relax, they increase the diameter of the lumen, thus increasing the amount of blood supplied. This helps relieve ischemia and pain attacks. But, unfortunately, nitrates cannot prevent the development of a heart attack in the global sense of the word, and does not increase life expectancy, therefore, these drugs are recommended to be taken only during an attack ("Dinisorb", "Isoket"), and on a permanent basis, choose something else ...

Anticoagulants

If, in addition to angina pectoris, the patient has a threat of thrombus formation, then these drugs for coronary heart disease are prescribed to him. Symptoms and treatment, drugs depend on how prevailing one or another link of the pathological process. One of the most famous means of this series is "Heparin". It is administered in a high dose once for acute myocardial infarction, and then the level in the blood plasma is maintained for several days. The clotting time must be carefully monitored.

Diuretics

Drugs for the treatment of coronary artery disease are not only pathogenetic, but also symptomatic. They affect such a link as high blood pressure. If you increase the amount of fluid that the body will lose, then you can artificially lower the pressure to normal levels and eliminate the threat of a second heart attack. But do not do it too quickly, so as not to provoke a collapse. There are several types of these drugs, depending on which part of the loop of Henle (part of the nephron) they affect. A competent doctor will select the medicine necessary in this situation. One that will not aggravate the patient's condition. Be healthy!

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The essence of pathology

Many people are interested in what ischemic heart disease is and how to treat it. This term is understood as myocardial damage, which is caused by a lack or complete cessation of the blood supply to the heart.

ICD-10 code - I20-I25. Cardiac ischemia.

Pathology can be expressed in the form of acute conditions - heart attack or cardiac arrest. Chronic manifestations are also possible - heart failure, angina pectoris, postinfarction cardiosclerosis. Symptoms of pathology depend on the form and severity of the disease.

Causes

Ischemia of the heart develops under the influence of the following factors:

How does this pathology manifest itself? Coronary artery disease has a number of symptoms:

In addition to the main symptoms, people with this diagnosis may feel general weakness and increased fatigue. Often, the disease is accompanied by dizziness. In more rare cases, fainting conditions are observed.

Angina pectoris is considered one of the main forms of ischemia.... This condition is characterized by periodic seizures that begin suddenly with physical or emotional stress.

In this case, the patient experiences a feeling of lack of air, tightness in the chest, pain that radiates to the shoulder blade, neck or arm.

Cardiac ischemia. Why does the "motor fail"

First aid in the development of an attack of angina pectoris is to perform the following actions:

Treatment methods

Can this disease be cured? Doctors say that it is impossible to completely eliminate the pathology, however, with the help of correctly selected drugs, it is possible to stop its development and significantly improve the prognosis.

To get such results, you need to choose a complex therapy. It should include traditional methods of treatment and folk recipes.

Elimination of risk factors is a mandatory element of therapy.... To do this, it is important to make adjustments to a person's lifestyle, eliminate hypodynamia, get rid of bad habits and establish the correct diet.

It is also important to eliminate stressful situations and emotional overload.

Medicinal methods consist in the use of 2 main categories of funds. These include Nitroglycerin and its derivatives, which have a longer lasting effect..

Thanks to the use of such drugs, it is possible to relieve spasm and expand the coronary vessels. This helps to facilitate the passage of blood and oxygen to the heart.

The simplest medicine from this group is Aspirin, which is prescribed according to a certain scheme..

In addition, agents that reduce the formation of cholesterol and inhibit its absorption in the intestine can be used to treat ischemia. Sometimes drugs are required that accelerate metabolic processes and promote the elimination of lipids from the body.

Vitamins are very useful for coronary heart disease. Doctors usually prescribe a combination of vitamins E and P with ascorbic acid.

As an addition to traditional therapy, alternative methods are also actively used to combat coronary heart disease. The most effective recipes include the following:

To cope with ischemia, it is imperative to perform special therapeutic exercises.

At the initial stages of the development of the disease, it is useful to run and swim. Skis and bicycles are no less effective. In this case, the loads are permissible only during the period of remission of the pathology.

In more complex cases of ischemia, therapeutic exercises are indicated. The specific complex should be selected by the exercise therapy doctor, taking into account the clinical picture.

Classes should be conducted by an instructor. This is carried out in a hospital or clinic under the supervision of a specialist. Be sure to measure your pulse.

As a rule, the complexes include exercises in a standing and sitting position. Walking and movement for the upper and lower extremities is also shown.

It is very useful to do breathing exercises... All exercises should be performed slowly and smoothly, maintaining a small range of motion.

To relieve stress on the heart, self-massage of the limbs can be performed.... Thanks to this, it is possible to facilitate the outflow of blood from the periphery to the central part. The simplest techniques include stroking, kneading and rubbing.

Health food

Diet is also important for coronary heart disease.

With the development of this pathology, a person must definitely eat honey, raisins, nuts. Pumpkin seeds, cottage cheese, lemons and oranges are also beneficial.

It is imperative to maintain a balance of proteins, fats and carbohydrates, observing the proportions of 1: 1: 4.

If you are overweight, you should reduce the calorie content of food. To do this, exclude fatty meats from the diet - especially pork and lamb. You also need to give up margarine and butter.

It is important to ensure that the diet includes a sufficient amount of vitamins and minerals.

Forecast

Many people wonder how long they live with coronary heart disease... The forecast depends on a number of interrelated factors.

An unfavorable outcome is possible when ischemia is combined with arterial hypertension, diabetes mellitus, and complex lipid metabolism disorders.

With the help of adequate therapy, you can only slow down the progression of the disease. If you do not start treatment, the patient faces disability and death.

Coronary artery disease is considered a serious condition. Why is it dangerous:

• insufficient energy metabolism of cardiomyocytes - myocardial cells;
• the appearance of postinfarction cardiosclerosis;
• "Stunned" and "dormant" myocardium;
• problems with systolic and diastolic myocardial functions;
• violation of contractility, conduction, myocardial excitability.

All these changes that occur in the myocardium provoke the development of a stable decrease in coronary circulation. In this case, we are talking about the appearance of heart failure.

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Drug groups

Coronary artery disease is a disease that cannot be completely cured. It is very important to start therapy on time to prevent the situation from getting worse. It is aimed at increasing the quality and duration of the patient's life. Only a cardiologist can prescribe a treatment for coronary heart disease, while the drugs should be selected individually.

The algorithm for getting rid of the disease may be different for each patient. It all depends on what complications led to ischemia. Modern medicine has recently significantly expanded the mechanisms of drug treatment of atherosclerosis and chronic ischemia.

For coronary heart disease, various medications are prescribed. During this period, it is important to prevent an increase in blood pressure, an attack of angina pectoris, and it is also important to control metabolic processes, especially lipid metabolism. Accordingly, you need to take a whole range of drugs.

Antiplatelet agents... They prevent platelets and red blood cells from sticking together. Another important property of these drugs for coronary heart disease is the prevention of their attachment to the inner wall of the vessel. Due to the intake of antiplatelet agents, the blood is thinned, and its fluidity is improved. Thus, it becomes easier for the heart to pump it.

Preparations:

Beta-blockers... Treatment of coronary heart disease with them occurs for a long time, and sometimes for the whole life.

This group is prescribed for attacks of angina pectoris, arterial hypertension, heart failure, and also if the ischemic process is accompanied by a violation of the heart rhythm. Drugs are necessarily prescribed to patients after myocardial infarction.

A characteristic feature of beta-blockers is that they must be canceled gradually, each time reducing the dosage.

These drugs act on beta-adrenergic receptors, the result is a decrease in heart rate, which means a decrease in myocardial oxygen demand.

Preparations:

• "Metoprolol" is also an active substance. There are other drugs: Betalok, Egilok, Metocard.
• "Bisoprolol". With this active substance there are also drugs such as "Concor", "Bisogamma", "Coronal", "Biprol".
• Carvedilol is an active ingredient in the drug of the same name, as well as in "Dilatrend", "Coriol", "Talliton".

Angiotensin-converting enzyme inhibitors. They interfere with the production of angiotensin II enzymes from angiotensin I by blocking them. This is important, since it is angiotensin 2 that provokes vasospasm. This action of drugs in this group ensures the maintenance of normal blood pressure indicators.

Preparations:

• "Lisinopril".
• "Enalapril" (this drug is combined with a diuretic - "Enalapril N").
• Captopril.

Statins... They affect the properties of the blood, improving lipid metabolism. This lowers cholesterol levels. Taking them is very important for people with ischemic processes. This is due to the fact that the level of cholesterol in the blood of a person with coronary heart disease should be lower than that of a healthy person.

Statins prevent or stop the development of atherosclerotic plaques that are already there. It is also the prevention of the formation of new ones. The drugs affect the frequency of cardiovascular contractions.

Preparations:

• "Simvastatin".
• "Atorvastatin".
• Lovastatin.
• The most effective in the fight against atherosclerotic plaques is called "Rosuvastatin".

Fibrants... They are used to treat dyslipidemia. Their difference from statins is that fibrants act on triglycerides, and statins - only on HDL, and do not have any effect on triglycerides. That is why they are prescribed together with extensive vascular lesions with complications.

It should be noted that Fenofibrate is the most compatible with statins of all fibrants. When using this drug, mortality, according to statistics, is reduced by 25%.

Nitrates. They improve the work of the heart, as they affect the level of contraction of vascular smooth muscles. This unloads the myocardium. The action is mainly directed at the venous vessels - their lumen expands and blood is deposited. This action provokes a drop in blood pressure and headaches. For this reason, they are not prescribed for people whose blood pressure does not exceed 100/60 mm. rt. Art.

Nitrates do not have a prolonged effect and do not improve the prognosis in any way. They stop attacks of angina pectoris. In severe manifestations of ischemic heart disease, nitrates are administered intravenously. But quite often they are prescribed for admission and in the form of pills.

Preparations:

• "Isosorbide mononitrate".

Diuretics These are diuretic drugs that remove excess fluid from the body. They should not be taken uncontrollably, as they can lead to dehydration, and further exacerbate the situation. With ischemic heart disease, diuretics are prescribed for the following purposes:

• Decrease in blood pressure. In this case, low dosages are prescribed, since they are taken in combination with other drugs.
• Prevention of congestion in heart failure. In this case, high doses are prescribed.

When diuretics are taken, blood sugar levels rise, so they are rarely prescribed for people with diabetes. The scheme of such treatment is compiled by the doctor individually.

Diuretics have a positive effect on the heart muscle, since the volume of circulating blood in the body decreases, because fluid is rapidly excreted. Consequently, the load on the myocardium decreases.

Loop diuretics - "Furosemide", which is used both in tablets and in the form of injections. This drug is an emergency aid, as it is used for forced diuresis.

