Violations of the coronary circulation. Irreversible disorders of coronary blood flow

The heart is the central "pumping station" of the circulation. The cessation of heart activity even for a few tens of seconds can lead to serious consequences. Day and night, week after week, month after month and year after year, the heart pumps blood continuously. With each stroke, 50-70 ml of blood (a quarter or a third of a glass) is ejected into the aorta. With 70 beats per minute, this will be 4-5 liters (at rest). Get up, walk, climb the stairs - and the figure will double or triple. Start running - and it will increase by 4 or even 5 times. On average, the heart pumps up to 10 tons of blood per day, even with a lifestyle not associated with hard work, and per year - 3650 tons. During the life of the heart - this little worker, whose size does not exceed the size of a fist - pumps 300 thousand tons blood, working continuously, without stopping even for a few seconds. The work that the human heart performs throughout life is sufficient to lift a loaded railway car to the height of Elbrus.

To ensure this gigantic work, the heart needs a continuous supply of energetic and plastic materials and oxygen. The energy that the heart muscle (myocardium) develops during the day is approximately 20 thousand kgm. Energy intake is usually calculated in calories. It is known that 1 kcal is equivalent to 427 kgm. The efficiency of the heart and other muscles is approximately 25%. In order to develop energy equal to 20 thousand kgm, the heart must expend approximately 190 kcal per day.

Energy source - the process of oxidation of sugar or fats, which requires oxygen. When consuming 1 liter of oxygen, 5 kcal is released; with an energy expenditure of 190 kcal per day, the heart muscle must absorb 38 liters of oxygen. From 100 ml of flowing blood, the heart absorbs 12-15 ml of oxygen (other organs absorb 6-8 ml.). To deliver the necessary 38-40 liters of oxygen, about 300 liters of blood must flow through the heart muscle per day.

The heart muscle is supplied with blood through the coronary, or coronary, arteries. Coronary circulation has a number of features that distinguish it from blood circulation in other organs and tissues. It is known that in the arterial system there is a pulsating blood pressure: it increases during the contraction of the heart and decreases during its relaxation. An increase in pressure in the arteries with a contraction of the heart increases blood flow through organs and tissues. In the vessels of the heart, the opposite ratio is observed. With the contraction of the heart muscle, intramuscular pressure increases to 130-150 mm, which significantly exceeds the blood pressure in the capillaries. As a result, the capillaries shrink. Unlike blood flow in other organs and tissues, increased blood flow through the coronary vessels is observed not during contraction, but during relaxation of the heart.

With a rarer heart rate, the duration of periods of relaxation (diastole) of the heart increases, which naturally improves coronary blood flow, facilitating the nutrition of the heart muscle. With a rare rhythm, the heart works more economically and productively.

Interruptions in the supply of blood to the heart muscle reduce energy production and immediately affect the work of the heart. It is this condition that occurs in cases of coronary circulation disorders that are not accompanied by more serious consequences.

Disturbances in the blood supply to the heart muscle can occur with a sharp increase in the demand for oxygen in the heart muscle if the body does not have the ability to adequately increase coronary blood flow when the vessel is clogged with a blood clot, impaired patency, and atherosclerosis. In all these cases, there is a decrease in blood delivery to the heart muscle and a significant weakening of the function of the heart (despite the fact that the heart has some reserve devices for emergency supply of its energy). Such reserves in the heart muscle are the reserves of oxygen bound by the pigment - myoglobin, as well as the ability of the heart muscle to produce energy even without oxygen consumption (due to anaerobic glycolysis). However, these reserves are weak. They can provide energy to the myocardium only for a short time. Therefore, the heart can perform its function only if there is an uninterrupted supply of blood to the heart muscle (the amount of blood supply must correspond to the intensity of work).

In the process of evolution, nature has created a complex, “multi-storied” system of regulation of coronary blood flow. The vascular muscles of the coronary arteries are innervated by fibers of the sympathetic and parasympathetic nervous systems. Sympathetic fibers cause constriction of the coronary vessels, and parasympathetic - expansion. However, such reactions are observed only in the conditions of experiments on the vessels of a stopped heart. In cases where the heart continues to work, irritation of the sympathetic and parasympathetic fibers causes other reactions.

Under the influence of impulses coming through the sympathetic nerves, the work of the heart muscle increases sharply, the strength of each contraction increases, the amount of blood ejected by the heart into the vascular system and the frequency of contractions increase. All this leads to a significant increase in the energy consumption of the heart muscle and to the accumulation of a large amount of some metabolic products, which, as we already know, have a local vasodilating effect. Therefore, in a beating heart, irritation of the sympathetic nervous system leads not to narrowing, but to expansion of the coronary vessels. The parasympathetic system causes opposite shifts.

