IBS stable angina pectoris code for ICD 10. IHD

Ischemic heart disease (abbreviated as IHD, disease code according to ICD-10-I20-I25) is a complete or partial violation of the blood supply to the heart muscle. It occurs due to the pathology of the coronary arteries. IHD, as well as ischemic stroke (ICD-10 code - I60-I69) account for approximately 90% of all diseases of the heart, circulatory system, and brain.

Reasons for the development of coronary artery disease

Classification and nomenclature

Angina pectoris, known to many as "angina pectoris". It is documented as - I20.
Acute myocardial infarction - I21.
Recurrent myocardial infarction - I22. This pathology is diagnosed if 28 calendar days have not passed since the moment of the attack (heart attack).
Various complications of acute infarction - I23.
Other forms of coronary artery disease have been assigned the code I24. This category previously included angina pectoris (it was listed as a separate item, has the ICD-10 code - I20) and neonatal ischemia (transferred to cardiovascular pathology, perinatal period, code - P29).
I25 - chronic course of coronary artery disease.

Almost all points have clarifications about the duration of the disease from the onset of an attack to hospitalization or death of the patient. Doctors, in addition to the code designation of the disease, must indicate this time period. The date of onset of the disease is established from the words of the patient or his relatives.

List of diseases with ICD code 10

At the moment, the ICD codes of the tenth revision are the most relevant and are widely used by doctors around the world. For coding diseases, an alphanumeric system is used, which makes the coding structure as convenient and understandable as possible.

The ICD codes are known in all countries and are essential not only for classification but also for statistics on morbidity or mortality in health services.

angina pectoris

Particular attention, perhaps, deserves angina pectoris, colloquially known as "angina pectoris". 10-20% of people over the age of 65 experience this disease.

As noted above, previously this disease was considered one of the forms of cardiac ischemia, but now it has a separate code. Paragraph I20, in addition, includes:

unstable angina, where angina pectoris actually belongs, ICD-10 code - I20.0;
angina pectoris with spasm, which had documented evidence - I20.1;
other forms of angina - I20.8;
angina pectoris, unspecified - I2.9.

Causes of these diseases

Risk factors will be the same for almost all diseases of the cardiovascular system. The main factors are:

male gender;
elderly age;
obesity;
heredity;
taking hormonal contraceptives;
smoking;
alcoholism;
hypodynamia;
elevated blood pressure for a long time;
diabetes;
constant stress;
overwork;
excessive physical activity;
irrational nutrition;
lack of vitamins and minerals.

An important cause of coronary artery disease is the ratio of blood types of cholesterol - high molecular weight, low molecular weight and very low molecular weight lipoproteins. It is because of the imbalance of cholesterol that atherosclerosis occurs, which further leads to coronary artery disease (ICD-10 - I20-I25) or ischemic stroke (ICD-10 - I60-I69). Often these conditions can be accompanied by a heart attack - the necrosis of part or all of an organ due to a lack of blood supply.

pharmachologic effect
Pharmacokinetics
Indications for use
Dosage
Side effects
Contraindications
Pregnancy and breastfeeding
drug interaction
Overdose
Release form
Terms and conditions of storage
Compound

Application of Betaloc ZOK tablets
Reviews
Frequently Asked Questions and Answers
Prices in online pharmacies
conclusions

Betaloc is a medicine for hypertension, coronary heart disease (angina), and heart failure. It is also prescribed for support after a heart attack and the prevention of migraine attacks (headache). According to the classification, it belongs to the second generation beta-blockers. Regular Betaloc tablets should be taken 2-4 times a day, as directed by your doctor. Today they are considered obsolete. Betaloc ZOK is a sustained release drug that can be taken once a day. It is a popular medicine in Russian-speaking countries. It is efficient and affordable. Its indications for use, contraindications, dosage, side effects, etc. are described below.

Betaloc ZOK: instructions for use

pharmachologic effect	Selective beta-1-blocker without internal sympathomimetic activity. Protects the heart from the stimulating effect of catecholamine hormones. As a result, blood pressure decreases at rest and during exercise for a period of 24 hours or longer. With heart failure, the survival of patients improves, the frequency of hospitalizations decreases. Taking Betaloc ZOK tablets ensures a stable concentration of the active substance in the blood plasma. This metoprolol succinate compares favorably with obsolete tablets, the active ingredient of which is metoprolol tartrate.
Pharmacokinetics	After taking the Betaloc ZOK tablet (metoprolol sustained release dosage form), the therapeutic effect lasts more than 24 hours. At the same time, a stable release rate of the active substance (metoprolol) is observed for 20 hours. It undergoes oxidative metabolism in the liver. About 5% of the taken dose of the drug is excreted in the urine unchanged, the rest - in the form of metabolic products.
Indications for use	arterial hypertension; angina pectoris; stable symptomatic chronic heart failure with impaired systolic function of the left ventricle of the heart (as adjuvant therapy to the main treatment); to reduce mortality and the frequency of re-infarction after the acute phase of myocardial infarction; cardiac arrhythmias, including supraventricular tachycardia, a decrease in the frequency of ventricular contractions during atrial fibrillation and ventricular extrasystoles; functional disorders of cardiac activity, accompanied by tachycardia; prevention of migraine attacks.

Watch also a video about the treatment of coronary artery disease and angina pectoris

Learn how to take control of heart failure

Dosage	Features of the dosage of the drug Betaloc ZOK for hypertension, coronary heart disease (angina pectoris), heart failure, after a heart attack - read here. Tablets can be divided in half, but should not be chewed or crushed. They should be swallowed with liquid. Can be taken on an empty stomach or after meals - this does not affect the effect.
Side effects	If you took a dose more than necessary, or a combination with other drugs for hypertension gave a powerful joint effect, then arterial hypotension may occur. In rare cases, the pressure is so low that the patient faints. Bradycardia is also possible - slowing the heart rate to 45-55 beats per minute. While taking Betaloc ZOK tablets, patients sometimes complain of increased fatigue, dizziness, pain in the abdomen, nausea, constipation, or vice versa, diarrhea. Exercise tolerance may worsen, there may be shortness of breath. Drowsiness or insomnia, dryness of the oral mucosa, dry eyes, skin rash are rarely observed. The weakening of male potency while taking metoprolol succinate is caused by psychological reasons, and not by the action of the drug. If more severe side effects occur, contact your doctor immediately.
Contraindications	AV block II and III degree; chronic heart failure in the stage of decompensation; clinically significant sinus bradycardia; sick sinus syndrome; cardiogenic shock; severe disorders of peripheral arterial circulation (threat of gangrene); arterial hypotension; patients with suspected acute myocardial infarction with a PQ interval of more than 0.24; if the pulse rate is less than 45 bpm or if the systolic "upper" blood pressure is below 100 mm Hg; intravenous administration of slow calcium channel blockers (like verapamil); children and adolescents under 18 years of age (efficacy and safety have not been established); hypersensitivity (allergy) to other beta-blockers; allergy to the auxiliary components of the tablet. Use the drug with caution in case of AV blockade of the 1st degree, Prinzmetal's angina, bronchial asthma, chronic obstructive pulmonary disease, diabetes mellitus, severe renal failure, metabolic acidosis, together with cardiac glycosides.
Pregnancy and breastfeeding	Like other beta-blockers, Betaloc ZOK should not be administered during pregnancy and during breastfeeding, unless the expected benefit to the mother outweighs the potential risk to the fetus and/or child. Possible negative side effects are bradycardia (low heart rate) in the fetus, newborn or breastfeeding children. The active substance (metoprolol) is excreted in breast milk in small amounts.
drug interaction	Non-steroidal anti-inflammatory drugs, in particular, diclofenac, weaken the antihypertensive effect of metoprolol and other beta-blockers. When Betaloc was combined with diltiazem, cases of severe bradycardia were observed. Tell your doctor about all other medicines you are taking and discuss possible interactions with them.
Overdose	Overdose symptoms - low pulse, AV blockade of I-III degree, asystole, marked decrease in blood pressure, other symptoms of the cardiovascular system. There may also be suppression of pulmonary function, impaired and loss of consciousness, tremor, convulsions, increased sweating, nausea, vomiting, jumps in blood glucose. Treatment - in the first place, taking activated charcoal and gastric lavage. Further - in the hospital in the intensive care unit. Cardiac arrest due to an overdose may require resuscitation for several hours.
Release form	Tablets with delayed release, coated white or almost white, oval, biconvex, possibly with a notch and engraving. Sold in plastic bottles or cardboard packs.
Terms and conditions of storage	The drug should be stored out of the reach of children at a temperature not exceeding 30 ° C. Shelf life - 3 years.
Compound	The active substance is metoprolol succinate. Excipients - ethylcellulose, hyprolose, hypromellose, microcrystalline cellulose, paraffin, macrogol, silicon dioxide, sodium stearyl fumarate, titanium dioxide.

Prices for Betaloc Zoc produced by AstraZeneca/ZiO-Zdorovye

Prices for an analogue of the drug Betaloc Zok - tablets Egilok C

Note. The manufacturer of the drug Egilok C is Egis, Hungary.

Application of Betaloc ZOK tablets

Betaloc ZOK is a medicine that belongs to the group of beta-blockers. It lowers the heart rate and reduces the amount of blood the heart pumps with each beat. Mechanism of action - the drug blocks adrenaline and other hormones that make the heart work intensively. Due to this, the load on the heart decreases, the likelihood of a first and repeated heart attack decreases. Betaloc also normalizes the rhythm if the heart beats too often or not regularly.

When it is most often prescribed:

arterial hypertension;
chest pain - long-term treatment, but not for quick relief;
heart failure - in certain cases, if there are no contraindications.

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In what cases this drug should not be used:

you have already had an allergy to Betaloc, other beta-blockers or tablet excipients;
bradycardia - too low heart rate;
systolic "upper" blood pressure below 100 mm Hg. Art.;
there are still other cardiological contraindications.

Do not prescribe Betaloc ZOK or other beta-blockers on your own!

Do not suddenly stop taking this medicine without talking to your doctor. If the doctor decides that you should no longer take Betaloc ZOK, you need to reduce the dose gradually, and not stop immediately. Otherwise, your blood pressure may rise.

Important! Betalok - what is the difference between different types of tablets

Currently, only Betaloc ZOK is recommended for use, which is enough to take once a day. Its effectiveness has been proven in hypertension, heart failure, and for the prevention of a heart attack. It even inhibits the development of atherosclerosis. Conventional Betaloc tablets, in which the active ingredient metoprolol tartrate, are inferior in effectiveness to other beta-blockers. They are also worse tolerated by patients. They should not be used, even though the price is low.

The drug Betaloc ZOK (metoprolol succinate) is recommended for use. Regular Betaloc tablets (metoprolol tartrate) - no.

Betaloc may cause drowsiness, dizziness, or lightheadedness. In the first days of taking this medicine, it is not advisable to drive a car or perform other dangerous work. Wait a few days for your body to adjust. If you experience the side effects listed above, immediately sit down to rest. Unpleasant sensations can be aggravated by alcohol intake, overheating, physical exertion, and a cold with a high temperature. If you take Betaloc together with other medicines for hypertension, then hypotension may occur - blood pressure will drop excessively.

