What is atherosclerosis of the coronary arteries. Causes of the development of atherosclerosis of the heart vessels and its consequences

Atherosclerosis of the coronary arteries of the heart - The blood supply to the heart is provided by two coronary arteries that arise from the very beginning of the aorta (the central blood vessel of our body). Any disruption of blood circulation through the coronary (coronary) arteries of the heart leads to disruption of the heart muscle and can cause the development of a heart attack (death of part of the heart muscle). Most common cause disorders of blood circulation in the coronary arteries of the heart is atherosclerosis of these arteries. Atherosclerosis of the coronary arteries is characterized by the formation of dense plaques (seals) in the walls of the arteries, which over time destroy and deform the artery wall and narrow its lumen. The degree of narrowing of the artery lumen and impaired blood circulation determine the severity of symptoms of atherosclerosis of the coronary arteries. It must be said that the symptoms (signs) of atherosclerosis of the coronary arteries are identical to the symptoms of coronary heart disease, the main cause of which is atherosclerosis of the heart vessels.

Myocardial infarction - vascular necrosis of the heart muscle, which is the most severe variant of acute ischemic heart disease and in almost every third case ends in death.

By localization distinguish infarction of the anterior, posterior and lateral walls of the left ventricle, interventricular septum, apex of the heart and extensive infarction. Isolated infarction of the right ventricular wall is relatively rare. In some cases, an extensive infarction can spread to the atria.

In relation to the layer of the heart muscle There are transmural (most common), subendocardial, intramural and rare subepicardial myocardial infarction.

Depending on the temporal characteristics of the occurrence, we can talk about a primary (acute) myocardial infarction, occurring within 4 weeks before the formation of a scar, a recurrent one, developing 4 weeks after the acute one, and a recurrent one, observed within 4 weeks of the primary or repeated infarction.

Stages of development of infarction: 1) the ischemic stage lasting up to 18 hours is characterized by the almost complete absence of macroscopic changes in the heart. Only towards the end of this period can one see some uneven blood supply to the myocardium. However, after 30 minutes, electron microscopy reveals swelling of cardiomyocyte mitochondria, destruction of their cristae, and a decrease in the number of glycogen granules. Subsequently, rupture of the sarcolemma, edema, minor hemorrhages and release of individual neutrophils into the myocardium develop. 2) the necrotic stage is characterized by already visible necrosis, which is noted 18-24 hours after the onset of ischemia. In the myocardium there is a focus of irregular shape, yellowish-white color, flabby consistency, surrounded by a dark red rim (ischemic infarction with a hemorrhagic rim). Microscopic examination of the heart muscle distinguishes three zones: necrotic, demarcation and preserved myocardium. The necrosis zone is represented by cardiomyocytes with the phenomena of karyolysis, plasmolysis and plasmorexis, surrounded by demarcation inflammation, in the zone of which, in addition to large quantity hyperemic vessels contain many polymorphonuclear neutrophils (leukocyte shaft). Edema phenomena are observed in the intact myocardium. 3) stage of organization. Already from the 3rd day, the disintegration of dead muscle cells by macrophages begins, and individual fibroblasts appear. However, only by the 7th day, granulation tissue with a large number of fibroblasts and macrophages is formed at the edges of the necrosis, gradually replacing the affected area over the course of a month. As a result, on the 28th day a scar forms (post-infarction cardiosclerosis).

Complications: with transmural myocardial infarction, the development of fibrinous pericarditis, arrhythmias (complete or incomplete heart block, ventricular extrasystoles, paroxysmal arrhythmia), and pulmonary edema is possible.

Causes of death: acute cardiovascular failure, cardiogenic shock, ventricular fibrillation, asystole. Rhythm disturbances occur when the interventricular septum, in which the conduction system of the heart is localized, is damaged. As a result of softening of the heart muscle in the area of ​​transmural infarction (myomalacia), the development of an acute cardiac aneurysm with its subsequent rupture is possible. In this case, death occurs from tamponade of the pericardial cavity.

Sudden coronary death- a naturally occurring fatal outcome of a disease of the cardiovascular system within one hour from the onset of its development in persons who were previously in a stable condition (in the absence of signs allowing a different diagnosis to be made). Sudden cardiac death includes cases of sudden cessation of cardiac activity, which are characterized by the following signs: 1) death occurred in the presence of witnesses within one hour after the onset of the first threatening symptoms; 2) before death, the condition of the patients was assessed by others as stable and not causing serious concern; 3) death occurred under circumstances excluding other causes (violent death, injuries, other fatal diseases).

HEART DISEASES – Heart-Disease.ru – 2007

Coronary atherosclerosis is a lesion of the coronary arteries that supply the heart, in which their lumen narrows and the blood supply to the heart decreases.

Atherosclerosis is a complex, multistage pathological process, affecting the inner lining (intima) of large and medium-sized arteries. The intima contains a thin layer connective tissue and is delimited from the muscular lining of the artery (media) by an internal elastic membrane, and from the lumen of the vessel by a monolayer of endothelial cells forming a continuous, smooth, non-adhesive surface. The endothelium acts as a semi-permeable membrane, which, on the one hand, is a barrier between the blood and the vascular wall, and on the other hand, ensures the necessary exchange of molecules between them. On the surface of the endothelium there are specialized receptors for various macromolecules, in particular, for low-density lipoproteins. The endothelium secretes a number of vasoactive substances (endothelin, prostacyclin, nitric oxide), as well as factors of coagulation and anticoagulation systems, due to which it plays a key role in the regulation of vascular tone, blood flow and hemocoagulation.

