Myocardial ischemia - an acute or prolonged mismatch myocardial oxygen and nutrients to the amount of coronary blood flow.The incidence of myocardial ischemia in the world of cardiologists has high performance and, unfortunately, the percentage of death from this disease is also at a high level, despite the progressive advances in the treatment of ischemic heart damage.
There is some direct correlation in the incidence of myocardial ischemia and increasing age.Maximum incidence of myocardial ischemia in the age group 50 years after.Patients female significantly prevalent cases of silent ischemia form, whereas acute myocardial ischemia is more common in the male population.For women, a factor of increased risk of myocardial ischemia is the onset of menopause, during which noted a progressive increase in indicators of cholesterol and a tendency to increased blood pressure numbers.
most common etiopathogenetic cause of myocardial ischemia is the ather
basic etiopathogenetic mechanisms of myocardial ischemia are as organic narrowing of the coronary arteries, caused atherosclerotic lesions, coronary spasm, and the coronary microcirculation disturbances.
organic narrowing of the coronary arteries due to the fact that the favorite localization of atherosclerotic lesions is precisely this segment of the bloodstream.As a result of narrowing of a coronary artery due to intraluminal location of atherosclerotic plaque develops a compensatory expansion of the distal coronary artery temporarily corrects hemodynamic disturbances.Another compensatory mechanism during myocardial ischemia is the formation of bypasses.With the depletion of the compensatory capacity of collateral circulation develops clinical myocardial ischemia.
Some clinical forms of myocardial ischemia can be provoked coronary spasm, which is extremely short-lived and successfully docked taking nitrate-containing drugs.The occurrence of myocardial ischemia in coronary spasm mostly triggered hyperreactivity affected part of the coronary artery in response to a vasoconstrictor effect, hyperventilation at elevated physical activity, local reduction products humoral substances vasodilating action, due to the high content of cholesterol.
subepicardial myocardial ischemia develops most often as a result of violations of hemodynamics at the microcirculatory level, due to the formation of unstable platelet aggregates, which are prone to rapid spontaneous disaggregation.By increasing the size of platelet aggregates, caused an increase in the production of thromboxane can develop subendocardial myocardial ischemia.
Coronary as one of etiopathogenetic mechanisms of myocardial ischemia, formed as a result of existing atherosclerotic plaque ulceration.Coronary duration depends on the severity of hypercoagulation changes in hemostasis.In a situation where fibrinolytic activity is preserved, it can develop spontaneous thrombolysis and Trouble signs of myocardial ischemia irreversible.
Symptoms and signs of myocardial ischemia
for clinical symptom characteristic of myocardial ischemia should distinguish pathognomonic symptoms of typical angina attack and non-specific clinical symptoms, which can be observed in other diseases.
so-called "anginal attack" myocardial ischemia is a sharp progressive emergence of severe pain syndrome in the area of compressive retrosternal burning character, often occurring after physical activity or against the background of well-being that is adverse clinical signs.Irradiation of pain can even extend to the groin, but often limited to the upper body.
duration of angina attack myocardial ischemia depends on the clinical form of the disease and can vary from 5 minutes as angina, to half that observed in myocardial infarction.
a minority of patients with myocardial ischemia, observed atypical localization of pain, for example, in the epigastric region, simulating the clinical manifestations of diseases gastroenterological profile.This type of abdominal angina attack when myocardial ischemia is more common in female patients.There is also the atypical clinical types of myocardial ischemia is an asthmatic, in which the patient has absolutely no pain, and progressive respiratory disorders.
diagnosis of myocardial ischemia solely on the basis of clinical manifestations is impossible.More reliable diagnostic techniques have instrumental destruction of the heart muscle, such as electrocardiography.When the ECG recording, you can not just suspect fact ischemic myocardial injury, but also to determine the localization of damage to the heart muscle.For example, myocardial ischemia lower region of the left ventricle is accompanied by direct changes in the ECG II, III, V7-9 leads and reciprocal changes in leads V1-4.Transmural myocardial ischemia of the left ventricle with the localization of the front or rear of the evident rise in front-segment depression or ST, as well as the appearance of negative T wave coronary mostly in chest leads.Localization is difficult to diagnose ischemia of the posterior wall infarction, to identify which require electrocardiography not only standard but also additional leads.
