Treatment of IBS preparations of the first stage. Medicines for emergency care for heart ischemia

The date: 10.04.2019

Has a pronounced antiagonal effect;

Increases tolerance K. exercise;

Has a cardioprotective action;

Improves the erectile function in patients with IHD.

Chronic Ischemic Heart Disease: Treatment News

Published in the journal:

Yu.A. Karkov
FSBI Russian Cardiological Scientific and Production Complex of the Ministry of Health of Russia. 121552, Russia, Moscow, ul. 3rd Cherepkovskaya, 15a

The main purpose of the treatment of chronic ischemic heart disease (IBS) is to reduce the risk of complications, primarily myocardial infarction, and mortality (increase in life expectancy) when providing good quality Life. IN recent times New opportunities appeared in the treatment of IBS: an increase in the duration of the use of double antiagregative therapy and a more intense reduction in low-density lipoprotein cholesterol with combination therapy, new antianginal therapy schemes and some others. The positions of invasive treatment are refined, including the ratio between endovascular treatment and coronary shunting. The modern multicomponent strategy of the patient with chronic IBS allows you to achieve not only improvement in the quality of life, but also an increase in life expectancy, including without cardiovascular complications.
Keywords: chronic ischemic heart disease, medication treatment, anti-infanal therapy, invasive treatment.

Chronic ISChemical Heart Disease: Treatment News

Yu.A.Karpovh.
RUSSIAN CARDIOLOGICAL SCIENTFIC-INDUSTRIAL COMPLEX OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION. 121552, Russian Federation, Moscow, 3-Ia Cherepkovskaia, d. 15A

The Main Aim of Chronic Ischemic Heart Disease (IHD) Treatment Is to Reduce The Risk of Complications - Especially A Myocardial Infarction, And Mortality (To Increase Life Excectancy) in Providing A Good Quality Of Life. New Treatment Options for IHD Have Been Worked Out Recently: Therase of Duration Of Dual Antiplatelet Therapy and Intensive Lowering Of Low-Density Lipoprotein Cholesterol Levels As A Part of Combined Therapy, New Schemes of Antianginal Therapy and Some Others. The Characteristics of Invasive Treatment, Including The Correlation Between Endovascular Treatment and Coronary Arttery Bypass Graft Surgery, Have Been Outlined. Modern Multi-Component Strategy Using For Management of Patients WITH CHRONIC IHD ALLOWS US TO IMPROVE NOT ONLY THE QUALITY OF LIFE, BUT ALSO TO INCREASE LIFE EXPECTANCY, WITHOUT CARDIOVASCULAR COMPLICATIONS.
Key Words.: Chronic Ischemic Heart Disease, Drug Therapy, Antianginal Therapy, Invasive Treatment. [Email Protected]

ischemic disease

The scheme of drug therapy in accordance with the recommendations on the maintenance of patients with a stable IHD included drugs with a proven positive impact on the forecast for the disease (Table 1), which are required for appointment if there are no direct contraindications to their reception, as well as a numerous antiagonal group or Anti-Hiscetic drugs.

The prevention of complications of the IBS is carried out by appointing antiagregants ( acetylsalicylic acid - ASK or clopidogrel), statins (it is important to achieve the target level of cholesterol of lipoproteins of low density - xs LDL), drugs blocking the activity of the renin-angiotensin system. There is evidence of the effectiveness of inhibitors of angiotensin gluttering enzyme (IAPF) perindopril and ramipril, and in their intolerance - angiotensin receptor blockers. The most priteled effects of the IAPF in patients with a low fraction of emission of the left ventricle (FV LV), transferred to them, diabetes (SD), arterial hypertension (AG), however, in patients with IHD, without specified states, you can count on a reduction in cardiovascular risk. Also in the scheme treatment of IBS There were ß-adrenoblocators (ß-LB), which were recommended to all patients after those transferred to them.

What changes occurred or appeared additional featuresThe use of which in everyday clinical practice improves the results of the treatment of patients with IBS?

Preparations that improve the forecast for chronic IBS

Antiagregant therapy. Most patients with a stable IBC continue to be preferred to the assignment of ASK in the dose range from 75 to 150 mg / day, which is associated with a favorable benefit ratio, as well as the low cost of treatment. Clopidogrel is considered as a drug of the 2nd line appointed at a dose of 75 mg 1 time per day with the intolerance of ASK or as an alternative to ACC in patients with a common atherosclerotic lesion.

Combined or double antitrombocitar therapy (dates), including ASK and a second anti-aggregant (ticugrellor or clopidogrel), is a standard for treatment for patients who survived acute coronary syndrome -Ocs (depending on the strategy of reference), as well as patients with stable IBS, subjected to planned percutaneous coronary interventions - CCV (ASK with clopidogrel). The duration of treatment in these cases, depending on the type of the implanted stent, did not exceed 1 year after the event. Recently, the efficacy and safety of dates in patients after 1 year and more transferred to them were actively studied. After completing several studies, especially the studies of Pegasus-Timi 54, it became obvious that in patients after those transferred after 1 year it is possible to consider the possibility of longer dates, especially in cases of high risk of ischemic complications and low risk of bleeding, which was noted in new European Recommendations for the treatment of patients with it without lifting ST. Recently, a new indication was registered for the use of a ticagrelor.

As for patients with chronic IBS, according to american recommendations By keeping these patients, dates can be considered in cases where there is a high probability of developing ischemic complications.

Lipid lining therapy. All patients with proven IBS recommended the appointment of statins in doses that allow you to achieve the target level of HC LDL<1,8 ммоль/л или более 50% от исходного уровня. Для этих целей часто используются высокие дозы статинов - аторвастатин 40-80 мг или розувастатин 20-40 мг. Вместе с тем недавно в исследовании IMPROVE-IT было показано, что у пациентов с ОКС длительное применение комбинированной терапии симвастатин + эзетимиб, которая больше снижает ХС ЛПНП, чем монотерапия, достоверно улучшает сердечно-сосудистый прогноз . Это позволяет рекомендовать такую комбинированную терапию у больных с недостаточным снижением ХС ЛПНП на монотерапии статинами.

Recently registered (USA and the European Union) A new class of lipid lining drugs - PCSK9 monoclonal antibodies or a propreteen convertise of subtilisine-cake-type 9 (PSCT9) at subcutaneous administration 1 time in 2-4 weeks reduce HC LDL by 40-60%, including including on the background of statins, possess good tolerability. Already, these drugs (the registration of drugs alirocumab and evocumab in Russia is planned in 2016) can significantly increase the effectiveness of patient therapy with the family form of hypercholesterolemia, as well as in the intolerance of statins. In the future, with a favorable completion of a series of clinical studies, in which the effectiveness and safety of PCT9 inhibitors during prolonged use are studied, these drugs can be used in the treatment of patients with IHDs together with statins to overcome the "residual" risk.

ß-ab.. As already noted, ß-AB was recommended to all patients after it without limitation on the duration of use, regardless of the presence of angina and other testimony to their application, since evidence of improving the forecast in this cohort of patients was previously obtained. However, many experts noted that the appointment of ß-AB after 3 years and more after the patients suffered without angina and without heart failure does not have evidence of improving the forecast. The fact is that studies with a duration of more than 2-3 years in order to assess the influence of ß-AB to the forecast after it was not. Recently, in American recommendations for the diagnosis and treatment of a stable IHD, it was first noted that if after 3 years after it does not have angina, chronic heart failure with a reduced FV LV, AG, then the therapy of ß-ab can be finished. Thus, it is indicated for the option of the therapy of ß-ab in the absence of angina and other indications for the purpose of the preparations of this class.

Antianginal (Anti-Hishemic) Therapy

Therapy aimed at eliminating the ischemic manifestations of angina and / or nonsense myocardial ischemia includes ß-AB, calcium channel blockers (BKK), prolonged nitrates, inhibitor of the IF cells of the sinus node cells (Ivabradin), cytoprotective preparations (trimetazidine), late sodium inhibitor Current (ranolazine) and activator of potassium channels (nicorandyl). All these drugs have an antiagonal (anti-hiece) effect, which has been proven in the course of controlled clinical studies.

ß-ab.. For the treatment of angina ß-k, they are prescribed in a minimum dose, which, if necessary, gradually increases to complete control of angina attacks or maximum dose. It is believed that the maximum decrease in the need of myocardium in oxygen and the growth of coronary blood flow is achieved with the frequency of heart rate (CSS) 50-60 UD / min. In case of insufficient effectiveness, as well as the impossibility of using the maximum doses of ß-AB due to unwanted manifestations, it is advisable to combine them with calcium antagonists - AK (dihydropyridine derivatives of long-term action) or Ivabradin. If unwanted phenomena occurs, it may be necessary to reduce the dose of ß-ab or even cancel them. In these cases, it should be considered the appointment of other rhythm-rejuvenating drugs - verapamila or Ivabradin. The latter, unlike verapamil, can join ß-ab for improving the control of heart rate and increase anti-isice efficiency. If necessary, you can join ß-ab Nicoradil. In patients with stable angina, ranolazine or trimetazidine can be used in combination with SD.

Table 1. Medical treatment of chronic IBS

BKK

Nitrates and nitrate-like. The variety of dosage forms allows the use of nitrates to patients with a different severity of the disease both to relieve and the prevention of angina attacks. Nitrates can be used in combination with other antichangal drugs. The weakening of sensitivity to nitrates is often developing with long-term use of prolonged action drugs or transdermal dosage forms. For prevention of tolerance to nitrates and its elimination, intermittent reception of nitrates is recommended during the day; Reception of nitrates of average duration of action - 2 times a day, prolonged action is -1 times a day; Alternative Molidomin therapy.

Molotomine, who is close to nitrates on the mechanism of anti-naiginal action, are prescribed with nitrate intolerance. It is usually prescribed to patients with contraindications to the use of nitrates (with glaucoma), with poor tolerability (severe headache) of nitrates or tolerance to them.

Inhibitor of the sinus knot Ivabradin. At the heart of the antichangal action of Ivabradin is a selective decrease in the heart rate by inhibiting the transmembrane ion ion current if in the sinus node cells. In contrast to ß-AB, Ivabradin reduces only the heart rate, does not affect the reduction, conductivity and automaticism of myocardium, as well as blood pressure (AD). The drug is recommended for the treatment of angina in patients with sinus rhythm with contraindications / intolerance to the reception of ß-ab or together with ß-AB in their insufficient antiagonal effect. It was shown that the accession of the drug to ß-AB in patients with IBS with a decreased FV LV and CSS\u003e 70 UD / min improves the disease forecast. The drug is not recommended to be appointed simultaneously with the BCC.

Nicorandil. Antianginal and anti-hichokes drug Nicoradil simultaneously has the properties of organic nitrates and activates adenosine trifhosphate-dependent potassium channels. Reception of nicorandila effectively reduces myocardial ischemia - provides a simultaneous decrease in after- and preloading to LV with a minimal effect on hemodynamics and does not have many shortcomings characteristic of standard opponents. Opening adenosintrifosphate-dependent potassium channels of mitochondria, Nicorandil completely reproduces the protective effect of ischemic preconditioning: contributes to energy saving in the heart muscle and prevents irreversible cellular changes in the conditions of ischemia and reperfusion.

It is shown that a single dose of nicorandila (10 or 20 mg), adopted 2 hours to intradermal coronary intervention in patients with OX, reduced the frequency of cases of increasing the level of troponin I, as well as the frequency of increase in troponin 3 and 5 times compared with upper border Norms compared to the control group. It is also proved that nicorandyl is able to reduce the rate of development of arrhythmias, aggregation of platelets, stabilize the coronary plaque, contribute to a decrease in the severity of co-coordard oxidation, normalize the function of the endothelium and the sympathetic nervous activity in the heart.

Nicorandil does not cause tolerance development, does not affect hell, heart rate, conductivity and myocardial reductions, lipid exchange and glucose metabolism. It is recommended for the treatment of patients with microwave walls (with ineffective ß-ab and ak). The drug can also be used to relieve angina attacks.

There are no data on the impact on the prognosis in patients with a stable IHD for other anti-native drugs. The exception was the drug Nicorandil, which is in a randomized double-blind placebo-controlled study of YUNA (Impact of Nicorandil In A ^ Ta; United Kingdom, n \u003d 5126, midnight Observations of 1.6 years) significantly reduced 17% reduced the risk of death from IHS, nepatal and unscheduled hospitalization of communication with heartache (P \u003d 0.014) and reduced the risk of ox (p \u003d 0.028) by 21%). Moreover, the maximum decrease in the absolute risk of unwanted events was observed in patients with the greatest source risk.

In a multicenter prospective observation study in the JCAD parallel groups (Japanese Coronary AG: YSU Disease; Japan, N \u003d 5116, the average surveillance period of 2.7 years) studied the influence of nicoordil for remote outcomes in patients with IHD. The frequency of the main endpoint (death from any reason) in the Nicorandila group was 35% lower compared to the control group (p \u003d 0.0008). Also, in the Nicorandila group, a significant decrease in the frequency of additional end points was noted: cardiac death (-56%), the fatal of them (-56%), cerebrovascular and vascular death (-71%), stagnant heart failure (-33%), over-all circulation stop And breathing (-64%).