Disease

Dosage

arterial hypertension	50-100 mg 1 time per day. Usually prescribed in combination with other drugs for pressure, most often with diuretics (indapamide, hydrochlorothiazide), as well as calcium channel blockers - dihydropyridine derivatives (amlodipine, felodipine).
angina pectoris	100-200 mg 1 time per day. Often prescribed in combination with another antianginal drug.
Stable chronic heart failure functional class II	The initial dose is 25 mg per day. After two weeks, it can be increased to 50 mg per day and further, if necessary, double every 2 weeks. The maintenance dose for long-term treatment is 200 mg per day.
Stable chronic heart failure III and IV functional class	The initial dose is 12.5 mg per day. Then it is selected individually. It is desirable for the patient to be under the supervision of a doctor, because. under the influence of the drug in some patients, the symptoms of heart failure may worsen. With good tolerance, the dose of Betaloc ZOK is doubled every 2 weeks until a maximum dose of 200 mg per day is reached.
Heart rhythm disorders	100-200 mg per day
Supportive care after myocardial infarction	200 mg per day
Tachycardia	100-200 mg per day
Prevention of migraine (headache) attacks	100-200 mg per day

If the pressure drops too much or the pulse drops below 45-55 beats per minute, the doses of Betaloc LOK or concomitant medications are reduced. However, in most patients, the body adapts over time, and they tolerate average therapeutic doses well. If hypotension develops at the beginning of treatment, then the dosage of the drug is reduced, and over time they try to increase it again. For patients with kidney disease, as well as for the elderly, there is no need to adjust the dose of the drug. In working with them, the doctor can adhere to the recommendations indicated in the table above. In severe liver disease, the dose may need to be reduced.

Betaloc ZOK should be taken every day, without gaps, preferably at the same time. Take the pill even on days when you feel fine. It is advisable to have a home blood pressure monitor. Check your blood pressure regularly - every day or every 3-7 days. This must be done following the rules. For more information, read the article "Blood pressure measurement: a step-by-step technique".

Reviews

Judging by the reviews, Betaloc ZOK helps well with hypertension and cardiac arrhythmias, and rarely causes side effects. It also has a very affordable price compared to newer beta-blockers. Therefore, for more than 10 years, it has retained its popularity among doctors and patients.

Tablets are only part of a complex of measures for the treatment of hypertension, the prevention of heart attack and stroke. If you do not pay attention to the transition to a healthy lifestyle, then the condition of your vessels will continue to deteriorate. After a few years, even the most powerful drugs won't be able to keep your blood pressure under control. How it will end is well known to everyone ... Quitting smoking is far from the only thing that needs to be done. Take care of your diet, learn to avoid conflicts at work and in the family. You also need regular physical activity, preferably outdoors.

The effect of drugs on each person is individual. Concor or cheaper bisoprolol tablets help some better, Betaloc Lok helps others. In any case, the #1 cure for arrhythmia and hypertension is magnesium. Because the main cause of these diseases is magnesium deficiency in the body. Try taking magnesium tablets with vitamin B6. They will likely help you reduce your beta-blocker doses or even stop taking them altogether.

The cardiologist is simply too lazy to deal with you. But increased upper pressure - this may be a signal of problems with the kidneys. You need to study the article “Causes of hypertension and how to eliminate them”, and then be examined, as it is written there. In particular, take blood and urine tests that check the functioning of the kidneys.

Read more "live" reviews of patients taking Betaloc ZOK here.

Frequently Asked Questions and Answers

Betaloc ZOK was prescribed for arrhythmia. It seems to help, but it's still not calm. The mother died suddenly of a heart attack at the age of 47. What else can you do besides taking the pills?

Heart problems arise from a lack of nutrients that it consumes for its work. First of all, it is magnesium. Try taking the supplements listed below along with chemical medications. With a high probability, after a while you will be able to refuse to take a beta-blocker, remaining only on natural remedies.

Proven effective and cost-effective blood pressure supplements:

Magnesium + Vitamin B6 from Source Naturals;
Taurine from Jarrow Formulas;
Fish oil from Now Foods.

Read more about the technique in the article "Treatment of hypertension without drugs". How to order hypertension supplements from the USA - download instructions. Get your blood pressure back to normal without the harmful side effects that Noliprel and other "chemical" pills cause. Improve heart function. Become calmer, get rid of anxiety, sleep like a baby at night. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, to the envy of your peers.

Should I take Betaloc tablets for panic attacks?

If you are already taking this medicine or your doctor has prescribed it for panic attacks, then yes. Voluntarily - no. Either way, try motherwort or other mild herbal sedatives. Also magnesium with vitamin B6 and psychotherapy. If you have a fear of public speaking, good coaching will help. Clinging to beta-blockers is the last thing.

I was prescribed bisoprolol, but it does not help well with palpitations. At the slightest load, the pulse quickens to 100-120 beats per minute. Is it worth switching from bisoprolol to Betaloc?

It is unlikely that switching from one beta-blocker to another will help. Although it's all individual. It will only be possible to predict in advance when genetic research becomes widely available. Until then, doctors and patients select drugs only by trial and error. In any case, try to strengthen the heart with magnesium-B6 and coenzyme Q10 in addition to "chemical" drugs. It is 100% harmless and is very effective for most patients.

The cardiologist said to take Betaloc, biprol or concor. Which one to choose - decide, they say, for yourself. Which of these drugs is more sparing for blood vessels?

The harsh everyday life of domestic medicine ... Let's say you somehow choose a medicine. Do you also prescribe your own dosage? It's practically a piece of art. Too low a dosage - will not help or assist. Too high - there will be hypotension ... Your contact with this doctor did not work out - change him to another. I will add that biprol and concor are the same bisoprolol, but from different manufacturers. Therefore, the price of medicines in the pharmacy is different.

Disturbed by frequent aching pains in the region of the heart. I did an ECG - the doctor said it was normal, but Betaloc ZOK was prescribed anyway. I'm afraid of a heart attack. What else can be done to reduce the risk?

If you are already 40 years old, then you are doing the right thing by worrying. A heart attack can strike suddenly - and hello ... What to do for prevention:

In addition to medications, take the natural remedies described here. They are important for strengthening the heart, even if there is no hypertension, and even more so if the pressure is elevated.
If you are overweight, then switch to the low-carb Atkins diet.
Once every 3 months, take blood tests for cholesterol, triglycerides, C-reactive protein. The last analysis on the list is the most important.
Ideal for relaxed jogging with pleasure.

conclusions

Metoprolol is a second generation beta blocker that has been known since the 1980s. However, it is still often prescribed to patients with hypertension and cardiovascular disease. Betaloc ZOK is a tablet whose active ingredient is metoprolol succinate. Pharmacies also sell regular Betaloc tablets, without ZOK, which contain metoprolol tartrate.

Currently, only Betaloc ZOK is recommended. It is enough to take one tablet per day, it is really effective for hypertension, coronary heart disease and some types of heart failure. Betalok tablets, the active ingredient of which is metoprolol tartrate, should be taken 2-4 times a day. They are considered obsolete because they are inferior in effectiveness to other beta-blockers.

The main thing that you learned from the article is how Betaloc ZOK and ordinary Betaloc differ from each other. Tablets that contain metoprolol tartrate are recommended to be changed to a more modern drug. Betaloc ZOK cannot be called a leader among beta-blockers. Competing drugs - bisoprolol, carvedilol, nebivolol - may be superior in effectiveness. However, physicians are still actively prescribing metoprolol succinate to their patients. Because it's easy to take, more or less helpful, it's attractively priced, and it's well-researched.

Beta blockers: general information
Diuretic drugs
Hypertension medications for the elderly

Heart attacks: causes, signs and types, first aid and withdrawal

The name "heart attack" can hide a wide range of pathological conditions caused by diseases of the heart and blood vessels, which periodically or systematically remind themselves of themselves in this way, even despite the fact that the patient is constantly taking treatment. These are angina attacks, life-threatening rhythm disturbances (arrhythmias), hypertensive crisis with arterial hypertension, etc. Sometimes a heart attack occurs in people who, in general, are not very sick, but not very healthy either, whose nervous system is especially sensitive to any impact. This group includes patients diagnosed with vegetative-vascular dystonia with its characteristic panic attacks and adjustment disorders.

Attacks of tachycardia, pain in the heart, and even disruption of the rhythm can be the result of psycho-emotional and physical stress in healthy people.

Heart attack, but the reasons are different

Usually people call a heart attack everything that is accompanied by acute intense prolonged (20-30 minutes or more) pain in the heart and evaluate it with one word “bad”, which includes other symptoms (palpitations, arrhythmias, shortness of breath, cyanosis).

The reason for them may be:

Myocardial infarction, which is usually preceded by coronary artery disease, unstable angina;
Pulmonary embolism (PE), often developing as a result of a sedentary lifestyle in old age, thrombophlebitis of the venous vessels of the legs;
Atrial fibrillation;
Dissecting aortic aneurysm that occurs at any age against the background of arterial hypertension;
Heart failure resulting from a weakening of the contractility of the heart, which could be caused by various diseases of the cardiovascular system (arterial hypertension, atherosclerotic cardiosclerosis, aortic defects, etc.)

All these diseases can complement each other, exist in isolation, but each of them can be asymptomatic or atypical, which is why the concept of “heart attack” is so widely used and it’s good, because a person who does not have a medical education will be able to explain the essence of the problem in a nutshell.

You don't have to be a doctor to distinguish a life-threatening attack from a condition that requires the use of sedatives, you just need to know the symptoms of a heart attack well. Life is such that any of us can find ourselves in a situation where another person needs help, and conscience will not allow to pass by, because myocardial infarction at the beginning of its development (until a diagnosis is made) is also called a heart attack.

Real heart attack

Pain during a heart attack, which is based on the death of myocardial cells resulting from the closure of a vessel by a thrombus, or a sharp spasm of arterial vessels, leading to a violation of the blood supply to the heart muscle (ischemia), is quite long (up to half an hour). In addition, they are particularly intense, and arresting an attack with nitroglycerin or other drugs through the mouth, as a rule, does not give an effect, does not alleviate suffering by changing the position of the body, access to fresh air, ammonia and rest.

In addition to pain, the course of a heart attack, depending on its cause, may be accompanied or expressed by other symptoms:

Feelings of fear and anxiety (panic attack), forcing the patient to take a motionless frozen posture with a reflection of horror in the eyes.
Strong palpitations and / or heart rhythm disturbances.
Unpleasant sensations behind the sternum, in the arm, in the back and neck.
Feeling short of breath, shortness of breath, general weakness.
Vertigo, nausea, heaviness in the epigastrium, as if food were stuck, sometimes with heartburn and/or vomiting.
Sweating, pallor or cyanosis (cyanosis) of the skin, possibly a decrease in the temperature of the extremities.

It is useful to focus on such a heart attack, which is called a "silent heart attack", which proceeds almost imperceptibly, without any symptoms and can happen to each of us, but patients suffering from diabetes are more prone to such MI.

What to do in case of a heart attack?

It is better for the patient himself to do nothing, it is advisable to call someone so that another person provides first aid for a heart attack.

In such situations, you need to keep in mind the likelihood of myocardial infarction, therefore, tactics should be appropriate:

Measurement of pulse (number of beats, rhythm, filling, tension) and blood pressure (in the presence of a tonometer);
Nitroglycerin under the tongue;
An urgent call on 103, starting with the words "heart attack", because with a heart attack, and other similar conditions, every minute counts.

Of course, heart problems can catch a person in any place where there is no apparatus for measuring blood pressure and nitroglycerin, so the very first aid for a heart attack should be to let the emergency medical workers know about the patient as soon as possible.

