Ischemic heart disease treatment and prevention. How to prevent the onset and further development of coronary heart disease? Astragalus for angina attacks and chest pain

Coronary heart disease annually causes the death of millions of people, being the rightful leader in the list of diseases with the highest number of deaths.

The key task in reducing the indicators of this sad statistics was the prevention of coronary artery disease. It is a set of measures that prevent the occurrence of disease and death. Prevention of ischemia is usually divided into primary and secondary.

It is a series of measures that reduce the risk of ischemia. The priority direction of prevention is the elimination or mitigation of risks that can have a negative impact on health and become a cause. These include:

• insufficient motor activity;
• smoking;
• lack of rational principles in nutrition;
• excess weight;
• diabetes.

Primary prevention of coronary disease is intended to be carried out among a healthy population at risk. It is the influence of these negative factors that can further lead to the development of ischemia. To avoid this, the following measures are taken:

• eating healthy food;
• maintaining adequate weight;
• normalization of blood sugar levels;
• compliance with the mode of physical activity;
• normalization of blood pressure.

Primary prevention of coronary heart disease is a task of the state level. Its solution is based on the introduction of health improvement programs for the population. Unfortunately, at the moment this issue is not sufficiently developed.

Factors that increase the risk of developing coronary artery disease

Body weight control

Every year the number of overweight people is increasing.

Excessive body weight puts an extreme strain on the heart and causes hypertension, which contributes to the development of coronary heart disease.

In addition, overweight is often a consequence of diabetes mellitus, which also serves in coronary artery disease.

Primary prevention of CHD necessarily includes weight control. To do this, it is recommended to use the calculation of BMI (body mass index). The indicator is obtained by dividing the mass (in kilograms) by the height (in meters) squared (that is, multiplied by itself).

Table. Body mass index, interpretation and recommendations.

Indicator	Meaning	Recommended activities
19-23	Weight is normal	maintenance
23-27,5	Overweight	decline
27,6-30,0	1 degree of obesity	decline
30,0	2 degree of obesity	decline

Calculation example:
Initial data: height 180 cm, weight 65 kg.
Calculation of the BMI indicator: 65 / (1.8 × 1.8) \u003d 65 / 3.24 \u003d 20.06.

Proper nutrition

The following nutritional principles are distinguished in the prevention of coronary artery disease, which help reduce the risk of ischemia:

1. The main rule is to refuse or limit sugar intake.
2. A balanced diet plays an important role in the prevention of coronary artery disease.
3. The number of calories consumed should not exceed the number burned. This will prevent the formation of excess adipose tissue.
4. Restriction of food with an increased amount of animal fat. It is these lipids that cause an increase in cholesterol levels.
5. Prevention of coronary artery disease involves moderate salt intake. It is recommended to limit to 4 grams per day. This has a beneficial effect on blood pressure indicators.
6. It is recommended to drink enough water - up to 2 liters per day.

To give up smoking

Passive and active smoking increase the risk of coronary heart disease by 57 percent. At the same time, the number of deaths among smokers is 5 times higher than among those who are indifferent to cigarettes.

It is extremely important to prevent smoking among children and young people. Those suffering from a bad habit can resort to the following ways to solve the problem:

• taking nicotine-replacing drugs (cytisine, tabex, etc.);
• taking homeopathic remedies that relieve intoxication and reduce cravings for cigarettes;
• the use of antidepressants in case of severe psycho-emotional dependence;
• visiting a psychologist for advice.

Regular physical activity

Prevention of coronary artery disease necessarily includes physical activity. They help to increase muscle tone, improve blood supply to all organs, including the heart itself. It is extremely important to understand that physical activity in the prevention of coronary artery disease should be dosed.

Excessive physical activity will give a negative result. Hardening or games with a sports bias would be appropriate. Also, daily morning exercises are suitable for the prevention of coronary heart disease. It is possible to perform the following exercises:

1. You need to stand up straight and place your hands on your belt. Spread your arms to the sides, inhale and return to the starting position. You can repeat the exercise up to 10 times. In this case, it is important to monitor the respiratory rhythm. It must be stable.
2. The starting position is similar to exercise 1. You need to raise your hands up, then inhale. Next, bend over and exhale. Repeat up to 10 times at an average pace.
3. It is necessary to stand up, stretch your arms forward, then part and inhale. After returning to the starting position, exhale. Perform the exercise slowly, up to 10 times.
4. Sit on a chair, bend your leg at the knee, clap your hands under the knee. Repeat with the second leg. The cycle includes 5-7 repetitions.
5. Stand next to a chair. Sit down on the exhale, stand up on the inhale. The cycle includes 5-7 repetitions.

Secondary prevention of coronary artery disease

For patients diagnosed with ischemia, secondary prevention of coronary artery disease plays an important role. It pursues the following goals:

• prevention of recurrence of the disease;
• prevention of spasm of the coronary arteries;
• stabilization of the rhythm of the heart muscle;
• Exercise therapy for IHD for recovery;
• pharmacological rehabilitation therapy.

Education

It is extremely important in prevention to educate patients with the basics of maintaining a proper lifestyle. The specialist should monitor the patient's condition on a regular basis, making adjustments to habits and behavior. Understanding the foundations of a healthy lifestyle is laid in childhood and is supported with the help of special programs. Following the basic rules of a healthy lifestyle and giving up bad habits can significantly reduce mortality from coronary artery disease.

Diet and weight control

For patients with coronary heart disease and it is extremely important to eat right. becomes a key moment in the organization of rehabilitation therapy of the patient and prevention. Recommended:

• reduce the amount of fat in food of animal origin (eat lean foods with no more than 20 grams of fat per 100 grams of product);
• consume polyunsaturated fatty acids (found in fish, nuts, vegetable oils);
• reduce salt intake.

You can control body weight based on the methodology described earlier, guided by the BMI index.

Healthy lifestyle

A healthy lifestyle is based on a combination of several factors at once. First of all, for secondary prevention of ischemia it is necessary:

• stop smoking;
• do not drink alcoholic beverages;
• observe the motor mode;
• do swimming or gymnastics;
• spend enough time outdoors;
• pay attention to strengthening immunity and hardening;
• in coronary heart disease, it is recommended to take vitamins for prevention.

Rules for a healthy lifestyle

exercise therapy

A set of exercise therapy exercises for IHD allows you to increase blood circulation in order to further normalize heart functions. The training program for prevention is developed based on the patient's belonging to a certain group:

• group 1 (for patients with angina pectoris);
• group 2 (cardiosclerosis after myocardial infarction);
• group 3 (left ventricular aneurysm after myocardial infarction).

For the first group, in the prevention of coronary artery disease in patients, a dynamic load of all muscle groups with full amplitude is allowed. Classes can last up to half an hour.

For the second group of patients, it is necessary to focus on breathing exercises and the load of the muscle groups of the heart at a slow or medium pace. The duration of the load is up to 25 minutes with obligatory rest breaks.

For the third group, in the prevention of coronary artery disease, the duration of the exercise is set to no more than 15 minutes with an incomplete amplitude. The pace is slow, pauses are required.

Therapeutic exercise for prevention is contraindicated in:

• acute heart failure;
• pulmonary edema;
• severe shortness of breath;
• severe pain sensations;
• elevated temperature;
• deterioration detected on the electrocardiogram.

Spa treatment

Treatment in sanatorium-resort institutions is complex. Therapy is aimed at restoring the full functioning of the heart and blood vessels.

Preventive treatment of ischemia is carried out at the Caucasian Mineralnye Vody: in Kislovodsk, Pyatigorsk, Zheleznovodsk.

The following procedures are prescribed in the sanatorium:

• visiting the pool;
• health path;
• oxygen therapy;
• mud treatment;
• circular shower;
• enhanced external counterpulsation (in the absence of contraindications).

The average cost of IHD prevention in sanatoriums with full board for 14 days ranges from 40 thousand to 300 thousand, depending on the level of the institution. It is also possible to purchase kursovka (treatment only). In this case, the price for 2 weeks will be 10-50 thousand rubles. However, with angina pectoris 3-4 classes, prevention in sanatoriums is contraindicated.

Dispensary registration at the cardiologist

When detected, it is extremely important to ensure regular monitoring of the patient by a cardiologist. Only a specialist is able to take preventive measures on the basis of an examination and a planned study. It is recommended to visit a cardiologist as a preventive measure 1-2 times a year, in complicated cases 2-4 times.

Useful video

For more information about the treatment and prevention of coronary heart disease, see this video:

Conclusion

1. Coronary heart disease is easier to prevent than to treat. The best option would be competent prevention of this disease.
2. Compliance with the rules of a healthy lifestyle, proper nutrition, dosed loads can have a positive impact.
3. If IHD has already been identified, then it is important to carefully monitor your health and eliminate risk factors. For this, sanatorium treatment, exercise therapy, and the rejection of bad habits are recommended.
4. If the recommendations are followed, the patient will be able to live for many years.

Prevention of coronary heart disease in clinical practice

In 1998, the recommendations of the second joint working group of the European Society of Cardiology, the European Society of Atherosclerosis and the European Society for Hypertension "Prevention of coronary heart disease in clinical practice" were published in the journals "European Heart Journal", "Atherosclerosis" and "Journal of Hypertension". These data will undoubtedly be of interest to the general medical community.

The main idea of ​​the recommendations is to concentrate the efforts of therapists, cardiologists, general practitioners on reducing the risk of developing coronary heart disease (CHD) and its complications, as well as other clinical manifestations of atherosclerosis. The task is to make the prevention of coronary artery disease an integral part of the medical and preventive work of a practical doctor. Doctors still pay a lot of attention to the treatment process and do not use enough of the huge potential that

incorporated in the prevention of coronary artery disease. The main principle: IHD is a multifactorial disease, therefore, risk assessment of its development and prevention should be multifactorial.

A key element of patient management is the provision on the need to achieve target levels of blood pressure and blood lipids as the main factors that determine the risk of developing coronary artery disease and its complications. To achieve the target levels, both lifestyle changes (diet, physical activity, smoking cessation) and the use of lipid-normalizing and antihypertensive medications are recommended.

