Coronary insufficiency - a condition in which decreases or stops completely coronary blood flow.As a result, the heart muscle is not sufficiently provided with nutrients by oxygen.Deficiency can be divided into two types: coronary insufficiency rest and stress.A common coronary artery disease manifested coronary insufficiency.It is known that often infarcts, and for this reason there.But it is possible for other pathologies and diseases noted the changed structure of the coronary vessels.On heavy pathology will indicate pain during physical rest.
Coronary insufficiency causes
1. The combination of vascular and metabolic factors;
2. Increased heart function associated with an increase in the metabolic demands of the heart when the coronary vessels are unable to increase blood flow;
3. The vessels of the blood flow is reduced if the myocardial metabolic demands have not changed.
causes of coronary heart disease can be varied, but usually are caused by spasms, th
most common cause of coronary heart disease is atherosclerosis of coronary arteries, coronaritis, various vascular injury (eg, falls, blows, compression), congenital and acquired heart defects.Also, bacterial endocarditis, pulmonary trunk stenosis, syphilitic aortrit, shock and collaptoid condition, anemia, scattering aortic aneurysm.
also cause coronary insufficiency could serve a sudden violation of patency of the arteries coronary due to spasm and occlusion of complete or partial (eg, air bubbles or droplets of fat), embolism, thrombosis, compression, adhesion, separation and rather rare presence of congenital shunt between the pulmonary andcoronary arteries.At the heart neishemizirovannyh areas will increase metabolic demands.However, quite important to neishemizirovannom site and to the defeat of the artery to redistribute the blood ("steal").
pathological process, which is accompanied by perfusion pressure in the coronary arteries, arterial hypoxia and anemia, carbon monoxide poisoning, and more, vasodilatation is not able to meet the metabolic demands of the heart.Chronic or acute form of coronary heart disease will be developed depending on the intensity and duration of exposure to a particular factor.
narrowing or decrease in the ability to expand the struck coronary arteries can lead to chronic coronary insufficiency.Typically, this is caused by atherosclerosis, and the inflammatory processes are not excluded.
Conclusion: The common cause of coronary heart disease is the development of hypertensive disorders due to inflammation, atherosclerosis, koronaritov, vasculitis, and heart defects.Also, people with severe infectious diseases and increased blood clotting will be predisposed to the disease.
Manifestations of chronic forms of coronary heart disease does not differ on the degree of narrowing of the coronary arteries.This is due to collateral circulation, as in some cases it organically fully and functionally, and some not.
coronary insufficiency symptoms
If transfer cardiovascular disease, the most common cause of death - that of coronary heart disease because the heart and blood vessels are damaged equally.Symptoms usually complex nature, however, is leading angina.However, diagnosis can be made against the background of a heart attack.
diagnosis of coronary insufficiency is often based on the patient's history and complaints.Quite common are the only symptom of pain lasting 10 minutes behind the breastbone or in the heart (angina pectoris, or angina).In the case of persistent pain can assume coronary infarction or focal changes of different sizes.Pretty rare to find pain lasting up to 3 hours, which will not cause a heart attack.
Pain paroxysmal character, that may occur suddenly due to less physical activity and mental stress.The most common precipitating factors of the pain are plentiful meal, fast walking, climbing stairs and, as a rule, more often observed in the windy cold days in the winter.
patient condition is aggravated during physical exertion, and because of this he feels stiffness.It appears desire to maintain a stationary position.The face becomes pale, breathing shallow and slow.It will also be shown "accompanying" symptoms:
- the emergence of the urge to defecate and urinate;
- dyspepsia are expressed in the form of vomiting, hiccups, nausea, increased salivation;
- are abundantly released gases;
- will begin the selection of light urine in large amounts.
But keep in mind that "the accompanying symptoms of" coronary insufficiency nonspecific and may even be accompanied by a functional disorder, and heart attack.In younger people sometimes will manifest typical symptoms of this disease.For this reason, you should always pay attention to the presence of suspicious symptoms, especially pain in the left side of the sternum.Often, young people suffering from these diseases, outwardly look older, which is important in the diagnosis.
Despite the difficulties in diagnosis, the early stages of coronary heart disease, in addition to clinical examination, medical history and electrocardiogram, during and after exercise, alone, significant assistance is provided biochemical (determination of electrolyte, lipid metabolism and catecholamine), togetherThe factors that contribute to the development of coronary heart disease.
also often may be shortness of breath, cough, heart palpitations, or clinically not have any symptoms until the angina attack.
acute coronary insufficiency
This condition, which is caused by a spasm of the coronary vessels supplying the heart with blood.Spasms occur at rest, with little physical or emotional stress, since there is a sharp increase in tissue oxygen demand.Quite often, sudden death syndrome associated with the disease.Diseases such as stenosis, vascular embolism can provoke acute coronary insufficiency.
clinical syndrome of acute coronary insufficiency is angina or angina due to temporary disruption of the coronary circulation.The basis is the attack cardiac anoxia, whereby the accumulation of incomplete oxidation products in tissues, resulting in irritated receptor system.The origin of seizures depends on the functional aspects that cause vasospasm.Strengthening and nature of the attack depends on the reaction of the vascular wall, irritating force of atherosclerotic lesions, which increase the tendency to spasm.Also, attacks can arise due to the accumulation of catecholamines.
