Treatment of IHD: drugs. Ischemic heart disease - treatment, drugs and symptoms

Coronary heart disease is a pathological condition caused by a lack of nutrition of the heart muscle due to the narrowing of the lumen of the coronary vessels or their spasm. It combines several diagnoses, such as angina pectoris, myocardial infarction, cardiosclerosis, sudden coronary death, and others.

To date, it is the most common disease in its category in the world and ranks first among the causes of death and disability in all developed countries.

Predisposing factors

To date, the criteria for predicting the development of a disease have been derived. Ischemic heart disease was no exception. There is not just a list, but a classification of risk factors grouped according to a certain trait, which can contribute to the onset of the disease.

1. Biological:
   - age over 50;
   - sex - men are more often ill;
   - genetic predisposition to dysmetabolic diseases.
2. Anatomy:
   - high blood pressure;
   - obesity;
   - presence of diabetes mellitus.
3. Lifestyle:
   - violation of diet;
   - Smoking;
   - Inactivity or excessive physical activity;
   - alcohol consumption.

Development of the disease

Pathogenetic causes of the development of the disease can be both extra- and intravascular problems, such as narrowing the lumen of the coronary arteries due to atherosclerosis, thrombosis or spasm, or pronounced tachycardia with hypertension. But all the same in the first place for the reasons for the development of a heart attack is atherosclerosis. Initially, a person develops a metabolic disorder, which is expressed in a persistent increase in lipid levels in the blood.

The next stage is the fixation of lipid complexes in the walls of the vessels and sweating them inside endothelial cells. Atherosclerotic plaques are formed. They destroy the wall of the vessels, make it more fragile. This condition can have two outcomes: either a clot breaks off from the plaque and clogs the artery upstream, or the diameter of the vessel becomes so small that the blood can no longer circulate freely and feed a certain area. In this place, a focus of ischemia is formed, and then necrosis. If this entire process occurs in the heart, then the disease will be called IHD.

There are several clinical forms and the corresponding treatment of IHD. Preparations are selected based on the pathophysiological component.

Sudden coronary death

Otherwise, it is called a cardiac arrest. It can have two outcomes: a person dies or goes into intensive care. Associated with sudden instability of the myocardium. This diagnosis is an exception, when there is no reason to suspect another form of ischemic heart disease. Treatment, the drugs of choice for medical professionals remain the same as in resuscitation. Another condition - death should occur instantly and with witnesses, or no later than six hours after the onset of a heart attack. Otherwise, it already falls under another classification.

Angina pectoris

This is one of the forms of IHD. It also has its own additional classification. So:

1. Stable exertional angina.
2. Vasospastic angina pectoris.
3. Unstable angina, which, in turn, is divided into:
   - Progressive;
   - first arising;
   - early postinfarction.
4. Angina of Prinzmetalla.

The most common is the first species. The association of cardiologists has long developed the treatment of coronary artery disease with angina pectoris. Drugs should be taken regularly and for a long time, sometimes all life. If you follow the recommendations, you can postpone for some time unpleasant consequences for health.

Myocardial infarction

It is established taking into account the data of the electrocardiogram, laboratory and anamnestic indicators. The most informative are the increases in such enzymes as LDH (lactate dehydrogenase), ALaT (alanine aminotransferase) and ASAT (aspartate aminotransferase), which are normally contained within the cell and appear in the blood only when it is destroyed.

Infarction is one of their finals, which can lead to uncontrolled ischemic heart disease. Treatment, drugs, help - all this may be late, because with an acute attack there is very little time left to reverse the damage.

Diagnostics

Naturally, any survey begins with a survey and examination. Collect anamnesis data. The doctor is interested in such complaints as pain behind the breastbone after physical exertion, the presence of shortness of breath, fatigue, weakness, a feeling of palpitations. Noteworthy will be the evening swelling, warm to the touch. And also how the treatment of IHD is carried out. Drugs can tell a lot to the doctor. For example, "Nitroglycerin". If it helps to relieve an attack, it almost always speaks in favor of angina.

