Coronary heart disease is a pathology of the heart, which is based on myocardial damage due to insufficient blood supply due to atherosclerosis and thrombosis or spasm of the coronary arteries of the heart usually occurring against it. Coronary heart disease is one of the most common diseases and one of the main causes of death, as well as temporary and permanent disability of the population in the developed countries of the world.
IHD classification
The concept of "coronary heart disease" is a group. It combines both acute and chronic pathological conditions. Currently, Russia uses the classification of coronary heart disease according to clinical forms, each of which has its own significance due to the characteristics of clinical manifestations, prognosis and treatment tactics, recommended in 1979 by a group of WHO experts.
Sudden coronary death (primary cardiac arrest)
sudden coronary death with successful resuscitation;
sudden coronary death (death).
Angina pectoris
stable angina pectoris (indicating the functional class);
Laboratory diagnostics (lipid spectrum) - determination of cholesterol level;
ECG;
Echocardiography (ultrasound examination of the heart);
USDG (vascular diagnostic method) - allows you to evaluate the development of atherosclerotic plaques;
Halter - daily recording of a cardiogram (you can evaluate the work of the heart with expired loads);
Stress tests;
Final consultation with a cardiologist;
Risk factors for the development of coronary heart disease:
elderly age;
male gender;
hereditary factors;
poor nutrition;
high cholesterol;
arterial hypertension;
diabetes;
overweight;
physical inactivity;
smoking;
alcohol consumption;
stressful situations.
Pathogenesis of IHD
According to modern concepts, IHD is based on myocardial damage due to its insufficient blood supply. The imbalance between the real blood supply to the myocardium and its needs for blood supply can occur due to the following circumstances:
Causes inside the vessel:
atherosclerotic narrowing of the lumen of the coronary arteries;
thrombosis and thromboembolism of coronary arteries;
coronary artery spasm.
Causes outside the vessel:
tachycardia;
myocardial hypertrophy;
arterial hypertension.
Under the influence of a number of risk factors, atherosclerotic plaque formation occurs. At first, the lumen of the vessel does not change significantly. As lipids accumulate in the plaque, ruptures of its fibrous cover occur, which is accompanied by the deposition of platelets and fibrin, which contribute to local narrowing of the vessel. Along with lipidofibrotic plaques, almost exclusively fibrotic stenosing plaques are formed that undergo calcification.
As each plaque develops and increases, the number of plaques increases, so does the degree of stenosis of the lumen of the coronary arteries, which largely (although not necessarily) determines the severity of the clinical manifestations and the course of IHD. Narrowing the lumen of the artery to 50% is often asymptomatic. Typically, clear clinical manifestations of the disease occur when the lumen is narrowed by 70% or more. The closer the stenosis is located to the beginning of the vessel, the greater the mass of the myocardium undergoes ischemia in accordance with the zone of blood supply. The most severe manifestations of myocardial ischemia are observed with stenosis of the main trunk or the mouth of the left coronary artery.
Coronary heart disease treatment
Therapy in our clinic is based on:
the use of medicines;
lifestyle changes and elimination (if possible) of risk factors.
Prevention of Coronary Heart Disease
The general goal of preventing coronary heart disease, both for patients with its clinical manifestations or other atherosclerotic diseases, and for people with a high risk of morbidity, is the same: to reduce the risk of developing the main forms of coronary artery disease or other forms of atherosclerotic diseases, thereby reducing the rates of premature disability, mortality; increase survival. These recommendations set the goals of not only lifestyle changes, but also control of blood pressure, blood lipids and diabetes by the methods of secondary and primary prevention of coronary diseases.
