In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
After you are diagnosed with ischemic heart disease, you wonder what will happen next. After all, you are only 50 years old and you do not feel like a pensioner chained to your chair. You need a plan: how to change your lifestyle, how to follow your diet, how to take medications prescribed by your doctor. Here are a handful of tips.
It started innocently. You were running to the bus stop where the bus was just leaving and suddenly you felt a choking pain in your chest, somewhere near your sternum, radiating simultaneously to your neck, shoulder and left arm. You got a little out of this pain and went to your doctor, who told you that these were the classic symptoms of a stable form of coronary heart disease, popularly known as a wreath. The pain you feel (often accompanied by anxiety, shortness of breath, palpitations and nausea) usually radiates to the throat, neck or shoulder, making the hands feel numb. In this form of a wreath, pain usually occurs during exercise and disappears as soon as you stop exercising or take nitroglycerin.
Your doctor had an easier task this time, because women often experience coronary pain attacks differently than men (no retrosternal location of pain, no radiation to the hand). Ladies describe their heart ailments as simple shortness of breath, and if they already feel pain, they are not able to accurately determine its nature, which unfortunately causes diagnostic mistakes.
In angina, pain occurs irregularly, it can occur both in the morning after getting out of bed and during everyday activities, both several times a week and only once a month.
In fact, you were lucky not to have a form of the disease called the silent killer, in which the sick person has no symptoms, and ischemic changes in the heart can only be detected with an EKG. Okay, so you didn’t ignore the initial symptoms and went to the doctor right away, and he could start treatment.
A heart in the palm of your hand
To correctly diagnose the condition of the heart, your GP has ordered a standard ECG (or electrocardiogram) test. However, it is worth knowing that its effectiveness in detecting coronary artery disease is only 15%, and 30%. In accidents, the results of the examination in sick people are perfectly normal if the ECG was taken in the period between the pain attacks. However, you had some changes, so your doctor, to be sure of the diagnosis, sent you to a cardiologist who has better diagnostic equipment.
A cardiologist commissioned you to carry out a thorough 24-hour Holter test, which detects changes in the work of the heart in as many as 70 percent. sick people, even those who show no clinical symptoms. This examination allows for many hours of recording of the ECG record under normal conditions of patient activity (note – however, it is inadvisable to pass through the gates, e.g. in shops). It shows rhythm disturbances and abnormalities in the blood supply to the heart muscle. The result of this test confirmed an earlier diagnosis of your GP.
However, before the cardiologist released you from the office with the prescription file, he told you to get on a stationary bicycle (the test can also be performed on a treadmill) and performed the so-called exercise test. It is a test by taking an EKG during your simulation of cycling. It allows the assessment of the physical capacity of the body of the studied patients, mainly of the circulatory system (in people with coronary artery stenosis, there is a critical level of exercise load, above which it is no longer possible to supply the required amount of oxygen).
If you were to come to an even larger facility with your symptoms, such as a cardiology clinic in a large city, the doctors could do some other more detailed examinations. These include, among others:
• Exercise test combined with heart muscle scintigraphy (where at the end of the exercise test, a radioactive compound is administered intravenously, which penetrates into the heart cells, and the scintigraphic apparatus creates an image of the heart muscle).
• Echocardiography, which is performed after the administration of dobutamine to increase the heartbeat, which is equivalent to an ECG exercise test.
• Coronary angiography (coronary angiography) consisting in X-ray visualization of coronary vessels after the so-called contrast. This is invasive as the contrast is injected through a catheter that is inserted into the femoral artery. They are performed more and more often because it allows, among others, for the assessment of atherosclerotic changes in the coronary vessels.
• Computed tomography based on the analysis of single photon emission (so-called SPECT) with the use of thallium isotope (201Tal) or other complex tests.
“Heart” dilemmas
On the way from your cardiologist to the pharmacy, you wonder what this angina is and why it happened to you. The Latin binary name of the disease angina pectoris indicates: the nature of the ailment – angina is a painful choking, pressure, and the place where the pain occurs – pectoris means thoracic.
In health encyclopedias, you can read that coronary artery disease is a syndrome characterized by insufficient blood supply and oxygen supply to the heart muscle caused by the narrowing or obstruction of the coronary arteries. Its most common forms are angina pectoris and myocardial infarction. On the other hand, the most common type of angina pectoris is called stable, in which the symptoms are caused by physical exertion or strong emotions, while the pain subsides after cessation of activity or after calming emotions. In the more dangerous – unstable form of angina – pains may also appear at rest, and any change in the current course of the disease is a symptom of its exacerbation and requires immediate consultation and medical intervention.
The most common cause of ischemic heart disease is atherosclerosis, in which cholesterol deposits in the form of atherosclerotic plaques are formed. This narrows the lumen of the vessels and reduces the blood supply to the heart. An exception worth mentioning here is Prinzmetal’s variant angina, the so-called variant angina, which is caused by a constriction of a coronary vessel rather than a build-up of plaque in a blood vessel.