Thiazide diuretics are drugs that are prescribed for long-term use in cardiovascular diseases with the presence of hypertension. These include "Hypothiazide" and "Indapamide".

Contraindications

It is important that a qualified doctor prescribes the therapy. Each group of drugs that are listed above have their own contraindications that must be taken into account.

With ischemia of the heart, beta-blockers are always prescribed. These drugs have a number of contraindications, which include bronchial asthma, bradycardia, hypotension, showing symptoms, as well as atrioventricular blockade from stage 2.

There are also relative contraindications, the presence of which in some patients can cause dangerous situations. These include: aortic stenosis, increased intracranial pressure, angle-closure glaucoma.

Anticoagulants are another group of drugs that cannot be taken on a self-prescribed regimen. Contraindications for use:

• Bleeding (these drugs can by themselves cause profuse bleeding if taken incorrectly).
• Ulcers in the gastrointestinal tract.
• Spasm of the bronchi.
• High blood pressure.
• Malignant neoplasms.

A course of treatment

If there is a risk of developing coronary heart disease, then drugs are prescribed to correct the patient's condition. These are antihypertensive drugs and statins. Antiplatelet agents are prescribed selectively if there is a risk of blood clots and a blood test has confirmed this condition.

If, with uncomplicated cardiac ischemia, the patient has stable exertional angina, antiplatelet agents, statins, ACE inhibitors and antianginal drugs are required. Of the latter, Nicorandil is most often prescribed. This substance promotes relaxation of smooth muscle cells and performs a protective function against cardiomyocytes during ischemic processes. This drug works better on the heart. This is due to the fact that Nicorandil reduces both preload and afterload, while nitrates reduces only one of them. These actions are aimed at stopping angina pectoris and preventing these attacks.

Of the ACE inhibitors in this case, doctors often prescribe Ramipril and Perindopril.

After myocardial infarction, therapy is more extensive. According to the medical protocol, such patients are prescribed antiplatelet agents, beta-blockers, ACE inhibitors, statins, aldosterone antagonists.

In the chronic course of heart failure and ischemic heart disease, patients on an ongoing basis take ACE inhibitors, beta-blockers, aldosterone antagonists, and polyunsaturated fatty acids, ivabradine are also required.

Ivabradine preparations are prescribed for stable angina pectoris. These funds can be taken in place of beta-blockers. Especially if there are contraindications for taking them. You can also combine them.

These schemes are not the same for everyone. Many require other drugs, according to the symptoms and diseases that the patient has in the anamnesis.

Patient lifestyle

People with a diagnosis of ischemic heart disease, in addition to drug therapy, need to adjust their lifestyle. The most important factors are a decrease in physical activity and exertion, as well as the introduction of dietary nutrition.

When a person is excessively overloaded, then the myocardium has a large load. Accordingly, the demand for oxygen increases significantly. And if the need does not coincide with the possibility of the vascular system, then ischemia will develop. At the time of treatment, such patients should limit all kinds of stress, and gradually increase it during the rehabilitation period.

The dietary food is also specific, and is prescribed by the doctor. The main principles are:

• Limiting salt intake.
• Exclusion of animal fats from the diet, as they provoke atherosclerosis.
• Avoiding fried, smoked, high-calorie foods.
• Exclusion of sweets, as they contain fast-absorbing carbohydrates.

If a person is overweight or obese, then it is necessary to lose weight. This is the main condition that will help normalize the condition.

Ischemic heart disease is a serious myocardial damage that requires long-term and serious therapy. Treatment with drugs is prescribed only by a qualified specialist based on the results of the diagnosis. It is important not only to take medications on time, but also to lead a correct lifestyle.

cardiograf.com

Medicines used to treat coronary artery disease

You should take medications prescribed by a cardiologist not from time to time, but constantly. Treatment is carried out exclusively under the supervision of specialists, replacement of drugs and dose adjustment, if necessary, is carried out only by a doctor. Drug use is indicated throughout life from the moment of diagnosis.

If the state of health has worsened, you should conduct a new examination and undergo a course of treatment in a specialized medical cardiology center or the cardiology department of the hospital at your place of residence. It is also recommended to conduct regular courses of therapy in a hospital, regardless of the condition, in order to avoid complications. Good results have been obtained in cardiological sanatoriums, where special programs are provided for such patients.

Treatment of coronary heart disease with medications

IHD therapy is always complex. Only in this case is there a high probability of the success of the treatment measures.

Antihypertensive drugs and angiotensin-2 enzyme blockers in the treatment of ischemic heart disease

Fluctuations in blood pressure and an increase in its indicators to significant values ​​have an extremely negative effect on the state of the coronary vessels, as well as on the state of other organs and systems of the body.

The result of increased pressure in relation to ischemic heart disease:

1. Compression of coronary and other vessels.
2. Hypoxia.

Normalization of blood pressure to acceptable levels is a key factor in general therapeutic and preventive measures in the diagnosis of coronary artery disease.

The rate of blood pressure in coronary artery disease

Target level 140/90 mm. rt. Art. and even less (most of the patients).

The optimal level is 130/90 (for patients with diabetes mellitus).

Satisfactory level 130/90 mm. rt. Art. (for patients diagnosed with kidney disease).

Even lower rates are for patients who have a variety of severe comorbidities.

Examples:

• Enalapril

APF

ACE belongs to the class of angiotensin-2 enzyme blockers. It is this enzyme that is "guilty" in the mechanism of triggering the increase in blood pressure. In addition, angiotensin-2 has a negative effect on the functional state of the heart, kidneys, and blood vessels.

Facts. Currently, a lot of data have been obtained on the positive effect of ACE on the body of patients with coronary artery disease. The prognosis for taking angiotensin enzyme inhibitors is more favorable, because now these drugs are prescribed very widely (subject to serious contraindications and significant side effects.)

Some drugs that belong to the ACE group:

• Lisinopril
• Perindopril.

Long-term use or excess of dosages in some patients causes a number of side effects, a common complaint. Therefore, ACEs are used only on the recommendation of a cardiologist.

Angiotensin receptor inhibitors

In some cases, this group of drugs (ARBs) has a higher effect, since the therapeutic effect in this case is directed at the angiotensin receptors, not at the angiotensin itself. Receptors are found in the myocardium and other organs.

Angiotensin receptor blockers (ARBs):

• Effectively lowers blood pressure.
• Reduces the risk of overgrowth of the heart (eliminate the risk of hypertrophy).
• They help to reduce the already existing hypertrophy of the heart muscle.
• Can be prescribed to those patients who cannot tolerate angiotensin enzyme blockers.

ARBs have been used as directed by a cardiologist for life.

List of funds:

1. Losartan and its analogues:

• Kozaar
• Lozap
• Lorista

1. Valsartan and its analogues:

• Diovan
• Valsacor

1. Candesartan and its analogue Atacand
2. Telmisartan, analogue of Mikardis, etc.

The selection of the drug is carried out only by a cardiologist, who takes into account all available factors - the type of disease, the severity of its course, individual manifestations of symptoms, age, concomitant pathologies, etc.

Medicines to improve the functional ability of the heart

This group of drugs is intended for long-term use and is intended to improve the activity of the myocardium.

Beta blockers

The products are specifically designed to block adrenal receptors and other stress hormones.

Action:

• Decrease in heart rate.
• Blood pressure normalization.
• General beneficial effect on the heart muscle.

Indications:

• Postinfarction condition.
• Left ventricular dysfunction (with or without concurrent heart failure, provided there are no contraindications).

Courses:

Long-term use.

Short-term appointment.

Contraindications:

• Bronchial asthma.
• Diabetes mellitus (since beta blockers can increase blood sugar).

Examples:

• Anaprilin (obsolete, but still prescribed)
• Metoprolol, Egilok
• Bisoprolol, Concor
• Nebilet
• Corvitol.

Nitrates

This group of medications is intended for quick relief of a painful attack (angina pectoris).

• Nitroglycerin, Nitromint
• Isosorbide dinitrate, Isoket
• Mononitrate, Monocinque.

Application result:

• Expansion of the coronary vessels.
• Decreased blood flow to the heart muscle due to the expansion of the deep veins in which blood accumulates.
• Decrease in heart oxygen demand.
• Analgesic effect due to the combination of the general therapeutic effect.

Attention! With prolonged use of such drugs, addiction sets in, and they cannot have an effect.

AFTER A INTERRUPTION IN TAKING, THE ACTION RESTORES.

Cardiac glycosides

Appointed if available:

• Atrial fibrillation
• Severe puffiness.

Examples:

• Digoxin
• Korglikon.

Action:

• Strengthening of heart contractions.
• Slowing down of the heart rate.

Peculiarities:

The development of a large number of negative side effects, while co-administration, for example, with diuretics, increases the risk of a side effect and the brightness of its manifestation. Such drugs are prescribed infrequently and only in the case of clear indications.

Cholesterol normalizing agents

Reference. Cholesterol norms

• no more than 5 mmol / l (total cholesterol),
• not higher than 3 mmol / l (lipoprotein level, "bad" cholesterol with low density);
• not lower than 1.0 mmol / l ("good" high-density cholesterol, lipoproteins).

Attention! An equally important role is played by atherogenic indices and the amount of triglycerides. A whole group of patients, including severe patients with diabetes mellitus, need constant monitoring of these indicators, along with the above.

Examples of some drugs (statin group):

• Atorvastatin
• Simvastatin.

In addition to taking such funds, a mandatory item of the treatment and prophylactic program is the normalization of nutrition. It is not enough to use one, even the most effective diet, without taking medication, and vice versa. Traditional methods are a good addition to the main treatment, but they cannot completely replace it.

Drugs affecting blood viscosity

With increased blood viscosity, the risk of thrombosis in the coronary arteries increases. In addition, viscous blood interferes with the normal blood supply to the myocardium.

Therefore, in the treatment of coronary artery disease, special means are actively used, which are divided into two groups:

• Anticoagulants
• Antiplatelet agents.

Aspirin

It is the most common, effective and available blood thinner and is recommended for patients with CHD for a long time.

Dose:

70 - 150 mg per day. After heart surgery, the dose is often increased.

Contraindications:

• Diseases of the gastrointestinal tract (stomach ulcer)
• Diseases of the hematopoietic system.

Warfarin

This anticoagulant is prescribed for a persistent form of atrial fibrillation.

Action:

• Ensuring the maintenance of INR (blood clotting) indicators.
• Dissolution of blood clots.
• The normal level of INR is 2.0 - 3.0.
• Main side effect:
• The possibility of bleeding.

Reception features:

• after a comprehensive examination
• under the control of laboratory blood tests.

Methods for controlling blood sugar (glucose) levels

Currently, the blood sugar control criterion is used, which displays the amount of glucose in a patient over the past seven days - this is a determination of the level of glycated hemoglobin. A one-time analysis from case to case cannot give a complete picture of the course of the disease.