The relationship between drug and non-drug methods and the tactics of patient management are determined by the level of absolute multifactorial coronary risk. This risk is expressed as the probability of occurrence of clinical manifestations of coronary artery disease, atherosclerotic lesions of other localization or their complications in

over the next 10 years. The absolute individual risk is determined by five main indicators: age, gender, smoking, systolic blood pressure and total cholesterol levels, taking into account heredity, changes in the lipid spectrum, and the presence of diabetes mellitus. Patients with pre-existing symptoms of CAD or other atherosclerotic lesions are at very high risk.

medical priorities. Against the background of well-known general recommendations to reduce smoking, choose a healthier diet, increase physical activity, addressed to the entire population as part of a population-based prevention strategy, the target group for the implementation of the proposed medical approach are patients with clinical manifestations of coronary artery disease, atherosclerotic lesions of other localization or a high risk of their development. Patients at greatest risk benefit most from preventive measures. In accordance with this, the following target groups are distinguished, arranged in descending order of priority:

1. Patients with coronary artery disease or other

diseases associated with atherosclerosis (AS).

2. Healthy individuals with a high risk of developing coronary artery disease and other diseases associated with AS, due to a combination of such risk factors as smoking, elevated blood pressure, lipid metabolism disorders (elevated levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) , low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides), high blood sugar, a history of early development of coronary artery disease in the family, and people with severe hypercholesterolemia (or other forms of dyslipidemia), hypertension or diabetes mellitus.

3. Close relatives of patients with early development of coronary artery disease or other diseases associated with AS, as well as healthy individuals with a very high risk.

4. Other persons (patients) being examined as part of routine clinical practice.

Measures for the first group of patients are described in the section "Secondary prevention", in relation to

other groups - in the section "Primary prevention".

secondary prevention. Lifestyle change. Success in this direction is determined by the patient's willingness to change lifestyle. The moment a patient is diagnosed with coronary artery disease or a high risk of developing it provides him with an ideal opportunity to reconsider his lifestyle, and the doctor's advice falls on fertile ground.

To give up smoking. The doctor should advise the patient to stop smoking in the name of maintaining health and life, inform him about the dangers of passive smoking, while relying on the help of family members. In some cases, nicotine replacement therapy may be useful at the first stage of smoking cessation, especially in severe nicotine dependence. Stopping smoking of other family members who live in the same room with a smoker can help him quit smoking and not return to this habit again.

Changing the nature of nutrition:

1. Reduce total fat intake to 30% or less of the total calorie intake; saturated fat to one

a third or less of all consumed fats; cholesterol up to 300 mg per day. Given the nature of the diet of the urban population of Belarus, it is necessary to increase the consumption of fish and other seafood.

2. Increase consumption of fresh vegetables, fruits and grain products.

3. Reduce the total calorie content of the daily diet if the weight is increased.

4. Reduce salt and alcohol intake if you have high blood pressure.

Increasing physical activity. Recommended aerobic exercise (walking, swimming, cycling) for 20^0 min 4^ once a week. It is important that exercise increases the level of high-density lipoproteins (anti-atherogenic), reduces triglycerides, the likelihood of thrombosis, and helps to normalize weight.

Overweight and obesity. To assess body weight and identify obesity, the body mass index (BMI) is used, which is calculated by the formula: weight in kg / (height in m2).

Persons who are overweight (BMI>25 kg/m2) and obese (BMI>30 kg/m2), especially those with

Centrally obese individuals are at increased risk of coronary artery disease and should be assisted professionally with an appropriate diet and increased physical activity to reduce weight. Weight loss will also help lower blood pressure, total cholesterol, and blood sugar levels. Waist size is often used as a clinical measure of obesity and weight loss monitoring. A waist circumference >94 cm in men and >80 cm in women indicates that you should get rid of extra pounds, and if the waist circumference is > 102 cm in men and >88 cm in women, professional blood pressure is required. It emphasizes the need to achieve and constantly maintain the target level of blood pressure - less than 140/90 mm Hg. If this level of pressure cannot be achieved due to lifestyle changes, antihypertensive drugs should be prescribed. In patients with exertional angina, preference is given to p-blockers, and if they are intolerant or insufficiently effective, calcium antagonists of prolongation

bathroom action. Patients with a history of myocardial infarction should be given β-blockers, and patients with left ventricular dysfunction should receive ACE inhibitors.

blood lipids. The level of total cholesterol must be consistently reduced to 5.0 mmol/l (190 mg/dl) and below, and LDL-C to 3.0 mmol/l (115 mg/dl) and below. Formally, the levels of HDL-C and triglycerides are not considered as criteria for the effectiveness of treatment, however, the level of HDL-C<1,0 ммоль/л (40 мг/дл) и триглицеридов >2.0 mmol/l (180 mg/dl) is an indicator of an increased risk of developing coronary artery disease.

If it is not possible to consistently maintain the target level of LDL-C through lifestyle changes, medical treatment should be considered. Preference should be given to inhibitors of HMG coenzyme-A reductase (statins), as this class of lipid-normalizing drugs has demonstrated undeniable efficacy in reducing coronary and general mortality and increasing life expectancy. Statins also significantly reduce the risk of stroke in

patients with ischemic heart disease.

Blood sugar. It has not yet been established how much blood sugar control reduces the risk of cardiovascular events in patients with diabetes and CAD, but it is known that normoglycemia contributes to the prevention of micro- and macrovascular complications in people with diabetes. In type 1 diabetes (insulin-dependent diabetes mellitus), the following target levels should be achieved:

fasting blood sugar - 5.16.5 mmol / l (91 - 120 mg / dl);

postprandial blood sugar (peak) - 7.69.0 mmol/l (136-160 mg/dl);

glycosylated hemoglobin (HNA) - 6.2-7.5%.

In addition, hypoglycemia should be avoided.

For the majority of patients with type 2 diabetes (non-insulin dependent diabetes mellitus), it is necessary to achieve lower levels of these indicators. For some patients, especially the elderly, maximum care should be taken to achieve target levels.

Other preventive drug therapy. V

In addition to non-drug and drug control of blood pressure and blood lipids, it is necessary to take into account the advisability of prescribing drugs to patients that reduce the risk of complications and mortality:

Aspirin (at least 75 mg/day) or other agents that affect platelet aggregation, if possible, in all patients.

β-blockers - for patients who have had a myocardial infarction.

ACE inhibitors - patients with a decrease in left ventricular systolic function (ejection fraction< 40) или тем, у кого в период острого инфаркта миокарда были симптомы сердечной недостаточности.

Anticoagulants - in patients after myocardial infarction with an increased risk of thromboembolic complications, including patients with extensive anterior myocardial infarction, left ventricular aneurysm or thrombosis, paroxysmal tachyarrhythmia, chronic heart failure and a history of thromboembolism (under the control of prothrombin and other indicators of hemostasis).

primary prevention.

The first step is the determination of coronary risk, which is carried out using a special card (Fig. 1, see the paper version of the journal).

To determine the absolute risk of developing clinical manifestations of coronary heart disease in the next 10 years, you should select the table for the desired sex and its part corresponding to the age and smoking status (smoker, non-smoker) of this person. Then you need to find the cell closest to his (her) systolic blood pressure and cholesterol level, and compare the shading of this cell with the scale at the bottom of the diagram. The charts allow you to assess the impact that changes in cholesterol levels, blood pressure, or smoking status may have on overall risk. Moving along the tables (diagrams) to the right, one can trace the influence of a long-term (for decades) action of the risk factor. This can be helpful when discussing the issue with younger people. In patients with diabetes mellitus, familial hyperlipidemia, low HDL-C (<1,0 ммоль/л у мужчин и <1,1 у женщин), имеющих прямых родственников с

early coronary heart disease (men under 55, women under 65), the risk increases by one category compared to that determined by the map. The criterion for high risk is its level > 20% or risk extrapolated to the age of 60 years > 20% in the next 10 years.

For patients whose coronary risk is assessed as high, intensive measures to reduce the levels of risk factors with the use of medications as indicated are recommended.

Lifestyle. Individuals at high risk of developing CAD especially need professional support to stop smoking, make healthy dietary choices, and increase physical activity. In primary prevention, importance is attached to the prevention of obesity and the reduction of excess weight. Lifestyle changes can help avoid medication. The lifestyle recommendations for patients with CAD outlined above may also be helpful for those at high risk for the disease.

Arterial pressure. It is emphasized that the achievement

target blood pressure levels significantly reduces the risk of stroke, myocardial infarction and heart failure in these patients. The decision to use antihypertensive drugs is based both on the assessment of absolute coronary risk, and on the level of systolic and diastolic pressure and the presence of target organ damage (Fig. 2, see the paper version of the journal).

For patients with an increase in systolic blood pressure (SBP) >180 mm Hg and/or diastolic blood pressure (DBP) > 100 mm/Hg that persists despite lifestyle changes, the risk of developing complications (CHD, cerebral stroke, heart failure) is so high that medical treatment is required. Drug treatment is also necessary for those patients whose SBP is consistently maintained at 160-179 mm Hg. Art. In individuals with a more moderate increase in blood pressure (SBP 140 - 159 and / or DBP 90 -94 mm Hg), drug treatment is prescribed for target organ damage or a high risk of coronary artery disease. If, at the same blood pressure levels, the absolute risk

low, then you can do without drugs.

When conducting therapy aimed at lowering blood pressure, it is necessary to determine the target level of reduction and titrate the dose of the drug until the goal is reached. It is preferable to start treatment with one drug. If necessary, you can add a second or third drug. As part of primary prevention, the target level for lowering blood pressure is 140/90 mm Hg. and below. In young people, patients with diabetes mellitus and renal parenchymal diseases, the target blood pressure level may be even lower.

The effectiveness of diuretics and β-blockers in reducing morbidity and mortality from cardiovascular disease in people with arterial hypertension is well established. Similar efficacy has recently been found for calcium antagonists and ACE inhibitors. Therefore, antihypertensive drugs of various classes can be used with equal success for adequate control of blood pressure.

blood lipids. The decision to use lipid-lowering drugs depends on the ab-

absolute risk of developing coronary artery disease, lipid levels and cases of early development of coronary artery disease or other diseases associated with atherosclerosis in the family (Fig. 3, see the paper version of the journal). Patients with familial hypercholesterolemia are at such a high risk of developing coronary artery disease that drug treatment is always necessary. In other cases, tactics are determined by the level of coronary risk. At a risk of more than 20%, total cholesterol, HDL-C (a-cholesterol), triglycerides, LDL-C are determined. A lipid-lowering diet should be observed with repeated control after 3-6 months. If it is not possible to reduce LDL-C to 3.0 mmol / l (total cholesterol to 5.0 mmol / l), lipid-normalizing drugs are prescribed against the background of constant adherence to a lipid-lowering diet. When using lipid-lowering drugs, it is necessary to titrate the dose of drugs until the target level of cholesterol reduction is reached. Sometimes in individuals at high risk of developing CAD, the target level of lipid reduction cannot be achieved either with the help of diet or with the help of the maximum dose of lipid-lowering drugs; v

in this case, combined drug treatment is required. Even in those patients who have very high levels of total cholesterol or LDL-C and fail to achieve the target level of lipid reduction, the risk of developing coronary artery disease can be significantly reduced. There are four main groups of drugs of choice (statins, fibrates, niacin, bile acid sequestrants), but the evidence for the efficacy and safety of statins is most demonstrative in primary prevention.

