Myocardial ischemia - the effect on the functional activity of the heart

October 31, 2014

 myocardial ischemia
 Ischemic myocardial damage can occur not only in the form of clinically significant cases with severe pain. About a third of patients do not feel pain, so myocardial ischemia in this case is considered to be pain-free option. Often, this option may be indicative of changes far advanced in atherosclerosis of the coronary vessels.


How can you recognize myocardial ischemia

Conducting instrumental methods under load or stress How to beat stress? Create an oasis  How to beat stress? Create an oasis
   They are the only methods that can detect changes in the myocardium. Application load tests increases myocardial oxygen demand, so it is much easier to detect hidden processes. Of particular concern are the data research methods to detect silent ischemia.

Symptoms appear silent myocardial ischemia in patients with significant narrowing of the lumen of the coronary arteries due to atherosclerosis. Often coronary patients no complaints, and the sudden death may occur as a result of the expressed pathological changes in the blood vessels. Identify changes of this kind, which are the cause of ischemia may hold if the time instrumental examination.

Silent myocardial ischemia is considered by experts as a manifestation of coronary heart disease. This statement became the basis for the classification of silent ischemia, from which there are three types of ischemia. Silent myocardial ischemia is a separate option, or type, in this case up to now there is no accurate data on the clinical significance of this variant ischemic changes in the myocardium.

Signs of myocardial ischemia on ECG missing, so diagnostic importance is only the method of myocardial scintigraphy, held during the load test.

For silent ischemia is characterized by the absence of pain, but a twinge of the type of angina episode can cause lasting physical exertion. If the intensity of the load will continue to grow, it can lead to cardiac arrhythmia or shortness of breath. In this context, great importance is attached to the load tests that evaluate the nature of cardiac deficiency of oxygen due to the load. The most common load tests are:

  • veloergometry
  • Treadmill

If a patient has symptoms of myocardial ischemia, the method of choice for examination is ECG. Currently, there is an opportunity to assess the human cardiac cycle during the day (method of 24-hour Holter monitoring). For the patient, this is not onerous, whereas it increases for the physician the effectiveness of the diagnostic activities.


What it is important for the development of myocardial ischemia

Under physiological conditions, there is a balance between the need of the heart muscle of oxygen and oxygen supply. If this balance is disturbed, it is the development of ischemia. Causes of myocardial ischemia associated with the presence of narrowing of blood vessels of the heart, which is a result of atherosclerosis. One can observe a decrease in the lumen of blood vessels, which in some cases reach nearly 70%. Such changes can become a cause of death in the presence of relative health.

There are the following risk factors for myocardial ischemia:

  • family history, that is, the presence of this kind of "coronary" disease in close relatives
  • smoking
  • the presence of diabetes
  • presence of hypertension
  • high cholesterol

Through the introduction of modern diagnostic methods (bifunctional monitors simultaneously recording the ECG and blood pressure), it was shown that ischemic damage frequently occurs in persons with low blood pressure. Myocardial ischemia ECG developed in a low diastolic blood pressure that must be considered when carrying out a comprehensive survey.

The presence of organic vascular changes is not the sole cause of ischemia. A situation may arise spasm of the coronary vessels, which has been called vasospastic angina Vasospastic angina - how to cope with it?  Vasospastic angina - how to cope with it?
 . There is a possibility of development of the inflammatory process in the walls of the coronary arteries (coronary), which is also reflected in the functional activity of the myocardium, which manifests itself in the form of myocardial ischemia.


Appointment of anti-ischemic therapy

Myocardial ischemia statistics upconverts total deaths from diseases of the cardiovascular system. Treatment of myocardial ischemia has to start with the correction of risk factors. The first step is to normalize the diet, give up bad habits. Recommended exercise Myths about exercise: do not believe  Myths about exercise: do not believe
 That should be agreed taking into account the health of the patient. If there are comorbidities (metabolic disease, hypertension), it is important to choose the right medication.

Treatment of silent myocardial ischemia is carried out in two directions. This may only be a monotherapy or a combination of several drugs.

In some cases, the effectiveness of the combined treatment exceeds the use of only one drug, so the question of choice of medical tactics must be strictly individual. If ischemic changes are progressing, it may require lifelong therapy. This applies to receive antiplatelet agents, statins and other drugs.

Acute myocardial ischemia requires urgent action, so you need to pay attention to prevention, clinical examination of cardiac patients. Preventive focus includes the development of programs of social and preventive significance, as well as improving existing treatment standards. Transient painless subendocardial ischemia Subendocardial ischemia - What might be the consequences  Subendocardial ischemia - What might be the consequences
   infarction can be induced by the influence of stress, physical load, a heavy meal, and other factors. Specific therapy in clinical situation, this is not required, it is important to eliminate the effect of harmful factors.

Transient ischemia is diagnosed in the newborn period if the infant suffered intrapartum hypoxia. In some parts of the heart muscle suffers from blood circulation, which is reflected in its functional activity. The complex of therapeutic measures include the appointment of tools that enhance the metabolic processes. The presence of different types of ischemic damage explains why the left ventricular myocardial ischemia involves an individual approach in the treatment process.

