An attack of coronary heart disease. Ischemic heart disease (CHD)

Pain in the chest can be manifested by diseases of the heart, respiratory organs, gastrointestinal tract, spine, mediastinum, central nervous system. All internal organs a person is innervated by the autonomic nervous system, the trunks of which depart from spinal cord. When approaching chest nerve trunk gives offshoots to individual bodies. That is why sometimes stomach pains can feel like pains in the heart - they are simply transmitted to common trunk, and from it to another organ. Moreover, roots spinal nerves contain sensory nerves that innervate musculoskeletal system. The fibers of these nerves are intertwined with the fibers of the nerves of the autonomic nervous system, and therefore completely healthy heart may respond with pain various diseases spine.

Finally, chest pain may depend on the state of the central nervous system: constant stress and high neuropsychic stresses, a malfunction occurs in her work - neurosis, which can manifest itself, including pain in the chest.

Some chest pains are unpleasant, but not life-threatening, but there are chest pains that need to be removed immediately - a person's life depends on it. In order to understand how dangerous chest pain is, you need to see a doctor.

Chest pain caused by obstruction of the coronary (heart) arteries

The coronary arteries carry blood to the heart muscle (myocardium), which works non-stop throughout life. The myocardium cannot even do for a few seconds without a new portion of oxygen and nutrients delivered with blood, its cells immediately begin to suffer from this. If the blood supply is interrupted for several minutes, then myocardial cells begin to die. The larger the coronary artery suddenly becomes obstructed, the larger the area of ​​the myocardium is affected.

Spasms (compression) of the coronary arteries usually occur against the background of coronary disease heart disease (IHD), the cause of which is a partial blockage blood vessels atherosclerotic plaques and narrowing of their lumen. Therefore, even a slight spasm can block the access of blood to the myocardium.

A person feels such changes in the form of acute penetrating pain behind the sternum, which can radiate to left shoulder blade and in left hand, down to the little finger. The pain can be so severe that the patient tries not to breathe - respiratory movements intensify pain. At severe attacks the patient turns pale, or, conversely, blushes, his blood pressure, as a rule, rises.

Such chest pains can be of short duration and occur only during physical or mental stress(angina pectoris), and can occur on their own, even during sleep (angina at rest). Angina attacks are difficult to get used to, so they are often accompanied by panic and fear of death, which further increases the spasm coronary vessels. Therefore, it is so important to clearly know what to do during an attack and have everything you need at hand. The attack ends as suddenly as it began, after which the patient feels a complete loss of strength.

The peculiarity of these pains is that in no case should a person endure them - they must be removed immediately. You can’t do without consulting a doctor here - he will prescribe both the course of the main treatment and the medicine that needs to be taken when pain occurs (the patient should always have it with him). Usually in emergency cases take a nitroglycerin tablet under the tongue, which relieves pain within 1 to 2 minutes. If after 2 minutes the pain has not disappeared, then the pill is taken again, and if this does not help, then you should immediately call an ambulance.

What can happen if you endure chest pain? The cells of the area of ​​the myocardium, which is supplied by the affected artery, begin to die (myocardial infarction) - the pain intensifies, becomes unbearable, a person often comes pain shock With sharp decline blood pressure and acute heart failure (the heart muscle cannot cope with its work). It is possible to help such a patient only in a hospital setting.

A sign of the transition of an angina attack to myocardial infarction is the increase in pain and the lack of effect from the use of nitroglycerin. The pain at the same time has a pressing, squeezing, burning character, begins behind the sternum, and then can spread to the entire chest and abdomen. The pain can be continuous or in the form of repeated attacks one after another, increasing in intensity and duration. There are cases when the pain in the chest is not very strong, and then patients often suffer myocardial infarction on their legs, which can cause an instant disruption of the heart and death of the patient.