Currently, atherosclerosis is considered as a reaction to damage to the vascular wall (primarily the endothelium). Damage does not mean mechanical injury to the endothelium, but its dysfunction, which is manifested by increased permeability. The most important damaging factor is hypercholesterolemia.

In general, atherosclerosis is a process characterized by patterns characteristic of any inflammation: exposure to a damaging factor (low-density lipoproteins that have passed through the endothelium of the vessel, where they have undergone oxidation), cellular infiltration, phagocytosis and the formation of connective tissue.

Infiltration occurs by monocytes circulating in the blood, transforming into macrophages aimed at capturing oxidized low-density lipoproteins with their subsequent destruction. This is how lipid strips are formed on the walls of the vessel - foam cells formed from macrophages with accumulated cholesterol esters.

Subsequently, connective tissue develops around the area of ​​lipid accumulation and the formation of a fibrous atherosclerotic plaque occurs.

Atherosclerosis of the coronary arteries does not always manifest itself immediately. Often the disease damages the heart and blood vessels asymptomatically for many years and, if not treated timely diagnosis and treatment, leads to angina pectoris, myocardial infarction, disorders heart rate and heart failure.

In most cases, if symptoms of coronary heart disease are present, diagnosing the disease is not difficult. For this purpose, methods such as ECG, daily ECG monitoring, echocardiography, radionuclide studies, exercise tests (bicycle ergometry and treadmill test) are used.

However, diagnosing the disease in the early stages, before symptoms appear, is different.

Early detection of atherosclerosis of the coronary arteries became possible after the advent of techniques computed tomography with a very short time for obtaining sections on electron beam tomography and multislice computed tomography devices. A feature of these methods is the ability to obtain images of calcifications of the coronary arteries. The study takes only 5-10 minutes in total, and the time for direct data collection is 30-40 seconds (one breath hold). Such studies are not burdensome for the patient and do not require special preparation or physical activity. The results of the study do not depend on the patient’s gender and physical fitness.

Causes of atherosclerosis of the coronary arteries, and methods of its treatment

Many people know that with atherosclerosis, deposits settle on the walls of blood vessels. cholesterol plaques, which gradually reduce the lumen of this vessel. Atherosclerosis of the coronary arteries is the same process, but it occurs specifically in the coronary arteries, which is why insufficient blood flows to the heart muscle. What are the reasons for this condition?

Causes of blockage of blood vessels

Atherosclerosis of the heart vessels can develop due to internal and external causes. If you thoroughly count all the reasons, there may be about 200 of them. The most common among them are the following:

• hypertension;
• high cholesterol (cholesterol is the main component of plaques that settle on arterial walls);
• smoking (tobacco smoke contains substances that damage the walls of blood vessels and accelerate the development of atherosclerosis);
• passive lifestyle;
• excess weight.

The main cause of the disease is high level cholesterol

These are just some examples. There are family-hereditary causes when the content of various classes of lipids in the plasma decreases. The hereditary nature also includes negative eating habits, which include the consumption of animal fats and foods that contain high amounts of cholesterol.

If a person understands that some of these prerequisites are present in his life, he needs to be more careful and more attentive to his health. In addition, it is important to detect the onset of the disease in a timely manner.

Symptoms of the disease

Atherosclerosis of the coronary arteries is characterized by symptoms that do not always prompt a person to immediately consult a doctor. These signs may masquerade as other diseases. It is very important to identify them as early as possible and seek help. Symptoms may include:

Chest pain is a reason to see a doctor

chest pain, pressing or burning, may radiate to the back or left shoulder;

shortness of breath, especially manifested at the onset of pain, sometimes due to lack of air a person cannot lie down, since this feeling is aggravated by this position to such an extent that the person cannot breathe at all;

dizziness;

nausea;

vomit.

As you can see, atherosclerosis manifests itself in signs characteristic of ischemic heart disease, angina pectoris, myocardial infarction and cardiosclerosis. Accordingly, you need to imagine how these diseases manifest themselves. For example, during myocardial infarction, severe chest pain is observed, which resembles angina pectoris, but does not go away after nitroglycerin. Loss of consciousness and manifestations of heart failure are also possible. With cardiosclerosis, swelling and shortness of breath appear.

About fifty percent of patients experience some of these symptoms before they have a heart attack, but do not pay attention to them. We must not forget that atherosclerosis of the coronary arteries can for a long time do not manifest themselves in any way, so you need to be examined regularly, especially for those people who are at risk.

Diagnostic methods

Since very often atherosclerosis of the heart vessels is accompanied symptoms of ischemic heart disease, diagnosis is not difficult. Several methods are used to make an accurate diagnosis.

Device for daily monitoring of ECG

ECG, daily ECG monitoring;

echocardiography;

bicycle ergometry, treadmill test;

radionuclide studies;

CT scan;

multislice CT;

electron beam tomography.

Without a doubt, a detailed story from the patient about his condition is very important. It is important to list all symptoms, even those that seem minor. This will help identify diseases associated with atherosclerosis and diagnose accurate diagnosis, on which the entire direction of treatment will depend.

Treatment

Treatment largely depends on the stage of atherosclerosis. If the disease is detected in time, then at the beginning of its development it may be enough to use medications that lower cholesterol levels. It is also very important to change your lifestyle, which includes reducing stressful situations, moderate physical exercise and dieting.