Norm:

HbA1c (glycated hemoglobin) no more than 7%.

Stabilization of blood sugar is achieved through non-drug measures:

• applying a special diet
• increased physical activity
• reduction in excess body weight.

In addition, if necessary, medications are prescribed (by an endocrinologist).

Other drugs - diuretics, antihypoxants, nonsteroidal anti-inflammatory drugs

Diuretics (diuretics)

Action:

• Lowering blood pressure (in low dosages).
• In order to remove excess fluid from tissues (high doses).
• With symptoms of congestive heart failure (high doses).

Examples:

• Lasix

Some of the drugs have a sugar-increasing effect, so they are used with caution in the case of diabetes.

Antihypoxants

Action:

Reducing the oxygen demand of the heart muscle (at the molecular level).

Example of a remedy:

Trimetazidine.

Non-steroidal anti-inflammatory drugs

Until recently, NSAIDs were often used by patients with coronary artery disease. Large-scale studies in America have confirmed the negative effect of these drugs on patients with myocardial infarction. Studies have shown a worsening prognosis for such patients in the case of the use of NSAIDs.

Examples of funds:

• Diclofenac
• Ibuprofen.

1. You should never take any of the most expensive and popular drug that has helped a loved one or a friend well, even if he has the same diagnosis as yours. An illiterate selection of a medicine and its suboptimal dosage will not only not help, but will also harm health.
2. It is categorically impossible to select any medicinal products according to the instructions for them, which are contained in the package. The insert is provided for informational purposes only, but not for self-medication and dose selection. In addition, the doses indicated in the instructions and those recommended by the cardiologist may differ.
3. You should not be guided in the choice of drugs by advertising (TV, media, newspapers, magazines, etc.). This is especially true of various "miracle" drugs that are not distributed through the official pharmacy network. Pharmacies that are authorized to sell medicines must also receive a special license confirming this right. Their activities are regularly monitored by the relevant authorities. Unscrupulous distributors, whose activities cannot be controlled, often promise almost instant healing in such cases and often advocate the complete exclusion of traditional medications that the doctor has prescribed from the course of treatment. This is extremely dangerous for patients suffering from their favorite forms of coronary artery disease.
4. Do not trust the selection of any drugs to a pharmacist. Such a specialist has other tasks. Treatment of patients is not within the competence of a pharmacist, even if he has sufficient experience in his field.
5. Only an experienced cardiologist with extensive experience in clinical practice is able to correctly prescribe a drug, determine the duration of treatment, select the optimal doses, analyze drug compatibility and take into account all the nuances. The doctor selects the treatment only after a complex, serious and rather long-term examination of the body, which includes hardware and laboratory tests. Do not neglect the recommendations of experts and refuse such a study. Coronary heart disease treatment is not an easy and not a quick task.
6. In the case when drug therapy does not give the desired effect, the patient is usually offered a surgical operation. There is no need to give it up. A successful operation in severe coronary artery disease is able to save the patient's life and raise it to a new, higher quality level. Modern cardiac surgery has achieved tangible success, so you should not be afraid of surgical intervention.
Chronic ischemia Chronic cerebral ischemia what is it

Ischemic heart disease, or ischemic heart disease (exertional angina, unstable angina), is a consequence of narrowing or blockage of the main arteries of the heart with atherosclerotic plaques. Atherosclerotic plaques are composed of deposits of cholesterol and other lipid fractions, calcium and connective tissue fibers. Over time, they become more and more, and when the lumen of the vessel is blocked by 50 percent or more, the blood flow becomes difficult, the delivery of oxygen and nutrients to the heart muscle decreases, oxygen starvation (hypoxia) develops, which leads to myocardial ischemia.

The larger the atherosclerotic plaque, the smaller the lumen of the vessel, which means less blood passes through it, and then angina pectoris is more pronounced. A sudden complete violation of the patency of the coronary artery, when a thrombus forms on an atherosclerotic plaque, leads to a vascular catastrophe, since oxygen ceases to flow to the actively working heart muscle. If it is not possible to restore blood flow in time, a serious complication of coronary artery disease develops - myocardial infarction - necrosis of a portion of the heart muscle.

HOW TO DETERMINE THE CAUSE

Coronary angiography can be done to determine the cause of angina pectoris or myocardial infarction in the coronary vessels. X-rays taken during this study allow us to determine the exact location of atherosclerotic plaques and the degree of narrowing of the coronary arteries.

HEARTACHE

Exercise, emotional stress, cold air and smoking can cause angina attacks. The classic pain attack with angina pectoris has a clear beginning and end, lasts about 5 minutes, and stops when taking nitroglycerin and ending physical activity.

The pain can be felt behind the sternum, it can be given to the left arm, shoulder blade, jaw, neck. It is often of a pressing, burning, squeezing character. Sometimes an attack of angina pectoris is accompanied by a feeling of lack of air, cold sweat. With a prolonged attack (more than 15 minutes), especially if the pain is wave-like, strong, and cannot be relieved by the usual dose of nitroglycerin, an ambulance must be called - these symptoms may indicate a myocardial infarction requiring urgent medical attention.

If attacks occur with the same frequency and are of the same type, then this is stable angina. If the attacks become more frequent, occur with less exertion and even at rest, become more severe and prolonged in time, are poorly stopped by the usual dose of nitroglycerin, then here one can suspect unstable angina. In this case, an urgent medical consultation is required.

Pain in the area of ​​the heart is not always the result of coronary artery disease or other heart disease. It can occur with osteochondrosis, and with diseases of the lungs, stomach and other organs. For any pain in the chest area, you must consult a doctor - he will conduct an examination, make the correct diagnosis and prescribe timely treatment .

FIRST AID AT SEAL

If you have an angina attack, stop exercising, if you are walking, stop, sit down, calm down and relax, put a nitroglycerin tablet under your tongue, or use a nitroglycerin spray. The tablet should dissolve completely. If the pain persists, after 3 to 5 minutes, take 3 more nitroglycerin tablets or spray into your mouth up to three times. If the attack of angina pectoris cannot be relieved within 15 minutes even after taking three nitroglycerin tablets, then chew an aspirin tablet with water (aspirin prevents blood clots) and seek emergency medical help.

Remember: you should always have nitroglycerin with you wherever you are!

RISK FACTORS

Risk factors contributing to the development of cardiovascular disease can be divided into two groups.

Factors that a person cannot control. Age and gender (men over 45 and women over 55 are more likely to get sick). Early development of ischemic heart disease in close relatives.

Factors that a person can control. High blood pressure, smoking, high blood cholesterol, high blood glucose (), excessive alcohol consumption, sedentary lifestyle, overweight, stress.

TREATMENT METHODS

If the disease, despite active drug therapy, progresses, modern surgical methods are used to restore the blood supply to the myocardium: balloon angioplasty - expansion of the vessel by inflating the balloon - and stenting of the coronary arteries - the installation of a special stent (metal frame), allowing for a long time to expand the artery of the heart and provide normal blood flow. If the narrowing of the coronary vessels is significant and multiple, a more complex operation is used - coronary artery bypass grafting.

For the treatment of coronary artery disease, different classes of medicines are used today, the action of which is aimed at preventing myocardial ischemia and angina attacks, vascular thrombosis, preventing the progression of atherosclerosis, and lowering blood pressure and pulse rate (heart rate).

MEASURES FOR PREVENTION OF CARDIOVASCULAR DISEASES

Regular monitoring of blood pressure levels. Aim for blood pressure below 140/90 mm Hg. Art.

Controlling blood cholesterol levels... If it rises, talk to your doctor about taking cholesterol-lowering drugs. The total cholesterol level should be below 5 mmol / L, the low density lipoprotein cholesterol level should be below 3 mmol / L. To change your diet: eat healthy food with less animal fat (for men 60 - 105 g / day, for women 45 - 75 g / day) and rich in vegetables, fruits, complex carbohydrates, dietary fiber, fish. Eliminate fatty meats, strong meat broths, any fat, sausages, sausages, dumplings, canned meat, mayonnaise, caviar, butter, fatty cottage cheese, cakes with cream, ice cream from the diet.

Movement is life! These are not just words. Move more, be physically active (at least 30 minutes of moderate physical activity most days of the week). If you already have heart problems and are taking medication prescribed by your doctor, talk to him about your individual level of physical activity. The load should be reasonable so as not to bring the body to an attack of angina pectoris or shortness of breath. Useful activities such as cycling, dosed walking, swimming, playing sports (football, volleyball). Intense exercises are not recommended - weightlifting (lifting weights and squeezing the barbell). Sports that are highly competitive and competitive, such as tennis, can be dangerous for heart disease. Exercise or physical activity soon after a heavy meal is undesirable.

Body weight control... Watch your waist circumference. If a man's waist is more than 102 cm, and a woman's is more than 88 cm, then this indicates an abdominal one, which increases the risk of cardiovascular complications.

Do not smoke... Smoking is a powerful developmental factor. It promotes the appearance of cholesterol plaques on the walls of blood vessels, which, in turn, become thinner and lose elasticity.

Less stress... Learn to control your psycho-emotional state (avoid conflict situations).

Sugar level... Monitor your blood glucose levels. The norm is 6 mmol / l.

LIVE LONG

In our time, coronary heart disease is not a sentence at all. The main thing is to pass the examination on time, radically change your lifestyle, start treatment and follow all the recommendations of the attending physician. Taking medications should be constant, long-term, daily. Even after heart surgery, the patient needs to continue taking medications prescribed by the doctor and maintain a reasonable lifestyle to prevent the progression of coronary artery disease.

If the patient follows all the doctor's recommendations, if he is positively disposed, then he will be able to keep his illness under control, thereby preventing exacerbations and complications, which means that his life will not lose its colors and will be full and long!

For these purposes, all patients suffering from attacks of chest pain should constantly have nitroglycerin with them.

It should be borne in mind that the first intake of nitroglycerin (especially in an upright position) can cause a decrease in blood pressure and fainting, so it is advisable to put the patient in prison. And when an attack of angina pectoris occurs in bed, on the contrary, it is necessary to sit down or stand up to reduce the load on the heart.

The same measures are carried out as first aid for ischemic heart disease, manifested by the equivalents of angina pectoris - attacks of shortness of breath or severe weakness during exertion.

To alleviate the condition in the event of such complications of coronary heart disease as arrhythmias (sinus tachycardia, atrial fibrillation, etc.), in order to slow down the heart rate, massage of the carotid sinus can be used. The procedure must be carried out very carefully, in the supine position, the neck is unbent.

Within five seconds, pressure is made on the neck area located immediately at the angle of the lower jaw. The pressure is carried out strictly from one side. You can also apply short-term pressure to the eyeballs.

