Modern means of treating IBS. Calcium channel blockers

The date: 15.04.2019

Ischemic heart disease (IBS) - a disease that develops against the background of insufficient supply of the heart muscle (myocardium) oxygen.

The narrowing of the lumen and atherosclerosis of the coronary arteries, violate the blood circulation process, which is the cause of oxygen starvation of the heart. In this article, we will look at how the treatment of IBS is underway, the drugs of which type are used and what role they play.

hidden (asymptomatic);
stenocardic;
arrhythmic.

The main methods of treating IBS

drug (CHA treatment with drugs);
not drug (surgical treatment);
elimination of risk factors contributing to the development of the disease.

Medical treatment of IBS - General principles

Comprehensive medical treatment of the IHD is aimed at suspension of the development of pathology, mitigating negative symptoms, an increase in the duration and quality of the patient's life.

Preparations with heart ischemia are prescribed by a cardiologist.

As preparations for treating IBS, improving the forecast:

antiagregants - block the formation of blood clots in vessels;
statins - help reduce blood cholesterol;
blocators of renin angiotensin-aldosterone system - prevent an increase in blood pressure.

Medicines for heart ischemia for the removal of symptoms:

inhibitors sinus node;
calcium antagonists;
activators of potassium channels;
nitrates;
antihypertensive preparations.

Reception of drugs for the treatment of ischemic heart disease appointed by a cardiologist is constant. Replacing medicines or a change in dosage with IHD is carried out by an exclusively attending physician.

Preparations for the treatment of IBS not Panacea: recovery is impossible without a diet, reasonable physical activity, normalization of sleep mode, refusal of cigarettes and other bad habits.

Antiagreganta

Antitrombocytic drugs (antiagregants) - class medicinal preparationsdusting blood (acting on the collapse). They prevent combination (aggregation) of platelets or erythrocytes, reduce the risk of thrombus formation. Antiagregants for the treatment of IBS - an important component comprehensive treatment Diseases.

Aspirin (acetylsalicylic acid) - in the absence of contraindications (stomach ulcers, blood-made system diseases) is the main means of the prevention of thrombosis. Aspirin is effective with IHD, has a balanced combination useful properties and side effects, it is characterized by a budget value.
Clopidogrel - a medicine of a similar action, which is prescribed with aspirin intolerance to patients.
Warfarin - has a more intense effect, contributes to the dissolution of thrombus, maintains the level of blood reducing. Warfarine for the treatment of IBS is prescribed after a comprehensive examination with regular blood monitoring to the indicator of many (may cause bleeding).

Hydolipidemic drugs (statins)

Statins, actively lowering blood cholesterol, in the complex special diet - This is a mandatory element of IBS therapy. The hypolypidemic agents for the treatment of ischemic heart disease are effective in case of permanent reception:

Rosavastatin;
Atorvastatin;
Simvastatin.

The narrowing of the coronary arteries with IHD

Rhenin-angiotensin-aldosterone system blockers

The list of methods of treatment of the disease necessarily includes tablets from heart ischemia, normalizing blood pressure. Its increase negatively affects the condition of coronary vessels. Possible result - Progression of IBS, the risk of developing a stroke, and also chronic form heart failure.

Blockers (inhibitors) angiotensive receptors - drugs used in the treatment of ischemia, blocking enzyme receptors angiotensin-2 (in the structure of cardiac tissue). Therapeutic effect - Lower blood pressure, elimination of the risk of radiation of fabric and heart muscles (hypertrophy) or its reduction.

Preparations of this group are accepted strictly under the supervision of a doctor in a long period.

ACE inhibitors - act as blockers of an angiotensin-2 enzyme activity, which is the cause of improving blood pressure. The negative effects of the enzyme on heart fabrics and blood vessels were revealed. Positive dynamics is noted when applying the following preparations related to the ACE group:

Treatment of IBS preparations of sconium (angiotensin receptor blockers):

Lozartan (, Kozar, Lorist);
Kandesartan (ataandan);
Telmisartan (Macardis).

Groups of drugs for symptomatic treatment of IBS

As part of a complex of therapeutic measures, preparations are prescribed from ischemia of hearts that bind symptoms of the disease. In patients with the risk of an unfavorable course of the disease, considered in the article preparations are prescribed under the Heart Izhemia (intravenous).

Beta adrenoblocators

Beta-adrenoblays (BAB) - a central group of drugs that contribute to improving the work of the heart. Their action is aimed at reducing the frequency of heart rate, and the settlement of the average daily blood pressure indicators. Showing for use when - as inhibitors of recipers of stress hormones. Beta-adrenobloclars eliminate the symptoms of angina and are recommended for receiving patients who transferred. The list of such drugs for the treatment of IBS, as BAB includes:

Oxprenolol;
Supolyol;
Metoprolol;
Carvedilol;
Nebivolol.

