Cheering shape of heart attack. Brave form of myocardial infarction

Date: 03.03.2020

We are accustomed to the fact that if we do not hurt, it means everything is in order. However, it is so dangerous to think, since there are states that are not reflected in the overall condition of the patient, while the launch of pathological processes inside the body. The diseases of myocardial ischemia belong to such diseases.

Features of the disease

Brave ischemia myocardium (BBIM) is a temporary violation of blood supply, metabolism and electrical activity of the heart, which is not accompanied by specific symptoms like pain or shortness.

The International Classification of Diseases (ICD-10) assigns non-Bulk Ischemia of Ischemia myocardial code I25.6.

BIM can flow as an independent disease or combined with others. Statistical data show that the elderly men of male are most often ill.

Classification of solemary myocardial ischemia

Barely Ischemia is made to divide the COHN classification from 1993 to several types:

First. It appears in people with stenosis installed coronary survey, however, provided that they did not suffer in the last attacks of angina, violations of heart rhythms and stagnant heart failure.
Second. Diagnosed in people who have underwent myocardial infarction, however, not suffering from the attacks of angina.
The third. Manifests itself in patients with angina.

If you simplify, then the second and third type includes patients whose history is present.

Causes of occurrence

The most common cause of nonsense ischemia is an atherosclerotic vessel damage. Atherosclerotic plaques abnormally narrowing the vessel, thereby disturbing the blood supply of the heart muscle. Ischemia can also appear against the background of spasm of coronary vessels, changing the activity of coronary arteries. Spasm most often also occurs due to atherosclerosis of the arteries.

Doctors distinguish several risk factors, which, together, can lead to atherosclerosis and spasm, and in the future and to bezbolic ischemia. To those can be attributed:

diabetes;
high cholesterol content in blood;
frequent emotional shocks;
obesity;
passive lifestyle;
elderly age;

Hereditary predisposition also has a great influence. So, it has been proven that if there are cases of basic ischemia in a family history, the risk of getting raised to 60%.

About symptoms that are characteristic of solemn myocardial ischemia, read below.

Symptoms

The peculiarity of nonsense ischemia is that the patient feels satisfactory. Holy symptomatics is completely absent, so patient up to the development of complications may not be aware of its problem.

Often the disease is accompanied by general symptoms, for example, rapid fatigue, weakness and dizziness, which many patients do not attach attention. About how diagnosis and treatment with solemn myocardial ischemia, read further.

Diagnostics

Often ischemia is revealed by chance, since it does not bother the patient. However, if the patient came with suspicion of nonsense ischemia, then the diagnostic events start with the collection of the history of complaints, life and family. These data help assume ischemia and identify risk factors. Further, the doctor conducts a physical inspection, which reveals noises in the heart, wheezing in lungs and other indicative signs.

Further diagnosis is laboratory and hardware studies designed to confirm the diagnosis. Such can be considered:

Common en-z blood and urine, helping to analyze the general condition of the patient.
Biohim. An-s blood helps to identify the risk factors of ischemia in the patient.
ECG showing left ventricular hypertrophy.
EchoCG, evaluating the structurality and size of the heart, degree of lesion, allowing to study blood flows inside the heart,
Monitoring ECG on a holter showing BIM episodic.

If necessary, other studies can be carried out, for example, ChPEX, drug samples, radioisotope samples and MSCTs, which are carried out only in the presence of specific equipment.

More details about the diagnosis of hidden myocardial ischemia will tell a specialist in the video below:

Treatment

The treatment of asymptomatic myocardium ischemia is based on a combination of therapeutic and drug techniques. It is advisable to carry out therapeutic measures in a hospital, as this will help track the patient's condition.

Therapeutic

In the first pairs, the therapeutic method is to limit any stress: physical and emotional. At the same time, the patient can be done by therapeutic physical education, which will only improve its condition. In any case, you first need to discuss this moment with the attending staff.

During the whole treatment, you must adhere to the right nutrition. So, you need to exclude salty and fat, limit fluid consumption up to 1.2 liters, lean on vegetables and fruits. In the same period, it is necessary finally.

Medicate

Medical therapy is aimed at the overall improvement of the patient's well-being and the restoration of normal blood flow. For this, prescribe drugs like:

antiagregants that reduce blood consumption;
beta adrenoblockers expanding vessels;
calcium antagonists inhibiting calcium penetration into the muscle;
hypocholesterolemic drugs that reduce cholesterol levels;
aCE inhibitors that reduce blood pressure;

Other drugs, such as nitrates for relieving pain symptoms, diuretics for removing the load on the heart or antiarrhythmic for the normalization of heart rhythms can also be applied.

Operation

Since BBE is often found in late dates, drug therapy is not always successful, so surgical intervention is often required. The basic types of operation refers:

Coronary angioplasty, implying the installation of a metal stent into a narrowed vessel. The stent helps to expand the vessel and keep it in good condition.
Aorticoronary artery shunting, during which the surgeon creates a vascular course, according to which blood is delivered to the affected area.

Other operations can also be applied: from balloon angioplasty to heart transplantation.

Prevention of the disease

Preventive measures are aimed at eliminating threatening factors and are concluded in:

Full failure of smoking.
Regulation of consumption of alcoholic beverages. For a day, it is impossible to use more than 30 grams of alcohol.
Exclusion of psycho-emotional stress. If they can not be avoided, you need to take sedatives.
Support normal body weight. You can find out the optimal index with a calculator from the network, or by sharing your own weight in kg to growth in meters, erected into a square. The index should vary within 20-25.
Compliance with normal physical activity. Phys. Loads must be daily and constant, take at least 20 minutes a day. Separately, it is advisable to deal with dynamic cardiovasculations.
Compliance with the rules where the consumption of fatty, fried and canned products will be reduced. For normal operation of the heart, there is more fiber, vegetables and fruits, low-fat meat and fish.
Control cholesterol, blood sugar and insulin.

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University. HM Berbekova, Faculty of Medicine (KBSU)

Education Level - Specialist

Additional education:

"Cardiology"

GOU "Institute of Improvement of Doctors" Ministry of Health and Social Development of Chuvashia

Many people with serious and rapidly developing pathologies are not suspected of them due to the lack of special symptoms. These deviations are the most dangerous, since due to the lack of severe discomfort of the patient and does not think about the appointment of diagnosis and treatment. Often the outcome with such diseases is very sad.

