Causes, symptoms and treatment of cardiac ischemia

What is cardiac ischemia?

Cardiac ischemia is a disease that is a violation of the blood circulation of the myocardium. It is caused by a lack of oxygen, which is carried through the coronary arteries. The manifestations of atherosclerosis prevent its entry: narrowing of the lumen of the vessels and the formation of plaques in them. In addition to hypoxia, that is, a lack of oxygen, tissues are deprived of some of the beneficial nutrients necessary for the normal functioning of the heart. 

Ischemic disease is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of the fairer sex of a number of hormones that prevent the development of atherosclerosis of blood vessels. With the onset of menopause, the hormonal background changes, so the possibility of developing coronary disease increases dramatically.

As part of the classification of coronary heart disease, the following forms are distinguished:

Causes, symptoms and treatment of cardiac ischemia

  • Painless the form. This myocardial ischemia is typical for people with a high pain threshold. Its development is facilitated by hard physical labor, alcohol abuse. The risk group includes the elderly, as well as patients with diabetes. This form of ischemia is painless, which is why it is often called dumb. However, in some cases, there may be discomfort in the chest. It occurs in the early stages of the development of the disease. The characteristic symptoms of painless ischemia of the heart are tachycardia, angina pectoris, a sharp decrease in blood pressure. There may be weakness in the left arm, shortness of breath, or heartburn.

  • Primary cardiac arrest. It refers to sudden coronary death. It occurs immediately after a heart attack or within a few hours after it. This manifestation of coronary heart disease is promoted by overweight, smoking, arterial hypertension, and ventricular fibrillation becomes the cause. Allocate sudden coronary death with successful resuscitation or ending in death. In the first case, qualified medical assistance should be provided immediately. If defibrillation is not done in time, the patient dies.

  • Angina pectoris. Compressive or pressing pain, discomfort in the chest area – these are the main symptoms by which this form of coronary disease is determined. It often manifests itself in the form of heartburn, colic or nausea. Pain from the chest can radiate to the neck, left arm or shoulder on the same side, sometimes to the jaw and back. Discomfort occurs during active physical exertion, after eating, especially when overeating, a sharp increase in blood pressure. Angina causes stress and hypothermia. In all these situations, there is a need for more oxygen for the heart muscle, but due to clogged arteries, this is not possible. To cope with pain, which can last up to 15 minutes, it is enough to stop physical activity, if it was caused by them, or take short-acting nitrates. The most popular among these drugs is nitroglycerin.

    Causes, symptoms and treatment of cardiac ischemia

    Angina can be stable or unstable. In the first case, it is caused by the action of environmental factors: smoking, significant physical activity. You can cope with it with the help of nitroglycerin. If it becomes ineffective, this indicates the development of unstable angina. It is more dangerous, as it often causes a myocardial infarction or death of the patient. One type of unstable angina is new-onset angina. The main distinguishing feature of this form of the disease is that the onset of seizures began no later than a few months ago. The cause of angina pectoris for the first time can be a strong emotional or physical stress. In this case, the coronary arteries can function normally. The second group of patients is formed by patients who have had a myocardial infarction and have a pathology of the coronary arteries. If the development of the disease will occur imperceptibly, it is likely that it will develop into stable angina. But another option is also possible. Often, the first symptoms soon pass, the attacks stop, and over the next years, the patient does not manifest angina pectoris. At the same time, regular examinations are required to prevent unexpected myocardial infarction.

    Progressive angina, which is another type of unstable, is characterized by an increase in seizures. They happen more often, become more intense and longer, may be accompanied by choking, shortness of breath and increased heart rate. The first attacks occur with significant loads. As angina progresses, a slight physical exertion is enough to increase the heart rate and cause shortness of breath. Attacks occur at night, become more frequent in stressful situations. Nitroglycerin may not be effective in controlling pain. The prognosis for progressive angina varies, but in most cases it precedes or is the onset of myocardial infarction. Although a complete cessation of seizures and the onset of remission are possible.   

  • Myocardial infarction. This acute form of coronary disease can be triggered by strong emotional experiences, physical overstrain, as a result of which the blood supply to one of the heart sections is stopped. Circulatory disturbance can last from several minutes to several hours. Atherosclerotic plaques located in the vessels can collapse, leading to the formation of a blood clot. It is he who causes circulatory disorders. Deprived of oxygen and nutrients, cells die.