Calcium antagonists

Calcium antagonists - means that prevent angina attacks. The feasibility of their use is comparable to beta-adrenoblockers: help reduce the number of heart abbreviations, level the manifestation of arrhythmia, reduce the number of myocardial cuts. Effective in application for the prevention of IBS, as well as in the vasospast form of angina. It is also possible to familiarize themselves with the treatment of flicker arrhythmia.

Self effective drugs From Heart Ischemia:

Verapamil;
Parotel Amlo;

Nitrates and nitrate-like

Skin attacks stop and prevent complications in acute myocardial ischemia. Nitrates remove pain, expand the coronary artery, reduce the influx of blood to the heart, which reduces its need for oxygen.

Preparations with heart ischemia (nitrates):

Nitroglycerin (nitromint) - inhalation or by language;
Nitroglycerin in the form of ointments, disks or patches;
Isosorbide dinitrate (isosorbide dinitrate long-acting);
Isosorbide mononitrate (isosorbide mononitrate long-acting);
Mononitrate (monocynex);
Molotomine (Molidomine prolonged action) - prescribed with intolerance of nitrates.

Sinus node inhibitor

The inhibitor of the sinus node (Ivabradin) - reduces the frequency of heart abbreviations, but does not affect the reduction of myocardium and blood pressure indicators. Ivabradin is effective when the stable sinus walls are treated with the intolerance of beta-blockers. In some cases, the reception of Ivabdin in a complex with beta-blockers has a beneficial effect on the disease forecast.

Activator of potassium channels

Activator of potassium channels - nicorandyl (anti-ischemic effect). The drug expands the coronary vessels and counteracts the sedimentation of platelets on the walls of the arteries (the formation of atherosclerotic plaques). The action of nicorandila does not affect the number of heart abbreviations, arterial pressure indicators. The drug is shown in the treatment of microwave angina, prevents and stopping the attacks of the disease.

Antihypertensive drugs

Antihypertensive drugs - drugs with a property lowering an increased blood pressure. This group includes medicines related to different pharmacological classes, and various impact mechanisms.

Antihypertensive drugs with ischemic disease include diuretics. Diuretics (diuretic) - in small dosages reduce pressure, with more significant dosages removed excess liquid from the body. Diuretics include:

Furosemide;
Laziks.

The previously described beta-adrenoblastors, calcium antagonists, ACE inhibitors (an angiotensional enzyme inhibitors) are facilitated:

Cilaproke;
Coexipril;
QuinaPril;
Perindopril;
Cilaproke.

Treatment of vasospadic shape angina

Vazospadic shape of angina - this is a special form of the disease with characteristic painful sensations and discomfort in the area of \u200b\u200bZagadina, even in a calm state. The reason is the spastic pathology of the vessels supplying the heart muscle, the narrowing of the lumen of the right coronary artery, difficult to flow blood to myocardium.

As preventing attacks, calcium antagonists are recommended, during the exacerbation period - nitroglycerin and prolonged nitrates. Sometimes, the combination of calcium antagonists with small doses of beta-adrenoblocators is shown. In addition, such adverse factors should be avoided as stress, smoking, supercooling.

Heart vessels during the attack of angina

Treatment of microvascular angina

Symptoms of the disease are manifested by the painful sensations of the sternum without changes in the coronary vessels. Patients with such diagnosis include diabetes patients or suffering arterial hypertension. In case of pathological changes in the microswokes of the heart, a reception is prescribed:

statins;
antiagregants;
aCE inhibitors;
ranolazin.

beta blockers;
calcium antagonists;
long-term exposure nitrates.

First aid preparations

First aid with IHD is to remove or relieve pain syndrome.

Actions and preparations for first aid with IHD:

Nitroglycerin is the main means of first aid for patients with characteristic pains for the sternum. Instead of nitroglycerin, it is possible to use a single dose of smell or nitrolling. Preparation It is advisable to take in a sitting position, to avoid fainting (with a decrease in blood pressure).
If the condition does not improve, prior to the arrival of the medical team of doctors to give a patient with a chopped tablet aspirin, balallin or analgin.
Drugs can be taken no more than 3 times in a row with a small interval, since most of them reduce blood pressure.

During the symptoms of IBD, potassium preparations (Panangin and analogs) are preferably taken.

