Cardiovascular disorders

Сърдечно-съдови заболявания

Ischemic heart disease

(CHD or coronary artery disease)
Coronary artery disease is damage to the myocardium caused by impaired blood flow through the coronary arteries. Damage to the coronary arteries may be organic (irreversible) and functional (transient). The main cause of organic damage to the coronary arteries is stenotic atherosclerosis. Functional impairment factors are coronary artery spasm, transient platelet aggregation, and intravascular thrombosis.
The term Coronary Heart Disease includes acute transient and chronic pathological conditions. The final manifestation of coronary heart disease is myocardial infarction.

Clinical symptoms

Burning feeling behind the breastbone, under the shoulder blade, in the spine, in the upper abdomen; pain in the chest, under the shoulder blade, in the spine, in the upper abdomen; a feeling of chest heaviness (“tightness”, “as if a concrete slab placed on the chest”); feeling of irregular heart work or a feeling of a sinking heart

The Coronary Heart Disease treatment includes:

Non-drug therapy. It includes diet and lifestyle adjustment measures. Patients are prescribed to limit their physical activity. This is because during physical activity myocardial blood demand always increases. If this need is not met, manifestations of pathology occur. Diet for coronary heart disease includes salt and water intake restriction. Reducing stress on the heart muscle also helps. A low-fat diet is usually prescribed in order to prevent atherosclerosis progression. Animal fats, fried and smoked foods, as well as “fast” carbohydrates intake are restricted or completely excluded.
Drug therapy. Includes the prescription of adrenoblockers, antiplatelet drugs, and cholesterol-lowering drugs. In the absence of contraindications, patients also take diuretics, nitrates, and antiarrhythmics.
Intervention therapy includes coronary angiography with PTCA and stent placement.
In the presence of indications and lack of effect of the above methods, surgery must be performed. Coronary artery bypass grafting is a popular intervention. This operation allows you to restore blood supply to the ischemic region. The interventions are performed with the help of an artificial blood supply or a beating heart.

Coronary heart disease prevention

This disease is quite dangerous, so timely prevention must be carried out. Preventive measures include lowering blood pressure, lowering blood cholesterol levels, quitting smoking, reducing the physical and emotional stress risks, regular moderate physical activity, and maintaining an optimal weight.

High blood pressure is a very common and widespread disease. Depending on the causes that cause it, high blood pressure is divided into hypertension and symptomatic (secondary) hypertension.
Hypertension (primary, essential hypertension) is a separate disease. Secondary (symptomatic) hypertension is a consequence of other diseases (kidney, endocrine, cardiovascular, etc.).
Measurement of blood pressure in the morning after waking up, on an empty stomach, and after spontaneous urination gives the values ​​of basal blood pressure. According to the standard of the World Health Organization, the values ​​of normal blood pressure are 135-140/85-90 mm/Hg.
Hypertension is more common in people engaged in mental work, accompanied by neuropsychiatric stress. In women, the disease often occurs during and after menopause. Hereditary factors are of significance for the development of hypertension. Predisposing factors include smoking and alcohol abuse, as well as being overweight.
The incidence of the disease is higher in men (in a ratio of 2.6:1 compared to women). In recent years, there has been an increase in the incidence of the disease among younger age groups (between 25 – 40 years of age).
Clinical symptoms
There are no complaints in the initial stage. Hypertension is usually found by accident upon medical examination on another occasion or during preventive tests. The only sign is the presence of elevated blood pressure above normal values. These values ​​are initially incidentally elevated, higher in the evening or upon neuropsychiatric stress. Gradually, the increased blood pressure values ​​become permanently maintained.
Early complaints are headache, disturbed sleep, tinnitus, palpitations, mild mental and physical fatigue. The headache is more pronounced in the morning after sleep and in the evening after work. It is usually localized in the frontal and occipital areas and has a “tightening” nature. In the later stages of the disease, the complaints become permanent, and blood pressure values ​​stabilize in the range of 150-180/95-110 mm/Hg.
In the course of the disease, hypertensive crises often occur, with a rapid and sharp rise in blood pressure up to and above 190/115 mm/Hg and more severe headaches. The crisis has a different duration – from 1-2 hours to 3-4 days and is accompanied by severe headache, frequent nausea, and vomiting, dizziness, impaired vision and hearing, palpitations, tremors, etc.
Sometimes there is epileptic-like seizure with temporary loss of consciousness, hearing, and vision. Seizures are due to transient cerebral edema. In the course of a more severe hypertensive crisis, complications can occur – stroke or heart attack. In the later stages of the disease, vital organs can be damaged. The so-called hypertensive heart with hypertrophy and sclerotic changes mainly of the left ventricle and heart vessels, with the development of left ventricular failure. Renal sclerosis with renal failure can also develop.
The so-called hypertensive encephalopathy with inadequate hemorrhage and stroke can occur in the brain. Retinal hemorrhage and impaired vision may occur. Heart attack and stroke are much more common in patients with hypertension than in people with normal blood pressure (approximate ratio of 6:1).
Treatment is usually conservative. Patients without complaints are usually reluctant to seek drug treatment. The goal of treatment is to permanently lower blood pressure until it reaches normal or close to normal values ​​(up to and below 140/90 mm/Hg). An appropriate diet is prescribed, limiting salt and fat intake.
A suitable and rational work rhythm, 8-hour night’s sleep, prevention procedures, controlled exercise, avoidance of strong emotions, and mental stress are recommended. Smoking and alcohol abuse are strictly prohibited.
Drug treatment involves the use of a number of medications that lower blood pressure to normal or close to normal levels. All these antihypertensive drugs are taken only with a doctor’s prescription and constant monitoring of blood pressure. In addition, diuretics, hypnotics, neuro-sedatives, and other drugs may be prescribed.
The most appropriate antihypertensive drugs are clarified during treatment. Drug treatment is long and difficult, and the dosage must be constantly adjusted and monitored in view of the course of the disease. There is currently a large selection of effective medications that affect high blood pressure.
Prevention of hypertension consists in maintaining a healthy diet, hygiene, and occupational schedule, avoiding smoking and alcohol abuse, exercising active sports, including hiking, eliminating conditions leading to emotional stress. It is appropriate and reasonable to maintain appropriate underweight and monitor blood pressure values.