How to treat atherosclerosis of coronary vessels. Symptoms and treatment of atherosclerosis of the coronary vessels of the heart
Among all heart diseases coronary atherosclerosis occupies a special place. This pathology is accompanied by severe symptoms, which, unfortunately, are often ignored until a cardiac catastrophe occurs in the form of a heart attack. This disease is considered incurable, but with timely detection and complex therapy, doctors can alleviate the patient’s condition and maintain his ability to work until old age.
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What is pathology
In medicine, atherosclerosis of the coronary arteries is a vascular disease that is accompanied by the formation of dense lipid deposits on the intima of blood vessels. The pathology develops gradually and in most cases is detected in late stages. The problem is based on changes in lipid metabolism, in which large amounts of high-density lipoproteins accumulate in the blood. Over time, these substances settle on the inner wall of the vessel - the intima, which causes its lumen to narrow.
As a rule, atherosclerosis begins in the aorta coronary vessels, that is, in the largest sections of the bloodstream. Lipid deposits are located closer to the branches. The pathological process impedes blood flow, as a result of which the heart experiences a deficiency of oxygen and nutrients. Since the work of the organ is continuous and quite intense, this causes noticeable clinical symptoms.
Atherosclerosis of the aorta of the coronary arteries develops with young. However, due to the fact that the growth of lipid deposits is slow, the manifestation (first exacerbation) of the disease occurs closer to retirement age - at 50-55 years. That is why disease is often considered a natural accompaniment of old age. However, in recent years, medical statistics have shown a trend towards an increase in cardiac ischemia and mortality due to detached blood clots in young people.
Development of the disease
With careful attention to one's own health, a person can detect the first symptoms of atherosclerosis of the coronary arteries long before old age. This, according to experts, is the norm, especially considering the lifestyle of modern people. It predisposes to the earlier appearance of massive cholesterol plaques in the vessels supplying the heart muscle.
In its development, the disease goes through several stages, each of which can last decades:
- Initial to clinical stage accompanied by a slight deposition of cholesterol in the form of a fatty spot on the walls of blood vessels. This usually occurs where the intima of the artery is damaged. Over time, the lipoprotein spot transforms into longitudinal or transverse stripes, the thickness of which does not exceed several microns. Clinical signs There is no atherosclerosis of the coronary vessels at this stage.
- The second clinical stage of atherosclerosis of the heart vessels is accompanied by the proliferation of lipid deposits. Due to an increase in their thickness, a decrease in blood supply to the heart is noticeable, especially if the patient is in a state of activity. At this stage, fibrin fibers and red blood cells join the cholesterol plaques, and a fairly large blood clot can form. Experts call this process multifocal atherosclerosis of the coronary arteries, which is often complicated by blood clot rupture and death. The symptoms at this stage are already quite pronounced: palpitations and shortness of breath during physical exertion appear, and arrhythmia is observed.
- The third and final stage of atherosclerosis of the coronary and coronary vessels is accompanied by thickening of the plaque due to the addition of calcium to it. In this case, the lumen of the arteries narrows significantly, the walls of the arteries are deformed, becoming less elastic and dense. The condition is accompanied by sharp pain under the sternum during exercise of any intensity, arrhythmia, periodic heart attacks, and general weakness.
Despite the fact that modern medicine has extensive capabilities to eliminate atherosclerosis, treatment is more effective when the disease is detected in the initial stages.
Diagnostics
Coronary atherosclerosis is detected in most cases during routine heart examinations. The doctor may suspect a pathology based on the results of the ECG: it will clearly show signs of ischemia. To confirm the diagnosis use complex methods diagnosis of coronary atherosclerosis. Typically they include:
- stress scintigraphy, which allows you to determine the location of lipid deposits, their size and the degree of protrusion into the lumen of the vessel;
- in combination with intravascular ultrasound of the coronary arteries, which are necessary to identify areas of arteries with impaired blood flow and contractile functions;
- radiography of the heart vessels with contrast (coronary angiography), which is designed to determine the location and extent of atherosclerotic lesions;
- echocardiography with stress, which allows you to identify disturbances in cardiac contractility and changes in blood flow that appear periodically, for example, during emotional or physical stress.
In addition, a number of laboratory tests are carried out to determine the concentration of high-density lipoproteins in the blood.
The disease rarely affects one part circulatory system. When diagnosing coronary atherosclerosis, it may be necessary to study other groups of vessels (, and so on).
Video: coronary angiography of the heart - approaches, techniques and stages
Treatment methods
The approach to treating the disease depends entirely on the stage of atherosclerotic changes and the existing symptoms. On initial stage Treatment of atherosclerosis of the coronary arteries involves conservative treatment. To prevent further development of the disease, it is enough to change your lifestyle:
- quit smoking and alcohol;
- normalize nutrition, first of all, exclude animal fats and sweets from the menu, replacing them with fresh vegetables and fruits, white dietary meat and fish;
- regularly engage in feasible sports - swimming, yoga, gymnastics or race walking(the optimal type of sport and degree of stress will be determined by the attending physician).
In addition to strengthening blood vessels and normalizing the level of harmful lipoproteins in the blood, these measures will help normalize weight.
Indicated for atherosclerosis of the coronary arteries of the heart and medications. Patients with this diagnosis are prescribed complex therapy to reduce harmful lipids in the blood. use statins: Atorvastatin, Rosuvastatin, Pitavastatin and their analogues. Drugs in this group actively inhibit enzymes responsible for the synthesis of harmful fatty compounds in hepatocytes. In addition, they help restore the inner lining of blood vessels. Thanks to this property, they are indispensable in the initial stages of atherosclerosis.
Statins are not prescribed to patients with serious liver dysfunction: hepatosis, hepatitis, liver failure, cirrhosis.