One of these aids includes solemnly myocardial ischemia. This form of the pathology of the cardiovascular system is very common. She meets in people without any other violations in the work of the heart. And the solemn myocardial ischemia in most cases is not detected, the patient does not observe any discomfort, it is painless. It is possible to detect it with the help of special diagnostic methods or in late development stages.

This disease is expressed in violation in the work of the heart muscle. Cutting reductions of the heart muscle, the exchange of nutrients, its reduction is violated. These violations are not accompanied by pain symptoms. But they can be diagnosed with echocardiography. The disease can manifest itself both independently, and together with other ailments of the cardiovascular system.

Forms

There are several forms of such ailment as solemn ischemia myocardium. They differ in the severity. 1 The type of disease occurs in people who in the past did not have any heart problems. They did not meet with:

Angina. This disease is distinguished by pronounced symptoms. Patients complain of a sharp, pressing pain in the heart and chest. Pain may be in the neck, upper limbs, jaw, etc.
Myocardial infarction. The main cause of myocardial infarction is the insufficient blood supply to the muscles of the heart. This leads to the mass death of its cells.
Heart failure. Reduced the number of abbreviations of the heart muscle. This significantly limits the supply of blood, oxygen and nutrients of organs. Patients complain about pain in the field of chest, weakness, inoperability, fast fatigue, frequent dizziness.

2 The type of this disease occurs in those people who survived myocardial infarction. But patients do not suffer from sharp pains, which are observed during angina.

Finally, 3 Type of nonsense ischemia can be found among patients with myocardial infarction and regular progressive attacks of angina.

People with 2 and 3 types of this illness suffer from a complex of cardiovascular diseases. They differ in serious symptoms and health hazards.

The reasons

There are many reasons for the occurrence of BBE. The main of them is atherosclerosis. It is expressed in a strong destruction of vessels. They decrease in diameter to anomalous sizes. This greatly prevents the normal blood supply to myocardium. The narrowing of the vessels is caused by the formation of malignant plaques. The main reason for their education can be called a large content of such a substance such as cholesterol, in the blood.

The main prerequisites for the rapid development of the IBS include:

Spasm of vessels.
Incorrect meals
The presence of bad habits.
Excess weight.
A low-effective lifestyle.
The overaffect of sugar and cholesterol in the blood.
Stress.
Hypertension, etc.

The degree of gravity and the rate of development of the CHA may depend on:

Genes. This disease is often transmitted from close relatives by inheritance.
Cholesterol level in the blood. A large percentage of low-density lipoprotein organism in most cases leads to the formation of plaques. They significantly slow down blood circulation and providing oxygen, vitamins and minerals as the very heart muscle and organs. This reduces the level of "useful" lipoprotein, which performs a number of important functions. He accelerates the metabolism, improves their assimilation, etc.
Frequent use of tobacco. Tobacco use in absolutely any form negatively affects the state of the cardiovascular system as a whole.
Character features of the patient. Excessive flareness, aggressiveness, emotionality and the desire for permanent rivalry can be one of the reasons for the development of the CHA.
Floor. Men suffer from this disease several times more often than women.
Age. On average and older age increases the risk of this ailment.

Significantly affecting the course and development of IHDs may be characteristic of each patient features for the perception of pain. Many patients do not perceive pain even at the most recent stages of the disease. Many factors can affect pain perception: from physiological features to the conditions of education.

Experts allocate the phenomenon of negation. The patient, fearing to accept the fact of the presence of a disease, tries to deny him in every way. Many people with ischemic disease do not recognize this diagnosis, do not begin to treat the illness. Against this background, pain and the degree of their perception are reduced. The danger lies in the fact that the development of the IBS does not stop. The history of the patient's disease can endally ended due to the lack of timely intervention of specialists.

Symptoms

Cheerful ischemia, as mentioned above, is distinguished by the absence of pain in the patient. But there are some less obvious symptoms that allow you to determine the presence of this disease. These include:

Dyspnea.
Dizziness.
Fatigue.
Weakness.
Disability.

Patients rarely pay special attention to these symptoms. They write them down on excessive load, chronic fatigue, etc.

Diagnostics

This disease is found in most cases purely randomly. In suspects of the presence of a patient, cheerful ischemia conducts a number of procedures aimed at diagnosing the disease.

First, the specialist holds consultation with the patient. Complaints are studied, the history of illness. The doctor asks a patient a number of questions about his lifestyle, the number of physical exertion in everyday life, manifestations of pain in the chest and heart pain, the presence of fatigue and weakness, level of sugar and cholesterol in the blood, etc. All information obtained is used for the primary diagnosis of the disease.

After the initial examination of the patient is produced. The doctor conducts a number of standard procedures: determining the presence of wrees in the lungs, reduction rate of the heart muscle, level of blood pressure, etc.

The most common diagnostic method is blood test. It is used to determine many different diseases. A general blood test identifies the presence and development of inflammatory processes in the body, determines the presence of diseases and ailments that can lead to the emergence of myocardial ischemia. The biochemical blood test determines the level of sugar, cholesterol, insulin in the blood.

To date, there are many innovative diagnostic methods. One of these includes electrocardiography. The main object of research using this apparatus is the left ventricle of the heart. Its general condition and the main distinguishing features of ischemia are studied.

Ehoche studies the overall condition of the heart, vessels, heart muscle. The speed of contraction of myocardium is investigated.

Multipurope monitoring relates to very effective diagnostic methods. It uses a portable device that registers the health of the patient when exposed to many different factors. Recording is carried out at least within a day.

To determine this disease, various types of samples are used. One of them - with exercise. For a certain time, the patient performs certain exercise. It is followed by a special ECG apparatus. In the presence of ischemia, characteristic changes arise on the cardiogram.

The medicinal samples are ideal for those persons who, according to health and other reasons, cannot do physical exercises. The patient uses medicines that increase the number of abbreviations of the heart muscle. The degree of circulatory disorders in the body is checked.

In addition to the cardiologist, therapist may also carry out treatment. But in most cases it only consults and prescribes medication.

Treatment

There are several methods for the treatment of this disease. Their choice is caused by the severity of the aless. In the early stages of ischemia used therapeutic treatment.