Blood sugar. Currently, there is no data on the effectiveness of blood sugar control in reducing the risk of developing coronary artery disease or other diseases associated with AS in patients with diabetes. However, in individuals with both types of diabetes, the risk of developing diseases associated with AS is directly dependent on the degree of hyperglycemia. Blood sugar control (as defined in patients with coronary artery disease) is effective in preventing microvascular disease and other complications associated with diabetes, so it is desirable to achieve adequate blood glucose control in all people with diabetes.

blood sugar. At any level of risk factors (smoking, blood pressure, blood lipids) or any combination of them, the absolute risk of developing coronary artery disease is much higher in patients with diabetes than without it. Therefore, it is important to achieve a targeted reduction in the level of risk factors in patients with diabetes mellitus.

Examination of close relatives. In close relatives of patients suspected of having familial hypercholesterolemia or other hereditary forms of dyslipidemia, blood lipid levels should be determined.

Prepared by G.I. SIDORENKO, IL KOZLOV (Belarusian Research Institute of Cardiology)

Medical news. - 2000. - No. 8. - S. 34-38.

Health care in Norway

At the beginning of the 21st century Norway is an example of a modern democracy where society as a whole is responsible for the welfare of every citizen. On the territory of about 400 thousand square meters. km is home to 4.525 million people. Due to geographical features, the population is unevenly distributed throughout the country: 2/3 live in densely populated areas, 1/3 -

in coastal areas of the Norwegian Sea. For many Norwegians, fishing is still the main source of income. However, in the mid-60s, oil fields were discovered in Norway, which was the beginning of the growth and strengthening of the socio-economic well-being of citizens and the state as a whole. This affected the average duration

According to the WHO, cardiovascular disease is the most common cause of death in the world's population. At the same time, coronary heart disease (CHD) leads to death in 30-50% of cases. Prevention of coronary heart disease is necessary for everyone, since the disease develops in a latent form.

In coronary heart disease, under the influence of certain factors, the heart muscle stops receiving sufficient blood supply. Myocardial damage occurs, in which the amount of oxygen and nutrients supplied to it decreases. IHD is usually caused by damage to the coronary arteries that carry blood to the heart. So, the vessels cease to function normally if they spasm, clog with a thrombus (with increased blood viscosity), or deposits of atherosclerotic (cholesterol) plaques begin on the walls of the artery.

Clinical forms of ischemic disease:

• Angina. It is characterized by episodic suffocating and burning pains behind the sternum, which can respond in the shoulder joint or the peritoneal region. It occurs when the myocardium is depleted due to oxygen starvation.
• Myocardial infarction. Occurs when the heart artery is clogged: since the blood stops feeding the heart muscle, partial death of its tissues (necrosis) begins.
• Cardiosclerosis. It develops after a myocardial infarction - dead myocardial cells are replaced by connective tissue.
• Arrhythmic variant of ischemic disease. Oxygen starvation of the heart muscle leads to conduction disturbances and, accordingly, pathological changes in the heart rhythm.
• Heart failure. Symptoms of oxygen deficiency spread to all tissues of the body, peripheral circulation is disturbed.
• Sudden coronary cardiac arrest. If timely help is not provided to the victim, it leads to death.

In the first stages of the disease, a person may not be aware of the health problems that have arisen: the body is trying to redistribute the load on other systems, and for some time the symptoms of the disease do not appear.

The first signs of myocardial damage:

• shortness of breath;
• feeling of interruptions in the work of the heart;
• an increase (very rarely - a decrease) in blood pressure.

At a later date, the above symptoms are accompanied by pain in the sternum or radiating to the neck, shoulder joint.

Measures to prevent a disease that has not occurred before are called primary prevention of coronary heart disease. To implement it, pay attention to the way of life and eliminate the sources of negative changes.

Factors that increase the risk of coronary heart disease

• genetic predisposition. Think about whether you have relatives who suffer or have died from cardiovascular disease.
• Age. Upon reaching the age of 40-50, take tests every six months and undergo an examination (biochemical parameters, ultrasound of the heart, cardiogram, etc.).
• Floor. Due to the influence of estrogen, women are less prone to atherosclerosis. After the onset of menopause, when hormonal changes occur, the risk of coronary artery disease in women increases.
• Accompanying illnesses. For example, people who are obese, atherosclerotic, arterial hypertension, or diabetic are more likely to have problems with the cardiovascular system. Therefore, it is imperative to correct the existing pathological conditions.
• Bad habits. Smoking, consumption of alcoholic beverages, a tendency to overeat affect the appearance, well-being and loosen the work of internal organs.
• Insufficient physical activity or excessive exercise. Both physical inactivity and an unhealthy passion for sports wear out the body. Give preference to moderate cardio loads - cycling, brisk walking, volleyball. Exercise three times a week for 30-40 minutes.
• Hyperresponsibility and constant stress. Contact a psychotherapist or get acquainted with modern relaxation methods to improve adaptation to stressful influences (meditation, self-massage, keeping a personal diary).

If at the appointment with a cardiologist, problems with the nutrition of the heart muscle were diagnosed or the patient suffered one of the clinical forms of the disease, secondary prevention of coronary heart disease is prescribed. Pharmaceuticals, physiotherapy, traditional methods come to the rescue, in difficult cases - surgical intervention (coronary angioplasty, coronary artery bypass grafting).

Medicines for the prevention and treatment of coronary artery disease

With the help of medicinal substances, it is necessary to slow down or, if possible, eliminate the process of thrombus formation and the deposition of atherosclerotic plaques. It is also necessary to restore metabolic processes in the myocardium. Additionally, it is worth prescribing drugs to normalize heart rate and blood pressure. For this purpose, the following groups of drugs are used:

Group of medicines	Representatives and dosage	Purpose	Contraindications
Anticoagulants	Acetylsalicylic acid- 250 mg, warfarin- 5 mg 2 r / day; ticlopidine- 0.25 g twice a day, clopidogrel- 75 mg.	Make blood more viscous and prevent clotting	Peptic ulcers of the gastrointestinal tract, liver failure, blood clotting disorders
Lipid-lowering drugs	Statins: lovastatin- 80 mg, atorvastatin- 10 mg, fluvastatin- 40 mg twice a day.	Eliminate atherosclerotic plaques and prevent their occurrence	Liver and kidney disorders, diabetes mellitus, osteoporosis
	Fibrates: clofibrate– 5 g up to 4 times a day, fenofibrate- 145 mg.
	Others: cholestyramine- 4 g up to 4 times a day .; a nicotinic acid- up to 0.5 g per day.
ß-blockers and other antiarrhythmic drugs	Carvedilol- up to 25 mg per day.	Normalize cardiac conduction	Bronchial asthma, bradycardia, hypotension
	Amiodarone- 200 mg three times a day.
ACE inhibitors, angiotensin receptor blockers	Captopril- 100-150 mg, cilazapril - 500 mg.	Normalize blood pressure	Disorders of the excretory system, pulmonary diseases
	Losartan- 50 mg.
Means that restore metabolism in the heart muscle	Trimetazidine- 70 mg, levocarnitine- up to 1 g, creatine phosphate- 1-2 g, mildronate- 500 mg.	Restore myocardial nutrition	Renal or hepatic insufficiency, hypersensitivity to drugs
Nitrates	Nitroglycerine- ½ or 1 tab. under the tongue as a first aid treatment for angina pectoris	Expand the coronary vessels	Cerebral hemorrhage, hypotension, glaucoma
Diuretics	Hypothiazide- 25 mg per day.	Relieve swelling caused by impaired microcirculation in the extremities	Hypokalemia, renal failure

Note! The article provides approximate dosages for review! Women during pregnancy should coordinate the intake of any drug with a doctor!

Physiotherapy methods

These methods of preventing coronary heart disease are used according to the doctor's indications and only in combination with drug therapy.

• shock wave therapy;
• enhanced external counterpulsation;
• stem cell treatment;
• quantum (laser) therapy.

The procedures are aimed at stimulating the regeneration of cardiomyocytes.

With the help of traditional medicine recipes and herbal remedies, you can correct the patient's condition in the initial stages of coronary artery disease, but with serious violations, you should not count on a complete cure.

hawthorn fruit

Use infusion and tincture:

1. To prepare the infusion 1 tbsp. l. raw materials are poured with a glass of hot water and insisted in a thermos for two hours. The filtered liquid is taken 1-2 tbsp. l. before meals.
2. Alcohol tincture is used 30-40 drops per glass of water up to 4 times a day.

motherwort herb

Pour 15 g of motherwort herb with a glass of boiling water and let it brew until cool. Drink 1/3 cup before meals 3 times a day. You can use ready-made tincture - dilute 30-50 drops in 1/2 glass of water and drink 3-4 times a day.

Horseradish with honey

Grind horseradish root in a blender and mix with honey in equal proportions. Eat 1 tsp daily. means by drinking water.

Garlic tincture

The average head of garlic (up to 50 g) is crushed and infused in 200 g of vodka. Apply three times a day, diluting 8 drops of tincture with cool water.

Note! It is necessary to use horseradish and garlic with caution in patients with diseases of the digestive tract (gastritis, mucosal manifestations).

Royal jelly and pollen

Take 5-10 g before meals twice a day.

Memo on the prevention of coronary heart disease

• Include foods rich in omega-3 fatty acids (nuts, fish, olive oil) and potassium (baked potatoes, dried apricots) in your diet. Limit meals from offal and fatty meats, reduce butter consumption.
• Take vitamin complexes and supplements. Complexes containing omega-3, omega-6 and omega-9 are especially useful.
• Give up bad habits.
• Keep a sleep and wake schedule.
• During the period of remission, gradually include physical exercises to improve microcirculation in the myocardium.

