Coronary artery disease (CHD): what is it, symptoms, treatment

What is coronary artery disease?

Coronary heart disease (IHD) is a disease of the arteries that supply the heart muscle. The disease usually develops due to atherosclerosis (hardening) and plaque (slices of calcified material) in the blood vessels. As a result, coronary arteries often cannot carry blood as efficiently as they should and may even become completely blocked (blocked). Since the heart muscle needs a constant supply of oxygen and nutrients to survive, blockage of the coronary artery quickly leads to significant problems such as heart attack and stroke.

IHD is caused by factors such as smoking and lack of physical activity, as well as medical conditions such as high blood pressure (

arterial hypertension) and diabetes. Treatment involves managing risk factors through lifestyle adjustments and prescription medications, and sometimes direct repair or replacement of arteries with surgical or specialized procedures.

CHD symptoms

Coronary artery disease usually does not cause symptoms until it becomes advanced. Quiet symptoms may include dizziness, indigestion-like disorders, fatigue, and lack of energy. More visible CHD symptoms include shortness of breath and chest pain. These are all warning signs of heart attack and you should see your doctor if there are any signs or symptoms of coronary artery disease.

Frequent symptoms

In general, CHD symptoms are associated with constriction of the heart's blood vessels, which can intermittently interfere with the heart muscle from receiving optimal blood supply.

The most common symptoms of coronary artery disease are:

• Dyspnea: If a person has insufficient blood flow in the coronary vessels, they may feel that they cannot catch their breath, they don't have enough air, or they cannot breathe. These sensations are often referred to as shortness of breath. It is more likely to occur or worsen with physical exertion or emotional stress. Sometimes shortness of breath may not be so obvious, and the person may only feel that they have no energy.
• Chest discomfort: Often, insufficient blood flow to the coronary arteries can manifest as chest discomfort.

Chest discomfort caused by coronary artery disease is more likely to occur with strenuous exercise and improve with decreased physical activity.

• Dizziness: You may experience intermittent dizziness if you have coronary artery disease. Most likely, it will be accompanied by physical activity, but this can happen at any time.
• Lack of energy: With coronary artery disease, there may be a feeling of reduced energy and frequent or unexpected fatigue. This is a particularly alarming sign if there are other symptoms of coronary artery disease, but it may be the only sign of the disease.
• Chest pain (angina): Typical angina is described as severe chest pain, tightness and pressure that is most intense on the left side of the chest and may affect the jaw and left shoulder. With coronary artery disease, angina pectoris may occur within a few seconds and resolve on its own or worsen within a few minutes, which is a sign myocardial infarction (heart attack). Many people who have a heart attack as a complication of coronary artery disease recall having had short episodes of chest pain in the past month.
  • Progressive coronary artery disease can cause angina pectoris if the heart muscle temporarily does not receive sufficient blood flow through the coronary arteries. Exertional angina occurs in an almost predictable manner, such as during physical exertion or high stress, and usually means that the plaque has become large enough to cause partial obstruction of the coronary arteries.

Rare symptoms

The atypical symptoms of coronary artery disease are not widely recognized. People experiencing these symptoms may not even mention them to their doctor, even at their regular check-ups. This can lead to missed diagnosis, inadequate therapy, and worse outcomes.

Atypical symptoms of coronary artery disease include:

• Unstable angina: unlike stable exertional angina, unstable angina can occur at any time and without a specific pattern or trigger. It is not triggered by stress or exercise and usually appears at rest. If you have unstable angina, you are at high risk of developing complete occlusion of the coronary artery, which can lead to a heart attack.
• Atypical chest pain: angina pain is usually described as pressure or a feeling of strong squeezing. But it can also manifest as a hot or burning sensation or even soreness when touched, and it can be located in the back, shoulders, arms, or jaw. In particular, women are more likely to experience atypical chest pain as a result of coronary artery disease, and some women may have no chest discomfort at all. Instead, they may experience tingling or numbness on the left side of their chest or arm.
• Heartbeat: a fast or irregular heartbeat can feel like a pounding or shaking and is often accompanied by dizziness or lightheadedness.
• Quiet heart attacks. Heart attacks are usually characterized by excruciating chest pain and shortness of breath. However, coronary artery disease can cause silent heart attacks that occur without any noticeable signs, and can be diagnosed by examining the heart for other symptoms.