Useful video

On the causes of the occurrence of ischemic heart disease and modern methods of diagnosis and treatment, find out from the following video:

Conclusion

Medication drugs for ischemic heart disease should be taken only under the supervision of the cardiologist.
The CDS treatment course is appointed on the basis of a full-fledged survey in hospital and laboratory diagnostics.
With such a disease such as heart ischemia, treatment: tablets, capsules, aerosols - dosing of all drugs, the duration of admission and compatibility with other drugs is determined exclusively by a cardiologist.
Medicase treatment of IBS as a component of a part of therapeutic activities continues indefinitely for a long time. Even with improved well-being, it is categorically not recommended to stop treatment - this can provoke the attacks of angina, the development of myocardial infarction or a heart stop.

Enough serious disease And it is necessary to approach his treatment with all seriousness. Only the integrated purpose of the necessary drugs can bring the desired results. It is also necessary to remember that only an experienced good cardiologist is capable of designating suitable therapy. It is not possible to cope with a similar task independently, since it is necessary to take into account not only the individual features of the course of the disease, but also the compatibility of drugs among themselves so that one of them does not neutralize the effect of another or the more so did not provoke the patient's deterioration on the contrary. For this, the main remedy is selected from each drug group that will neutralize the disease completely.

It is very important to also pay attention to the causes of the disease - the selection of drugs should be carried out precisely with these features.

Ischemia is a complex disease that requires an integrated approach to treatment. Some tablets do not cope here - it is important to change the lifestyle, reconsider the habits.

Only when complying with the required mode in the complex with the reception of the necessary drugs, you can achieve the desired result.

It is also clearly understood that even if the course of treatment will bring excellent results and the disease will no longer make it felt, it still does not mean that no longer needs to take care of your health. In case of impact on the body of provoking factors, the recurrence of the development of pathology is very high. Under all the recommendations of the attending physician, the likelihood of the fact that the disease does not return will not return anymore. But then it is very important to pay attention to the reception of drugs that contribute to maintaining the heart of the heart.

Selection of therapy

First of all, it is necessary to take into account the fact that therapy should be selected on the basis of the following factors:

the causes of the occurrence of IBS;
the purpose of therapy. Therapy can be supportive (after the main course of treatment and stabilization of the state), for removal acute attack, restoration after surgery, etc.;
accompanying illnesses;
as far as the launched disease, the features of its flow, at what stage.

Of course, the individual characteristics of the patient's body should be taken into account. It may have allergies to some designated drugs, possess individual intolerance. All this is very important to know a doctor before drawing up a list of recommendations in the reception of the necessary drugs.

Additional measures

In addition to receiving medicines, it is very important to eliminate the impact of absolutely all provoking factors:

reduced arterial pressure. And IHS - often not only complement each other, but also separately provoke complications. To prevent it very important to keep track of your arterial pressure, not allowing not only its smooth and stable increases, but also sharp jumps. It is also important to control your diet. It is obesity that largely provokes an increase in blood pressure, therefore it is worth abandoning fatty foods (especially animal fats), as well as rapidly digestible carbohydrates;
control over cholesterol in the blood. To do this, it is necessary to minimize the consumption of sour cream, butter and chicken eggs;
reducing the amount of fluid consumed. Overhabitable liquid use contributes to the formation of various edema, which should be avoided in this case. When accumulating a large amount of fluid in the body increases blood volume, which significantly increases the load on the heart;
refusal of smoking and abuse of alcoholic beverages;
normalization of sugar. To do this, it is necessary to reduce the consumption of sweet food;
elimination of other provoking factors, namely the control of their lifestyle. For example, it is necessary to have physical activity in the life of such people, but at the same time physical exertion should be moderate, do not cause pain and other unpleasant sensations. Ideal for this, swimming or hiking on the fresh air. This will simultaneously help solve several tasks: contributes to the discharge of blood, prevents the occurrence of edema, as well as obesity.

Aqua aerobica occupation

If the data is simple recommendations will not be observed, even at the completion of high quality and effective course Treatment still soon IBS will return again, since provoking factors in fact will not go anywhere and will contribute to the resumption of the acute phase of the disease.

Groups of necessary drugs

As mentioned earlier, it is necessary a complex approach To the treatment of IBS. In the choice of medical drugs, you should follow exactly the same tactics to achieve a long-lasting desired result. Next, consider the main groups of drugs that are used in the treatment of this disease.

Lowering pressure

Elevated blood pressure has a negative impact on the work of the heart muscle. This is due to the fact that the squeezed vessels are worse than the oxygen, which causes oxygen starvation of the heart. Therefore, to control your pressure and keep it in the norm - the most important task with IHD.