IHD is a chronic disease that, with the wrong lifestyle, can progress. Therefore, take care of your health before the onset of alarming symptoms and take the time to prevent ischemia.

Primary prevention of coronary artery disease should be observed by all people. Particular attention to these measures should be given to persons falling into at least one of the risk groups for this pathology.

IHD can be triggered by various reasons. Primary prevention of the disease involves the elimination of modifiable risk factors, the presence of which a person can control. These include:

• high body weight;
• negative eating habits;
• alcohol consumption;
• smoking;
• low level of physical activity;
• hypertension.

Such risk factors apply not only to coronary heart disease, but also to many other diseases of various body systems.

High body weight

Obesity is a provoking factor in many disorders in the body. To control your weight, it is important not only to monitor the indicators on the scales, but also take into account the body mass index (BMI).

High body weight is directly related to other risk factors for CHD - dietary habits and level of physical activity. A hereditary predisposition may also have a value, but this circumstance remains unchanged.

To reduce body weight, you need to change your diet and add moderate physical activity. You can contact a nutritionist who will recommend some tests and develop an individual diet.

When normalizing weight, it is important to remember that you can not starve. All restrictions should be introduced gradually so that the body does not experience stress.

Food habits

The risk of coronary heart disease is associated with a high number of calories consumed, which inevitably leads to weight gain. Another risk factor is the excessive consumption of animal fats, which leads to high cholesterol levels.

For the prevention of coronary artery disease, certain rules should be followed:

• Limit daily calories. It must be calculated on an individual basis, taking into account age, weight, height and level of physical activity.
• Eat in a balanced way. The diet should contain 10-15% proteins, 55-60% carbohydrates, 25-35% fats, but mostly of plant origin.
• The diet should be based on cereals, vegetables, fruits, dairy products. Moderate consumption of meat, lean fish, and poultry is important.

Eating habits are reflected in the level of glucose, with a constant excess of which there is a risk of diabetes. It can provoke the development of coronary artery disease. It is necessary to limit sweets, carbonated drinks, canned food, flour products as much as possible.

Eating behavior is one of the most important factors affecting health. Proper nutrition is the prevention of most existing diseases of various body systems.

Alcohol

Alcohol abuse carries the risk of developing many diseases, including coronary heart disease. At the same time, the absolute rejection of it does not exclude the possibility of coronary artery disease, but serves as a prevention of other diseases.

Moderate consumption of alcohol is considered a dosage of up to 30 grams per day. This is a calculation for pure ethanol.

It is a well-known fact that dry red wine is good for blood vessels, but this does not mean its general benefit. It is permissible to occasionally drink one glass of such a drink.

Smoking

There are thousands of chemicals in tobacco smoke, but a person receives more harm from carbon monoxide and nicotine.

For the prevention of coronary artery disease and many other diseases, smoking should be completely excluded. At the same time, it is important to take into account that passive smoking, that is, inhalation of smoke, also brings harm.

With low physical activity, the risk of coronary heart disease increases significantly. To prevent the disease, they should be administered at least half an hour a day. One day off is allowed.

Physical activity should be moderate. Useful for jogging, swimming, cycling, skiing. Even brisk walking is effective - if there is no time for a walk, then from work you can walk at least part of the way.

It is important to combine physical activity with rest. If the work is sedentary, then, if possible, you need to do a warm-up during breaks.

Hypertension

Prevention of hypertension can be classified as both primary and secondary measures. Primary prevention of hypertension consists of proper nutrition, limiting alcohol, not smoking, maintaining a normal weight, and moderate exercise.

If, despite a healthy lifestyle, the pressure still rises, then drug therapy may be required. Its need is determined individually, taking into account the presence of other risk factors for coronary artery disease.

If coronary heart disease is still diagnosed, then prevention of its progression and development of complications is required. To this end, secondary prevention is needed. It includes the following measures:

• lifestyle modification;
• drug therapy;
• slowing down the progression of coronary sclerosis, ensuring, if possible, its partial regression;
• prevention of exacerbation of the disease and its clinical complications.

Some surgical interventions may also be considered as secondary prevention.

With diagnosed coronary heart disease, it is especially important to lead a correct lifestyle. It consists in observing the following principles:

• proper and balanced nutrition;
• complete cessation of smoking and alcohol;
• normalization of body weight;
• maintaining normal levels of sugar and cholesterol (implied with proper nutrition).

Features of the diet for IHD depend on the presence of concomitant diseases. In some cases, patients need a specific treatment table. A common indication for coronary heart disease is table number 10.

Treatment table No. 10 is indicated for cardiovascular diseases (stage of compensation) and insufficient blood supply. The basic principles of the diet are as follows:

• reduce fats and carbohydrates;
• refuse table salt;
• limit fluid intake;
• refuse heavy food;
• eat 5 times a day;
• eat foods high in potassium, magnesium and lipotropic substances.

In the treatment of coronary heart disease, a whole range of drugs are used. Certain medications are important in preventing the progression of the disease and the development of complications. For these purposes, as prescribed by a doctor, it is possible to receive:

• Anticoagulants of indirect action. They are necessary at the risk of vascular complications, including intracardiac thrombosis, thromboembolism, deep vein thrombosis, atrial fibrillation.
• β-blockers. With their help, they reduce the risk of recurrent myocardial infarction and death from coronary artery disease.
• Angiotensin-converting enzyme inhibitors. They are able to slow down the progression of atherosclerosis, differ in anti-ischemic action. Such drugs are used for concomitant arterial hypertension, diabetes mellitus, signs of heart failure.
• lipid-lowering agents. They are indicated in case of hyperlipidemia, angina pectoris, myocardial infarction. The intake of such funds has a positive effect on the prognosis of life with coronary artery disease.
• Plavix (Clopidogrel). The drug reduces the risk of myocardial infarction, ischemic stroke, sudden death. After stenting, this drug is used to prevent stent thrombosis.

Such a preventive measure means surgical intervention. It allows you to restore blood flow through the arteries of the heart with their stenosis. Such a measure is necessary for the normal blood supply to the heart muscle.

Often, in order to revascularize the myocardium, coronary artery bypass grafting or stenting is used. Such techniques are direct operations.

Thrombosis

The cause of most possible complications in coronary artery disease is thrombus formation. For its prevention, it is necessary to maintain a healthy lifestyle, which consists in proper nutrition, moderate physical activity and the rejection of bad habits.

At the risk of thrombosis, nutrition should be based on cereals, fresh vegetables and fruits, dairy products, lean meat, vegetable oils. It is useful to use foods rich in Omega-3, vitamin E, flavonoids.

It is also important to prevent any diseases of infectious origin, to prevent severe overheating or hypothermia of the body.

Drug prevention of thrombosis includes taking anticoagulants, antiaggregants, folic and nicotinic acid, B vitamins (6, 12), vitamin E, bioflavonoids. Such therapy should be prescribed by a specialist.

Separately, it is worth considering the prevention of thrombosis after surgery. It must be included after the operation, regardless of the technique used.

myocardial infarction

One of the complications of coronary heart disease is myocardial infarction. In cardiology, it is considered an exacerbation and the most severe form of ischemia.

Prevention of myocardial infarction should include the treatment of any existing diseases. Of particular importance is diabetes mellitus and arterial hypertension.

If myocardial infarction has already happened, then medical prevention of coronary artery disease is necessary. A positive effect is observed when taking drugs with antianginal action: Carbocromen, Intensain, Intencordin. Other drugs should also be included in the prevention:

• β-blockers;
• indirect anticoagulants;
• calcium channel blockers;
• angiotensin-converting enzyme inhibitors.

Blood pressure control is important. If the diastolic index exceeds 100 mm Hg. Art., then the risk of coronary artery disease increases. In this case, the use of antihypertensive drugs is indicated.

In case of myocardial infarction, physical rehabilitation is also important. The level of physical activity is selected individually, focusing on the results of the tests. More often they resort to physiotherapy exercises and walking on flat terrain. In this case, a certain speed is recommended. Usually it is 3-4 km / h, that is, 80-100 steps.

It is important to maintain normal cholesterol levels - up to 300 mg per day is allowed. It is also necessary to limit the consumption of table salt to 5-6 grams per day.

Treatment of a pathology such as cardiac ischemia is characterized by some features. Non-drug therapy includes:

• regular physical education and the duration of such training is determined by a specialist
• a change in diet involves the rejection of salty and fatty foods, as well as limiting water intake to reduce the load on the heart muscle
• elimination of stressful situations and emotional overstrain

1 What is coronary artery disease and why is it scary?

IHD (ischemic heart disease) is a pathological condition, the characteristic feature of which is a discrepancy between myocardial oxygen demand and its delivery. This situation can occur when the lumen of the coronary vessels is narrowed by atherosclerotic plaques (which is the most common cause of coronary artery disease) or due to spasm of the coronary arteries (occurs less frequently).

There are modifiable and non-modifiable risk factors for developing coronary artery disease. The first includes the circumstances of life that can be changed. With non-modifiable factors, a person is born and remains for life, it is impossible to influence or change them.

Modifiable factors include:

• an increase in blood cholesterol (hypercholesterolemia);
• increased blood pressure (hypertension);
• diabetes;
• smoking;
• low physical activity and obesity.

Non-modifiable risk factors for coronary artery disease are:

• male gender;
• age;
• burdened family history of cardiovascular diseases.

The concept of coronary heart disease combines a number of pathologies. These include:

1. 1. Angina.
2. 2. Myocardial infarction.
3. 3. Sudden cardiac death.
4. 4. Small focal cardiosclerosis.
5. 5. Large focal cardiosclerosis.
6. 6. Chronic aneurysm of the heart.

IHD is characterized by high mortality and a number of dangerous complications. The relevance of its prevention is undeniable.

Rheumatism of the heart: causes, treatment and prevention

Coronary artery disease (IHD) is a pathological condition, the characteristic feature of which is a discrepancy between myocardial oxygen demand and its delivery. This situation can occur when the lumen of the coronary vessels is narrowed by atherosclerotic plaques (which is the most common cause of coronary artery disease) or due to spasm of the coronary arteries (occurs less frequently).

3 Smoking cessation

One of the most important prevention goals is smoking cessation. Even a simple advice from the attending physician, a conversation helps the patient to stop using cigarettes. If necessary, the patient's close family and friends can be involved to provide support in quitting cigarettes.