Call 103 - heart attack

A person who calls an ambulance about a heart attack cannot be accused of going out of his way and making a diagnosis. What kind of attack - the doctors will figure it out, and the spoken words have a magical effect: the station dispatcher knows that a catastrophe has occurred, the patient's serious condition is urgent, therefore, a cardio team is required. Sometimes it is these words that save lives, so it would be appropriate to briefly touch on some emergency cases that are difficult to diagnose in the first minutes.

A person’s life is threatened by acute heart failure: an attack of shortness of breath, proceeding as cardiac asthma, can quickly transform into pulmonary edema or develop into cardiogenic shock in the case of extensive myocardial infarction. An attack of tachycardia with a gallop rhythm, as a rule, complements the phenomena of suffocation. Patients suffering from chronic heart failure know what palpitations and painful sensations of acute lack of air are, accompanied by anxiety, sweating, cyanosis, they must constantly keep all the necessary medicines nearby, but, meanwhile, they are always very frightened, because "grab » in most cases, these attacks are at night. Needless to say, for people who are nearby, these phenomena will have the significance of a heart attack, which requires an immediate call to an ambulance.

Video: help with an attack - myocardial infarction

An attack of palpitations, unusual in frequency and rhythm, occurring against the background of some kind of cardiac pathology, often has to be attributed to heart attacks and life-threatening conditions. Patients who are often visited by attacks of arrhythmia also take heaps of drugs, they know when and what they themselves try not to take to the extreme or to remove an arrhythmia attack on their own (taking antiarrhythmic drugs, β-blockers). But ... anything happens, and when the situation gets out of control of the patient, he calls an "ambulance", which deals with the relief of an attack at the patient's home.

What is done for arrhythmias?

There are various types of arrhythmias, dangerous and not very dangerous, for example, if not everyone, then many have heard about such a rhythm disorder as atrial fibrillation. For the first time, an attack of this kind of arrhythmia frightens the patient, he feels that something terrible is happening to his heart, so the best solution would be to urgently seek medical help. In addition, this condition usually requires hospitalization. Of course, by calling 103, a person will report that he is having a heart attack.

An ambulance doctor can relieve an arrhythmia attack with the help of antiarrhythmic drugs, it is better for the patient and his relatives not to do this. An individual approach is needed here, drugs that restore the rhythm have their own indications and contraindications, and there is no single algorithm for stopping an attack of all arrhythmias. Usually, in such cases, verapamil is used, which is administered intravenously, and along the way, the issue of hospitalization in a specialized hospital is decided.

As for the attack of tachycardia, the patient usually copes with it himself with the help of β-blockers, for example. However, such self-activity is possible if the cause is known, the diagnosis is established and treatment is prescribed, otherwise, you need to consult a doctor.

Clue in the nature of pain

Sometimes it is really very difficult to distinguish between heart pain, and, accordingly, a heart attack from pain of another origin, including cardiac, but there are still differences:

gender, age, atherosclerosis

Probably, angina pectoris is one of the most frequent "affairs of the heart", more than half of people with problems of the cardiovascular system suffer from this disease. Atherosclerosis of the arterial vessels in general, and of the coronary arteries in particular, is the main cause of the development of angina pectoris, the clinical manifestation of which can be considered a heart attack.

Heart failure in patients with atherosclerosis is formed when there is a disproportion between the needs of the heart muscle in oxygen and the possibilities of blood circulation in the arterial vessels of the heart. This is especially pronounced if a person receives additional physical activity, and the heart has to work hard to provide the tissues of the body with the necessary substances. The situation will be complicated by the insufficiency of detours with which the body could compensate for the violation of blood flow. In addition, a negative effect in this case is given by factors that negatively affect the arteries of the heart:

In the systole phase (myocardial contraction), the loaded heart muscle compresses the small arterial vessels, making it difficult for blood flow in them.
Increased end-diastolic volume, increased pressure in the LV (left ventricle), reduced myocardial contractility leads to increased pressure inside the heart muscle.

Symptoms of a heart attack stem from the formed coronary insufficiency. Due to the imbalance between the transport of oxygen with the blood and the need of the heart muscle for it, the myocardium begins to experience oxygen starvation and, under conditions of hypoxia, responds with ischemia. This should be remembered by people at risk for myocardial infarction (gender, age, weight, excessive exercise, bad habits, hypercholesterolemia, atherosclerosis).

Attack with unchanged vessels

It should be noted that signs of an angina attack are not excluded in people with unchanged heart vessels.

"Seize the heart" can in other cases:

Increased production of physiologically active substances (catecholamines) and their accumulation in the myocardium during psycho-emotional and / or physical stress causes the heart to work intensively, which is manifested by rapid heartbeat. Under conditions of stress on the heart muscle, the myocardium requires an additional volume of oxygen, which cannot be delivered due to vasospasm and blood flow disturbance caused by catecholamines. These active substances include the so-called "hormone of fear" - adrenaline, the production of which is sometimes provoked by the patients themselves - lovers of all kinds of extreme sports. Contributes to a strong heartbeat, attacks of shortness of breath and angina pectoris another hormone of the adrenal glands - norepinephrine, called the "hormone of rage", which is actively synthesized during stress. People with vegetative-vascular dystonia are very familiar with paroxysms caused by the influence of the sympathetic-adrenal system. They are distinguished by a variety of symptoms and are often classified as a panic attack: the vessels are clean, the heart is healthy, and signs of an angina attack are evident.
Under the influence of the sympathetic-adrenal system, the coagulation factors of hemostasis are activated. When there is no agreement in the processes of coagulation and anticoagulation, the prerequisites are created for the formation of disseminated intravascular coagulation (DIC), which further exacerbates coronary insufficiency, if it occurs, and contributes to the development of myocardial ischemia.
If the movement of blood along the microcirculatory bed encounters an obstacle on its way, then it goes around along the lateral vessels (collaterals). This adaptive mechanism exists in case of unforeseen circumstances and is especially developed in women, which is programmed by nature (pregnancy, childbirth), and the male gender is considered a risk factor. Women are protected by collaterals, however, for the time being, until hormonal function fades with the onset of menopause. After 60 years, both sexes are equally likely to get a heart attack. Underdevelopment of collaterals (bypasses) reduces the body's defenses, and a heart attack will occur faster in such people compared to patients who are doing well in this regard. Clearly, young women of reproductive age benefit.

If a person is lucky, then during a heart attack, a sudden onset of acute coronary insufficiency can turn on mechanisms that compensate for blood circulation and thereby prevent the formation of an ischemic focus. In an attempt to adapt to circumstances, existing fistulas are revealed, and new ones are urgently formed. In addition, the myocardium tries to supplement the supply of oxygen by increasing its extraction from the arterial blood. However, the “coronary supply” is not bottomless, and when it is depleted, the symptoms of a heart attack become more and more pronounced.

IHD is the most common disease in the world, as they say, "the disease of the century." To date, there are no methods that can reverse the development of coronary artery disease back. A complete cure is also impossible. But with timely and systematic treatment, the development of the disease can be slowed down a little, and life expectancy can be increased - this is also possible.

What is ischemic heart disease?

IHD is an acute or chronic dysfunction of the heart. It occurs due to insufficient supply of nutrients from the coronary arteries directly to the heart muscle. The main reason is atherosclerosis, plaques form, which eventually narrow the lumen in the arteries.

The blood flow decreases, the balance between: needs and capabilities of the heart to supply him with the food he needs for life.

IHD is included in the ICD code 10. This is the International Classification of Certain Diseases 10 revision. ICD-10 includes 21 classes of diseases, among which there is coronary artery disease. IHD code: I20-I25.

Classification

Acute:

unexpected coronary death of the patient;
acute heart attack;
angina pectoris (vasospastic, variant);
angina (unstable).

Chronic:

strenuous angina (indicates the functionality of the class and rest);
postinfarction cardiosclerosis, disturbed heart rhythm and its conduction;
aneurysm;
painless ischemia.

Symptoms

Mental symptoms:

panic, almost animal fear;
inexplicable apathy;
causeless anxiety.

Diagnostics

Purpose of diagnosis:

find existing risk factors: previously undiagnosed diabetes mellitus, bad cholesterol, kidney disease, etc .;
according to the results of the diagnosis, the condition of the heart muscle and arteries should be assessed;
choose the right treatment;
to understand whether surgery is needed, or conservative treatment can still be carried out.

First, you need to consult a specialist cardiologist. If operation is shown then the cardiosurgeon is necessary. With elevated sugar, treatment is first carried out by an endocrinologist.

Blood tests ordered:

general;
blood for sugar;
overall lipid profile;
urea, creatine (assesses the performance of the kidneys).

Urinalysis:

microalbuminuria (MAU) - for the presence of a protein called albumin.
proteinuria - determines the health of the kidneys.

Other diagnostics:

measurement of blood pressure;
radiography;
ECG without load;
ECG with exercise;
determination of the level of bad cholesterol in the blood;
Echo KG - ultrasound of the heart;
coronary angiography.

When diagnosing, it is necessary to take into account the forms of IHD, there are five of them:

Angina pectoris.
Vasospastic angina.
Myocardial infarction.
Postinfarction cardiosclerosis.
Heart failure.

Causes

There are two reasons:

It is called a disease - "heat". This is when the liver overproduces cholesterol. This is called the imbalance of the regulatory system Mkhris-pa.
This is a disease - "cold", associated with digestion. With an abnormal slowdown in digestion and a violation of fat metabolism, an imbalance of the Bad-kan regulatory system occurs.

Excess blood cholesterol accumulates in the vascular walls in the form of atherosclerotic plaques. Gradually, the lumen in the vessels narrows, as a result of which there can be no normal blood circulation, so the blood supply to the heart worsens.

Development mechanism

The heart is known, pumps blood, but it also desperately needs a good blood supply, which means nutrients and oxygen delivery.
The heart muscle is nourished by blood coming from two arteries. They pass from the aortic root and go around the heart in the form of a crown. Therefore, they have such a name - coronary vessels.
Then the arteries divide into several branches, smaller ones. Moreover, each of them should nourish only its part of the heart.
If the lumen of even one vessel narrows a little, the muscle will begin to experience a lack of nutrition. But if it is completely clogged, then the development of many serious diseases is inevitable.
Initially under heavy load the person will experience a slight pain behind the sternum - this is called exertional angina. But the metabolism of the muscle will worsen over time, the lumens of the arteries will narrow. Therefore, pain will now appear more often even: with a slight load, then in a horizontal position of the body.
Together with exertional angina can form along the way chronic heart failure. It is manifested by shortness of breath, severe edema. If a sudden rupture of the plaque occurs, it will lead to the occlusion of the remaining lumen of the artery, then myocardial infarction inevitable.
It can lead to cardiac arrest and even death, if you do not provide emergency assistance to a person. The severity of the lesion will depend only on where exactly the blockage occurred. In the artery or its branching, and which one. The larger it is, the more serious the consequences for a person.
For the development of a heart attack The lumen should narrow by at least 70%. If this happens gradually, then the heart can still adapt to the decrease in blood volume. But a sharp blockage is very dangerous, it often leads to the death of the patient.

Risk factors

Treatment

There are many treatments for this serious disease. Proper treatment will not only improve the quality of life, but even significantly extend it.

Treatment methods:

conservative- life-long medication, physiotherapy exercises, healthy nutrition are indicated, bad habits are completely unacceptable now, it is desirable to lead only a healthy lifestyle.
surgical- restores the patency of blood vessels.

Conservative treatment

A significant role will be played by: reduction in consumption animal fats, only healthy foods should be present in the diet, leisurely walking is good.

Thus, the affected myocardium will be able to quickly adapt to the functionality of the vessels supplying the myocardium with blood.