In addition, patients with coronary atherosclerosis are prescribed drugs that reduce myocardial oxygen demand, reduce the severity of ischemic changes and reduce. For this purpose, drugs of several groups are used:
- drugs containing beta blockers - Bisoprolol, Nebilet, Betalok, Anaprilin;
- ACE blocking drugs - Enalapril, Lisinopril, Perindopril;
- calcium channel inhibitors - Amlodipine, Amlotop, Diltiazem, Cardilopin;
- means for thinning the blood and preventing thrombosis - Clopidogrel, Aspicor, Aspirin Cardio.
The dosage and combination of drugs is selected by the doctor individually, taking into account the patient’s current condition, test results and existing concomitant diseases.
If the patient exhibits signs of stenosing atherosclerosis of the coronary arteries, surgical intervention is resorted to.
- During the operation, various methods are used:
- coronary artery bypass grafting to create an artificial channel bypassing the affected areas of the artery;
- balloon angioplasty for forced expansion of the artery lumen;
stenting an artery to expand its lumen.
Such methods can radically solve the problem in advanced cases, but they do not cancel the lifelong use of the previously listed drugs.
The prognosis of coronary atherosclerosis entirely depends on the timely detection of the disease and the patient’s compliance with all the cardiologist’s instructions. With adequate and competent therapy, the prognosis is favorable, while advanced cases of cardiac atherosclerosis often result in severe complications and death.
Video: balloon angioplasty and stenting of the coronary arteries
If left untreated, the disease progresses and can cause the patient's death. Atherosclerosis of the coronary arteries is dangerous for the development of coronary heart disease and myocardial infarction. According to international classification diseases of the 10th reading, atherosclerosis is assigned code 170.
Causes of the disease
Atherosclerosis of the coronary vessels develops due to lipid metabolism disorders. It is this condition that provokes an increase in cholesterol levels in the blood, which is why cholesterol plaques form on the walls of blood vessels. Gradually growing, they block the lumen, and this interferes with the normal movement of blood.
This process is long-term and can develop over decades, while a person does not suspect that irreversible pathological changes occur in the vessels. Experts identify many factors predisposing to the development of atherosclerosis, among them:
- abuse of high-fat foods;
- lack of physical activity;
- genetic predisposition;
- vascular weakness;
- high blood pressure;
- being male;
- age over 45 years;
- obesity;
- long-term smoking;
- diabetes.
In addition, hormonal changes contribute to an increase in blood cholesterol levels. Therefore, the period of menopause in women is a unique period of risk for the development of atherosclerosis. Psycho-emotional stress also disrupts lipid metabolism. Under the influence of the above factors, the inner wall of the artery is primarily damaged.
Low-density lipoproteins, or, as they are otherwise called, “bad cholesterol,” easily penetrate into places where defects form. This is how a lipid stain is formed. As a result of various chemical reactions occurring in this area, the inflammatory process begins. All this favors the accumulation of cholesterol and connective tissue, the gradual formation of atherosclerotic plaque.
Such a pathological process entails the following changes in the vascular wall:
- disruption of arterial nutrition;
- proliferation of connective tissue;
- deposition of calcium salts on the walls of blood vessels;
- decreased elasticity of blood vessels;
- deformation and compaction;
- narrowing of the lumen;
- disruption of the blood supply to organs.
Atherosclerosis develops as a result of blockage of an artery by cholesterol plaque
Course of the disease and symptoms
At the beginning of its development, the disease has a slow course and can develop for many years, but actively progresses in the second half of life. Most often, the disease manifests itself between 40 and 55 years. This mechanism is triggered by a combination of negative factors and hereditary predisposition. Signs of the disease become noticeable when pronounced violation blood circulation
This occurs when the lumen of the blood vessels narrows by more than half. In this case, they talk about stenosing atherosclerosis. Atherosclerosis of the aorta of the coronary arteries is asymptomatic for a long time. The aorta is the largest vessel of the human body, and for a long time it tapers without definite clinical manifestations. Pathology can be suspected based on specific symptoms.
In case of defeat thoracic aorta, the blood supply to the heart and cerebral vessels is disrupted. This manifests itself in the development of angina pectoris. Painful sensations in the heart area radiate to the spine and top part chest, as well as in the hand. The pain is constant and can last for several days in a row. In addition, blood pressure increases, general weakness and dizziness occur.
Impaired blood flow in the cerebral arteries can cause unexplained fainting.
Coronary atherosclerosis is characterized by the following manifestations:
- sharp and burning chest pain;
- irradiation of pain to the upper body and jaw;
- feeling of discomfort after minor physical activity;
- dyspnea;
- the pain lasts no more than 15 minutes;
- painful symptoms are eliminated after taking nitroglycerin.
Depending on the depth of changes occurring in the myocardium and blood vessels, 3 stages of the disease are distinguished: ischemia, thromonecrotic changes, fibrosis. At the stage of ischemia, the heart experiences a deficiency arterial blood, which leads to hypoxia and dystrophic changes. The main manifestation of this stage is chest pain.
A gradual increase in plaque size increases the risk of rupture, and atherosclerosis enters the thrombonecrotic phase. It is characterized by damage to atherosclerotic deposits and subsequent thrombus formation with blockage of the artery lumen. This stage can manifest itself as myocardial necrosis, or infarction.
This is the most dangerous form of coronary heart disease (CHD). Its main symptom is super-intense acute chest pain, accompanied by an increased fear of death. At the stage of fibrotic changes, chronic ischemia develops as a result of stenotic atherosclerosis.
Complications of atherosclerosis of the aorta and heart vessels are the following conditions:
- arterial circulation failure;
- sclerotic changes in the myocardium;
- cardiac ischemia;
- heart attack
Acute pain in the heart area - warning sign, indicating possible atherosclerosis
Diagnostic methods
Diagnosis of atherosclerosis of the coronary arteries is carried out in 2 stages. First, the patient is interviewed. It is important that he talks in detail about the symptoms that bother him. When listening to the heart, the doctor will detect muffled tones and systolic murmur in the upper part of the organ. Tachycardia (rapid pulse) will indicate pathology. This is detected by counting heartbeats per minute.