It has been established that the heart has its own mechanism of nervous regulation - the intracardiac nervous system, which continues to function even after the organ's connections with the brain and spinal cord are completely turned off. The fibers of the intracardiac nervous system innervate not only the heart muscle, but also the muscles of the coronary vessels. The regulation of coronary circulation can be carried out both by mechanisms functioning in the organ itself, and by a complex interaction of nerve signals that arise in the heart with impulses coming to the heart from the central nervous system.

Numerous, often duplicating each other, regulatory mechanisms ensure that the level of coronary blood flow is adapted to the energy needs of the heart muscle at rest, during physical exertion, emotional and mental stress.

The amount of coronary blood flow increases dramatically during intense physical activity, in which increased activity of the heart muscle causes an increase in its oxygen demand. The resulting expansion of the coronary vessels leads to a significant increase in the amount of blood flowing through the myocardium.

A similar effect is exerted by some adverse effects on the body associated with oxygen starvation or the accumulation of the main "slag" of life - carbon dioxide. The mechanisms of regulation of coronary blood flow in a healthy body quickly and accurately respond to changes in the needs of the heart muscle for oxygen or the conditions for its delivery.

Therefore, systematic physical activity, as well as a number of seemingly unfavorable factors and conditions that contribute to the development of oxygen starvation (stay in the mountains, at high altitudes, breathing gas mixtures with a low oxygen content and an increased carbon dioxide content, etc.) In reality, mechanisms are constantly trained that provide enhanced delivery of blood and oxygen to the heart muscle. The reserve capacity of these mechanisms increases and, consequently, increases the resistance of the heart and the body to the action of adverse factors.

This fact is of particular importance. It is possible to improve the state and capabilities of any regulatory mechanism only when increased demands are placed on the body. Not rest, namely increased activity, systematic training, i.e., periodic loads alternating with rest, is the only way to strengthen the mechanisms that regulate blood pressure, heart function and coronary blood flow.

Violation of the activity of the regulatory mechanisms described above can cause disorders in the blood supply to the heart muscle, sometimes leading to the appearance of necrosis foci in it - myocardial infarction.

The possibility of the occurrence of neurogenic lesions of the heart in the experiment was proved by the prominent Russian pathologist A. B. Fokht. He discovered that when the vagus nerves are stimulated, areas of necrosis of the heart muscle appear. When a drop of turpentine is injected into the trunk of the vagus or sympathetic nerve that innervates the heart, an electrocardiogram is recorded, which is characteristic of coronary circulation disorders. The degeneration and death of the myocardium occurred after mechanical damage to the fibers of the heart nerves, as well as with chronic irritation or damage to parts of the central nervous system that are in charge of regulating the function of the heart and blood vessels.

Myocardial injury can be reproduced in animal experiments with electrical stimulation of the vagus nerve, using stimuli weaker than those that can slow the heart rate.

When probing the coronary vessels by inserting a thin and flexible polyethylene catheter into the arterial system (if its coccyx touches the mouth of the coronary artery), a spasm of the coronary arteries, clearly visible on x-ray, develops, as well as changes in the electrocardiogram typical of coronary circulation disorders. Irritation of certain areas of the brain stem causes an increase in blood pressure and shifts in the electrocardiogram, which are characteristic of coronary blood flow disorders.

Clinical experience also indicates the possibility of acute coronary insufficiency when exposed to the central nervous system. Thus, for example, lesions of the base of the brain caused by acute disorders of cerebral circulation, as well as lesions of the interstitial brain or brain stem, are often accompanied by a disorder of the coronary circulation.

It was found that emotional and mental stress is accompanied by an increase in the amount of adrenaline, norepinephrine and related products (catecholamines) in the heart muscle, which leads to a significant increase in the energy of contractions and an increase in the heart's need for oxygen. But if the heart and its coronary vessels are not sufficiently trained, they cannot provide a sharp increase in myocardial blood supply. In this case, phenomena of oxygen starvation of the heart muscle, i.e., coronary insufficiency, may occur. There is a disproportion between the needs of the myocardium for oxygen and its supply to the heart with blood. This leads to the so-called "angina pectoris". In a practically healthy person, at the time of sudden physical or emotional stress, pain behind the sternum may occur. In addition, some researchers admit the possibility of direct neurogenic spasm of the coronary vessels.
G. N. Aronova in the laboratory studied the magnitude of the coronary circulation, using electronic sensors implanted in the dog's heart. In unanesthetized animals, with a sudden action of stimuli that cause pain reactions and negative emotions (the appearance of fear), a decrease in the amount of coronary blood flow and signs of coronary insufficiency were often noted.