In another observation study of OSAKA ACUTE CORONARY INSUFFICIENCY STUDY; Japan, N \u003d 1846, the median of the surveillance period of 709 days) patients with acute them, who suffered an emergency Chkv, Nicorandil, assigned to orally from the moment of discharge, reduced the risk of death from any reasons for 50, 5% (p \u003d 0.0393), regardless of the outcome of the CHV. However, Nicorandil is used in clinical practice only for angina therapy.

Randomized clinical researches With the use of nicoordil domestic production, additional clinical effects have revealed additional clinical effects in patients with a stable IBS with respect to isosorbide-5-mono-nitrate: improved indicators erectile function and an increase in the increase in the diameter of the cavernous arteries in men, an increase in the velocity of cerebral blood flow, which is especially important for elderly patients who have insufficiency brain circulation . Adding nicorandila to standard therapy of stable angina facilitated a significant decrease in the concentration of highly sensitive C-reactive protein (p \u003d 0.003) and fibrinogen levels (p \u003d 0.042) on the background of receiving rosuvastatin, which confirms positive influence Nicorandila on the processes of reduction of oxidative damage and systemic inflammation. The use of nicoradil in patients with a stable angina of the functional class III, complicated by heart failure with a low FV LV, has not only allowed to obtain a more pronounced antiagonal effect, but also improve the systolic function of the heart, reduce the remodeling of the LV.

Ranolazin Selectively inhibits late sodium channels, which prevent overloading intracellular calcium - negative factor With myocardial ischemia. Rolandsin reduces the reduction and stiffness of myocardium, improves myocardial perfusion, reduces the need of myocardium in oxygen, does not affect the frequency heart Rhythm and hell. It is usually prescribed in combination therapy with insufficient anti-angular effectiveness of basic drugs.

The recently completed study studied the influence of ranolazine over the course of IHD in patients after incomplete revascularization of myocardium using PCV with stenting. It was previously shown that in 80% of patients after CVD there is an incomplete revascularization of myocardium, which is subsequently connected with more high mortality and repeated hospitalization with revascularization. River-PCI study included 2619 patients between November 2011 and May 2013 in 245 centers in Israel, USA, Europe and Russia, which were randomized to obtain a ranpolazine of 1000 mg 2 times a day (N \u003d 1332) or placebo (n \u003d 1297). Three-sized lesions were in 44% of patients, 33% had chronic complete occlusion and 14% had previously transferred the operation of the Aorticoronary shunting (AKSH). Everyone had an incomplete revascularization, which was determined as the presence of one or more lesions with a 50% diameter of stenosis and more coronary artery (Ka) 2 mm in diameter and more.

The average observation period was 643 days, during which 26.2% of the Panolazine Group and in 28.3% of the placebo group have events of the combined primary endpoint (associated myocardial ischemia revascularization or hospitalization without revascularization). The difference did not have a reliable value (risk ratio of 0.95). At the same time, the researchers noted a very high frequency of cardiovascular events in patients with incomplete revascularization. Almost 1/2 of cases of recycled revascularization associated with the development of ischemia, the CCV was performed on stenosis, which were previously left untreated. There was no reliable differences in the frequency of development of individual events of primary or secondary end points: revascularization associated with ischemia (15.3% against 15.5%, respectively, in Ranolazine and placebo groups); hospitalization associated with ischemia without revascularization (15.3% against 17.9%); Cardiovascular death (1.6% against 1.6%); Sudden heart death (0.5% against 0.9%) or im (8.4% against 9.0%). In the Rolanzin group, transient ischemic attacks were more common compared to the placebo group (1.0% against 0.2%; risk ratio 4.36; p \u003d 0.02) and reliably more patients finished research prematurely for all reasons (40.0 % against 35.7%, p \u003d 0.006); Table. 2.

One of possible causes The unsuccessful completion of the project researchers consider the lack of objective evidence of the resumption of ischemia after the CVD as a criterion for inclusion in the study. Thus, the use of ranolazine in patients with chronic IBS after incomplete revascularization does not affect the disease forecast.

Table 2. Research River-PCI: Effect of Ranolazine on the course of IHD in patients with incomplete revascularization after PCV

Events	Rolandzin (n \u003d 1332)	Placebo (n \u003d 1297)	R
Primary endpoint *	345 (26,2%)	364 (28,3%)	ND
Revascularization associated with ischemia	15,3%	15,5%	ND
Hospitalization associated with ischemia without revascularization	15,3%	17,9%	ND
THEM	8,4%	9,0%	ND
Death OT cardiovascular reasons	0,5%	0,9%	ND
Tradality ischemic attack	1,0%	0,2%	0,02
Stopped receiving	189 (14%)	137 (11%)	0,04

After publication of the main result of the River-PCI study, a new analysis of the assessment of QG on Quality of Quality of Life was conducted. Analysis of 2389 participants in the study showed that although in both groups there was a significant improvement in the KZ on the scale of the Seatlovsky questionnaire for 1 month and 1 year after the index PCV, reliable differences between the Ranolazin and Placebo groups were not detected. However, in patients with diabetes and in a group with more severe angina, it was originally a reliable improvement in this questionnaire after 6 months after the intervention, which was leveled by 12 months.

Trimetazidin. The drug is an anti-host metabolic modulator, improves myocardial metabolism and energy supply, reduces myocardium hypoxia, without influencing hemodynamic performance. It can be appointed with any other antichangal drugs. Recently, restrictions were made to prescribe the drug with motor disorders (Parkinson's disease, essential tremor, muscle rigidity and restless legs). Currently, the effectiveness of the drug is being studied in reducing the risk of cardiovascular events in more than 7 thousand patients after CWV with stenting in an international randomized placebo-controlled study (AT-PCI).

Features medical treatment Vazospady angina

ß-AB with vazospad angina against the background of angio-graphically intact ka is not recommended. Best results According to the prevention of ischemia in patients with vasospadic angina, BKK is shown. At the same time, there are practically no data on the effect of such therapy on the forecast of vasospadic angina. Recently, researchers from the Japanese Coronary Spasm Association conducted a multicenter study in which 1429 patients were included ( average age 66 years; Men / Women 1090/339) with vasospadic angina (the diagnosis was exhibited by solving participating doctors). More than 90% of patients received BKK therapy; 695 (49%) took different nitrates, such as nitroglycerin, isosorbide mononitrate and dinitrate (551 patients) and nicorandyl (306 patients). The primary endpoint was the amount of cardiac events (cardiovascular death, nefatal them, hospitalization with unstable angina or heart failure, successful resuscitation).

During the study (on average, 32 months), the events of the primary endpoint were noted in 5.9% of patients. According to the analysis of the same selected steam, the total frequency of cardiac events was the same in patients who received and did not receive long-term therapy with nitrates (11% against 8%, respectively for 5 years; risk ratio 1.28; 95% confidence interval - di 0.72 -2.28). Monotherapy Nicoradil was associated with a neutral influence on the forecast for a vasospast angina (risk ratio of 0.8; 95% di 0.28-2.27). However, according to multifactorial analysis (COX model), the simultaneous use of different nitrates together with nicorandyl may increase the risk of cardiac events (risk ratio of 2.14; 95% di 1.02-4.47; p \u003d 0.044), especially when Simultaneous use of nitroglycerin and nicorandila. It was concluded that the long-term use of nitrates in combination with BKK did not improve the prognosis in patients with vasospadic angina patients.

In cases where the CA spasm takes place on the background of stenosing atherosclerosis, you can assign small doses ß-ab - in combination with dihydropyridine ak. The prognostic effect of ASK, statins, IAPF with vasospadic angina against the background of angiographically intact ka is not studied.

Features of medication treatment of microvascular angina

Currently, the assignment of statins and antiagregants is also recommended for the treatment of this form of the IBC. To prevent attacks, ß-ab is prescribed, and in case of insufficient efficiency, AK and long-acting nitrates are used. In cases of persisting angina, IAPF and Nicoradil are prescribed. Previously, clinical observations on the effectiveness of nicoradil in patients with this shape of angina were published.

In the ending recently, the study of RWISE was attended by 142 patients (96% of women; average age 55 years old) with microvascular angina. In addition to symptoms associated with myocardial ischemia, all had no obstructive lesion of ka (stenosis less than 50%) and a reduced coronary reserve (less than 2 5) in a sample with acetylcholine. In this placebo-controlled study, the ranolazine was not effective in reducing the number of seizures of the stainlessness of the stress or the improvement of myocardial perfusion (p \u003d 0.81). However, in the Rolazine group, there was a decrease in the symptoms of depression (p \u003d 0.009). Thus, in patients with microvascular angina, the effect of the drug on the reserve index of myocardial perfusion was not revealed.

Myocardial revascularization with chronic IBS

When discussing the issue of the revascularization of myocardium during stable angina (balloon angioplasty with stenting, ka or AKSH), the following circumstances are taken into account:

The effectiveness of antianginal therapy. If, after prescribing the patient, including combined therapy in optimal doses, it remains the attacks of angina with an unacceptable for a particular patient with a frequency, it is necessary to consider revascularization.
The results of load samples. The results of any load sample can identify the high-risk criteria of complications that are talking about an unfavorable remote forecast.
Risk of intervention. Take into account accept anatomical features lesions clinical characteristics Patient, operational experience of this institution. As a rule, the invasive procedure refrain in cases where the intended risk of death during its implementation exceeds the risk of death of a particular patient within 1 year.
The question of conducting invasive treatment should be discussed in detail with the patient, and the decision is to be taken collegially with the participation of the attending physician, surgeon and invasive cardiologist. After successful invasive therapy, it is necessary to continue to make drugs.

The choice of myocardial revascularization method

It should be recalled that the previously conducted studies, in particular the study, did not establish advantages in improving a remote forecast when comparing two strategies of patients with stable IHS - only optimal medical therapy (OMT) or PCV with implantation mainly metallic uncovered stents + OMT. Recently, the results of almost 12-year observation of patients who previously participated in the Courage study were published. It turned out that with longer periods of observation, the number of dead from all reasons in both groups was not statistically different (Table 3).

These and other evidence suggests that CCV is shown, as a rule, only in the case of ineffective anti-infanal treatment in order to improve the CZ patients with a stable IBS, since this method of invasive therapy does not affect the risk of developing cardiovascular events and mortal outcome.

Table 3. Courage study: the effect of PCV for remote survival in patients with stable IBS

Information on survival was available for 1211 patients or 53% of the original population
with an average observation period of 11.9 years. In total, 561 patients died during observation, of which
180 - during the first study and 381 - during the extended period of observation

Successful shunting improves not only KZ, but also in a number of clinical situations - the prognosis of the disease, reducing the risk of developing nefatal and death from cardiovascular complications. This refers to patients who have stenosis more than 50% of the main trunk of the left ka; Scrogulation of the proximal segments of all three basic ka; coronary atherosclerosis other localization involving proximal department front descending and envelope arteries; multiple occlusion ka; Diffuse distal hemodynamically significant stenosis. Reducing the systolic function of LV (FV Lzh<45%) является дополнительным фактором в пользу выбора шунтирования как способа реваскуляризации миокарда.

In recent years, several randomized studies have been conducted, in which the results of CSH and CCV in patients with a multi-sued lesion of ka were compared. In the studies of Syntax, Freedom and Artsii, only stents covered with medicine I generation were used. The frequency of stencil thrombosis was from 5 to 10% for 5 years. Since the stanta thrombosis is accompanied, as a rule, an unfavorable outcome, it determined the worst forecast in a group of pentated patients compared with the operated. When using the henth of the generation of the II generation, the frequency of development of wall thrombosis and, it is important to emphasize, the need for repeated revascularization is less. In a recent metaanalysis, which carried out a comparison of stenting and CS in the treatment of patients with a multi-sized lesion patient, it was shown that the frequency of repeated revascularization is constantly reduced by changing the CCV technology from the greatest when the cylinders are smaller when the hentings with the generation I generation and the minimum The case of the implantation of the henth of the heating of the II generation. Two major studies (Excel and Noble) are currently being conducted, in which the effectiveness of the treatment of patients with an unprotected lesion of the main trunk of the left and complex lesion with a low or intermediate SYNTAX index using a new generation of medicinal coating stents against KSH is being studied. The first results of these studies are expected in 2016.

Conclusion

IHD refers to frequently encountered cardiovascular diseases and is the main cause of cardiovascular mortality in Russia. The treatment regimen with the purpose of antiagregants, statins, blockers of the renin-angiotensin-aldosterone system and anti-infanal drugs should be used in all patients with a diagnosis of stable IHS flowing with the attacks of angina.

With the occurrences of angina, despite the treatment and under certain clinical situations, invasive treatment is carried out, the doctor, a coronary surgeon and an invasive cardiologist take part in the choice of the patient's opinion.

The modern multicomponent strategy of the patient with chronic IBS makes it possible to achieve not only the improvement of the KZH, but also an increase in life expectancy, including without cardiovascular complications.

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The heart is one of the main organs of a person. This is our engine that works without rest, and if earlier, the faults in his work were observed in the elderly, then lately, the heart disease was significantly raised and are at the beginning of the list of life-threatening diseases.