If during the examination it becomes clear that these methods are not enough, a decision may be made to expand the area of ​​the vessel narrowed due to pathology, otherwise known as stent implantation. Bypass surgery may also be necessary, which involves creating an additional path that bypasses the affected area of ​​the heart. Coronary artery bypass grafting is performed if significant narrowing of the main artery that leads to the heart is detected.

You need to understand the following: if bypass surgery is prescribed, this means that there is no other option. In this case, the lumen of the artery can be narrowed by 75 percent. In some medical institutions Bypass surgery may be suggested if the patient has already had a heart attack. This operation is performed under general anesthesia.

In any case, you can't do it self-treatment. Only a doctor can prescribe the necessary drug therapy or surgical intervention. However, these methods will bring little benefit if you do not follow a diet and do not eat in moderation. active image life.

Proper nutrition is the first step towards good health.

Atherosclerosis coronary vessels loves junk food, so you don't need to feed him that. It is better to eat more fruits and vegetables, as they contain a lot of potassium, fiber, folic acid and vitamins. They also do not contain cholesterol and a large amount of calories and fat, which contribute to the development of atherosclerosis. It is recommended to consume dairy products, as they contain beneficial elements. However, this advice should not be extended to butter and sour cream.

If you consult a doctor, you can use methods traditional medicine. For example, garlic can be very useful, as it delays the formation of cholesterol plaques. But you need to be careful, as garlic can cause palpitations. Such people are advised to purchase garlic-based preparations at the pharmacy.

Some of the listed treatment methods are included in the prevention of atherosclerosis. Generally speaking, for prevention it is important to healthy image life.

Preventive measures

Atherosclerosis of the coronary vessels especially loves those people who do not take care of themselves. How to avoid this?

An active lifestyle means your longevity

Our heart loves and appreciates being treated with care, which includes caring for the vessels that help it function. It’s better to make every effort now to keep yourself in shape than to run to doctors later in search of the right treatment.

Coronary atherosclerosis

IHD - coronary heart disease - TREATMENT ABROAD - Heart-attack.ru - 2008

Atherosclerosis is a gradual process in which cholesterol plaques (clumps) settle on the walls of the arteries. Cholesterol plaques cause hardening of the artery walls and narrowing of the internal artery channel (lumen). Arteries that are narrowed due to atherosclerosis cannot deliver enough blood to keep the parts of the body they supply functioning properly. For example, atherosclerosis of the arteries causes a decrease in blood flow to the legs.

Reduced blood flow in the legs can correspondingly cause leg pain when walking or doing exercises, trophic ulcer, longer healing of leg wounds. Atherosclerosis of the arteries that supply blood to the brain can lead to vascular dementia (mental degradation due to the gradual death of brain tissue over many years) or to stroke ( sudden death brain tissue).

For many people, atherosclerosis can remain silent (without symptoms or health problems) for many years or even decades. Atherosclerosis can develop starting from adolescence, but all symptoms and health problems usually appear already in adulthood, when the arteries are already significantly narrowed.

Cigarette smoking, high blood pressure, increased level cholesterol and diabetes may accelerate the development of atherosclerosis and lead to earlier onset of symptoms and complications, especially in people with a family history of developing atherosclerosis at an early age.

Coronary atherosclerosis (or coronary artery disease) refers to atherosclerosis, which causes hardening and narrowing of the coronary arteries. Diseases that arise due to a decrease in blood supply to the heart muscle due to coronary atherosclerosis are called coronary diseases heart (CHS).

Coronary heart disease include:

• heart attacks,
• sudden death
• chest pain (angina),
• abnormal heart rhythms
• heart failure due to weakening of the heart muscle.

Atherosclerosis is confidently taking the lead among cardiovascular diseases leading to death. The main reasons for this dynamics: a passive lifestyle provokes its development, the disease is difficult to detect in the early stages and cure in the later stages. The main threat among different types atherosclerosis represents coronary atherosclerosis, about which we'll talk below.

The coronary (coronary) artery is the artery that delivers oxygenated blood to the “central” muscle of the heart, the myocardium. The latter is responsible for the rhythmic contractions of the heart, which form the basis of blood circulation and do not stop throughout a person’s life.

Atherosclerosis – chronic illness arteries, in which cholesterol plaques form in them, blocking the lumen of the artery and interfering with normal blood flow.

Atherosclerosis of the coronary arteries is a blockage inside the coronary arteries that leads to a lack of oxygen in the tissues of the heart.

Why does the lumen of the artery narrow?

It's all about cholesterol. His high concentration leads to the formation of plaques from it on internal walls arteries. The walls become narrower, oxygen in important organs becomes smaller, tissues undergo hypoxia and die.

High cholesterol levels can have several causes. The most obvious one is poor nutrition. The more fried potatoes enters the stomach, the more harmful (in excess) substance enters the blood. Less obvious is poor metabolism, including lipoproteins, which are responsible for removing cholesterol from the body. Lipoproteins high density cope with their task, and similar proteins of low and very low density can themselves be deposited in plaques along with cholesterol.

Plugs initially appear as deposits on the inner walls of blood vessels. Over time, the growths become larger due to the arrival of new portions " building material and occurrence in the lesions of the connective tissue. This is how coronary sclerosis develops. Subsequently, one of two things happens: either the vessel slowly but surely closes to the point of complete blockage, or the clot ruptures, releasing its contents and immediately blocking the artery.