These symptoms are not necessarily associated with disease in a specific coronary artery or with a specific type of atypical coronary artery disease.

Complications

There are several serious complications of coronary artery disease. They can occur after several years of untreated coronary artery disease, when the arteries become so diseased that there is a complete obstruction of blood flow through the coronary arteries. This leads to inadequate delivery of oxygen and nutrients to the heart muscles, which can lead to the death of heart muscle cells and subsequent dysfunction of part of the heart muscle itself.

• Myocardial infarction (heart attacks): A heart attack is a lack of blood flow to the myocardium (heart muscle). It is usually characterized by crushing chest pain and shortness of breath. Symptoms may also include nausea, vomiting, upset stomach, shortness of breath, extreme tiredness, sweating, numbness, or tingling on the left side of the chest, left arm, shoulder, or jaw.
• Arrhythmia (irregular heartbeats): An irregular heartbeat can start after a heart attack. If a heart attack affects the pacemaker of the heart, it can lead to an irregular heart rhythm. It can cause tiredness, dizziness, heart palpitations or syncope.
• Heart failure: If part of the heart muscle becomes weak after a heart attack, heart failure (weak heart). Heart failure manifests itself in the form of fatigue, shortness of breath, and swelling of the legs.
• Stroke: A blood clot (thrombus) in the coronary arteries can displace and travel to the brain, obstructing blood flow and causing a stroke. A stroke is a violation of blood flow in an artery in the brain that can cause different symptoms depending on which part of the brain is affected. Symptoms may include inability to speak, loss of vision, weakness on one side of the face, arms and / or legs, loss of sensation on one side of the body, or loss of consciousness.

Causes and risk factors for ischemic heart disease

Coronary artery disease (CHD) is caused by a number of medical conditions, genetic predisposition and lifestyle choices. Over time, these factors contribute to the development of atherosclerosis. Atherosclerosis, the main cause of coronary heart disease, can make the coronary blood vessels (supplying the heart muscle) prone to clotting. High cholesterol levels, which can also contribute to the development of coronary artery disease, increase the likelihood of blood clots in the coronary arteries.

Common Causes

CAD develops as a slow process in which the arteries that supply blood to the heart muscle become narrow, stiff, and painful inside.

The accumulation of cholesterol, inflammation in these affected arteries forms plaque that can penetrate into the bloodstream. A buildup of plaque increases the likelihood of blood clots forming in your arteries, which can interfere with blood flow to your heart muscle.

There are several known causes of coronary artery disease.

• Atherosclerosis: arterial disease throughout the body, atherosclerosis develops over time. Atherosclerosis causes the smooth, elastic lining of the arteries to become hardened, stiff, and swollen. It is characterized by the buildup of plaque within the arteries. Atherosclerosis is the main cause of coronary artery disease.
• Hypertension: Chronic high blood pressure can contribute to or cause coronary artery disease. Over time, excessive pressure on the arteries can interfere with the normal structure of the arteries, as well as their ability to expand and contract as they should.
• High cholesterol. Elevated cholesterol levels has long been contributing to the development of ischemic heart disease. Excess cholesterol and fat in the blood can damage the lining of the arteries. There has been controversy over whether high blood cholesterol is caused by diet, genetics, or metabolism. Of course, for some people, dietary changes can lower cholesterol levels; for others, the change in diet has no effect. High cholesterol levels are likely caused by a combination of factors that are different for everyone.
• Diabetes. Type I diabetes and type II increases the chances of developing the disease, and the likelihood of coronary heart disease is higher if blood sugar is not properly controlled.
• Obesity (overweight): If you are more than overweight, you have an increased risk of developing coronary artery disease. It is due to the metabolism of lipids (fat molecules) or hypertension that results from obesity.
• Inflammation: The inflammation causes damage to the inner lining of the heart's blood vessels. There are a number of causes of inflammation, including stress, a high-fat diet, dietary preservatives, infections, and illness, all of which are thought to contribute to the development of coronary artery disease.

Genetics

There appears to be a genetic component in CHD, and people who have genetic risk development of the disease, it may be necessary to take chronic medications to reduce the risk of heart attack and other complications of coronary artery disease.

Some of the genetic defects associated with CHD cause changes cholesterol metabolism or vascular diseases; some make a person more prone to inflammation; and some cause coronary artery disease without a well-understood mechanism.

