Ischemic heart damage caused by deterioration of blood supply to certain areas of the myocardium due to the development of pathological changes in coronary vessels. The main cause is atherosclerosis of vascular lesions. Subendocardial ischemia continues the long-term, functional changes associated with the development of vascular spasm heart.

Immediate causes ischemia

Changes at the level of the myocardium are coming. The clinical picture may develop in two ways:

• restoration of disturbed metabolism Impaired metabolism   myocardial
• progression of circulatory failure with damage to muscle fibers

Ischemic changes are a consequence of the restriction or closure of the lumen of the coronary vessels. This is one of the causative factors in the development of the pathological condition in the myocardium. The lumen of the vessel may taper in atherosclerosis when atherosclerotic plaque becomes large, as well as poor circulation, which lead to the formation of blood clots.

One mechanism that predisposes to the development of ischemia is the change in blood viscosity upward. This contributes to the clotting, enhanced aggregation of blood cells. Thrombotic masses overlap vessel lumen, leading to disruption of normal circulation.

Compensatory capabilities of the body to ensure the elimination of ischemia without serious or irreversible effects. If the process of coronary vasospasm is prolonged, it can cause myocardial infarction Myocardial infarction - the most formidable diagnosis Because the heart muscle is experiencing increased oxygen demand. Lack of oxygen, which is prolonged, causing metabolic changes in the myocardium, which eventually ends up developing a heart attack.

Signs of ischemia on the electrocardiogram

To register heart tones can be using electrocardiography. This type of study allows you to graphically display the character of the heart, heart rate. This allows the doctor to detect changes in time and appropriate treatment. Ischemic changes are characteristic changes, so electrocardiography is required by studies on patients.

Subendocardial ischemia on the ECG appears the change of one of the teeth (T wave), which revealed a specialist in deciphering the graphic recording. In general, the electrocardiogram is not different from the normal values, with noteworthy presence broadening tooth T. The degree of change of the tooth depends on the exact pathologic nidus localized ischemia.

In some cases, changes in a symmetrical peaked high T wave can occur not only during ischemia as well as in healthy persons (normal variant). Barb could meet two-phase, reduced or flattened. Different versions of the T wave must be interpreted in conjunction with clinical presentation and the results of additional inspections.

What should be the doctor's tactics

Violation of the functional activity of the heart develops in coronary ischemia. Treatment subendocardial ischemia is performed taking into account an individual approach, which is determined by the clinical picture of the disease. The course of drug therapy shall be appointed at the same time compliance with diet and appropriate diet. Meals should be balanced the content of the main ingredients in line with the needs of the body. Much attention is paid to exercise stress, which are calculated respectively detected pathology of the patient. Developed a course of physiotherapy, spa treatment are an integral part of treatment.

Antiarrhythmic therapy aimed at normalizing heart rhythm. At the first signs of failure are appointed diuretics, drugs from the group of glycosides and other hearts that allow you to restore altered function of the heart.

One of the necessary drugs is aspirin. People have to take it, not only as a therapeutic drug, as well as an important means of prevention. Specialists was set necessary dose taking this drug, which provides for prevention of complications such as thrombosis. Enough to take 325 mg of aspirin to reliably prevent the complications of having heart disease.

Quite often, the phenomenon of ischemia occur against the backdrop of various metabolic disorders. In this regard, the patient should undertake a study of blood lipid spectrum to detect deviations from normal values. When elevated levels of cholesterol should be appointed medications that are combined, called statins. They are used effectively normalize blood cholesterol levels. In some cases these medicines may affect negatively on the functional state of the liver, so it is important to take into account what has comorbidities of the patient, especially in terms of diseases of the liver, gallbladder.

Development of cardiac ischemia Ischemia of the heart - what forms can manifest   You can prevent the influence of a large number of risk factors. Foremost among such factors include a healthy lifestyle. A prerequisite is the removal of taking any alcohol, smoking, strong tea and coffee. Timely appeal to the specialist, the regular passage of annual checkups largely help to reduce the incidence. In the future, you need to implement all the recommendations cardiologist, as it generally affects the effectiveness of the remedial measures.

