Coronary insufficiency
Coronary insufficiency is a condition in which coronary blood flow decreases or stops completely. As a result, the heart muscle is not adequately supplied with nutrients, oxygen. Insufficiency can be divided into two types: coronary insufficiency of rest and tension. A common ischemic disease is manifested by coronary insufficiency. It is known that often infarcts for this reason also arise. But it is possible for other pathologies and diseases to notice the altered structure of the coronary vessels. Severe pathology will be indicated by painful sensations during physical rest.
Coronary insufficiency of cause
1. Combination of vascular and metabolic factors;
2. Enhanced work of the heart associated with an increase in the metabolic needs of the heart in the case where coronary vessels are unable to increase blood flow;
3. In blood vessels the blood flow decreases, if the metabolic demands of the myocardium have not changed.
The causes of coronary insufficiency may be varied, but, as a rule, they are caused by spasms, thrombotic or atherosclerotic stenosis. It happens that the foreign body can also cause the cessation or reduction of blood flow.
most common cause of coronary artery disease is atherosclerosis of coronary artery heart coronaritis, various vascular injuries( e.g., falling, impact, compression), congenital and acquired cardiac defects. As well as bacterial endocarditis, stenosis of the pulmonary trunk, syphilitic aortrit, shock and collaptoid condition, anemia, scattering aortic aneurysm.
also cause coronary insufficiency may serve as a sudden breach patency of the arteries of the coronary due to spasm and clogging fully or partially( e.g., air bubbles or oil droplets), embolisms, thrombosis, compression, adhesion, delamination and rather rare presence of congenital shunts between the pulmonary and coronaryArteries. Metabolic inquiries will increase in non-ischemic areas of the heart. However, it is quite important to redistribute blood( "stealing") in the non-ischemic area and in that part of the artery's lesion.
pathological process, which is accompanied by perfusion pressure in the system coronary artery, arterial anemia and hypoxia, carbon monoxide poisoning and more vasodilation not able to meet the metabolic demand of the heart. The chronic or acute form of coronary insufficiency will develop depending on the intensity and duration of the effect of one or another factor.
Narrowing or diminishing the ability to expand the affected coronary arteries can lead to the development of chronic coronary insufficiency. As a rule, it is caused by atherosclerosis, but inflammatory processes are not ruled out.
Conclusion: The frequent causes of coronary heart disease is the development of hypertensive disorders due to inflammation, atherosclerosis, koronaritov, vasculitis, as well as heart disease. Also, people with severe infectious diseases and with high blood coagulability will be predisposed to this disease.
The manifestations of the chronic form of coronary insufficiency are no different from the degree of narrowing of the coronary vessels of the heart. This is due to the collateral circulation, as in some cases it is organically fully functional and, in some, not.
Coronary insufficiency
If symptoms remit cardiovascular disease, the most common cause of death - that of coronary heart disease, because the heart and blood vessels are damaged equally. Symptoms, as a rule, are of a complex nature, nevertheless, the leading part is an attack of angina pectoris. However, the diagnosis can be made against a background of a heart attack.
Often, the diagnosis of coronary insufficiency is based on anamnesis and patient complaints. A fairly common single symptom are pains lasting 10 minutes behind the sternum or in the heart area( angina pectoris or angina pectoris).In the case of longer pain, coronary pathology of the myocardium or focal changes of different sizes can be assumed. Quite rarely you can find painful sensations lasting up to 3 hours, which do not cause a heart attack.
Pain of paroxysmal nature that can occur suddenly due to physical exertion and less often with mental stress. The most common factors provoking pain are: abundant food intake, fast walking, climbing stairs and, as a rule, are most often observed on windy cold days, in the winter.
The patient is aggravated by the condition during physical stress and because of this he feels stiff. There is a desire to maintain a motionless position. The face becomes pale, the breathing is superficial and slow. There will also be "accompanying" symptoms of the disease:
- the emergence of a urge to defecate and urinate;
- dyspeptic disorders are expressed as vomiting, hiccups, nausea, increased salivation;
- there will be abundant gases;
- the release of light urine in large quantities will begin.
But it should be borne in mind that the "accompanying symptoms" of coronary insufficiency are nonspecific and can also accompany functional disorder and heart attack. People of young age will occasionally show typical symptoms for this disease. For this reason, you should always pay attention to the presence of suspicious signs, especially pain in the left side of the sternum. Often, young people who suffer from these diseases look older, outwardly, which is important in diagnosing.
Despite the difficulties that arise in the diagnosis, in the early stage of coronary insufficiency, in addition to clinical examination, history and ECG, after and during physical exertion, at rest, biochemical research( determination of electrolyte, lipid metabolism and catecholamine)Factors that contribute to the development of ischemic disease.
Also, dyspnoea, cough, fast heartbeat, or clinically there may be no symptoms until the attack of angina pectoris.
Acute coronary heart disease
This condition is caused by a spasm of the coronary vessels supplying the heart with blood. Spasms occur in a state of rest, with insignificant emotional or physical loads, as there is a sharp increase in the need for tissues in oxygen. Quite often, the syndrome of sudden death is associated with this disease. Such diseases as stenosis, vascular embolism can provoke acute coronary insufficiency.
