Ischemic heart disease: general information

Coronary heart disease (IHD) is defined as myocardial damage caused by coronary artery disease. The term "coronary heart disease" is synonymous with the term "coronary heart disease". The defeat of the coronary arteries can be of an organic or functional origin. Organic damage - coronary artery atherosclerosis, functional factors - spasm, transient platelet aggregation and thrombosis. Atherosclerotic stenoses of the coronary arteries are detected in approximately 95% of IHD patients. Only 5% of patients have normal or little coronary arteries.

The occurrence of myocardial ischemia in coronary blood flow disorders of other etiology (coronary artery anomalies, coronary arteries, aortic stenosis, relative coronary insufficiency with myocardial hypertrophy) does not belong to ischemic heart disease and is considered within the framework of the corresponding diseases ("ischemia without ischemic heart disease").

Ischemia is an inadequate blood supply. Myocardial ischemia occurs when myocardial oxygen demand exceeds the possibility of its delivery through the coronary arteries. Therefore, the cause of ischemia may be either an increase in myocardial oxygen demand (as coronary arteries decrease the coronary blood flow increase-a decrease in the coronary reserve), or a primary decrease in coronary blood flow.

Normally, as myocardial oxygen demand increases, coronary arteries and arterioles expand with an increase in coronary blood flow 5-6 times (coronary reserve). With coronary artery stenoses, the coronary reserve decreases.

The main cause of a sudden decrease in coronary blood flow is spasm of the coronary artery. Many patients with IHD have a combination of atherosclerotic lesion and propensity to spasm of the coronary arteries. Additional reduction in coronary blood flow causes platelet aggregation and coronary thrombosis.

Ischemic heart disease, most often associated with an atherosclerotic process, involves deterioration of the blood flow through the coronary arteries. Clinical manifestations of coronary heart disease (CHD) include painless ischemia, angina pectoris, acute coronary syndrome (unstable angina, myocardial infarction), and sudden cardiac death. The diagnosis is made on the basis of characteristic symptoms, ECG, stress tests and sometimes (coronary angiography). Prevention requires changing the corrected (modifiable) risk factors (such as hypercholesterolemia, hypodynamia, smoking). Treatment includes prescribing drugs and procedures designed to reduce ischemia and restore or improve coronary blood flow.

In the USA Ischemic heart disease is the leading cause of death in people of both sexes (one third of all deaths). Mortality among men of the Caucasoid race is in the range of 1 to 10 000 in the age group from 25 to 34 years and almost 1 per 100 in the age group from 55 to 64 years. Mortality among Caucasoid men aged 35 to 44 years is 6.1 times higher than among women of the European-European race of the corresponding age. For unknown reasons, the gender difference is less pronounced among other races.

The mortality rate among women increases after menopause, and by the age of 75 equals or even exceeds that of men.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Clinical forms of ischemic heart disease

There are 3 main clinical forms of IHD:

1. Angina pectoris

• Angina of Stress
• Spontaneous angina (rest stenocardia)
• Unstable angina

2. Myocardial infarction

• Myocardial infarction with a Q
• Myocardial infarction without Q wave

3. Postinfarction cardiosclerosis

The main complications of IHD:

1. Sudden coronary death
2. Heart rhythm disturbance
3. Heart failure

Before the establishment of an accurate diagnosis, unstable angina and myocardial infarction are combined with the term "acute coronary syndrome". In addition to these clinical forms of IHD, there is a so-called "painless myocardial ischemia" ("mute" ischemia).

Among all patients with IHD, there are two main groups (the two extreme variants of the clinical course of IHD):

1. patients who suddenly have acute complications of ischemic heart disease - acute coronary syndromes: unstable angina, myocardial infarction, sudden death;
2. patients with gradual progression of angina pectoris.

In the first case, the causes are a rupture of an atherosclerotic plaque, a spasm of the coronary artery, and an acute thrombotic occlusion. More often, small ("hemodynamically insignificant") plaques are stained, stenosing less than 50% of the lumen of the coronary artery and not causing stress angina. These are plaques with a high content of lipids and a thin capsule (the so-called "vulnerable", "unstable" plaques).

In the second case, there is a gradual progression of stenosis with the formation of a "hemodynamically significant" plaque stenosing more than 50% of the lumen of the coronary artery. In this case, "stable" plaques with a dense capsule and a smaller content of lipids are formed. Such stable plaques are less prone to rupture and are the cause of stable angina pectoris.

Thus, to a certain extent, there has been a change in the notion of the clinical significance of the degree of stenosis of the coronary arteries-in spite of the fact that clinical manifestations of myocardial ischemia occur with more severe stenosis, acute coronary syndromes are more often observed with minor stenosis, due to the rupture of small but "vulnerable" Atherosclerotic plaques. Unfortunately, the first manifestation of IHD is more often acute coronary syndromes (more than 60% of patients).

[13], [14],

Prophylaxis of coronary heart disease

Prevention of IHD involves the elimination of risk factors for atherosclerosis: cessation of smoking, reduction of excess body weight, healthy diet, rational exercise, normalization of the serum lipid profile (especially the use of HMG-CoA reductase inhibitors - statins), control of arterial hypertension and diabetes.