Marina Solovyov

Prinzmetal angina or variant angina, was first described in 1959. This is a rare form of angina associated with coronary artery spasm - the vessels that supply blood to the heart; This distinguishes it from other types of diseases in which the blood supply to the heart is disturbed, generally because of reduction of the lumen of the arteries as a result of atherosclerosis. In some cases, Prinzmetal variant angina can lead to serious ventricular arrhythmia, myocardial infarction and sudden death.

According to statistics, Prinzmetal angina occurs, on average, four cases per 100 000, but the prevalence of this disorder in the different countries are not the same. For example, in Britain, people rarely suffer from spasms of the coronary arteries - researchers attribute this to the fact that there are widely used calcium channel blockers, which are prescribed for the treatment of various diseases (these drugs relax the walls of blood vessels). In Japan and South Korea, spasms of the coronary arteries are detected in 40% of patients who go to the doctor complaining of symptoms associated with angina, and which pass angiography.

Causes

It is not known exactly what causes a spasm of the coronary arteries. They can develop in people who do not suffer from coronary heart disease associated with impaired patency of the arteries that feed the heart muscle. However, some patients with angina and Prinzmetal detected severe coronary artery disease affecting at least one of the coronary arteries. In such cases, spasm normally occurs in the area where the blood vessel patency broken.

It is assumed that triggers spasms in the coronary arteries Prinzmetal angina can become a strong emotional stress, exposure to very low temperatures, the use of cocaine, smoking, drugs which can narrow blood vessels.

Symptoms of angina Prinzmetal

During an attack of angina pectoris Angina - oxygen deficiency   Prinzmetal patients usually feel a pressure, a very strong pain in the retrosternal space - sometimes referred section, located behind the breastbone. The pain often radiates to the neck, jaw, shoulders and arms. Generally, variant angina attacks occur at rest; they may start each time at one and the same time, and often it occurs between midnight and eight o'clock in the morning. An attack can last anywhere from five minutes to half an hour. Chest pain quickly goes away after taking nitroglycerin. Sometimes angina leads to heart palpitations and loss of consciousness. In some cases, during an attack and / or slightly after Prinzmetal angina attack patients experience severe headache intensity close to pain that occur in migraine.

Diagnosis of angina Prinzmetal

In the diagnosis of angina can be used Printsemetala electrocardiography at rest; its results are particularly useful during attacks of this disorder. Stress test ECG usually gives a negative result, because patients with variant angina Variant angina - severe and under-studied form   symptoms not associated with physical activity.

Furthermore, for the diagnosis of variant angina apply so-called provocative tests. Initially, during their conduct of the work of the heart was observed only with the help of an electrocardiogram. However, after several patients died during the procedure, provocation tests carried out in the steel during coronary angiography: This method allows the rapid detection artery spasms and, if necessary, to eliminate them with drugs.

Provocative test is that physicians cause the patient to coronary artery spasm, using various means, e.g., methacholine, adrenaline, phenylephrine, serotonin, histamine, dopamine. However, currently this purpose are most often used acetylcholine and ergonovine.

In the differential diagnosis is necessary to exclude violations such as myocardial infarction and acute coronary syndrome.

Treatment of angina Prinzmetal

For successful treatment of variant angina is important to avoid the factors that can provoke repeated bouts of illness. These factors include smoking, alcohol consumption, severe stress How to beat stress? Create an oasis   and anxiety Anxiety - how to distinguish normal from disease? .

If angina Prinzmetal happened the first time, the patient required hospitalization; in the hospital his condition will be closely watched doctors and will be carried out a detailed examination.

To relieve the symptoms of an attack are advised to take from one to three nitroglycerin tablets. To prevent further attacks, may be used the following formulations:

• Calcium channel blockers - these drugs in most cases effectively prevent spasms of the coronary arteries are typical variant angina;
• Beta-blockers in combination with nitrates and / or calcium channel blockers may be administered to patients with severe coronary artery disease.

In cases where drug therapy fails, surgical intervention is necessary.

Complications

Prinzmetal angina can lead to the following complications:

• Myocardial infarction. The probability of this complication is 30%, and is highest in patients with severe coronary artery disease;
• Arrhythmia.

In rare cases, variant angina can result in sudden death of the patient. The risk of death is particularly high if the disease is accompanied by a few spasms of the arteries.

Forecast

The forecast is favorable, provided that patients taking calcium channel blockers, refrain from smoking and, in general, lead a healthy lifestyle.