First aid for coronary artery disease complicated by myocardial infarction consists in urgently calling an ambulance. This must also be done if the attack of chest pain lasts more than five minutes, does not go away within five minutes after the nitroglycerin tablet is absorbed, is accompanied by weakness, vomiting, and also if such an attack occurs for the first time.

It is also important to properly lay the patient: the head should be raised relative to the body. A nitroglycerin tablet is given under the tongue. If available: crushed aspirin tablet, analgin or baralgin, valocordin. It is also advisable to give the patient two tablets of panangin or other potassium preparations before the ambulance arrives.

Coronary artery disease first aid

First aid for febrile conditions

With a febrile state, the patient feels weakness, muscle and headaches, frequent heartbeat; it is thrown into the cold, then into the heat, with pronounced sweating.

A very high fever can be accompanied by loss of consciousness and seizures. At a high body temperature, a so-called febrile state occurs. With an increase in temperature, the body reacts to various infectious diseases, inflammatory processes, acute diseases of various organs, allergic reactions, etc.

In febrile conditions, there is a subfebrile temperature (no higher than 38 ° C), high (38–39 ° C), very high (above 39 ° C) - fever.

Provide the patient with rest and bed rest;

In case of intense heat, wipe the patient with a napkin dipped in lukewarm water, vodka;

Call the local therapist of the polyclinic to the patient, who will determine further treatment;

In case of a severe febrile condition (with convulsions, loss of consciousness, etc.), call an ambulance.

Cardiac ischemia

Ischemic heart disease (coronary artery disease, coronary heart disease) is considered as ischemic damage to the myocardium due to oxygen deficiency with inadequate perfusion.

a) sudden coronary death;

Stable exertional angina;

Progressive exertional angina;

Spontaneous (special) angina pectoris;

c) myocardial infarction:

Large focal (transmural, Q-infarction);

Small focal (not Q-infarction);

d) postinfarction cardiosclerosis;

e) heart rhythm disturbances;

f) heart failure.

In the 1980s. the concept of "risk factors" for cardiovascular diseases associated with atherosclerosis has gained the greatest acceptance. Risk factors are not necessarily etiological. They may affect the development and course of atherosclerosis, or may not have their effect.

Atherosclerosis - it is a polyetiological disease of elastic and muscular-elastic type arteries (large and medium caliber), manifested by infiltration of atherogenic lipoproteins into the vessel wall

with the subsequent development of connective tissue, atheromatous plaques and organ circulatory disorders.

Risk factors for cardiovascular disease can be divided into two groups: manageable and unmanageable.

Uncontrollable risk factors:

Age (men> 45 years old, women> 55 years old);

Controllable risk factors:

Negative emotions, stress;

Gypsrholistsrinsmia (LDL cholesterol> 4.1 mmol / L, as well as reduced HDL cholesterol levels< 0,9).

Angina pectoris paroxysmal chest pain (compression, squeezing, unpleasant sensation). At the heart of the onset of angina pectoris is myocardial hypoxia (ischemia), which develops in conditions when the amount of blood flowing through the coronary arteries to the working muscle of the heart becomes insufficient, and the myocardium suddenly experiences oxygen starvation.

The main clinical symptom of the disease is pain localized in the center of the sternum (chest pain), less often in the region of the heart. The nature of the pain is different; many patients feel pressure, constriction, burning, heaviness, and sometimes cutting or sharp pain. The painful sensations are unusually intense and are often accompanied by a feeling of fear of death.

Irradiation of pain in angina pectoris is characteristic and very important for diagnostics: to the left shoulder, left arm, left half of the neck and head, lower jaw, interscapular space, and sometimes to the right side or to the upper abdomen.

Pain occurs under certain conditions: when walking, especially fast, and other physical exertion (with physical exertion, the heart muscle needs a more significant supply of nutrients with the blood, which cannot be provided by narrowed arteries in atherosclerotic lesions).

The patient must stop, and then the pain stops. Particularly typical for angina pectoris is the appearance of pain after the patient leaves a warm room in the cold, which is more often observed in the autumn-winter time, especially when the atmospheric pressure changes.

With excitement, pains appear outside of connection with physical stress. Attacks of pain can occur at night, the patient wakes up from sharp pains, sits up in bed with a feeling of not only sharp pain, but also with the fear of death.

Sometimes chest pain with angina pectoris is accompanied by headache, dizziness, vomiting.

Exertional angina- these are transient attacks of pain (compression, squeezing, discomfort) in the chest, at the height of physical or emotional stress due to an increase in the metabolic needs of the myocardium (tachycardia, increased blood pressure). The duration of the attack is more often 5-10 minutes.

Newly-onset angina pectoris is released in a separate form within 4 weeks, and in elderly patients within 6 weeks. It is referred to as an unstable state.

Stable angina pectoris. After a certain period of adaptation (1–2 months), a functional restructuring of the coronary circulation occurs, and angina pectoris acquires a stable course with a constant threshold of ischemia. The level of stress that causes an attack of angina pectoris is the most important criterion in determining the severity of coronary heart disease.

Progressive angina pectoris is a sudden change in the nature of the clinical manifestations of angina pectoris, the usual stereotype of pain under the influence of physical or emotional stress. At the same time, there is an increase in the frequency and severity of attacks, a decrease in tolerance to stress, a decrease in the effect of taking nitroglycerin. Progressive angina is considered as one of the most severe types of unstable angina (10-15% of cases end in myocardial infarction).

Among all the variants of unstable angina pectoris, the most dangerous is rapidly progressing within hours and the first days from the onset of progression. Such cases are referred to as acute coronary syndrome, and patients are subject to emergency hospitalization.

Spontaneous (special) angina- attacks of pain in the chest (tightness, compression), arising at rest, against the background of unchanging myocardial oxygen demand (without an increase in heart rate and without an increase in blood pressure).

Diagnostic criteria for spontaneous angina pectoris:

a) attacks of angina pectoris usually occur at rest at the same time (early morning hours);

b) rise (total ischemia) or depression of the ST segment on the ECG recorded during an attack;

c) during angiographic examination, unchanged or slightly altered coronary arteries are determined;

d) the introduction of ergonovine (ergometrine) or acetylcholine reproduce the changes on the ECG;

e) p-blockers increase spasm and have a pro-ischemic effect (worsen the clinical situation).

Treatment of angina pectoris and other forms of coronary heart disease is carried out in four main directions:

1) improved oxygen delivery to the myocardium;

2) a decrease in myocardial oxygen demand;

3) improving the rheological properties of blood;

4) improving metabolism in the heart muscle.

The first direction is more successfully implemented with the help of surgical methods of treatment. Subsequent directions - due to drug therapy.

Among the large number of drugs used to treat angina pectoris, the main group stands out - antianginal drugs: nitrates, beta-blockers and calcium antagonists.

Nitrates increase the stroke volume of the ventricles, reduce platelet aggregation and improve microcirculation in the heart muscle. Among them, the following drugs can be distinguished: nitroglycerin (nitromint), sustak, nitrong, nitromac, nitroglanurong, isosorbide dinitrate (cardiket, cardiket-retard, isomac, isomac-retard, nitrosorbide, etc.), isosorbide 5-mononitrate (efox, efox -long, monomak-depot, olikard-retard, etc.). In order to improve microcirculation in the heart muscle, molsidomin (corvaton) is prescribed.

Beta-blockers provide an antianginal effect, reducing the energy expenditure of the heart by reducing the rate of heart contractions, lowering blood pressure, negative inotron effect and inhibition of platelet aggregation. Thus, myocardial oxygen demand decreases. Among this large group of drugs, the following have recently been used:

a) nonselective - propranolol (anaprilin, obzidan), sotalol (sotacor), nadolol (korgard), timolol (blockarden), alprepalol (antin), oxpreialol (trazikor), pindolol (visken);

b) cardioselective - atenalol (tenormin), metoprolol (egilok), talinolol (cordanum), acebutalol (sectral), celiprolol;

c) β-blockers - labetalol (trandat), medroxalol, carvedilol, nebivolol (nebilet), celiprolol.

Calcium antagonists inhibit the flow of calcium ions inside, reduce the inotropic function of the myocardium, promote cardiodilation, reduce blood pressure and heart rate, inhibit platelet aggregation, have antioxidant and antiarrhythmic properties.

These include: verapamil (isoptin, finoptin), diltiazem (cardil, dilzem), nifedipine (cordaflex), nifedipine retard (cordaflsx retard), amlodipine (normodipine, cardylopi).

Primary prevention of cardiovascular disease focuses on lowering atherogenic lipid levels through lifestyle changes. This is the limitation of the use of animal fats, weight loss, physical activity.

High serum cholesterol levels can be corrected by diet. It is recommended to limit the consumption of animal fats and the inclusion in the diet of foods containing polyunsaturated fatty acids (vegetable oils, fish oil, nuts). The diet should also include vitamins (fruits, vegetables), mineral salts and trace elements. To normalize bowel function, dietary fiber must be added to food (products from wheat bran, oats, soybeans, etc.).

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Psychological attitudes sometimes create absolutely amazing things for people! Therefore, psychologists advise everyone to choose a positive thought, and then follow it throughout the day.

Tomography, according to scientists at the University of Ottawa, will help predict possible relapses after a stroke. We are talking about mild strokes. The nuance is the relevance of the tomography, it is necessary.

Arrhythmias. A person usually does not feel the beating of his heart, the appearance of arrhythmias is perceived as an interruption in his work.

Arrhythmia is a violation of the rhythm of cardiac activity caused by the pathology of the formation of excitation impulses and their conduction through the myocardium. Failure of the heart rhythm can be caused by psychoemotional arousal, disturbances in the endocrine and nervous systems. Once arising, arrhythmias often recur, so their timely treatment is extremely important.

By the nature of manifestation and development mechanisms, several types of arrhythmias are distinguished. The provision of emergency care primarily requires paroxysmal tachycardia, which is possible both in young and old age. The attack begins suddenly with a strong push in the chest, pancreas, a "blow" to the heart, followed by a strong heartbeat, short-term dizziness, "darkening of the eyes" and a feeling of tightness in the chest.

Paroxysmal tachycardia usually develops as a result of acute coronary insufficiency and myocardial infarction, and the attack is often accompanied by pain in the chest or in the region of the heart. There are several forms of paroxysmal tachycardia. The usual medical examination of patients does not always allow differentiating them; this can be done only by the method of electrocardiological research.

Symptoms At the moment of an attack, the patient's neck veins pulsation attracts attention. The skin and mucous membranes are pale, slightly cyanotic. With a prolonged attack, the cyanosis increases. The number of heartbeats increases up to once a minute, the filling of the pulse is weaker. Blood pressure can be low, normal, or high.

First aid. Any form of paroxysmal tachycardia requires emergency medical attention.