    Myocardial infarction is accompanied by severe chest pain. Unlike angina pectoris, it will not be possible to cope with it by taking nitroglycerin tablets. Moreover, external influences, such as stress, do not necessarily lead to a heart attack. Sometimes tissue necrosis occurs for no apparent reason during sleep or in the early morning. Other symptoms of myocardial infarction include nausea and vomiting, difficulty breathing, and abdominal pain. The complete absence of signs of the disease is often observed in patients with diabetes mellitus. In the absence of the necessary studies, a heart attack goes unnoticed. To determine any changes is possible only with the help of an electrocardiogram or echocardiography.

    If myocardial infarction is suspected, urgent hospitalization is required. The doctor prescribes medication and bed rest. Previously, recovery after a heart attack took months, but modern drugs and therapies have reduced this period to several days. A patient who has undergone such an attack of coronary disease is contraindicated in active physical activity, it is necessary to engage in physiotherapy exercises, gradually increasing the intensity of exercises. It is necessary to take drugs prescribed by a doctor throughout life, even in the absence of pain and discomfort. 

  • Cardiosclerosis. In this form of coronary disease, dead heart cells are replaced by scar tissue. It does not participate in the contraction of the myocardium and causes hypertrophy of parts of the heart, as well as deformation of its valves. As a result, the process of pumping blood is disrupted, and heart failure develops.

    Cardiosclerosis can be diffuse and focal. In the first case, the scar tissue replaces the heart cells evenly, being distributed throughout the muscle. With focal cardiosclerosis, the connective tissue affects only certain areas. It is usually caused by a myocardial infarction.

    Plaques in the arteries cause the development of atherosclerotic cardiosclerosis. The development of myocardial cardiosclerosis is promoted by the inflammatory process directly in the heart muscle. Increases the risk of disease overeating, smoking, sedentary lifestyle. For a long time, cardiosclerosis can be asymptomatic, especially in the case of an atherosclerotic form. Patients during rehabilitation and prevention should follow a diet that involves a minimum intake of salt, fats and liquids.

Symptoms of ischemia of the heart

Causes, symptoms and treatment of cardiac ischemia

There are several main symptoms of cardiac ischemia:

  • Pain in the chest and behind the chest. It can be piercing, baking or compressive in nature. Unpleasant sensations arise unexpectedly and disappear after 3-15 minutes. In the early stages of coronary disease, discomfort may be mild. Severe pain is given to the left arm and shoulder, less often – to the jaw and right side. They appear during sports, or with strong emotional stress. To get rid of the discomfort that has arisen due to physical activity, it is enough to take a short break. When such measures do not help and the attacks become severe, they resort to the help of drugs.

  • Dyspnea. Like pain, it first appears during movement and is caused by a lack of oxygen in the body. As the disease progresses, shortness of breath is accompanied by each attack. The patient experiences it even at rest.

  • Heartbeat disorders. It becomes more frequent, and the blows in this case are felt more strongly. There may also be interruptions at some points. At the same time, the heartbeat is felt very weakly.

  • General malaise. The patient experiences dizziness, may faint, quickly gets tired. There is increased sweating and nausea, turning into vomiting.

  • Angina pectoris. In the old days it was called “angina pectoris”. This phrase is not accidental, because angina pectoris is not pain, but severe squeezing and burning in the chest and esophagus. It may be felt in the form of pain in the shoulder, arm, or wrist, but this is less common. Angina is easily confused with heartburn. It is not surprising that some try to cope with it and use soda for this. In cardiology, angina pectoris is considered the most striking symptom, indicating the presence of coronary heart disease and preventing myocardial infarction. It is much worse when the disease proceeds without external manifestations. The asymptomatic form in most cases leads to death.

With a heart attack, there is a complete overlap of the lumen of the arteries with plaques. The pain increases at the same time gradually and after half an hour becomes unbearable. Unpleasant sensations may not go away for several hours. In the chronic form of coronary heart disease, the lumen of the vessel is not completely blocked, the attacks of pain are less long.