The patient must limit itself from emotional and physical stress. Any overvoltage can adversely affect the health and heart.

A specialist is appointed therapeutic physical culture. Its regular execution allows you to improve the patient's well-being, to increase the elasticity of the blood vessels, to accelerate to the optimal indicators of myocardial reduction and so on.

Finally, an excellent measure in the fight against ischemia is a diet. Proper balanced nutrition reduces cholesterol and blood sugar levels, which prevents the formation of plaques in the vessels, which disturb the blood circulation and the supply of myocardium and oxygen organs. It is necessary to completely exclude from the diet are strongly salted or fried dishes, semi-finished products, sweet and flour, fast food. Special attention in the preparation of the diet should be given to fruit, vegetables, beans, croups. It is worth consulating no more than one and a half liters of fluid during the day.

It is worth abandoning smoking and other bad habits.

The second method of treatment - drug. It is appointed to stop the development of the disease and to improve the health of the patient.

There are many varieties of medicines. These include:

Antiagregants. They significantly reduce blood ability to coagulation.
Beta adrenoblockers. They contribute to the expansion of damaged vessels and improving the supply of blood organs.
Calcium antagonists. These drugs are aimed at preventing the penetration of this element into muscle mass.
Hypocholesterolemic drugs. They prevent the formation of plaques in the vessels, reducing the level of cholesterol in the blood.
Preparations aimed at reducing blood pressure.

And the last method of treatment - stationary. It is used with mocardium ischemia launched. Under the conditions of the hospital, in addition to drug treatment, an operation can be made.

There are many types of operations that allow you to completely eliminate the disease or save the patient from its symptoms. One of the most common operations is the installation of the stent. It is made of special metal alloys and is installed in the affected vessel. This stand helps to expand the walls of the vessels and improves blood supply.

And the second rather popular operation is artificially creating a vascular bed. It allows you to continuously supply the heart muscle or organ blood, oxygen and nutrients.

There are many ways of anesthesia during operations - from local anesthesia to general anesthesia. It all depends on the duration of the patient's operation and health.

The operation is selected strictly taking into account the health status of the patient and the severity of the disease. Operations can be both minor and global. There are no cases when the myocardium transplantation was made under myocardium ischemia.

Bearing ischemia in hearty myocardium, as the pathology of the heart, denoted by Abbrevia BIM, for the first time, opened a cardiologist Wood in 1957, discovering in part of patients when determining deviations on ECG, the absence of pain symptoms.

Hello, dear blog readers Site!

Over the past month, there have been several articles on the blog on the current theme of heart disease and vessels.

We are talking about the reasons, symptoms, treatment and prevention of cholesterol plaques in the vessels. Also about such serious problems as the complete blockade of the left leg of the Gis beam and acute heart failure. Information is useful for everyone.

Today we are talking about hearty ischemia heart muscle, which is a serious threat not only to health, but also premature death.

As the diagnostic medical equipment improves, the prevalence of heart muscle diseases in the absence of external manifestations is only increasing.

Who is this article?

The topic of the disease is of interest absolutely for all people. Cheering variety of ischemia in myocardium is a type, a form of heart disease (IBS), the cause of which is a disruption of the delivery of oxygen in the heart tissue in the blood vessels.

Of course, the state of the vessels varies with age, but atherosclerosis, unfortunately, may occur in children. The work of the heart during atherosclerosis of heart (coronary) vessels is worsening.

Periodically, temporary violations of a state that do not require treatment, changes in electrical activity, which are difficult to determine without special instrument for diagnosis.

After 55 years of age, ischemia, which is not accompanied by painful syndrome in the chest, is found already at each 8 person. In patients with different shapes of angina, the prevalence of a dumb ischemia in old age according to the results of the study is 60 - 80%.

On average, non-smoking adults robes asymptomatic ischemia is 42%, and smokers - 63.

Causes of solemn myocardial ischemia

The causes of the formation of solemn myocardial ischemia are common to all forms of heart disease, among leading provocateurs BBIM:

* Pathology of heart vessels;
* atherosclerosis;
* Thrombosis.

The main causes of silence of heart ischemia in humans are primarily associated with the inability of coronary vessels to provide myocardial cells with oxygen in the desired quantity. Among the provoking factors causing the appearance of symptoms of stupid ischemia myocardium, such reasons:

* smoking;
* physical overload;
* emotional stress;
* Hodge action.

Medicine has not yet answered the question of why the same causes and contributing to the development of factors are caused in one case the pain of IBS in one case, and in the other - non-barred ischemia.

The differences between the flow of these forms of heart disease according to ECG data is not detected. Multiple theories explaining the phenomenon.

Theory №1.

The pain in the heart occurs when the pain threshold is overcome, corresponding to the irritation of the paint muscle of the heart muscle of a certain intensity and continuing for more than 3 minutes.

If pain receptors are irritated by signals of weak intensity or pain syndrome lasts less than 3 minutes, then the painful alarm is transmitted to the brain.

The objection of this theory is cases of severe pain in the heart, shortness of breath with changes to the ECG, lasting less than 3 minutes and with the most minor deviations on the ECG.

Theory №2.

The cause is the violation of the operation of sensitive nerve fibers, which occurred as a result of the myocardial infarction or nerve damage in diabetes.

Of course, diabetic neuropathy is a direct indication to visit the cardiologist and go through the BIM diagnostic procedure using ECG or HALTERA monitoring.

However, not all of all suffering from this disease, BIM is found on the ECG.

Theory number 3.

The cause of the formation of hidden ischemia can serve as the damage to the nerves of the sympathetic nervous system, ensuring the activity and sensitivity of myocardium.

Indeed, with BIM cardiomycetes - special excitable muscle cells of the heart, reduce sensitivity to the adenosine substance. This substance has the ability to annoy pain receptors, which is why pain occurs.

Many adenosine stands out at the time of bouts of ischemia. And, if the sensitivity to the adenosine is not lost, then the person feels an attack of the pain.

And since with BBIM sensitivity to adenosine is lost, there is no pain during ischemic attack. The danger is that not feeling pain, a person does not reduce physical activity, does not take medicine and does not cause ambulance.