Relevance. Despite the modern achievements of medicine, the last decade is characterized by the steady growth of cardiovascular diseases in the population. Atherosclerosis, coronary heart disease, hypertension and complications came out in the first place among the causes of morbidity, disability, disability and mortality in economically developed countries. In Russia, the annual mortality from cardiovascular causes exceeds one million people. Myocardial infarction develops in 0.9-1.4% of men aged 40-59, in men of the older age group - 2.1% per year. There is a steady increase in the incidence among young and middle-aged persons. Despite the decline in hospital mortality, the overall mortality from this disease remains high, reaching 40-60%. It should be noted that most of the fatal outcomes occurs at the pre-hospital stage.

Numerous epidemiological studies revealed a significant prevalence of arterial hypertension among the adult population. In the European Union countries, the number of patients with increased arterial pressure reaches 20-30%, in Russia - 30-40%. Arterial hypertension is one of the main risk factors for the formation of ischemic heart disease, brain stroke, heart failure. These circumstances determine the importance of introducing new achievements of cardiology into practical health care.

purposework- Examine the main modern principles for the treatment of ischemic heart disease.

1. Ishandhikingbole.zn.frome.rDCA

(IBS; Lat. morbus. ischaemicus. cORDIS from Dr. Greek. ? Accounts - "I delay, holding back" and b? MB - "Blood") --patological state characterized by an absolute or relative impairment of the blood supply to myocardium due to the defeat of the coronary arteries.

Ischemic heart disease is due to the disorder of the coronary blood circulation, the lesion of myocardium arising from the violation of the equilibrium between the coronary blood flow and the metabolic needs of the heart muscle. In other words, myocardia needs more oxygen than it comes with blood. IHD can be acute (in the form of myocardial infarction), as well as chronically (periodic attacks of angina).

IHD is a very common disease, one of the main causes of mortality, as well as the temporary and resistant loss of the working capacity of the population in developed countries of the world. In this regard, the problem of IBS takes one of the leading places among the most important medical problems of the XXI century.

In the 80s. There was a tendency to reduce mortality from IHD, but nevertheless in developed countries of Europe, it amounted to about half of the total mortality of the population while maintaining a significant non-uniformity of the distribution among the contingents of various sexes and age. In the USA in the 80s. Mortality of men at the age of 35-44 was about 60 per 100,000 population, and the ratio of dead men and women at this age was approximately 5: 1. By age of 65-74 years, the total mortality from the IBS of both sexes has reached more than 1600 per 100,000 population, and the ratio between the dead men and women of this age group decreased to 2: 1.

The fate of patients with IHD, which constitutes a substantial part of the contingent observed by doctors, largely depends on the adequacy of the outpatient treatment, from the quality and timeliness of the diagnosis of those clinical forms of the disease that require the provision of emergency care or urgent hospitalization.

According to statistics in Europe, IHD and a stroke of the brain define 90% of all diseases of the cardiovascular system, which characterizes IBS as one of the most common diseases.

1.1 Etiologyandpathogenesis

A number of factors contribute to the emergence of IBS. Among them, in the first place should be put a hypertensive disease, which is detected from 70% of patients with IHD. Hypertensive disease contributes to a more rapid development of atherosclerosis and spasm of coronary arteries of the heart. A predisposing factor in the occurrence of IBS is also diabetes mellitus, which contributes to the development of atherosclerosis due to the violation of the exchange of proteins and lipids. When smoking, spasm of coronary vessels develops, as well as rising blood clotting, which contributes to the occurrence of thrombosis of altered coronary vessels. Genetic factors have a certain meaning .. It has been established that if parents suffer from IBS, then their children have 4 times more often than those who are healthy. Hypercholesterolemia significantly increase the likelihood of the occurrence of IBS, since it is one of the important factors contributing to the development of atherosclerosis in general and coronary vessels in particular. In obesity, the IBS occurs several times more often than those with a normal body weight. In patients with obesity, the amount of cholesterol in the blood is increased, in addition, these patients lead a low-lived lifestyle, which also contributes to the development of atherosclerosis and IHD.

IHD is one of the most common diseases in industrialized countries. Over the past 30 years, the frequency of the occurrence of IBS increased by 2 times, which binds to mental overvoltage. In men, the IBS appears about 10 years earlier than women. Faculty of physical labor is becoming less likely than people of mental labor.

1.2 Pathologicalanatomy

Pathoanatomic changes depend on the degree of damage to the coronary vessels atherosclerosis. When angina, when there is no myocardial infarction, there are only small foci of cardiosclerosis. The defeat of at least 50% of the space of the lumen of one of the coronary vessels is necessary to develop angina. Angocardia is particularly hard, if two or three coronary vessels are affected at the same time. With myocardial infarction already in the first 5-6 hours after a painful attack, necrosis of muscle fibers occurs. After 8-10 days after myocardial infarction, a large number of newly formed capillaries appear. From this time, the connecting tissue is rapidly developing in the necrosis areas. From this point on, the scarring begins in the necrosis areas. After 3-4 months.

1.3 Symptomsandsignsischemicdiseaseshearts

The first signs of IHD, as a rule, become painful sensations - that is, the signs are purely subjective. The reason to appeal to the doctor should be any unpleasant feeling in the field of the heart, especially if it is unfamiliar to the patient. Suspicion of the IHD should occur in the patient and if the pain in the bladded region occurs during physical or emotional loads and go alone, have an attack.

The development of the CHD lasts for decades, during the progression of the disease, its shapes may vary and, accordingly, clinical manifestations and symptoms. Therefore, we will consider the most common symptoms of IBS. However, it should be noted that about one third of patients with IHDs may not even experience any symptoms of the disease, and not even know about its existence. The rest can be disturbed by such symptoms of IBS like pain in the chest, in the left hand, in the lower jaw, in the back, shortness of breath, nausea, excessive sweating, heartbeat or heart rate disorders.

As for the symptoms of such an IBS form as a sudden heartfelt death: a few days before the attack, a person appears the brediction of the unpleasant feeling behind the sternum, psycho-emotional disorders are often observed, fear of close death. Symptoms sudden heart death: loss of consciousness, stopping respiratory, no pulse on large arteries (sleepy and femur); lack of heart tones; Expansion of pupils; The appearance of a pale gray shade of the skin. During an attack, which often occurs at night in a dream, after 120 seconds after its start, the cells of the brain begin to die. After 4--6 minutes, irreversible changes in the central nervous system are occurring. After about 8--20 minutes, the heart stops and death occurs.

2. Classificationischemic heart disease

1.Sudden cardual death (Primary heart stop, coronary death) is the most severe, lightning clinical clinical version of the CHA. It is the IBS that causes 85--90% of all cases of sudden death. Only those cases of sudden cessation of cardiac activity include sudden cardiac death, when death comes with witnesses within an hour after the appearance of the first threatening symptoms. At the same time, before the death of patients, the condition of the patients was estimated as stable and non-concern.

Sudden heart death can be provoked by excessive physical or neuropsychiatric tension, how can it arise alone, for example, in a dream. Immediately before the onset of sudden cardiac death, approximately half of the patients, a pain attack is noted, which is often accompanied by the fear of close death. Most often, sudden heart death occurs in community-friendly conditions, which determines the most frequent lethal outcome of this form of the IBS.

2.Angina (Breast toad) is the most common form of CHA. Angina is an attacks of suddenly appearing and usually quickly disappearing pain in the chest. The duration of the attack of angina ranges from a few seconds to 10--15 minutes. The pain most often occurs during physical stress, for example, when walking. This is the so-called angina angina. Less often, it arises with mental work, after emotional overloads, when cooled, after abundant food, etc. Depending on the stage of the disease, the stainlessness of the stress is divided by first angina angina, stable angina (with an indication of the functional class from I to IV), progressive angina. With the further development of the IWS, the stress angina is complemented by resting the rest, in which pain attacks occur not only at a voltage, but also at rest, sometimes at night.

3.Infarction myocardia - the formidable disease in which the progress of the angina chase can go. This form of IHD is due to the acute insufficiency of the blood supply to myocardium, which is why there is a focus of necrosis, that is, the leaning of the fabric. The main reason for the development of myocardial infarction is a complete or almost complete blockage of the arteries of a thrombus or a swollen atherosclerotic plaque. With a complete blockage of the artery, the thrombus occurs the so-called large-scale (transmural) myocardial infarction. If the blockage of the artery is partial, then several smaller deaths are developing in myocardium, then they talk about the small-fought myocardial infarction.

Another form of manifestations of IBS is called post-infarction cardiosclerosis. Post-infarction cardiosclerosis occurs as a direct consequence of myocardial infarction.

Post-infarction cardiosclerosis - This is the defeat of the heart muscle, and often the heart valves, due to the development of scar tissue in the form of areas of various magnitude and prevalence that replace myocardium. A post-infarction cardiosclerosis is developing because the dead sections of the heart muscle are not restored, but are replaced by a scar cloth. Manifestations of cardiosclerosis are often becoming such conditions as heart failure and various arrhythmias.

The main manifestations of cardiosclerosis are signs of heart failure and arrhythmias. The most visible symptom of heart failure is a pathological shortness of breath, which occurs with minimal exercise, and sometimes even at rest. In addition, reinforced heartbeats, increased fatigue and swelling, caused by excessive fluid delay in the body can be signs of heart failure. Combining various types of arrhythmias symptom are the unpleasant sensations associated with the fact that the patient feels like his heart beats. At the same time, the heartbeat may be rapidly (tachycardia), regenerated (bradycardia), the heart can fight with interruptions, etc.

It should be recalled again that, ischemic illness develops in a patient for many years, and the earlier the correct diagnosis is made and the appropriate treatment has begun, the more sick chance of a full life in the future.

Cheerful ischemia Myocardia is the most unpleasant and dangerous variety of IBS, since, in contrast to the attacks of the angina, the episodes of nonsense ischemia proceeds imperceptibly for the patient. Therefore, 70% of cases of sudden cardiac death occur in patients with solemary myocardial ischemia. In addition, cheerful ischemia increases the risk of arrhythmias and stagnant heart failure. It can only be identified from a patient a hearty and a cardiologist using such research methods as long-term Halter monitoring, functional load tests, echocardiography. In case of timely examination and the correct diagnosis of the myocardial, solemn ischemia is successfully treated

3. Diagnosticsischemicdiseaseshearts

ischemic disease heart stroke

The correct diagnosis of ischemic heart disease is able to put only a cardiologist using modern diagnostic methods. Such a high percentage of death rate from the IBS in the 20th century is partly due to the fact that due to the abundance of various symptoms and frequent cases of the asymptomatic course of the IBS, the setting of the correct diagnosis was difficult. Nowadays, medicine has made a huge step forward in the methods of diagnosis of IBS.

Interview patient

Of course, any diagnosis begins with a patient's survey. The patient must be able to recall all the sensations in the heart of the heart, which he experiences and experienced earlier, determine whether they changed or for a long time remained unchanged, whether he had such symptoms as shortness of breath, dizziness, reinforced heartbeat, etc. In addition, the doctor must be interested in which diseases suffered a patient for life, what medications usually takes and much more.

Inspection patient

In case of inspection, the cardiologist listens to possible noises in the heart determines whether the patient has edema or sinushesity (symptoms of heart failure)

Laboratory research

During laboratory studies, cholesterol and blood sugar are determined, as well as enzymes that appear in the blood at heart attack and unstable angina.

Electrocardiogram

One of the main methods for the diagnosis of all cardiovascular diseases, including IHD, is electrocardiography. The method of registration of an electrocardiogram is widely used in cardiological diagnostics and is a mandatory step in the examination of the patient, regardless of the preliminary diagnosis. ECG is used and with a dispensary examination, with prophylactic medical examinations, with exercise samples (for example, on a cyergometer). As for the role of the ECG in the recognition of the IBS, this examination helps to detect deviations in the mode of operation of the heart muscle, which may be crucial for the diagnosis of IBS.

Holterovskoye monitoring ECG

Halter monitoring of an electrocardiogram is a long, more often daily registering ECG, which is carried out offline in the hospital or outpatient. At the same time, the conditions for conducting the survey should be as close as possible to the daily life of the patient, both at rest and during a variety of physical and psychological loads. This allows you to register not only the symptoms of IBS, but also the conditions, the causes of their occurrence (at rest, during load). Halter monitoring helps a cardiologist to determine, and the level of load at which the attack begins, after what time it ends, as well as reveal the attacks of the stenocardia of rest, which often occur at night. Thus, a reliable picture of a person's state is created for more or less long time, episodes of ischemia, heart rate disorders are revealed.

Load tests

Electrocardiographic load tests are also an indispensable method of diagnosing angina. The essence of the method is to register ECG during the patient's dosage exercise. In case of physical activity, the conditions requiring high myocardial security with oxygen are created individually: it is such conditions that will help identify the inconsistency between the metabolic needs of myocardium and the ability of the coronary arteries to provide sufficient blood supply to the heart. In addition, the Sample Samples with exercise can also be used to identify coronary failure in individuals who do not complaint, for example, during solemn myocardial ischemia. The most popular of them and the most commonly used can be considered a cyergometric sample, which allows you to accurately dose muscle work in a wide range of power.