To do this, use the following drugs:

APF inhibitors

aCE inhibitors. They block the effects of substances that increase blood pressure, and minimize the negative impact of the other components on the heart, kidney, the liver. That is, this medicine contributes to a systematic pressure reduction;
diuretics. Dorganic remedies contribute not only to a decrease in blood pressure and minimize the development of hypertension, but also impede the development of stolev in heart failure. It is also very important if there is a risk of developing brain edema, even swelling. Sometimes in the early stages of diuretics hypertension and are able to independently stabilize the blood pressure without the use of any other drugs. The most important thing at the same time also minimize the consumption of salt, as it contributes to the fluid delay in the body and thereby blocks the action of diuretics.

In case of ischemic heart disease, such medications will be required to prevent significant increase in blood pressure, as it sharply and significantly increases the load on the heart muscle, therefore such differentials should be avoided.

Improving heart work

In this case, the treatment of ischemic heart disease drugs includes a variety of, which are aimed at solving a wide variety of problems. Sometimes, at first glance, it may seem that some drugs do not particularly have a particular relation to this problem, but still it is always necessary to remember that all organs in the body are interconnected and therefore problems with one entails problems with Other bodies. That is why it is important when serious problems Heart to control the health status of other organs.

So, the main groups of drugs that contribute to the normalization of the work of the heart can be divided into the following main large groups:

Anaprin

beta blockers. Such medicines block the effects of adrenaline on the heart muscle, or rather, inhibit it in the body. With serious heart problems, any experiences are destructive and therefore this factor is very important in this case. Also, similar drugs are able to eliminate arrhythmia, contribute to a decrease in blood pressure and reduce heart rate. Preparations are contraindicated with asthma and diabetes. Widely used after myocardial infarction. (Anaprilin, metoprolol);
reducing blood viscosity medication. The more thick blood in humans will be - the harder it is to pump it, as well as the higher the risk of thrombus. Most often, aspirin is used for this purpose. It is shown to use mainly after surgery, as well as for the prevention of the occurrence of thrombus, if there is a predisposition or heredity. In more complex situations, it is necessary to use preparations for dissolving thrombus (if the thrombus has already been formed, but it is not possible to remove it);
preparations to reduce sugar levels. But at the same time, it should immediately say that there are few hope for such drugs, if the patient does not comply with the basic recommendations, namely the diet;
reduced cholesterol. It is this indicator in the blood contributes to the development, as well as hypertension. Ideally, if it is as small as possible in the blood of patients with IHS. For this, it is also necessary to comply primarily to the diet and minimize the consumption of animal fats. But it will not be possible to reduce such an indicator in one day and therefore, if necessary, it is very important to start receiving drugs in a timely manner to stabilize this indicator in the body. Statins are assigned for this purpose. Most often, the doctor appoints a constant reception of this group of drugs, but it is important to approach this issue with all seriousness, since the approach should only be integrated and in any way otherwise. Reception of drugs will be ineffective without compliance with the diet, and the diet without drugs will also not bring the expected results. That is why it is important to adhere to strictly all the recommendations of the doctor not only in matters of directly receiving drugs, but also in relation to nutrition;
contraindications and side effects. The effect of drugs is essential to reduce the frequency of the heart muscle, but at the same time an increase in its intensity. Digoxin;
nitrates. Preparations of this group are used directly to relieve the attack. They contribute to the expansion of coronary vessels and veins to reduce the influence of blood to the heart, which helps to reduce the load on it.
Nitroglycerine
Most often used from this group nitroglycerin. It reduces the oxygen starvation of the heart (as it reduces its need for oxygen), and also minimizes pain, either eliminate them at all. The main disadvantage of nitrates is that the addiction of the body is developing and therefore, with long-term use, they cease to perform their functions and stop the attacks of angina. That is why for a long time they are prescribed only with severe forms. At the same time, if they even cancel their reception, then soon they will again have the desired impact on the patient's body.
Any medication from coronary heart disease can only be prescribed by the doctor, since many such drugs can possibly find a mass of side effects and contraindications and even with similar symptoms, an excellent preparation for one patient may be destructive for another. The doctor should always take into account the individual features of each patient and in accordance with them to compile a sheet of recommendations. Also before it needs to go comprehensive examinationTo identify the accompanying diseases and the degree of IHD.

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INmaintenance

The heart is one of the main organs of a person. This is our engine that works without rest, and if earlier, the crashes in his work were observed in the elderly, then in recent times Heart diseases have grown significantly 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, annual mortality from cardiovascular reasons 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 are determined great importance The introduction of 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 IBS problem takes one of the leading places among the most important medical problems 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, constituting 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 shapes Diseases 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. 8-10 days after myocardial infarction appears a large number of Newly formed capillaries. From this time in the areas of necrosis, the rapidly develops connective tissue. 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. After about 8--20 minutes, the heart stops and death occurs.

