The course of chronic ischemic heart disease

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Heart and vessels in such a complex biological system, which is the human body, have a fairly rich possibilities for ensuring circulation and transport of energy and plastic materials, and oxygen, without which impossible the organism vital activity. So naturally, chronic ischemic heart disease manifests itself much later than developing any obstruction in the coronary circulation. We must bear in mind that the patient comes to the doctor only when the pain in the heart, shortness of breath and other subjective feelings, preventing him to live and work. One of the most frequent manifestations of coronary heart disease is angina, or as it is now called, stenocardia (tightness of the chest).
Angina. Development of angina, i.e. attack, chest pain, often accompanied by a cold sweat, palpitations, feeling the fear of death, and the reflected pain in the left arm, especially in the II and III fingers, or between the inner edge of the blades and spine, or in the jaw, at the root of the language, or even pain in the wrist joints, and not only left, but sometimes on the right.
Pain in angina shows the relationship of attack with spasm of the arteries and heart failure krovoobrascheniya the heart muscle, leading to hypoxia and accumulation of non-completely oxidized products of metabolism. Medical assistance should be aimed at elimination of the existing at the moment obstacles for normal blood flow in the arteries of the heart. Clinically this patient's situation is often seen a cry for help choking because of lack of oxygen in the tissues of the heart muscle. In cases when the core of attack are functional changes in the neurovascular apparatus of the heart and possible use of vasodilators (validol, nitroglycerine, mustard on the region of the heart, or between the shoulder blade and the spine, and others) to remove pain attack, occurs practical recovery. If the angina attacks occur against the background sclerotic-modified coronary vessels and in the lumen of the vessels have a solid atherosclerotic plaques that obstruct blood flow, then resort to more energetic influences (intravenous infusion of various drugs, giving oxygen and other)to quickly resolve the tissue hypoxia and relieve pain, a sense of fear of death. However, the patient it is important to determine adverse moments caused the attack to the doctor to timely and correctly to be guided in the provision of preventive and curative care (C. M. Bogoliubov). It is well known that an attack of angina triggered by emotional stress, physical stress, intoxication, cold, etc.
There are three clinical types of angina: 1) angioneuroticeski form, which occurs most often in emotional arousal, particularly in individuals with the General neurosis, unstable nervous system, responsive to the influence of the word, most often in short, causing mental injury to a person. In these cases, coronary artery spasm may occur androgennam way, i.e. through the Central nervous and autonomic nervous system, or by increasing the reactions of sympathetic-adrenal system, which throws in humoral Wednesday excessive amounts of catecholamines. Arrived in the myocardium adrenaline and noradrenaline are dramatically increasing its need for oxygen, resulting develops a mismatch between the supply and demand of myocytes in oxygen and there is angina; 2) angina and angina at rest. Angina is developing under the influence of physical loads, require an increased blood flow to skeletal muscle and cardiac muscle is not able to provide, while developing a violation of the relationship between demand and supply of the heart muscle with oxygen. When strokes of peace, when, due to growth in advanced atherosclerosis occurs narrowing of the coronary arteries, the shortage of blood to the myocardium is so pronounced that does not provide the metabolic processes in the myocytes even during the time of peace; 3) form of angina, clinically flowing quite difficult and varied, and accompanied by cardiac asthma, rhythm and lead to the development of heart failure (I. K. Shkhvatsabaia).
When each of these forms of angina, there are different changes in the function and structure of cells of the myocardium. These changes are accompanied by many clinical manifestations that doctors consider when establishing a diagnosis and a prescription medicine and physical methods for the treatment and secondary prevention of new attacks and to prevent the progression of coronary heart disease.