Medical therapy- administration of antianginal drugs. They prevent or completely remove angina attacks. But often conservative treatment is not always effective, then surgical methods of correction are used.

Surgery

Treatment is selected depending on the degree of damage to the coronary vessels:

Coronary artery bypass grafting- take a vessel (artery, vein) from the patient and sutured to the coronary artery. Thus, they create a bypass blood supply. Blood now in sufficient volume will flow into the myocardium, eliminating ischemia and angina attacks.
- a tube (stent) is inserted into the affected vessel, which from now on will prevent further narrowing of the vessel. The patient after the installation of the stent will have to undergo long-term antiplatelet therapy. In the first two years, control coronary angiography is indicated.

In severe cases, they may offer transmyocardial laser myocardial revascularization. The surgeon directs the laser to the affected area, thereby creating many additional channels less than 1 ml. The channels, in turn, will promote the growth of new blood vessels. This operation is done separately, but can also be combined with aortic coronary bypass surgery.

Medicines

Medicines should be prescribed only by a doctor.

Their arsenal is quite large, and often it is required to take several drugs of different groups at once:

nitrates- this is the well-known nitroglycerin, it not only expands the coronary arteries, but also the delivery of blood to the myocardium will improve significantly. Apply with unbearable pain, prevention of seizures;
antiplatelet agents- for the prevention of thrombosis, dissolution of blood clots: Cardiomagnyl, Heparin, Laspirin, etc.;
beta blockers- the need for oxygen decreases, normalizes the rhythm, is endowed with antiplatelet effects: Vero-Atenolol Metoprolol, Atenolol-Ubfi, Atenolol, etc.;
calcium antagonists- have a wide spectrum of action: hypotensive, antianginal, improves tolerance to small physical exertion: Nifedipine, Isoptin, Verapamil, Veracard, Verapamil-LekT, etc.;
fibrates and statins- lower blood cholesterol: Simvastatin, Lovastatin, Rosuvastatin, etc.;
drugs that improve metabolism in the heart muscle - Inosin-Eskom, Riboxin, Inosie-F, etc.

Folk remedies

Before treatment, be sure to consult with your doctor.

Folk remedies:

Most popular recipes:

1 st. l. flattened hawthorn fruits;
400 ml of boiling water.

At night, put the fruits in a thermos, pour boiling water over it. Let them insist until the morning. Drink 3-4 times a day, 30 ml before meals for 1 hour. Reception 1 month, then take a break for a month and you can repeat.

crush the hawthorn;
motherwort herb.

Mix in equal proportions: take 5-6 tbsp. l. and pour 1.5 liters of boiling water, wrap and let it brew until warm. Take 0.5 cup 2-4 times a day, preferably before meals, for half an hour.

white mistletoe leaves - 1 tbsp. l.;
buckwheat flowers - 1 tbsp. l.

Pour 500 ml of boiling water and leave for 9-10 hours. Drink 2-4 tbsp. l. 3-5 times a day.

field horsetail - 20 gr.;
hawthorn flowers - 20 gr.;
grass of the bird mountaineer - 10 gr.

Pour 250 ml of boiling water, leave for about an hour, be sure to strain. Drink in small sips throughout the day can be taken every week.

corn root - 40 gr.;
medicinal lovage - 30 gr.

Pour boiling water (cover with water) and cook for 5-10 minutes, insist for an hour. Take 1/4 tbsp. 2-3 times a day, always after meals.

Modern methods of treatment

Treatment methods are improving, but the principle of treatment remains the same - it is the restoration of blood flow.
This is achieved in 2 ways: medical, surgical. Drug therapy is the basic basis of treatment, especially for chronic coronary artery disease.
Treatment prevents the development of some serious forms of coronary artery disease: sudden death, heart attack, unstable angina. Cardiologists use various drugs: reducing "bad" cholesterol, antiarrhythmic, blood thinning, etc.
In severe cases, surgical methods are used:
- The most modern method of treatment- This endovascular surgery. This is the latest trend in medicine that allows you to replace surgery with a bloodless one without incisions. They are less painful, never cause complications.
  The operation is performed without incisions., catheter and other instruments are inserted through small punctures in the skin and carried out under the control of radiation imaging techniques. Such an operation is performed on an outpatient basis, even anesthesia is not used in most cases.

Complications and consequences

Complications include:

the formation of focal cardiosclerosis and diffuse atherosclerotic cardiosclerosis - there is a decrease in functioning cardiomyocytes. In their place, a rough connective tissue (scar) is formed;
"Sleeping" or "stunned" myocardium - the contractility of the left ventricle is disturbed;
diastolic, systolic function is disturbed;
other functions are also impaired: automatism, excitability, contractility, etc.;
inferiority - cardiomyocytes (energy metabolism of myocardial cells).

Consequences:

According to statistics, 1/4 of deaths occur precisely because of coronary heart disease.
A frequently diagnosed consequence is diffuse, post-infarction cardiosclerosis. The connective tissue, growing, is replaced by a pathogenic fibrous scar with valvular deformity.
Myocardial hibernation is an adaptive reaction. The heart tries to adapt to the existing blood supply, adapts to the existing blood flow.
Angina - begins with insufficient coronary circulation.
Diastolic, or systolic left ventricular dysfunction - impaired contractility of the left ventricle. Or it is normal, but the ratio between: the filling of diastole and atrial systole is broken.
Conduction is disturbed and arrhythmia has developed - the initiating myocardial contraction does not function correctly.
Heart failure is preceded by: myocardial infarction.

The most dangerous types of coronary artery disease and angina pectoris, which are spontaneous in nature, they can instantly disappear and reappear. They can transform into a heart attack or simply copy.

IHD diagnosis- This is not a sentence, but a reason not to lose heart. It is necessary to act and not to miss precious time, but to choose the optimal treatment tactics. A cardiologist will help you with this. This will not only save your life, but also help you stay active for years to come. Health to all and longevity!

Ischemic heart disease is a pathology of the heart muscle associated with a lack of its blood supply and increasing hypoxia. The myocardium receives blood from the coronary (coronary) vessels of the heart. In diseases of the coronary vessels, the heart muscle lacks blood and the oxygen it carries. Cardiac ischemia occurs when the demand for oxygen exceeds the availability. The vessels of the heart in this case usually have atherosclerotic changes.

The diagnosis of coronary artery disease is common among people over 50 years of age. With increasing age, pathology occurs more often.

Species and subspecies

Ischemic disease is classified according to the degree of clinical manifestations, susceptibility to vasodilating (vasodilating) drugs, resistance to physical activity. IHD forms:

Sudden coronary death is associated with disorders of the conduction system of the myocardium, that is, with sudden severe arrhythmia. In the absence of resuscitation measures or their failure, instantaneous cardiac arrest when confirmed by eyewitnesses, or death after an attack within six hours of its onset, the diagnosis is "primary cardiac arrest with a fatal outcome." With successful resuscitation of the patient, the diagnosis is "sudden death with successful resuscitation."
Angina pectoris is a form of coronary disease in which there is a burning pain in the middle of the chest, or rather, behind the sternum. According to ICD-10 (International Classification of Diseases 10th revision), angina pectoris corresponds to code I20.

It also has several subspecies:

Angina pectoris, or stable, in which the supply of oxygen to the heart muscle is reduced. In response to hypoxia (oxygen starvation), there is pain and spasm of the coronary arteries. Stable angina, unlike unstable, occurs during physical exertion of the same intensity, for example, walking a distance of 300 meters with a normal step, and is stopped by nitroglycerin preparations.
Unstable angina pectoris (ICD code - 20.0) is poorly controlled by nitroglycerin derivatives, pain attacks become more frequent, the patient's exercise tolerance decreases. This form is divided into types:
- first appeared;
- progressive;
- early postinfarction or postoperative.
Vasospastic angina caused by vasospasm without atherosclerotic changes.
Coronary syndrome (syndrome X).

According to the international classification 10 (ICD-10), angiospastic angina (Prinzmetal's angina, variant) corresponds to 20.1 (angina pectoris with confirmed spasm). Angina pectoris - ICD code 20.8. Unspecified angina was assigned code 20.9.

Myocardial infarction. An attack of angina, lasting more than 30 minutes and not stopped by nitroglycerin, ends with a heart attack. Diagnosis of a heart attack includes an ECG analysis, a laboratory study of the level of markers of damage to the heart muscle (fractions of creatine phosphokinase and lactate dehydrogenase enzymes, tropomyosin, etc.). According to the extent of the lesion, there are:
- transmural (large-focal) infarction;
- small focal.
According to the international classification of the 10th revision, acute infarction corresponds to code I21, its varieties are distinguished: acute extensive infarction of the lower wall, anterior wall and other localizations, unspecified localization. The diagnosis of "repeated myocardial infarction" was assigned the code I22.
Postinfarction cardiosclerosis. Diagnosis of cardiosclerosis using an electrocardiogram is based on conduction disturbance due to cicatricial changes in the myocardium. This form of coronary disease is indicated no earlier than 1 month from the moment of a heart attack. Cardiosclerosis - cicatricial changes that have arisen at the site of a heart muscle destroyed as a result of a heart attack. They are formed by rough connective tissue. Cardiosclerosis is dangerous by turning off a large part of the conduction system of the heart.

Other forms of coronary artery disease - codes I24-I25:

Painless form (according to the old classification of 1979).
Acute heart failure develops against the background of myocardial infarction or in shock conditions.
Heart rhythm disturbances. With ischemic damage, the blood supply to the conduction system of the heart is also disturbed.

Code I24.0 according to ICD-10 is assigned to coronary thrombosis without infarction.

Code I24.1 according to the ICD - Dressler's post-infarction syndrome.

Code I24.8 according to the 10th revision of the ICD - coronary insufficiency.

Code I25 according to ICD-10 - chronic ischemic disease; includes:

atherosclerotic ischemic heart disease;
myocardial infarction and post-infarction cardiosclerosis;
cardiac aneurysm;
coronary arteriovenous fistula;
asymptomatic ischemia of the heart muscle;
chronic unspecified coronary artery disease and other forms of chronic ischemic heart disease lasting more than 4 weeks.

Risk factors

The tendency to ischemia is increased with the following risk factors for coronary artery disease:

Metabolic, or syndrome X, in which the metabolism of carbohydrates and fats is disturbed, cholesterol levels are elevated, and insulin resistance occurs. People with type 2 diabetes are at risk for cardiovascular disease, including angina and heart attack. If the waist circumference exceeds 80 cm, this is an occasion to pay more attention to health and nutrition. Timely diagnosis and treatment of diabetes mellitus will improve the prognosis of the disease.
smoking. Nicotine constricts blood vessels, increases heart rate, increases the need for blood and oxygen in the heart muscle.
Liver diseases. In liver disease, cholesterol synthesis increases, which leads to increased deposition on the walls of blood vessels with further oxidation and inflammation of the arteries.
Drinking alcohol.
Hypodynamia.
Constant excess of caloric content of the diet.
Emotional stress. When unrest increases the body's need for oxygen, and the heart muscle is no exception. In addition, during prolonged stress, cortisol and catecholamines are released, which narrow the coronary vessels, and cholesterol production increases.
Violation of lipid metabolism and atherosclerosis of the coronary arteries. Diagnosis - the study of the lipid spectrum of blood.
Syndrome of excessive seeding of the small intestine, which disrupts the functioning of the liver and is the cause of vitamin deficiency of folic acid and vitamin B12. This increases the level of cholesterol and homocysteine. The latter disrupts peripheral circulation and increases the load on the heart.
Itsenko-Cushing's syndrome, which occurs with hyperfunction of the adrenal glands or with the use of steroid hormone preparations.
Hormonal diseases of the thyroid gland, ovaries.