There are also atypical (atypical) forms of myocardial infarction, when the pain begins, for example, in the anterior or posterior surface of the neck, mandible, left hand, left little finger, left shoulder blade area, etc. Most often, such forms are found in the elderly and are accompanied by weakness, pallor, cyanosis of the lips and fingertips, heart rhythm disturbances, and a drop in blood pressure.

Another atypical form myocardial infarction is abdominal form when the patient feels pain not in the region of the heart, but in the abdomen, usually in its upper part, or in the region of the right hypochondrium. These pains are often accompanied by nausea, vomiting, liquid stool, bloating. The condition is sometimes very similar to intestinal obstruction.

In this topic, we will consider what ischemic attacks are. Ischemic attacks occur acutely and are characterized by unstable focal and cerebral symptoms, their duration does not exceed 24 hours. Ischemia, insufficiency of blood flow or, conversely, hyperemia, cerebral edema, small focal hemorrhages can be their basis.

Ischemic attacks causes

etiological factor transient transient ischemic attacks is atherosclerosis, hypertension and their combination. Much less often, this pathology is caused by vasculitis (collagenous, syphilitic, rheumatic), thromboangiitis, blood diseases, diabetes.

In the pathogenesis of this pathology, the leading place is occupied by microembolism emanating from atheromatous masses of ulcerative plaques located along the blood flow in main vessels neck. Emboli of this origin consist of cholesterol crystals, as well as platelet conglomerates. Blood platelets secrete adenosine diphosphoric acid - an intense aggregant, at the moment when they come into contact with a rough area vascular wall in the area of ​​ulceration of an atheromatous plaque. Under the influence of this acid, platelet aggregation occurs with the formation of emboli, which are carried away by the blood flow to the brain, and, reaching small-caliber vessels, the emboli get stuck in them. As a result of irritation of the vascular endothelium by a foreign substrate, a spasm of the surrounding vessels occurs, followed by perivascular edema. medulla, which is accompanied by focal symptoms. The so-called platelet emboli are rather friable, they easily undergo lysis, or decay, the edema caused by them is eliminated, and clinical symptoms undergo reverse development. Microemboli may also be of cardiogenic origin. Development transient disorders cerebral circulation with focal symptoms may be due to the mechanism of vascular brain failure. It occurs when, in the presence of an atherosclerotically altered vessel or extravascular compression with phenomena of partial occlusion, accompanied by chronic insufficiency blood supply to the brain, any extracerebral factor (weakening of cardiac activity, massive blood loss, lowering blood pressure of any origin) causes an additional decrease in blood supply to the brain. As a result of insufficiency of blood supply in the corresponding parts of the brain, symptoms of ischemia develop, manifested by certain focal symptoms. Restoration of blood flow due to increased cardiac activity or other factors leads to the elimination of the symptoms that have arisen. For example, the cause of the disorders described above in vestibulobasilar insufficiency is often cervical osteochondrosis, in which the posterior osteophytes in the region of the uncovertebral joints compress vertebral artery. With simultaneous insufficiencies carotid arteries a sharp tilting of the head can cause a short-term fainting with a fall muscle tone in the legs, the so-called drop attack state. The clinical picture of vestibulo-basilar insufficiency occurs approximately 2 times more often than insufficiency in the carotid pool. This is explained by the fact that in brain stem, a much smaller volume than in the cerebral hemispheres, there are formations, the damage of which gives clear symptoms, while significant parts of the hemispheres are clinically silent. Transient disorders of cerebral circulation can also occur as a result of changes physical and chemical properties blood - its increased viscosity, the development of hypoxia, lowering sugar levels.