Angina occurs much less frequently in rheumatism, as well as its development is possible without coronary vessels.In serious anatomical vascular lesions will indicate nocturnal seizures that occur during rest, which are quite heavy.They can occur suddenly and is accompanied by severe chest pain.Typically, duration of 2-20 minutes.If the length of more than 35 minutes, it should be assumed to have a heart attack.Pain is always radiating into the left side of the body, but it may be in the wrist, shoulder and ear.
chronic coronary insufficiency
manifested form of coronary artery disease develops due to angina, coronary atherosclerosis.All due to the fact that the supply of oxygen for coronary not according to the needs of the heart due to the elasticity of the affected vessels sclerosis.
are 3 degrees of chronic coronary insufficiency:
1st (initial degree) chronic coronary insufficiency accompanied by occasional bouts of angina, which can be caused by a significant physical or emotional load.Atherosclerotic arterial changes are not expressed.
2nd (severe or significant) the degree of chronic coronary insufficiency, where the occurrence of angina attacks are associated with conventional or moderate exercise.It can be noted atherosclerotic narrowing of coronary 1-2 branches of more than 50%.
third (heavy) the degree of chronic coronary insufficiency accompanied by angina that occurs at rest, with minimal load.More can be seen abnormal heart rhythm.
patient's condition will deteriorate during any loads, as modified arteries are narrowed, not expanded.If a metabolic disorder lasting and complex, the process will take a more persistent nature: the old plaques appear on the new deposits that will increase, narrowing the lumen of the artery.As a consequence, reduced blood flow to the myocardium.
Coronary insufficiency treatment
complex treatment of coronary insufficiency and is aimed at eliminating the reasons causing it.It is also aimed at improving the oxygen supply to the myocardium, prevention and symptom relief.Cardiology hospital treatment of coronary insufficiency include surgical and medical methods.It is important to know how to provide first aid in case of attack, coronary insufficiency.
have to give the patient a comfortable position, and put to bed in the absence of cough or shortness of breath, providing free access to fresh air.A factor that contributed to the attack should be eliminated if possible.
First we need to take nitroglycerin, take one tablet every five minutes, but not more than 3 times.If this drug is not present, Validol can approach or any candies with menthol.If no allergy to aspirin, it is necessary to take a quarter pill in order to avoid blood thinners.
Treatment of chronic forms of coronary heart disease is carried out by 3 groups of medications: calcium channel blockers, nitro compounds, β-adrenergic blockers.
Nitrates prolonged and short action designed to enhance the veins, thus reducing venous return of blood to the myocardium, as well as reduced end-diastolic pressure.Nitrates reduce the toxic effects on the heart by accelerating the metabolism of catecholamines.
β-adrenoceptor blockers are substances that are similar in structure to the stimulant receptors izadrina.Thus, the action is terminated on natural and synthetic catecholamine.Each patient's individual response to the drug, so 60-320 mg daily dose.
calcium channel antagonists can relieve hyperactivity condition of the coronary vessels.And thanks to the current slowdown in intracellular calcium on the calcium channels.Depending on the form and stage of coronary insufficiency is necessary to limit the labor force, recommended physiotherapy.It is necessary to follow a strict diet, counting calorie intake.If the patient is overweight, it is necessary to reduce calories by 30%, but in the case of exhaustion, power more strengthened.
Diuretics are prescribed to restore the acid-base and water-salt balance.They are able to bring the body of excess fluid and eliminate swelling.Furasemid and ethacrynic acid have forced the action.Clopamide, Tsiklometazid and Hydrochlorothiazide have a moderate effect.Long may only be used Veroshpiron, Spiranolakton, Daytek and amiloride.
treatment of coronary insufficiency initially performed using vazolatatorov and alpha-blockers, in order to improve the hemodynamic parameter.However, cardiac glycosides (Digitoxin, Strophanthin, Korglikon, Digosksin, Tselanid) are the main agents, since they increase the heart rate.In the early days assigned maximum dose to reduce the tachycardia, then slowly decreases the dosage.Maintenance treatment of coronary insufficiency will be held when the dosage be established, in which the patient has all the indicators are stable.