Men over 50 and menopausal women are most likely to experience angina and heart attacks.

Risk factors for coronary artery disease that aggravate the course of coronary heart disease: uremia, diabetes mellitus, pulmonary insufficiency. IHD is aggravated by disturbances in the conduction system of the heart (blockade of the sinoatrial node, atrioventricular node, bundle of His bundle).

The modern classification of coronary artery disease allows doctors to correctly assess the patient's condition and take the right measures for its treatment. For each form that has a code in the ICD, its own diagnostic and treatment algorithms have been developed. Only freely orienting in the varieties of this disease, the doctor will be able to effectively help the patient.

Ischemic cardiomyopathy is a pathology caused by a nutritional deficiency of myocytes, muscle cells of the myocardium. In the International Classification of Diseases (ICD-10), it is assigned to the group of ischemias, and not to the types of cardiomyopathies. The disease is characterized by an increase in the volume of the heart muscle, which causes the development of atherosclerosis of the coronary arteries, and manifestations of chronic heart failure. There are no pronounced symptoms of other types of cardiomyopathies.

Difficulties in terminology

The ischemic form of cardiomyopathy is an ambiguous disease. Since the first mention, it has changed its name several times:

1965 - T. Harrison described ischemic disorders of regional myocardial contractility outside cicatricial ones, proposing the concept of "myocardial asynergy";
1969 - N. Raftery introduced the term "ischemic failure" for this myocardial pathology, focusing on one of the main clinical syndromes of the pathology - heart failure;
1979 - V. Bursh described several cases of CHF that arose after a heart attack. At the same time, he noted that the ischemic form of the disease can be considered a true cardiomyopathy with its inherent manifestations.

Experts from the World Health Organization classified the pathology as specific cardiomyopathies. And in the ICD-10 edition, it is presented among diseases of the circulatory system as one of the varieties of coronary heart disease (CHD).

The essence of pathology

The progression of the disease contributes to the formation of atherosclerotic plaques. The narrowing of the coronary vessels caused by them leads to hypoxia - the heart is deficient in oxygen and essential nutrients. The myocardium cannot fully perform the contractile function, as a result of which the cavities of the heart muscle gradually increase.

The process may be accompanied by structural and geometric changes in the ventricles (fibrosis and hypertrophy). These are clear signs of chronic ischemia of the heart. It leads to myocardial apoptosis - programmed cell death, provoking cardiac failure.

Classification of the disease and its consequences

Ischemic cardiomyopathy causes thickening of the walls of the heart chambers (dilated hypertrophy). According to the localization of the pathological process, two forms of the disease are distinguished:

symmetrical - the left and right chambers of the heart muscle evenly increase;
asymmetric - changes occur mainly in one of the parts of the heart.

In the absence of adequate therapy, ischemic cardiomyopathy can cause serious complications:

damage to the conduction pathways of the heart;
the occurrence of extrasystoles;
atrial fibrillation;
myocardial infarction;
heart failure.

This type of disease, compared with other cardiomyopathies, has a worse prognosis for the health and life of the patient.

Reasons for the development of pathology

The main cause of the development of pathology is atherosclerosis, which affects the coronary vessels. Arterial stenosis increases intramyocardial stress - manifestations of coronary artery disease trigger the process of hibernation ("falling asleep") of the myocardium. The heart loses its ability to fully function. Difficulties with pumping blood provoke the development of angina pectoris, causing heart attacks. Often, ischemic cardiomyopathy manifests itself after myocardial infarction, sometimes with recurrent necrosis. Among the factors provoking the development of the disease, there are:

hypertension;
metabolic problems (endocrine pathologies, menopause, sudden weight loss, obesity);
alcohol abuse;
smoking;
high concentration of cholesterol in the blood;
genetic predisposition;
advanced age.

Often, the manifestations of ischemic cardiomyopathy contributes to the long-term use of hormonal drugs.

Symptoms of pathology

Symptoms of ischemic cardiomyopathy are nonspecific. With the development of the disease, symptoms of heart failure appear:

arrhythmias;
rapid irregular heartbeat;
pressing pain in the chest;
increased fatigue;
headache;
fainting states;
weight gain;
puffiness;
insomnia;
moist cough;
dyspnea.

As the pathology progresses, an increase in the volume of the heart is observed.

Diagnostic measures

An experienced doctor is able to notice signs of congestion of the cardiovascular system already on a physical examination. But to make an accurate diagnosis, specific examinations are prescribed:

clinical blood and urine tests (determination of concomitant pathologies);
biochemical assessment of blood composition (analysis of cholesterol, triglycerides, certain hormones);
ECG (detection of arrhythmias, myocardial hypertrophy);
EchoCG (visualization of violations of the contractile functions of the heart);
radiography (determination of an increase in the shadow of the heart);
coronary angiography (assessment of changes in coronary vessels, detection of atherosclerotic plaques, enlargement of small coronary branches);
myocardial scintigraphy (radioactive thallium accumulates in damaged myocardial foci).

Sometimes an MRI or biopsy is also prescribed. Differentiate the disease with other types of cardiomyopathies, including idiopathic and alcoholic.

Principles of therapy

In the treatment of ischemic cardiomyopathy, first of all, it is necessary to influence the main cause of its occurrence - cardiac ischemia. For this, the patient needs to reconsider his lifestyle. He is recommended to follow a diet low in cholesterol, sodium and animal fats, give up addictions, and perform feasible physical exercises.

Medical treatment

Medicines are used to reduce the symptoms of the disease, improve the functioning of the heart muscle and prevent the development of complications. Depending on the course of the disease, they are prescribed:

beta-blockers (lower blood pressure and heart rate);
calcium antagonists (dilate the coronary arteries and lower blood pressure);
aldosterone inhibitors and diuretics (remove excess fluid from the body);
anticoagulants (prevent thrombosis);
means that control the pulse rate and its rhythm.

Sometimes the patient is prescribed hardware procedures (plasmapheresis).

Surgical impact

Surgical treatments for ischemic cardiomyopathy include:

installation of a cardiac stimulator, defibrillator (stabilization of the heart rhythm);
angioplasty (counteracting vascular stenosis);
stenting (installation of "dilators" of arteries);
atherectomy (restoration of the lumen of the arteries).

Sometimes coronary bypass surgery is used to improve blood flow to the heart muscle. Serious damage to the heart requires an organ transplant.

Traditional medicine

In the ischemic form of cardiomyopathy, conservative treatment is often supplemented with phytotherapy. Widely used:

viburnum (vitamins C and A, pectins, tannins, phytoncides, micro and macro elements, organic acids);
flax seeds (amino acids, fatty acids, glycosides, esters, vitamins of group B, E, A, F, C);
hare cabbage (organic acids, folic acid, carotene, rutin, vitamins C, A);
oats (B vitamins, amino acids, micro and macro elements, beta D-gluconate);
jaundice (flavonoids, glycosides, organic and fatty acids).

Treatment with traditional medicine involves lowering blood pressure, normalizing the heart rhythm and eliminating manifestations of heart failure. It is carried out under the supervision of an experienced physician.

Prevention measures

Primary prevention means preventing the occurrence of pathology. For this you need:

give up bad habits;
balance nutrition;
prevent the occurrence of metabolic disorders;
timely treat heart and viral diseases.

If there is a hereditary predisposition to the development of cardiomyopathies, it is necessary to be observed by a specialist and regularly conduct an ultrasound of the heart. Secondary prevention measures are aimed at preventing the progression of the pathology and possible complications. Secondary prevention measures for ischemic cardiomyopathy include:

refusal of intensive sports training and hard physical work;
regular visits to the cardiologist and echocardiography;
taking medications prescribed by a doctor;
body weight control;
adequate response to stressful situations;
organization of a balanced daily routine;
systematic monitoring of blood glucose and cholesterol levels.

When diagnosing ischemic cardiomyopathy, self-medication is unacceptable.

Ischemic cardiomyopathy occurs intermittently. But if the disease is left untreated, it can lead to death. It is extremely important that the pathology is detected as early as possible. A temporary “lull” in cardiomyopathy should not be a reason to stop treatment.

What is dangerous pulmonary hypertension and how to cure it

Disease classification
Potential Complications
LG forecasts

Pulmonary hypertension (PH) is a syndrome of various diseases united by a common characteristic symptom - an increase in blood pressure in the pulmonary artery and an increase in the load in the right heart ventricle. The inner layer of blood vessels grows and interferes with normal blood flow. To move blood into the lungs, the ventricle is forced to contract strongly.

Since the organ is not anatomically adapted to such a load (with PH, the pressure in the pulmonary artery system rises to 25-30 mm Hg), it provokes its hypertrophy (growth) with subsequent decompensation, a sharp decrease in the strength of contractions and premature death.

According to the generally accepted classification for coding medical diagnoses developed by the World Health Organization, the disease code according to ICD-10 (last revision) - I27.0 - primary pulmonary hypertension.

The course of the disease is severe, with a pronounced decrease in physical capabilities, cardiac and pulmonary insufficiency. PH is a rare disease (only 15 cases per million people), but survival is unlikely, especially in the primary form in the later stages, when a person dies as if from cancer - in just six months.

Such rare diseases are called “orphan” ones: treatment is expensive, there are few drugs (it is not economically profitable to produce them if the consumers are less than 1% of the population). But this statistic is of little consolation if trouble has touched a loved one.

The diagnosis of "pulmonary hypertension" is established when the pressure parameters in the pulmonary vessels during exercise reach 35 mm Hg. Art. Normally, blood pressure in the lungs is 5 times lower than in the body as a whole. This is necessary so that the blood has time to be saturated with oxygen, freed from carbon dioxide. With an increase in pressure in the vessels of the lungs, it does not have time to receive oxygen, and the brain simply starves and turns off.

PH is a complex, multivariate pathology. During the manifestation of all its clinical symptoms, damage and destabilization of the cardiovascular and pulmonary systems occur. Particularly active and neglected forms (idiopathic PH, PH with autoimmune damage) lead to system dysfunction with inevitable premature death.

PH can be a solo (primary) form of the disease, or form after exposure to another underlying cause.

The causes of PH have not been fully explored. For example, in the 60s of the last century in Europe, there was an increase in the disease caused by uncontrolled intake of oral contraceptives and diet pills.

In case of endothelial dysfunction, a prerequisite may be a genetic predisposition or exposure to external aggressive factors. In each case, this leads to a violation of the metabolic processes of nitric oxide, a change in vascular tone (the appearance of spasms, inflammation), the growth of the inner walls of blood vessels with a simultaneous reduction in their lumen.

An increased concentration of endothelin (a vasoconstrictor) is due to either increased secretion in the endothelium or a decrease in its breakdown in the lungs. The sign is typical for idiopathic PH, congenital childhood heart defects, systemic diseases.

The production or availability of nitric oxide is disrupted, the synthesis of prostacyclin decreases, the excretion of potassium increases - any deviation provokes arterial spasm, proliferation of the walls of the arteries, and a violation of the blood flow of the pulmonary artery.

The following factors can also increase pressure in the pulmonary arteries:

Cardiac pathologies of various origins;
Chronic lung diseases (such as tuberculosis or bronchial asthma);
Vasculitis;
Metabolic disorders;
PE and other pulmonary vascular problems;
Extended stay in highlands.