Functional sample

In addition, functional samples that provoke spasm of the coronary artery are sometimes used to diagnose the IBS. This is a cold test and a sample with ergometrine. However, the first of them gives reliable results only in 15--20% of cases, and the second can be dangerous by the development of severe complications and therefore these methods applies only to specialized research institutions.

Ultrasonic study hearts. Ehoche

In recent years, an ultrasound examination of the heart became very common - echocardiography. EchoCG makes it possible to interpret the acoustic phenomena of the working heart, to obtain important diagnostic signs with most cardiac diseases, including with IHD. For example, Ehoche reveals the degree of violation of the function of the heart, changes in the size of the cavities, the condition of the heart valves. In some patients, the contrinity of myocardium is not determined at rest, but arise only in conditions of high load on myocardium. In these cases, stress echocardiography is used - the heart ultrasound technique in which myocardial ischemia is recorded, induced by various stress agents (for example, dosed by physical activity).

4. Modernmethodstreatmentischemicdiseaseshearts

CDP treatment, assumes the collaboration of the cardiologist and the patient immediately in several directions. First of all, you need to take care of changing the style of life. In addition, drug treatment is appointed, and if necessary, surgical treatment methods are used.

Changing the lifestyle and neutralization of risk factors include mandatory smoking, correction of cholesterol levels (with a diet or drugs), a decrease in body weight. The so-called "Mediterranean diet" is recommended for patients with "Mediterranean diet", which includes vegetables, fruits, light dishes from birds, fish and seafood.

A very important point of non-drug treatment of IBS is the struggle with a sedentary way of life by increasing the physical activity of the patient. Of course, an indispensable condition for the successful treatment of IBS is pre-treatment from hypertension or diabetes, if the development of IBS occurs against the background of these diseases.

The objectives of the treatment of ischemic heart disease are defined as an improvement in the quality of life of the patient, that is, a decrease in the severity of symptoms, preventing the development of such forms of IBS, as a myocardial infarction, unstable angina, sudden cardiac death, as well as an increase in the life expectancy of the patient. The initial relocation of the attack of angina is carried out with the help of nitroglycerin, which has a vasodilatory action. The rest of the drug treatment of ischemic heart disease is prescribed only a cardiologist, based on the objective picture of the disease. Among the drugs that are used in the treatment of IBS, drugs can be distinguished by drugs that contribute to the reduction of the need of myocardium in oxygen, an increase in the volume of the coronary channel, etc. However, the main task in the treatment of IBS is to free the overlap vessels - using medications is practically not solved (in particular, sclerotic plaques are practically not destroyed by medicines). In serious cases, the operation will be required.

Aspirin was considered a classic tool with a classic agent for many years, many cardiologists even recommend applying it prophylactically in small quantities (half / one fourth tablet per day).

The modern level of cardiology has a varied arsenal of medicines aimed at treating various forms of IBS. However, any medicines can only assign a cardiologist and can only be applied under the control of the doctor.

With more severe cases, IBS uses surgical treatment methods. Pretty good results shows coronary shunting, when the artery is blocked or a thrombus, the artery is replaced by an "artificial vessel", which takes on the conduct of blood flow. These operations are almost always performed on a non-working heart with artificial blood circulation, after shunting the patient accounts for a long time to restore from extensive operating injury. The shunting method has many contraindications, especially in patients with a weakened organism, but when the operation is successful, the results are usually good.

The most promising method of treating IBS is currently considered endovascular surgery (X-ray grower). The term "endovascular" is translated as "inside the vessel". This is a relatively young direction of medicine has already gained strong position in the treatment of IBS. All interventions are carried out without cuts, through punctures in the skin, under X-ray observation, for the operation of a fairly local anesthesia. All these features are most important in the sick, for whom, due to concomitant diseases, or due to the overall weakening of the body, traditional surgical intervention is contraindicated. From the methods of endovascular surgery, the IWC is most often used balloon angioplasty and stenting, which allow to restore the permeability in the arteries affected by ischemia. When using balloon angioplasty, a special cylinder is introduced into the vessel, and then he is inflated and "moves" at the side atherosclerotic plaques or blood clocks. After that, the so-called stent is introduced into the artery - the mesh tubular frame from the "medical" stainless steel or alloys of biologically inert metals, capable of independently expanding and maintaining a given vessel shape.

Treatment of ischemic heart disease, primarily depends on clinical form. For example, although stenasia and myocardial infarction uses some general principles of treatment, nevertheless, the treatment tactics, the selection of activity and specific drugs can differ dramatically. However, some general directions are allocated for all forms of IBS.

1. Limitation physical load.At physical activity, the load on myocardium increases, and as a result of this, the need of myocardium in oxygen and nutrients. If the myocardial blood supply is violated, this need is unsatisfied, which actually leads to the manifestations of IBS. Therefore, the most important component of treating any form of IBS is the restriction of physical exertion and gradual increases of it during rehabilitation.

2. Diet.With IHD, in order to reduce the load on myocardium in the diet, we limit the reception of water and sodium chloride (sodium salt). In addition, given the importance of atherosclerosis in the PAT Pathogenesis, much attention is paid to the restriction of products that contribute to the progression of atherosclerosis. An important component of treating IHD is the fight against obesity as a risk factor.

It should be limited, or if possible, refuse from the following groups of products.

· Animal fats (fat, butter, fatty meat varieties)

· Fried and smoked food.

· Products containing a large amount of salt (salted cabbage, salt fish, etc.)

· Restrict the reception of high-calorie food, especially fast suction carbohydrates. (chocolate, candy, cakes, dough).

To correct body weight, it is especially important to monitor the ratio of energy coming with eaten food, and energy consumption as a result of the body's activities. For a stable weight loss, the deficit should be at least 300 kilocalories daily. On average, a person who is not engaged in physical work in a day spends 2000--2500 kilocalories.

3. Pharmacotherapy for HebS. There are a number of groups of drugs that can be shown to use with one form or another CHD. In the US, there is a formula for treating IBS: "A-B-C". It implies the use of the triads of drugs, namely antiagregants, in-adrenoblockers and hypocholesterolemic drugs.

Also, in the presence of related hypertension, it is necessary to ensure the achievement of target levels of arterial pressure.

Antiagregants (a). Antiagregants prevent platelet aggregations and red blood cells, reduce their ability to gluing and sticking to the endothelium of blood vessels. Antiagregants facilitate the deformation of erythrocytes when passing through the capillaries, improve blood flow.

· Aspirin - accepted 1 time per day at a dose of 100 mg, with suspected development of myocardial infarction, a single dose can reach 500 mg.

· Clopidogrel - accepted 1 time per day 1 tablet 75 mg. Received within 9 months after the completion of endovascular interventions and AKSH.

B-adrenoblays (b). The extension of the action on B-ArenoPratems Adrenoblockers reduce the heart rate and, as a result, consumption of oxygen myocardium. Independent randomized studies confirm an increase in life expectancy in adrenoblator receptions and reducing the frequency of cardiovascular events, including repeated. Currently, it is inappropriate to use the preparation of Atenolol, since according to randomized research, it does not improve the forecast. B-adrenoblocators are contraindicated with accompanying light pathology, bronchial asthma, COPD. Below are the most popular in-adrenoblays with proven properties of improving forecast with IHD.

· Metoprolol (Betalok Zok, Betalki, Egilov, Methodographer, Vazocardin);

· Bisoprolol (Concorp, Coronal, Bisogamma, Biprol);

· Carvedilol (dilatrend, Talliton, Coriol).

- Statins and Fibrats (C). Cholesterol drugs are applied to reduce the rate of development of existing atherosclerotic plaques and preventing new ones. A positive effect on life expectancy has been proven, these drugs also reduce the frequency and severity of cardiovascular events. The target level of cholesterol in patients with IHD should be lower than those without IHD, and is 4.5 mmol / l. Target Level of LDL in patients with IBS - 2.5 mmol / l.

· Lovastatin;

· Simvastatin;

· Atorvastatin;

· Rosavastatin (the only drug, reliably reducing the size of atherosclerotic plaques);

Fibrats. The class of drugs that increase the anti-theaterogenic fraction of HDL, with a decrease in which mortality from IBS increases. Applied to the treatment of dyslipidemia IIA, IIB, III, IV, V. differ from the statins by the fact that they mainly reduce triglycerides (LPONP) and may increase the PLP fraction. Statins mainly reduce LDL and do not provide significant effect on LPONP and HDL. Therefore, for the maximum effective treatment of macrovascular complications, a combination of statins and fibrats is required. With the use of fenofibrate, the mortality from IBS decreases by 25%. From fibrats, only fenofibrate is safely combined with any classes of statins (FDA).

· Fenofibrat.

Other classes: Omega-3-polyunsaturated fatty acids (omakor). The CDC is used to reduce the phospholipid layer of the cardiomyocyte membrane. Restoring the structure of the omakor cardiomyocythic membrane restores the main (life) functions of the sedz cells - the conductivity and the reduction, which were violated as a result of myocardial ischemia.

Nitrates.There are nitrates for injecting administration.

Preparations of this group are derivatives of glycerol, triglycerides, diglycerides and monoglycerides. The mechanism of action lies in the influence of the nitro group (NO) on the contractile activity of the smooth muscles of the vessels. Nitrates mainly act on the venous wall, reducing the preload on myocardium (by expanding the vessels of the venous bed and blood deposition). The side effect of nitrate is to reduce blood pressure and headaches. Nitrates are not recommended for arterial pressure below 100/60 mm Hg. Art. In addition, it is currently reliably known that the reception of nitrates does not improve the prediction of patients with IBS, that is, does not lead to an increase in survival, and is currently used as a drug to relieve the symptoms of angina. Intravenous drip administration of nitroglycerin, allows you to effectively deal with angina phenomena, mainly against the background of high blood pressure numbers.

Nitrates exist both in injecting and in tablet forms.

· Nitroglycerin;

· Isosorbide mononitrate.

Anticoagulants.Anticoagulants inhibit the appearance of fibrin yarns, they impede the formation of thrombus, contribute to the cessation of the growth of the three-bodies that have already arisen, strengthen the effects of endogenous enzymes that destroy fibrin.

· Heparin (the mechanism of action is due to its ability to specifically bind to antithrombin III, which dramatically increases the inhibitory effect of the latter with respect to thrombin. As a result, the blood is folded slower).

Heparin is introduced under the skin of the abdomen or with the help of infusomat intravenously. Myocardial infarction is an indication for the purpose of the heparinocylactic thrombov, heparin is prescribed at a dose of 12,500 me, is introduced under the skin of the abdomen daily for 5-7 days. In the conditions of Orit, heparin is introduced by a patient with the help of infusoma. The instrumental criterion for the purpose of the heparin is the presence of depression of the S-T segment on the ECG, which indicates an acute process. This feature is important in terms of differential diagnostics, for example, in cases where the patient has ECG signs of previously occurring infarction.

Diuretics.Diuretic products are designed to reduce the load on myocardium by reducing the amount of circulating blood due to the accelerated removal of the fluid from the body.

Loop.Preparation "Furosemid" in tablet form.

Loop diuretics reduce the reabsorption of Na +, K +, Cl - in the thick ascending part of the loop of Genla, thereby reducing the reabsorption (reverse absorption) of water. They have a fairly pronounced rapid effect, usually apply as emergency preparations (for the implementation of forced diuresis).

The most common drug in this group is Furosemide (Laziks). There is in injecting and tablet forms.

Tiazid.Tiazide diuretic belong to Ca 2+ saving diuretics. Reducing the reabsorption of Na + and Cl - in the thick segment of the rising part of the loop of the gene and the initial separation of the dystal tube of nephron, thiazide drugs reduce urine reabsorption. With systematic reception of drugs of this group, the risk of cardiovascular complications is reduced in the presence of a concomitant hypertensive disease.

· Hypothiazide;

· Indapamide.

Inhibitorsangiotensin-turningenzyme.Acting on an angiotensin-converting enzyme (ACE), this group of drugs blocks the formation of angiotensin II from angiotensin I, thus preventing the implementation of angiotensin II effects, that is, leveling spasms of vessels. This ensures the maintenance of target figures of blood pressure. Preparations of this group have a nephro- and cardioprotective effect.

· Enalapril;

· Lysinopril;

· Captive.

Antiarrhythmicpreparations.Amyodaron preparation is available in tablet form.

· Amiodaron refers to the III group of antiarrhythmic drugs, has an integrated antiarrhythmic effect. This drug acts on Na + and K + channels of cardiomyocytes, and also blocks B - and B-adrenoreceptors. Thus, amiodaron has an anti-infanal and antiarrhythmic effect. According to randomized clinical studies, the drug increases the life expectancy of patients, regularly accepting it. When receiving tablet forms of amiodarone, the clinical effect is observed approximately 2-3 days. The maximum effect is achieved in 8-12 weeks. This is associated with a long period of semi-anniversary of the drug (2-3 months). In this regard, this drug is applied in the prevention of arrhythmias and is not a means of emergency.

Taking into account these properties of the drug, the following scheme of its application is recommended. During the saturation period (the first 7-15 days), amiodarone is prescribed in a daily dose of 10 mg / kg of patient weight in 2-3 reception. With the onset of a persistent antiarrhythmic effect, confirmed by the results of daily ECG-monitoring, the dose is gradually reduced by 200 mg every 5 days before the maintenance dose of 200 mg per day is reached.