The most important risk factors that can lead to angina pectoris include, in particular, high blood levels of the so-called bad LDL cholesterol (above 130 mg%) and low concentration of good HDL cholesterol (below 35 mg%). Even exceeding the norm by 10% of the total cholesterol level increases the risk of developing coronary heart disease by 30%.
Other important factors accelerating the development of coronary heart disease are cigarette smoking (if you are a smoker, you have no choice – you must quit this addiction as soon as possible) and arterial hypertension (effective treatment of hypertension significantly reduces the mortality rate of patients with coronary artery disease). The intensification of atherosclerotic processes is also caused by diabetes and dangerous abdominal obesity, more common in men than in women. However, in any case of excess weight, it is beneficial to lose unnecessary kilograms.
The group of risk factors also includes old age, a sedentary lifestyle, menopause, increased levels of fibrinogen, homocysteine or uric acid in the blood. Recent studies even take into account the presence of certain microorganisms in the body (Chlamydia pneumoniae and Helicobacter pylori), which, according to the inflammatory theory of atherosclerosis, are important to initiate the disease process.
In addition, a greater risk of developing the disease was also shown in people whose grandparents, parents or siblings suffered from this disease at a relatively young age (men before the age of 55, women before the age of 65). However, the gene responsible for the development of the disease has not yet been identified.
Let’s save what we can
If this is just the beginning of the disease, you think, it’s not too late. I should start working immediately so that I would be able to live to old age without fear of a heart attack at a bus stop. The cardiologist also said that you have to: force yourself to exercise every day in the fresh air to oxygenate the body, change eating habits so as not to overeat high-cholesterol animal fats, and finally stop going “on a smoke” during breaks at work.
It is therefore necessary to introduce a diet consisting in excluding yolks, butter, cream, lard and fatty meat (cholesterol) from the diet. We replace butter with margarine, we give up fat in favor of oil, instead of red meat we eat poultry and fish.
The U.S. government’s Food and Drug Administration (FDA) has officially confirmed the fact that consuming 40 grams of almonds (about 34) daily can significantly reduce the risk of coronary heart disease. The American guidelines for the prevention of cardiovascular disease in women also recommends regular, moderate physical activity (such as brisk walking) for at least 30 minutes, preferably daily. The “3x30x130” rule has gained popularity, which means effort 3 times a week for at least 30 minutes with a heart rate of about 130 beats per minute.
The same guidelines recommend that ladies conduct their exercise and diet in such a way as to achieve a standard tabulated body weight and to keep the waist circumference below 88 cm. Otherwise, doctors warn that ischemic heart disease will develop for many years and, if left untreated, will lead to a heart attack. It is worth noting that in women the risk of coronary heart disease increases sharply after the menopause.
Honey on your heart
If you leave the cardiologist with a prescription file and you think that you can only buy some of the medications with angina pectoris, you are risking your life. Better check which group the prescription medication belongs to and see how it will bring relief to your heart.
The most commonly used medications for angina are:
1 Anti-anginal drugs – to inhibit or prevent angina attacks.
• Nitrates (nitroglycerin and its derivatives, e.g. Nitrocard, Nitroglycerinum Prolongatum, Natispray, Nitromint – they are excellent at stopping coronary attacks and reducing pain, but if used chronically they stop working, because they immunize the body. They also cause a rapid drop in blood pressure, therefore the best take them seated.
• Beta-blockers – reduce the heart’s need for oxygen:
– metoprolol (Betaloc, Metoprolol, Metocard, Lopresol);
– bisoprolol (Concor, Bisocard, Bisopromerck, Antipress, Coronal);
– atenolol (Atenolol, Cardiopress, Tenormin, Normocard).
Attention! Women who have had a heart attack or have chronic ischemia should use these drugs for the rest of their lives, because beta-blockers reduce by 30%. risk of another heart attack.
• Calcium channel blockers (only those that slow the heart rate) – verapamil and its derivatives (Isoptin, Staveran, Diltiazemretard, Diacordin).
• Metabolic drugs whose task is to protect heart cells – trimetazidine (Preductal MR, Trimetaratio, Metazidine) – improve the use of energy by heart cells in the conditions of ischemia and hypoxia.
2. Anticoagulants – their task is to prevent the formation of blood clots in the coronary vessels or to dissolve them, if they have already formed.
• Heparyna (Calciparine, Heparinum).
• Streptokinase (Streptokinase) given within 6 hours of the onset of an infarction dissolves the clot that forms at the site of the rupture of the plaque.
• Anti-platelet drugs (inhibit the formation of a blood clot in the lumen of the coronary artery and thus prevent a heart attack):
– acetylsalicylic acid (Acard, Acesan, Polocard) used at a dose of 75-150 mg per day;
– klopidogrel (Plavix, Iscover).
3. Drugs lowering blood cholesterol levels – reduce the level of LDL cholesterol and also reduce the size of the atherosclerotic plaque, causing widening of the coronary vessel.
• Statues:
– atorwastyna (Tulip, Sortis, Atoris);
– pravastyna (Elisor, Pravachol);
– simwastatyna (Simvacor, Vasilip, Zocor);
– lowastatyna (Lovasterol, Mevacor).
Text. Rafał Jabłoński, M.Sc. pharmacy
Source: Let’s live longer