In the objection of this theory, it was found that some patients alternate the attacks of different forms of ischemia.

Symptoms of solemn myocardial ischemia

The absence of symptoms of myocardial ischemia is a very dangerous phenomenon, because without treatment, BIM, BEM will progress. The man in this case does not know about his myocardial pathology, does not undergo a diagnosis, assuming that he doesn't need everything well with health and treat him.

Since there are no direct symptoms of the non-Bulk Form of the IBS, pay attention to indirect signs and determine the main risk group on asymptomatic mute ischemia, struck the heart muscle.

An indirect sign indicating the possibility of ischemia is the narrowing of coronary arteries by 70% caused by atherosclerosis.

Clinical signs are manifested during exercise. This means that it is necessary to pay attention to changes in well-being during this period of time.

The indirect signs of episodes of transient (temporary) BIM will serve as changes that occur in well-being under the action of the same load. For example, in such a situation.

3 months ago, man easily climbed the stairs without cargo on the 4th floor. Today, he cannot repeat this climbing with the same ease, although he did not gain excess weight and feels well.

In such a situation, you should not write off the deterioration of physical activity for age. Perhaps a person should listen to his feelings. Signs of heart disease serve:

* Rhythm interruptions;
* stronger than the usual accelerated heartbeat;
* low blood pressure;
* Blue or patch of lip and nasolabial triangle;
* Dyspnea.

On the electrocardiogram, cardiac pathology can manifest itself frequent surges of extrasystole - extraordinary, chaotic myocardial cuts.

Diagnosis of solemn myocardial ischemia

The basis of the diagnostic study of BIM and identifying symptoms of nonsense ischemia myocardium is the ECG. This diagnostic method reveals sometimes in people who do not complain on pain in the heart, signs of oxygen starvation of myocardial cells.

Another important method of diagnosis is a study of coronary vessels. Almost all of all suffering from insanity forms of ischemia, the diagnosis detects atherosclerosis, narrowing or other pathologies of coronary arteries of myocardium.

The picture of the disturbances of the coronary blood circulation as a whole is similar to the signs of the lesion of myocardium during angina.

To prescribe treatment from the nonsense form of myocardial ischemia, a thorough diagnosis is carried out. Diagnostic methods include research:

* ECG;
* coronary perfusion;
* study of myocardial metabolism;
* ECG monitoring 2 days;
* cardioprobes;
* Ultrasound of the heart.

The probability of BIM increases if the ECG data detects changes in the ST segment.

To clarify the causes of changes and definitions of the IBS form, the patient is prescribed:

* analyzes - blood biochemistry and urine;
* Echo-kg with load tests;
* CT Hearts with contrast.

Treatment of solemn myocardial ischemia

According to the results of the diagnosis of myocardium to the patient, and even in the absence of heart symptoms, prescribe drugs for intro drugs or surgical treatment of Ischemia BBE.

In the list of drugs for temporary disorders in the heart muscle caused by BBE:

* Cardiomagnet, aspirin cardio;
* Lovastatin from the Statin Group;
* Fenofibrate;
* ENAP from spasm arteries;
* Bisoprolol for better power of the heart;
* Amiadroon for rhythm normalization;
* diuretic - Laziks, Veroshpiriron.

With serious violations of the heart activity, to achieve improved human condition at a given disease, resort to surgical intervention. Upon mute, interference ischemia ischemia are the same as with other types of IBS.

According to the results of research, the patient is carried out operations:

* balloon angioplasty;
* stenting;
* Aorticoronary artery shunting.

Surgical intervention serves as the main method of treatment with significant damage to the arteries, and the postoperative reception of drugs - the prevention of the progression of the disease and the appearance of complications.

Meals for solemn myocardial ischemia

A feature of patients with basal forms of ischemia in myocardium BBE and the diagnosis of other types of IBS are the symptoms of the lack of B6.

Bran bread, seafood, garlic, prunes, Bulgarian pepper, pistachios, dates must be in the diet of people with signs of heart disease.

To load with cholesterol and plaques deposition, you need control of oily food in daily nutrition. Fat meat should be replaced with seafood.

They have an iodine that is necessary to produce thyroxine and split fat. Tyroxin is the most important hormone of the thyroid gland, from the level of which depends the metabolism of a person.

It should be reduced by the use of salt, smoked, fried products. Incorrect nutrition, low or, on the contrary, increased physical activity acquire the nature of the main affixing factors that increase the risk of sudden death.

Complications of solemn myocardial ischemia

Burel cases of ischemia in myocardial tissues in 5% of cases are also found in healthy, not knowing about the presence of symptoms BBE on EGC diagnosis. A similar phenomenon is explained by the prevalence of atherosclerosis and caused by the poor condition of the arteries.

The prognostically unfavorable serious complications of the ischemic mute shape of the heart disease serve:

* Transformation into a pain of IBS;
* resistant arrhythmia;
* Myocardial necrosis;
* heart failure.

The main consequence and complication of the non-declared and untreated hidden ischemia is a myocardial infarction or sudden death.

According to statistical medical data, the risk suddenly die from myocardial infarction with a dumb ischemia increases 6 times, the risk of arrhythmia increases by 2 times compared to persons not suffering from BIM.

Prevention of solemn myocardial ischemia. Physical exercises for solemn myocardial ischemia

To measures of prevention of BIM, preventing manifestations of symptoms of nonsense ischemia in myocardial tissues:

* Timely treatment;
* change lifestyle;
* power optimization;
* control of temporal violations of blood pressure;
* systematic control over weight;
* full-fledged rest;
* Dosage physical activity.

The physical exertion in the ischemic forms of heart disease is aimed at improving blood circulation in the heart muscle. However, with pronounced atherosclerosis of the coronary arteries, excessive loads pose a threat to life.

To allow such overloads for the heart is impossible. And it is necessary to eliminate the symptoms of myocardial hypoxia, it is necessary to include performing breathing exercises in the exercise complex.

Patients with solemary ischemia myocardium should carry out the physical exercises of the same group as with IHD. Before class, you must measure the pulse.

During the execution of the exercise complex, you must necessarily control the speed of heartbeat. With any load, the increase in the pulse should not be\u003e 10% of the worker.

Another important condition is the pauses between the exercises throughout the time of physical training.