At the second stage, laboratory and instrumental examination methods are prescribed. A blood test reveals increased rate cholesterol. For this purpose, a lipid profile is performed. It also reflects lipoprotein and triglyceride levels. Changes in liver and kidney tests are assessed by biochemical analysis blood and is an important diagnostic indicator.
The diagnosis is confirmed by the results of the following instrumental methods examinations:
- Coronary angiography. An X-ray of the heart with contrast reveals the location of the affected vessel, its length and the degree of narrowing.
- Intravascular ultrasound with Doppler. Structural changes in blood vessels, such as wall thickness and impaired contractility, are detected. In addition, hemodynamics and valve condition are assessed.
- Stress scintigraphy. The location of lipid plaques and the degree of their severity are determined.
- Pristress-ECHO. Evaluates changes in cardiac contractility in areas with impaired blood flow.
Treatment methods
Therapeutic tactics regarding atherosclerosis of the coronary arteries is determined by the severity of the disease and its stage. Pathology requires lifestyle changes, in particular, it is necessary:
- completely stop smoking and drinking alcohol;
- exclude animal fats, fried foods and sweets from the diet;
- increase the consumption of fresh vegetables and fruits, dairy products;
- follow the cardiologist’s recommendations on physical activity;
- Take measures to lose weight if you have extra pounds.
The disease is subject to conservative and surgical treatment. Drug therapy is used at the initial stage of atherosclerosis of the heart vessels and allows to slow down the course of pathological changes, as well as eliminate the symptoms of the disease. Symptomatic therapy includes taking painkillers and drugs that normalize blood pressure and blood circulation.
Treatment requires the use of drugs from the group of statins. Taking them effectively reduces cholesterol levels in the blood. This effect is due to the ability to suppress the production of cholesterol in the liver. These are drugs such as Mevacol, Lovastatin, Simvastatin.
For atherosclerosis of the coronary arteries, drugs are also prescribed that reduce the heart's need for oxygen. Their use allows to minimize the manifestations of ischemia. For this, the patient is prescribed beta-blockers, antiplatelet agents, calcium channel blockers, and ACE inhibitors.
To prevent the formation of fats in the liver, fibrates are prescribed. But they must be taken in short courses, since long-term use will negatively affect the condition of the body. These drugs include Fenofibrate and Clofibrate. Thrombolytic drugs are prescribed to restore blood flow.
Treatment of atherosclerosis of the coronary arteries is aimed at restoring patency and eliminating pathological deposits on the walls of blood vessels
Surgical treatment methods are used in advanced cases of the disease. The following methods are practiced:
- Balloon angioplasty. Through femoral artery A catheter with a balloon is inserted into the affected vessel, which expands the narrowed area.
- Coronary artery bypass surgery. An alternative path for blood flow is created, bypassing the artery affected by the plaque.
- Coronary stenting. A frame stent is installed on the walls of the narrowed artery, holding the walls in an expanded state.
Atherosclerosis of the coronary arteries is a slowly progressive but serious disease leading to the death of the patient. Therefore, it is important to monitor blood cholesterol levels and, if changes in indicators are detected, adjust your lifestyle and diet. These measures will help prevent complications in the presymptomatic period of the disease.
If the pathology is revealed for more than late stage, then it is important to follow your doctor’s recommendations regarding taking medications. This determines the favorable prognosis for the patient’s life. Atherosclerosis is dangerous for the development of coronary heart disease and myocardial infarction.
What is vascular atherosclerosis
Vascular atherosclerosis is systemic disease, which affects blood vessels in almost the entire body: brain vessels, heart vessels (coronary vessels), arteries, vessels of the lower extremities. The form and symptoms of atherosclerosis depend on the location of the disease.
The essence of atherosclerosis is that on the inner surface of the arteries (which in healthy condition even and smooth) growths appear - cholesterol deposits. They harden and affect the inner walls of the vessel. These growths (“cholesterol atherosclerotic plaques”) are covered with connective tissue, protrude into the cavity of the blood vessel and narrow the lumen of the vessel, reduce its diameter and impede blood circulation. Internal organs Those suffering from lack of nutrition cease to function fully. The risk of thrombosis and stroke increases.
Causes of atherosclerosis
The causes of atherosclerosis can be divided into primary and secondary. The primary causes of atherosclerosis include previous diseases:
- gout ( increased level uric acid in the body);
- hypertension (systematically high blood pressure);
- diabetes mellitus (carbohydrate metabolism disorders);
- hypothyroidism (insufficient function thyroid gland);
- acute and chronic kidney diseases;
- liver diseases, which result in increased production of endogenous cholesterol.
Secondary factors in the formation of atherosclerosis are lifestyle, dietary habits, and the presence of bad habits.
- alcohol and smoking;
- excess body weight;
- sedentary lifestyle;
- consumption of fatty and fried foods (especially trans fats);
- long-term use hormonal contraceptives;
- advanced age;
- stress, physical and emotional stress.
Forms and symptoms of vascular atherosclerosis
Symptoms of atherosclerosis depend on the location of the disease.
- Atherosclerosis of cerebral vessels. They often say “cerebral atherosclerosis of cerebral vessels.” In this case, the arteries of the brain are affected by cholesterol plaques located in large and medium-sized vessels. Symptoms: memory loss, concentration, decreased mental activity, dizziness, headaches. Symptoms of cerebral atherosclerosis of the cerebral vessels are often associated with typical signs of aging.
- Atherosclrosis of the carotid arteries(carotid atherosclerosis) is a disease characterized by damage to the carotid arteries. The carotid arteries are the most important conductors of oxygen for the brain. Speech abilities, thinking, sensations and motor activity depend on the full functioning of these arteries. When the carotid arteries are damaged, the full functioning of the brain and the entire body is disrupted. Symptoms of this atherosclerosis: unintelligible speech, loss of vision in one eye, memory impairment, sensations of loss of sensitivity, numbness of the limbs.
- Atherosclerosis of the coronary vessels. There is a disturbance in the blood supply to the tissues of the heart, externally this manifests itself as attacks of angina, cardiosclerosis, cardiac arrhythmia, myocardial infarction.