Marina Solovyov

Article Tags:
  • ischemia

How to treat cardiac arrhythmias - assistance to the cardiologist

December 8, 2014

 how to treat cardiac arrhythmias
 How to treat cardiac arrhythmias? The main thing - it's not worth it to treat yourself. Only a cardiologist can choose the most effective treatment for this particular patient. But the general idea of ​​how and what you need to treat cardiac arrhythmias, every patient should have.


What is cardiac arrhythmia and how to treat

Cardiac arrhythmia - a violation of frequency (more than 100 beats per minute - tachycardia, less than 60 beats per minute - bradycardia) and frequency (beats - the emergence of single or paired premature heartbeats, atrial fibrillation - chaotic contraction of the atria with a frequency of up to 600 per minute without relations with the ventricles of the heart, etc.).

Cardiac arrhythmias can accompany many diseases of the heart. The cause of these states can be: violation of the nervous regulation of cardiac activity (at tumors, traumatic brain injuries, stress), various diseases of the heart muscle (myocarditis, myocardial dystrophy), ischemic heart disease (IHD), violation of the ratio of potassium ions, sodium, calcium and magnesium inside the heart muscle cells and in the extracellular medium, valvular heart disease, chronic poisoning by certain poisons, as well as combinations of different reasons.

In order to effectively treat cardiac arrhythmias, need to identify and eliminate (or at least treat) the cause of the disease. At the same time prescribe a particular type of arrhythmia.


Treatment of tachycardia

Tachycardia can be of different types:

  • sinus tachycardia - increased activity occurs when the sinus node - the main source of electrical pulses;
  • ectopic tachycardia Tachycardia - the body to the limit?  Tachycardia - the body to the limit?
   - When the source is located outside the rhythm of the sinus node in the atria or the ventricles; this type of tachycardia is usually manifested in the form of attacks (paroxysms) and is called paroxysmal tachycardia; wherein, if the source of ectopic beat is in atrial tachycardia called supraventricular and ventricular in - ventricular.

Tachycardia is accompanied by a sensation of palpitations, shortness of breath, general weakness, loss of efficiency.

Treatment attack tachycardia begin with, the patient can be physical and mental rest. The attack of supraventricular tachycardia can be removed using a reflex action on the vagus nerve, for example, pushing the eyeballs, causing gagging, natuzhivayas, squeezing the abdominal muscles, holding her breath. Such treatment is contraindicated elderly and patients with impaired cerebral circulation. With the ineffectiveness of using drugs with fast action (eg, propranolol, verapamil).

Than to treat cardiac arrhythmias (drugs), if the attacks are repeated regularly? In this case, usually prescribed antiarrhythmic drugs for continuous use (atenolol, propanorm, sotaleks, Concor).

Ventricular tachycardia - is the most life-threatening form of tachycardia, it is often accompanied by loss of consciousness and the need for resuscitation. Such a patient should immediately call an ambulance, but before her arrival in the case of respiratory disorders to conduct artificial respiration. The attack is usually removed the intravenous administration of drugs with antiarrhythmic activity - lidocaine or Cordarone. If drug therapy does not work, then spend cardioversion (using a defibrillator).


Treating bradycardia

Severe attacks bradycardia may be accompanied by severe weakness, dizziness Dizziness - if the ground is slipping from under his feet  Dizziness - if the ground is slipping from under his feet
 , Shortness of breath, darkening of the eyes, sometimes - loss of consciousness. If such attacks are repeated, the patient required implantation of a permanent pacemaker. If the patient does not feel unpleasant symptoms, treatment is usually not indicated.


Treatment of arrhythmia

Beats in most cases does not require special treatment - just treat the underlying disease. But if the beats are very frequent or causes patient discomfort, it is necessary to constantly take drugs with antiarrhythmic activity - atenolol, Cordarone, VFS, sotaleks, etatsizin, propanorm.


How to treat atrial fibrillation of the heart

Atrial fibrillation may be constant or in the form of attacks. The attacks of atrial fibrillation can occur easily and invisibly to the patient, and may be - it is very difficult. Heavy attack patients felt a sudden chaotic heartbeat, general weakness, dizziness, semiconscious state. Sometimes the patient during an attack may lose consciousness. The attack may be complicated by pulmonary edema, thrombus occlusion of large blood vessels, ischemic stroke Stroke - a serious brain injury  Stroke - a serious brain injury
   and so on.

Treatment of atrial fibrillation includes treatment of the underlying disease (eg, myocarditis) and to restore normal heart rhythm. At constant atrial fibrillation prescribed antiarrhythmic drugs - VFS, Cordarone, propanorm, sotaleks. If medical treatment fails, surgery is performed to establish an artificial pacemaker (pacemaker).

The attack of atrial fibrillation removed the intravenous administration of procainamide quinidine or ingestion. If the attack continues for a long time, to reduce the risk of thromboembolism Thromboembolism: severe complications  Thromboembolism: severe complications
   the patient is prescribed drugs that lower blood clotting (eg warfarin).

Than to treat cardiac arrhythmias, can identify only a doctor.

Galina Romanenko

Article Tags:
  • arrhythmia