In case of slow development of the disease in the coronary vessels, the patient begins to detect IHD (coronary heart disease) in chronic form. This diagnosis means that the heart does not have enough oxygen, and is accompanied by pain in the heart area, shortness of breath, dizziness, and fatigue. When a blood clot ruptures, ischemic heart disease occurs acute form– myocardial infarction. In this case, the oxygen supply to the heart muscle abruptly stops, and the myocardium begins to undergo necrosis or, in other words, die. In this case, the issue of a person’s life is decided in the next few hours or even minutes.

Thus, the narrowing of the lumen of the artery is caused by the deposition of cholesterol on the walls of blood vessels, leading to their blockage and can be the cause of both serious chronic diseases and sudden death.

Who is predisposed to the disease?

• Increased blood cholesterol levels. More cholesterol means more chances for a blood clot.
• Sedentary lifestyle. Stagnation of blood in the body helps cholesterol settle on the walls of the arteries.
• Obesity. Excess weight creates a load on the entire body, including the cardiovascular system.
• Hypertension. High blood pressure increases the chance of damage to the walls of blood vessels.
• Diabetes. Metabolic disorders can have unpredictable effects on the entire body.
• Poor nutrition. Especially dangerous is a large amount of animal fats, cholesterol and salt.
• Smoking. It narrows and dilates blood vessels, increasing the load on them, and also spoils the internal structure of arteries and veins.

Those who have several of these factors in their lives should think about their future, since the chance of developing atherosclerosis is quite high for them.

Symptoms of atherosclerosis

All symptoms of insufficient blood circulation in the heart can be divided into two categories: general and ischemic. General are associated with a deterioration in blood flow throughout the body, ischemic are associated specifically with the heart.

General symptoms:

• Shortness of breath, poor exercise tolerance. The lungs have to supply more oxygen to the body to make up for the deficiency.
• Dizziness. If there is insufficient blood pressure, the brain cannot function normally.
• Coldness in hands and feet. Blood does not flow to distant areas of the body in sufficient volume, as a result of which the temperature decreases.
• Nausea, vomiting, bad feeling, clouding of consciousness. Everything that accompanies diseases of the cardiovascular system.

These symptoms are a sure sign that the disease has not yet reached full strength, but is already approaching.

From ischemic symptoms It is worth highlighting the following:

• Attacks of angina. Sharp chest pain, usually from behind. It appears during physical activity and is associated with the fact that the heart cannot receive enough oxygen.
• Irregular heart rhythm. With a lack of blood, the heart can work “idle”.
• Hypertension. Blockages in the coronary arteries increase blood pressure.
• Ischemic heart disease in chronic or acute form. As noted above, lack of nutrition for the myocardium can result in a number of problems, including fatal ones.
• Cardiophobia. Simply put, it is the fear of death when any heart problem occurs. It is dangerous because any fear increases the flow of testosterone and heart rate, and these changes can aggravate a heart attack or heart attack.

These symptoms indicate that there is a problem and needs to be addressed urgently. Therefore, if you notice several of these cardiac symptoms or coronary artery disease, the main thing is not to panic and immediately consult a doctor.

Medical diagnosis of the disease

The basis for diagnosing almost any disease, including atherosclerosis, is asking the patient about his health (history) and various tests.

In addition to anamnesis and tests, ultrasound of the heart and echocardiography are used. An ultrasound picture of the heart makes it possible to assess the extent of the lesion: changes in the internal shape, wall thickness, and the level of contractility of the chambers. Carrying out the procedure during physical activity allows you to see areas that receive less oxygen. 24-hour ECG monitoring is often used, in which a recording device is attached to the body and remains with the person for a long time.

Computed tomography (CT), multislice CT, and electron beam tomography make it possible to expand the picture and learn more about the patient’s heart condition. The administration of contrast agents during examinations shows a detailed drawing of arteries, veins and vessels. Based on this information, the doctor can choose the type of treatment.

Intravascular ultrasound, radionuclide studies, treadmill test, scintigraphy and bicycle ergometry are prescribed if it is necessary to clarify the details of the diagnosis.

In general, the diagnosis of coronary atherosclerosis is quite extensive in its methods and depends on the individual patient, his capabilities and the capabilities of the hospital in which he is located.

How to treat coronary arteries?

First and foremost important rule in treatment - no self-medication! At best, it will have no effect, and the disease will develop further. At worst, the disease can worsen.

In mild cases and cases moderate severity Sometimes medication and lifestyle changes are sufficient. The drugs are aimed at two goals: combating further narrowing of the lumen of the vessel and eliminating the consequences of coronary atherosclerosis. The first point is achieved by reducing cholesterol in the blood, the second is achieved by strengthening and protecting the heart muscle.

Improving lifestyle plays even more important role here important role than tablets. Adequate diet, moderate exercise under the guidance of a cardiologist, refusal bad habits, treatment of obesity and other diseases such as diabetes will put the patient on his feet as quickly as medical intervention. And in general there is not a single disease that would be adversely affected by a healthy lifestyle.

IN severe cases, if there is no other option, the doctor may prescribe surgery. A common option is the implantation of a stent, which can be used to expand the damaged vessel and ensure normal blood flow. If this is not enough, coronary artery bypass grafting may be required. This method creates a healthy bypass for the blood, bypassing the atherosclerotic vessel.