If the exact cause of PH is not established, the disease is diagnosed as primary (congenital).

Disease classification

According to the severity, 4 stages of PH are distinguished:

The first stage is not accompanied by a loss of muscle activity. A hypertensive person can withstand the usual rhythm of life without feeling dizzy, fainting, weakness, pain in the sternum, or severe shortness of breath.
At the next stage, the physical capabilities of the patient are limited. A calm state does not cause any complaints, but with a standard load, shortness of breath, loss of strength, and impaired coordination appear.
At the third stage of the development of the disease, all these symptoms are manifested in hypertensive patients, even with little activity.
The last stage is characterized by severe symptoms of shortness of breath, pain, weakness, even at rest.

The first clinical symptoms of PH appear only after a double excess of pressure in the pulmonary vessels. The key symptom of the disease is shortness of breath with its own characteristics that make it possible to distinguish it from signs of other diseases:

Other symptoms of PH are also common to most patients:

Rapid fatigue and weakness;
Fainting and heart rhythm disturbances;
Endless dry cough;
swelling of the legs;
Painful sensations in the liver associated with its growth;
Pain in the chest from an enlarged artery;
Hoarse notes in the voice associated with infringement of the laryngeal nerve.

Most often, hypertensive patients come to a consultation with complaints of constant shortness of breath, which complicates their usual life. Since there are no special signs in primary PH that make it possible to diagnose PH during the initial examination, the examination is carried out in a complex manner - with the participation of a pulmonologist, a cardiologist and a therapist.

Methods for diagnosing PH:

To avoid errors, PH is diagnosed only as a result of studying the data of complex vascular diagnostics. The reason for visiting the clinic may be:

The appearance of shortness of breath with the usual load.
Pain in the sternum of unknown origin.
Constant feeling of everlasting tiredness.
Increasing swelling of the lower extremities.

In the first stages, the disease responds to the proposed therapy. Key considerations in choosing a treatment regimen should be:

Identification and elimination of the cause of the patient's poor health;
Decreased pressure in the vessels of the lungs;
Prevention of blood clots in the arteries.

Potential Complications

Of the negative consequences, it should be noted:

Heart failure. The right half of the heart does not compensate for the resulting load, this aggravates the patient's situation.
PE - thrombosis of the artery of the lung, when the vessels are blocked by blood clots. This is not just a critical condition - there is a real threat to life.
A hypertensive crisis and a complication in the form of pulmonary edema significantly reduces the patient's quality of life and often leads to death. LH provokes an acute and chronic form of heart and lung failure, life-threatening hypertension.

PH can develop both in adulthood and in infants. This is due to the peculiarities of the lungs of a newborn. When it is born, a strong pressure drop occurs in the arteries of the lungs, due to the launch of the expanding lungs and the flow of blood.

This factor serves as a prerequisite for PH in newborns. If with the first breath the circulatory system does not reduce the pressure in the vessels, decompensation of the pulmonary blood flow occurs with changes characteristic of PH.

The diagnosis of "pulmonary hypertension" in infants is established if the pressure in its vessels reaches 37 mm Hg. Art. Clinically, this type of PH is characterized by the rapid development of cyanosis, severe shortness of breath. For a newborn, this is a critical condition: death usually occurs within a few hours.

In the development of PH in children, there are 3 stages:

At the first stage, increased pressure in the pulmonary arteries is the only anomaly, the child has no distinct symptoms. During exercise, shortness of breath may appear, but even a pediatrician does not always pay attention to this, explaining the problem by the detraining of the modern child's body.
At the second stage, cardiac output decreases, demonstrating a detailed clinical symptomatology: hypoxemia, shortness of breath, syncope. The pressure in the vessels of the lungs is consistently high.
After the onset of right gastric insufficiency, the disease passes into the third stage. Despite high arterial pressure, cardiac output, accompanied by venous congestion and peripheral edema, falls sharply.

Each stage can last from 6 months to 6 years - from minimal hemodynamic changes to death. Nevertheless, therapeutic measures for young patients are more effective than for adults, since the processes of pulmonary vascular remodeling in children can be prevented and even reversed.

LG forecasts

The prognosis in the treatment of pulmonary hypertension in most cases is unfavorable: 20% of the recorded cases of PH ended in premature death. An important factor is the type of LH.

In the secondary form, which develops as a result of autoimmune failures, the statistics are the worst: 15% of patients die due to insufficiency within a few years after diagnosis. The life expectancy of this category of hypertensive patients is affected by the average blood pressure in the lungs. If it is held at around 30 mm Hg. Art. and above and does not respond to therapeutic measures, life expectancy is reduced to 5 years.

An important circumstance will be the time of accession to pulmonary insufficiency and also cardiac. Idiopathic (primary) pulmonary hypertension is characterized by poor survival. It is extremely difficult to treat, and the average life expectancy for this category of patients is 2.5 years.

To minimize the risk of developing such a formidable disease, simple measures will help:

If your child passes out at school or grandma has unusual shortness of breath, don't put off a visit to the doctor. Modern drugs and methods of treatment can significantly reduce the clinical manifestations of the disease, improve the quality of life in pain, and increase its duration. The earlier the disease is detected, the more carefully all the doctor's instructions are followed, the more likely it is to defeat the disease.

IHD occupies a strong leading position among the most common heart pathologies, often leads to partial or complete disability and has become a social problem for many developed countries of the world. A busy rhythm of life, constant stressful situations, weakness, poor nutrition with a large amount of fat - all these reasons lead to a steady increase in the number of people suffering from this serious illness.

The term "ischemic heart disease" combines a whole group of acute and chronic conditions that are caused by insufficient supply of oxygen to the myocardium due to narrowing or blockage of the coronary vessels. Such oxygen starvation of muscle fibers leads to disruption in the functioning of the heart, changes in hemodynamics and persistent structural changes in the heart muscle.

Most often, this disease is provoked by atherosclerosis of the coronary arteries, in which the inner wall of the vessels is covered with fatty deposits (atherosclerotic plaques). In the future, these deposits harden, and the vascular lumen narrows or becomes impassable, disrupting the normal delivery of blood to the myocardial fibers. From this article you will learn about the types of coronary heart disease, the principles of diagnosis and treatment of this pathology, the symptoms and what cardiologist patients need to know.

Types of IHD

Currently, due to the expansion of diagnostic capabilities, cardiologists distinguish the following clinical forms of coronary artery disease:

primary cardiac arrest (sudden coronary death);
angina pectoris and spontaneous angina pectoris;
myocardial infarction;
postinfarction cardiosclerosis;
circulatory failure;
heart rhythm disturbances (arrhythmias);
painless ischemia of the heart muscle;
distal (microvascular) ischemic heart disease;
new ischemic syndromes (hibernation, stupor, myocardial metabolic adaptation).

The above classification of coronary artery disease refers to the International Classification of Diseases X system.

Causes

In 90% of cases, coronary artery disease is provoked by narrowing of the lumen of the coronary arteries, caused by atherosclerotic changes in the walls of blood vessels. In addition, disturbances in the correspondence of coronary blood flow and the metabolic needs of the heart muscle may be the result of:

spasm of slightly changed or unchanged coronary vessels;
tendency to thrombosis due to disorders of the blood coagulation system;
violations of microcirculation in the coronary vessels.

Risk factors for the development of such etiological causes of IHD can be:

age over 40-50 years;
smoking;
heredity;
arterial hypertension;
diabetes;
obesity;
increased levels of total plasma cholesterol (more than 240 mg / dl) and LDL cholesterol (more than 160 mg / dl);
hypodynamia;
frequent stress;
irrational nutrition;
chronic intoxication (alcoholism, work at toxic enterprises).

Symptoms

In most cases, coronary artery disease is diagnosed already at the stage when the patient has its characteristic signs. This disease develops slowly and gradually, and its first symptoms make themselves felt when the lumen of the coronary artery is narrowed by 70%.

Most often, coronary artery disease begins to manifest itself as symptoms of angina pectoris:

a feeling of discomfort or pain in the chest that appears after physical, mental or psycho-emotional stress;
the duration of the pain syndrome is no more than 10-15 minutes;
pain causes a feeling of anxiety or fear of death;
pain can radiate to the left (sometimes to the right) half of the body: arm, neck, shoulder blade, lower jaw, etc.
during an attack, the patient may experience: shortness of breath, a sharp feeling of lack of oxygen, tachycardia, increased blood pressure, nausea, increased sweating, arrhythmia;
pain may disappear on its own (after the cessation of the load) or after taking Nitroglycerin.

In some cases, angina pectoris can manifest itself with atypical symptoms: proceed without pain, manifest itself only as shortness of breath or arrhythmia, pain in the upper abdomen, and a sharp decrease in blood pressure.

With the passage of time and in the absence of treatment, coronary artery disease progresses, and the above symptoms may appear at a much lower intensity of exercise or at rest. The patient has an increase in seizures, they become more intense and prolonged. This development of coronary artery disease can lead to myocardial infarction (in 60% of cases it occurs for the first time after a prolonged angina attack), heart failure or sudden coronary death.

Diagnostics

Diagnosis of suspected coronary artery disease begins with a detailed consultation with a cardiologist. The doctor, after listening to the patient's complaints, always asks questions about the history of the appearance of the first signs of myocardial ischemia, their nature, and the patient's internal sensations. An anamnesis is also collected about previous diseases, family history and medications taken.

After questioning the patient, the cardiologist conducts:

measurement of pulse and blood pressure;
listening to the heart with a stethoscope;
percussion of the borders of the heart and liver;
general examination to detect edema, changes in the skin condition, the presence of pulsations of the veins, etc.

Based on the data obtained, the following additional laboratory and instrumental examination methods can be prescribed to the patient:

ECG (in the initial stages of the disease, an ECG with stress or pharmacological tests may be recommended);
Holter ECG (daily monitoring);
phonocardiography;
radiography;
biochemical and clinical blood tests;
Echo-KG;
myocardial scintigraphy;
transesophageal pacing;
coronary angiography;
catheterization of the heart and large vessels;
magnetic resonance coronary angiography.

The volume of diagnostic examination is determined individually for each patient and depends on the severity of symptoms.

Treatment

IHD treatment is always complex and can be prescribed only after a comprehensive diagnosis and determination of the severity of myocardial ischemia and damage to the coronary vessels. These can be conservative (prescribing medications, diets, exercise therapy, spa treatment) or surgical techniques.

The need for hospitalization of a patient with coronary artery disease is determined individually depending on the severity of his condition. At the first signs of a violation of the coronary circulation, the patient is recommended to give up bad habits and follow certain rules of rational nutrition. When compiling his daily diet, a patient with coronary artery disease should adhere to the following principles:

reducing the amount of products containing animal fats;
refusal or sharp restriction of the amount of table salt consumed;
increase in the amount of plant fiber;
introduction of vegetable oils into the diet.

Drug therapy for various forms of coronary artery disease is aimed at preventing angina attacks and may include various antiangial drugs. The treatment regimen may include the following groups of drugs:

In the initial stages of coronary artery disease, drug therapy can significantly improve the state of health. Compliance with the doctor's recommendations and constant dispensary observation in many cases can prevent the progression of the disease and the development of severe complications.