- Atherosclerosis of the thoracic aorta. Symptoms: increased systolic blood pressure, dizziness, hoarseness, difficulty swallowing, prolonged pressing or burning pain in the chest.
- Atherosclerosis of the lower extremities. On initial stages diseases symptoms of atherosclerosis of the lower extremities include fatigue and pain in calf muscles
- , chilliness in the legs, cramps, pale skin of the legs. Obliterating atherosclerosis of the vessels of the lower extremities , is one of the forms of atherosclerosis of the legs. In this disease, cholesterol plaques form on the walls of the arteries and interfere with normal blood flow, causing narrowing of the blood vessels (stenosis) or complete blockage, called occlusion or obliteration
. In the advanced stage of obliterating atherosclerosis of the vessels of the lower extremities, an irreversible process of necrosis occurs - gangrene of the leg (death of all tissues below the site of artery blockage).
Complications resulting from atherosclerosis
As a result of atherosclerosis, a chronic autoimmune process often develops in atherosclerotic plaques. The connective tissue grows and this leads to slow deformation and narrowing of the lumens, thereby causing a chronic, slowly increasing insufficiency of blood supply to the organ that is fed through the affected artery. It is also possible that the lumen may be blocked by a blood clot or the contents of an atherosclerotic plaque that has disintegrated.
As a result, the most severe complications of vascular atherosclerosis are stroke, heart attack (tissue necrosis) and gangrene in the organ that is supplied by this artery. Stroke is blood circulation in the brain. A distinction is made between ischemic stroke (a cholesterol plaque or blood clot blocks a vessel) and hemorrhagic stroke (bleeding in the brain, often a consequence of high blood pressure). Thus, through stroke, complications resulting from atherosclerosis lead to neurological problems, including paralysis.
When talking about a heart attack, they most often mean myocardial infarction (a consequence of atherosclerosis of the coronary vessels), a lesion of the heart. In this case, necrotic changes in the tissues of the heart muscle are irreversible; a connective tissue scar will remain. And in the future, this scar will interfere with normal blood flow in the vessels of the heart.
In the case of atherosclerosis of the vessels of the lower extremities, complications in the form of gangrene often lead to amputation.
All these conditions and diseases are life-threatening and often lead to disability.
Prevention of atherosclerosis
Prevention of atherosclerosis includes quitting smoking, weight regulation, limiting emotional overload, certain dietary restrictions, and increasing physical activity.
To maintain the body and prevent atherosclerosis, you should eat foods low in salt, sugar and cholesterol. A low-calorie diet with low content fat It is necessary to eat cereals, vegetables, herbs, red wine, and unrefined vegetable oil.
Treatment of vascular atherosclerosis
Treatment of atherosclerosis can be medicinal and surgical.
Treatment of cerebral atherosclerosis is, of course, medication. Prescribed drugs that:
- dilate blood vessels in the brain;
- strengthen the elasticity of the vascular wall;
- improve metabolism at the cellular level of the brain;
- lower the level of cholesterol in blood vessels;
- relieve vascular spasms.
In the treatment of atherosclerosis of the vessels of the lower extremities, in addition to taking medications, physiotherapeutic treatment is also used. In the presence of trophic ulcers, antibiotic ointments are used.
In the treatment of atherosclerosis of the vessels of the lower extremities, it is also allowed surgical intervention, but usually this is a last resort. Surgery is prescribed in case of pronounced ischemia and the occurrence of very severe complications.
The need and extent of surgical intervention is determined by the surgeon. Surgery does not cause atherosclerosis complete cure. The complication is eliminated, not the cause that caused it (atherosclerosis). Therefore, after surgery, changes in lifestyle, nutrition and conservative treatment required.
- treatment of a concomitant disease that aggravates atherosclerosis (for example, diabetes mellitus, hypertonic disease etc.),
- smoking cessation,
- low cholesterol diet,
- moderate physical activity,
- in case of atherosclerosis of the vessels of the legs - wearing comfortable shoes.
Dienai line drugs are suitable both for already diagnosed atherosclerosis and for the prevention of vascular atherosclerosis. In this case, the difference will only be in the duration of administration and in the amount of drugs.
For example, for the prevention of cerebral atherosclerosis You can take Midivirine - a source of oligonucleotides and natural taurine.
For the prevention of atherosclerosis of heart vessels- you can take one basic Dienay or in combination with Venomax, - a source of oligonucleotides and bioflavonoids, the drug cleanses blood vessels and strengthens the walls of blood vessels.
For the prevention of atherosclerosis of blood vessels of the lower extremities- you can also take Venomax, but in combination with Venomax Axiom. Venomax Axima accelerates the outflow of lymph from tissues in which blood circulation is reduced and eliminates swelling of the lower extremities.
In cases of progressive atherosclerosis The following complexes can be recommended:
- Atherosclerosis of cerebral vessels, - drugs:
- 1st month: Dienai 70 capsules
- 2nd month: Venomax 50 capsules + Vazomax 30 capsules
- 3rd month: Midivirin 70 capsules
- 4th month: Neurostim 50 capsules
- 5th month: Neurostim Indigo 10 capsules
- Obliterating atherosclerosis of the vessels of the lower extremities, - drugs:
- 1st month: Dienay + Venomax Axiom 10 capsules
- 2nd month: suppress the inflammatory process in blood vessels. The latter is very important, since as a result of inflammation, the atherosclerotic plaque becomes unstable and can rupture at any time, fraught with the formation of a blood clot and the development of myocardial infarction.
Clinical trials of Dienai have shown that the level of cholesterol and triglycerides in the blood is reduced by 25-30%, unlike pharmacological drugs statins, which have a direct suppressive effect on cholesterol synthesis; discontinuation of Dienai does not cause a sharp reverse effect, that is, an even higher increase in cholesterol levels . Dienai can and should be taken with traditional lipid-lowering drugs, since the mechanisms of its antiatherogenic action are different, and therefore complement and make comprehensive treatment multifactorial atherosclerosis.