At the Institute of Experimental Pathology and Therapy, they evoked negative emotions in male monkeys. For this, the male was separated from the female, with whom he had previously been together for a long time. The female was transferred to an adjacent cage, where another male was placed. All this caused the animal, which remained alone, to scream, worry, fits of rage, the desire to break the barrier. However, all attempts to connect with the female were in vain. The animal left alone witnessed the intimacy that arises between a former girlfriend and a new cohabitant. The electrocardiogram showed signs of acute coronary insufficiency. Attacks of violent rage and sharp emotional reactions were replaced by periods of deep depression. The state of oxygen starvation of the heart muscle increased, and in a number of experiments the animals died from acute myocardial infarction. An autopsy confirmed the diagnosis. These cruel experiments are necessary in order to understand the mechanisms of a heart attack in humans. Doesn't life sometimes bring us similar surprises? Are some situations that lead a person to a heart attack less ruthless, hopeless, tragic?

It has also been found experimentally that experimental neuroses in monkeys, arising under other circumstances, sometimes cause severe disturbances in the coronary circulation. Neuroses were reproduced according to the classical Pavlovian method, similar to that used by M. K. Petrova in the experiments described above on dogs (by overstraining the processes of excitation or inhibition, or by “collising” these processes). Such injury to the higher parts of the brain was accompanied by the appearance on the electrocardiogram of changes characteristic of coronary insufficiency and myocardial infarction.

A similar state arose even with changes in the usual daily rhythm of life, for example, with a shift in daytime and nighttime regimes, when at night the monkeys were exposed to influences characteristic of the daytime - feeding, exposure to light stimuli, etc., and left in silence and darkness during the day .

The same effect was caused by the regime in which the day was compacted to 12 hours with a 6-hour change of "day" and "night", as well as the regime in which lighting and other stimuli characteristic of daytime affected animals continuously day and night. for many days. If such types of regimens continuously and randomly replaced each other - so that the animal did not have time to adapt to each of them, then after a few months a breakdown of higher nervous activity occurred, often accompanied by violations of the coronary circulation. In some cases, myocardial infarction was detected.

In experiments on animals, it was found that disorders of the coronary circulation sometimes appeared with injuries of the skull and even with the introduction of air into the ventricles of the brain.

It is known that coronary circulation is affected by signals acting through the higher parts of the brain (cerebral cortex) by the mechanism of conditioned reflexes. Changes in blood flow in the heart muscle usually occur not only immediately at the time of an increase in heart function with an increased load, but also in advance, adapting the heart to the work ahead. However, conditioned signals can not only increase but also decrease coronary blood flow, which sometimes leads to acute disorders of the coronary circulation.

For remote control of coronary blood flow, a special device was developed, which was applied to one of the coronary arteries of the heart during a preliminary surgical operation. The device was a loop controlled by nylon threads, brought through the chest wall to the surface of the animal's body. A few days after the operation, when the wound healed and the animal became practically healthy, it was possible, by tightening the loop, to cause a sudden cessation of blood flow in one of the coronary arteries, and by loosening the loop, to restore coronary blood flow.

This technique was used by a group of employees in the study of the effects of coronary circulation disorders on the activity of internal organs and systems. After carrying out a series of experiments on the same animal, in the future, it was enough just to place the animal in the machine and touch the skin in the place where the loop was usually controlled in order to cause changes typical of a violation of the coronary circulation.

Thus, the setting of experiments in which disturbances in the coronary circulation were systematically reproduced becomes a conditioned signal that causes disturbances without tightening the loop.

Conditioned reflex disorders of the coronary circulation can also occur in humans. Let's give some examples. Once, during the performance of a symphony, the conductor suddenly felt a sharp attack of pain behind the sternum and had to leave the stage. The vasodilators relieved the pain. And he continued to work. Then the conductor had to perform the same piece again. As he approached the musical phrase, during which the first attack had earlier occurred, he again had sharp pains behind the sternum. The conductor refused to perform this symphony, and the attacks stopped.

In another case, sharp pains behind the sternum arose in an employee who was in a hurry to work. The attack was eliminated by vasodilators. But the next day, when he reached the same intersection, the attack of pain was repeated. The man had to change the way he went to work, and the attacks stopped. In both cases, apparently, we are talking about patients with latent manifestations of coronary insufficiency, which were activated under the action of typical conditioned signals by the mechanism of a conditioned reflex.

The results of an 8-month follow-up of a young patient are described, in whom the tense expectation of an unpleasant procedure (an injection, intravenous injection, etc.) caused an increase in blood pressure and electrocardiogram shifts characteristic of coronary circulation disorders. It was noted that in patients with myocardial infarction, talking about the situation and difficulties that preceded the onset of a heart attack can cause chest pain and changes in the electrocardiogram, indicating a violation of the coronary circulation.