Before the arrival of the doctor, the patient should be laid down, and then the techniques of reflex action on the heart should be used:

a) moderate (not painful) pressure with the ends of the thumbs on the eyeballs for 20 seconds;

b) pressure, also for 20 seconds, on the area of ​​the carotid sinus (the muscles of the neck above the collarbones);

c) voluntary breath holding;

d) taking antiarrhythmic drugs that previously relieved seizures (novocainamide, lidocaine, isoptin, obzidan).

Complete atrioventricular block is a violation of impulse conduction from the atrium to the ventricles, resulting in their uncoordinated contractions. The causes of the disease are myocardial infarction, atherosclerosis of the heart vessels.

Symptoms Dizziness, darkening in the eyes, a sharp pallor of the skin, sometimes fainting and convulsions. Rare pulse - up to beats per minute. Further decrease in heart rate leads to death.

First aid. Providing the patient with complete rest. Oxygen therapy (oxygen cushion, oxygen inhaler, in their absence - provide access to fresh air). They urgently call an ambulance. If the condition worsens, the first aid provider performs mouth-to-mouth artificial respiration, closed heart massage. Hospitalization in the cardiac intensive care unit or intensive care unit of the cardiology department. Transport on a stretcher in the supine position. The final treatment is not unsuccessfully carried out in the cardiology departments of hospitals, where modern antiarrhythmic drugs, methods of electrical impulse therapy and electrocardiostimulation are used.

In the prevention of arrhythmias, timely treatment of heart diseases, annual preventive examinations and dispensary observation are important. Physical conditioning, optimal work and rest regime, rational nutrition are necessary.

Hypertensive crises - an acute increase in blood pressure, accompanied by a number of neurovascular and autonomic disorders. It develops as a complication of hypertension.

What are the standards for blood pressure in adults?

The World Health Organization proposes to be guided by the following indicators: for persons in age, systolic pressure fluctuates within mm Hg. Art. and diastolic - no more than 89 mm Hg. Art.

Systolic pressure is from 140 to 159 mm and diastolic pressure is from 90 to 94 mm Hg. Art. are considered transient. If the systolic blood pressure is 160 mm Hg. Art. and above, and diastolic - 95 mm Hg. Art. then this indicates the presence of the disease.

The difficulty of dealing with arterial hypertension lies in the fact that about 40 percent of patients do not know about their disease. And only 10 percent of those who know and are treated in a polyclinic manage to lower their blood pressure to normal levels. Meanwhile, a sudden weakening of cardiac activity can cause excitation of the central nervous system, which, in turn, dramatically increases blood pressure. That is why hypertensive crises are often observed in people suffering from high blood pressure.

Symptoms With arterial hypertension, severe headache, dizziness, tinnitus, flashing "flies" before the eyes, nausea, vomiting, palpitations, minor tremors, chills occur, the face becomes covered with red spots. High blood pressure - up to 220 mm Hg. Art. Pulse of frequent beats per minute. A crisis can last up to 6-8 hours and, in the absence of emergency medical care, be complicated by an acute violation of cerebral or coronary circulation, in some cases - pulmonary edema.

First aid. They urgently call a doctor. Before his arrival, provide the patient with complete rest. The position of the victim is half-sitting. To lower blood pressure, previously prescribed antihypertensive (pressure-lowering) agents are used: reserpine, dopegit, isobarine, tazepam, etc. Warmers for the legs.

Prevention. The earliest possible detection and treatment of hypertension. Patients with high blood pressure are required to regularly take antihypertensive drugs prescribed by a doctor. They should resolutely give up smoking and drinking alcohol, avoid psycho-emotional overload. It should also be borne in mind that the majority of patients are negatively affected by work in the night shift and its fast pace, forced body position, frequent bending and lifting, very high and very low temperatures, food with limited fluid and salt.

Ischemic heart disease is one of the most common diseases today, which is based on impaired blood circulation in the heart muscle. In a healthy person, there is complete harmony between the need for oxygen in the myocardium and the blood supply to the heart; the disease develops when this harmony is disturbed. Most often it occurs in people with so-called risk factors - smokers, sedentary, alcohol abusers, overweight, suffering from hypertension. In older people, in addition, the disease is associated with sclerosis of the coronary vessels. Many experts pay attention to the prevalence of coronary artery disease also among people with certain character traits and lifestyle, those, for example, who are characterized by dissatisfaction with what has been achieved, prolonged work overload, chronic lack of time.

Clinically, coronary heart disease manifests itself most often in the form of myocardial infarction and angina pectoris.

Myocardial infarction - necrosis of a portion of the heart muscle due to clogging of the coronary vessel by a thrombus. The main cause of the disease is atherosclerosis (chronic arterial disease, leading to a narrowing of the lumen of the vessel). In addition, metabolic disorders, strong nervous excitement, alcohol abuse, and smoking play an important role in the occurrence of heart attacks.

Every year, a heart attack claims thousands of lives; even more people are deprived of the opportunity to work fully for a long time.

Symptoms The disease begins with acute chest pains, which take on a protracted nature, are not relieved by either validol or nitroglycerin. (Painless forms of myocardial infarction are often observed.)

The pain is given to the shoulder, neck, lower jaw. In severe cases, a feeling of fear arises. Cardiogenic shock develops (it is characterized by cold sweat, pallor of the skin, weakness, low blood pressure), shortness of breath. The heart rhythm is disturbed, the pulse is fast or slow.

First aid. They urgently call a doctor. The patient is provided with complete physical and mental rest and measures are taken to relieve pain (nitroglycerin under the tongue, mustard plasters on the heart area, oxygen inhalation).

In the acute stage of myocardial infarction, clinical death can occur.

Since its main signs are cardiac arrest and respiratory arrest, then revitalization measures should be aimed at maintaining the function of respiration and blood circulation by means of artificial ventilation of the lungs and closed heart massage. Let us recall the technique for their implementation.

Artificial ventilation of the lungs. The patient is placed on his back. Cover the mouth and nose with a handkerchief. The person providing assistance kneels, supports the patient with one hand, puts the other on his forehead and throws his head back as much as possible; takes a deep breath, pinches the victim's nose tightly, and then presses his lips to his lips and blows air forcefully into the lungs until the chest begins to rise. 16 such blows are produced per minute.

Closed heart massage. After one injection, 4-5 pressures are made. To do this, the lower end of the sternum is groped, the left palm is placed two fingers above it, and the right palm is placed on it, and the chest is rhythmically squeezed, making pressure per minute.

Resuscitation measures are carried out before the onset of pulse and spontaneous breathing or before the arrival of an ambulance.

Angina pectoris occurs as a result of spasm of the coronary arteries, which can be caused by atherosclerosis of the vessels of the heart, excessive mental and physical stress.

Symptoms Severe attack of chest pain radiating to the scapula, left shoulder, half of the neck. Breathing is difficult, the pulse is quickened, the face is pale, and sticky cold sweat appears on the forehead. The duration of the attack is dominant. Prolonged angina often turns into myocardial infarction.

First aid. They urgently call a doctor. The patient is provided with complete physical and mental rest. To relieve pain, they resort to nitroglycerin or validol (one tablet at an interval of 5 minutes). Oxygen is inhaled. On the heart area - mustard plasters.

Prevention of coronary heart disease. Knowledge of the risk factors is the basis for its prevention. An important role is played by the nutritional regimen - limiting the calorie content of food, excluding alcoholic beverages. Recommended four meals a day, including vegetables, fruits, cottage cheese, lean meat, fish. If you are overweight, a diet prescribed by your doctor is indicated. Physical exercises, walks, hiking are required. We must decisively quit smoking. Rational organization of work, education of tact and respect for each other are also important means of prevention. We should not forget about the timely treatment of chronic cardiovascular diseases (heart defects, rheumatism, myocarditis, hypertension), leading to coronary heart disease.

Tags: Heart disease, arrhythmia, complete atrioventricular block, blood pressure, myocardial infarction, coronary heart disease, angina pectoris, first aid, prevention

Emergency care for an attack of angina pectoris

An attack of angina pectoris can be considered a pre-infarction condition, and that is why help with severe heart pain should be provided immediately and correctly. Well-coordinated actions in such situations can greatly alleviate the patient's condition and prevent the development of severe complications. In everyday life, everyone can face a situation when urgent help is needed by a loved one, neighbor, colleague, or just a stranger on the street. In this case, it is extremely important to know by what signs to recognize an attack of angina pectoris, and how to alleviate the patient's condition.

Cardialgia (pain) with angina pectoris develops against the background of a lack of oxygen in the myocardium, provoked by ischemia (i.e., the supply of insufficient blood to the muscle fibers due to narrowing of the coronary vessels). Oxygen deficiency in the heart muscle is especially noticeable during physical and psycho-emotional stress, since it is in these states that the need for it increases significantly. Due to insufficient nutrition of the myocardium, lactic acid accumulates in it, which provokes pain.

Signs of an angina attack

Signs of an attack of angina pectoris are few, but quite characteristic and in most cases they are rarely confused with other diseases. The main symptom of this condition is a sudden onset of pain behind the sternum or to the left of the sternum, which appears after physical or psycho-emotional stress, hypothermia, and sometimes at rest. The most common causes of an attack are brisk walking (especially in hot, cold, or windy weather), climbing stairs, and overeating. In the later stages of coronary heart disease, an attack of angina pectoris can develop during sleep or against the background of absolute rest.

Cardialgia is pressing or burning in nature, and in most patients its irradiation (reflection) is observed in the left half of the body (arm, scapula, stomach area, throat, cervical vertebrae, lower jaw). Sometimes the pain can be given to the right hand. In the supine position, cardialgia increases.

Patients describe the nature of pain in angina pectoris in different ways:

The duration of the pain is about 5 minutes (less often about 15-20). As a rule, after elimination of the provoking cause (physical activity, cold, stress), it can pass on its own or disappear 2-3 minutes after taking the Nitroglycerin tablet.

Cardialgia with angina pectoris is often accompanied by a noticeable anxiety of the patient or fear of death. During an attack of angina pectoris, the patient may experience:

• nausea and vomiting;
• pallor;
• sweating;
• dizziness;
• belching or heartburn;
• difficulty breathing or shortness of breath;
• palpitations and increased heart rate;
• rise in blood pressure;
• numbness and coldness of the limbs.

Signs of atypical angina attacks

In some cases, an attack of angina pectoris is atypical or not accompanied by cardialgia. Such types of this ailment greatly complicate their recognition.

In some patients, pain in the heart is completely absent and is felt only in the zones of its typical irradiation:

• in the shoulder blades (right or left);
• in the IV and V fingers of the left hand;
• in the left or right hand;
• in the cervical vertebrae;
• in the lower jaw;
• in the teeth;
• in the larynx or pharynx;
• in the ear;
• in the upper abdomen.