Drug dosage regimen
All the drugs listed above applied sequentially, first a course of one drug, then another, etc. Each package is a course for a month.
Dosage: start taking 1 capsule per day, then increase the dosage by 1 capsule every 3 days. The maximum dosage is 3-4 capsules per day.
In case of atherosclerosis of the vessels of the head, it is necessary to understand that Dienai preparations cleanse the vessels (for the vessels of the head this is sensitive), so there may be discomfort in the form of a headache. In this case, simply reduce the dosage to a comfortable level.
In case of myocardial infarction, stroke, enderteritis, type 1 or 2 diabetes, taking the above drugs is necessary in combination with pharmacological drugs prescribed by your attending physician.
HEART DISEASES – Heart-Disease.ru – 2007
Coronary atherosclerosis is a lesion of the coronary arteries that supply the heart, in which their lumen narrows and the blood supply to the heart decreases.
Atherosclerosis is a complex, multi-stage pathological process that affects inner shell(intima) of large and medium caliber arteries. The intima contains a thin layer of connective tissue and is delimited from the muscular layer of the artery (media) by an internal elastic membrane, and from the lumen of the vessel by a monolayer of endothelial cells forming a continuous, smooth, non-adhesive surface. The endothelium acts as a semi-permeable membrane, which, on the one hand, is a barrier between the blood and the vascular wall, and on the other hand, ensures the necessary exchange of molecules between them. On the surface of the endothelium there are specialized receptors for various macromolecules, in particular, for low-density lipoproteins. The endothelium secretes a number of vasoactive substances (endothelin, prostacyclin, nitric oxide), as well as factors of coagulation and anticoagulation systems, due to which it plays a key role in the regulation of vascular tone, blood flow and hemocoagulation.
Currently, atherosclerosis is considered as a reaction to damage to the vascular wall (primarily the endothelium). Damage does not mean mechanical injury endothelium, and its dysfunction, which is manifested by increased permeability. The most important damaging factor is hypercholesterolemia.
In general, atherosclerosis is a process characterized by patterns characteristic of any inflammation: exposure to a damaging factor (low-density lipoproteins that have passed through the endothelium of the vessel, where they have undergone oxidation), cellular infiltration, phagocytosis and the formation of connective tissue.
Infiltration occurs by monocytes circulating in the blood, transforming into macrophages aimed at capturing oxidized low-density lipoproteins with their subsequent destruction. This is how lipid strips are formed on the walls of the vessel - foam cells formed from macrophages with accumulated cholesterol esters.
Subsequently, around the area of lipid accumulation develops connective tissue and the formation of a fibrous atherosclerotic plaque occurs.
Atherosclerosis of the coronary arteries does not always manifest itself immediately. The disease often damages the heart and blood vessels asymptomatically for many years and, if timely diagnosis and treatment is not carried out, leads to angina pectoris, myocardial infarction, heart rhythm disturbances and heart failure.
In most cases, if symptoms of coronary heart disease are present, diagnosing the disease is not difficult. For this purpose, methods such as ECG, daily ECG monitoring, echocardiography, radionuclide studies, exercise tests (bicycle ergometry and treadmill test) are used.
However, diagnosing the disease in the early stages, before symptoms appear, is different.
Early detection of atherosclerosis of the coronary arteries became possible after the advent of computed tomography techniques with a very short time for obtaining slices using electron beam tomography and multislice computed tomography. A feature of these methods is the ability to obtain images of calcifications of the coronary arteries. The study takes only 5-10 minutes in total, and the time for direct data collection is 30-40 seconds (one breath hold). Such studies are not burdensome for the patient and do not require special preparation or physical activity. The results of the study do not depend on the patient’s gender and physical fitness.
Causes of atherosclerosis of the coronary arteries, and methods of its treatment
Many people know that with atherosclerosis, cholesterol plaques settle on the walls of blood vessels, which gradually reduce the lumen of this vessel. Atherosclerosis of the coronary arteries is the same process, but it occurs specifically in the coronary arteries, which is why insufficient blood flows to the heart muscle. What are the reasons for this condition?
Causes of blockage of blood vessels
Atherosclerosis of the heart vessels can develop due to internal and external causes. If you thoroughly count all the reasons, there may be about 200 of them. The most common among them are the following:
- hypertension;
- high cholesterol (cholesterol is the main component of plaques that settle on arterial walls);
- smoking (tobacco smoke contains substances that damage the walls of blood vessels and accelerate the development of atherosclerosis);
- passive lifestyle;
- excess weight.
The main cause of the disease is high cholesterol
These are just some examples. There are family-hereditary causes when the content of various classes of lipids in the plasma decreases. The hereditary nature also includes negative eating habits, which include the consumption of animal fats and foods that contain high amounts of cholesterol.
If a person understands that some of these prerequisites are present in his life, he needs to be more careful and more attentive to his health. In addition, it is important to detect the onset of the disease in a timely manner.
Symptoms of the disease
Atherosclerosis of the coronary arteries is characterized by symptoms that do not always prompt a person to immediately consult a doctor. These signs may masquerade as other diseases. It is very important to identify them as early as possible and seek help. Symptoms may include:
Chest pain is a reason to see a doctor
chest pain, pressing or burning, may radiate to the back or left shoulder;
As you can see, atherosclerosis manifests itself in signs characteristic of ischemic heart disease, angina pectoris, myocardial infarction and cardiosclerosis. Accordingly, you need to imagine how these diseases manifest themselves. For example, during myocardial infarction, severe chest pain is observed, which resembles angina pectoris, but does not go away after nitroglycerin. Loss of consciousness and manifestations of heart failure are also possible. With cardiosclerosis, swelling and shortness of breath appear.
About fifty percent of patients experience some of these symptoms before they have a heart attack, but do not pay attention to them.
We must not forget that atherosclerosis of the coronary arteries may not manifest itself for a long time, so you need to be examined regularly, especially for those people who are at risk.
