Coronary heart disease (CHD) is a pathology that occurs as a result of the myocardial oxygen starvation due to blood supply failure. This illness is considered to be one of the most common in the world. CHD is one of the most frequent causes of death.
CHD is developing when the myocardium has not enough of the blood supply. In the majority of cases its connected to the decreased diameter of the blood vessels. Less common reason is the significant increase in myocardial oxygen demand.
More often these two causes are combined. Stress, physical activity or the medications intake increase the oxygen demand and the blood vessels condition that feed the heart won’t give a chance to satisfy the need completely.
Basic reasons of coronary vessels diameter decrease are:
In vast majority atherosclerosis causes the CHD. Thrombosis happens later. Blood clots are not usually formed in the healthy, not clogged with the atherosclerotic plaques, blood vessels.
Basic risk factors of the CHD are:
The more there are risk factors the higher is the chance of CHD and the more severe its clinical course. Part of the risk factors can be controlled, which makes it possible to prevent the illness.
CHD is a wide term. Illness includes in itself a number of clinical forms that are characterized by different symptoms and course. Following clinical forms of CHD are distinguished:
Cardiac angina. A patient feels pain in the heart while physical activity. Depending on the functional class of cardiac angina, these symptoms can occur during the highly intensive physical activity (first class) or at rest (fourth functional class). Pain is determined by the myocardial blood supply failure and its oxygen starvation.
Myocardial infarction usually occurs due cardiac angina. As a result of myocardial oxygen starvation the necrosis (death) of its part occurs. This happens when the coronary artery is clogged with the atherosclerotic plaque or a blood clot for more than 90%. A patient feels severe pain in the heart and it is the main symptom of this CHD form.
Postinfarction cardiosclerosis is determined by the scarring of the damaged myocardial sections. It is accompanied by the heart conductivity disorders, hemodynamic impairments, arrhythmias, heart failure. As an independent CHD form the postinfarction cardiosclerosis is established if a person doesn’t suffer from cardiac angina.
Basic way of diagnostics that helps to exactly establish the CHD is electrocardiography (ECG). Additional methods are:
Other diagnostics methods are:
Echocardiography (ultrasound of the heart) helps to assess the speed of the blood flow through the coronary arteries, myocardium and valvular apparatus condition, the contractile activity of the heart.
Laboratory tests help to diagnose the myocardium infarction. Tests for troponin, LDH, creatine kinase, myoglobin are done.
Angiography is a radiographic method of analysis where a contrast agent is injected into the coronary blood vessels. Then, a number of X-ray pictures or scans are done with the help of the computed tomography. Method is usually done to make a decision about the necessity of the surgical treatment of CHD.
Conservative treatment is mostly applied for the CHD. A patient is prescribed the medications that slow down the illness progression, decrease the risk of the myocardial infarction and increase the life quality reducing or eliminating the symptoms.
There are also treatment methods that help to reach a complete clinical recovery. As a result, person can refrain from using medications partially or completely and lead same lifestyle as before the CHD occurrence.
Among the most effective methods of the treatment are:
Stenting. Metal spiral is inserted into the coronary artery. It widens the vessel and presses the atherosclerotic plaques against the artery walls. Normal blood supply of the myocardium is restored as a result of this surgery.
Coronary artery bypass surgery is a surgery of choice if there are multiple lesions of the heart blood vessels. The purpose of this treatment method is the creation of the additional arteries that feed the myocardium. Bypass is also created from patient’s own blood vessels taken from the other body parts.
Atherectomy is the operation aimed attheblood clot removal from the coronary artery. It’s done with the help of a laser or the surgical instrument. Atherectomy can be held if there is just one clot that clogs the normal blood flow while the general condition of the coronary arteries remains satisfactory.
Laser revascularization. During this type of surgery on the myocardium a doctor makes several holes. After that, the blood starts to flow from not only coronary arteries, but also from the left ventricle cavity directly. It helps to ensure the myocardium trophism even if the obvious atherosclerosis of the coronary arteries is present.
Along with traditional methods of the treatment new therapeutic approaches are being developed.
In recent years, the following promising ways to struggle with CHD, its symptoms and consequenceshave been developed:
Stem cells treatment. CHD causes the gradual myocardium damage. Muscular tissue is not restored but replaced by the connective tissue. Stem cells treatment is used to recreate the normal myocardium structure that helps to normalize the heart rate and conductivity. Stem cells are taken from the patient’s blood, and then they are cultured to increase their number and injected intravenously.
Shock wave therapy. Impact of the shock waves contributes towards the new blood vessels growth and myocardium blood supply restoration. Treatment result in the stable clinical improvement (functional class of the cardiac angina decreasing, physical activity tolerance increasing).
Quantum therapy. Percutaneous laser irradiation of blood is applied for the CHD treatment. This technique helps to reduce the symptoms of the cardiac angina due to the blood rheology improvement, expansion of coronary vessels, and improvement of the metabolism in the heart muscle.
Enhanced external counterpulsation. Cuffs are put on the person’s limbs. During thecertain phases of the cardiac cycle the air is injected or pumped into or from the cuffs.To ensure the long-term effect the procedure should be done regularly. This leads to the revascularization (the formation of collateral branches of the arteries), endothelial function improvement (there is a functional extension of the vessels) and eliminating of the heart failure.
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