Othersgroupsdrugs.

· Ethylmethylhydroxypyridine

Preparation "Mexidol" in tablet form. Metabolic cytoprotector, antioxidant-antihypoxant, which has a complex effect on key structures of cardiovascular diseases: anti-seaterosclerotic, anti-chemic, membrancial. Theoretically ethylmethylhydroxypyridine succinate has a significant positive effect, but at present, data on its clinical efficacy, based on independent randomized placebo-controlled studies, no.

· Mexicor;

· Coronaters;

· Trimetazidine.

4. Using antibiotics for HebS. There are results of clinical observations of the comparative efficiency of two different antibiotics and placebo courses in patients who entered the hospital or with acute myocardial infarction, or with unstable angina. Studies have shown the effectiveness of a number of antibiotics in the treatment of IBS. The effectiveness of this type of therapy pathogenetically not justified, and this technique is not included in the CHA treatment standards.

5. Endovascular coronoangioplasty. The use of endovascular (forcetable, transluminal) interventions (coronaugioplasty) is developing under various IBS forms. These interventions include balloon angioplasty and stenting under the control of coronary angiography. At the same time, the tools are introduced through one of the major arteries (in most cases the femoral artery is used), and the procedure is performed under control of x-ray. In many cases, such interventions help prevent the development or progression of myocardial infarction and avoid open operational intervention.

The individual area of \u200b\u200bcardiology is engaged in this direction of treatment of CDS - interventional cardiology.

6. Surgical treatment.

Conducts aorto-coronary shunting.

With certain parameters of coronary heart disease, testimony arise to coronary shunting - operation at which the blood supply to myocardium is improved by connecting the coronary vessels below their place of lesion with external vessels. The most famous aorticoronary shunting (AKSH), in which the aorta is connected to the coronary arteries segments. For this, autotransplants are often used as shunts (usually a large subcutaneous vein).

It is also possible to use balloon dilatation of vessels. Under this operation, the manipulator is introduced into the coronary vessels through the artery puncture (usually femoral or radial), and through a cylinder filled with a contrast agent, an extension of the vessel lumen is performed, the operation is, in fact, the burning of coronary vessels. Currently, "clean" balloon angioplasty without subsequent implantation of the stent is practically not used, due to low efficiency in the remote period.

7. Others non-drugs methods treatment

- Hirudotherapy.Hirudotherapy is a method of treatment based on the use of antiagregated properties of saliva leech. This method is alternative and did not take clinical trials for compliance with the requirements of evidence-based medicine. Currently, Russia is used relatively rarely, not included in the standards for providing medical care for IHD, it is applied, as a rule, at the request of patients. The potential positive effects of this method are concluded in the prevention of thrombosis. It is worth noting that in the treatment according to the approved standards, this task is performed using heparofilax.

- Methodshock-wavetherapy.The effect of low-power shock waves leads to myocardial revascularization.

An extracorporeal source of a focused acoustic wave allows you to remotely affect the heart, causing "therapeutic angiogenesis" (vesa formation) in the zone of myocardial ischemia. The impact of UVT has a double effect - short-term and long-term. First, the vessels are expanding, and the blood flow is improving. But the most important thing begins later - in the area of \u200b\u200bthe defeat, new vessels arise, which are already providing a long-term improvement.

Low-intensity shock waves cause shift voltage in the vascular wall. This stimulates the release of vascular growth factors, launching the growth process of new vessels, feeding the heart, improve myocardial microcirculation and reducing angina phenomena. The results of such treatment theoretically is to reduce the functional class of angina, an increase in the tolerance of physical activity, reducing the frequency of attacks and drug needs.

However, it should be noted that at present, adequate independent multicenter ranked studies assessing the effectiveness of this technique were not carried out. Studies referred to as evidence of the effectiveness of this technique are usually produced by the companies themselves manufacturers. Or do not correspond to the criteria of evidence-based medicine.

This method did not receive widespread in Russia due to dubious efficacy, high cost of equipment, and the absence of relevant specialists. In 2008, these method did not enter the IHD medical care standard, and the execution of data of manipulations was carried out on a contractual commercial basis, or in some cases under voluntary health insurance agreements.

- Usingstemcells.When using stem cells, the procedure performs calculate that polypotent stem cells introduced into the patient's body are differentiated into the missing cells of myocardium or the adventitization of vessels. It should be noted that stem cells actually have this ability, but at present the level of modern technologies does not allow differentiate polypotent cell into the cloth we need. The cell itself makes the choice of the differentiation path - and often not the one that is needed for the treatment of IBS.

This treatment method is promising, but so far the clinical approbation has not passed and does not meet the criteria of evidence-based medicine. The years of scientific research are required to ensure that the effect of patients from the administration of polypotent stem cells.

Currently, this method of treatment is not used in official medicine and is not included in the Assistance Standard for CHA.

- QuantumtherapyHebS.It is therapy by exposure to laser radiation. The effectiveness of this method has not been proven, an independent clinical study was conducted.

Posted on Allbest.ru.

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Heart Ischemia - Basic Information

Doctors allocate the following forms of ischemia:

Myocardial Cheese Ischemia (Bim) There arises in patients with a high pain threshold. It develops due to severe physical work, excessive use of alcoholic beverages. No disease is not accompanied by pain. Characteristic symptoms: discomfort in the chest, the increase in heartbeat, hypotension, the weakness of the left hand, shortness of breath, etc.
Sudden coronary death. The heart stops after an attack or a few hours after it. After coronary death, successful resuscitation or lethal exodus follows. The heart stops due to obesity, smoking, arterial hypertension. The main reason is the flicker of ventricles.
Stenzardia is an IBS form (ischemic heart disease), which manifests itself compressing pain in the chest, discomfort, heartburn, intestinal spasms, nausea. Breast pain irradiates in the neck, the left upper limb, and sometimes in the jaw or back from the same side. These symptoms appear after exercise, food or increase pressure. The attack occurs against the background of stress or supercooling. To relieve the attack, which lasts about 15 minutes, refuse to physically loads or take nitrate-containing gear-action drugs (nitroglycerin).
Myocardial infarction Arises against the background of strong emotional experience or physical overvoltage due to the cessation of blood flow to the heart department. The attack can last a few hours. Cholesterol plaques on the walls of the vessel are destroyed, form a clutch, which clogs the clearance of the vessel and provokes hypoxia. A characteristic symptom - the pain in the chest, which does not disappear after the nitroglycerin acceptance, is accompanied by nausea, attacks of vomiting, difficulty breathing, spasms in the abdomen. Fully absent signs can have diabetics.
With cardiomyocytes (heart cells), the cardiomyocytes (heart cells) die and replace the scar cloth, which does not participate in the reduction of the heart. As a result, the sections of the heart increase, the valves are deformed, the blood circulation is broken and the functional insufficiency of the heart occurs.

With ischemia, the heart suffers from oxygen starvation

Thus, the disease is accompanied by pain in the chest, shortness of breath, female heartings, malaise (weakness, vertigo, pre-corrupt state, excessive sweat, nausea with vomiting). In addition, during an attack, the patient feels strong pressure or burning in the chest area, anxiety, panic.

Heart Ischemia may occur as a result of atherosclerosis, improper nutrition, smoking, alcohol abuse. The pathology provokes a passive lifestyle or intensive physical exertion, overweight, diabetes mellitus.

Diagram of drug treatment

The CHA treatment scheme is selected depending on the clinical picture for each patient individually. Comprehensive therapy consists of the following items:

treatment without medication;
medication therapy;
endovascular coronaohangioplasty (minimally invasive procedure in the area of \u200b\u200bmyocardial vessels);
other ways of therapy.

For the treatment of IBS, antiagregants, statins, angiotensin II receptor anthiotensin receptors and other drugs are used

The question of what measures to take in each case, solves a cardiologist.

Comprehensive therapy stops the development of the disease, softens negative symptoms, increases the duration and quality of the patient's life.

Doctors identify medicines from coronary heart disease, which improve the forecast:

Antiagregants are medicines that reduce thrombosis due to the oppression of aggregation (gluing) platelets.
Statins reduce cholesterol production in the liver, due to which its concentration is reduced in the bloodstream.
Anthogonists of the renin-angiotensin-aldosterone system warn arterial hypertension.

For symptomatic treatment, β-adreneroblasts, inhibitors of the IF channels of the sinus node, block plates of slow calcium channels, opener of potassium channels are used. In addition, nitrates and hypotensive agents are actively used to eliminate symptoms.

As mentioned earlier, the patient must take drugs against ischemia throughout life. The decision on the appointment of medication, the replacement of the drug and the change in the dosage takes a cardiologist. However, full-fledged treatment includes a diet, moderate physical activity, normalization of the sleep mode and rejection of bad habits.

Antitrombocytic drugs

Medical preparations that dilute blood due to the reduction of its consumption are called antiagregants (antithrombocytic drugs). These means are preventing gluing (aggregation) of thrombicitis and red blood cells, reduce the likelihood of blood clots in vessels.

Aspirin prevents thrombosis

Antiagregants are used for the complex therapy of heart ischemia:

Acetylsalicylic acid (aspirin) is a basic means for preventing thrombosis. The drug is contraindicated in ulcerative diseases and diseases of the blood-forming organs. Medication is effective, relatively safe and inexpensive. In order to avoid adverse reactions, the rules of receipt of the drug should be followed.
Clopidogrel acts similarly to aspirin, medication is used in hypersensitivity to components of acetylsalicylic acid.
Warfarin contributes to the destruction of blood clots, maintains blood consumption level. Tablets are prescribed only after complete diagnosis and with a systematic study of blood on MNO (indicator reflecting the velocity of the formation of a thrombus). This is necessary, since the drug can provoke hemorrhage.

Antiagregants apply only for medical reasons.

Lipid-related drugs

Patients must control the level of cholesterol in the blood, doctors refer to the norm of the following numbers:

Common cholesterol is about 5 mmol / l.
Low density lipoproteins (main cholesterol carriers) - 3 mmol / l.
High density lipoproteins (connections that carry fats in the recreation liver) - 1 mmol / l.

Statins reduce blood cholesterol

In addition, it is worth paying attention to the atherogenic coefficient (the degree of risk of occurrence) and the level of neutral fats. In severe cases, when the main disease is accompanied by diabetes, these values \u200b\u200bmust be constantly monitored.

To achieve these goals, the patient must adhere to the diet and take special drugs. Only integrated treatment guarantees a good and persistent therapeutic effect.

Statins are used to reduce cholesterol concentration under ischemia: rosevastatin, atorvastatin, simvastatin, etc., the appointment of medicines is engaged in the attending physician.

Angiotensin II receptor antagonists

The list of medicines under ischemia includes medicines that normalize blood pressure. Arterial hypertension negatively affects the state of myocardial vessels. In the absence of treatment of hypertension, the likelihood of progression of ischemia, the development of stroke, chronic functional insufficiency of the heart increases.

Angiotensin receptor inhibitors reduce pressure

Inhibitors of angiotensin receptors are medicines that block the angiotensin-2 receptors (enzyme localizing in heart fabrics), they reduce blood pressure, prevent hypertrophy (increasing the volume and mass of the organ) or a decrease in the heart. Similar funds are taken for a long time under medical control.

Inhibitors of angiotensin glider enzyme (IAPF) block the activities of angiotensin-II, due to which the pressure increases. The enzyme negatively affects the muscular fabric of the heart and blood vessels. The patient's condition is improving when it applies the following means from the ACE group:

Leased
Perindopril
Enalapril,
Ramipril.

For the treatment of heap ischemia, angiotensin-II receptor blockers are used: Lozartan, Kandesartan, Telmisarthane, etc.

Application of β-adrenoblockers

Beta-adrenoblays (Bab) have a beneficial effect on the functionality of the heart. Babs normalize heart rhythm and stabilize blood pressure. They are prescribed during arrhythmias as a stress hormone blockers. Preparations from this group eliminate signs of angina. Doctors prescribe β-adrenobral patients after a heart attack.

Babs normalize the work of the heart and eliminate the symptoms of angina

For the treatment of heap ischemia, the following women apply:

Oxprenolol,
Supolyab
Propranolol,
Bisoprolol,
Metoprolol,
Nebivolol, etc.

Before use of the drug, it is worth consulting with the doctor.

Calcium channel blockers

Medical treatment of heart ischemia is carried out with the use of funds that block L-type calcium channels. They are intended to prevent angina attacks. Calcium antagonists will stop the symptoms of arrhythmias, reducing the frequency of myocardial cut. In most cases, these medicines are used to prevent ischemia, as well as at the stenasa of rest.

Calcium antagonists eliminate the signs of arrhythmia

The most effective drugs include the following:

Parotale-Amlo,
Diltiazere retard
Nifedipine.

In order to avoid adverse reactions, medicines take only medical testimony.

Nitrates against IBS

With the help of nitrates and nitrate-like tools eliminate the symptoms of angina and prevent complications of acute ischemic heart disease. Nitrates stop pain, expand myocardial vessels, reduce blood flow to the heart, which is why the organ needs oxygen.