Study from Canada identified 182 genetic variants associated with ischemic heart disease. The researchers described this as further evidence that CHD is polygenic, which means that there are many genes that cause the disease. In general, genes associated with a polygenic disease can be inherited together, but in different combinations. Studied genetic abnormalities were especially common among youth, which is defined as under 40 for men and under 45 for women.

In general, genetic markers of CAD are more common in young people with CAD, who are less likely than older people to have long-term illnesses and lifestyle factors that contribute to the development of CAD over time.

Genetic changes that lead to certain identifiable problems have also been found. For example, one study found that the genotype LDLR rs688 TT associated with increased susceptibility to coronary artery disease in patients, and LDLR rs688 may be used as a predisposing genetic marker for CHD, although the researchers said further research is needed to confirm their findings.

Genetic susceptibility to CAD can be inherited, and some genetic mutations can occur even without an identifiable hereditary cause. In other words, a person can develop a mutation even if it was not passed on from their parents.

Lifestyle

There are a number of lifestyle factors that increase your risk of coronary heart disease. These habits certainly look familiar as they are implicated in numerous health problems.

• Smoking: One of the main causes of atherosclerosis and coronary artery disease, smoking exposes the body to various toxins, damaging the inner lining of blood vessels, making them prone to the formation of atherosclerotic plaques and blood clots.
• Diet: An unhealthy diet can contribute to CHD due to high cholesterol levels, high fat content, and exposure to preservatives that are not good for the body. A healthy diet is rich in fresh fruits and vegetables, as well as healthy fats found in nuts, legumes, lean meats, and fish. This type of diet contains vitamins, minerals, and antioxidants that can help reduce harmful fats and substances that lead to atherosclerosis.
• Passive lifestyle: Physical activity is produced by hormones and chemicals that increase the level of healthy fats in the body, which are known to reduce the harm that contributes to atherosclerosis; without proper activity, a person misses these important benefits. In addition, a sedentary lifestyle contributes to obesity, which increases the risk of coronary heart disease.
• Stress: Stress produces a number of hormones that can increase stress on the heart and also cause damage to blood vessels. Unlike some other lifestyle risk factors, it is unclear what role stress plays in CHD, but experimental models suggest an association.

Diagnostics

In order to diagnose coronary heart disease, the doctor uses certain methods of examining the patient.

First, he examines the patient, collects a complete history, examines complaints, conducts auscultation and percussion of the heart. Then hardware studies are carried out, which include:

• ECG;
• electrocardiography with stress test;
• Holter monitoring;
• ultrasound scanning;
• Echo-KG;
• dopplerography;
• angiography;
• CT scan;
• scintigraphy;
• ballistocardiography;
• veloergometry.

Various methods make it possible to find irregularities in the work of the heart, to clarify the degree of their intensity, to determine the main trends in the development of the disease.

A careful study of the tissues allows one to determine their structural changes, their loss of functionality, as well as the loss of the normal shape and size of the ventricles.

The doctor also detects foci of atherosclerosis and vasoconstriction.

With ischemic heart disease, the following laboratory tests are prescribed:

• clinical blood test;
• blood chemistry;
• lipid profile;
• determination of blood clotting time;
• clarification of the duration of bleeding.

They make it possible to identify the provoking factors of coronary heart disease, to determine the degree of existing disorders, to establish the risk of thrombosis.

Coronary artery disease treatment

The fight against the development of the disease involves an integrated approach that depends on many factors. A conservative method is necessarily used, and if it is ineffective, surgical intervention is indicated.

The main treatment is complemented by exercise therapy, the use of a special diet, folk recipes and preventive measures.

Drug treatment

To correct the symptoms and causes of the development of coronary heart disease, the following are used:

• drugs that prevent thrombosis (Acetylsalicylic acid, Warfarin, Clopidogrel, Thrombopol).
• substances that increase the supply of oxygen to the heart muscle (Betalok, Coronal, Metocard).
• medicines that lower blood cholesterol levels (Lovastatin, Rosuvastatin).
• antiarrhythmics (Amiodarone).
• pain relievers (nitroglycerin).
• diuretics (Lasix, Furosemide).
• calcium antagonists (Amlodipine, Anipamil, Verapamil, Diltiazem, Nifedipine, Tiapamil).
• substances that suppress the synthesis of an angiotensin-converting enzyme (Captopril or Enalapril).
• beta blockers (Atenolol, Bucindolol, Metoprolol, Nebivolol, Propranolol, Timolol).
• sedative medicines (Afobazol, Gerbion, Phenibut).