Silent myocardial ischemia
Conclusion "silent myocardial ischemia" may be set solely according to the additional instrumental examination methods, despite the fact that this type of ischemia refers to the clinical forms.For silent myocardial ischemia has all the same etiopathogenetic mechanisms of development as in other clinical forms (metabolic disturbances, changes in the electrical activity of the myocardium, its perfusion) with the only difference being that they are transitory in nature and are not accompanied by the development of a typical clinical picture of how,for example, angina pectoris.
Painless form of myocardial ischemia can occur as equally common in individuals with unknown pre-diagnosis "myocardial ischemia", and in patients suffering from other long-term clinical forms of this disease (angina pectoris).According to the findings of numerous randomized studies on the phenomenon of silent myocardial ischemia, 3% of the registration of signs of this disease on the ECG occurs in completely healthy people.The emergence of silent ischemia contributes to the reduction in total pain sensitivity to various stimuli.Pathogenetic basis of silent myocardial ischemia is not only vasoconstriction, but the increased demand of the heart muscle of oxygen.
main link in the establishment of the clinical forms of myocardial ischemia is to conduct a comprehensive survey tool of man.Silent myocardial ischemia in the ECG is recorded only when used daily Holter monitoring and its symptoms are similar to those that exist in other embodiments, the flow of this disease.In addition to routine electrocardiographic research would be appropriate stress echocardiography with physical and pharmacological tests, but the largest percentage of reliability with regard to verification of the diagnosis has coronary angiography.
treatment of myocardial ischemia
All therapeutic measures used in establishing the patient's ischemia, are aimed at improving the quality of life is directly dependent on reducing the frequency of anginal attacks, the prevention of complications of cardiac profile and increase the survival rate.
The initial therapeutic focus of the measures is to correct the modifiable risk factors, implying a complete rejection of bad habits, leveling dyslipidemic disorders correction method of feeding behavior, avoid excessive psycho-emotional and physical activity.
in respect of medical treatment of myocardial ischemia is currently used a wide variety of drugs that can be combined into small groups of etiopathogenetic orientation.So, antianginal symptomatic therapy involves administering to the patient a beta-blocker (atenolol in a daily dose of 100 mg), which provide not only a reduction in severity, but the frequency of ischemic episodes within the first month of the regular admission.Patients with frequent ischemic episodes with severe pain, note the rapid and effective pain relief when using nitrate-containing drugs, even in the form of an oral (sublingual nitroglycerin 1 tablet).Selection of nitrates of prolonged or short pharmacological action depends on the clinical form of myocardial ischemia (angina at functional class III preferred to use long-acting form of the drug).
Recent randomized studies in the field of pharmacological correction anginal syndrome, myocardial ischemia confirmed the positive results of trimetazidine in a daily dose of 60 mg, which is the drug of metabolic action.Antianginal trimetazidine effect is due to its ability to optimize energy metabolic processes in the myocardium and improve the microcirculation of the heart muscle and improve blood flow in the coronary arteries.
causal treatment in respect of the drugs of choice in myocardial ischemia are lipid-lowering drugs action (Torvakard 40 mg 1 r / d.) If they are systematically extended reception.
all patients suffering from a pathogenic or clinical form of myocardial ischemia, demonstrated a lifelong use of antiplatelet agents actions (Cardiomagnyl 1 tablet at night) in order to minimize the risk of complications of the cardiac profile.
In recent years greatly improved the possibility of cardiac surgery, allowing to carry out revascularization in ischemia, but this operational manual should be performed only on strict conditions (absence of a positive effect of the use of drug therapy, a high risk of developing complications of the cardiac profile, with a history of episodes of ventricular arrhythmia).Selection of the operating manual in myocardial ischemia depends on the severity of hemodynamic disturbances and the degree of coronary artery stenosis.
Myocardial ischemia - a doctor will help ?In the presence or suspected myocardial ischemia should immediately seek the advice of professionals such as a therapist, a cardiologist.