Diagnostic methods
Since atherosclerosis of the heart vessels is very often accompanied by symptoms of coronary artery disease, diagnosis does not cause difficulties. Several methods are used to make an accurate diagnosis.
Device for daily monitoring of ECG
electron beam tomography. Without a doubt, a detailed story from the patient about his condition is very important. It is important to list all symptoms, even those that seem minor.
This will help identify diseases associated with atherosclerosis and make an accurate diagnosis, on which the entire direction of treatment will depend.
Treatment
Treatment largely depends on the stage of atherosclerosis. If the disease is detected in time, then at the beginning of its development it may be enough to use medications that lower cholesterol levels. It is also very important to change your lifestyle, which includes reducing stressful situations, moderate exercise and diet.
You need to understand the following: if bypass surgery is prescribed, this means that there is no other option. In this case, the lumen of the artery can be narrowed by 75 percent. Some medical institutions may offer bypass surgery if the patient has already had a heart attack. This operation is performed under general anesthesia.
In any case, you can't do it self-treatment. Only a doctor can prescribe the necessary drug therapy or surgical intervention. However, these methods will bring little benefit if you do not follow a diet and do not lead a moderately active lifestyle.
Proper nutrition is the first step towards good health.
Coronary atherosclerosis loves junk food, so there is no need to feed it with junk food. It is better to eat more fruits and vegetables, as they contain a lot of potassium, fiber, folic acid and vitamins. They also contain no cholesterol and large quantity kilocalories and fat, which contribute to the development of atherosclerosis. It is recommended to consume dairy products, as they contain beneficial elements. However, this advice should not be extended to butter
and sour cream. If you consult a doctor, you can use traditional medicine methods. For example, garlic can be very useful, as it delays the formation of cholesterol plaques. But you need to be careful, as garlic can cause palpitations
. Such people are advised to purchase garlic-based preparations at the pharmacy. Some of the listed treatment methods are included in the prevention of atherosclerosis. Generally speaking, for prevention it is important to healthy image
life.
Preventive measures
Atherosclerosis of the coronary vessels especially loves those people who do not take care of themselves. How to avoid this?
An active lifestyle means your longevity
Our heart loves and appreciates being treated with care, which includes caring for the vessels that help it function. It’s better to make every effort now to keep yourself in shape than to run to doctors later in search of the right treatment.
Coronary atherosclerosis
IHD - coronary heart disease - TREATMENT ABROAD - Heart-attack.ru - 2008 is a gradual process in which cholesterol plaques (clumps) settle on the walls of the arteries. Cholesterol plaques cause hardening of the artery walls and narrowing of the internal artery channel (lumen). Arteries that are narrowed due to atherosclerosis cannot deliver enough blood to keep the parts of the body they supply functioning properly. For example, atherosclerosis of the arteries causes a decrease in blood flow to the legs.
Reduced blood flow in the legs can consequently cause pain in the legs when walking or doing exercises, trophic ulcers, and longer healing of wounds on the legs. Atherosclerosis of the arteries that supply blood to the brain can lead to vascular dementia (mental degradation due to the gradual death of brain tissue over many years) or to stroke ( sudden death brain tissue).
In many people, atherosclerosis may remain hidden form(without symptoms or health problems) for many years or even decades. Atherosclerosis can develop starting in adolescence, but all symptoms and health problems usually appear in adulthood, when the arteries are already significantly narrowed.
Cigarette smoking, high blood pressure, high cholesterol, and diabetes can speed up the development of atherosclerosis and lead to earlier onset of symptoms and complications, especially in people with a family history of atherosclerosis. early age.
Coronary atherosclerosis (or coronary artery disease) refers to atherosclerosis, which causes hardening and narrowing of the coronary arteries. Diseases that occur due to a decrease in blood flow to the heart muscle due to coronary atherosclerosis are called coronary heart disease (CHD).
Coronary heart disease include:
- heart attacks,
- sudden death
- chest pain (angina),
- abnormal heart rhythms
- heart failure due to weakening of the heart muscle.
Atherosclerosis of the coronary arteries is chronic disease, which provokes the accumulation of fatty deposits on the endothelium of the heart vessels.
As the pathology progresses, ischemic heart damage may develop. This occurs as a result of narrowing of the lumen of the artery or its complete occlusion. Lack of therapy can lead to serious consequences, including death.
Physiology of the disease
The first atherosclerotic plaques can form at an early age. Typically, their formation takes more than ten years.
Initially, fatty formations do not affect blood flow due to their small size. As the deposits progress, they begin to fill the lumen of the vessel, significantly narrowing it.
If left untreated, stenosing atherosclerosis of the coronary arteries may occur, which is characterized by blocking of more than 50% of the lumen of the vessel.
This disease can occur in various arteries:
- Mozgovykh;
- Coronet;
- Limbs;
- In the lumen of the aorta.
Atherosclerosis of the coronary arteries contributes to the gradual narrowing and thickening of the blood vessels of the heart.
Damage to the heart arteries leads to disruption of oxygen and blood supply to the myocardium and increased heart rate.
This pathology is the main cause of the development of coronary artery disease, and in case of complications - myocardial infarction.
Main causes, risk factors
Atherosclerosis of the coronary vessels of the heart occurs due to damage to the artery and metabolic disorders, in particular fat metabolism. Cholesterol plaques are formed as a result of a significant increase in the level of low-density lipoproteins (LDL).
There are also risk factors that can lead to the development of this pathological process:
- Arterial hypertension. This phenomenon is especially dangerous for patients who have passed the 50-year mark. Because a persistent increase in blood pressure has a negative impact on the thickness and elasticity of the arteries.
- Tobacco smoking. Inhaling tobacco smoke provokes an increase in the level of a special protein that affects blood clotting. This leads to the formation of blood clots. In addition, nicotine increases heart rate and increases blood pressure. This category also includes “passive smokers”.
- Familial hyperlipoproteinemia.