2. Classificationischemic heart disease

1.Sudden cardual death (Primary heart stop, coronary death) - This is the most severe, lightning clinical option IBS. 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 IBS is due acute insufficiency The blood supply to myocardium, because of which the focus of necrosis occurs, 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 disease develops in a patient for many years, and the earlier the correct diagnosis is made and the appropriate treatment has begun, the greater the sick chance of full life further.

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 The level of cholesterol and sugar in the blood is 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 obligatory stage 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 everyday life Patient, both in a state of 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 heavy complications And therefore these methods applies only to specialized research institutions.

Ultrasonic study hearts. Ehoche

IN last years Very common ultrasound procedure Hearts - 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.

Very important moment non-drug treatment Hebc is the fight against 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, the IBS are used. surgical methods Treatment. Pretty nice 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 on currently Endovascular surgery (X-ray mergery) is considered. 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 pathogenesis of IBS, much attention It 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, salty 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. Proved positive influence For life expectancy, these drugs 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 Important in plan differential diagnosisFor example, in cases where the patient has ECG signs of previously infarction events.

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. Posses are quite pronounced fast actionusually apply as drugs emergency (for the implementation of forced diurea).

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). Concerning this drug It is used in the prevention of arrhythmias and is not a means of emergency assistance.

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 enter 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 (formerly transport, transluminal) interventions (coronarylasty) is developing various forms HebS. 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 relatively rare, not included in the standards for the provision medical care With IHD, applies, as a rule, at the request of patients. Potential positive effects this method Poves 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 possess this ability, but at present the level modern technologies It 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. Requires years scientific researchTo ensure that the effect that is expected by patients from the administration of polypotent stem cells.

Currently, this treatment method is not used in official medicine And it is not included in the provision of assistance with IHD.

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

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Features of the treatment of various versions of angina

Threw stress

Comparatively low-active patients with moderately pronounced angina, especially in old age, it is often sufficient to recommend the receipt of nitroglycerin in cases where the attack does not pass independently after stopping the load for 2-3 minutes and / or the preventive intake of the isosorbide of dinitrate before loading, for example, nitrosorbide 10 mg (under the tongue or inside) or isosorbide-5-mononitrate 20-40 mg inside.

With a more pronounced angina tension, beta blockers are added to treatment. The dose of beta-blockers is selected not only by the anti-inanimal effect, but also by influence on the heart rate. CSS should be about 50 per minute.

In the presence of contraindications for beta-blockers or in case of insufficient treatment, beta-blockers are used calcium antagonists or prolonged nitrates. In addition, instead of beta blockers you can use amiodaron. With angina pharmacy of the III-IV FC, combinations of 2-3 drugs are often used, for example, a constant reception of beta-blockers and calcium antagonists and preventive reception of prolonged nitrates before loading.

One of the most frequent errors in the appointment of antianginal preparations is their use in insufficient doses. Before replacing or adding the drug, it is necessary to estimate the effect of each drug in the maximum portable dose. Another error is the purpose of constant reception of nitrates. Nitrates are appropriate to assign only before the planned load, which causes angina. Permanent reception of nitrates is useless or even harmful, because It causes the rapid development of tolerance - progressive reduction or complete disappearance of antiagonal action. The effectiveness of drugs is constantly monitored by increasing tolerance physical Loads.

Patients with preservation of heavy angina (FKIII-IV), despite drug treatment, is shown to conduct coronoagographics to clarify the nature and degree of damage to coronary arteries and assessing the possibility of surgical treatment - balloon coronaugulagioplasty or aortocortonary shunting.

Features of the treatment of patients with X syndrome. X syndrome is called the stress angina in patients with normal coronary arteries (the diagnosis is established after the coronary frame). The cause of syndrome X is the reduction of the ability to vasodilat the small coronary arteries - "microwave angry".

In patients with syndrome X, surgical treatment is impossible. Pharmacotherapy in syndrome X is also less effective than in patients with stenosis of coronary arteries. It is often noted refractoriness to nitrates. Antianginal effect is observed about half of the patients. Medical treatment is selected by the method of trial and error, primarily assess the effectiveness of calcium nitrates and antagonists. In patients with inclination to tachycardia, treatment starts with beta blockers, and patients with bradycardia can be observed positive effect From destination Eufili-on. In addition to antianginal preparations, the A-1-blockers can be effective in syndrome X, for example, doxazosin. Additionally uses such drugs like mildronat or trimetazidine. Considering that patients with syndrome X have a very good forecast, the basis of therapeutic measures is rational psychotherapy-explanation of the safety of this disease. Adding to antichangal prepartes of imipramine (50 mg / day) increases the effectiveness of therapeutic measures.