Regardless of which method the doctor prescribes to the patient, you need to start treatment as soon as possible - take pills, run in the morning or sign up for surgery, because in atherosclerosis, lost time can cost further well-being or even life.

Prognosis for atherosclerosis

If treatment is started in time, the progression of the disease can be stopped. It is almost impossible to completely restore damaged arteries, but with timely measures taken and competent medical intervention, sclerotic plaques will decrease, blood flow will increase and the patient’s condition will improve.

But you need to come to terms with the fact that atherosclerosis of the coronary arteries of the heart is a disease that you have to live with. You can’t take pills for a week, run, eat vegetables and get better. Those who are faced with this disease need to change their lifestyle, adapting it to new conditions, if they do not want to spend the remaining time in hospitals and intensive care units.

Disease Prevention

If the reader feels well and does not plan to devote 10-20 years of his life to fighting a serious chronic disease, he should think about his health now. Adding fuel to the fire is the fact that atherosclerosis of the coronary vessels of the heart does not manifest itself in any way. early stage, and can only be detected by the manifestation of symptoms. That is, it's too late.

Prevention is simple: you need to give up bad habits, play sports or physical labor, eat well, treat diseases in a timely manner and visit a cardiologist for examination every few years. Naturally, following this list is not so easy, but following it will improve the quality of life and greatly prolong it.

As a result, atherosclerosis of the coronary arteries is a dangerous chronic disease that manifests itself in late stages and if not handled carefully can lead to death. It affects the central arteries of the heart and is reluctant to treat, although it can be stopped and even achieve positive dynamics. In order not to find yourself lying in intensive care after a heart attack, you need to consult a doctor in time when symptoms appear, and even better, take care of your health and not get sick at all.

Diseases of the heart and the associated vascular system have currently become a huge problem of modern human civilization. Moreover, the more prosperous a society is in terms of living standards, the more serious the situation in terms of the number of people suffering from coronary heart disease.

What are coronary heart diseases?

The human heart is a very complex, finely tuned and sensitive mechanism, the purpose of which can be reduced to one function - the delivery of substances necessary for proper functioning to every cell of the body.

In addition to the heart itself, vessels are also involved in this activity, the system of which permeates the human body, which completely ensures the uninterrupted delivery of everything necessary to the cells of the organs most distant from the heart.

Crown

artery and its role in the human life support system

The full functioning of this system is ensured by the heart muscle, the rhythm and completeness of contractions of which also depend on the normal supply of blood - the carrier of everything necessary for normal life human body. Blood flows to the heart muscle through vessels called coronary vessels.

Hence the names: artery, etc. And if the required blood flow in the coronary arteries is reduced, the heart muscle is deprived of nutrition, which leads to the occurrence of coronary diseases such as heart failure, abnormal heart rhythms and heart attacks. The reason for this is coronary atherosclerosis.

What is it and why is it scary?

Over time and under the influence of many factors, which will be discussed later, fats and lipids settle on the walls of the arteries, forming ever-growing sticky plaques that create obstacles to normal blood flow.

Thus, the lumen of the artery gradually decreases, and less and less oxygen is supplied to the heart, which leads to pain in the chest region - angina pectoris. At first, these pains can only bother a person under heavy loads, but gradually they become a response to even small efforts, and subsequently can occur at rest.

Complications and diseases associated with atherosclerosis

Atherosclerosis of the coronary arteries inevitably leads to diseases such as heart disease. It is worth noting that so-called heart diseases claim incomparably more lives than cancer or infectious diseases - and precisely in the most developed countries.

Damage to the coronary arteries naturally causes negative impact on the heart muscle, which in turn causes angina, heart attacks, heart attacks, heart rhythm disturbances, heart failure and, worst of all, cardiac death.

Symptoms of coronary heart disease

The human body has an individual anatomical structure. And the anatomy of the heart, the arteries that feed it, each have their own characteristics. The heart is fed by two coronary arteries - the right and left. And it is the left coronary artery that provides the heart muscle with oxygen in the amount required for its normal functioning.

When blood flow in it decreases, chest pain occurs - symptoms of angina pectoris, and their appearance is often not associated with special stress. A person can experience them while at rest, for example during sleep, and while walking, especially on rough terrain or on stairs. Such pains can also be provoked by weather conditions: in winter, in cold and windy weather, they can bother you more often than in summer.

What you need to know about angina

First of all, this disease is the result of acute heart failure, provoked by insufficient blood supply to the heart muscle due to the fact that the left coronary artery is damaged. Another name for the disease, known to many from Russian classical literature, is angina pectoris.

A characteristic manifestation of this disease is pain, already described earlier. But it is also possible (most often on initial stages) the sensation is not pain as such, but pressure in the chest, burning. Moreover, the amplitude of pain has fairly wide boundaries: from almost insignificant to unbearably acute. Its distribution area is mainly on the left side of the body and rarely on the right. Painful sensations may appear in the arms and shoulders. Affects the neck and lower jaw.

The pain is not constant, but paroxysmal, and its duration is usually from 10 to 15 minutes. Although they can last up to half an hour - in this case, a heart attack is possible. Attacks can be repeated at intervals from 30 times a day to once every month, or even years.

Factors contributing to the development of coronary heart disease

As stated earlier, coronary heart disease is the result of damage to the coronary arteries. There are several generally accepted factors that cause the coronary artery that supplies the heart muscle to fail.