The use of drugs can reduce the risk of vascular occlusion, reduce manifestations ischemia, improve cardiac conduction and make the patient feel better.

Surgical intervention

With the ineffectiveness of conservative methods, various operations are used to improve the patient's condition.

Indications for this method of treatment are irreversible changes in the inner wall of the vessels of the heart or a pronounced narrowing of their diameter.

It is not recommended to carry out surgical intervention if the recovery period has not yet ended after the heart attack, with severe chronic heart failure or the impossibility of normal contractile activity ventricles.

• The most commonly performed angioplasty is to restore vascular patency.
• Angio-shunting consists in creating collaterals bypassing the coronary artery. Anastomosis is made from the tissues of the large vessels of the patient himself. This method leads to a significant improvement in the general well-being of a person.
• External counterpulsation is also used. It creates the prerequisites for increasing diastolic pressure, which can significantly reduce the load on the left ventricle. This reduces oxygen starvation, increases the intensity of cardiac output and improves the blood supply to the heart muscle.

In case of an extremely serious condition of the patient and the possibility of performing this operation, a heart transplant is performed.

Complementary and alternative treatments

An integrated approach implies a combination of traditional methods of combating coronary heart disease with a number of special, including non-traditional, measures. They help to reduce oxygen deprivation of the myocardium, reduce the frequency of attacks and significantly improve the patient's well-being.

However, it is worth noting that the use of such treatment methods is allowed only after consultation and full approval of the cardiologist.

Certain medicinal plants, foods, dietary supplements, and exercise can damage the patient's condition. Therefore, their use should be strictly dosed and timed.

Nutrition and Supplements

Obesity is one of the main factors provoking the onset of coronary heart disease. Therefore, the diet becomes an important point in the patient's treatment.

It is desirable to give preference to low-calorie food, rich in vitamins and minerals.

It is recommended to include in the diet in large quantities foods with a high concentration of ascorbic acid (citrus fruits, cranberries, chokeberry).

You need to eat more plant foods.

Prohibited:

• fat meat;
• canned fish;
• rich broths;
• egg dishes;
• oil;
• caviar;
• seafood soups;
• alcohol;
• coffee;
• strong tea, etc.

Milk and milk products are also subject to restrictions.

Salt intake should be in the limit of ten grams per day.

Lean meats and fish are allowed for consumption, but in limited quantities and only boiled.

In general, it is allowed to include no more than one hundred grams of protein per day in the composition of meals. When the norm is exceeded, various nitrogenous compounds are formed, which significantly worsen the patient's condition. The presence of any fats and carbohydrates in food must be strictly controlled.

It is recommended to use fractional nutrition, since a significant filling of the stomach can provoke an attack.

It is recommended to stew and bake dishes.

The last meal should take place no later than three hours before bedtime.

Only with the special permission of a specialist is it allowed to include biologically active additives in the list of taken substances to stabilize metabolic processes in the myocardium and the body as a whole. A strictly dosed intake of antioxidants, carotenoids, fish oil, flavonoids is recommended.

Reception is especially important B vitamins, C and E, as well as potassium, magnesium, selenium and zinc, which improve heart function.

Herbs and other folk remedies

Herbal medicine can significantly improve the general condition of the patient with coronary heart disease.

It is recommended to receive a collection consisting of hawthorn, valerian, motherwort and chamomile. Take a tablespoon of the mixture of plant materials in a glass of boiling water and insist for three hours. Drink before every meal.

The tool allows you to improve cardiac conduction, reduce the manifestations of arrhythmias and calm the patient.

A collection that includes periwinkle, hawthorn, valerian, calendula, lemon balm, mistletoe, motherwort, caraway and dill. One tablespoon of the herbal mixture is poured into a glass of boiling water. Insist for an hour and take it twice a day. The composition has antiarrhythmic and sedative effects.