Stock Footage, I hope, dear friends will help you learn more about this issue.

Perhaps some should visit the Doctors and pass the survey to prevent the development of a hidden form of heart ischemia flowing almost asymptomatic.

Health to everyone!

Myocardial ischemia is the basis of coronary heart disease and is accompanied by a significant deterioration in blood circulation and the development of hypoxia in the tissues of the heart muscle. Such a state can provoke the occurrence of angina. Myocardial infarction and even the onset of sudden coronary death.

According to statistics, the ischemic heart disease is observed by almost 50% of the elderly men and 1/3 of women. In 30% of cases, it leads to the death of the patient. It is usually accompanied by the appearance of sores for the sternum, but about 20-40% of patients proceeds in a nonsense (or dumb transient) form.

With the heartless form of the ischemia of the heart muscle during the examination of patients, already pronounced atherosclerosis of coronary vessels, manifested in their narrowing by 50-70% or more. These changes are capable of long time not to manifest itself and are found randomly only when conducting an ECG or other heart surveys.

In this article, we will introduce you with the reasons, manifestations, methods of diagnosis and treatment of solemn myocardial ischemia. This information will help you understand the essence of such a pathological condition and the need for its timely detection to start effective treatment.

Myocardine Ischemia Ischemia often takes place in elderly people suffering from arterial hypertension

Experts allocate two main forms of solemn myocardial ischemia:

full-haired form of ischemia - pain never arise;
cheering form of ischemia with episodes of pain - pain arise episodically.

Such a course of ischemia can be observed both in people who have previously never transferred the attacks of angina and in individuals who have already undergone myocardial infarction or suffering from variant, unstable or stable angina. More often, solebral ischemia of the heart muscle is observed at the second category of patients.

When conducting an ECG or ECG on a holder in preventive purposes or during a survey about another disease, frequent extrasystoles may be detected in such patients.

Cheering ischemia can manifest itself a variety of features, and experts allocate four main options for the flow of this state.

The course of heartless heart muscle ischemia is observed most often. In patients, it flows on the background of angina and is detected at about 20-40% of patients. In this case, almost 75% of the angina attacks are not accompanied by pain syndrome, and the remaining 25% are expressed in cardiagia. characteristic of this disease.

II option

Patients do not feel the presence of ischemia of the heart muscle or signs of the coming myocardial infarction. They are not disturbed by pain in the heart, and often the myocardial necrosis has already been revealed from them only after the ECG.

The first signs of myocardial infarction in such patients may become arrhythmias or the offensive of sudden coronary death. According to some studies, similar to the flow of cheerful ischemia, leading to the necrosis of the heart muscle, is observed in 12.5% \u200b\u200bof patients.

III option

In such patients, the episodes of the myocardium ischemia proceed asymptomaticly, and only at the occurrence of a heart attack, they feel pain in the heart. Such a violation of the blood circulation of the heart muscle can remain unnoticed or accidentally detected when performing an ECG on a holder or load samples. Experts suggest that such a clinical manifestation of ischemia may be associated with an increase in the painful threshold and the patients simply do not feel less severe pain in the heart.

IV Option

In such a form, cheerful ischemia proceeds infrequently, but recently the number of such cardiologist has become increasing. They have signs of insufficient blood supply to the heart muscles are detected only when carrying out an in-depth preventive inspection using load samples.

BIM in cardiology is one of the variants of ischemia, in which there is an objective confirmation of myocardial disease, but there are no clinical manifestations. We observe this pathology in patients suffering from various forms of ischemia, and even in individuals without previously diagnosed coronary pathologies. The prevalence of this disease is about five percent among the population.

The chance of getting sick ischemia myocardium in patients with burded heredity, the presence of essential hypertension, obesity, hypodynamine, diabetes and bad habits is increasing. BIM signs can be detected on an electrocardiogram of each eighth examined, which over fifty-five years old. Next, we proceed to consider the causes of the described pathology and find out what is provoking factors.

Pathogenesis of the development of solemary ischemia myocardium

Pathogenetic mechanisms for the development of pain and nonsense ischemia myocardium are largely similar. The myocardial ischemia of any form develops due to the inconsistency between the need of myocardium in oxygen and insufficient coronary blood supply, which does not allow to fully ensure a sufficiently high level of oxygen tissue saturation.

The most often bbm attacks are observed in the evening or in the morning, which is correlated with the circadian heart rhythm. Increasing the number of attacks in the morning is largely due to physiological changes observed immediately after accessing from sleep, including:

an increase in blood pressure;
an increase in heart rate;
a significant activation of platelets;
increased catecholamines.

In all patients suffering from BIM, multiple damage to the coronary arteries is observed, and mainly the main trunk of the left or right artery, and the high length of the coronary stenosis. Currently, there are no accurate data regarding the causes of the absence of pain in patients with BII.

Reducing the sensitivity of nerve endings in the heart can have a lot of various mechanisms that are completely dependent on the causes of the appearance of pathology. For example, during diabetes, damage to nerve fibers conductive signals may be observed due to the toxic effects of a series of cytostatics.

Among other things, relatively recently in patients with BIM have revealed an increase in the activity of the antinocirtable (anesthetic) system, in which there is a decrease in pain due to increasing the effect of the CNS. As a result of these processes, the pain threshold is significantly increased. Considering that the pain in the heart area under ischemia is observed only when they achieve a certain intensity threshold, it turns out that the threshold does not reach BIM, in order to manifest a clear symptom.

The reasons

The main cause of the disease is atherosclerosis of vessels. Plaques, scattered through the walls, narrow the lumens, breaking blood supply and make it difficult to free blood. In addition, doctors allocate other reasons:

spasms of coronary vessels;
arterial hypertension;
diabetes;
excess cholesterol;
stress;
obesity or overweight;
alcohol abuse;
smoking;
passive lifestyle;
improper nutrition;
age;
paul, more often male;
hereditary factor.

It is no coincidence, because it is over the years that irreversible changes in the vessels occur. But recently the trend has been noticeable to the fact that the disease is significantly "rarely". Often, pathology is diagnosed in young men under 40 years living in large megalopolis.

In the female body, estrogens perform a peculiar protective role. But after seventy years, when menopause passes into a persistent stage, they fall into the same risk group. Male representatives do not have these hormones. This is due to their predisposition.