Changes in the electrocardiogram, characteristic of the state of acute coronary insufficiency, were observed in people during hypnosis, when they were inspired by a feeling of fear and anger. In experiments conducted in the laboratory of P. V. Simonov, actors and researchers mentally reproduced unpleasant events. With imaginary fear, they experienced an increase in heart rate and shifts in the electrocardiogram, which are characteristic of coronary blood flow disorders.

With continuous recording of the electrocardiogram in a working environment, train drivers found that an unforeseen emergency situation causes sharp shifts in the electrical activity of the heart, characteristic of oxygen starvation of the heart muscle.

Changes in electrocardiograms typical of coronary insufficiency are described in individuals who are in a state of fear or anxiety. Emotional stress (anticipation of a surgical operation, sports competitions and professional nervous tension) can cause changes in the electrocardiogram, indicating a violation of the coronary circulation.

It is known that acute disorders of the coronary circulation can develop at night during sleep against the background of mental and physical rest. Some researchers tend to see this as evidence of the coronary action of the vagus nerve, believing that night is the “kingdom of the vagus” (i.e., the state when the tone of the parasympathetic nervous system predominates). In reality, however, the situation is much more complicated. It has now been proven that sleep is not only rest, peace, and inhibition. During sleep, periods of rest are accompanied by the emergence of states of a kind of vigorous activity of the brain, disconnected for a while from the influences of the external environment. These are periods of "paradoxical sleep", during which there is, as it were, a repeated reproduction and experience of daytime impressions, which is necessary to systematize them and fix them in memory. Thus, paradoxical sleep is an active process that often occurs with phenomena of shifts in the activity of internal organs, characteristic of strong emotional stress.

It has been suggested that disorders of the coronary circulation that sometimes occur during sleep appear not against the background of rest, but during paradoxical sleep and the enhanced brain activity that occurs during it, during which daytime impressions and emotions are often reproduced and experienced again. This assumption was confirmed in a number of subsequent observations.

All of the above makes it clear that even in practically healthy individuals, an overstrain of the nervous system and negative emotions can cause coronary insufficiency, i.e. oxygen starvation of the heart muscle. This can lead to a number of complications: changes in the heart rhythm, interruptions (the appearance of extraordinary contractions), and sometimes to the occurrence of heart muscle flutter. Acute oxygen starvation of the heart muscle causes an attack of pain, typical electrocardiogram shifts and other disorders. If the disturbed circulation is not restored, a myocardial infarction may occur.

The reserve capacity of the coronary circulation, which is so necessary for the body in emergency situations, is sharply reduced in atherosclerosis (which often leads to a direct disruption of the blood supply to the muscles of the heart and other organs).

In violation of the coronary circulation, many diseases can develop that must be treated in a timely manner. For example, VVD treatment should be started after the first signs of appearance and preferably in specialized clinics.

When the supply of a myocardial area with blood is interrupted or reduced, there is a lack of nutrients and oxygen in it to carry out a full contraction and impulse conduction. This condition is called coronary insufficiency and is associated with changes in the coronary artery system.

The most common cause is atherosclerosis, but a similar syndrome also occurs with inflammatory, metabolic, anatomical disorders of the vessels that feed the heart, and blood diseases. Acute pathology leads to a heart attack, and in a chronic course, angina attacks occur.

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Causes of coronary insufficiency

In most cases, coronary arteries lead to obstruction of blood flow to the myocardium. The main risk factors are:

obesity,
stress,
high blood cholesterol,
genetic predisposition,
smoking,

In addition to coronary heart disease, as the main manifestation of coronary insufficiency, there are a number of diseases that occur with attacks of pain in the heart by type or are complicated by the formation of a focus of necrosis in the heart muscle (infarction):

arteritis of the coronary vessels (with, systemic lupus erythematosus, syphilis);
violation of the structure of the arteries (deformation) after radiation therapy, hereditary changes in the formation of fibrin fibers;
compression of the arteries by a tumor or adhesion;
vessel injury;
bacterial,;
thyrotoxicosis;
occlusion of the lumen by a thrombus or embolus.

Symptoms of the disease

The leading sign of coronary insufficiency is. It has the following characteristic features:

localized behind the sternum, gives to the left shoulder, shoulder blade, neck;
has a pressing or compressive character;
occurs during stress (physical or emotional);
accompanied by shortness of breath, weakness, fear of death.

In patients, the rhythm of heart contractions is disturbed, in the later stages, weakness of cardiac activity occurs, manifested by edema, accumulation of fluid in the chest, abdominal cavity, palpitations and asthma attacks.

