Dr. Elena Berezovskaya says about heart disease, rather, explains Namco is myocardial infarction and how to avoid it?
In the first place in the list of all presumptive diagnoses I would put it CHD coronary heart disease. Why?..
A few days ago I received a small letter from an old friend about the incident that happened with him. Night he had a severe, crushing chest pain that spread down my left arm, lower jaw, and also had other complaints. He called an ambulance twice. Of course, doing an electrocardiogram (ECG) injected something intravenously (it turned out that it wasn’t painkillers or heart medication), I offered to go to the hospital, but the patient refused. The next day it was the local therapist did not really said, looked at the ECG and disappeared? What’s next? And what the diagnosis was my friend?
Don’t need to be a narrow specialist in the field of cardiology (I’m not a cardiologist), but still the classic signs of coronary heart disease (CHD) can recognize any doctor. And the fact that my friend had an attack of angina (a type of IBS, or simply angina pectoris), and maybe even a myocardial infarction (mi) (little stroke), there is no doubt. There are other diseases, do not argue, but on the first place in the list of all presumptive diagnoses I would put it coronary artery disease. Why?
The heart is a muscular hollow organ, performing the function of a pump in our body. It is from the heart muscle depends on normal blood circulation in whole body. When the heart contracts, the heart muscle receives a minimum of blood for their own consumption, but during relaxation of the heart (which lasts for a split second) blood filling the heart (the muscle wall) increases. Blood to the tissues supplied with oxygen, which is essential in the life processes of the cells of the tissues. If the blood supply is suffering, it means not enough oxygen, so there is ischemia of the tissue, i.e. instead of the synthesis processes come processes of decay (necrosis). In the tissues appear toxic substances that aggravate this even more necrosis. So a vicious circle, and if time does not improve the blood supply to the injured tissue, it can cause serious complications.
The heart tries to compensate for the lack of oxygen different and quite a long time without special characteristics for which people would pay attention. This means changes in the rhythm of heartbeats, thickening of the walls of the heart, especially its left half, samsuiluna minor injuries related to poor blood flow to different areas of the heart. Often only ECG or echocardiography may show an existing hidden problems, which may be a predisposing factor to more serious cardiac disorders.
Coronary heart disease includes several diagnoses that reflect the stages of the disease, that is, from a simple angina to acute or chronic heart failure.
It is necessary to take note that globally, cardiovascular diseases occupy the first (in some countries, second) on the mortality and morbidity of adult population. Most often in males, and the peak disease ischemic heart disease falls on the age category from 50 to 60 years.
There are five of the most serious risk factors:
- Smoking – this risk can be reduced by half (50%!) when Smoking cessation;
- diabetes often causes micro – and macrovascular complications;
- hypertension (high blood pressure) is the influence of this factor depends on the degree and duration of the disease;
- family history – if a close relative has a sick disease, then the chance of getting sick man increases.
- the high lipid content in the blood (hyperlipidemia) is quite often genetically hardwired, but are also largely dependent on diet.
To less serious risk factors include:
- obesity – weight gain more than 30% from ideal weight;
- sedentary lifestyle;
- General nervous depression – a major factor for the increase in acute myocardial infarction.
Signs that occur in disease, dependent on the extent of damage to the heart muscle. If the lack of oxygen is short, the pain in the chest mainly on the left and front, minor and can go by itself, especially after a few minutes of rest. But with age, the accumulation of risk factors, therefore, the processes of compensation are suffering, there are more and more serious symptoms, primarily pain, shortness of breath, discomfort in the chest.
What is myocardial infarction? This severe lack of blood (oxygen), which causes rapid damage to the heart muscle, causing pockets of her immobilization. The diagnosis of IM is based on the history of the disease (as and when there is pain, its intensity, other symptoms, other diseases), ECG and cardiac enzymes (the substances, the level of which is determined in the blood).
You always need to remember that if the compressive acute pain lasts more than 30 minutes does not decrease the intake of nitroglycerin tablets, THEY in this case is not excluded. It must also be remembered that 30% (almost one third!) all myocardial infarction occurs quietly, without special signs or intense pain. This applies to diabetics, older people, patients with hypertension.
Electrocardiogram (ECG) does not always show the classic signs of THEM in the first place the Q-wave, as we were taught in medical institutions. This prong is the norm in W and V1 (this information is for doctors, so forgive me readers for such specificity). Please note also that this prong occurs only with the development of transmural THEM. You always need to consider its width and depth. First and foremost, pay attention to the tines T and ST-segment.
The question is: in a patient suspected THEM, but he refused to go to the hospital. What to do next? Yes, each person has the right to decide the question of admission, that is the question of your life. And do not be offended medical personnel if suddenly the patient refused treatment. Now the conditions in many hospitals in the former Soviet Union are such that to be much more favorable than in a hospital where the heating problems, and medications, and with food. My father had to bring your own bed linen, to buy himself drugs in pharmacies, and the mother was wound three times a day with bags of food
First and foremost, you need to calmly explain to the patient what can be complications if he still refuses hospitalization. And we must think about prevention of recurrent cardiac ischemia and its complications.
Worldwide have long developed a very good scheme for the prevention/treatment of IHD. And they are good! A positive result of such schemes is known, confirmed and no doubt.
I offer you the following advice, but don’t forget: starting any course of treatment, even preventative, check with your personal physician who knows your problems better, which may appoint the necessary additional research, to prescribe the necessary medications, taking into account all the pros and cons.
- Smoking cessation is a intractable problem, largely depends on the will of the person. To quit Smoking you can gradually or suddenly, the advantage for health will anyway (50%).
- The transition from a sedentary lifestyle to moving (fresh air, exercise).
- Control of blood pressure. The causes of high blood pressure.
- Control of blood sugar levels.
- Diet (reducing consumption of fatty foods, partial replacement of animal fats by vegetable fats, limiting salt intake). Reducing the blood lipids with special medicines (consult your doctor).
- Cardiac medications – type, dose and length of treatment can determine your doctor, taking into account indications and contraindications.
- Aspirin 1 tablet (325 mg) daily.
- Nitroglycerin (and other nitrates) – there is no reliable data that the level of the lesion of the cardiac muscle will be smaller, but the nitrates partially relax the heart muscle and widen heart vessels, reducing thus the consumption of oxygen in heart. It is necessary to apply the nitrate binding intervals with short breaks to prevent habituation of the cardiac muscle to the drug.
- Drugs that block calcium channels – are assigned based on ECG data, it is not always desirable for some patients (consult a doctor).
- Antiarrhythmic drugs (riboxinum, etc.).
Prevention and treatment must always be individualized and controlled by the patient, and his doctor. Don’t be afraid to ask questions of your doctors, because you trust them with their health and therefore their lives. And you, dear colleagues, do not be afraid to answer questions truthfully, and even if you don’t always know the answer, then there is the medical literature, using other colleagues in the discussion group.
Author:Dr. Berezovskaya Elena Petrovna