In severe cases, when a person cannot cope with addiction on their own, nicotine replacement therapy can be used.

One of the most important prevention goals is smoking cessation. Even a simple advice from the attending physician, a conversation helps the patient to stop using cigarettes. If necessary, the patient's close family and friends can be involved to provide support in quitting cigarettes.

Myocarditis of the heart: signs of the disease, treatment and prevention

Fundamentals of a healthy diet for the prevention of coronary artery disease

Changes in the diet should be aimed at getting rid of excess body weight and the concentration of total plasma cholesterol.

Basic rules of preventive nutrition:

• consume no more than 2000 kcal per day;
• the presence of cholesterol in food should not exceed 300 mg per day;
• fats can provide no more than 30% of the energy value of food.

Strict adherence to the prescribed diet can reduce total blood cholesterol by 10-15%. To reduce the content of triglycerides in the blood, the introduction of more fatty fish or omega-3 polyunsaturated fatty acids into the diet in the form of food supplements at a dose of 1 g per day is suitable. Alcohol is limited to moderate doses - 50 ml per day of ethyl alcohol. In the presence of heart failure, arterial hypertension and diabetes - the rejection of alcohol is mandatory.

Obesity and overweight are associated with a high risk of death in patients with cardiovascular disease. Bringing to normal body weight in patients suffering from coronary artery disease, along with obesity and overweight, leads to a decrease in blood pressure, correction of lipid and glucose levels in the blood. Initially, it is recommended to follow a diet that has the following characteristics:

• reduction in consumption, and sometimes a complete rejection of easily digestible carbohydrates and sugar (carbohydrates should cover 50-60% of calories per day, vegetables and fruits are more suitable for this, not counting potatoes and fruits that contain a lot of glucose - bananas, apricots , sweet plums, pears, melons, raisins and grapes);

Diet therapy is carried out under the supervision of a doctor who takes into account medical indications and contraindications. The rate of weight loss of the patient should be no more than 0.5-1 kg per week. Drug therapy for obesity is used with a body mass index of at least 30, and if there is no effect from the diet, then pharmacotherapy is carried out in specialized hospitals.

The greatest difficulty in the correction of overweight is the preservation of the achieved result. Therefore, it is important to achieve high motivation in the pursuit of maintaining a normal weight throughout life after achieving a positive result. In every program that involves weight loss, physical activity remains the most important aspect.

Strict adherence to the prescribed diet can reduce total blood cholesterol by 10-15%. To reduce the content of triglycerides in the blood, the introduction of more fatty fish or omega-3 polyunsaturated fatty acids into the diet in the form of food supplements at a dose of 1 g per day is suitable. Alcohol is limited to moderate doses - 50 ml per day of ethyl alcohol. In the presence of heart failure, arterial hypertension and diabetes - the rejection of alcohol is mandatory.

• correspondence of food consumed and energy expended during the day;
• compliance with the limit of fat intake;
• self-restriction in the use of alcoholic beverages (alcohol is a high-calorie product and reflex increases appetite);
• reduction in consumption, and sometimes a complete rejection of easily digestible carbohydrates and sugar (carbohydrates should cover 50-60% of calories per day, vegetables and fruits are more suitable for this, not counting potatoes and fruits that contain a lot of glucose - bananas, apricots , sweet plums, pears, melons, raisins and grapes);
• restriction in the use of sweets, sugary drinks, hot spices and spices.

The general rules of eating behavior include eating 4-5 times a day: in addition to the three main meals, 2 additional ones are introduced. Be sure to have breakfast, between dinner and breakfast should not be more than ten hours. The last time you need to eat no later than two hours before falling asleep. Between meals should not be more than 3-4 hours.

Other measures to improve eating habits include:

• lack of fluid intake during meals. Water can and should be drunk half an hour before a meal and 30 minutes after a meal.
• food can be eaten not too cold and not too hot, warm
• do not eat if there is no appetite (does not apply to scheduled meals). Do not eat in company with family members or friends, chew popcorn out of habit at the cinema, etc.
• tracking the calorie content of an additional portion during snacks. It should be less than 10 kcal
• don't salt food automatically without tasting it
• avoiding fast food, you need to eat for a minimum of 15-20 minutes, chewing thoroughly
• refusal to visit fast foods, in the assortment of which most dishes contain fats, and far from the first frying
• don't buy food to take home when you're hungry
• when buying food, pay attention to the information on the label about the content of fats, carbohydrates, dietary fiber
• do not eat semi-finished products that may contain not only unknown fats, but also harmful additives
• try to avoid salting fresh vegetables, eggs, vegetable salads, boiled potatoes
• refusal to eat crackers, chips, all kinds of snacks, even salted peanuts
• restriction in the diet of canned meat and fish, because they contain a lot of salt
• gradually reduce the amount of salt in the diet
• cook so that the dishes have a minimum amount of fat. The following food processing methods are preferred: baking, poaching, boiling, microwave cooking, grilling

Breakfast should account for about 25% of the calories eaten per day, 15% for lunch, about 35% for lunch, only 10% for afternoon tea, and about 15% for dinner. This is due to certain physiological rhythms of the release of hormones and enzymes, levels of physical activity during the day and night. Calories received in the late evening and night hours are not completely processed by the body.

Daily calorie calculation

When compiling a diet, it is necessary to maintain a balance of energy when eating food and daily physical activity in order to maintain and maintain normal body weight (body mass index in the range of 18.5-24.9 kg/m2). To reduce body weight, the daily calorie requirement must be reduced, but not drastically.

The opinion of all experts on alcohol is unanimous: its use is not recommended if you want to eat healthy. In the case of its use, it is desirable to reduce the amount in terms of absolute alcohol to 30 g / day for men and 20 g for women. The choice should be stopped on dry red wines.

They say about the hypercaloric type of nutrition if the body weight of a person has increased in 3 months. This means that more calories were taken in than were expended. Therefore, even if the diet is balanced in terms of nutrient composition, their number should be reduced due to high-calorie foods and dishes. In order for body weight to begin to decrease with overweight and obesity, it is necessary to subtract 300-500 kcal from the number of daily calories calculated by the formula, adhere to such a daily caloric intake for a long time, but in no case resort to hunger strike or mono-diets. With fasting days, the daily calorie content should be at least 900-1000 kcal per 24 hours, and not zero, as many are mistaken!

The WHO CINDI program for the integral prevention of noncommunicable diseases formulated 12 principles of healthy nutrition. They include the intake of food, which is of plant origin. Food of animal origin is acceptable, but in smaller quantities. Several times a day you need to eat grain products, healthy bread (for example, whole grains), rice.

Also, according to the above recommendations, you need to control the consumption of fats, it is better to replace saturated fats with unsaturated vegetable oils. Instead of fatty meats (for example, pork), you can eat beans, beans, lentils, fish, chicken. With regard to dairy products, WHO's CINDY program for the integral prevention of noncommunicable diseases states to choose foods that are low in fat and salt.

Preference is given to products with a minimum amount of sugar, refined sugar should be avoided, while minimizing sugary drinks, cakes and other sweets. Choose low-salt foods Total salt intake should be no more than one teaspoon (6 g) per day, including salt found in bread and processed, cured, smoked, or canned foods. Food is best cooked with a steam method, you can use a microwave oven. Children need to be taught proper nutrition from an early age.

In primary and secondary prevention of coronary artery disease, the anti-atherogenic nature of nutrition is considered a priority. Every day you need to include in the diet the following foods:

• sea ​​fish
• 1-2 tbsp. tablespoons of vegetable oils
• legumes
• more than 400 g per day of vegetables, herbs and fruits
• soy and its products
• plant foods high in fiber, with pectin

Eating 40-50 g of sea fish at least 3-4 times a week reduces the risk of thrombosis, myocardial infarction and stroke. Water-soluble dietary fiber reduces the absorption of cholesterol in the intestine.

5 Physical activity

It is useful to compare the maximum heart rate calculated during exercise tests and during daily exercise. Patients who have had a myocardial infarction and are recovering motor activity especially need information about the dosage of physical activity. Specialized physical rehabilitation is safe and significantly improves the quality of life.

With angina pectoris, it is recommended to take nitroglycerin out of turn before the expected load. This often helps to avoid a pain attack.

Exercise has a positive effect on carbohydrate and lipid metabolism, so dosed physical activity is especially necessary for people with overweight, obesity and diabetes.

All patients diagnosed with coronary heart disease, after consultation with their doctor, can walk daily at an average pace for 30-40 minutes.

Causes

The causes of cardiac ischemia are also divided into two types, these are causes that can be eliminated and which cannot.

Removable causes include:

• improper nutrition. Getting rid of bad eating habits, such as overeating, eating a lot of fat, fried and salty foods, and so on, can save you from developing a pathological condition;
• endocrine diseases, especially diabetes mellitus (insufficient amount or complete absence of insulin in the body);
• regular increase in blood pressure;
• stress;
• smoking.

Unrecoverable causes include:

• age. The older the person, the more likely they are to develop coronary heart disease;
• gender, often pathology is diagnosed in males;
• genetic predisposition.

If you engage in the prevention of preventable causes, adhere to all medical recommendations, you can reduce the risk of ischemia to a minimum.

To save life, all causes are eliminated.

Diet

Diet occupies a leading place in the prevention and control of coronary artery disease. It is aimed at optimizing the intake of nutrients that have a positive effect on overall metabolism (metabolism). The intake of simple carbohydrates, animal fats, salt is rationally excluded. With excess body weight, the calorie content of the diet decreases.

Experts, regarding the daily diet, give the following recommendations:

1. It is necessary to limit as much as possible (but it is not recommended to exclude) the use of animal fats (lard, fatty meat, butter).
2. Avoid fried foods.
3. Limit the use of confectionery.
4. Increase the content of minimally processed cereals in the diet (does not apply to people with gluten intolerance (celiac disease)).
5. Provide the bulk of the diet with fruits, vegetables and other fresh plant foods.
6. Be sure to have omega-3 fatty acids (sea fish, fish oil). It is recommended to eat sea fish or other seafood three times a week.

So, eating a hot dog, pizza, and two plates of salted borscht in a day, a person consumes about 15 g of salt. Recently, the World Health Organization (WHO) adopted a limit of up to 5 g of salt per day, recognizing that in today's society it is impossible to consume less. Think about whether you should always add salt to food?