The first of these can rightfully be called an excessively high level of cholesterol in human blood, which, due to its viscosity, is the root cause of the formation of plaques on the walls of the arteries.

The next risk factor contributing to the development of heart disease, namely heart attack, is hypertension - excessive blood pressure.

The coronary arteries of the heart suffer enormous damage from smoking. The risk of damage to arterial walls increases many times due to harmful effects on them are the chemical compounds that make up tobacco smoke.

The next risk factor that increases the likelihood of coronary artery disease is a disease such as diabetes. With this disease, the entire vascular system person, and the likelihood of developing heart disease at an earlier age significantly increases.

Heredity can also be considered a risk factor influencing the occurrence of heart disease. Especially if the fathers of potential patients had heart attacks or died as a result of coronary diseases before the age of 55 years, and in mothers before the age of 65.

Prevention and treatment of coronary heart diseases

You can avoid or reduce the risk of developing coronary heart disease if you perform, strictly and continuously, several simple recommendations, which include a healthy lifestyle, giving up bad habits, reasonable physical activity and undergoing annual preventive examinations.

Treatment of coronary heart disease includes several options: drug therapy and cardiac surgery. The most common is coronary artery bypass grafting, in which blood is sent to the heart muscle along a bypass route: along a segment of the aorta stitched parallel to the affected area healthy vessel taken from the patient himself. The operation is complex, and after it the patient requires a long period of rehabilitation.

Another type of treatment is coronary artery angioplasty using a laser. This option is more gentle and does not require dissection of large segments of the body. The affected area of ​​the coronary artery is reached through the vessels of the shoulder, thigh or forearm.

Unfortunately, no matter what operations are performed, even the most successful of them do not eliminate atherosclerosis. Therefore, in the future it is necessary to comply with all medical instructions, this applies not only medical supplies, but also the recommended diet.

Systemic damage to large and medium-sized arteries, accompanied by the accumulation of lipids, proliferation of fibrous fibers, dysfunction of the endothelium of the vascular wall and leading to local and general hemodynamic disorders. Atherosclerosis may be the pathomorphological basis of IHD, ischemic stroke, obliterating lesion lower limbs, chronic occlusion of mesenteric vessels, etc. Diagnostic algorithm includes determining blood lipid levels, performing ultrasound of the heart and blood vessels, and angiographic studies. For atherosclerosis it is carried out drug therapy, diet therapy, and, if necessary, revascularizing surgical interventions.

ICD-10

I70

General information

Atherosclerosis is damage to the arteries, accompanied by cholesterol deposits in the inner linings of blood vessels, narrowing of their lumen and disruption of the nutrition of the blood supply to the organ. Atherosclerosis of the heart vessels is manifested mainly by attacks of angina pectoris. Leads to the development of coronary heart disease (CHD), myocardial infarction, cardiosclerosis, and vascular aneurysm. Atherosclerosis can lead to disability and premature death.

With atherosclerosis, damage occurs to arteries of medium and large caliber, elastic ( major arteries, aorta) and muscular-elastic (mixed: carotid, arteries of the brain and heart) types. Therefore, atherosclerosis is the most common cause of myocardial infarction, ischemic heart disease, cerebral stroke, circulatory disorders of the lower extremities, abdominal aorta, mesenteric and renal arteries.

IN last years the incidence of atherosclerosis has become rampant, outstripping the risk of developing disability, disability and mortality such causes as injuries, infectious and oncological diseases. With the greatest frequency, atherosclerosis affects men older than 45-50 years (3-4 times more often than women), but occurs in patients more young.

Mechanism of development of atherosclerosis

With atherosclerosis, systemic damage to the arteries occurs as a result of lipid and protein metabolism disorders in the walls of blood vessels. Metabolic disorders are characterized by a change in the ratio between cholesterol, phospholipids and proteins, as well as excessive formation of β-lipoproteins.

It is believed that atherosclerosis goes through several stages in its development:

Stage I– lipid (or fat) stain. For the deposition of fats in the vascular wall, microdamage to the walls of arteries and local slowing of blood flow play an essential role. The areas of branching vessels are most susceptible to atherosclerosis. The vascular wall loosens and swells. Enzymes in the arterial wall tend to dissolve lipids and protect its integrity. When the defense mechanisms are exhausted, complex complexes of compounds are formed in these areas, consisting of lipids (mainly cholesterol), proteins, and their deposition in the intima occurs ( inner shell) arteries. The duration of the lipid spot stage varies. Such fatty spots are visible only under a microscope, they can be detected even in infants.

Stage II– liposclerosis. It is characterized by growth in areas of fatty deposits of young connective tissue. Gradually, an atherosclerotic (or atheromatous) plaque is formed, consisting of fats and connective tissue fibers. On at this stage atherosclerotic plaques are still liquid and can be dissolved. On the other hand, they are dangerous, because their loose surface can rupture, and plaque fragments can clog the lumen of the arteries. The wall of the vessel at the site of attachment of the atheromatous plaque loses its elasticity, cracks and ulcerates, leading to the formation of blood clots, which are also a source of potential danger.