In some patients, an attack of angina pectoris begins with numbness of the fourth and fifth fingers of the left hand and a sharp muscle weakness of the upper limb. After a while, they develop cardialgia and other signs of angina pectoris.

Patients often describe angina pectoris as shortness of breath, severely limiting physical activity and occurring on inhalation and exhalation. This condition may be accompanied by a cough that worsens when trying to move.

In some patients, an attack of angina pectoris can proceed according to the collaptoid variant. With this course, the patient's blood pressure sharply decreases, dizziness, nausea and severe weakness appear.

An attack of angina pectoris can be felt by episodes of arrhythmia, which occurs at the peak of physical activity. Such arrhythmias are stopped by taking Nitroglycerin.

In rare cases, an attack of angina pectoris is not accompanied by pain. In such cases, myocardial ischemia manifests itself as severe weakness or shortness of breath, which are caused by low cardiac contractility or incomplete relaxation of the myocardium.

All atypical forms of angina pectoris are more often observed in patients with diabetes mellitus, heart failure, after myocardial infarction or in elderly patients. Symptoms accompanying such forms of myocardial ischemia are eliminated after cessation of physical or emotional stress and taking Nitroglycerin.

First aid

Most often, pain in the environment with angina pectoris appears during walking or other physical activity. In such cases, the patient should immediately stop moving and take a comfortable sitting position. If cardialgia appears during sleep, you need to sit up in bed and lower your legs down.

During an attack of angina pectoris, it is forbidden to stand up, walk and perform any actions associated with physical activity. The patient needs to provide an influx of fresh air, remove clothing that restricts breathing from him, and ensure the most comfortable temperature regime.

A person experiencing cardialgia needs to take a Nitroglycerin or Nitrolingvala tablet under the tongue. Also, to eliminate an attack of angina pectoris, preparations in the form of sprays can be used: Isoket or Nitrominat. They are injected under the tongue, and one injection is one dose of the drug. After taking these nitrate drugs, the patient can be offered to take one crushed tablet of Aspirin, and in the presence of signs of emotional arousal, Corvalol or Valokardin.

It is recommended to call an ambulance for an attack of angina pectoris in such situations:

• an attack of angina pectoris happened for the first time;
• the nature of the attack has changed (it has become more prolonged, the pain is more intense, shortness of breath, vomiting, etc.);
• cardialgia was not eliminated by taking Nitroglycerin tablets;
• the pain in the heart is getting worse.

For a quicker relief of an attack of angina pectoris after taking the above drugs, it is recommended to carry out a light massage (or self-massage) of the face, neck, back of the head, shoulders, wrists, left half of the chest and knee joints. Such actions will allow the patient to relax and relieve tension.

Often, an attack of angina pectoris is accompanied by a severe headache. To eliminate it, the patient can take a pill of a non-narcotic analgesic (Baralgin, Spazmalgon, Analgin, Sedalgin).

After carrying out such events, it is necessary to count the pulse and measure the blood pressure. With severe tachycardia (more than 110 beats per minute), the patient needs to take 1-2 tablets of Anaprilin, and with a pronounced rise in blood pressure - 1 tablet of Clonidine (under the tongue).

Pain in the heart after taking Nitroglycerin or other nitrate drugs should be eliminated after 2-3 minutes, in the absence of such an effect, the patient must repeat taking one of the drugs. During one attack, the patient can be given no more than three tablets of Nitroglycerin and Nitrolingval or no more than three injections of Isoket or Nitrominate.

Usually, after the measures taken, an attack of angina pectoris is eliminated after 2-5 (less often 10) minutes. In the presence of cardialgia within 15 minutes after taking Nitroglycerin, it is necessary to urgently call an ambulance, since this condition of the patient can lead to the development of myocardial infarction.

If the attack of angina pectoris was eliminated on its own, then the patient is advised to limit any physical or emotional stress, observe bed rest and call a doctor.

In what cases is Nitroglycerin contraindicated during an angina attack?

The patient or his relatives should be aware that when signs of low blood pressure are detected (with a collaptoid course of angina pectoris), taking drugs from the group of organic nitrates (Nitroglycerin, Isoket, etc.) is contraindicated. The following signs can indicate hypotension:

• the patient experiences severe weakness;
• dizziness;
• pallor;
• cold sweat.

In such cases, the sequence of actions should be as follows:

1. Lay down the patient.
2. Call an ambulance.
3. Give him a crushed Aspirin tablet.
4. To reduce pain, you can use pill analgesics (Baralgin, Sedalgin, etc.).

Emergency care for a prolonged attack of angina pectoris

Emergency care for a prolonged attack of angina pectoris can only be provided by a doctor.

If necessary, repeated administration of Nitroglycerin (1-2 tablets under the tongue) is carried out, followed by intravenous jet injection of non-narcotic analgesics (Baralgin, Maksigan, Analgin) with 50 ml of 5% glucose solution. To enhance the analgesic effect and provide a sedative effect, antihistamines (Pipolfen, Diphenhydramine) or tranquilizers (Seduxen, Relanium) can be used.

In the absence of anesthesia, the patient is injected with narcotic analgesics (Promedol, Morphine hydrochloride, Omnopon) in combination with Droperidol or a tranquilizer. Also, neuroleptanalgesia (intravenous administration of Talomonal or a mixture of Fentanyl and Droperidol) can be used to eliminate pain in the heart.

With a pronounced decrease in blood pressure, which often occurs after taking drugs from the group of organic nitrates (Nitroglycerin, Isoket, etc.), the patient is injected with Polyglyukin's solution (intravenously, drops per minute). If there is no effect, the introduction of 0.2 ml of 1% Mezaton solution may be recommended.

When stopping an attack of angina pectoris occurring against the background of a persistent rise in blood pressure, antihypertensive and vasodilating agents (Dibazol, Papaverin, Platifillin, etc.) can be used.

After stabilizing the condition of the patient who brought an attack of angina pectoris, he is recommended to undergo a dynamic electrocardiographic examination and a number of other diagnostic procedures. Based on the data obtained, the doctor will be able to prescribe further treatment for coronary heart disease.

How to help with an attack of angina pectoris. By cardiologist V.A.Abduvalieva

1. First aid for angina

An attack of angina pectoris is a rather serious manifestation of the disease that requires urgent help. During an attack, a person is recommended to resort to the following algorithm for providing assistance:

1. Create complete rest to reduce stress on the heart.
2. If a calm environment does not help, you should take a nitroglycerin tablet, placing it under the tongue. Usually 1-2 tablets are sufficient, and in severe cases, tablets will be sufficient.
3. If the attack persists, the patient should lie down, raising his head, unbutton the collar of his clothes, loosen the belt on his trousers and make several breathing movements. Having opened windows and doors, it is necessary to provide fresh air to the room, as well as apply warm heating pads to the legs.
4. During an attack, a person is very worried about fear for his life, so you should take some kind of sedative, such as seduxen or valerian. Usually, all these measures are enough to eliminate even the most severe attack.

If the attack of angina pectoris does not stop, the pain does not go away and the repeated intake of nitroglycerin does not work within 15 minutes, you should call an ambulance.

Nitroglycerin is one of the most effective medicines that quickly relieves a heart attack.

It reduces the heart's need for oxygen by improving its delivery to the affected areas of the myocardium, increasing the contractility of the heart muscle and eliminating spasm in the coronary arteries. Anesthesia with nitroglycerin occurs quickly, and after 45 minutes the drug is excreted from the body.

The following forms of nitroglycerin are usually used: tablets, capsules or drops.

The drug is taken as follows: one tablet or capsule of nitroglycerin is placed under the tongue without swallowing. The medicine gradually dissolves and after a minute or two, an analgesic effect occurs.

In the case of using drops, 2-3 drops of nitroglycerin solution are dripped onto a piece of sugar and placed under the tongue. Do not swallow, but wait until it dissolves. You can do without sugar by dropping 3 drops of the drug on or under the tongue.

If nitroglycerin is poorly tolerated, drops containing nitroglycerin, lily of the valley tincture, menthol and belladonna are used. This combination is well tolerated by patients, since menthol reduces pain from nitroglycerin. A drop of tincture is used at one time.

If there is a tendency to heart disease, including angina pectoris, in order to prevent a heart attack, it is recommended to take nitroglycerin: before emotional or physical exertion, before climbing stairs or up a mountain, a few minutes before going out in windy and frosty weather, with the appearance of severe paroxysmal dyspnea ... In other cases, nitroglycerin is not recommended.

In the event that after the use of nitroglycerin there is a pain in the head, the medicine should be taken in small doses (half a tablet or 1/3), gradually increasing the dose.

There is no analogue to nitroglycerin. It has an anti-angina and analgesic effect, helps to lower blood pressure. Therefore, you should be very careful those who have a tendency to its sharp decline. The drug may cause headache, weakness and dizziness.

Heart pain cannot be tolerated, nitroglycerin should be taken as soon as possible as much as necessary. It is more difficult to stop the lingering pain that can cause serious complications. Also, you should not take it unnecessarily. Especially in the case of self-relief of a heart attack - when it goes away by itself at rest after 1-2 minutes. He should always be at hand.

Natroglycerin should be taken with extreme caution if a person suffers from glaucoma or has suffered an acute cerebrovascular accident. In such cases, a detailed consultation with a doctor is necessary.

If your home medicine cabinet does not have nitroglycerin, you can take corinfar, cordafen, or fenigidin under the tongue instead. The effect can be seen within 3-5 minutes, and the duration of action of such drugs is up to 5 hours.

After the end of the heart attack, you cannot immediately get out of bed, but it is better to lie down for 1-2 hours, observing complete physical and psychological calm. If an ambulance was not called, it is better to ask your local doctor for help and, before he arrives, observe a home regimen, avoiding complete physical and emotional stress.

Drugs such as Validol, Valocarmid or Valocordin are less effective in such cases. Although they can cause a favorable background to alleviate the effects of other drugs.

Video

Watch in the video how to provide first aid for an attack of angina pectoris:

Emergency care for angina pectoris

Angina pectoris is the most common form of coronary artery disease (CHD). The high-risk group for sudden death and myocardial infarction is primarily comprised of patients with exertional angina. Therefore, it is necessary to quickly establish a diagnosis and provide emergency care for a prolonged attack of angina pectoris. Emergency diagnosis of an angina attack is based on the patient's complaints, anamnesis data and, to a much lesser extent, on ECG data, since in a large percentage of cases the electrocardiogram remains normal. In most cases, taking into account the nature, duration, localization, irradiation, conditions for the onset and cessation of pain, it is possible to establish its coronary origin.

The duration of an anginal attack with angina pectoris is most often min, less often up to 10 minutes. Usually, it stops after the cessation of physical activity or the intake of nitroglycerin by patients. If the painful attack lasts more than 15 minutes, then the intervention of a doctor is required, since a prolonged attack of angina pectoris can lead to the development of acute myocardial infarction.