Risk factors for coronary artery disease

Probable risk factors for coronary heart disease are divided into two groups: those that can be changed and those that cannot be modified. The second group includes:

• age
• family history of the disease

Dyslipidemia is modifiable. These are deviations from the norm in the lipid profile of the blood. This group also includes low physical activity, smoking cigarettes and cigars, arterial hypertension, overweight and obesity, a disease such as diabetes mellitus.

As for age: the older a person is, the stronger atherosclerotic changes are expressed in his body, which leads to a high incidence of coronary artery disease. Before the age of 55, the incidence of coronary artery disease in men is higher than in women. After 55 years, there is an almost equal number of men and women with this diagnosis.

Family history. The risk of developing coronary heart disease is higher in those whose relatives have the same diagnosis. Especially if the degree of relationship is the first: brothers and sisters, mom and dad, sons and daughters. The risk of being diagnosed with coronary artery disease is high if relatives have this disease at a relatively young age.

Smoking speeds up the heartbeat, increases the activity of the sympathoadrenal system. Because of it, local vasospasms occur, the likelihood of arrhythmias increases, etc. In smokers with experience, atherosclerosis of the coronary arteries is strongly pronounced, especially in comparison with non-smokers.

High blood pressure greatly increases the risk of developing coronary artery disease. Also an exciting factor is the high pulse pressure in older people.

Low physical activity leads to deviations in metabolism. Body weight increases, abdominal obesity occurs, which is reflected in an increase in blood pressure. It should be noted that life expectancy is generally longer in physically active people. And obese people have a high chance of getting some kind of heart disease.

The risk of cardiovascular diseases increases by 10% with an increase in human weight by 5-10%. Obesity increases the relative risk of type 2 diabetes by 2 to 8 times.

Metabolic syndrome and diabetes

With the so-called metabolic syndrome, the amount of visceral fat increases, hyperinsulinemia develops, fat and carbohydrate metabolism is disturbed, etc. The metabolic syndrome is a risk factor for developing coronary artery disease, stroke, and myocardial infarction. Tissue sensitivity to insulin is influenced by factors such as improper eating, old age, extra pounds, smoking, drinking alcohol, fasting, mono-diets, etc. Early detection of the metabolic syndrome is important.

unhealthy diet

An increased risk of coronary artery disease occurs if a person eats foods that are high in saturated fats, simple sugars, while eating foods with a high glycemic index. The Eskimos of Greenland, according to studies, rarely develop heart disease, which is associated with their diet. The Eskimos consume a small amount of salt (compared to the inhabitants of Europe and the CIS countries), eat mainly fish and the meat of sea animals. Arterial hypertension and obesity are atypical for them.

In the CIS countries, the calorie content of the diet of many people exceeds the norm, they consume a lot of sweets. Deficiency in the diet of vegetables also affects atherogenesis. This should be taken into account when drawing up measures for the prevention of coronary heart disease.

According to studies, this includes an increased content of lipoprotein, C-reactive protein, homocysteine. With a deficiency of estrogen in women, atherosclerosis and coronary artery disease occur. Before menopause, they have a higher blood level of HDL cholesterol than men of the same age. During the postmenopausal period, the protective effect of estrogens decreases, which increases the risk of coronary heart disease.

The assessment of risk factors includes recording and measuring their levels. Timely detection of arterial hypertension is important. Even asymptomatic hypertension poses a danger to humans. The fact of smoking is recorded when smoking at least one cigarette per day. Only those who have not smoked a single cigarette in a year are considered non-smokers.

This criterion has been adopted by WHO. Why exactly in a year? Since the risk of developing CVD is statistically significantly reduced only 12 months after the complete cessation of smoking. The degree to which cigarettes affect the body depends on how much a person smokes per day. The degree of tobacco dependence is determined by the Fagerstrom test.

Assessment of physical activity. The doctor, with the help of a conversation, finds out the patient's attitude to physical activity, both at home and as physical education or sports. According to standards, such as the European recommendations for the prevention of CVD, which were adopted in 2008, physical activity should be at least 30-40 minutes every day, at least 4 times a week.

Assessment of excess body weight. To assess body weight, doctors are guided by the body mass index - the ratio of body weight (kg) to height (m2). The norm is an index in the range of 18.5-24.9. Excess body weight is fixed at an indicator of 25-30, and obesity - at 30 or more. Visceral obesity is also assessed: it is fixed at a waist circumference of more than 102 cm in men and more than 88 cm in women.

Assessment of actual nutrition. Nutrition is assessed in different ways. The 24-hour method makes it possible to evaluate the patient's nutrition over the past day. All food eaten is coded in conventional units. With the help of tables and programs, information is obtained on the daily intake of energy, proteins, fats, carbohydrates, dietary fiber, vitamins and mineral elements.

The frequency method of assessment provides information on a person's nutrition for the last 3 months prior to the survey. Among the simpler methods: the calculation of the pyramid of healthy eating and the express method of assessing nutrition. For the last named, a standard questionnaire is used. The advantage of the method is that the results can be obtained in a very short time.

Food diary. When using this method, the person himself daily writes down the number and names of foods and dishes eaten. The time of meals is also indicated, and sometimes the reasons for eating. After the patient's nutrition is assessed, it can be adjusted or a new daily diet can be made, taking into account such factors:

• body mass index
• age
• food preferences.

Assessment of the total risk of coronary heart disease. With the help of special epidemiological studies over several years, it is possible to calculate how often or less often coronary heart disease occurs in a cohort of people with any risk factor, relative to a cohort of people without an analyzed risk factor. For example, smokers and non-smokers. This indicator is called relative risk.

In order to prioritize interventions for primary and secondary prevention of coronary artery disease, it is important to assess the overall risk. If several factors are combined, it can multiply significantly. Therefore, experts have created riskometers, dividing patients into high-risk, medium and moderate risk groups.

In recent years, a new European model of risk metrics has been proposed, developed under the 5COKE project. This model calculates the probability of fatal cardiovascular events in the next 10 years in individuals without coronary artery disease. This model of riskometry is recommended by the VNOK. Parameters that are taken into account when calculating the risk:

• age
• smoking
• blood cholesterol level
• systolic blood pressure

Risk factors are predisposing causes that increase the likelihood of a disease or its exacerbation. Risk factors for coronary heart disease are divided into two groups. One of them includes inevitable causes that cannot be eliminated. Risk factors for coronary heart disease include:

• age, people over 40 are more susceptible to heart disease;
• gender, the risk group includes mainly men;
• heredity, the disease in most cases is inherited.

The second group includes factors that can be regulated:

• smoking;
• excess of cholesterol in the blood;
• excessive alcohol consumption;
• obesity;
• sedentary lifestyle;
• high blood pressure.

To reduce the risk of developing the disease, it is necessary, if possible, to reduce or completely eliminate the factors that make up the second group. This will significantly reduce the possibility of getting ischemia.

Risk factors for coronary artery disease are divided into two groups: those that can be changed and those that are not. The second group includes gender, age, family history of the disease.

1. The older a person becomes, the brighter the manifestation of atherosclerotic changes, which leads to an increased incidence of coronary artery disease. Before the age of 55, men are more likely to suffer from this pathology. After this age, the number of men and women who fell ill with it levels off.
2. The risk of coronary artery disease in those whose relatives had a similar diagnosis is much higher. This is especially true of the first degree of kinship: parents - children. The risk increases if the disease occurs in relatives at a young age.

The first group of factors contributing to the development of coronary artery disease includes changes in the lipid profile of the blood, low physical activity, smoking, arterial hypertension, diabetes mellitus, overweight.

• Smoking speeds up the heartbeat, activates the sympathetic-adrenal system. It causes the occurrence of local vasospasms, increases the likelihood of arrhythmias, etc. Smokers with experience experience atherosclerosis of the coronary arteries.
• High blood pressure greatly increases the risk of developing the disease. A factor that is important to pay attention to is increased pulse pressure in the elderly.
• Deviations in metabolism are caused by insufficient physical activity. Weight increases, abdominal obesity appears, which causes an increase in pressure. It is important to note that life expectancy is longer in people who live actively. Cardiac pathologies "love" obese people. An increase in body weight by 5-10% increases the risk of diseases of the cardiovascular system by 10%. Obesity up to 8 times increases the risk of developing type 2 diabetes.
• The risk of developing coronary artery disease is associated with eating foods that are saturated with fats, sugars, with a preference for foods that have a high glycemic index.
• Non-traditional factors include excessive levels of lipoprotein, homocysteine, C-reactive protein. Atherosclerosis and coronary artery disease occur in women in case of estrogen deficiency.

Diagnostics

Diagnosis consists of a number of laboratory and instrumental methods of examination

Diagnosis of coronary artery disease is carried out using special instrumental techniques. When talking with the patient, complaints and the presence of symptoms characteristic of such a disease are revealed. An analysis of the history of life involves the identification of risk factors for the development of coronary artery disease, and the presence of such a heart disease in one of the relatives is also found out.

During a medical examination, wheezing and heart murmurs are detected in the lungs, blood pressure is measured, and signs of hypertrophy are diagnosed.

To detect cardiac ischemia, the following diagnostic studies are prescribed:

• a general blood test helps to identify signs of an inflammatory process in the human body
• general urinalysis allows diagnosing an increased concentration of protein, erythrocytes, leukocytes and identify pathologies that may be a complication of cardiac ischemia
• analysis of specific enzymes is performed in acute coronary syndrome and suspected myocardial infarction

What other diagnostic methods can detect the disease:

1. coagulogram
2. echocardiography
3. electrocardiography
4. chest x-ray
5. stress - echocardiography
6. coronary angiography

Doppler ultrasound of peripheral vessels makes it possible to diagnose atherosclerotic changes in the vessels of the lower extremities, neck, kidneys and head. With pronounced changes in such vessels, one can suspect the same transformations in the heart vessels.

stressful situations

Stress is one of the strongest factors today that cause diseases. Stress ulcers, diabetes mellitus, hypertension and other diseases are caused by a simple daily reaction to annoying or oppressive circumstances.

First of all, you need to learn to control your emotions and reactions to the environment, even if it does not live up to expectations. It is appropriate to mention the types of temperament - choleric people will have the hardest time, but, in the end, the person decides for himself whether to be nervous or explain the situation to himself in a different way.

Stressful situations need to be brought under control. They are always there, but it is important to learn how to respond to them correctly. You can’t let stress take over you, otherwise the chances of getting sick become very high.