Stage III- atherocalcinosis. Further plaque formation is associated with its compaction and the deposition of calcium salts in it. An atherosclerotic plaque can behave stably or grow gradually, deforming and narrowing the lumen of the artery, causing a progressive chronic violation of the blood supply to the organ fed by the affected artery. At the same time, there is a high probability of acute blockage (occlusion) of the lumen of the vessel by a thrombus or fragments of a disintegrated atherosclerotic plaque with the development of an infarction site (necrosis) or gangrene in the limb or organ supplied by the artery.

This point of view on the mechanism of development of atherosclerosis is not the only one. There are opinions that infectious agents play a role in the development of atherosclerosis (herpes simplex virus, cytomegalovirus, chlamydial infection, etc.), hereditary diseases accompanied by an increase in cholesterol levels, mutations in cells of the vascular walls, etc.

Factors in the development of atherosclerosis

Factors influencing the development of atherosclerosis are divided into three groups: fatal, removable and potentially removable.

Unremovable factors include those that cannot be eliminated with the help of volitional or medical influence. These include:

• Age. With age, the risk of developing atherosclerosis increases. Atherosclerotic changes in blood vessels in one way or another are observed in all people after 40-50 years.
• Floor. In men, the development of atherosclerosis occurs ten years earlier and is 4 times higher than the incidence rate of atherosclerosis among women. After 50-55 years, the incidence of atherosclerosis among women and men levels off. This is explained by a decrease in the production of estrogen and their protective function in women during menopause.
• Burdened family heredity. Often, atherosclerosis develops in patients whose relatives suffer from this disease. It has been proven that heredity for atherosclerosis contributes to the early (before 50 years) development of the disease, while after 50 years genetic factors do not play a leading role in its development.

Removable factors of atherosclerosis are those that can be eliminated by the person himself by changing familiar image life. These include:

• Smoking. Its effect on the development of atherosclerosis is explained negative impact nicotine and tar on the vessels. Long-term smoking several times increases the risk of hyperlipidemia, arterial hypertension, and coronary artery disease.
• Unbalanced diet. Eating large amounts of animal fats accelerates the development of atherosclerotic changes in blood vessels.
• Physical inactivity. Doing sedentary lifestyle life contributes to disruption fat metabolism and the development of obesity, diabetes, vascular atherosclerosis.

Potentially and partially avoidable risk factors include those chronic disorders and diseases that can be corrected through prescribed treatment. These include:

• Arterial hypertension. Against the background of increased blood pressure conditions are created for increased saturation of the vascular wall with fats, which contributes to the formation of atherosclerotic plaque. On the other hand, a decrease in the elasticity of the arteries during atherosclerosis helps maintain high blood pressure.
• Dyslipidemia. Violation of fat metabolism in the body, manifested by an increased content of cholesterol, triglycerides and lipoproteins, plays a leading role in the development of atherosclerosis.
• Obesity and diabetes. Increase the likelihood of atherosclerosis by 5-7 times. This is due to a violation of fat metabolism, which underlies these diseases and is trigger mechanism atherosclerotic vascular lesions.
• Infections and intoxications. Infectious and toxic agents have a damaging effect on the vascular walls, contributing to their atherosclerotic changes.

Knowledge of the factors contributing to the development of atherosclerosis is especially important for its prevention, since the influence of removable and potentially removable circumstances can be weakened or completely eliminated. Elimination unfavorable factors allows you to significantly slow down and alleviate the development of atherosclerosis.

Symptoms of atherosclerosis

With atherosclerosis, the thoracic and abdominal aorta, coronary, mesenteric, renal vessels, as well as the arteries of the lower extremities and the brain are more likely to suffer. In the development of atherosclerosis, preclinical (asymptomatic) and clinical periods are distinguished. In the asymptomatic period, it is found in the blood increased contentβ-lipoproteins or cholesterol in the absence of symptoms of the disease. Clinically, atherosclerosis begins to manifest itself when the arterial lumen narrows by 50% or more. During the clinical period, three stages are distinguished: ischemic, thrombonecrotic and fibrous.

In the stage of ischemia, insufficient blood supply to one or another organ develops (for example, myocardial ischemia due to atherosclerosis of the coronary vessels is manifested by angina pectoris). In the thrombonecrotic stage, thrombosis of the altered arteries occurs (thus, the course of atherosclerosis of the coronary vessels can be complicated by myocardial infarction). On the stage fibrotic changes connective tissue grows in poorly supplied organs (for example, atherosclerosis of the coronary arteries leads to the development of atherosclerotic cardiosclerosis).

Clinical symptoms of atherosclerosis depend on the type of arteries affected. The manifestations of atherosclerosis of the coronary vessels are angina pectoris, myocardial infarction and cardiosclerosis, which successively reflect the stages of cardiac circulatory failure.

The course of atherosclerosis of the aorta is long and asymptomatic, even in severe forms. Clinically atherosclerosis thoracic aorta manifested by aortalgia - pressing or burning pains behind the sternum, radiating to the arms, back, neck, upper abdomen. Unlike pain with angina, aortalgia can last for several hours or days, periodically weakening or intensifying. A decrease in the elasticity of the aortic walls causes increased work of the heart, leading to hypertrophy of the left ventricular myocardium.

Atherosclerotic lesion of the abdominal aorta is manifested by pain in the abdominal area various localizations, flatulence, constipation. With atherosclerosis of the abdominal aortic bifurcation, numbness and coldness of the legs, swelling and hyperemia of the feet, necrosis and ulcers of the toes, and intermittent claudication are observed.