Ischemic attacks symptoms

Transient disorders of cerebral circulation of the ischemic type usually occur against the background of atherosclerosis and are manifested by focal symptoms, the nature of which is determined by the part of the brain in which the circulatory decompensation occurred. With circulatory disorders in the basin of the carotid arteries, a feeling of numbness is most common upper lip, one half of the face along the ulnar edge of the arm, less often in the leg. Short-term mono- or hemiparesis, aphatic symptoms may also develop. With the localization of disorders in the region of the vertebrobasilar system, patients complain of bouts of dizziness, sometimes with nausea and varying degrees incoordination of movements (from the easiest to the inability to walk), as well as on occipital pain, noise in the ear, hearing loss, light irritation in one half of the field of view, up to short-term hemianopia. A number of psychotic disorders can also be observed, for example, different kinds impairment of consciousness, a kind of violation of voluntary activity in the form of inhibition of action, emotional disorders, hallucinatory syndromes and amnestic syndrome. Cerebral symptoms in these cases are either absent or are expressed weakly, in a relatively rare cases examination may reveal nystagmus. Transient disorders of cerebral circulation that occur against the background of hypertension, in to a large extent different from those described above. They are primarily accompanied by cerebral symptoms - a sharp headache, nausea, vomiting, non-systemic dizziness, sometimes psychomotor agitation, epileptic seizures. clinical picture complement the expressed autonomic symptoms- sweating, hyperemia of the face. There may be focal transient symptoms of brain damage. So, for several minutes, the patient experiences disorientation in the environment, a twilight state of consciousness, fainting, difficulty in speech, paresis, hemianesthesia or hemianopsia as symptoms of a short-term cerebrovascular accident or a hypertensive cerebral crisis. These phenomena can be kept for several hours and days. Apparently, at the heart of a significant part of the transient brain disorders lies no blockage cerebral vessel, and its spasm with subsequent phenomena of stasis. A slight spasmolytic vasoconstriction is enough to cause edema and temporary anemia in this part of the brain. All these phenomena can quickly and without a trace pass, and the impaired brain function can soon be restored. More persistent paresis or other focal symptoms are based on changes in the form of small foci of softening or small punctate hemorrhages around the precapillaries and arterioles. As a result of a cerebral vascular crisis in those suffering from hypertension may also develop acute edema brain. It begins with a sharp headache, which is accompanied by nausea and vomiting, sometimes dizziness and a feeling of a veil before the eyes. Soon comes the stupor, lethargy, soporous state, sometimes with a period psychomotor agitation or epileptic fit. Symptoms focal lesion there is no brain, but neck stiffness, Kernig's symptom, increased pressure are clearly detected cerebrospinal fluid, increased protein content in it with normal cytosis. This syndrome, called acute hypertensive encephalopathy, is composed of cerebral and meningeal symptoms, accompanied by an increase in blood pressure and an increase in heart rate. In the fundus, there is sclerosis of the retinal vessels and the "crossover phenomenon", or the Gunn-Salus symptom, which is quite characteristic of arterial hypertension. After 4-5 days, usually all symptoms disappear, but in some cases, increasing, they can lead to death. The described states can be repeated.

Ischemic attacks diagnosis

Diagnosis can often be difficult. In most cases, certain disorders occur in the patient for the first time, and it is not always possible to quickly establish what their genesis is. Significant difficulties arise in the diagnosis of syncope. A clear boundary between syncope (fainting) and clinical manifestations violations cerebral blood supply does not exist. However, the young age of patients, the instability of vegetative parameters make it possible to diagnose with a certain degree of certainty fainting rather than transient cerebrovascular accidents. Violation of blood circulation in the brainstem in the region of the vestibular nuclei may be accompanied by the occurrence of attacks of systemic dizziness, which should be distinguished from the defeat of the labyrinth. A thorough otoneurological examination and anamnesis data can help in making the diagnosis. Detection of additional neurological symptoms in the form of hearing, balance, sensory impairment and will indicate the vascular genesis of the lesion. On the other hand, identifying indications of poor tolerance riding in transport, riding on a swing suggest the presence of congenital vestibulopathy. Some difficulties may arise when differential diagnosis transient disorders of cerebral circulation with the first manifestations multiple sclerosis. The young age of patients, the absent-mindedness of symptoms, which do not allow attributing the emerging symptoms to any one vascular pool, allow us to come to the correct conclusion about multiple sclerosis.