Nitroglycerin bows pain and expands coronary vessels

The following medicines are prescribed at IHD:

Nitroglycerin in the form of sublingual (under the tongue) tablets and droplets for conducting inhalations.
Ointment, disk or nitroglycerin plaster.
Isosorbit Dinitrate.
Isosorbita mononitrate.
Mononitrate.

Molomine is used for hypersensitivity to nitrates.

Hypotensive means

Preparations from this group reduce increased blood pressure. Such an effect has drugs from different pharmacological classes with a different mechanism of action.

Diuretics, Bab, Calcium Channel Blockers, IAPF will help reduce pressure under ischemia

Hypotensive drugs under heart ischemia include diuretic products (diuretics). These medicines lower pressure and in a higher dosage remove extra tissue from the body. Effective diuretics - Furosemid, Laziks.

As mentioned earlier, β-adrenoblays, calcium channel blockers, IAPFs have a hypotensive effect:

Cilascrop
Captop
Koexispril,
QuinaPril,
Perindopril
Cilaproke.

It is categorically not recommended to prescribe drugs.

Other medicines

The inhibitor of the IF channels of the sinus node called Ivabradin reduces the heart rate, but does not affect the reduction of the heart muscle and blood pressure. The drug is used for treatment with hypersensitivity to β-adrenoblockers. Sometimes these medicines are prescribed together to improve the disease forecast.

In comprehensive treatment, Ivabradin and Nicoradil are used

Nicoradil's potassium channels operate contributes to the expansion of myocardial vessels, prevents the formation of cholesterol plaques. The drug does not affect heart rhythm and blood pressure. It is used for cardiac syndrome X (microscillic angina). Nicorandil warns and eliminates the symptoms of the disease.

Treatment of angina prinmethala

This shape of angina is manifested by pain, pressure, burning in the chest even at rest. Such symptoms arise due to spasms of vessels that transport blood to myocardium. The clearance of the coronary vessel is narrowed, and the blood is hard to go to the heart.

Symptoms of angina printelae manifest even in calm state

To prevent attacks, calcium channel blockers are taken. During the exacerbation of the disease, nitroglycerin and long-term nitrates are prescribed. In some cases, calcium channel blockers and β-adrenoblays are combined. In addition to receiving medicines, it is recommended to avoid smoking, stressful states, supercooling.

Microsievous angina

The disease is manifested in breasts without structural changes in myocardial vessels. Diabetics or hypertensive suffer from microvascular angina. If there are pathological processes in the microvascular system of the heart, doctors prescribe the following drugs:

Statins,
Antiagregants
ACE inhibitors,
Ranolazine.

Most often, hypertensive and diabetics suffer from microvascular angina

To stop painful sensations, β-adrenoblays, calcium antagonists, prolonged nitrates are taken.

Medicines for emergency care for heart ischemia

With IHD, it is primarily necessary to stop painful sensations, for this purpose the following drugs are used:

Nitroglycerin quickly eliminates the pain in the chest, for this reason it is often prescribed to provide emergency care. If necessary, the drug can be replaced with smell or nitrolling, only a single dose of medication is used. During the reception of drugs, it is better to sit down, otherwise there is a possibility of losing consciousness against the background of a sharp decline in pressure.
At the first symptoms of the attack, the ambulance brigade should be called. During the waiting for doctors, the victim takes Aspirin, Barallgin, Analgin. Tablet is pre-crushed.
Medications are recommended to take no more than 3 times with a small gap. This is explained by the fact that many of them show a hypotonic effect.

The attending physician consults on the issue of selection of drugs for emergency care.

In the event of symptoms of heart ischemia, it is necessary to take potassium-containing drugs (for example, Panangin).

Preventive measures

The prevention of ischemic disease is to comply with the following rules:

The patient must refuse cigarettes and alcoholic beverages.
It is necessary to eat properly, the daily diet should include vegetables, fruits, cereals, lean meat, marine products (including fish).
It is necessary to use products as often as possible, which are sources of magnesium and potassium.
It is important to exclude fatty, fried dishes, smoked products, marinates and consume the minimum amount of salt.
It should be given preference to products with a minimum amount of low density lipoproteins.
Moderate exercise improves the overall condition of the patient. For this reason, it is recommended to make hiking daily, doing charging. You can go swimming, running or cycling.
Hardening the body is also not contraindicated. The main thing is to consult a doctor with a doctor who will tell about contraindications and explain the rules of safe hardening.
It should sleep at least 7 hours per day.

Observing these rules, you will improve the quality of life and minimize negative factors that provoke heart achemia.

Thus, the treatment of ischemic disease should be comprehensive. Medications with IHD appoints exclusively cardiologist and only after careful diagnosis. Medicines for ischemia are accepted for life. Do not stop treatment, even with improved state, otherwise the likelihood of the next attack of angina, heart attack or heart stop is increasing.

I will say right about applied further in the text of the reduction of IBS. This is an abbreviated name of coronary heart disease. This dangerous disease is acute or chronic heart dysfunction. Disease occurs due to violation of vessels, which should pass the blood flow and oxygen directly to the heart muscle.

However, if thrombus (atherosclerotic plaques) are formed in the cavity of the vessels, their narrowing occurs, the blood flow is disturbed. This is a narrowing, blockage of the body of the vessel, Tromb called ischemia.

In addition to sclerotic plaques, the spasm of the vessels can break the blood flow. This happens with a strong, sudden stress, the pathological change in the psycho-emotional state of the patient.

Modern medicine has many ways to treat this pathology, which are widely used with varying degrees of efficiency. Let's talk today about the signs of IWC. Modern treatment, methods of therapy Briefly consider:

Symptoms of ischemia

IBS - usually develops in the second half of life, more often after 50 years. Symptoms usually appear after exercise and manifest as follows:

There are signs of angina (pain in the chest).
- There is a sense of insufficiency of inhaled air, the breath itself is difficult.
- A sudden stopping of blood circulation due to pathologically frequent reduction of the heart muscle (more than 300 reductions per minute), with all the ensuing consequences.

Even after reading the symptoms of IBS, you need to know that some patients do not feel any signs of this dangerous disease, even with a heart attack.

Modern treatment of ischemic disease

IBS therapy is carried out in several directions:

Medicia treatment: Special preparations are used to reduce the attacks of the disease, its intensity and frequency. Drugs are designed to strengthen the heart, enhancing the crossings of coronary vessels. Usually drug therapy is used to treat ischemia in the early stages, when the drugs are most effective.

Surgery: With the help of surgical intervention, IBS is treated with acute flow when it is necessary and most efficient. The operation is carried out to stabilize the patient's condition, examine, take analyzes, prepare for surgical intervention. The operation is a stenting or aorto-coronary shunting, which involve the extension of the lumen of the vessels, eliminating the obstacle and stimulating the necessary blood flow to the heart muscle.

Excessive heart treatment and vessels:

Unfortunately, medical therapy is not always effective, and the aortocortonary shunting (surgical operation) for some reason cannot be carried out. Therefore, patients should know that modern non-invasive treatment methods have been developed that help to deal with ischemia without a heavy operation. Here are some methods of non-operational therapy:

Shock-wave therapy. This modern method of treatment of IBS implies the use of a shock wave generator, which is specifically designed to take into account the clinical and anatomical features of the chest. Shock-wave therapy will cause several courses. As a result of treatment, angina decreases, the frequency, the soreness of the attacks is reduced, the need for a frequent intake of drugs is disappeared.

UNKP (external counterpulcation). This modern method is intended for the treatment of CHD, angina, heart failure. It is often carried out with insufficient effectiveness of drug therapy. UNCP is recommended for patients with severe concomitant diseases, such as diabetes mellitus. Treatment can be carried out outpatient.

The result of treatment becomes a decrease in the class of angina, the frequency and severity of attacks decreases, the need for drugs is reduced. After treatment, there are practically no side effects and complications.

Gravitational. This method implies the use of a physiotherapeutic factor of high gravity. The treatment is shown for therapeutic, orthopedic and surgical profiles, is the newest medical methodology. In the process of treatment, an enhanced muscular load on the lower limbs is reinforced.

As a result, a reinforced blood flow is achieved, collateral blood circulation is enhanced, the process of the development of ischemia is stopped, metabolism improves. This method is very well tolerated by patients, effective and improves the quality of drug treatment.

Stem cells. The new method of treating IBS is the use of own stem cells of the patient. This treatment is assigned after a thorough examination, which will confirm the effectiveness of cellular treatment in each case.

The need to apply a particular treatment method is determined by the attending physician, taking into account the data of the surveys conducted, the severity of the patient's condition, its age and other indicators.

Remember that the IBS is a very dangerous disease, the treatment of which does not require deposctions. Therefore, in the presence of symptoms, with painful sensations in the chest, immediately consult a doctor -cadeistologist. Be healthy!

According to modern classification, the IBS includes sudden death, angina and myocardial infarction. But this section will only be considered by IWC in the manifestations of angina. This is a heart disease group (especially ischemic and coronary failure) arising from the violation of blood flow to myocardium due to the narrowing of the coronary

Term "ischemia" There was a combination of Greek words LH / Yu, which means "delay, stop", and NTTA - "Blood". At the same time, blood supply is broken in any section of the heart, the discrepancy between the needs of the heart (myocardium) in oxygen and the level of heartflow and incoming oxygen appears. This condition can be acute and chronic, to be temporary (reversible) and irreversible.

As a result of long, irreversible changes in the myocardial portion, cardiac cells are damaged and dying. It is manifested when the narrowing of coronary vessels reaches 50%. If the narrowing approaches 70-80%, there are pronounced seizures of angina. In addition to atherosclerosis of the coronary arteries, a number of factors are in the emergence of IBS - the state of the vessels and the number of chemicals, which produce the inner walls of blood vessels.

Atherosclerosis - This is a chronic disease in which the defeat of the arteries occurs. It is expressed in the fact that in the inner wall of the vessel, fats and calcium salts are deposited, the rebirth of the muscular fabric is developing into the connecting. As a result, the vessel wall is compacted, its narrowing occurs, the blood flow is disturbed. This causes adverse changes in the organs, which leads to various diseases. Atherosclerosis is one of the most common contemporary diseases. Its prevalence is great among the inhabitants of Europe, North America, and in the countries of the East, in Africa, South America, it occurs much less frequently.

Men sick more often than women, and atherosclerosis, they arise about 10 years earlier. Such a difference is due to lifestyle, genetic features, hormonal factors. Over the past decades, mortality from IBA has significantly increased, the reason for which atherosclerosis appeared. The occurrence of atherosclerosis is due to a combination of many factors that bear the name of risk factors. These include: arterial hypertension, smoking, long-term emotional loads, metabolism of metabolism in the body.

The mechanism of the occurrence of atherosclerosis: the inner casing of the vessel is damaged, platelets are rushed into place of damage, they settled there, coated with a connective tissue with subsequent addition of lipids. Cholesterol is one of several residential-like compounds found in the blood and tissues of a person. It is generated by liver cells. Cholesterol exists in the body in several types. One of them is high density compounds. This part is very important, as it protects the body from atherosclerosis, makes cholesterol from the tissues of the body and the walls of the arteries, returns it to the liver to reuse or remove it from the body. Another part of cholesterol - low density compounds. It is she who plays a role in the formation of plaques and the development of atherosclerosis.

Gradually, the process is progressing, cracks, ulcers are formed on plaques, and swarms are formed on their surfaces. They close the clearance of the arteries. Thrombosis occurs. The most terrible complication in this is a tomb of thromba. There are more than 30 factors that contribute to the emergence of IBS, it is an increase in blood pressure, an increase in blood cholesterol, smoking, a sedentary lifestyle, frequent use of alcohol, heredity (the presence of diseases of the cardiovascular system in close relatives), belonging to Male floor, an objective process of aging of the body, overwork, non-regulation of labor and recreation, irrational nutrition, stressful situations.

Stress in our days, many times increases the risk of EBS. In stress conditions, the human body produces so-called stress hormones. In the process of this, a large amount of vitamins and nutrients is spent. It is also very important to change the composition of blood - accelerating blood coagulation, which leads to the gluing platelets and ultimately to the formation of plaques and thrombus.

Clinical manifestations

Angina - The most important and common manifestation of IBS. This common disease, the main symptom of which is pain behind the sternum or compressive nature. Pain applies, gives to the left hand, shoulder, shovel, often in the neck and lower jaw. Stenokard attack can manifest itself in the form of discomfort in breasts - burning, gravity, cutting. A characteristic symptom for angina is the appearance of the pain behind the sternum when the patient is out of the warm room in the cold. Often the deterioration is observed in the autumn-winter period, with a change in atmospheric pressure. Pain occurs during exercise (in the initial stages of the disease - the so-called angina stress) and stops alone or after taking nitroglycerin. With the excitement of pain appear out of physical voltage.

Pain attacks may arise at night, after eating, when the abdomen and the high position of the diaphragm. The duration of the attack of angina is almost always more than 1 minute and less than 15 minutes. Its duration depends on the behavior of the patient. If you stop physical load and adopt nitroglycerin, the attack will be shorter and less intense. One of the signs of angina is that the pain is intensified in the lying position and decreases when the patient sits or stands. This is because in the position lying intensifies the influx of venous blood to heart and myocardium requires more oxygen. The strength of the attack is different. At this time, the pulse is usually slow, rhythmic, but sometimes it can be accelerated (tachycardia), arterial pressure can also be improved. The attacks can be rare (once a week or less), may not be repeated for several months or, on the contrary, becoming increasingly frequent and long.