A prolonged attack of retrosternal pain, as a rule, indicates development. But, depending on the location of the site of necrosis, the functionality of the nervous and circulatory systems, there are such forms:

Severe angina, poorly amenable to therapy, in the presence of a 75% decrease in blood flow through the coronary vessels, damage to 2 or 3 branches, the trunk of the left or external right artery, is an indication for surgical treatment. Use a stent, bypass, or balloon expansion.

Watch the video about acute coronary syndrome, its causes and treatment:

Diagnostic methods

In addition to the data obtained by questioning the patient and listening to the heart, the results of such examination methods are taken into account:

general blood test and specific enzymes that increase with the destruction of myocardial cells (creatine phosphokinase, troponin T, lactate dehydrogenase), ALT, AST;
lipid profile, blood sugar, coagulogram, C-reactive protein;
ECG, as the most informative method, can be performed with stress tests, transesophageal or Holter (daily monitoring). The ST segment is displaced, with a deep infarction, a Q wave is formed;
coronary angiography is prescribed to visualize the patency of the arteries when determining indications for surgery;
Echocardiography reveals a violation of the movement of the walls of the left ventricle, anomalies in the structure of the chambers and valves;
MRI and CT are recommended in difficult cases to assess the degree of myocardial damage and identify the cause of the pathology;
myocardial scintigraphy helps to detect areas with poor blood flow.

Treatment of coronary insufficiency

To restore blood flow in the affected arteries, drugs and correction of nutrition and lifestyle are used. With a severe degree of the disease, surgical methods are indicated to restore myocardial nutrition.

First aid

If you suspect acute coronary insufficiency (heart attack), you need to call an ambulance as soon as possible, and even better - a cardiology team.

At this time, the patient should be seated or laid down with an elevated chest. Then give a lozenge and an Aspirin tablet, it should be chewed. You can repeat after 15 minutes.

If the patient is unconscious, there is no spontaneous breathing, there is no pulse on the carotid artery, then it is urgent to start artificial ventilation (mouth-to-mouth) and heart massage with rhythmic pressure on the lower third of the sternum with both hands before the doctors arrive.

Medications

The appointment of drugs is carried out depending on the cause of myocardial malnutrition. In ischemic disease, antiplatelet agents, beta-blockers and lipid-lowering agents are prescribed. In addition, diuretic and antiarrhythmic drugs and nitrates may be recommended. Thrombolytics (enzymes and anticoagulants) are used to dissolve blood clots in the acute stage.

An active inflammatory process requires the inclusion of corticosteroids and antibiotics in the complex therapy in the presence of infection. In diseases of the organs of the endocrine system, it is necessary first of all to restore the hormonal balance.

Prognosis for pathology

The success of the treatment of coronary syndrome depends on the degree of impaired vascular patency, the presence of concomitant diseases (hypertension, diabetes, lipid metabolism disorders), as well as the age of patients, the possibility of developing collateral circulation.

In difficult cases, treatment can only stop the development of heart failure, but it is difficult to achieve a full recovery.

A favorable prognosis is noted with functional spasms of blood vessels, slight progression of angina pectoris, and a timely operation.

Prevention of coronary heart failure

To prevent ischemia of the heart muscle is required:

exclude alcoholic beverages, smoking;
sharply limit animal fats, sugar, white flour, table salt in the diet;
get rid of excess weight;
daily devote time for therapeutic exercises, hiking;
control the ECG;
measure blood pressure, cholesterol and blood sugar;
undergo a full course of treatment for infectious, autoimmune and endocrine diseases.

Coronary insufficiency occurs when there is a violation of the supply of blood to the heart muscle. The most common cause is atherosclerosis of the coronary arteries. Also, an inflammatory process, vascular thrombosis or embolism can lead to coronary syndrome.

Clinical manifestations are attacks of pain in the heart of the type of angina pectoris, complications occur in the form of myocardial infarction or sudden cardiac arrest. Treatment is with medications and surgery. Progression can be prevented through lifestyle changes.

Causes

Coronary insufficiency syndrome can occur for various reasons. Most often it is caused by spasms, atherosclerotic and thrombotic stenosis.

Main reasons:

coronaritis;
vascular damage;
stenosis of the pulmonary trunk;
anaphylactic shock;
violation of the patency of the arteries. This can happen due to absolute or partial occlusion of blood vessels, spasm, thrombosis, and so on.