The sequence of measures for a prolonged attack of angina pectoris:

nitroglycerin tablets under the tongue, simultaneously intravenously in a stream in 20 ml of 5% glucose solution, non-narcotic analgesics are injected (analginml 50% solution, baralgin - 5 ml, maxigan - 5 ml) in combination with small tranquilizers (seduxenml) or antihistamines (dimedrolml 1 % solution), which enhance the analgesic effect and have a sedative effect. At the same time, the patient takes 0.2-0.5 g of acetylsalicylic acid, preferably in the form of an effervescent tablet (for example, anapirin).

If within 5 minutes the pain syndrome does not stop, then immediately proceed to the intravenous administration of narcotic analgesics (morphine hydrochloride ml 1% solution, promedol ml 1% solution, etc.) in combination with tranquilizers or the neuroleptic droperidol (2-4 ml 0.25 % solution). The most powerful effect is provided by neuroleptanalgesia (narcotic analgesic fentanyl ml 0.005% solution in combination with droperidol ml 0.25% solution).

After stopping the anginal attack, it is necessary to make an ECG to exclude acute myocardial infarction.

Emergency care for myocardial infarction

Myocardial infarction is an ischemic necrosis of a portion of the heart muscle resulting from an acute discrepancy between myocardial oxygen demand and its delivery through the coronary vessels. This is the most severe manifestation of ischemic heart disease, requiring urgent care to the patient. Emergency diagnosis of myocardial infarction is based on the clinical picture, leading in which is severe pain syndrome, and ECG data. Physical examination does not reveal any reliable diagnostic signs, and changes in laboratory data usually appear several hours after the onset of the disease. As with angina pectoris, pain occurs behind the sternum, radiates to the left arm, neck, jaw, epigastric region, but, unlike angina pectoris, the attack lasts up to several hours. Nitroglycerin does not have a lasting effect or does not work at all. In atypical cases, the pain may be mild, localized only in the places of irradiation (especially in the epigastric region), accompanied by nausea, vomiting, or absent altogether (painless myocardial infarction). Sometimes, already at the beginning of the disease, complications (heart rhythm disturbances, cardiogenic shock, acute heart failure) come to the fore in the clinical picture. In these situations, the ECG plays a decisive role in the diagnosis. The pathognomonic signs of myocardial infarction are arched segment elevation S-T above the isoline, the formation of a monophasic curve, pathological tooth Q. In clinical practice, there are forms of myocardial infarction without changes in the S-T segment and the Q wave.

Emergency care for myocardial infarction begins with the immediate relief of anginal status. Pain not only delivers severe subjective sensations, leads to an increase in the load on the myocardium, but can also serve as a trigger for the development of such a formidable complication as cardiogenic shock. Anginal status requires immediate intravenous administration of narcotic analgesics in combination with antipsychotics and tranquilizers, since conventional analgesics are ineffective.

If less than 6 hours have passed since the onset of myocardial infarction, intravenous administration of actilisis is very effective. This drug promotes clot lysis.

Combinations of drugs used in the treatment of pain syndrome in acute myocardial infarction:

The drugs are recommended to be administered intravenously slowly. They are preliminarily diluted in 5-10 ml of isotonic sodium chloride solution or 5% glucose solution. Until the pain syndrome is completely arrested, which often requires repeated administration of analgesics, the doctor cannot consider his task completed. Other therapeutic measures, which are carried out simultaneously or immediately after the relief of pain syndrome, should be aimed at eliminating complications that arise (rhythm disturbances, cardiac asthma, cardiogenic shock). In uncomplicated myocardial infarction, drugs are prescribed that limit the zone of necrosis (nitrates, beta-blockers, thrombolytics).

The main symptoms

To understand what algorithm should be used in an emergency, you need to clearly know all the symptoms and possible manifestations of angina pectoris.

The most common symptom is pain. It has a number of distinctive characteristics:

In addition to pain, symptoms of an angina attack are:

In addition, angina pectoris can be accompanied by atypical symptoms (stomach pain, arrhythmia, neurological disorders). Then the algorithm for providing first aid also changes. In this case, the ischemic history can help to understand. That is, if the patient in the past suffered from angina pectoris or suffered a heart attack, then the attack is likely to recur. If the patient has a healthy heart, then it is necessary to look for other causes of poor health (stroke, stomach ulcer, etc.).

Emergency medications

First aid for angina pectoris can be provided using various medications, which are probably available in the first aid kit of a patient with coronary heart disease.

Nitroglycerin is the drug of choice and comes first in the emergency algorithm. For an emergency, pills, capsules, or a spray are suitable. In order for the drug to begin to act as quickly as possible, it is placed in the sublingual region to assist the patient. Due to the high permeability of the vein wall, the drug almost instantly enters the systemic circulation and begins to act.

This medicine causes the coronary arteries to dilate and also affects other vessels in the body. As a result, oxygen delivery to myocardial cells is improved and the patient's condition is significantly improved. In addition, this drug helps to stop the hypertensive crisis, which is often a provoking factor of angina pectoris.

When providing emergency care to patients using nitroglycerin, special attention should be paid to the level of blood pressure. In the event that the pressure in a patient with an angina attack is less than 90/60 mm Hg, nitroglycerin should not be used. This is due to the fact that by expanding the vessels, it leads to even more pronounced hypotension. As a result, blood flow through the coronary arteries becomes even worse and the risk of developing myocardial infarction increases significantly.

Other drugs that are included in the emergency care algorithm for patients with angina pectoris are:

The general principle of emergency care is to use only drugs with a short duration of action. This is due to the fact that in heart disease the situation changes very quickly and it so happens that hypertension and tachycardia are replaced by a decrease in pressure and pulse.

Other techniques

First aid for angina pectoris includes other techniques. In this case, the algorithm of actions is approximately the following:

In parallel, it is necessary to use various medicines that are at hand.

Correctly performed emergency first aid for an attack of angina pectoris often saves the patient's life and prevents the development of a heart attack.

First aid for coronary heart disease

The main pathogenetic factors of ischemic heart disease are:

• organic stenosis of the coronary arteries caused by their atherosclerotic lesions;
• spasm of the coronary vessels, usually combined with atherosclerotic changes in them (dynamic stenosis);
• the appearance of transient platelet aggregates in the blood (due to an imbalance between prostacyclin, which has a pronounced antiaggregatory activity, and thromboxane, a powerful vasoconstrictor and stimulator of platelet aggregation).

Ischemic myocardial lesions of a different origin (rheumatism, periarteritis nodosa, septic endocarditis, heart trauma, heart defects, etc.) do not belong to coronary artery disease and are considered as secondary syndromes within the indicated nosological forms.

Sudden death (primary cardiac arrest)

• the patient is placed on his back without a pillow on a rigid base;
• check for a pulse on the carotid or femoral artery;
• if a cardiac arrest is detected, an external cardiac massage and artificial respiration are immediately started.

Resuscitation measures begin with a single blow with a fist on the middle part of the sternum (Fig. 1, a). Then they immediately start indirect heart massage with a frequency of compressions of at least 80 per minute and artificial lung ventilation ("mouth to mouth") in a ratio of 5: 1 (Fig. 1, b). If the ECG registers large-wave fibrillation (the amplitude of the complexes is higher than 10 mm) or ventricular flutter is performed with EIT with a power of 6-7 kW, with small-wave fibrillation, it is injected into the subclavian vein (the intracardiac route of administration is dangerous and undesirable) 1 ml of 0.1% adrenaline hydrochloride solution (through 2-5 minutes, repeated injections are possible up to a total dose of 5-6 ml), 1 ml of a 0.1% solution of atropine sulfate, mg of prednisolone, followed by EIT.

Rice. 1, a - the beginning of resuscitation: a single blow with a fist on the middle part of the sternum; b - indirect heart massage and artificial ventilation of the lungs ("mouth to mouth")

The criteria for the effectiveness of resuscitation measures are:

• constriction of the pupils with the appearance of their reaction to light;
• the appearance of a pulse on the carotid and femoral arteries;
• determination of the maximum blood pressure at the mercury level. Art .;
• reduction of pallor and cyanosis;
• sometimes - the appearance of independent respiratory movements.

After restoration of a hemodynamically significant spontaneous rhythm, 200 ml of 2-3% sodium bicarbonate solution (trisol, trisbuffer) 1-1.5 g of potassium chloride diluted or 20 ml of panangin in a stream, 100 mg of lidocaine in a stream (then drip at a rate of 4 mg / min), 10 ml of 20% sodium oxybutyrate solution or 2 ml of 0.5% seduxen solution in a stream. In case of an overdose of calcium antagonists - hypocalcemia and hyperkalemia - 2 ml of 10% calcium chloride solution is administered intravenously.

Rice. 2. The main provisions used for transporting sick and injured on a shield and stretcher:

a - with suspicion of a spinal fracture (consciousness is preserved); b, c - craniocerebral trauma (b - consciousness is preserved, signs of shock are absent, c - inclined position with the end lowered by no more than); d, e - for victims with the threat of acute blood loss or shock, as well as in the presence of them (d - the head is lowered, the legs are raised on; e - the legs are bent in the form of a penknife); f - damage or acute diseases of the chest organs, accompanied by acute respiratory failure; g - damage to the abdominal and pelvic organs, fractures of the pelvic bones, diseases of the abdominal and pelvic organs; h - injuries of the maxillofacial region, complicated by bleeding; and - lateral stable position for transporting unconscious victims

In the presence of risk factors for sudden death (see above), it is recommended to administer lidocaine (mg intravenously, mg intramuscularly) in combination with ornid (mg intramuscularly); with a decrease in blood pressure - 30 mg of prednisolone intravenously.

Ischemic heart disease is a group of diseases at the heart of which there is an insufficient blood supply to the heart muscle. with the development of ischemia and even necrosis in the muscle. This group includes the following diseases:

Angina pectoris
- myocardial infarction
- atherosclerotic cardiosclerosis
- chronic heart failure
- violation of the rhythm of the heart

Angina pectoris is a form of ischemic heart disease, in which there is! Short-term !! violation of coronary blood flow and the development of ischemia in the heart muscle. The main reason: atherosclerosis of the coronary arteries.

Contributing factors:

Emotional stress
- at the height of physical activity
- alcohol

The main symptom is the appearance of paroxysmal severe pains of a pressing, compressive nature, due to which the patient cannot budge. Localization of pain - behind the breastbone. Irradiation may appear: numbness and pain in the left arm, under the left shoulder blade, in the lower jaw on the left. After the cessation of movement, the pain may stop, with the resumption of movement, it may reappear. Such an attack is often accompanied by a pronounced fright, which is accompanied by pale skin, the appearance of cold sweat.