The main prerequisites for the rapid development of the IBS include:

Spasm of vessels.
Incorrect meals
The presence of bad habits.
Excess weight.
A low-effective lifestyle.
The overaffect of sugar and cholesterol in the blood.
Stress.
Hypertension, etc.

The degree of gravity and the rate of development of the CHA may depend on:

Genes. This disease is often transmitted from close relatives by inheritance.
Cholesterol level in the blood. A large percentage of low-density lipoprotein organism in most cases leads to the formation of plaques. They significantly slow down blood circulation and providing oxygen, vitamins and minerals as the very heart muscle and organs. This reduces the level of "useful" lipoprotein, which performs a number of important functions. He accelerates the metabolism, improves their assimilation, etc.
Frequent use of tobacco. Tobacco use in absolutely any form negatively affects the state of the cardiovascular system as a whole.
Character features of the patient. Excessive flareness, aggressiveness, emotionality and the desire for permanent rivalry can be one of the reasons for the development of the CHA.
Floor. Men suffer from this disease several times more often than women.
Age. On average and older age increases the risk of this ailment.

The leading cause of the reduction in the size of the myocardial blood supply is to reduce the diameter of the lumen of the vessels that feed the heart muscle. This occurs as a result of a constant change (for example, in the formation of atherosclerotic plaques on the wall of the vessel) and the transient - during spasme. The reason leading to the complete cessation of blood flow on the vessel may be an embl (fatty or air particle) or a thrombus (a group of blood cells merged with each other - platelets).

With thromboembolism, the clearance of the vessel is completely overlapped, and myocardial cells that do not receive food are dying. The death of a piece of fabric is referred to as necrosis. Myocardial necrosis arising from acute ischemia is called a heart attack. Depending on the size of the affected area, there is either the formation on the site of the broken muscular tissue of the scar from the connective tissue, or it stops the work of the heart, which leads to death.

The most common cause of nonsense ischemia is an atherosclerotic vessel damage. Atherosclerotic plaques abnormally narrowing the vessel, thereby disturbing the blood supply of the heart muscle. Ischemia can also appear against the background of spasm of coronary vessels, changing the activity of coronary arteries. Spasm most often also occurs due to atherosclerosis of the arteries.

Doctors distinguish several risk factors, which, together, can lead to atherosclerosis and spasm, and in the future and to bezbolic ischemia. To those can be attributed:

diabetes;
arterial hypertension;
high cholesterol content in blood;
frequent emotional shocks;
obesity;
passive lifestyle;
tobacocco;
alcohol abuse;
elderly age;

About symptoms that are characteristic of solemn myocardial ischemia, read below.

To date, the exact reasons that lead to the formation of the nonsense form of ischemic heart disease are unknown. But there is an assumption that such violations may occur against the background of states for which the complete or partial loss of the sensitivity of nerve receptors is characteristic. For example:

Old age.
Arterial hypertension.
Overweight.
Alcoholism and tobacco addiction.
Diabetes.
Genetic disorders.
High cholesterol content in the blood.
Low physical activity.
Frequent stress.

The exact reasons for the insolent flow of ischemia were not fully identified. There are alleged conditions under which such pathology is observed.

change the level of the threshold of pain;
diabetes mellitus, in which the autonomic nerve cardiac system is affected, which can lead to nonsense ischemia;
arterial hypertension;
aorticorial shunting;
cardiovascular risk factors;
atherosclerosis of the coronary arteries.

Allocate two types of basal form of ischemia:

Full Myocardial Ischemia (BBE).
The combination of the first type with painful episodes.

In addition, several more types of such disease can be distinguished, which further describe the patient's body's condition.

BIM, observed in people with obstructive IBS, which means the presence of high-aligned main coronary arteries. Stenicard attacks are not completely.
BIM, found in patients who previously postponed myocardial infarction. This type is more common than the first.
BIM present in people with variant, unstable and stable angina. This type is the most common.

Cheering ischemia - a pathological phenomenon developing in the field of myocardium. The main difference between the disease from the usual ischemic heart disease (IBS) is the absence of symptoms characteristic to defeat the heart muscle. Against the background of pathology, blood supply and exchange processes in tissues are disturbed, which affects the electrical activity of the organ.

The main provoking factor of ischemia is atherosclerosis. With such a violation, the blood supply to myocardium deteriorates, as a result, the deficiency of oxygen and nutrients is developing. The muscle gradually weakens, which leads to heart failure or acute pathology in the form of a heart attack. The development of atherosclerosis arises due to the violation of the vessels due to the formation of fat deposits on their walls.

The second most prevalence is the cause of ischemia - vascular spasm. It is a reaction to a certain external stimulus. Due to spasmization, the activity of vessels that feed myocardium is disturbed, which leads to pathological changes.

The development of ischemia contributes to the following factors:

elderly age,
regular alcohol consumption,
the presence of diabetes
stressful hypersensitivity
abuse of fatty food
low physical activity,
chronic hypertension
overweight.

Thus, the main reason for nonsense ischemia is in insufficient supply of myocardium with blood, which leads to a shortage of nutrients and oxygen.

Myocardine ischemia ischemia develops mainly against the background of atherosclerotic lesions of coronary vessels associated with a decrease in the elasticity and flexibility of vascular walls, as well as a significant narrowing of the arterial lumen due to plaques of atherosclerotic origin. Atherosclerotic plaques are formations that consist of a fatty mixture containing predominantly cholesterol, calcium and other substances.

Education in plaques vessels leads to a violation of blood circulation and blood supply to myocardium. Often the cause of a hidden ischemic form is a vascular spasm arising from supercooling, stress and other hypersensitivity to external factors. People with diabetes are often inclined to developing cheerful ischemic form.

An individual sensitivity to pain has an important meaning. Patients with ischemia are distinguished by low tactile and pain sensitivity, so sometimes obvious pain signs are simply not perceived by the patient. Some people, regardless of pathology, there is a rather high pain threshold, so painful syndrome, characteristic of ischemic attack, is simply not felt.

Etiology of solemn myocardial ischemia

Myocardine ischemia ischemia proceeds almost imperceptibly for the patient. The reasons for the appearance of the solemn myocardial infarction are very similar to the predisposing factors for pain. Such reasons include:

atherosclerosis;
improper nutrition;
lack of necessary physical exertion;
excessive physical exertion;
bad habits;
obesity;
diabetes;
psychosocial reasons.

