Coronary artery disease (CHD) is the leading cause of death worldwide. According to experts, in 2030 more than 23 million people will die from CVD.
Coronary artery disease (CHD) is a disease caused by insufficient supply of oxygen and nutrients to the heart (myocardium), which occurs due to a violation of the blood supply to the myocardium due to damage to the coronary arteries. Clinical manifestations of Coronary artery disease are varied: from acute manifestations in the form of myocardial infarction or sudden cardiac death to long-term chronic diseases – angina pectoris (recurrent chest pain), postinfarction cardiosclerosis, chronic heart failure.
Causes of Coronary artery disease
Coronary artery disease occurs as a result of atherosclerosis of large (epicardial) coronary (cardiac) arteries of varying degrees: from a slight narrowing of the lumen in a vessel to its complete obstruction by atheromal (cholesterol, fat) masses or a thrombus that developed at the site of a “vulnerable (damaged) atherosclerotic plaque Other causes of coronary artery disease are spasm of the coronary arteries and damage to the microvasculature in the myocardium. In most cases, they also develop against the background of existing atherosclerosis.
It is possible to identify the most susceptible to the development of Coronary artery disease population groups, people suffering from high blood pressure, dependent on tobacco smoking, suffering from high cholesterol levels, diabetes mellitus, with chronic kidney disease. Male gender and old age are also powerful risk factors for the development of coronary artery disease.
Symptoms of coronary artery disease
The main, but far from the only symptom of coronary artery disease is pressing or constricting pain in the chest or in the region of the heart. In chronic coronary artery disease, pain occurs initially during physical activity and causes a gradual decrease in its tolerance. In the acute form of ischemic heart disease, myocardial infarction or pre-infarction condition (unstable angina pectoris) develops. During an attack, the patient may also feel:
- pain or burning in the chest, under the shoulder blade, in the back, in the upper abdomen;
- a feeling of heaviness in the chest;
- feeling of uneven heartbeat, abnormal heart function, palpitations;
- feeling of sinking heart;
- shortness of breath;
- dizziness and fainting;
The malaise may disappear or disappear completely after the end of physical activity. With myocardial infarction or unstable angina pectoris, the connection between complaints and physical activity is lost, and complaints can develop at rest and last for a long time (tens of minutes, hours). Usually, all of the above symptoms do not appear at the same time. With various forms of the disease, some definite feeling of discomfort dominates.
If you notice such sensations in yourself, contact your cardiologist as soon as possible. If chest pain or other symptoms described above do not disappear within 10 minutes at rest, call an ambulance. The progression of coronary artery disease can develop slowly, over the years. Moreover, in some patients, the disease is asymptomatic or with erased or atypical symptoms. In order to prevent disturbances in the work of the heart or the development of severe forms of the disease, undergo a comprehensive examination of the heart in heart care center. A neglected disease is very dangerous! In a late stage, it can lead to a fatal heart attack or severe heart failure with severe disability.
Diagnosis of Coronary artery disease
Diagnosis of Coronary artery disease is carried out by cardiologists in several stages. When a patient is interviewed, complaints are clarified, symptoms that may be characteristic of the disease are specified. Examination of the patient helps to note visual changes – puffiness and altered skin color (cyanosis), listening to the heart reveals murmurs, rhythm disturbances. Further, the patient undergoes laboratory tests for certain indicators in the blood, which may indicate a pathology. Standard biochemical analysis is also important, as well as the determination of glucose and cholesterol levels. But the most accurate diagnostic method is instrumental:
- Ultrasound of the heart;
- stress tests with exercise or cardiac pacing;
- Holter ECG monitoring;
- angiography of the coronary arteries (coronary angiography).
Timely examination helps to avoid serious consequences and the development of irreversible pathology. Take a few hours for your health, because this time will help preserve the quality of life in the future.
Prevention of Coronary artery disease
It is much easier to prevent the onset of the disease than to cure it. To maintain healthy arteries and blood vessels, it is necessary to eliminate risk factors that negatively affect your health:
- To give up smoking;
- Blood pressure monitoring
- Normalization of the level of “bad” cholesterol (low density lipoproteins)
- Coping with stress and depression
- Minimizing alcohol consumption;
- Avoiding smoked, fatty, fried and salty foods.
Spend more time on an active lifestyle: moderate physical activity, remedial gymnastics, exercise in the morning, walking, swimming, dancing. Physical activity will help strengthen the walls of blood vessels and maintain normal weight, if necessary, reduce it.
The most important thing in prevention is timely observation by a specialist.
How to treat coronary artery disease
When coronary artery disease is detected, the cardiologist determines the treatment model. A clinic can offer you:
- drug therapy – a complex of modern medicines is prescribed, which allows you to take control of symptoms and significantly improve the prognosis of the disease. The main drugs for the treatment of coronary artery disease are: antiplatelet agents (reduce the likelihood of blood clots in the coronary arteries), B-blockers, nitrates, calcium antagonists, enzyme inhibitors / angiotensin II receptor blockers (prevent the development of pain, shortness of breath, edema and statins (allow to reduce and control cholesterol). When drug therapy does not help, they seek advice from a cardiac surgeon who will apply the following treatment methods:
- surgical intervention aimed at myocardial revascularization (restoration of normal blood flow to the heart muscle):
- stenting of the affected arteries of the heart – intravascular surgery. Under local anesthesia, a catheter is inserted through the radial (on the forearm) or, less often, through the femoral (groin) artery, through which a special device is passed into the arteries of the heart. A special metal frame structure coated with drugs that suppress inflammation at the site of intervention is installed in the place of the narrowing of the vessel with the help of a balloon. The balloon expands, as a result of which the stent presses the cholesterol plaque against the walls of the vessel and restores its patency;
- coronary artery bypass grafting is an open heart surgery, the purpose of which is to restore a full blood supply. It is carried out by bypassing the site of narrowing of the vessel using shunts (vascular prostheses), which redirect the blood flow from clogged parts of the arteries to healthy ones. The patient’s own arteries and veins are most often used as coronary bypass grafts. At the same time, arterial shunts have a significant advantage in terms of a long-term improvement in prognosis and relief from pain as a result of surgery. In our department of cardiac surgery, the operation is performed both with the use of a heart-lung machine and without (off pump).