- Excessive body weight. Deviation from normal weight values by 2–3 times is often accompanied by hypercholesterolemia and an increased likelihood of developing coronary heart disease (CHD).
- Abuse of alcoholic beverages, coffee, fried, fatty foods.
- Extremely high levels of “bad” cholesterol in the blood. According to WHO, about 60% of patients suffering from coronary atherosclerosis have abnormally elevated concentrations of low-density lipoproteins.
- Physical inactivity. A sedentary lifestyle increases the risk of heart and vascular diseases by 50%, worsens the patient's condition with diabetes, obesity, and hypertension.
- Pathologies of the kidneys and liver.
- Diabetes. The presence of such a pathology increases the likelihood of atherosclerosis in men by 2–4 times, in women – by 3–5 times.
- Prolonged stay in a stressful state.
- Development inflammatory processes in organism.
- Taking hormonal medications/hormonal imbalance in the body.
- Congenital cardiovascular diseases.
Also significant role Hereditary predisposition plays a role in the formation of fatty deposits on the walls of blood vessels.
The initial stage of development of coronary vascular atherosclerosis in most cases is asymptomatic. Early signs pathologies are most often noticed by middle-aged patients. Therefore, people over 35 years of age should have their body examined annually.
Among the first symptoms of the disease are:
- Pain in the sternum radiating to the left shoulder and/or back;
- Dizziness;
- Feeling nauseous;
- Shortness of breath, which may be accompanied by an inability to lie down (due to
- Violations respiratory function);
- Vomiting attacks;
- Paleness skin due to impaired blood circulation;
- Decreased performance;
- Unmotivated fatigue;
- Sleep disturbance;
- Memory impairment;
- Increased blood pressure;
- Uncomfortable sensations with a deep breath;
- Exacerbation of chronic diseases.
Similar clinical picture may appear due to the formation of various pathologies. Therefore, doctors may not immediately suspect atherosclerosis of the heart vessels.
As coronary artery disease progresses, the following may occur:
- Cardiosclerosis. Due to acute myocardial ischemia, fibrotic changes in heart. This pathological condition leads to impaired cardiac contractile function.
- Angina pectoris. This syndrome is characterized by the appearance of painful sensations in the chest area. This often occurs after severe psycho-emotional stress or high physical activity.
- Arrhythmia. This condition occurs due to myocardial damage and disturbances in the conduction of cardiac impulses.
- Heart attack. Occurs as a result of the death of cardiomyocytes. Necrosis occurs due to the formation of a blood clot, which prevents the normal passage of blood.
Some people may have a heart attack without any associated symptoms.
Modern diagnostics
To establish a diagnosis, the doctor must first conduct a visual examination of the patient and collect information about the presence of concomitant and/or hereditary pathologies and the patient’s lifestyle.
After this, the patient is sent to undergo some tests: urine (OAM), blood (OAK) and biochemical blood test. Based on the results, the therapist evaluates general state health and determines the level of low-density cholesterol.
If coronary atherosclerosis is suspected, auxiliary methods of examining the body are used:
| Name of the technique | Characteristic |
| Electrocardiography (EKG) | This type of test is often used to detect a previous heart attack. In some cases, daily monitoring of the heart muscle is required. To do this, the patient must wear a special device throughout the day without removing it. An ECG is characterized by recording the progress of electrical signals through the heart. After a heart attack, it is difficult for the impulse to pass through scar tissue, which is reflected on the ECG. |
| Stress testing | Indicated for patients who complain of worsening symptoms with physical activity. To conduct the examination, the patient stands on a treadmill to walk on it or an exercise bike to pedal. At this time, the cardiologist monitors ECG changes. In some cases, the patient takes a medicine under the supervision of a doctor, which provokes an increase in heart rate. Then the doctor is able to assess the state of the heart using MPT. |
| Computed tomography (CT) | CT can detect cholesterol plaques, which pose the greatest danger to the arteries. |
| Echocardiogram (ultrasound of the heart) | It is carried out by ultrasound examination of the cardiac region. An echocardiogram allows you to assess the thickness of the wall of this organ, the condition of the valves, and the size of the chambers. |
| Angiogram | This technique is characterized by the introduction of a special dye into the coronary vessel. The doctor then uses MPT or X-ray to take a picture of the heart. Contrast fluid allows you to detect the area of narrowing of the arteries. |
Angiography may be combined with computed tomography.
Is it possible to completely cure the pathology, how long does therapy last?
Atherosclerosis of the coronary arteries of the heart can be completely cured, but only if the pathology is identified early stage its development. In this case, the duration of complex therapy can reach from six months to 1 – 2 years.
In advanced cases, the doctor prescribes treatment only to improve the patient’s well-being and stabilize the level of low-density lipoproteins in the bloodstream.
Therapeutic effect occurs after 1.5 months. after starting to use the drugs, after which the therapeutic effect remains. If necessary, the doctor may increase the dosage of medications and/or prescribe an additional drug.
Which doctor should I contact?
If you suspect the presence of atherosclerotic deposits or hypercholesterolemia, you should make an appointment with a therapist. He must examine the patient and collect anamnesis. After this, the patient is sent for urine and blood tests with an extensive lipid profile.
Based on the results laboratory research, the doctor determines the level of “bad” cholesterol in the plasma. If necessary, he refers the patient to a cardiologist, who directly treats atherosclerosis of the arteries of the heart.
If diabetes mellitus is the cause of atherosclerotic deposits, the patient should also visit an endocrinologist.
Features of treatment
Coronary atherosclerosis requires fundamental change lifestyle. In this case you should:
- Review your diet by eliminating junk food;
- Increase physical activity on the body;
- Get rid of all bad habits.
Also, as necessary, the doctor may prescribe medications and/or the use of folk remedies. Advanced cases require surgical intervention.
Conservative therapy
If atherosclerosis of the coronary vessels is at an unadvanced stage, it can be treated by taking medications. However, it is impossible to achieve a complete recovery.
Medicines can only slow down the progression of the pathological process and improve the patient’s well-being.