With low efficiency of conservative treatment and large-scale damage to the myocardium and coronary arteries, a patient with coronary artery disease may be recommended to perform a surgical operation. The decision on intervention tactics is always selected individually. To eliminate the zone of myocardial ischemia, the following types of surgical operations can be performed:

angioplasty of a coronary vessel with stenting: this technique is aimed at restoring the patency of a coronary vessel by introducing a special stent (mesh metal tube) into its affected area;
coronary artery bypass grafting: this method allows you to create a bypass for blood to enter the area of myocardial ischemia, for this, sections of the patient's own veins or the internal thoracic artery can be used as a bypass;
transmyocardial laser myocardial revascularization: this operation can be performed when it is impossible to perform coronary artery bypass grafting, during the intervention, the doctor using a laser creates a lot of the thinnest channels in the damaged area of the myocardium, which can be filled with blood from the left ventricle.

In most cases, surgical treatment significantly improves the quality of life of a patient with coronary artery disease and reduces the risk of myocardial infarction, disability and death.

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Lokren: instructions for use, price, reviews and analogues

Lokren - a drug related to cardioselective beta-blockers, has a weak membrane-stabilizing effect, has a selective beta-adrenergic blocking effect, the drug has no partial agonistic activity.

Pharmaceutical companies produce the drug in the form of white tablets, each of which contains 20 mg of the active substance - betaxolol hydrochloride plus additional components - lactose monohydrate, magnesium stearate, titanium dioxide, silicon dioxide, microcrystalline cellulose.

The drug Lokren has proven itself in the treatment of arterial hypertension and pathologies of the cardiovascular system. However, it has its own contraindications and indications, as a result of which you need to figure out how to take the pills correctly? What reviews do doctors leave, what are the analogues of this remedy?

Composition, principle of action

The medicine is sold in 28 and 56 pieces in one package. Film-coated white tablets have a dividing line on one side, engraved on the other side. Additional components included in the composition:

Titanium dioxide.
Macrogol.
lactose monohydrate.
Microcrystalline cellulose.
Anhydrous colloidal dioxide.
magnesium stearate.

The active ingredient of the drug is characterized by several properties:

Cardioselective beta-adrenergic blocking property.
Does not show its own sympathomimetic effect.
It has a membrane-stabilizing effect.

The use of a drug leads to a decrease in heart rate and cardiac output, a decrease in upper and lower blood pressure at rest, as well as during physical exertion.

All these actions help to reduce the load on the heart muscle in a calm and active state.

The drug is quite effectively and completely absorbed from the gastrointestinal tract, the percentage of bioavailability is 85. It is excreted from the body through the kidneys, the half-life of the active substance is about 15-20 hours. If the patient has a history of liver pathology, then the elimination time increases by 33%.

The mechanism of the antihypertensive effect of beta-blockers has not been fully understood to date. It is in this category of drugs that the following antihypertensive effects are assumed:

Decreased cardiac output.
Elimination of spasm of peripheral arteries (this action is carried out due to the central effect, which leads to a decrease in sympathetic impulses of peripheral vessels, and also due to inhibition of renin activity).

With prolonged use, the antihypertensive effect of the drug is not reduced. With a single dose of the drug (at a dosage of 5-40 mg), the antihypertensive effect remains the same throughout the day.

Indications and contraindications for use

Instructions for use says that such a drug is recommended in the following cases:

With arterial hypertension, it may be the only treatment, and also be included in combination therapy.
For prophylactic purposes of angina attacks of all classes.

Heart failure of a chronic form at stages 2-3.
in cardiogenic shock.
Lactase deficiency, glucose malabsorption.
Low pressure.
Children's age up to 18 years.
Hypersensitivity to the drug or its constituent components.

The drug Lokren, respectively, and its analogues, should be taken with extreme caution and under medical supervision in such cases:

High levels of thyroid hormones in the blood.
Renal failure of chronic form.
Pathology of the liver.
With diabetes.
A skin disease that affects the skin (psoriasis).
Diseases of peripheral vessels.
depressive syndrome.

In addition to the above, they are taken with extreme caution during hemodialysis, a history of allergies, insufficiency of circulating blood volume, and chronic pulmonary obstruction. Lokren may cause the following side effects:

Asthenia, migraine, lethargy. Depressive syndrome, bradycardia, arrhythmia.

Dryness in the mouth, constipation or diarrhea, abdominal cramps, impaired taste buds, malfunction of the liver. Difficulty breathing, nasal congestion. Blurred visual perception, intrauterine growth retardation of the fetus.

Erectile dysfunction, pain in the lumbar region.

Reviews of doctors warn that in view of such adverse reactions as severe weakness and dizziness, one should be much more careful when driving a motor vehicle, as well as during hard work.

Since such symptoms can significantly reduce the speed of reaction and perception.

Instructions for use of the drug Lokren

Lokren and its analogues are recommended with extreme caution to elderly patients, and treatment is always started with a minimum dosage under medical supervision. Instructions for use and required dosages of Lokren:

Tablets are taken orally, swallowed, not chewed, crushed in any other way.
As a rule, the initial dosage is always 10 mg.
If after 11-15 days of treatment there is no pronounced decrease in blood pressure, it is permissible to increase the dose of the drug to 20 mg per day.
The maximum daily dosage of the drug is 40 mg.
In the treatment of arterial hypertension against the background of severe renal failure, the dose of the drug is reduced to 5 mg per day.
With mild renal insufficiency and moderate hepatic insufficiency, there is no need to adjust the dose.

Based on the feedback from patients, we can say that non-compliance with the dosage and frequency of administration leads to severe dizziness, difficulty breathing, bradycardia, fainting, a strong decrease in blood pressure, convulsions, heart failure, arrhythmia.

In case of an overdose of the drug, a slow infusion of isoprenaline is carried out, as well as symptomatic treatment, which includes gastric lavage, adsorbent tablets are prescribed. Features of the drug Lokren:

You can not abruptly cancel the pills. This is especially dangerous in coronary heart disease. The dosage should be reduced gradually over several weeks. During the withdrawal of the drug, you need to start taking other pills, Lokren's analogues are most often recommended.

When the patient has a history of compensated heart failure, tablets are recommended at lower dosages. The increase in doses is carried out under the supervision of a doctor.

The dose may be reduced if, while taking the drug, the heart rate becomes rare - up to 50 beats per minute in a relaxed state.

Before treatment with this agent, an assessment of the functional characteristics of the patient's external respiration is carried out. If bronchospasm develops, therapy is supplemented with a beta2-adrenomimetic agent.

Reviews of doctors indicate that the drug can show positive results in tests for doping elements in the human body.

Lokren's analogues are divided into two groups: the first - structural analogues for the active substance, the second - analogues for the pharmacological series (beta-blockers). Analogues of the drug by active substance:

Betoptik.
Optibetol.
Betak.

Analogues for the pharmacological series:

Vasocardin.
Aritel.
Egilok.

The price for Lokren varies from 750 to 980 rubles, there are 28 tablets in the package, the cost of a package with 56 tablets starts from 1278 rubles and more, depending on the manufacturer.

Structural analogue of Betak

The main active ingredient is betaxolol plus additional components - lactose monohydrate, microcrystalline cellulose, titanium dioxide, magnesium stearate and others. Indications for use are as follows:

Hypertrophic damage to the heart muscle.
Hypertonic disease.
Coronary heart disease, angina pectoris and rest.
Ischemic necrosis of a portion of the myocardium, which is caused by complete or partial insufficiency of blood supply (only in complex therapy).
Disorder of the heart rhythm.

The drug is allowed during pregnancy and during breastfeeding, but only with extreme caution and under the supervision of the attending physician. The instruction highlights the following situations when the use of the drug is strictly prohibited:

History of diabetes mellitus.
With bradycardia, chronic obstructive bronchitis.
Pathology of the functioning of the kidneys.
Childhood.
Allergy.
Lack of lactase.

With extreme caution, the drug is included in the treatment regimen with other beta-blockers, cardiac glycosides, calcium antagonists, antihypertensive drugs. Dosage and application rules:

It is taken only orally, one dose per day is enough, the intake does not depend on food. The medicine is washed down with a small amount of non-carbonated liquid.
The starting dose is about 5-10 mg per day.
After 10 days, the dosage can be increased to 20 mg.
The maximum dose per day is up to 40 mg.
If the patient has severe renal insufficiency, start therapy with 10 mg per day.
For patients with hepatic insufficiency, dosage changes are not carried out.

In some cases, adverse reactions such as migraine, dizziness, blurred vision, unreasonable anxiety, short-term memory loss, dry mouth, chest pain, renal colic may occur. Betak tablets are slightly cheaper than Lokren - the price for 30 pieces is 405 rubles.

Structural analogue of Betaxolol

The drug Betaxolol has an effective hypotensive property, helps to prevent an increase in arterial parameters, which are interconnected with strenuous physical activity and stressful situations.

Indications for use: arterial hypertension and as a preventive measure for angina attacks.

There are absolute and relative contraindications. It is strictly forbidden to take the drug in the following cases:

Acute form of heart failure, hypersensitivity to the active ingredient and the drug as a whole.
Up to 18 years of age.
With sick sinus syndrome.
Lack of lactase.
Cardiogenic shock.
Hypertension.

It is taken with extreme caution in chronic heart failure, as well as, if there is a history of psoriasis, circulatory failure, diabetes mellitus, depressive syndrome.

The medicine is taken orally, washed down with plenty of liquid. In treatment, the initial dose is 1 tablet per day. Reception features:

In renal insufficiency, the dosage is selected based on the functionality of the kidneys.
In hepatic insufficiency, a dosage change is not required. In the early stages of treatment, medical supervision is required.

The occurrence of a number of adverse reactions is not excluded, such as dryness in the oral cavity, severe abdominal cramps, constipation, diarrhea, changes in taste perception, nasal congestion, allergic reactions, increased sweating, skin manifestations similar to psoriasis.

The price of the medicine ranges from 307 to 420 rubles.

Corvitol: analogue in the pharmacological series

Corvitol is a drug that has a hypotensive, antiarrhythmic and antianginal effect, the main active ingredient is metoprolol.

It is recommended to take the medicine for heart rhythm disturbances, increased heart rate, coronary heart disease, arterial hypertension, severe headache attacks. The drug is not prescribed for such diseases:

Cardiogenic shock.
Sick sinus syndrome.
Decreased heart rate.
Decompensated heart failure.
arterial hypotension.
In children up to 18 years of age.
Hypersensitivity to the drug.

The drug is recommended with extreme caution if the patient has a history of diabetes mellitus, bronchial asthma, metabolic acidosis, chronic liver and / or kidney failure, myasthenia gravis, as well as patients over 60 years of age. Recommendations for use and dosage:

Tablets are taken orally, washed down with plenty of plain water.
If the reception is recommended twice a day, take it in the morning and evening, if once, then only in the morning.
The duration of treatment is not limited to a certain framework. The minimum course of treatment is 3 months.
As a rule, if the medicine is well tolerated by the patient, he can take it from a year to 3 years.
With hypertension and angina pectoris, you can take 50 mg 2 times a day, or immediately this dosage at a time.
In some cases, with arterial hypertension, the dosage may be 100 mg.

While taking the tablets, it is required to control blood pressure and heart rate, blood glucose levels in patients with diabetes mellitus.

With the diagnosis of heart failure, the medicine is recommended only after the stage of compensation has been reached. If the dosage exceeds 200 mg, then cardioselectivity decreases.

The price of Corvitol (50 mg of the active substance) is 364 rubles, the cost of 50 tablets of 100 mg of the active substance is 623 rubles, 100 tablets of 50 mg are approximately 300 rubles.