Spontaneous angina

To relieve seizures of spontaneous angina, primarily use sublingual reception of nitroglycerin. In the absence of effect, nifedipine is used (the tablet is chewed).

To prevent the occurrence of repeated seizures of spontaneous angina to the choice of calcium antagonists. Calcium antagonists are effective about 90% of patients. However, it is often necessary to use maximum doses Calcium antagonists or a combination of several drugs of this group at the same time, up to the use of all three subgroups at the same time: verapamil + diltiazem + nifedipine. With an insufficient effect, prolonged nitrates add to treatment. For several months, most patients have a noticeable improvement or complete remission. Especially often the rapid disappearance of inclination to spastic reactions and long remission It is observed in patients with isolated spontaneous angina, without concomitant angina stress (in patients with normal or low-change coronary arteries).

Beta blockers can enhance inclinations to coronary arterial vasospadic reactions. Nevertheless, if the attacks of spontaneous angina appear in a patient with a pronounced stress angina, calcium antagonists are used in combination with beta-blockers. The most appropriate use of Nibivolol. There are reports of fairly high efficacy of cordaron. In some patients, the appointment of doxazozin, clonidine or nico-randil.

Night angina

3 options are possible: angina walls of minimum stresses (angina, arising in the lying position - "Dtencardia Decubitus" and angina during dreams with an increase in heart rate and blood pressure), angina region due to blood circulation deficiency and spontaneous angina. In the first two cases, angina region is equivalent to paroxysmal night shorts. With all 3 embodiments, the appointment of nitrates of prolonged action per night (prolonged forms of isosorbide of dinitrate and mononitrate, nitroderma patch, nitroglycerin ointment) can be effective. With an estimated diagnosis of angina stress angina - it is advisable to estimate the effect of beta blockers. With spontaneous angina, calcium antagonists are most effective. In case of insufficiency of blood circulation, nitrates and ACE inhibitors are prescribed. Consistently evaluating the effectiveness of the destination various drugs and their combinations, select the most acceptable treatment option.

Surgical methods of treating IBS

The main indication for the surgical treatment of IBS is the preservation of severe angina (FC III-IV), despite the intensive drug treatment (refractory angina). The presence of angina stenocardium III-IV FC means that pharmacotherapy is not effective enough. The testimony and nature of surgical treatment are specified on the basis of the results of coronaryogiography, depending on the degree, prevalence and features of the damage to the coronary arteries.

There are 2 main methods of surgical treatment of IBS: balloon coronaugorallasty (cap) and aorticoronary artery shunting (AKSH).

Absolute readings to AKS are the presence of the stenosis of the furnace coronary artery trunk or three-sideways, especially if the emission fraction is reduced. In addition to these two testimony, the Conduction of the AKS is appropriate in patients with a two-way lesion, if there is proximal stenosis of the left front downward branch. Conducting ACCH in patients with stenosis of the left coronary artery stenosis increases the life expectancy of patients compared with drug treatment (survival for 5 years after AKSH - 90%, medical treatment - 60%). Slightly less effectively carrying out AKS with a three-dimensional lesion in combination with left ventricle dysfunction.

Coronoangioplasty is the method of t. N. Invasive (or interventional) cardiology. When conducting coronaohangioplasty, as a rule, stents are introduced into the coronary artery - metal or plastic endovascular prostheses. Against the background of the use of stents, a decrease in the frequency of the occurrence of the occurrence of the occurrence of the occurrence of reflux and restenosis of coronary arteries by 20-30% was noted. If after the cap during the 1st year there is no restenosis - the forecast for the next 3-4 years is very good.

The remote results of the cap are not yet studied. In any case, the symptomatic effect is the disappearance of angina - it is noted in most patients.

The treatment of heart ischemia depends on clinical manifestations Diseases.

Tactics of treatment, reception of some drugs and selection of physical activity, each patient may vary greatly.

The course of treatment of heart ischemia includes the following complex:

therapy without the use of drugs;
therapy with the use of medicines;
endovascular coronaohangioplasty;
treatment with the use of surgery;
other treatment methods.

Drug treatment of heart ischemia implies the adoption by a nitroglycerin patient, which is capable of stopping the seizures of angina, which is capable of the vasodilator effect in a short time.

This also includes the reception of a number of other medicines, which are appointed exclusively attending specialist. For their purpose, the doctor is based on data from the diagnosis of data from the diagnosis.