In any situation, you need to look for something good, positive. Even if you get sick, start recovering, at the same time, read books in parallel, develop yourself, and spend time with benefit.

Particularly susceptible to it are people who perform work with increased responsibility (medical workers, operators of the railway and aviation transport sectors), residents of megacities and large cities.

If the causative factors continue to act, a disease will form - chronic fatigue syndrome - damage to the regulatory zones of the central nervous system, depletion of nerve mediators, which is manifested by a mental disorder (depression, apathy, neurosis, aggression, etc.).

To protect yourself and your loved ones, read the causes of IHD.

In this state, the body is most susceptible to stress, and the harm from it is great, since the body's resistance is reduced. It is necessary to get rid of this pathogenic background.

When a person does not plan anything, he often encounters such problems:

• unforeseen situations requiring hasty decision-making that require unreasonably large efforts;
• at the last moment you have to finish something with emotional stress;
• constant tension in trying to keep everything in your head;
• late for meetings, delays at work;
• criticism from colleagues, friends, relatives.

All this entails regular experiences, turning into chronic stress.

It is important to be able to make a plan for anything. It can be of various duration (for a year, month, week, etc.), but it should always have priority. Clearly defined priorities are the key to confident performance.

keep your posture

Posture means much more than a person used to believe. Violation of posture leads to a change in blood flow in the vertebral arteries and vessels of the brain, overstrain of certain muscle groups.

This impoverishes the flow of oxygen, which provokes a bad mood, inattention, forgetfulness, and headaches. After all, it turns out a vicious circle!

Among other situations, when a person does not follow his posture, people slouch due to negative emotions. The worse a person's mood is, the less he thinks about his posture - he becomes even more hunched and downcast.

You need to straighten your head, shoulders and keep your posture in any mood. You should understand how serious the consequences can be, and control your posture.

Gymnastics

Regular dosed physical activity has many positive effects on the human body:

• reduction of excess body weight;
• normalization of insulin sensitivity;
• normalization of lipid metabolism;
• reduction of psychological and physical stress, adaptation to stress;
• normalization of vascular tone and blood pressure.

1. Take three deep breaths.
2. Rub the ears intensively (horizontally, then vertically).
3. Make a grin expression, intensively make chewing movements of large amplitude several times, without hitting your teeth against each other.
4. Rub the cheeks and wings of the nose.
5. Massage the back of the head, run your hands several times along the eyebrows outwards.
6. Massage your face with both palms.
7. Put your palms together, raise them to face height, grasp the fingertips of the other with the fingers of one hand, then vice versa.
8. Fold your palms at chest level, spread your fingers, press the palms and fingers of opposite hands towards each other, while springing your fingers.
9. Raise your hands at face level, palms facing you, bending your fingers alternately, starting with the thumb of your right hand, unbend in the reverse order.
10. Massage each finger individually.

Other exercise programs should take into account the age of the person and the presence of comorbidities.

The desire for revenge breeds chronic stress. When they say that the person we hate has power over us, they are right. He owns our thoughts, we think about him.

You need to take it calmer, you should not take revenge - nothing good usually comes out of this. You need to understand that it became possible to see a person in a certain situation, and he showed himself. It’s good that in this situation, and not when a lot depended on him.

You need to be able to forgive, and everyone will get what they deserve. If you cannot forgive your enemies, at least love yourself. Everyone responsible for his life, and the one who spends it on hatred - too.

Religion also speaks of this. People are so arranged that they quickly forget all the good things, and one misconduct can block all the positive things that a person has done.

This is what hits health the most, or rather, first on its mental component, and then on the physical one. Each person lives his own life, and if he is not limited, then full.

Everyone can help himself, and everything depends on him. “There is nothing worse than goodness that was not asked for” is an expression that, unfortunately, is often true.

Kindness is a voluntary act. If this is so, then the person experiences joy, which should be enjoyed. This is gratitude, and the rest are related attributes.

A person spends about 20 years of his life in a dream. Everyone needs an individual amount of sleep. When a person has insomnia, he begins to worry, suppressing sleep even more.

If this is a psychological reason, for example, debts, taxes, you need to pay them off as soon as possible. When the body calms down, sleep will appear. Experts recommend going to bed before the onset of fatigue and getting up in the morning, and not, for example, in the afternoon.

The question of the financial situation is not inferior to the previous ones in terms of its role in the formation of chronic psychological exhaustion and a decrease in stress resistance.

You should be smart about spending on pleasure. Everyone wants to relax, get more out of life, but debts, including loans, do not make anyone happier. You need to learn to treat money carefully and responsibly and teach this to your children.

Under a lying stone ... you know. Look for a variety of options for earning and part-time work. This is good even if you do not earn very much at first - there will be less time for worries.

In the end, if even with all the efforts made it is not possible to improve the material condition, it is better to regret your health and stop worrying and poisoning yourself from the inside. You need to be on the alert, but there will be an option - just do not miss it.

Doctors believe that alcohol and coronary heart disease should not be combined. Therefore, several times think about taking at least a portion of alcoholic beverages if you have been diagnosed with this.

The heart is not in vain compared to the engine of the human body. And if this engine malfunctions, it can disable the entire body. The heart, as a mechanism, is characterized by high reliability, however, it can also be susceptible to various diseases. The most dangerous of them is ischemic disease. What are the manifestations of this disease, and what does it threaten a person with?

Description of the disease

Everyone knows that the purpose of the heart muscle (myocardium) is to supply the body with oxygenated blood. However, the heart itself needs blood circulation. The arteries that deliver oxygen to the heart are called coronary arteries. There are two such arteries in total, they depart from the aorta. Inside the heart, they branch into many smaller ones.

However, the heart does not just need oxygen, it needs a lot of oxygen, much more than other organs. This situation is explained simply - because the heart works constantly and with a huge load. And if a person may not particularly feel the manifestations of a lack of oxygen in other organs, then a lack of oxygen in the heart muscle immediately leads to negative consequences.

Circulatory failure in the heart can occur for only one reason - if the coronary arteries pass little blood. This condition is called coronary heart disease (CHD).

In the vast majority of cases, the narrowing of the vessels of the heart occurs due to the fact that they are clogged. Vasospasm, increased blood viscosity and a tendency to form blood clots also play a role. However, the main cause of CAD is atherosclerosis of the coronary vessels.

Atherosclerosis used to be considered a disease of the elderly. However, this is far from the case now. Now atherosclerosis of the heart vessels can also manifest itself in middle-aged people, mainly in men. With this disease, the vessels are clogged with deposits of fatty acids, forming the so-called atherosclerotic plaques. They are located on the walls of blood vessels and, narrowing their lumen, impede blood flow. If this situation occurs in the coronary arteries, then the result is an insufficient supply of oxygen to the heart muscle. Heart disease can develop imperceptibly for many years, not particularly manifesting itself, and without causing much concern to a person, except in some cases. However, when the lumen of the most important arteries of the heart is 70% blocked, the symptoms become apparent. And if this figure reaches 90%, then this situation begins to threaten life.

Varieties of coronary heart disease

In clinical practice, several types of coronary heart disease are distinguished. In most cases, coronary artery disease manifests itself in the form of angina pectoris. Angina pectoris is an external manifestation of coronary heart disease, accompanied by severe pain in the chest. However, there is also a painless form of angina pectoris. With it, the only manifestation is fatigue and shortness of breath even after minor physical exercises (walking / climbing stairs several floors).

If attacks of pain appear during physical exertion, then this indicates the development of angina pectoris. However, in some people with coronary artery disease, chest pains appear spontaneously, without any connection with physical activity.

Also, the nature of changes in angina symptoms may indicate whether coronary disease develops or not. If the coronary artery disease does not progress, then this condition is called stable angina. A person with stable angina, with proper behavior and appropriate supportive care, can live for several decades.

It is quite another thing when angina pectoris becomes more and more severe over time, and the pain is caused by less and less physical activity. Such angina is called unstable. This condition is a reason to sound the alarm, because unstable angina inevitably ends in myocardial infarction, and even death.

In a certain group, vasospastic angina or Prinzmetal's angina are also distinguished. This angina is caused by spasm of the coronary arteries of the heart. Often spastic angina occurs in patients suffering from atherosclerosis of the coronary vessels. However, this kind of angina may not be combined with such a sign.

Depending on the severity, angina pectoris is divided into functional classes.

Signs of coronary heart disease

Many people do not pay attention to the signs of coronary heart disease, although they are quite obvious. For example, it is fatigue, shortness of breath, after physical activity, pain and tingling in the heart area. Some patients believe that “it should be so, because I am no longer young / not young.” However, this is an erroneous point of view. Angina pectoris and shortness of breath on exertion are not normal. This is evidence of a serious heart disease and a reason to take action as soon as possible and see a doctor.

In addition, IHD can also manifest itself with other unpleasant symptoms, such as arrhythmias, dizziness attacks, nausea, and fatigue. Heartburn and abdominal cramps may occur.

Pain in ischemic heart disease

The cause of pain is irritation of the nerve receptors of the heart by toxins formed in the heart muscle as a result of its hypoxia.

Pain in coronary heart disease is usually concentrated in the region of the heart. As mentioned above, pain in most cases occurs during physical exertion, severe stress. If pain in the heart begins at rest, then with physical exertion, they usually increase.

Pain is usually observed in the retrosternal region. It can radiate to the left shoulder blade, shoulder, neck. The intensity of pain is individual for each patient. The duration of the attack is also individual and ranges from half a minute to 10 minutes. Taking nitroglycerin usually helps relieve pain.

In men, pain in the abdomen is often observed, which is why angina pectoris can be mistaken for some kind of gastrointestinal disease. Also, pain in angina pectoris most often occurs in the morning.

Causes of coronary artery disease

Coronary heart disease is often considered inevitable for people who have reached a certain age. Indeed, the highest frequency of diseases is observed in people over 50 years of age. However, not all people fall ill with coronary artery disease at the same time, for some it occurs earlier, for some later, and someone lives to an advanced age without encountering this problem. Therefore, the development of IHD is influenced by many factors. And in fact, there is no single cause of coronary heart disease. Many factors have an impact:

• bad habits (smoking, alcoholism);
• overweight, obesity;
• insufficient physical activity;
• wrong diet;
• genetic predisposition;
• some concomitant diseases, for example, diabetes mellitus, hypertension.