  • Psychological symptoms. With a heart attack, the patient may experience inexplicable fear and anxiety. 

Causes of ischemia of the heart

Causes, symptoms and treatment of cardiac ischemia

The main reasons for which cardiac ischemia may occur are as follows:

  • Atherosclerosis. The myocardium is enveloped by two main arteries, through which blood flows to the heart. They are called coronary and branch into many small vessels. If the lumen of at least one of them is partially or completely closed, certain parts of the heart muscle do not receive the necessary nutrients, and most importantly, oxygen. There are no more arteries supplying the heart with blood, so its work is disrupted, and coronary disease develops.

    Clogged arteries are due to atherosclerosis affecting the arteries. It involves the formation of cholesterol plaques in the arteries that prevent the movement of blood. Performing active movements with a lack of oxygen in the heart muscle is accompanied by pain.

     At this stage, ischemic disease is expressed in the form of angina pectoris. Gradually, myocardial metabolism worsens, pain intensifies, becomes longer and appears at rest. Heart failure develops, the patient suffers from shortness of breath. If the lumen of a coronary artery suddenly closes as a result of plaque rupture, blood stops flowing to the heart, a heart attack occurs. As a result, death is possible. The patient’s condition after a heart attack and its consequences largely depend on the blockage of the artery. The larger the affected vessel, the worse the prognosis. 

  • Incorrect food. The reason for the formation of plaques on the walls of blood vessels is an excess of cholesterol in the body that comes with food. In general, this substance is necessary, as it is used to create cell membranes and produce a number of hormones. Cholesterol is deposited on the walls of blood vessels under the influence of stressful situations.

    Emotional stress causes the production of a special substance. It, in turn, contributes to the deposition of cholesterol in the arteries. A properly formulated diet allows you to reduce its amount in the body. It is worth limiting the use of foods that have saturated fats: butter, sausage, fatty cheeses and meats. It is recommended to give preference to fats contained in fish, nuts, corn. Contributes to the development of cardiac ischemia quickly digestible and high-calorie food.

  • Bad habits. Alcohol abuse and smoking affects the work of the heart muscle. Cigarette smoke contains a large number of chemicals, among which are carbon monoxide, which impedes the transport of oxygen, and nicotine, which increases arrhythmia. In addition, smoking affects the formation of blood clots and the development of atherosclerosis. 

  • Sedentary lifestyle or excessive exercise. Uneven physical activity creates an additional load on the heart. The cause of ischemia can be both physical inactivity and physical activity that exceeds the capabilities of the body. It is recommended to exercise regularly, individually determining the intensity, duration, frequency of training.

  • Obesity. Numerous studies have found a direct relationship between overweight and mortality from cardiovascular diseases. Therefore, obesity is one of the factors contributing to the development of ischemia.  

  • Diabetes. The risk of developing coronary heart disease is high for patients with type I and type II diabetes. They need to normalize carbohydrate metabolism in order to reduce risks.

  • psychosocial reasons. There is an opinion that people with higher social status and education are less exposed to coronary disease.

How to treat ischemia of the heart?

Causes, symptoms and treatment of cardiac ischemia

Diagnosis of coronary disease is carried out primarily on the basis of the patient’s feelings. Most often they complain of burning and pain in the chest, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, palpitations and rhythm disturbances. Be sure to perform electrocardiography if ischemia is suspected. Echocardiography is a research method that allows you to assess the state of the myocardium, determine the contractile activity of the muscle and blood flow. Blood tests are performed. Biochemical changes can reveal coronary heart disease. Conducting functional tests involves physical activity on the body, for example, walking up the stairs or doing exercises on the simulator. Thus, it is possible to identify pathologies of the heart at an early stage.

For the treatment of ischemia, the following groups of drugs are used in combination: antiplatelet agents, adrenoblockers, fibrates and statins. Specific means are selected by the doctor depending on the form of the disease. Antiplatelet agents improve blood flow, with the help of adrenoblockers, it is possible to reduce the frequency of contractions of the heart muscle and reduce oxygen consumption. The action of fibrates and statins is aimed at atherosclerotic plaques. Drugs reduce the rate of their appearance and prevent new formations on the walls of blood vessels.