In diagnosis IBS A patient asked very important, finding out the causes of the disease, an electrocardiographic study, which is repeated repeatedly, samples with dosage physical activity (cyerurgomegriya), drug samples. One of the modern methods carried out in cardiology hospitals is a radiographic study of the blood vessels, that is, the introduction of a substance in the blood, thanks to which it is possible to see the heart and large vessels and determine the nature, place of defeat, the prevalence of the process. This method is called "Coronoangiography".

Treatment

Traditional

Treatment IBS - This is a comprehensive program. It includes the methods of traditional therapy appointed by therapists and cardiologists, and methods of non-traditional, traditional medicine. The obligatory component of treatment is the fight against risk factors. It is necessary to normalize the lifestyle of the patient, eliminate hypodynamine, eliminate bad habits, adhere to a certain power mode, try to avoid unrest and emotional overloads.

Medical nutrition

The list of products needed by patients with this disease must necessarily include raisins, honey, nuts of any species, raw pumpkin, pumpkin seeds, sea cabbage, cottage cheese, strawberries. Peas, soybean, soybean oil and flour, eggplants, lemons and oranges with zest, rosehip in the form of a drink, gooseberry, cranberries. The content of proteins, fats and carbohydrates should relate as 1: 1: 4. With excess body, it is important to reduce the calorie food. It is necessary to exclude fatty meat from the diet (especially mutton and pork), solid margarine, butter, replacing it with vegetable, i.e. it is necessary to reduce the content of saturated fatty acids in used products, which are rich in animal fats, contributing to the formation of cholesterol, and increase The number of fats of plant origin. In addition, it is necessary to provide the body with an increased amount of vitamins and trace elements.

Drug therapy includes two main groups of drugs. This is, firstly, nitroglycerin and its derivatives longer action (they remove spasm and expand the coronary vessels, due to which blood access and oxygen is facilitated). Another group is drugs that contribute to improving blood composition (in this case, reducing clotting and preventing blood clots). The simplest preparation of them is aspirin (acetylsalicylic acid), assigned by a specific scheme. In addition, in some cases, medications are recommended that reduce cholesterol formations in the blood and inhibiting its absorption in the intestine. Also used drugs that accelerate metabolism and elimination of lipids from the body.

Very useful is the purpose of vitamins E and R. more appropriately, their combination with ascorbic acid. It must be remembered that all pharmacological preparations must appoint a doctor. Self-treatment with these means is unacceptable. In addition to the above funds, in the treatment and rehabilitation of patients with IBS, physical training is very important. In the initial manifestations of the disease, running, swimming, skiing, bike, i.e. physical exertion of cyclic type.

They should be carried out during periods outside the exacerbation of the disease. With more severe forms of IBS, physical exertion is recommended as complexes of therapeutic gymnastics. The complex for therapeutic physical education should be selected by the physical physical physician with the heart of the patient. Classes are asked by the instructor on therapeutic physical education by the group method in a hospital or polyclinic under the control of the doctor. It is necessary to measure the pulse before, during and after classes. Usually, these complexes include exercises in the initial position standing, sitting (for patients older than 50 years), walking, exercises for the upper and lower limbs using a gymnastic stick, breathing exercises and squeezing. Exercises are performed at a slow pace, smoothly, with a small amplitude of movements.

As a "unloading" of the work of the heart you need to use self-massage limbs. This is carried out in order to relieve 01 Oka blood from the periphery to the center. The most simple techniques of massage: stroking, rubbing, kneading. After a certain course of therapeutic physical education in the LPU, the patient can independently perform these exercises at home. In the treatment of patients with IHD, it is impossible to forget about the use of physical factors (methods of hardware physiotherapy). The type of physiotherapeutic treatment is selected by a physiotherapist.

In the absence of contraindications (such as progressive angina, resistant pain syndrome, roasting angina, an increase in blood pressure, the presence of arrhythmias) used balneotherapy sessions - carbon dioxide, radon, chloride and uodobromic healing baths. In patients with more pronounced angina, these impacts are applied gentle - in the form of four-chamber baths. Good soothing effect give an "electrosone", galvanic collar, electrophoresis of painkillers and sedatives.

In the absence of contraindications, you can use combinations of therapeutic baths and hardware physiotherapy. In specialized cardiological clinics and hospitals, laser therapy method of various types of laser radiation is widely used.

Phytotherapy

Requires: 2 tbsp. l. Rosehip fruits, 350 ml vodka.

Cooking method.

Rosehip fruits finely exterminate, pour into a glass bottle with a capacity of 0.5 liters, pour vodka. Insist in a place protected from light 2 weeks, shake daily.

Mode of application.

Take 20 drops on a piece of sugar 3 times a day, regardless of meals.

Requires: 5 g of fresh shine roots.

Cooking method.

Crumpled roots Khrena pour in thermos 1 glass of boiling water, insist for 2 hours. You can not polish.

Mode of application.

We use infusion for inhalations.

Requires: 1 tsp. Straight flowers.

Cooking method.

Flowers of nettles pour 1 glass of boiling water.

Mode of application.

Take 0.5 glasses 2 times a day: in the morning on an empty stomach and in the evening before bedtime.

Requires: 1 part of the leaf of coltsfoot, 2 pieces of vegetable dill fruits. The herbs of the jaundice, tongue flowers of sunflower, 1 l of steep boiling water.

Cooking method.

All components mix thoroughly, grind. 1 tbsp. l. The obtained collection is pouring steep boiling water, insist for 1 hour. It is obtained to strain, raw materials.

Mode of application.

Take 1/2 cup 5-6 times a day for a month, regardless of meals.

Requires: In 40 g of grass, a lovery of medicinal, crushed corn roots, 1 liters of boiled water.

Cooking method.

Ingredients mix, crush. 2 tbsp. l. The obtained collection is pouring with boiled water, bring to a boil, boil 7-8 minutes, pour into thermos and insist 40 minutes. The resulting decoction to strain, squeeze raw materials.

Mode of application.

Take 1/2 cup 3 times a day 30 minutes after receiving write. Conduct 3 courses to 7 days with a five-day interval.

Requires: 1 part of the layer of laminaria sharacte, 2 pieces of cornflowers, grass horsetail, Rosyanka grass, 1 liter of boiling water.

Cooking method.

Ingredients mix thoroughly, crushing. 3 tbsp. l. Put the obtained collection in enameled dishes, pour 1 liter of boiling water. Put on a water bath and bring to a boil. Boil for 1 min. Pour to thermos, insist 1 hour. It is obtained to strain, pour raw materials.

Mode of application.

Take 1/2 cup 6 times a day, preferably after meals, for 2 weeks.

Requires: In 20 g of flowers, the vasilka blue, kidney of birch, crushed rhizomes with the roots of nine-sided, cornflowers, leaf of tocheries, buckwheat flowers sowing. 1 cup of steep boiling water.

Cooking method.

All ingredients mix thoroughly, crushing. 2 tbsp. L, fenced to the enameled dishes, pour 1 glass of boiling water, put on a water bath, bring to a boil. Adjust to cool. The resulting decoction to strain, squeeze raw materials, bring to the original volume with boiled water.

Mode of application.

Take 1/2 cup 2 times a day 30 minutes before meals. It is not recommended to use for the night.

Requires: 1 parts of the root of a century tea, linden flowers. Fruit of raspberry, linen ground seed, 2 glasses of steep boiling water.

Cooking method.

All ingredients mix thoroughly, crushing. 4 tbsp. l. Put the received collection into enameled dishes, pour boiling water, put on a water bath and keep 30 minutes. Adjust to cool. The resulting decoction to strain, squeeze raw materials, bring to boiled water to the original volume.

Mode of application.

Take 1 cup 2 times a day directly 5-7 minutes before receiving write. Apply within a month. With insufficient effectiveness, the course is repeated after a two-week break.

Requires: 20 g of grass horseways, 30 g Highlander Highlander (Speech), 50 g of hawthorn flowers, 1 cup of steep boiling water.

Cooking method.

Grinded raw materials mix. 2 tbsp. l. Calculate boiling water. Stir, insist before cooling. Folded to strain, raw materials.

Mode of application.

Drink during the day.

Requires: 2 tbsp. l. The crushed root of the roast of garden, 1 cup of honey, 1 cup of freshly prepared carrot juice, 1 glass of boiled water.

Cooking method.

Had to pour water and leave for a day. Add honey and carrot juice. Mix. Store in a cold place.

Mode of application.

Take 1 tbsp. l. An empty stomach is 1 hour before meals or 1.5-2 hours after meals.

Requires: 2 tbsp. l. Shredden roots of blue blue.

Cooking method.

Pour raw materials 100 ml of boiling water, keep 10 minutes on low heat. Insist for 15 minutes, then strain and bring to the initial volume with boiled water.

Mode of application.

Take 1 st, l. 5 times a day after meals. Last time to take overnight.

Requires: 20 g leaves strawberries.

Cooking method.

Pour the raw material with 1 cup boiling water, boil for 10 minutes, then insist 2 hours, strain, leaves, bring to the original volume with boiled water.

Mode of application.

Take 1 tbsp. l. 3-4 times a day, regardless of meals.

Requires: 50 g garlic, 1 cup of vodka.

Cooking method.

Garlic crushed, pour vodka, insist in warm place for 3 days.

Mode of application.

Take 3 times a day at 8-10 drops of 1 tsp. Cold boiled water 3 times a day, regardless of meals.

Requires: 350 g of garlic, 200 ml of medical alcohol fortress 96%.

Cooking method.

Peeled garlic finely chopped and rub in a wooden spoon in a container. Take the bottom of 200 g of this mass together with the juice obtained, put into the vessel of glass, pour alcohol, tightly wait. The resulting tincture is not in the refrigerator no more than 12 days.

Mode of application.

Take 20 minutes before meals, pre-mixing with 1/4 cup of cold milk, within 10 days according to the following scheme: in the 1st day 1 drop in the morning, 2 drops at lunch, 3 drops before dinner. In the 2nd, 3rd, 4th and 5th day, add 3 drops to the reception. From the 6th to the 10th day, subsidize 3 drops to the reception.

Requires: 1 tsp. Leaf of mistletoe white, 2 tbsp. l, buckwheat flowers, 1 glass of boiling water.

Cooking method.

1 tsp. Pumps up boiling water, put on the night in a warm place, to strain in the morning.

Mode of application.

Take 2 tbsp. l. 20 minutes before meals 3 times a day.

Treatment of IBS by folk remedies: feature of the disease and methods of its treatment

Today, cases of heart disease are increasingly registered. And one of the most common is ischemic heart disease, which, with inadequate treatment, and at low-rise detection can lead to a fatal outcome. And the treatment of this disease is usually carried out comprehensively, applied both standard medicines and the funds of traditional medicine.

Causes and factors contributing to the development of IBS

Before switching to the main methods of treatment of ischemic disease, you need to know why it arises, and what factors provoke it.

But the main reason for the occurrence of IBS is the deposition of fat plaques that interfere with the normal flow of blood in the heart, as well as its further transportation throughout the body.

Also, factors such as the development of IBS contribute to:

Frequent increase in blood pressure, which is most often due to stress, as well as due to a weak nervous system, and, of course, because of other problems with the heart and blood vessels
Not an active lifestyle, due to which the body loses many, including becomes unacceptable for any changes. The body does not consume so much energy as it is necessary for normal operation. And besides, a sedentary lifestyle leads to weakness of all muscles, which very negatively affects the work of the heart
Incorrect meals These are usually attributing with sharp dishes, as well as very fat and sweet food. Few people thinking, a king hamburger, that because of him, problems with the heart can begin
Overweight and obesity. Since the main reason for the development of IBS is the deposition of fat plaques, then in the case of very complete people, this process is much faster, since the body practically consists of their fat. Yes, and the load on the heart during an overweight increases many times
Smoking. Everyone knows that the tobacco (nicotine) adversely affects the body, namely pollutes the lungs. And if there is an insufficient amount of oxygen in the lungs, and besides, he is poisoned by nicotine, he suffers from this heart
Heredity. Heredity plays a major role in the development of the disease. It is believed that if someone from close relatives have this disease, then the chances that it will develop, significantly increase
Diabetes. In diabetes, blood becomes much thicker than the body requires. And therefore, people suffering from diabetes develop many other diseases.
Frequent stresses that lead to the fact that the heart does not withstand constant excitement and begins to work accelerated, since even with low emotional voltage requires much more oxygen and nutrients to maintain the normal operation of all organs
Disease blood
Priced work schedule, as well as constant non-compliance with the regime and recreation, which leads to the timing of the entire body

Despite the fact that the public awareness of the ischemic heart disease is high, anyway, few people hold a healthy lifestyle to avoid the development of the problem.

Symptoms of Disease

Everyone should know the basic symptoms of the manifestation of this disease, since the earlier it was discovered and the steps were taken to improve the condition, the better it would be for the person himself.