All of these causes may play a role, but the immediate precursor to coronary atherosclerosis is an imbalance in the various types of cholesterol in the blood and an extremely high concentration of so-called bad cholesterol (or low-density lipoprotein). When the value of this concentration is above a certain limit, a person with a high degree of probability develops atherosclerosis of the vessels, and as a result, coronary heart disease. That is why it is important to monitor blood cholesterol levels. This is especially true for people who are overweight, hypertensive, sedentary and have bad habits, as well as those who among their relatives had many deaths from cardiovascular diseases.

A certain negative factor is the male gender. Statistics show that coronary heart disease is much more common in men than in women. This is due to the fact that women in the body produce female hormones that protect blood vessels and prevent the deposition of cholesterol in them. However, after the onset of the female menopause, the amount of estrogens produced by the female body falls, and therefore the number of women suffering from coronary artery disease rises sharply, almost comparing with the number of men suffering from this disease.

Separately, one should dwell on such a prerequisite for the disease as an improper diet. As you know, the highest percentage of the incidence of coronary artery disease - in developed countries. Experts mainly attribute this fact to the fact that in the countries of Europe and America, people consume more animal fats, as well as simple, easily digestible carbohydrates. And this, together with a sedentary lifestyle, leads to obesity, to an excess of cholesterol in the blood.

Doctors knowingly warn about foods containing bad cholesterol. These products include fatty meats, butter, cheese, eggs, caviar. The amount of these products in the diet of each person should be limited, they should not be consumed every day, or in small quantities. Although, on the other hand, only a small proportion of harmful cholesterol enters the body from the outside, and the rest is produced in the liver. So the significance of this factor should not be exaggerated, not to mention the fact that bad cholesterol can be called very conditionally, since it takes part in many metabolic processes.

Why is IBS dangerous?

Many people suffering from coronary artery disease get used to their illness and do not perceive it as a threat. But this is a frivolous approach, because the disease is extremely dangerous and without proper treatment can lead to serious consequences.

The most insidious complication of coronary heart disease is what doctors call sudden coronary death. In other words, this is a cardiac arrest caused by electrical instability of the myocardium, which, in turn, develops against the background of coronary artery disease. Very often, sudden coronary death occurs in patients with a latent form of coronary artery disease. In such patients, symptoms are often either absent or not taken seriously.

Another way of developing coronary heart disease is myocardial infarction. With this disease, the blood supply to a certain area of ​​\u200b\u200bthe heart deteriorates so much that its necrosis occurs. The muscle tissue of the affected area of ​​the heart dies, and scar tissue appears in its place. This happens, of course, only if the heart attack does not lead to death.

Heart attack and coronary artery disease in itself can lead to another complication, namely, to chronic heart failure. This is the name of a condition in which the heart does not adequately perform its functions of pumping blood. And this, in turn, leads to diseases of other organs and violations of their work.

How is IHD manifested?

Above, we indicated what symptoms accompany coronary heart disease. Here we will address the question of how to determine whether a person has atherosclerotic changes in the vessels in the early stages, even at a time when obvious evidence of coronary artery disease is not always observed. In addition, such a symptom as pain in the heart is not always indicative of coronary heart disease. Often it is caused by other causes, for example, diseases associated with the nervous system, spine, and various infections.

Examination of a patient complaining of negative phenomena typical of coronary heart disease begins with listening to his heart sounds. Sometimes the disease is accompanied by noises typical of IHD. However, often this method fails to detect any pathology.

The most common method of instrumental study of the activity of the heart is a cardiogram. With its help, you can track the spread of nerve signals through the heart muscle and how its sections are reduced. Very often, the presence of coronary artery disease is reflected in the form of changes on the ECG. However, this is not always the case, especially in the early stages of the disease. Therefore, a cardiogram with a stress test is much more informative. It is carried out in such a way that during the removal of the cardiogram, the patient is engaged in some kind of physical exercise. In this state, all pathological abnormalities in the work of the heart muscle become visible. Indeed, during physical exertion, the heart muscle begins to lack oxygen, and it begins to work intermittently.

Sometimes the method of daily Holter monitoring is used. With it, the cardiogram is taken over a long period of time, usually within a day. This allows you to notice individual deviations in the work of the heart, which may not be present on a conventional cardiogram. Holter monitoring is carried out using a special portable cardiograph, which a person constantly carries in a special bag. At the same time, the doctor attaches electrodes to the human chest, exactly the same as with a conventional cardiogram.

Also very informative is the echocardiogram method - ultrasound of the heart muscle. With the help of an echocardiogram, the doctor can assess the performance of the heart muscle, the size of its departments, and blood flow parameters.

In addition, informative in the diagnosis of coronary artery disease are:

• general blood analysis,
• blood chemistry,
• blood glucose test,
• blood pressure measurement,
• selective coronography with contrast agent,
• CT scan,
• radiography.

Many of these methods make it possible to identify not only the ischemic heart disease itself, but also its concomitant diseases that aggravate the course of the disease, such as diabetes mellitus, hypertension, blood and kidney diseases.

IHD treatment

Treatment of IHD is a long and complex process, in which sometimes the leading role is played not so much by the skill and knowledge of the attending physician, but by the desire of the patient himself to cope with the disease. At the same time, it is necessary to be prepared for the fact that a complete cure for IHD is usually impossible, since the processes in the vessels of the heart are in most cases irreversible. However, modern methods make it possible to extend the life of a person suffering from a disease for many decades and prevent his premature death. And not just to prolong life, but to make it full, not much different from the life of healthy people.

Treatment in the first stage of the disease usually includes only conservative methods. They are divided into drug and non-drug. Currently, in medicine, the most modern is the treatment regimen for the disease, called A-B-C. It includes three main components:

• antiplatelet agents and anticoagulants,
• beta blockers,
• statins.

What are these drug classes for? Antiplatelet agents prevent platelet aggregation, thereby reducing the likelihood of intravascular thrombus formation. The most effective antiplatelet agent with the largest evidence base is acetylsalicylic acid. This is the same Aspirin that our grandparents used to treat colds and flu. However, conventional Aspirin tablets as a regular medication are not suitable in case of coronary heart disease. The thing is that taking acetylsalicylic acid carries the risk of stomach irritation, peptic ulcer and intragastric bleeding. Therefore, acetylsalicylic acid tablets for cores are usually covered with a special enteric coating. Or acetylsalicylic acid is mixed with other components that prevent its contact with the gastric mucosa, as, for example, in Cardiomagnyl.

Anticoagulants also prevent the formation of blood clots, but have a very different mechanism of action than antiplatelet agents. The most common drug of this type is heparin.

Beta-blockers prevent the action of adrenaline on special receptors located in the heart - adrenaline receptors of the beta type. As a result, the patient's heart rate decreases, the load on the heart muscle, and as a result, its need for oxygen. Examples of modern beta-blockers are metoprolol, propranolol. However, this type of drug is not always prescribed for IHD, as it has a number of contraindications, for example, some types of arrhythmias, bradycardia, hypotension.

The third class of first-line drugs for the treatment of coronary artery disease are drugs to lower bad cholesterol in the blood (statins). Atorvastatin is the most effective statin. For six months of therapy with this drug, atherosclerotic plaques in patients are reduced by an average of 12%. However, other types of statins, such as lovastatin, simvastatin, and rosuvastatin, may be prescribed by your doctor.

Fibrate class drugs are also designed to reduce bad glycerol. However, the mechanism of their action is not direct, but indirect - thanks to them, the ability of high-density lipoproteins to process “bad” cholesterol increases. Both types of drugs - fibrates and statins can be prescribed together.

Also, with IHD, other drugs can be used:

• antihypertensive drugs (if coronary heart disease is accompanied by hypertension),
• diuretics (with poor kidney function),
• hypoglycemic drugs (with concomitant diabetes mellitus),
• metabolic agents (improving metabolic processes in the heart, for example, mildronate),
• sedatives and tranquilizers (to reduce the amount of stress and relieve anxiety).

However, nitrates are the most commonly used type of medication, taken right at the time of the angina attack itself. They have a pronounced vasodilating effect, help relieve pain and prevent such a formidable consequence of coronary artery disease as myocardial infarction. The most famous drug of this type, used since the last century, is nitroglycerin. However, it is worth remembering that nitroglycerin and other nitrates are symptomatic drugs for a single dose. Their continuous use does not improve the prognosis of coronary heart disease.

The second group of non-drug methods of dealing with coronary artery disease is physical exercise. Of course, during the period of exacerbation of the disease, with unstable angina, any serious exercise is prohibited, since they can be fatal. However, during the rehabilitation period, patients are shown therapeutic exercises and various physical exercises, as prescribed by the doctor. Such a dosed load trains the heart, makes it more resistant to lack of oxygen, and also helps to control body weight.

In the event that the use of medications and other types of conservative therapy do not lead to improvement, then more radical methods are used, including surgical ones. The most modern method of treating coronary heart disease is balloon angioplasty, often combined with subsequent stenting. The essence of this method is that a miniature balloon is inserted into the lumen of the narrowed vessel, which is then inflated with air and then blown off. As a result, the lumen of the vessel expands significantly. However, after some time, the lumen may narrow again. To prevent this from happening from the inside, the walls of the artery are strengthened with a special frame. This operation is called stenting.

However, in some cases angioplasty is powerless to help the patient. Then the only way out is the operation of coronary artery bypass grafting. The essence of the operation is to bypass the affected area of ​​the vessel and connect two segments of the artery in which atherosclerosis is not observed. For this purpose, a small piece of a vein is taken from the patient from another part of the body and transplanted in place of the damaged part of the artery. Thanks to this operation, the blood gets the opportunity to get to the necessary parts of the heart muscle.

Prevention

It is well known that it is always more difficult to be treated than to avoid the disease. This is especially true for such a severe and sometimes incurable disease as coronary artery disease. Millions of people around the world and in our country suffer from this heart disease. But in most cases, it is not an unfavorable combination of circumstances, hereditary or external factors that is to blame for the occurrence of the disease, but the person himself, his wrong lifestyle and behavior.

Recall once again the factors that often lead to early incidence of coronary artery disease:

• sedentary lifestyle;
• a diet high in bad cholesterol and simple carbohydrates;
• constant stress and fatigue;
• uncontrolled hypertension and;
• alcoholism;
• smoking.

To change something on this list, making it so that this problem would go out of our lives and we would not have to be treated for coronary artery disease, is within the power of most of us.