The fight against angina pectoris is carried out with the help of nitrates. Widely used for the treatment of coronary disease and natural lipid-lowering drugs. Anticoagulants affect the formation of blood clots, and diuretics help remove excess fluid from the body.

Moderate exercise is also required. Depending on the form of ischemia, a doctor develops a set of exercises. After all, excessive motor activity increases the oxygen demand of the heart muscle and has a negative impact on the development of the disease.

Surgery

Since plaques in the vessels cause their narrowing, it is possible to artificially increase the lumen in the coronary arteries. For this, stenting and balloon angioplasty are performed. During these bloodless surgical interventions, the lumen in the vessels expands, and blood flow normalizes. These methods have replaced the traditional shunting, which today is carried out only in some forms of coronary disease. During such an operation, the coronary arteries are connected to other vessels below the place where the blood flow in them is disturbed.

What to do during an attack?

In case of an unexpected attack while walking or playing sports, you should stop and rest, drink a sedative medicine and go out into the fresh air. Then you should take a nitroglycerin tablet.

 This drug works within 5 minutes. If the pain does not go away, you need to drink 2 more tablets. The ineffectiveness of nitroglycerin indicates serious problems, so if there is no improvement in the condition, you need to urgently go to the hospital. Prevention of coronary heart disease involves avoiding alcohol, smoking, proper balanced nutrition and regular exercise. You need to watch your weight and control your blood pressure. The presence of positive emotions and the absence of stress is important.   

Nutrition for ischemia

Causes, symptoms and treatment of cardiac ischemia

The basic principles of the diet for ischemia are as follows:

  • Patients with coronary disease will have to minimize salt, sugar, sweets and sweets, confectionery, that is, all sources of simple carbohydrates, fatty meat, caviar, spicy and salty foods, chocolate, coffee and cocoa in the diet.

  • The most important thing is to limit the consumption of foods containing high amounts of cholesterol and fat. Eat little, but often.

  • Be sure to eat foods that contain ascorbic acid, vitamins A, B, C, potassium, calcium.

  • Vegetable oil used for cooking should be replaced with corn, olive oil. It is much more useful, besides it contains omega-3 fatty acids, which have a positive effect on blood circulation.

  • The diet should be dominated by dairy products, with the exception of butter, cereals, seafood, vegetable soups, low-fat sea fish, such as cod, protein omelet, turkey, chicken.

  • Dishes are recommended to be steamed. In addition, products can be boiled or stewed.

Below is the usual menu for 7 days for patients with ischemia of the heart:

Monday

  • Breakfast – a slice of whole grain bread, oatmeal, a glass of weak tea without sugar

  • Second breakfast – natural yogurt

  • Lunch – vegetable salad, a piece of boiled chicken without skin, rice, a glass of fruit juice

  • Dinner – cottage cheese casserole without sugar, a glass of kefir

Tuesday

  • Breakfast – multi-protein omelet, apple, tea

  • Second breakfast – a glass of kefir

  • Lunch – baked potato, steamed cod, slice of rye bread, tea

  • Dinner – vegetable stew, unsweetened yogurt

Wednesday

  • Breakfast – oatmeal, fruit juice

  • Second breakfast – cottage cheese with fruits

  • Lunch – vegetable salad dressed with olive oil, roasted turkey, tea

  • Dinner – milk soup, tea

Thursday

  • Breakfast – boiled egg, slice of whole grain bread, natural yogurt

  • Second breakfast – apple

  • Lunch – baked chicken, buckwheat, tea

  • Dinner – vegetable soup, a glass of kefir

Friday

  • Breakfast – oatmeal, apple, carrot juice

  • Second breakfast – a glass of kefir

  • Lunch – soaked herring, baked potatoes, tea

  • Dinner – vegetable salad dressed with olive oil, a glass of milk

Saturday

  • Breakfast – cottage cheese casserole with fruit, tea

  • Second breakfast – natural yogurt

  • Lunch – boiled sea bass, vegetable salad, a glass of milk

  • Dinner – milk soup, tea

Sunday

  • Breakfast – millet porridge, natural yogurt

  • Second breakfast – protein omelette

  • Lunch – turkey and baked potatoes, tea

  • Dinner – vegetable soup, a glass of yogurt

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