Symptoms

The most common cause of death from vascular and heart diseases is coronary insufficiency. This is due to the fact that both the heart and blood vessels are damaged almost equally. In medicine, this phenomenon is called sudden coronary death. All the symptoms of this disease are complex, but the main and most significant is precisely the attack of angina pectoris.

sometimes the only symptom of coronary insufficiency is severe pain in the region of the heart or behind the sternum, which lasts about 10 minutes;
stiffness. Occurs during increased physical stress;
pallor of the skin;
dyspnea;
cardiopalmus;
breathing slows down, becomes more shallow;
vomiting, nausea, salivation increases;
urine has a light color and is excreted in larger quantities.

acute form

Acute coronary insufficiency- This is a pathological condition that develops as a result of a spasm of blood vessels that saturate the heart muscle with blood. A spasm can develop in a person both in a state of complete physical rest, and with increased emotional and physical. loads. Sudden death is directly related to this disease.

The clinical syndrome of acute coronary insufficiency is popularly called angina pectoris. The attack develops due to a lack of oxygen in the tissues of the heart. Oxidation products will not be excreted from the body, but will begin to accumulate in the tissues. The nature and strength of the attack directly depends on several factors:

the reaction of the walls of the affected vessels;
area and extent of atherosclerotic lesions;
annoying power.

If attacks develop at night, in a state of complete rest and are difficult, then this indicates that serious vascular damage has occurred in the human body. As a rule, pain occurs in the region of the heart suddenly, and lasts from two to twenty minutes. Irradiates to the left half of the body.

Chronic form

Occurs in humans due to angina pectoris and atherosclerosis of blood vessels. In medicine, there are three degrees of the disease:

initial degree of chronic coronary insufficiency (CCI). A person has infrequent attacks of angina pectoris. They are provoked by psycho-emotional and physical. loads;
pronounced degree of HKN. Attacks become more frequent and more intense. The reason is the physical activity of the average level;
severe degree of HKN. Attacks in a person occur even in a calm state. There is arrhythmia and severe pain in the region of the heart.

The patient's condition will gradually worsen, as the vessels will narrow. If the metabolic disorder is very long, then new deposits will appear on the plaques that have already formed on the walls of the arteries. The flow of blood to the heart muscle will decrease significantly. If chronic coronary insufficiency is not properly treated, sudden death can occur.

Sudden death

Sudden death is a quick death due to vascular and heart diseases that occurs in people whose condition can be called stable. In 85-90% of cases, the cause of this condition is coronary artery disease, including the course without severe symptoms.

asystole of the heart;
ventricular fibrillation.

When examining the patient, pallor of the skin is noted. They are cold and have a grayish tint. Pupils gradually become wider. Pulse and heart sounds are practically not determined. Breathing becomes agonal. Three minutes later, the person stops breathing. Death is coming.

Diagnostics

electrocardiogram;
coronary angiography (coronary angiography);
MRI of the heart (magnetic resonance imaging).

Treatment

Treatment of coronary insufficiency must be started as early as possible in order to achieve favorable results. It does not matter what causes this condition, but it requires qualified treatment. Otherwise, death may occur.

Treatment of coronary insufficiency syndrome should be carried out only in stationary conditions. The therapy is quite long and has a lot of nuances. The first thing to do is to fight the risk factors for coronary artery disease:

avoid overeating;
correctly alternate periods of rest and activity;
diet (especially important for the heart);
increase physical activity;
do not smoke or drink alcoholic beverages;
normalize body weight.

Medical therapy:

antianginal and antiarrhythmic drugs. Their action is aimed at the prevention and relief of angina attacks, the treatment of cardiac arrhythmias;
anticoagulants (in the treatment of OKN they occupy an important place, as they are intended for blood thinning);
anti-bradykinin honey. facilities;
vasodilator honey. funds (Iprazid, Aptin, Obzidan, etc.);
lipid-lowering drugs;
anabolic drugs.

Surgical and intravascular treatments are used to restore blood flow in the coronary arteries. These include the following methods:

coronary bypass;
stenting;
angioplasty;
direct coronary atherectomy;
rotational ablation.

Prevention

Proper treatment will help eliminate acute coronary insufficiency, but it is always easier to prevent the disease than to treat it. There are preventive measures that make it possible to prevent the development of this disease:

you need to exercise regularly. You can go swimming, walk more. Loads should be increased gradually;
avoid stressful situations. Stress is everywhere in our lives, but it is the heart that suffers most from it, so you need to try to avoid such situations in order to protect it;
balanced diet. The amount of animal fats in the diet should be reduced;

Coronary insufficiency is a very complex and dangerous disease that can lead to death. Therefore, it is important to know all its main symptoms and first signs in order to provide emergency care to the patient. Treatment of this disease is long and must be carried out in a timely manner to prevent the occurrence of sudden death. It should be especially noted that OKN has significantly “younger” over the past few years. Now it affects people of working age. The sooner the disease or condition that can provoke its development is treated, the more favorable the prognosis will be.