Objectively:

The situation is forced
- pallor of the skin
- cold sweat
- tachycardia
- muffled heart sounds (both)
- BP does not change

Help with an attack:

Sit down or lay down if possible
- calm down
- call an ambulance through the 3rd person
- ask if there is Nitroglycerin (tablets, inhalations, ointments, patches)
- if not, then stop any car on the street - there should be Nitroglycerin in the first aid kit (action in 2-3 minutes)
- blood pressure control

A side effect of nitroglycerin - a headache may appear in people with low blood pressure, it is relieved by taking Analgin.

After taking nitroglycerin and a calm position, the pain is relieved, up to a maximum of 30 minutes.

With an attack at home, you can supplement the treatment with the imposition of strips of mustard plasters along the periphery of the heart.

Tips and actions during the interictal period:

1. Make up the correct regime of work and rest. Try to reduce stress (physical and psychological), but a sedentary lifestyle is extremely dangerous. Assign daily kilometer walks (1000 steps per day)

2. To exclude risk factors for the progression of atherosclerosis.

3. For prophylaxis, medications of various groups are used:

a. Long-acting nitrates: nitrolong, sustak, nitrosorbitol, take over.

b. Beta-adrenergic blockers: concor, bidoc, bisoprolol - reduce the heart's need for oxygen. CONTRAINDICATIONS: Bronchitis, asthma, because cause bronchial spasm.

4. Before physical activity, you can dissolve a nitroglycerin tablet.

5. It is necessary to monitor the shelf life of nitroglycerin.

Classification of angina pectoris:

1. Primary angina pectoris - occurring for the first time within a month.

2. Stable angina pectoris - the patient knows when it will start. There are 5 functional classes:

a. The first functional class is seizures with great physical exertion.

b. The second functional class - when walking over 500, ascent to the 3rd floor.

c. The third functional class is walking 200 m on a flat surface, ascent to the 1st floor.

d. The fourth functional class - walking around the room

e. Fifth grade - angina at rest

3. Exertional angina pectoris is not stable, or progressive angina pectoris.

Signs of progression: Seizures last longer, more nitroglycerin is required, It is called a pre-infarction state. More dangerous than rest angina.

Additional examinations:

Necessary because the patient's condition can turn into myocardial infarction

ECG
- dopplerography
- blood for biochemistry (for CPK and troponins)

19.10.16

Cardiac ischemia.

Myocardial infarction is a clinical form of coronary heart disease, in which, as a result of the formation of a blood clot in a coronary artery, altered by atherosclerosis, a site of necrosis occurs in the heart muscle. In this case, the crushing of the heart muscle is sharply disturbed.

At the heart of thrombus formation, in addition to the lesion of coronary vessels by atherosclerosis, the role of the decay of atherosclerotic plaque has been established.

All this leads to a mismatch between the need for oxygen in the heart muscle and its delivery.

Etiology:

1. In 95% of cases - atherosclerosis and plaque disintegration, therefore, risk factors for myocardial infarction are: Sedentary lifestyle, obesity, metabolic disorders, arterial hypertension, diabetes mellitus and thyroid disease, age and gender.

2. Damage to the coronary arteries by inflammatory changes (rheumatic vasculitis in rheumatism).

Provoking factors:

1. Emotional excitement.

2. After excessive physical exertion.

3. At the height of physical activity.

4. Drinking alcohol.

5. Plentiful food intake + small amount of movement.

Pathogenesis, or the mechanism of development of a heart attack:

As a result of the disintegration of the atherosclerotic plaque, there is an increased aggregation of platelets, the formation of a thrombus, and as a result of exsanguination of the heart area, an aseptic area of ​​necrosis is formed in the heart muscle, separated from the healthy part of the heart muscle by an inflammatory shaft. As a result of treatment, there is an increase in blood flow from neighboring arteries, this is a bypass, collateral circulation, a decrease in the zone of necrosis, the development of connective tissue, and a scar is formed.

Forms of myocardial infarction.

Distinguish between small-focal and large-focal infarction and transmural infarction (not large in size, but very deep).

Options for the development of myocardial infarction.

1. Sudden death.

2. After primary angina pectoris and immediately comes to an end with myocardial infarction.

3. Diseases occur against the background of progressive angina pectoris.

4. A painless variant of the course and immediately death (in patients with diabetes mellitus).

Clinical picture:

Typical Anginal Pain.

The disease begins acutely, the patient remembers what preceded it, intense pressing compressive pains appear behind the sternum. Taking nitroglycerin relieves pain for a short period of time, but the pain lasts more than 30 minutes.

There is severe weakness, dizziness, loss of vision. This is due to a decrease in blood pressure, because decreased cardiac output.

Expressed fear of death.

Objectively:

Inappropriate behavior

Freezes

As a consequence, it rushes

Pale skin

Holding on to my heart, fright on my face

Pulse fast

Weak pulse filling

Blood pressure decreases

Rapid heart sounds, gallop rhythm

Shortness of breath is a poor prognostic sign.

Atypical variants of myocardial infarction.

Asthmatic variant.

It occurs in patients with widespread atherosclerosis, in patients with repeated heart attacks and diabetes mellitus.

It starts not with pain, but with an attack of cardiac asthma  pulmonary edema.

Symptoms:

Bologna cannot lie, he Sits down with his legs down.

Cough with frothy, pink expectoration.

The breath is bubbling

Severe bursting pain.

Moist rales in the lower parts of the lungs.

Congestion in the pulmonary circulation. The liquid part of the blood sweats into the alveoli (in a typical course, such a clinic is a complication).

Gastrological variant of the course of the disease:

It occurs with myocardial infarction, which is located in the posterior wall of the left ventricular muscle (lies on the diaphragm).

Pains appear in the left upper abdomen, vomiting, vomiting, loose stools, hiccups. They imitate the pathology of the gastrointestinal tract.

Symptoms from the CVS: Tachycardia, weakening of the pulse, lowering blood pressure, muffled tone. It can be confirmed by ECG and blood biochemistry.

Cerebral variant:

It manifests itself as indomitable vomiting, loss of consciousness, resembles a stroke, occurs in the elderly, with the spread of atherosclerosis: muffled tones, decreased blood pressure, tachycardia, pulse change. Diagnosis is by ECG and blood biochemistry.

Arrhythmic option:

It is manifested by the development of Paroxysm of atrial fibrillation or paroxysmal tachycardia. Diagnosis is by ECG and blood biochemistry.

Painless outpatient infarction:

Small focal, the clinic resembles angina pectoris. It is detected by the detection of scars in the heart muscle.

Myocardial infarction course (4 periods):

1. The most acute period - 1-3 hours

2. Acute period - 1-3 days (In the intensive care unit, monitoring results on the screen), the temperature rise to subfebrile numbers.

Intensive treatment is provided, MS must monitor the symptoms of complications, ensure compliance with strict bed rest. MS monitors the patient's bed. Nutrition is sparing, minimal, dried fruits are desirable.

3. Subacute period - lasts from 10 days to 2 weeks. The area of ​​necrosis decreases, the condition improves, the pressure stabilizes, the patient is taken to the first-level wards. The rehabilitation process is started. It is important to monitor the physiological functions in food Dried fruits, Vegetables.

4. Stage of scarring - lasts up to several months.

Principles of myocardial infarction treatment.

1) Taking an ECG

2) Blood biochemistry (markers of necrosis, there are 2 of them)

3) Creatinine-Phosphokinase - 2-fold increase, indicates necrosis

4) Increase Tropinin by 2 times

5) Doppler ultrasonography of the heart

Complications:

1) Heart rupture, with transmural infarction.

2) Cardiogenic shock, a form of acute vascular insufficiency, in which a vascular cut occurs. Blood is deposited in the abdominal cavity, there is no blood flow to the heart and brain. Causes: decreased contractility of the left ventricular muscle. Severe pain, vascular tone reflexively falls. Symptoms:

o Increased weakness,

o Confusion of consciousness,

o Cold sweat,

o skin is pale and cold,

o Acrocyanosis,

o Decrease in the amount of urine,

o Threaded rapid pulse,

o BP is reduced to a minimum.

3) Acute left ventricular failure - cardiac asthma syndrome -> pulmonary edema. Sudden contraction of the muscles of the left ventricle -> stagnation in the small circle -> pulmonary edema.

4) Arrhythmia.

1) Pericarditis - manifested by: shortness of breath, pain in the heart, pericardial rubbing noise.

2) Aneurysm of the heart - bulging of a thin, delicate scar in the heart. It can occur in the acute and subacute period of myocardial infarction when the patient rehabilitates himself. May threaten with rupture of an aneurysm.

3) Development of postinfarction allergic syndrome Dresler's syndrome - absorption of necrotic masses into the blood. Joint pain, arthritis, pleurisy, pericarditis, subfebrile condition, diagnosed with specific antibodies. It is treated with glucocorticoid hormones.

1. To relieve pain, reduce agitation in order to prevent complications.

2. Treatment of complications

3. Limit the ischemic zone.

If a heart attack is suspected, complete physical rest. Give an aspirin pill.

Fresh air, blood pressure, pulse, heart sounds, calming conversations. Give nitrates, Analgin.

Call resuscitation. Hospitalized after emergency care.

To reduce pain - narcotic pain relievers, drugs: droperedol + fentanyl - soothe the patient.

If drugs do not help - a mask with nitrous oxide + oxygen = the patient falls asleep.

To reduce the ischemic zone - Plavix. Chewed for thrombolysis.

For the prevention of arrhythmias - intravenous cap. polarizing mixture: potassium chloride, glucose, insulin.

Nitroglycerin is injected, covering with paper from the light I / O cap. They also administer blood clot-dissolving drugs. In / in enter Enoxyparin, Fraxiparine.

After the normalization of hemodynamic parameters (pulse, pressure), it is transferred to a stretcher on the sheets.

Transport to the intensive care unit, bypassing the emergency room, Take off your shoes, put on shoe covers, undress and go to the intensive care unit. They are transported quickly but smoothly. The condition is constantly monitored.

In intensive care - identification of complication symptoms + nursing care.

In the subacute period - rehabilitation. Aimed at reducing the zone of necrosis, restoring collateral blood circulation, restoring health, returning it to normal life

Rehabilitation includes therapeutic measures, physical rehabilitation, psychological rehabilitation.

There are several stages:

Stationary (a gradual increase in physical activity, the patient is raised, planted);

Sanatorium - the patient is transported to a cardiological sanatorium. There, under the control of the MS, they are taken out to walk on terrainks, with a constant increase in the load;

Outpatient - polyclinic. Drug therapy, constant increase in physical activity.

After discharge from the hospital, they take: beta-blockers (drugs of choice), reduce myocardial oxygen demand.