The clinical syndrome of acute coronary insufficiency is angina pectoris or angina due to temporary impairment of coronary circulation. The basis of the attack is oxygen starvation of the heart, resulting in the accumulation of incomplete oxidation of products in tissues, as a result, the receptor apparatus is irritated. The origin of seizures depends on the functional moments that cause vasospasms. Strength and nature of the attack depends on the reaction of the vascular wall, irritating force, atherosclerotic lesion, which will increase the inclination to spasm. Also, seizures may occur due to the accumulation of catecholamine.
Angina is much less likely to occur with rheumatism, and possibly its development without coronary artery disease. Serious anatomical vascular lesions will be indicated by night attacks that occur during rest, which are quite difficult. They can occur suddenly and are accompanied by severe chest pain. Typically, the duration of 2-20 minutes. If the duration is more than 35 minutes, we should already assume a heart attack. Pain always radiates to the left side of the body, but it can occur in the hand, shoulder, ear.
Chronic coronary insufficiency
It manifests itself as a form of coronary artery disease and develops due to angina pectoris, coronary atherosclerosis. Everything is due to the fact that the intake of oxygen through the coronary bed does not correspond with the need of the heart because of the elasticity of the sclerosis-affected vessels.
There are 3 degrees of chronic coronary insufficiency:
The 1st( initial degree) of chronic coronary insufficiency is accompanied by rare attacks of angina pectoris, which can be caused by significant physical or psychoemotional loads. Atherosclerotic arterial changes are not pronounced.
The 2nd( severe or significant) degree of chronic coronary insufficiency, where the onset of angina attacks is associated with normal or moderate physical exertion. You can see the narrowing of the lumen of the atherosclerotic process by 1-2 branches of the coronary system more than 50%.
The 3rd( severe) degree of chronic coronary insufficiency is accompanied by angina attacks that occur at rest, with minimal stress. You can also notice violations of the heart rate.
The patient's condition will worsen during any load, as the altered arteries narrow, not expand. If the metabolic disturbance is long-term and complex, the process will take a more persistent character: new deposits will appear on old plaques, which will increase, narrowing the lumen of the arteries. As a result, the blood supply to the myocardium will decrease.
Coronary insufficiency treatment
The treatment of coronary insufficiency is complex and is aimed at eliminating the causes that cause it. It is also aimed at improving the supply of oxygen to the myocardium, prevention and relief of seizures. Cardiac inpatient treatment of coronary insufficiency includes surgical and medicamental methods. It is very important to know how to provide first aid in case of an onset of coronary insufficiency.
The patient should be given a comfortable position, laid or planted in the absence of cough or shortness of breath, providing free access to fresh air. The factor that contributed to the occurrence of an attack should be eliminated whenever possible.
First of all it is necessary to take Nitroglycerin, take one tablet every five minutes, but no more than 3 times. If this drug is not available, then Validol may be approached or any sweets with menthol. If you are not allergic to Aspirin, you should take a quarter of the pill to avoid dilution of blood.
Treatment of the chronic form of coronary insufficiency is carried out with the help of 3 groups of medicines: calcium channel blockers, nitro compounds, β-adrenoreceptor blockers.
Nitrates of prolonged and short action are intended for the expansion of venous vessels, due to which the venous return of blood to the myocardium decreases, and the final diastolic pressure decreases. Nitrates reduce the toxic effect on the heart by accelerating the metabolism of catecholamines.
Blockers β-adrenergic receptors are substances that are structurally similar to stimulants of the receptors of isadrin. Thus, the effect on natural and synthetic catecholamines ceases. Each patient has an individual reaction to the drug, so a daily dose of 60-320 mg.
Calcium channel antagonists can remove the hyperkinetic state of coronary vessels. And this is due to a slowing of the calcium current inside the cell through the calcium channels. Depending on the form and stage of coronary insufficiency, it is necessary to limit labor activity, recommended physical therapy. It is necessary to observe a strict diet, counting the calorie content of food. If the patient is overweight, then the calorie needs to be reduced by 30%, but in case of exhaustion, the food is more intensified.
Diuretics are prescribed to restore the acid-base and water-salt balance. They can remove excess fluid from the body and eliminate puffiness. Furasemide and Etakrinaic acid have a boosted effect. Clopamid, Cyclomethaside and hydrochlorothiazide have a moderate effect. For a long time, only Veroshpiron, Spirnolactone, Dytek and Amiloride can be used.
The treatment of coronary insufficiency at the initial stage is carried out with the help of vasolatators and alpha-blockers, in order to improve the hemodynamic index. However, cardiac glycosides( Digitoxin, Strophantine, Corligicon, Digoscine, Celanide) are the main drugs, since they increase heart contractions. In the early days, the maximum dosage is prescribed in order to reduce the tachycardia, after which the dosage is gradually reduced. Supportive therapy for coronary insufficiency will be carried out when a dosage is set in which the patient will have all the indicators stable.