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Diseases with similar symptoms:

Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disturbed, and the heart ceases to fully fulfill its main function - supplying oxygen to all organs and tissues.

The amount of coronary blood flow depends on the tone of the coronary vessels. Irritation of the vagus nerve usually causes a decrease in coronary blood flow, which seems to depend on a decrease in heart rate (bradycardia) and a decrease in mean pressure in the aorta, as well as a decrease in the heart's need for oxygen. Excitation of the sympathetic nerves leads to an increase in coronary blood flow, which is obviously due to an increase in blood pressure and an increase in oxygen consumption, which occurs under the influence of norepinephrine released in the heart and adrenaline brought in by the blood.

Acute coronary insufficiency is characterized by a mismatch between the need of the heart for oxygen and its delivery with blood. Most often, insufficiency occurs with atherosclerosis of the arteries, spasm of the coronary (mostly sclerotic) arteries, blockage of the coronary arteries by a thrombus, rarely an embolus.

The result of acute coronary insufficiency is myocardial ischemia, causing a violation of oxidative processes in the myocardium and excessive accumulation of underoxidized metabolic products in it.

Myocardial infarction - focal ischemia and necrosis of the heart muscle that occurs after a prolonged spasm or blockage of the coronary artery (or its branches). The coronary arteries are terminal, therefore, after the closure of one of the large branches of the coronary vessels, the blood flow in the myocardium supplied by it decreases tenfold and recovers much more slowly than in any other tissue in a similar situation.

The contractility of the affected area of the myocardium drops sharply and then completely stops.

Cardiogenic shock is a syndrome of acute cardiovascular insufficiency that develops as a complication of myocardial infarction. Clinically, it manifests itself as a sudden sharp weakness, blanching of the skin with a cyanotic tint, cold sticky sweat, a drop in blood pressure, a small frequent pulse, lethargy of the patient, and sometimes a short-term impairment of consciousness.

In the pathogenesis of hemodynamic disorders in cardiogenic shock, three links are essential:

1) decrease in stroke and minute volume of the heart (cardiac index below 2.5 l/min/m2);

2) a significant increase in peripheral arterial resistance (more than 180 dynes/sec);

3) violation of microcirculation.

In severe shock, a vicious circle occurs: metabolic disorders in tissues cause the appearance of a number of vasoactive substances that contribute to the development of vascular disorders and erythrocyte aggregation, which, in turn, maintain and deepen existing disorders of tissue metabolism.

As tissue acidosis increases, deep violations of enzyme systems occur, which leads to the death of cellular elements and the development of small necrosis in the myocardium, liver, and kidneys.

Violations coronary blood circulation. Value coronary blood flow depends on tone coronary vessels.

3) violations coronary blood circulation; 4) disorders of the function of the pericardium. Mechanisms of development in heart failure.

Ischemic heart disease is myocardial damage caused by a disorder coronary blood circulation resulting from violations balance between...

Violations coronary blood circulation. Value coronary blood flow depends on tone coronary vessels. Irritation of wandering n.

Violations coronary blood circulation. Value coronary blood flow depends on tone coronary vessels.

coronary blood flow.
violations cerebral blood circulation.

... diseases caused by absolute or relative insufficiency coronary blood flow.
resulting from acute violations cerebral blood circulation.

In a crisis, dangerous violations cerebral coronary, less often renal and abdominal blood circulation leading to a stroke...

Violations cerebral blood circulation: damage to the internal carotid artery.
Violations cerebral blood circulation with persistent focal syndrome proceed differently.

... diseases caused by absolute or relative insufficiency coronary blood flow.
resulting from acute violations cerebral blood circulation.

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CORONARY INSUFFICIENCY

coronary insufficiency- a typical form of heart pathology, characterized by an excess of myocardial demand for oxygen and metabolic substrates over their inflow through the coronary arteries, as well as a violation of the outflow of metabolic products from the myocardium.

The leading pathogenetic factor of coronary insufficiency is myocardial ischemia.

Clinically, coronary insufficiency manifests itself as coronary heart disease (CHD). With damage to the coronary arteries, angina pectoris, myocardial infarction, arrhythmias, heart failure, and sudden cardiac death may develop.

Types of coronary insufficiency

All types of coronary insufficiency, depending on the degree and reversibility of myocardial damage, are divided into reversible and irreversible.

REVERSIBLE CORONARY FLOW DISORDERS

Reversible (transient) disorders of coronary blood flow are clinically manifested by various forms of angina pectoris and conditions after reperfusion (revascularization) of the myocardium, including the state of stunned myocardium.

angina pectoris

angina pectoris- a disease caused by coronary insufficiency, and characterized by reversible myocardial ischemia.