The reasons for the absence of painful syndrome during myocardial ischemia today is not fully studied. Several probable reasons for the development of such a variant of the course of the disease, including:

damage to nerve fibers in diabetes;
reduced pain;
atherosclerosis of the coronary arteries;
arterial hypertension;
violation of the conductivity of nerve fibers in myocardium.

The 2 main types of myocardial ischemia are allocated. In the first case, there is a complete lack of pain syndrome. With 2 variant of the course of the disease, myocardial ischemia is manifested by rare weakly-minded pain attacks that quickly pass. It was relatively recently noticed that there is a certain dependence between the human pathologies and the nonsense of the Miacard infarction.

Often, solebral myocardial ischemia is observed in people who have banned major coronary arteries, and the obvious signs of angina person can also not be. In addition, there are often cases of the appearance of solemn ischemia myocardium in people who in the recent past suffered a heart attack, and the episode that was previously occupied with a typical clinical picture. Among other things, the myocardial ischemia is often observed in people with an unstable or stable angina.

Clinical picture

To identify the disease, a narrow-dimensional diagnosis of solemary myocardial ischemia is required. It is impossible to determine the presence of pathology independently, since there are no pronounced symptoms. Little clinical manifestations arising from nonsense ischemia are often characteristic of other pathology of the cardiovascular system.

Common symptoms include the following:

Arrhythmia. Some forms of the presented disorder are manifested with IHD. The patient has a feeling of heart rhythm interruptions, uneven pauses between the phases of reduction and relaxation are observed. The attacks are usually short-lived.
Tachycardia. A characteristic symptom of ischemia, including nonsense, is the increase in cardiac rhythm. However, an increase in the frequency of abbreviations may be caused by natural, and not by pathological causes, for example, a strengthened physical activity. In addition, under the ischemia, the opposite symptom is often noted - the slowdown of the heart rhythm.
Low pressure is one of the consequences of ischemia, arising against the background of myocardial weakening. As a rule, it is noted simultaneously with a decrease in heart rate.
Dyspnea is observed in patients with cardiovascular lesions, under which myocardial supply is worse. The lack of oxygen provokes the acceleration of the respiratory reflex, as well as the sensation of the lack of air, short-term attacks of the suffocation. The appearance of dizziness is possible.

It should be remembered that the symptoms of solemary myocardial ischemia arise extremely rarely. In most cases, an anomaly is not accompanied by any signs until complications are repaired.

Classification of solemary myocardial ischemia

Barely Ischemia is made to divide the COHN classification from 1993 to several types:

First. It appears in people with stenosis installed coronary and coronary photography, however, provided that they did not suffer in the last attacks of angina, myocardial infarction, heart rate disorders and stagnant heart failure.
Second. Diagnosed in people who have underwent myocardial infarction, however, not suffering from the attacks of angina.
The third. Manifests itself in patients with angina.

If you simplify, then the second and third type includes patients, in the history of which is there ischemic heart disease.

In order to properly assess the severity of the patient's well-being at the time of treatment and tracking the dynamics of pathology in cardiology, a classification based on anamnesis data is used, and in addition, on episodes of ischemia and a clinical picture. According to it, three types of insulating type of ischemia stand out:

First type. Development of nonsense ischemia among patients with proven with the help of coronaryogiography by obvious stenosis of the heart artery. In such patients there are no attacks of angina, the pathology of the heart rhythm and stagnation of heart failure.
With the second type in the history of the patient's disease, ischemia without angina, but with myocardial infarction.
Against the background of the third type, quiet ischemia occurs in patients with angina. Each day, such patients noted cases of nonsense and pain attacks of ischemia.

In practical medical activities, specialists are widely used by classification, which includes two types of disease: when it is first noted BIM, which flows without explicit symptoms, which are characterized by myocardial ischemia, and the second type is when dumb ischemia is combined with pain angular episodes and other IBS forms.

Are there any symptoms during solemn myocardial ischemia?

Elderly patients are the main contingent of cardiology offices. This is not by chance, because with age, dystrophic processes occur in vessels, and exchange disorders are aggravated, the concomitant pathology is joined. It is worth noting that the latter in time of ischemia shows obvious signs of "rejuvenation", especially in the inhabitants of large cities.

Women due to hormonal features are less susceptible to ischemia of the heart, since estrogens have a kind of protective influence, but about 70 years, when there are persistent menopause, the incidence rates are equal to those in men. The absence of estrogen predetermines the earlier development of atherosclerosis and, accordingly, ischemic damage to the heart in men.

The violation of the fat exchange causes deposition on the walls of the arteries of lipid formations that impede blood flow and leading to oxygen starvation of heart tissues. These phenomena are significantly aggravated with general obesity and diabetes. Hypertension with crises contributes to damage to the inner liner of the arteries and circular deposits in them fat, which causes a significant deficit of blood flow.

The varieties of myocardial ischemia according to the international classification of diseases are:

Angina.
Myocardial infarction.
Disturbance of heart rhythm.
Sudden coronary death.
Cardiosclerosis due to previously transferred heart attack of the heart.
Heart failure.

Angina - the most common form of heart ischemia, which is diagnosed with most elderly people, not even complaints (asymptomatic form). The absence of pain should not calm down, especially, in individuals who have predisposing accompanying diseases and affected by risk factors.

The heart attack is myocardial necrosis, when the sharp lack of oxygen leads to the death of cardiomyocytes, violation of cardiac activity with a high risk of fatal outcome. The heart attack is one of the most severe and irreversible manifestations of ischemia. After healing the focus of necrosis in the place of damage remains a dense scar (post-infarction cardiosclerosis).

With a significant amount of necrotization, they talk about a large-scale infarction, often he penetrates the thickness of the muscle of the heart (transmural heart attack). Small foci of necrosis can be under the shells of the heart. Subcicarudial ischemia occurs under the outer shell (epicardium), subendocardial - knutri, under the endocardium.

A special form of the disease is the so-called transient, or non-creepy, dumb, ischemia of the heart muscle. It occurs approximately half of the patients with IBS, does not give any symptoms, but changes in myocardial cells are still occurring and it is possible to identify them, for example, with ECG.

