Coronary artery disease – Atherosclerosis of the coronary arteries

Description of coronary heart disease

The coronary arteries carry oxygen-rich blood to the heart muscle. Coronary artery disease (CHD) It leads to blockage of the arteries. If the lock It is complete, may be damaged portions of the heart muscle. In severe cases, the heart muscle dies. This can lead to a heart attack, also known as myocardial infarction (THEIR).

Coronary heart disease is the most common form of heart disease. It is the leading cause of death worldwide.

Causes of ischemic heart disease

Causes include:

• Thickening of the walls of the arteries, supplying the heart muscle;
• Accumulation of fatty plaques in the coronary arteries;
• A sudden spasm of the coronary arteries;
• Narrowing of the coronary arteries;
• The inflammation in the coronary arteries;
• The development of blood clots in the coronary arteries, that blocks blood flow.

Risk factors for coronary heart disease

Factors, which increase the risk of coronary heart disease:

• Paul: male (Men have a higher risk of heart attack, than women);
• Age: 45 and older men, 55 years and older women;
• Heredity: family history of heart disease;
• Obesity and overweight;
• Smoking;
• High blood pressure;
• A sedentary lifestyle can also increase the risk of coronary heart disease and premature death;
• High cholesterol (in particular, High LDL cholesterol, and low levels of HDL cholesterol);
• Diabetes;
• Metabolic syndrome (the combination of high blood pressure, obesity and insulin resistance).

Other risk factors include:

• Stress;
• Excessive alcohol consumption;
• Depression;
• A diet high in saturated fat, trans fats, cholesterol and / or high-calorie foods. Constant consumption of carbonated sugary drinks can increase the risk of coronary heart disease.

Coronary artery disease – symptoms

Most coronary artery disease may progress without any symptoms.

Angina – Sometimes there is pain in the chest – One of the first signs of coronary artery disease. Pain in the shoulder can give (and), hand (and), or jaw. Angina usually lasts for about 2-10 minutes. She often goes away after a short rest. Angina may cause:

• Physical activity or strenuous activity;
• Emotional stress;
• Cold weather;
• Large meal.

Chest pain may indicate a serious unstable angina or a heart attack symptoms, if there:

• Pain, that does not go after a rest or nitroglycerin;
• Severe angina;
• Angina, which begins at rest (No Activity);
• Angina, that lasts more than 15 minutes.

Accompanying symptoms may include:

• Breathlessness;
• Sweating;
• Nausea;
• Weakness.

In unstable angina needs immediate medical care. CAD in women may develop without chest pain, and only cause shortness of breath and fatigue.

Diagnosis of coronary heart disease

If you go to the emergency room with chest pain, Some tests will be done at once. They will determine the presence of angina or a heart attack. If there is a stable angina, They can be assigned to other tests, to determine the severity of the disease.

The doctor will ask about your symptoms and medical history. Examine physically.

Tests may include:

• Blood tests, to find specific substance in the blood (troponynы), that help the doctor determine whether a heart attack;
• Electrocardiogram – records heart activity by measuring electrical current through the heart muscle, and can detect the presence of past heart attacks, acute heart attacks, as well as problems of heart rate;
• Echocardiogram – It uses high-frequency sound waves (ultrasound), to examine the size, the shape and motion of the heart, It gives information about the structure and function of the heart;
• Stress test – recording of the electrical activity of the heart during increased physical activity;
• A nuclear stress test – heart is observed when administered radioactive materials into the blood stream, that helps to find problem areas;
• Coronary calcium score – type of X-ray tomography, which uses computer, to find the calcium deposits in the arteries of the heart;
• Coronary angiography – It carried out an x-ray of blood vessels after injection of contrast dye into the arteries. It allows the doctor to find abnormalities in the arteries.

Treatment of coronary heart disease

Treatment may include:

Nitroglycerin

This drug is usually taken during an attack of angina pectoris. It may be provided in the form of capsules, which dissolve under the tongue or as a spray. Dosage forms with prolonged action type (tablets, patch or ointment) They may be used, to prevent angina before vigorous activity.

Blood-thinning drugs

A small daily dose of aspirin, It has been shown, reduces the risk of heart attack. Talk to your doctor, before taking aspirin daily.

Other blood-thinning medicines include:

• Warfarin;
• Ticlopidine;
• Clopidogrel;
• Prasugrel.

Beta Blockers, calcium channel blockers and ACE inhibitors

Supplementation may help prevent angina. In some cases, they may reduce the risk of heart attack.

Drugs to lower cholesterol

Drugs, such as statins, often prescribed to people, that patients with CHD. Statynы (eg, atorvastatin) lower cholesterol, that can help prevent coronary heart disease attack.

Revaskulyarizatsiya

Patients with severe blockages in the coronary arteries is recommended to undergo the procedure, which will quickly improve the blood flow to the heart muscle:

• Percutaneous coronary intervention (CHKV), eg, ballonnaя angioplasty. In some cases, the set Stent, to keep the artery open;
• Coronary artery bypass grafting (AKS) – selected segments of the vessels in other areas of the body and sewn into the arteries of the heart, to redirect blood flow around clogged arteries.

Some studies have shown, that CABG may be more effective, than PCI. Lifestyle changes and intensive care may also be just as effective, as a PCI.

Options for treatment of refractory angina

Patient, who underwent revascularization, but after a while angina reappeared, despite medication, There are the following options for treatment:

• Enhanced external counterpulsation (UNCP) – with air cushions are inflated around the legs in time with the heartbeat. The patient receives 5 hour treatments per week for seven weeks. As shown, procedure reduces the symptoms of angina;
• Transmyocardial revascularization (TMR) – surgery using a laser to reduce chest pain.

Researchers are also studying the possibility of gene therapy as a possible treatment option CHD.

Prevention of coronary heart disease

To reduce the risk of coronary artery disease:

• Maintain a healthy weight;
• Eat foods low in saturated fat, red meat and meat products, as well as increase the number of products in the diet of whole grains, fruits and vegetables;
• Do the exercises in accordance with the doctor's recommendations;
• Quit smoking;
• Treat high blood pressure and / or diabetes;
• Take drugs to lower cholesterol or triglycerides;
• Ask your doctor about receiving low-dose aspirin every day;
• For some patients, it is recommended to take rosuvastatin. We need to ask your doctor about it.