Preparations used in treatment

Theoapia for ischemic heart disease provides for the reception of the following drugs:

Antiagreganta	Related to them acetylsalicylic acid and clopidogrel. Preparations, as it were, "dilute" blood, contributing to improving its fluidity and reducing the ability to adhere to platelets and erythrocytes to vessels. And also improve the passage of red blood cells.
Beta adrenoblocrators	This is metoprolol, carvedilol, bisoprolol. Preparations that reduce the heart rate of myocardium, which leads to the desired result, that is, myocardium receives the required volume of oxygen. They have a number of contraindications: chronic illness lungs, pulmonary failure, bronchial asthma.
Statins and fibers	These include Lovastatin, Penofibat, Simvastatin, Rosavastatin, Atorvastatin). These drugs are designed to lower cholesterol in the blood. It should be noted that its level in the patients with the diagnosis of heap ischemia must be twice as lower than that of a healthy person. Therefore, drugs of this group are immediately used in the treatment of heart ischemia.
Nitrate	This is nitroglycerin and isosorbide mononitrate. They are necessary to relieve the attack of angina. Possessing the vasodilatory impact on the vessels, these drugs make it possible in a short period of time to get a positive effect. Nitrates should not be used in hypotension - arterial pressure below 100/60. Their main side effects are headache and low blood pressure.
Anticoagulants	Heparin, which, as if "dilutes" blood, which contributes to the relief of blood flow and stop the development of existing thrombus, and also does not give to develop new thrombam. The drug can be administered intravenously either under the skin in the stomach.
Diuretics (thiazide - hypotheside, indapamide; looped - furosemid)	These drugs are necessary to remove excess fluid from the body, thereby reducing the load on myocardium.

The following medical preparations are also used: lysinopril, caption, enalaprin, antiarrhythmic drugs (amiodar), antibacterial agents and other drugs (mexicor, ethylmethylhydroxypyridine, trimetazidine, mildronat, coronatar).

Video

The video describes what drugs can be taken with IHD:

Restriction of exercise and diet

At physical exertion, the load on the heart muscle increases, as a result of which the need of myocardium of the heart in oxygen and the necessary substances is also increasing.

The need does not correspond to the possibility, therefore, the disease occurs. Therefore, an integral part of the treatment of IBS is the restriction of physical activity and gradually increasing it during rehabilitation.

Diet with heart ischemia also plays a big role. In order to reduce the load on the heart, the patient is limited in the reception of water and cook salt.

Also, much attention is paid to the restriction of those products that contribute to the progression of atherosclerosis. Fighting overweight, as with one of the main risk factors, is also an integral component.

It should be limited or refusing the following groups of products:

animal fats (salary, butter, fatty meat varieties);
fried and smoked food;
products containing a large amount of salt (salted cabbage, fish, etc.).

It should be limited to the use of high-calorie food, especially fast absorbing carbohydrates. These include chocolate, cakes, candy, snob.

In order to stick normal weightOne should follow the energy and its amount that comes with the food used and the actual energy consumption in the body. At least 300 kilocalories should flow into the body daily. An ordinary person who is not engaged in physical work, spends about 2,000 kilocalories per day.

Surgery

In special cases, surgical intervention is the only chance to save the life of a sick person. The so-called coronary shunting is an operation at which the coronary vessels are combined with external. Moreover, the connection is performed in the place where the vessels are not damaged. Such an operation significantly improves the nutrition of the heart muscle with blood.

Aorticonial shunt - operational interventionIn which the aorta is fastened with the coronary artery.

Balloon dilatation of vessels - an operation at which cylinders with a special substance are introduced into the coronary vessels. Such a balloon expands to the required damaged vessel. Enter it to a coronary vessel through another major artery using the manipulator.

Method of endovascular coronaugulagioplasty is another way of treating heart ischemia. Balloon angioplasty and stenting applied. Such an operation is carried out under local anesthesia, the auxiliary tools are introduced more often to the artery of the femoral, piercing the skin.

The operation controls the X-ray apparatus. This is an excellent alternative to a direct surgical operation, especially in the case when the patient has certain contraindications to it.

In the treatment of heap ischemia, other methods that do not provide for the use of drugs can be used. These are quantum therapy, treatment with stem cells, hirudotherapy, methods of shock-wave therapy, the method of enhanced outdoor counterpulsion.

Treatment at home

How can I get rid of the ischemia of the heart and carry out its prevention at home? There are a number of ways that will require only patient's patient desire.

These methods predetermine the activities that are aimed at improving the quality of life, that is, the minimum of negative factors.

Such treatment implies:

refusal of smoking, including passive;
refusal of alcohol;
diet and rational nutrition, which includes products of plant origin, low-fat meat, seafood and fish;
mandatory use of food rich in magnesium and potassium;
refusal of oily, fried, smoked marinated and too salted food;
power consumption with low content cholesterol;
normalization of physical exertion (required outdoor walks, swimming, jogging; exercise on the exercise bike);
gradual hardening of the body, including wiping and dumping cool water;
a sufficient night's sleep.