The transient ischemia of the heart is significantly more common among hypertensive, smokers, patients with stagnant heart failure. In all patients, without exception, patients with a silent form of pathology, there is a damage to the trunk vessels of the heart, multiple severe atherosclerosis, the greater length of the constraints of the narrowing.

Symptoms and signs of solemn myocardial ischemia

Despite the fact that the disease is serious, the symptoms are not manifested. The attack flows painlessly, but there are indirect signs to which attention should be paid:

bradyarithmy or tachycardia;
skin sinusiness;
frequent extrasystoles;
sharp decrease in blood pressure;
the appearance of shortness of breath;
the emergence of heartburn;
weakness or lack of functioning of the left hand.

Symptoms of solemn myocardial ischemia

The disease is not without reason called - "solemn myocardial ischemia", as it develops and progresses without showing symptoms. In case of heart disease, pain, dizziness is the main symptoms. But when bbim, they do not manifest. Other characteristic features are marked:

scinting of skin;
low blood pressure;
the weakness of the left hand;
uneven heart abbreviations (extrasystoles);
dyspnea;
heartburn.

Most of these manifestations of the disease do not associate with severe heart pathology and do not give it much importance. Men are generally confident that nightly rest will eliminate the unpleasant feeling. But the disease under all its painless symptoms progresses, approaching the unpleasant situation, not always ending with positively.

Dyspnea.
Dizziness.
Fatigue.
Weakness.
Disability.
Heartburn.

Patients rarely pay special attention to these symptoms. They write them down on excessive load, chronic fatigue, etc.

A distinctive feature of the disease is the connection of its manifestations with a load level on the heart muscle. The more developed violation of the coronary blood supply, the lower the functionality of myocardium. As soon as the load reaches the limit (individually for each patient) of the magnitude - there are occurrences of the disease (symptoms). Prior to the achievement of a certain level of load (constantly decreasing as disease progression), the patient has no complaints.

Disease is known from ancient times. The very name of the most common form of IBS - angina, originating from ancient Greek "squeezing, compression of the heart," confirms this. Later, when Latin became the language of medicine, the disease was called Angina Pectoris (breast disease, breast compression, breast disease).

Myocardis ischemia symptoms are exhaustively reflected by the ancient name. Patients complain about the occurrence of feelings of gravity, compression, constraint or acute chest pain, forcing them to measure and creating a feeling of lack of air and the inability to make a full breath. A characteristic feature of the attack of ischemic pain is their disappearance after stopping the load.

The peculiarity of nonsense ischemia is that the patient feels satisfactory. Holy symptomatics is completely absent, so patient up to the development of complications may not be aware of its problem.

The main symptom of the solemn myocardial infarction is the absence of a characteristic state of pain syndrome. Given that the presence of severe breast pain in most cases makes the patient to consult a doctor, with BIM diagnosis of pathology difficult and delayed in time.

tachycardia or bradycardia;
frequent extrasystoles;
drop in blood pressure;
cyanosis of the skin;
heartburn;
dyspnea;
significant weakness in the left hand.

All these symptoms may not be fully manifested and even in different degrees of intensity. Considering that there is no pain syndrome or present in the form of poorly promotional short-term attacks, most people do not pay attention to them.

The name of a similar ischemic form indicates asymptomaticity, so the very first symptoms are determined by the total absence of any pain characteristic of cardiovascular pathologies. Practice shows that patients have various options for the flow of such pathology. Some patients do not completely feel the onset of heart attack or ischemia, and the presence of such pathological conditions is found in them completely by chance when the ECG passes or during the preoperative load sample. The first symptoms in such patients may appear in the form of different arrhythmias or coronary sudden death.

In another group of patients, a similar ischemic form proceeds without painful syndrome, but upon the occurrence of an attack of a heart attack, characteristic pain still appears. With such a clinical course, it is very difficult to suspect the pathology, so the patient's pathology will usually find out randomly when conducting an ECG. The situation is even more complicated if, with such a course of ischemia, the patient has a high pain threshold, since it is fraught with a hidden infarction.

Custracy of nonsense ischemia consists in the complete painlessness of its episodes. There are only two indicators, according to which the patient or doctor may suspect the development of pathology: the presence of diagnosed angina and ischemia a history and direct detection of BBE in the framework of the prophylactic study of the heart functions with the fixation of the characteristic change on the cardiogram.

How is the heartache? Symptoms in women and men who form a clinical picture of the disease can occur typically and atypically.

In the ladies in the diseases of the heart, the attacks are less sharp, the pain often gives her neck, hands, back. Often on the background of this there is nausea and vomiting, and much more often than men, there is a cough and shortness of breath.

Common signs of heart pathologies can be considered:

shortness of breath, strong fatigue from ordinary actions;
nausea, pain in the upper stomach department;
swelling of the lower extremities in the evening;
student urination at night;
pulsating headache;
pain in the elbow joints and wrist;
chest pain.

Now we know how the heart hurts. Symptoms in women and men are important to recognize in a timely manner.

Diagnostics

The identification of this ischemic pathology often occurs randomly. Typically, the disease is detected after passing a prophylactic inspection or in the process of diagnostic measures absolutely another disease. Therefore, most doctors recommend regularly to make an ECG in order to initiate a diagnosis and begin treatment. This disease, like most others, is good to treat only with timely diagnosis.

After the pathology has been identified, laboratory and instrumental surveys are appointed:

analysis of urine;
general and biochemical blood test;
echocardiogram to determine the structure of the heart muscle, the size of the heart, the degree of atherosclerosis;
cardiogram on the holder.

Sometimes by the decision of the attending physician, a number of other surveys can be appointed. The need for this will show a decrypted cardiogram. Diagnostics and treatment will largely rely on examination data.

This disease is found in most cases purely randomly. In suspects of the presence of a patient, cheerful ischemia conducts a number of procedures aimed at diagnosing the disease.

After the initial examination of the patient is produced. The doctor conducts a number of standard procedures: determining the presence of wrees in the lungs, reduction rate of the heart muscle, level of blood pressure, etc.

Ehoche studies the overall condition of the heart, vessels, heart muscle. The speed of contraction of myocardium is investigated.