With cardiac diseases you need to take half a kilogram of honey and fill it with a bottle of vodka. Heat up until scale forms on the surface. Then they are removed from the heat and sprinkled with half a teaspoon of valerian, highlander bird, motherwort, chamomile and marsh dryweed. Strain and insist for three days in a cool and dark place. Take ten grams twice a day. The tool allows you to expand the lumen of blood vessels, calm the patient and strengthen the defenses of his body.

Promotes dilatation of arteries and stabilizes heart rate regular garlic. In addition, it regulates lipid metabolism and has an antithrombotic effect. It also actively removes toxins and increases resistance. It should be pre-crushed, add the required amount of honey and leave in this form for a week. The released syrup is taken twenty grams three times a day after meals.

Exercises

With ischemic heart disease, therapeutic exercises can be of great benefit. The following motor actions are recommended:

• it is necessary to take a sitting position. The upper limbs are slowly raised above the head, then lowered horizontally, parallel to the floor. Slowly they take in air into the lungs, and when they lower their hands, they exhale it. Performed five times (five times);
• hands rest on the sides while sitting. One upper limb, set wide to the side, slowly rises to the shoulder. An inhalation follows, then it goes down. Then the exercise is carried out with the other hand (five times);
• sit down, connect the upper limbs with your fingers and take them away from you to the maximum distance, keeping them parallel to the shoulder girdle (eight times);
• in a sitting position, put one leg in front of you, and bring the other under the chair. Change their positions slowly (tenfold);
• you need to stand up, bend the upper limbs at the elbow and close in front of the sternum. The body slowly turns in different directions, deep, unhurried breaths in and out (six times) follow at the same time;
• in a standing position, hands must be closed over the head. The lower limb rests on the tips of the fingers, the body bends in the same direction. Then the exercise is carried out in another (five times);
• you need to get up and grab the back of the chair. Slowly bend the knees and inhale. Then they straighten up and exhale (six times);
• you need to get up and slowly bend your whole body in different directions, raising the upper limb above your head (six times);
• you should stand up and put your hands on your sides, and then slowly turn your head in different directions (five times);
• it is required to lie with your back up and straighten the upper limbs at the seams. The lower ones, as far as possible, need to be raised one by one (six times);
• for half a minute, a leisurely walking in place is carried out. After the approval of the cardiologist, as the body strengthens and the general condition improves, the pace is allowed to accelerate somewhat;
• in the future, small jerks alternate with a slowdown in stride for three minutes;
• gradually begin to slowly bend the leg at the knee on the move (half a minute).

Performing physiotherapy exercises will activate blood circulation, improve tissue supply oxygen, reduce the manifestation of stagnation, stabilize the state of the vascular network and strengthen organism.

Prophylaxis

Ischemic heart disease is a pathology that is better avoided than then long and difficult to treat.

The main measures to prevent it are:

• a ban on the use of alcoholic beverages, strong coffee and tea;
• complete rejection of bad habits;
• daily moderate physical activity;
• taking vitamins and minerals that improve heart function;
• regular measurement of blood pressure and heart rate;
• balanced diet;
• adherence to the daily routine;
• stabilization of professional loads;
• control over body weight;
• prevention of endocrine pathologies, etc.

Preventive measures will make it possible to maintain the health of the heart muscle, reduce overload and improve metabolism in the body.

Constant monitoring of your condition will allow you to identify signs of an impending disease in time. A responsible attitude to your health will help prevent its development and progression in time.

Prognosis for ischemic heart disease

Ischemic heart disease is a serious pathology. According to the World Health Organization, it is the leading cause of death, especially among males. In Russia alone, at least 100 thousand people per year die from it. World statistics point to a figure of 70% of all those who died after 50 years.

IHD is most dangerous due to the occurrence of severe complications, often fatal. The most threatening are considered heart failure and stroke, from which about 70% of patients die.

People who see a doctor in a timely manner and have received appropriate treatment remain alive in almost 100% of cases. The neglected state reduces the indicator to 70%.

People who neglect the need to see a specialist and do not follow the parameters of the prescribed treatment make up 60 percent of all people who die as a result of a heart attack or a severe attack angina pectoris.

Complete recovery from coronary heart disease is practically not found, but the prognosis for life with early diagnosis and successful correction of the pathology is quite favorable.

It should be concluded that IHD is a severe pathology that requires individual, complex and long-term treatment. An important factor is also its timely detection, prevention of concomitant diseases and factors provoking its occurrence.