So, the main symptoms of the IBS can be attributed to:

The painful sensations behind the sternum, which can be like a godic and compressive nature. Mostly they are not strong, but still make a person, for example, will stop while walking
Feeling burning in the heart
The painful sensations that appear at the moment when a person leaves the room to the cold
Pain attacks can happen at any time, there is no clear dependence on the day and night. True, many patients celebrate, most often pain appear in autumn or in winter, when the weather is very unstable and the atmospheric pressure is constantly changing
Pain is usually enhanced if a person wants to lie down. But if he sees or gets up, the pain either subsides, either will pass at all

It should also be said that the attacks may happen just a week, and once every six months. But at a severe stage, they can occur every day, forcing a person to change their lifestyle.

Treatment of disease. Food

Quite often, many problems can be solved by changing their diet. And IHS is no exception. Of course, adding some products will not save completely from the disease, but to significantly improve the state and reduce the number of pain attacks may well.

Now people who suffer from coronary heart disease are recommended to add to the diet:

Cheremshu.
Bow. It is famous for his healing properties. True, it does not mean that it is necessary to eat his kilograms. A small piece once a day - this will be enough
Blackberry. It can be eaten in any form. True, it is fresh selling it only in the summer, but it's frozen, from which you can cook compotes, can be found in any major supermarket
Black currant. This berry is not only delicious, but also very useful. It also needs to be used in any form (compote, jam, etc.)
Cabbage that mono eat both in fresh form by adding to salads and in boiled or stew
Apples and pears. They can also be eaten in absolutely any form, since useful properties are always saved
Watermelon. This is a very useful berry, however, natural, without additives, watermelon can only be bought for two months a year. But even at this time you need to eat at least two kilograms per day
Corn, which can be simply cooking, or acquire a corn crucible and cook from her porridge
Apricots
Hawthorn. which you need to dry and brew

Of course, adding all these products to the diet will not heal, but will significantly improve the condition of the heart and blood vessels. In addition, those who want to get rid of the disease or at least reduce the number of attacks, you need to completely eliminate greasy dishes, since it is precisely most often the cause of a large cholesterol content in the blood. A high cholesterol leads to the deposition of plaques.

Folk remedies. Decorations

Most often, people resort to the help of scales:

Recipe 1. You need to take 150 grams of the roots of the poduelnik and pour them with 2 liters of cold water, then mix well. After that, put on fire and let boil. Keep decoction in the refrigerator, as it can quickly spoil
Recipe 2. You need to take Fennel, about ten grams. You only need to take fruit. Then pour boiling water (one glass) and strain. It is necessary to remove all particles of fruits. After that, a little water is added to the decoction to get a glass. Then take before eating
Recipe 3. For this decoction you need to take ten grams of dryers, pour boiling water and still heat in a water bath for about fifteen minutes. After the time passed, the decoction must be strain, give it to cool and dilute with boiled water so that it turns out exactly a glass. After the decoction is ready, it needs to be taken at half a cup after each meal
Recipe 4. You need to take either the seeds of dill, or the chopped dill itself. Takes about a tablespoon. It is pouring into a glass and pour boiling water. After the decoction was fill, he needs to drink throughout the day when the attack occurred
Recipe 5 You need to take five grams of nettle flowers, pour it with 200 milliliters boiling water. After the decoction cooled, you need to take half a glass twice a day

There are many decoction recipes, thanks to which a person can significantly improve his well-being. In addition, each of them is very easy to cook, you do not need to run around the pharmacies and look for the necessary grass. Everything is within walking distance, and you can buy it in any pharmacy.

Folk remedies. Horseradish

There are several most effective folk remedies in the treatment of IBS. This refers to hell. Many people may seem, what benefit from this plant, because it is customary to add it to the twist or to eat, refueling them with dishes.

But in fact, Khrena has a mass of healing properties, thanks to which it is used in the treatment of IBS.

There are three most popular recipes, which contains horseradish:

Recipe 1. It is necessary to take the root of the horse, about five grams, and it is smaller as fashionable. After that, the resulting mixture is poured a quarter of liters of boiling water and overflows to thermos. The decoction should stand at least three hours in order to brew better. After it is ready, it is necessary to carry out inhalation
Recipe 2. You need to take hell, lose it. To take a teaspoon every day and mix it with a teaspoon of honey. In order for the effect to be the most positive, you need to take a mixture of at least one and a half months
Recipe 3. You need to take grated horseradish (two tablespoons), pour boiling water and leave for the night. After that, mix with a glass of carrot juice and a glass of honey. Take the mixture every day per hour before meals on a tablespoon

Using horseradish in this form can be significantly improved by heart rhythm, as well as facilitate the state during IBS attacks.

Folk remedies. Hawthorn

Many people have a hawthorn associated only with the tincture, which is sold in pharmacies. That is why, by mistake, this is a berry is not considered useful. This is a huge misconception, since the hawthorn is recommended to use with various heart disease, and not only with IHD.

There are three ways to cook a hawthorn:

Decoction. You need to take six tablespoons of the berries of the hawthorn and the same dietary. All this is pouring boiling water one and a half liters, wrap in the blanket and leave for a whole day. After this time, the decoction is well fascinated so that there is not a single particle of a hawthorn or mother-in-law, and they use one glad three times a day.
Infusion. You need to take dry fruits of the hawthorn (tablespoon) and pour them with boiling water. Do it better in the thermos, as it is necessary to give in at least two hours. After the time passed, you need to take three spoons three times a day
Tea. For tea party lovers, this recipe will have to taste, as tea from the hawthorn is not only useful, but also a fairly pleasant taste. Take berries you need so much so that the color of tea is dark, but not black. For those who love tea with sugar, you can add it there

You can buy a hawthorn in the market at grandmothers, as well as at the autumn time just to ride on the bushes, which are often located next to the height entrances built in about the 70s.

Folk remedies. Fees

Another very good tool during the treatment of IBS is the use of fees. At the heart of such fees there are all herbs that are capable of providing a positive effect not only on the heart, but also on the vessels, and also to get rid of cholesterol plaques:

Recipe 1. You need to take a white mistletoe and buckwheat flowers. The proportion is two to one. After everything is mixed, you need to take a teaspoon from there and pour it with a glass of boiling water. Then you need to climb into a woolen blanket and leave for the night. Before drinking infusion, it needs to be well strain
Recipe 2. The root of corn and lovers to mix in proportion one to one (take about forty-grams). After everything was mixed, you need to pour water and put on fire. Boil approximately eight minutes, and then pour into the thermos, wrap and leave for a while. Before use you need to strain the decoction
Recipe 3. You need to take two tablespoons of the horsettle, three tablespoons of a hill, five tablespoons of a hawthorn. All this is mixed and pour a quarter liter boiling water. After that, let stand for about three hours. Before use strain

Many people resort to the treatment of folk remedies after drug preparations did not give proper effect. True, despite the fact that there are many positive feedback on the use of fees, decoction and teas with ischemic heart disease, they need to be treated very carefully, since some people may have individual intolerance to some kind of grass, and resulting in a strong allergic reaction.

Physical exercise

As mentioned above, one of the reasons for the development of IBS is the lack of physical exertion, namely a fixed or low-wear lifestyle. Most often it happens in people who are sitting for computer monitors or driving a car.

For people suffering from coronary heart disease, recommended cyclic sports, that is, swimming, running, bike. In addition, it is possible to resort to such only when there is no exacerbation period. Otherwise, it can only aggravate the situation.

For those who have been found not the initial stage of the disease, the medical gymnastics is recommended, and only under the supervision of a physiotherapist who can accurately calculate the load, which will benefit, not harm.

Forecast

Regardless of whether the patient is treated with folk remedies, or resorts only to drugs, there is a prediction that depends on the stage of the disease.

In the event that a person has found initial stage, that is, all the chances of correcting the situation and the preservation of the lifestyle that man lives.

If the disease was discovered in the third or fourth stage, the risk of infarction increases, which at best may hit the entire myocardial area.

But at the fourth stage, the patients are most often dying from the extensive myocardial infarction, as, even completely changing the diet and observing all the recommendations, the disease struck the large portion of the heart.

Treatment of IBS by folk remedies today is not uncommon. And besides, many cardiac doctors themselves offer to accept one or another decoction to maintain good well-being and additional assistance to medicines.

Modern methods of treatment of ischemic heart disease

Ischemic heart disease (IBS) is one of the main reasons for the temporary and resistant disability of the population in developed countries of the world. In this regard, the problem of IBS takes one of the leading places among the most important medical problems of the XXI century.

The fate of patients with IHD largely depends on the adequacy of the outpatient treatment, the quality and timeliness of the diagnosis of those clinical forms of the disease that require the provision of emergency care or urgent hospitalization.

Alexander Gorkov, head of the department of X-ray-thrust diagnostics and treatment of the district cardiological dispensary (Surgut, KhMAO - Ugra), told about the modern methods of treatment of ischemic heart disease.

V. Alexander Igorevich, what is IBS?

- Ischemic heart disease is characterized by an absolute or relative violation of myocardial blood supply due to the damage to the coronary arteries of the heart. In other words, myocardia needs more oxygen than it comes with blood. If the IBA manifested itself only by the symptoms of ischemia, it would be enough to constantly take nitroglycerin and not worry about the work of the heart. The term ischemic heart disease includes a number of diseases (arterial hypertension, heart rhythm disorders, heart failure, etc.), which is based on one reason - atherosclerosis of the vessels.

V. Pain in the heart and nitroglycerin - the lot of the people of the older generation?

- Previously it was considered, but now ischemic heart disease does not bypass the younger generation. Many factors of modern reality are assigned to such developments: ecology, hereditary predisposition, lifestyle associated with smoking, hypodynamines and rich diets.

Q. What are the effective methods of treatment of ischemic heart disease appeared in the Arsenal of Cardiologists over the past decades?

- The modern development of technology is accompanied by the improvement of treatment methods, but its main principle remains the same - restoration of blood flow on the narrowed or clogged coronary artery for normal myocardial nutrition. This can be achieved in two ways: drug and surgically.

Medical therapy with modern drugs with a proven level of efficiency today is the basic basis for the treatment of chronic IBS. The treatment is aimed at improving the quality of life of the patient, that is, a decrease in the severity of symptoms, preventing the development of such forms of IBS, as a myocardial infarction, unstable angina, sudden heart death.

To do this, in the arsenal of cardiologists there are various drugs that reduce the content of "bad" cholesterol, responsible for the formation of plaques on the walls of the vessels. In addition, drugs are used in the treatment of coronary heart disease, drugs that need to be taken once a day are used: these are antiagregants (dilute blood), antiarrhythmic, antihypertensive and others. It should be noted that only a cardiologist can assign these medicines based on the objective picture of the disease.

With more severe cases, IBS uses surgical treatment methods. Endovascular surgery is considered the most effective method of treating ischemic heart disease. This is a relatively young direction of medicine has already gained strong position in the treatment of IBS. All interventions are carried out without cuts, through a puncture under X-ray observation. These features are important to those patients who are contraindicated (due to concomitant diseases or general weakening of the organism) traditional surgical intervention.

From the methods of endovascular surgery with IHD, balloon angioplasty and stenting are used, which allow to restore the permeability in the arteries affected by ischemia. The essence of the method is that a special cylinder is introduced into the vessel, then he is swelling and "moves" atherosclerotic plaques or blood clocks to the sides. After that, the artery is set by a cylindrical wall (wire design of a special alloy), which is capable of retaining a given vessel shape.

The generally accepted and effective method of operational blood flow in a narrowed or clogged artery is the operation of the aortocortonary shunting, when the artery is blocked or a thrombus, the artery is replaced by an "artificial vessel", which takes on the conduct of blood flow. These operations are almost always performed on a non-working heart under conditions of artificial blood circulation, for which there are clear indications.

Nevertheless, the positive effect after surgical and endovascular treatment is stable and long.

V. Alexander Igorevich, what is the reason for choosing the method used?

- human health state, degree of damage to coronary arteries atherosclerotic plaques or blood closures, and one of the important indicators is time! In the framework of efficient work in the KhMAO - Ugra, the Ugra-Cor project, patients from the entire district in the first hours of the beginning of the pain syndrome fall into one of the three cents of interventional cardiology, including a district cardiological dispensary, and doctors have time to assist with the use of surgical Maloveraumatic methods. In 2012, in the cardiocenter, about 1,100 angioplasty operations were performed, about 300 of them - patients with acute coronary syndrome in the framework of the Ugra Cor project.

V. Alexander Igorevich, tell us how to change the life of a person with a diagnosis of ischemic heart disease?

- CDP treatment involves the joint work of the cardiologist and the patient in several directions. First of all, it is necessary to take care of changing the style of life and the impact on the risk factors of ischemic heart disease. This is a refusal of smoking, cholesterol level correction with diet or drugs. A very important point of non-drug treatment of IBS is the struggle with a sedentary way of life by increasing the physical activity of the patient. And, of course, the preliminary treatment of concomitant diseases, if the development of IBS occurs on their background.

Modern methods for the treatment of ischemic heart disease are effectively helping people to live a better and long life. But health is the daily result of human labor over himself. Direct your strength to keep your own health and take care of your heart health!

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Treatment of IBS preparations of the first stage. Medicines for emergency care for heart ischemia

Chronic Ischemic Heart Disease: Treatment News

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Forecast

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