There are several types of angina pectoris.

Stable exertional angina. Usually it is a consequence of a decrease in coronary blood flow to a critical level, a significant increase in the work of the heart, and more often a combination of both.

Unstable angina pectoris. It is characterized by increasing in frequency, duration and severity of angina attacks. These episodes are usually the result of a progressive decrease in coronary blood flow.

Variant angina (Prinzmetal's angina) is the result of a prolonged transient spasm of the branches of the coronary arteries.

Conditions after myocardial reperfusion develop in patients with coronary artery disease as a result of surgical resumption or a significant increase in coronary blood flow (for example, after coronary artery bypass grafting, stenting, or percutaneous intravascular angioplasty), as well as medical and spontaneous restoration of blood flow in the coronary arteries (for example, due to thrombolysis, disaggregation of blood cells) .

IRREVERSIBLE DISORDERS OF THE CORONARY BLOOD FLOW

An irreversible cessation or a long-term significant decrease in blood flow through the coronary artery in any region of the heart ends, as a rule, with myocardial infarction.

myocardial infarction- focal necrosis of the heart muscle as a result of an acute and significant discrepancy between myocardial oxygen demand and its delivery.

The most common cause of myocardial infarction is coronary artery thrombosis, which developed against the background of atherosclerotic changes (up to 90% of all cases).

With myocardial infarction, life-threatening complications are possible:

♦ acute heart failure (cardiogenic shock, pulmonary edema);

♦ rupture or aneurysm of the heart;

♦ valve insufficiency;

♦ cardiac arrhythmias;

♦ thromboembolism.

If the heart attack does not lead to the death of the patient, then the dead part of the heart is replaced by connective tissue - post-infarction cardiosclerosis develops.

With prolonged hypoperfusion of a myocardial site (for example, below an extensive atherosclerotic plaque in a coronary artery), a state of hibernation may develop (from the English. hibernation- inactivity, hibernation). The hibernated myocardium is characterized by a persistent decrease in its contractile function.

The state of hibernation of the myocardium is reversible and its function is gradually restored with the resumption of adequate coronary blood flow.

CARDIAC ISCHEMIA- pathology of the heart caused by acute or chronic recurrent myocardial ischemia due to narrowing or blockage of the lumen of the coronary arteries of the heart by atherosclerotic plaques or as a result of thrombosis or spasm of the coronary arteries associated with atherosclerosis. Etiology and pathogenesis. At the heart of I. b. With. always lies coronary insufficiency due to atherosclerosis of the coronary arteries of the heart. R development I. b. With. contribute to many internal and external factors, called risk factors. The main, or "big" risk factors include nek-ry disorders of lipid metabolism, usually characterized by a high content of cholesterol in the blood (hypercholesterolemia), arterial hypertension, diabetes mellitus, smoking, low physical activity; prolonged psycho-emotional stress.

The basis of the pathogenesis of myocardial ischemia at all forms And. With. is the discrepancy between the need of the heart muscle for oxygen and nutrients and their flow through the narrowed coronary arteries. An important pathogenetic factor in the development of myocardial ischemia in I. b. With. there may be a spasm of the coronary arteries of the heart. Great value in a pathogeny of coronary insufficiency at And. With. have impaired platelet function and increased blood clotting, which can impair microcirculation in myocardial capillaries and lead to arterial thrombosis, which is facilitated by atherosclerotic changes in their walls and slowing of blood flow in places of narrowing of the lumen of the arteries. Recurrent and prolonged attacks of angina during exacerbation I. b. With. often associated with the development of thrombosis.
Myocardial ischemia negatively affects the functions of the heart - its contractility, automatism, excitability, conduction. Short-term ischemia is usually manifested by an attack of angina pectoris or its equivalents: transient arrhythmias, shortness of breath, dizziness, etc. At the same time, any pronounced morphological changes do not have time to occur in the myocardium. If ischemia lasts 20-30 minutes, focal myocardial dystrophy develops.

Angina pectoris is a sudden attack of chest pain that develops as a result of an acute lack of blood supply to the heart muscle.

angina pectoris. It is characterized by transient attacks of retrosternal pain caused by physical or emotional stress or other factors leading to an increase in the metabolic needs of the myocardium. The duration of an anginal attack with angina pectoris is almost always more than 1 minute. And less than 15 minutes. The pain disappears at rest or after taking nitroglycerin under the tongue in 2-3 minutes.

First time angina pectoris. Duration up to 1 month from the moment of appearance. May progress to stable angina. Possible regression.