Manifestations of atherosclerosis of the mesenteric arteries are attacks of “abdominal toad” and impaired digestive function due to insufficient blood supply to the intestines. Patients experience the appearance sharp pain a few hours after eating. The pain is localized in the navel or upper divisions belly. The duration of a painful attack ranges from several minutes to 1-3 hours, sometimes pain syndrome relieved by taking nitroglycerin. There are bloating, belching, constipation, palpitations, increased blood pressure. Later, foul-smelling diarrhea with fragments appears undigested food and undigested fat.

Atherosclerosis of the renal arteries leads to the development of symptomatic vasorenal arterial hypertension. Red blood cells, protein, and casts are detected in the urine. With unilateral atherosclerotic lesions of the arteries, a slow progression of hypertension is noted, accompanied by persistent changes in the urine and persistently high blood pressure. Bilateral damage to the renal arteries causes malignant arterial hypertension.

Complications of atherosclerosis

Complications of atherosclerosis are chronic or acute vascular insufficiency of the blood-supplying organ. Development of chronic vascular insufficiency associated with a gradual narrowing (stenosis) of the lumen of the artery by atherosclerotic changes - stenosing atherosclerosis. Chronic failure blood supply to an organ or part of it leads to ischemia, hypoxia, dystrophic and atrophic changes, proliferation of connective tissue and the development of small focal sclerosis.

Acute occlusion of blood vessels by a thrombus or embolus leads to the occurrence of acute vascular insufficiency, which is manifested by the clinic of acute ischemia and organ infarction. In some cases, an arterial aneurysm can rupture with a fatal outcome.

Diagnosis of atherosclerosis

Initial data for atherosclerosis are established by clarifying the patient's complaints and risk factors. Consultation with a cardiologist is recommended. At general examination signs of atherosclerotic lesions of the vessels of internal organs are revealed: edema, trophic disorders, weight loss, multiple wen on the body, etc. Auscultation of the vessels of the heart, aorta reveals systolic murmurs. Atherosclerosis is evidenced by a change in the pulsation of the arteries, an increase in blood pressure, etc.

Data laboratory research indicate elevated levels of blood cholesterol, low-density lipoproteins, triglycerides. X-ray on aortography reveals signs of atherosclerosis of the aorta: its elongation, thickening, calcification, expansion in the abdominal or thoracic regions, presence of aneurysms. The condition of the coronary arteries is determined by performing coronary angiography.

Disturbances in blood flow in other arteries are determined by angiography - contrast radiography of blood vessels. With atherosclerosis of the arteries of the lower extremities, according to angiography, their obliteration is recorded. Using ultrasound of renal vessels, atherosclerosis of the renal arteries and corresponding renal dysfunction are detected.

Methods ultrasound diagnostics arteries of the heart, lower extremities, aorta, carotid arteries a decrease in the main blood flow through them, the presence of atheromatous plaques and blood clots in the lumens of blood vessels are recorded. Decreased blood flow can be diagnosed using rheovasography of the lower extremities.

Treatment of atherosclerosis

When treating atherosclerosis, the following principles are adhered to:

• limiting cholesterol entering the body and reducing its synthesis by tissue cells;
• enhancing the removal of cholesterol and its metabolites from the body;
• usage replacement therapy estrogens in women during menopause;
• impact on infectious pathogens.

Limiting dietary cholesterol is done by prescribing a diet that excludes cholesterol-containing foods.

For drug treatment atherosclerosis, the following groups of drugs are used:

• Nicotinic acid and its derivatives effectively reduce the content of triglycerides and cholesterol in the blood, increase the content of high-density lipoproteins, which have anti-atherogenic properties. The use of nicotinic acid preparations is contraindicated in patients suffering from liver disease.
• Fibrates (clofibrate) - reduce the synthesis of the body's own fats. They can also cause disturbances in liver function and the development of cholelithiasis.
• Bile acid sequestrants (cholestyramine, colestipol) – bind and remove bile acids from the intestines, thereby reducing the amount of fat and cholesterol in the cells. When using them, constipation and flatulence may occur.
• Drugs from the statin group (lovastatin, simvastatin, pravastatin) are the most effective for lowering cholesterol, because they reduce its production in the body itself. Statins are used at night, because cholesterol synthesis increases at night. May lead to liver problems.

Carrying out surgical treatment for atherosclerosis, it is indicated in cases of high risk or development of arterial occlusion by plaque or thrombus. On arteries they are carried out as open operations(endarterectomy), and endovascular - with dilatation of the artery using balloon catheters and installation of a stent at the site of narrowing of the artery, preventing blockage of the vessel.

In case of severe atherosclerosis of the heart vessels, which threatens the development of myocardial infarction, coronary artery bypass surgery is performed.

Forecast and prevention of atherosclerosis

In many ways, the prognosis of atherosclerosis is determined by the behavior and lifestyle of the patient himself. Elimination possible factors risk and active drug therapy can delay the development of atherosclerosis and achieve an improvement in the patient’s condition. With the development of acute circulatory disorders with the formation of foci of necrosis in organs, the prognosis worsens.

In order to prevent atherosclerosis, it is necessary to quit smoking, eliminate stress factors, switch to low-fat and low-cholesterol foods, systematic physical activity in proportion to capabilities and age, normalization of weight. It is advisable to include in the diet foods containing fiber and vegetable fats (linseed and olive oils), which dissolve cholesterol deposits. The progression of atherosclerosis can be slowed by taking cholesterol-lowering medications.

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