Physical examination includes pressure measurement, respiratory and pulse rate, and listening to the heart and lungs. The doctor is trying to hear pathological noises, increased heart tone, as well as rales and blisters in the lungs that would talk about stagnant processes.

Next, the doctor sends the patient to a laboratory and physical examination. We already talked about the tests, and the most common studies are ECG, Echocardiography and ultrasound of the heart.

Treatment

So we went to the most basic one. We are interested in the treatment of IHD. Drugs play a leading role in it, but not only they contribute to improving well-being. First of all, the patient needs to be explained that he will have to completely change his way of life. Remove excessive physical activity, balance the sleep and rest regime and fully eat. The diet should be given special attention. It should contain the necessary potassium, calcium and sodium for the heart, but at the same time limit the intake of salt, water, foods with an excess of animal fats and carbohydrates. If a person has excess weight, then it is necessary to correct it.

But besides this, methods for the pharmacological elimination of such a problem as ischemic heart disease have been developed. Treatment - preparations in the form of tablets, capsules, powders and solutions. With proper selection and regular application, you can achieve excellent results.

Antiaggregants

Groups of drugs for the treatment of IHD are divided into several classifications, but the most common - the mechanism of action. We will use it. Antiaggregants help improve blood fluidity. They act on coagulant and anticoagulant systems, somewhat separating them, and thus achieve liquefaction. These include "Aspirin", "Klopidogrel", "Warfarin" and others. When assigning them, it is necessary to always monitor the INR indicator (the international normalized ratio) to prevent the occurrence of bleeding in a person.

Beta-blockers

They act on the receptors in the walls of the vessels, slowing the heartbeat. As a consequence, it consumes less oxygen and less needs blood, which is very helpful even with narrowed coronary arteries . This is one of the most common medicines in IHD. The treatment, the drugs of choice and the dose depend on the attendant conditions. There are selective and indiscriminate beta-blockers. Some of them act more gently, others - a little stiffer, but the absolute contraindication is the patient's history of bronchial asthma or other obstructive pulmonary disease. Among the most common drugs - "Biprolol", "Viskin", "Carvedilol."

Statins

Doctors spend a lot of effort on the treatment of IHD. The drugs are being improved, new approaches are being developed, and the causes of the disease are being investigated. One of these advanced approaches is the impact on provoking factors, namely, dyslipidemia or a violation of the balance of blood fats. It has been proven that lowering cholesterol leads to a slower formation of atherosclerosis. And this is the main cause of IHD. Signs, treatment, preparations - all this has already been identified and developed, you only need to be able to use the available information with benefit to the patient. Examples of effective agents include "Lovastatin", "Atorvastatin", "Simvastatin" and others.

Nitrates

The work of these drugs is one of the diagnostic signs that help confirm the presence of the disease. But they are also needed as part of the program that is included in the treatment of IHD. Medications and preparations are carefully chosen, the dose is adjusted, the frequency of administration. They affect the smooth muscles in the walls of the vessels. Relaxing, these muscles increase the diameter of the lumen, thus increasing the amount of blood supplied. This helps to remove ischemia and painful attack. But, unfortunately, nitrates can not prevent the development of a heart attack in the global sense of the word, and does not increase the life expectancy, so they are recommended to take these medications only during an attack (Dinisorb, Isoket), but on a permanent basis choose something different .

Anticoagulants

If, in addition to angina pectoris, there is a threat of thrombosis in the patient, then these drugs are prescribed for CHD. Symptoms and treatment, drugs depend on how prevalent this or that link of the pathological process. One of the most famous means of this series is "Heparin". It is administered in a large dose once for acute myocardial infarction, and then for a few days maintain a level in the blood plasma. It is necessary to carefully monitor the time of blood clotting.

Diuretics

Preparations for the treatment of IHD are not only pathogenetic, but also symptomatic. They affect such a link as increased pressure. If you increase the amount of fluid that will lose the body, you can artificially reduce the pressure to normal numbers and eliminate the threat of a second infarction. But do not do it too fast not to provoke a collapse. There are several types of these drugs, depending on which part of the loop of Henle (the nephron site) they affect. A competent doctor will choose the medicine that is necessary in this situation. Such that does not aggravate the patient's condition. Be healthy!