The degree and type of load should define a specialist doctor. Also need control and constant advice with the attending physician. It all depends on the phase of the aggravation and degree of the disease.

Non-drug treatment includes measures to normalize blood pressure and treatment of existing chronic diseases, if any.

Video

Also, you can read what products should be submitted to your diet for the holding of the cardiovascular system:

Treatment with folk remedies

Phytotherapy plays an important role in the treatment of ischemic heart disease, as it contributes to an increase in the effectiveness of pharmacological preparations and improving the quality of life of the patient. Among the plants that best help in curing this ailment should be highlighted by a hayrs.

Specialists advise regularly to use tea, brewed on the basis of its leaves, fruits and flowers. At the same time, the fruits are recommended not to grind, but add a few pieces to a cup of boiling water.

To improve the blood supply of the heart muscle in tea, you can add the grass of the medicinal donel, leaves of linden with flowers or the labar flowers of the viscousistic.

A fairly effective folk remedy for the treatment of ischemic heart disease is horseradish. Five grams of the root of this plant should be grate and pour the glass of boiling water. The decoction must be insisted in the thermos two hours, and then use for inhalations. You can also be one teaspoon of grated shit to mix with one teaspoon of honey and eat once a day, drinking water. The duration of the reception of this medication should be a month and a half.

The most famous means of traditional medicine to combat ischemic heart disease is garlic. It can be used to prepare the healing tincture, grinding fifty grams of vegetable and bay glass of vodka. After three days, it should be started to use a tincture, diluting eight drops in a teaspoon of cold water.

Take the medicine you need three times a day. It is impossible not to mention the importance of such medicinal plants as mocicians, lettering, horsetail, leaves of raspberries, Melissa, oregano and other herbs that are used to prepare various healing fees.

Prevention

As preventive measures to prevent the occurrence of heart ischemia, the following should be selected:

it is impossible to overload yourself to work and often rest;
get rid of nicotine addiction;
do not abuse alcohol;
eliminate the use of animal fats;
food with a high calorie content limit;
2500 kilocalories per day - limit;
food should be high protein products: cottage cheese, fish, low-fat meat, vegetables and fruits;
moderately physical education, arrange hiking.

What is the forecast?

The forecast is mostly unfavorable. The disease is steadily progressing and is chronic. Treatment only only suspends the process of the disease and slows down its development.

Timely consultation of the doctor and proper treatment improve the forecast. Healthy lifestyle and full nutrition It also contributes to strengthening the heart function and improving the quality of life.

Cardiologist, doctor of functional diagnostics

Dr. Zhuravlev for many years helps patients with cardiopathology to get rid of the problems in the work of the heart and vessels, so the specialist conducts comprehensive therapy of hypertension, ischemia, arrhythmia.

A drug	Average daily dose (mg)	Frequency reception

Nitroglycerine	By need
Nitrosorbid.
Trinitolong
Ointment with niroglycerin
Izoket (cardic) -120
Izoket (cardic) retard
Isosorbide-5-Mononirate (Monocinque, Efox)
Plock Nitroderm
Molomin (Corvaton, Dilaside)
Beta blockers
Propranolol (Obizant)
Metoprolol (Methodocard, Corvitol)
Oxprenolol (trazicor)
Pindolol (Viscome)
Nadolol (Corgard)
Atenolol (tenorn)
Bisoprolol (Concorp)
Carvedilol (dilatrend)
Nebivolol (root)
Calcium antagonists
Verapamil (Isopin SR)
Nifedipin Gits (OSMO Adalat)
Diltiazese (Dilren)
Diltiazese (Altiazem RR)
Isradipine (Lomir sro)
Amlodipine (Norvask)
Additional drugs
Cordaron
Eufillin
Mildronat (?)
Trimetazidine (?)

Modern means of treating IBS. Calcium channel blockers

The main methods of treating IBS

Medical treatment of IBS - General principles

Antiagreganta

Hydolipidemic drugs (statins)

Rhenin-angiotensin-aldosterone system blockers

Groups of drugs for symptomatic treatment of IBS

Beta adrenoblocators

Calcium antagonists

Nitrates and nitrate-like

Sinus node inhibitor

Activator of potassium channels

Antihypertensive drugs

Treatment of vasospadic shape angina

Treatment of microvascular angina

First aid preparations

Useful video

Conclusion

Selection of therapy

Additional measures

Groups of necessary drugs

Lowering pressure

Improving heart work

Video

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