Basic goals traditional therapy atherosclerosis of the coronary vessels are:
- Relieving the load on the heart;
- Reducing the level of “bad” cholesterol in the blood;
- Preventing the formation of blood clots;
- Elimination of vascular spasms;
- Normalization of blood pressure indicators;
- Reducing the likelihood of developing a heart attack.
To achieve a similar effect, the following groups of medications are used:
| Name of pharmacological group | Name of medicine | Therapeutic effect |
| Preparations based on fibric acid (fibrates) | Gemfibrozil, Fenofibrate | Effective reduction concentrations of triglycerides in the bloodstream, an increase in high-density lipoproteins (HDL) in plasma. |
| Bile acid sequestrants (BAS) | Colestipol, Cholestyramine | Prevention of reabsorption of bile acids, their combination and natural elimination from the body. |
| Statins | Livazo, Pitavastatin, Simvastatin, Rosuvastatin | Inhibition of cholesterol synthesis in the liver, decrease in LDL levels, triglycerides, slight increase in HDL levels in the blood. |
| Products containing niacin | Enduracin, Niceritrol, Acipimox | Normalization of fat metabolism, regulation of redox processes in the body, reduction of the level of low-density lipoproteins in plasma. |
| Cholesterol absorption inhibitors | Ezetimibe | Blocking the absorption of dietary cholesterol. |
| Antihypertensive medications | Valsartan, Amlodipine, Bisoprolol, Lisinopril | Similar drugs are prescribed to normalize blood pressure, since high blood pressure worsens the condition of the affected artery. |
| Blood-thinning medications | Aspirin ( acetylsalicylic acid), Warfarin (prescribed for severe disease) | Thinning the blood, preventing the formation of blood clots. |
Some medications must be taken by the patient for life. Each medicine must be prescribed by the attending physician.
Self-medication can lead to serious consequences.
Surgery
Surgery carried out when there is a high number of cholesterol plaques, which significantly narrow the lumen of blood vessels. Surgical treatment is carried out in several ways:
After surgery, the patient should regularly monitor LDL levels.
Folk remedies
Atherosclerosis of the coronary arteries cannot be cured using alternative medicine methods. However, the use of folk remedies as an auxiliary therapy is allowed:
| Name of medicine | Required Ingredients | Cooking method | Reception scheme |
| Lemon-garlic infusion |
|
| Take 1 large spoon of the finished medicine before meals. |
| Tincture from medicinal herbs |
|
| Drink 0.1 l three times a day. before eating. |
| Decoction of medicinal plants |
|
Before each dose, it is necessary to prepare fresh medicine. | Drink 1 tbsp. 3 rubles/day before meals. |
| Nettle infusion |
|
| Drink 0.15 l twice a day. before the first and last meals. |
| Herbal decoction | To make the medicine, it is necessary to prepare the following herbs in equal proportions:
You also need 1 tbsp. hot boiled water. |
| Take ½ tbsp. twice/day. The recommended duration of the treatment course is 2 – 3 months. |
| Herbal infusion | Healing ingredients should be taken in equal proportions:
|
| Drink 1 tbsp. before eating 3 rubles/day. For patients whose age exceeds 70 years, reduce the dosage to ½ tbsp. |
You can also take olive oil, which contains a high concentration of Omega-3. Treatment should begin with consumption of 1 b. l. on an empty stomach, gradually increasing the dosage to 1 tbsp.
Application of any folk remedy must be agreed with the attending physician. You should not self-medicate, as this can lead to unforeseen consequences.
Diet and diet
In case of atherosclerosis of the coronary vessels, it is necessary to exclude from the diet dishes containing lipids of animal origin. They are contained in:
- Sale;
- Offal;
- Fatty meat and fish;
- Cream and butter made from them;
- Sausages;
- Chicken yolks;
- Mayonnaise;
- Dairy products;
- Cheeses.
You should also avoid fast food, margarine, sweets, coffee, smoked foods, canned food, over-salted and fried foods. Dishes must be steamed, boiled or baked.
Be sure to replace butter with vegetable oil, but use it in moderation.
Fats are great for fighting high cholesterol plant origin contained in:
- Oils made from plants, tree fruits;
- Nuts;
- Avocado;
- Cereals.
It is advisable to include such products in the menu every day. The menu should be dominated by vegetables, berries, fruits, cereal dishes, low-fat dairy products, lean meat, cheese, and skinless poultry. It is better to eat fish about 3 - 4 times a week.
For drinks, use herbal teas, compotes, fruit drinks, and freshly pressed juices. You can add a small amount of ginger to tea, which has a beneficial effect on the body.
Complications
Lack/untimely treatment of the disease in question can lead to serious complications in the form of:
- Angina pectoris;
- Heart failure;
- Myocardial infarction;
- Arrhythmias.
If an atherosclerotic plaque ruptures and the artery is blocked by its fragments, death may occur.
Prevention
To prevent vascular atherosclerosis you should:
- Give up habits that have a detrimental effect on the body;
- Stick to healthy balanced nutrition in moderation;
- Perform daily physical exercise;
- Control your weight;
- Avoid stressful situations;
- Treat all concomitant diseases in a timely manner.
Heart is vital important organ. It is necessary to pay special attention to his health. If discomfort occurs in the retrosternal region, this organ should be examined immediately.
These actions can save lives, since many heart diseases can be asymptomatic, including coronary atherosclerosis.
Bibliography
- Bagriy A.E., Dyadyk A.I. - Ischemic disease hearts, 2006.
- Belenkov Yu.N., Oganov R.G. - Cardiology. National leadership, 2007.
- Vlasova S.P., Lebedev P.A., Ilchenko M.Yu. - Endothelial dysfunction and arterial hypertension, 2010.
- Grigorenko E.A., Danilova L.I., Mitkovskaya N.P. - Heart and metabolic risk, 2008.
- Janashia P.Kh., Shevchenko N.M., Olishevko S.V. - Emergency cardiology, 2010.