Vasocardin: analogue according to the pharmacological series

The drug Vasocardin has antihypertensive, antiarrhythmic and antianginal properties. The drug is sold in the form of tablets, the active substance is metoprolol. Must be taken in the following situations:

Heart rhythm disorder.
Violations of the functioning of the heart, accompanied by angina pectoris.
coronary heart disease.
Hypertension (as monotherapy or with other drugs).

Instructions for use include many diseases in which you can not take the drug. It is necessary to list the most common:

Decreased heart rate.
Severe stage of peripheral blood circulation disorders.
During pregnancy, lactation.
Hypersensitivity to the active ingredient.
Stage of exacerbation of myocardial infarction.
Heart failure of chronic form in the stage of decompensation.

The remedy is recommended with extreme caution if there is a history of diabetes mellitus, functional pathologies of the liver and kidneys, psoriasis, metabolic acidosis, bronchial asthma, peripheral vascular lesions, as well as elderly patients. Features of application and dosage:

For arrhythmias, angina pectoris and migraine attacks, the dosage is 100-200 mg in 2 doses (morning and evening).
When diagnosed with arterial hypertension, the drug is prescribed at a dose of 50-100 mg up to 2 doses per day.
If the therapeutic effect is small, auxiliary antihypertensive drugs are included in the treatment regimen, or the dose of Vasocardin is gradually increased.
With a history of hyperthyroidism, the patient is recommended 150-200 to 4 doses per day.
With pronounced signs of a pathological condition of the liver, the dose is reduced depending on the patient's condition.
In violation of the functioning of the heart, accompanied by tachycardia, the dose is 100 mg 2 times a day.
Tablets should be swallowed whole, not chewed, washed down with non-carbonated liquid.

In a smoking patient, the effectiveness of treatment is reduced. When taking this remedy, the patient must be taught to count the heart rate. If the data obtained is less than 50 beats per minute, a doctor's consultation is required. The price of Vasocardin is from 55 to 105 rubles.

In summing up, it should be said that the effectiveness of Lokren and its analogues has been proven, which is confirmed by numerous reviews of doctors and patients. Medicines help to lower blood pressure, normalize it at the target level, improving the patient's quality of life. The video in this article will act as a visual instruction for using Lokren.

Causes, diagnosis and treatment of stable angina

Stable angina pectoris is a characteristic clinical syndrome, the specificity of which is manifested by the occurrence of paroxysmal pain in the retrosternal region, turning into pain of a compressive, aching or pressing nature, due to a certain level of load. The main symptoms of this pathology of a stable nature are a feeling of heaviness, pressure and pain behind the sternum during physical or emotional stress, pain in the heart that subsides when the load is removed, or after taking nitroglycerin.

Causes of pathology
Disease classification
Symptoms of a pathological condition
Diagnostics
Treatment of the disease
Forecast and prevention

This type of pathology, according to the classification, is recognized as the most common clinical manifestation of coronary artery disease with a steady trend in the course, in the absence of deterioration within 2-4 weeks. In cardiology, the disease is referred to as a type of angina pectoris, which is manifested by a characteristic symptom - dull pain, which increases over time with an increase in load, and disappears when it is removed. This is a type of disease in which an examination is necessarily carried out regarding the disability of the patient.

This condition is due to the fact that during stress of physical or emotional origin, the arteries are not able to provide the high demand of the heart muscle for oxygen consumption. Such a process provokes an acute transient ischemic pathology of the myocardium, as well as the formation of the initial stage of an attack.

Medical statistics have revealed an age and gender pattern - this disease affects about 70% of men in the age group from 50 to 60 years, in men under 50 years of age - the percentage of patients is much higher. Women tend to suffer from this disease less frequently, and between the ages of 65 and 75.

Causes of pathology

Cardiologists consider diagnosed coronary artery disease and atherosclerosis of the heart vessels to be the main causes of pathology, which provokes severe stenosis over time (in 90-97% of cases). An attack is possible under the condition of narrowing of the gaps in the coronary arteries in the range from 50% to 75%.

A sharp decrease in blood supply to the heart muscle can cause a spasm that lasts for a long time - in the area of \u200b\u200bthe small coronary vessels of the heart (coronary). This is caused by local hypersensitivity of the muscle cells of the vessel walls to various stimulating impulses, as well as to changes in the level of ANS tone. In elderly patients, an attack of an anginal nature can not only provoke an exacerbation of coronary heart disease, but also be a reflex accompaniment of attacks of such systemic diseases as pancreatitis, cholelithiasis, hernia of the esophagus, neoplasm of the cardiac section of the stomach.

As a rule, stable exertional angina develops with certain systemic diseases and pathologies:

connective tissue damage of rheumatoid origin,
arterial dystrophy associated with amyloidosis,
ischemic heart disease,
heart failure due to aortic stenosis or cardiomyopathy.

According to statistics, certain diseases and conditions are also risk factors that provoke the development of the disease:

high blood pressure;
obesity;
hypercholesterolemia;
diabetes;
heredity,
alcohol and smoking abuse;
asthenic syndrome and physical inactivity;
women are characterized by early menopause, use of COCs for a long time.

When diagnosing this disease, it is necessary to take into account that the more pronounced the pathological condition of the coronary arteries, the faster an attack can develop, as a result of provoking factors.

Disease classification

The loads carried by patients, the reaction to them, the rate of manifestation of an attack, the clinical picture during its course determine the classification of the pathology.

Class I includes a mild form of the disease, which is accompanied by initial manifestations. The occurrence of seizures is rare, and only with pronounced loads, severe stress. Symptoms disappear immediately after the removal of stress. In such cases, a disability examination is not prescribed.

Class II pathology is characterized by the appearance of paroxysmal pain during fast walking over long distances, when climbing (uphill, on the floor). Signs can be activated when freezing, after eating, with little stress. But pain in the heart can be stopped by removing the load. Limit walking - no higher than 4 km / h.

Class III according to the ICD is characterized by more severe symptoms - a clear and obvious decrease in physical mobility, retrosternal pain even when slowly walking for short distances, shortness of breath when lifting 1-2 flights. In this case, the attack can be stopped by taking nitroglycerin.

Class IV forms the group of the most severe patients. They are not able to physically move, because the attack begins instantly with any load. Symptoms appear with any movement, and often at rest, and the examination reveals not only the patient's incapacity for work, but sometimes disability.

Symptoms of a pathological condition

This disease is generally accompanied by a series of paroxysmal symptoms that occur during physical and emotional stress. The degree of their manifestation depends on the clinical picture of the course of the disease, its duration and the background on which it develops.

Patients with a diagnosed pathology complain of manifestations that are often similar to those of coronary artery disease - heaviness in the region of the heart, obvious and severe retrosternal pain - bursting, pressing or burning. Pain in the heart can be given to the shoulder of the left hand, between the shoulder blades, in the gastrointestinal tract, sometimes in the back of the neck.

The pain attack is accompanied by characteristic manifestations:

fear of dying
fatigue,
profuse sweating,
nausea, sometimes with vomiting,
pressure surges,
manifestations of tachycardia - increased heart rate.

The strength of the attack gradually increases, it can last from 1 minute to 15 minutes, the pain in the heart instantly disappears after reducing the load or after taking a nitroglycerin tablet (usually after five minutes). In a situation where the attack lasts more than 15-20 minutes, it can be assumed that it caused a myocardial infarction (International Classification of Diseases).

Patients of a young age often note a phenomenon, conventionally called “passing the pain”, which is characterized by a decrease or disappearance of pain with increasing load, which is explained by the lability of vascular tone.

Diagnostics

With typical manifestations of the disease, the diagnosis according to the ICD is easily established in 75-80% of cases according to the anamnesis, the results of the cardiogram, after which doctors have the opportunity to prescribe the correct treatment for stable angina pectoris. The criterion of the disease is the direct connection of seizures with stress and stressful situations, and their decrease in a calm state, or after a nitroglycerin tablet. In implicit cases, if it is impossible to immediately establish a diagnosis, an examination is prescribed.

Characteristic of the disease is the absence of changes in the electrocardiogram of the heart at rest in many patients. At the same time, on the cardiogram made at the time of the attack, a sign, as in IHD, is considered to be a decrease in the ST segment, inversion of the T wave and a pronounced rapid rhythm.

If it is impossible to immediately establish a diagnosis, or there is insufficient information about the history of stable angina pectoris, it is necessary to conduct daily ECG monitoring, which allows you to fix the alternation of pain / absence, and establish the moment and time of the duration of ischemic changes.

In order to clarify the clinical picture, bicycle ergometry is performed, and the results of the treadmill test are used. These studies help to give a full assessment of the degree of stress that the patient is able to endure before the onset of an attack. During these studies, the frequency of SS and the results of the cardiogram are constantly monitored, and blood pressure is monitored.

A positive load test during bicycle ergometry is considered when fixing the displacement of the ST segment by more than one mm, with a duration of more than 0.08 seconds, or the onset of an attack. If it is not possible to conduct a bicycle ergometry or perform a treadmill test, then doctors prescribe a transesophageal pacemaker (PE pacing) - a non-invasive therapy method in order to artificially speed up the heart rate and provoke an anginal attack.

The use of stress echocardiography makes it possible to obtain more information and identify ischemic disorders, determine the localization of areas with ventricular akinesia, as well as identify hypo and dyskinesia, which was not observed in a calm state.

Methods of laboratory diagnostics in this disease, in contrast to the detection of symptoms of coronary artery disease, are of an auxiliary nature. They are considered effective and effective for determining concomitant functional diseases and pathologies, such methods allow you to identify risk factors, and help to exclude other grounds for the appearance of pain.

For a complete and detailed determination of the state of the coronary vascular system, it is advisable to use CT coronary angiography, since such a study allows doctors to identify coronary atherosclerosis, assess the degree of stenosis, which ultimately allows choosing the optimal pathology treatment regimen.

Treatment of the disease

The main goal of therapeutic measures is to reduce the frequency of attacks, relieve their intensity until the main symptoms disappear, and, most importantly, remove the consequences, prevent the occurrence of complications - various heart pathologies and sudden death. Drug therapy consists in prescribing courses of taking drugs from the main groups - nitrates, beta-blockers and calcium channel blockers, which can reduce myocardial requests for oxygen consumption.

Nitroglycerin invariably has a positive effect at a certain stage of the disease, and it is advisable to take it to stop attacks, as in the syndrome of coronary artery disease, with pathologies of classes 1-3 according to the classification. Nitrates, which have a prolonged action, are prescribed by doctors for preventive purposes, to increase the periods between attacks. Their reception is recommended in cases where the attacks are repeated no more than once every 5-7 days, and are accompanied by burning pains in the heart. A good effect is given by lipid-lowering drugs and antiplatelet agents.

Surgical treatment of stable angina pectoris (according to the ICD) consists in myocardial revascularization, which is usually understood as coronary artery bypass grafting, but today there are already known cases of this procedure being carried out by stenting.

Forecast and prevention

A disease of this nature is dangerous because it can “doze off” for a long time and not show any signs, especially a tendency to progress, moreover, even a serious medical examination cannot establish the onset of the disease. With proper treatment methods, and constant monitoring of the patient by a cardiologist, the prognosis is quite favorable.

Medical statistics confirm the favorable clinical picture, and in 97% of cases - a return to normal life (subject to the recommendations of doctors, the absence of excessive stress, stress and the right lifestyle).

To reduce the number of risk factors for recurrent attacks, and the transition of pathology to myocardial infarction, doctors recommend a special diet with restriction of eating fatty foods, sugar, and pickles. Important for such patients is the constant monitoring of blood pressure (if necessary, stabilization of pressure) and the correction of a possible violation of carbohydrate metabolism.

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