Treatment of ischemic heart disease

Symptoms of CHD usually appear when there is significant narrowing of the arteries and insufficient blood supply to the myocardium.

Angina attacks may occur during physical exertion or severe stress. Usually, pain behind the sternum and shortness of breath appear due to fast walking or climbing stairs. At rest, they pass within 5–15 minutes. This sign helps doctors distinguish angina from other diseases with similar manifestations.

As the disease progresses, angina may occur with minor exertion and even at rest.

Pain during angina may vary — acute or aching, with a feeling of pressure in the chest. It may radiate to the left shoulder and arm, neck, lower jaw, and shoulder blade area. At the same time, the pulse becomes faster and shortness of breath appears. In severe attacks, dizziness, nausea, and other symptoms may occur.

If the pain is very severe or persists at rest for more than 15 minutes, it is necessary to seek medical attention urgently. It may be a symptom of acute cardiac ischemia or another condition requiring immediate medical care.

CHD develops due to narrowing of the lumen or blockage of the coronary arteries. This may be triggered by:

• progressive atherosclerosis;

• thrombosis of the coronary arteries;

• arterial spasm.

Atherosclerosis is the main cause of ischemia. As the disease develops, atherosclerotic plaques form in the vessels. Gradually, they increase due to the accumulation of cholesterol and narrow the vascular lumen. When the coronary arteries are affected in this way, CHD develops. If the lumen of the vessels is narrowed by more than 90%, pronounced symptoms of angina appear even at rest.

Acute ischemia may occur when a vessel is blocked by a plaque or a thrombus. The risk of thrombosis increases when atherosclerotic plaques rupture, which happens as the disease progresses or in the presence of other risk factors.

In rarer cases, cardiac ischemia is caused by vascular spasm, which occurs due to excessive physical exertion, severe psycho-emotional stress, the use of vasoconstrictor drugs, etc.

Depending on the degree of arterial narrowing, CHD may occur in two forms:

• acute — blockage of the arteries occurs and myocardial infarction develops;

• chronic — the diameter of the vessels narrows, which may initially not manifest itself or cause symptoms of angina, arrhythmia, and other disorders.

Coronary heart disease may manifest in different ways and lead to the development of other cardiovascular diseases.

Therefore, depending on clinical manifestations, the following forms of coronary heart disease are also distinguished:

• asymptomatic form of ischemia;

• angina (stable / unstable);

• arrhythmia — heart rhythm disturbance;

• cardiosclerosis — replacement of myocardial muscle fibers with scar tissue and deformation of the valves;

• myocardial infarction.

Coronary heart disease does not have specific signs. Chest pain and shortness of breath may occur in various diseases. Therefore, examinations are required to clarify the diagnosis and the cause of the disease.

At the first appointment, the doctor will ask about all complaints, lifestyle, and the presence of chronic conditions. Then the doctor will perform an examination, measure blood pressure, and prescribe additional tests.

For the diagnosis of heart diseases, the following are performed:

• electrocardiogram (ECG);

• 24-hour Holter ECG monitoring;

• echocardiography (heart ultrasound);

• coronary angiography (X-ray of the coronary arteries with contrast);

• myocardial scintigraphy (visualization of blood flow);

• computed tomography (CT) of the heart;

• stress test (ECG or scintigraphy during physical exertion);

• laboratory blood tests.

ECG allows assessment of the electrical activity of the heart, disturbances of which are a sign of disease. For the same purpose, 24-hour monitoring is performed. It makes it possible to track heart function during physical activity, rest, and sleep.

Echocardiography or ultrasound makes it possible to assess the structural condition of the heart, valve function, and the presence of damage. In some cases, CT is prescribed for better visualization.

Coronary angiography shows the condition of the coronary arteries through which blood flows to the myocardium. During the examination, it is possible to determine where and to what extent the arteries are narrowed. Scintigraphy is also performed to assess blood circulation. The studies may complement each other or be used as alternatives.

An important stage in the diagnosis of angina and coronary heart disease is the stress test — assessment of pulse and other heart parameters during physical activity. Most often, ECG is performed while exercising on a stationary bike or treadmill.

Blood tests are also обязательно prescribed: complete blood count, biochemistry, lipid profile, blood glucose level, cardiac-specific enzymes, and others.

For each patient, the doctor develops an individual examination program, taking into account all symptoms, overall health condition, and other characteristics. Only comprehensive diagnostics make it possible to confirm or rule out the diagnosis of CHD.

For CHD, medical and surgical treatment are used. Prescriptions depend on the degree of narrowing of the coronary arteries, the severity of symptoms, or the presence of complications.

Drug therapy is used to improve blood flow through the vessels supplying the heart, reduce the risk of complications, and treat concomitant diseases (atherosclerosis and others). The following medications are most commonly used in therapy:

• antiplatelet agents (aspirin, etc.) — help thin the blood and reduce the risk of thrombosis and vascular blockage;

• statins — reduce blood cholesterol levels;

• nitrates — promote dilation of the arteries and improve blood supply to the myocardium;

• calcium channel blockers — cause relaxation and dilation of blood vessels, improving blood flow to the myocardium;

• beta-blockers — relax the heart muscle, normalize pulse and blood pressure;

• angiotensin-converting enzyme (ACE) inhibitors — relieve vascular spasm and help lower blood pressure.

This is an approximate list of medications included in the CHD treatment protocol. The doctor selects treatment individually for each patient, taking into account the results of all examinations and other characteristics.

In case of blockage, significant narrowing of the coronary arteries, or ineffectiveness of drug therapy, surgical treatment is used. Depending on the indications, one of the following operations is most often performed:

• angioplasty and stenting — during the operation, the lumen of the damaged arteries is widened and stents are inserted to keep them open;

• coronary artery bypass grafting — blood supply to the myocardium is restored by creating blood flow around the affected arteries using vascular grafts (most often large vessels from the patient’s legs are sewn into the bloodstream).

At “Oxford Medical,” surgeries are performed in a modern surgical inpatient unit with two high-tech operating blocks. They are equipped with new diagnostic and treatment equipment. The inpatient unit also has an intensive care ward equipped with everything necessary to monitor and support vital body functions.

Operations are performed by experienced cardiac surgeons with many years of practice.

Coronary heart disease tends to progress gradually. If the blood supply to the myocardium remains insufficient for a long time or repeated episodes of acute ischemia occur, this may lead to structural and functional changes in the heart and the development of serious complications.

The main consequences of CHD include:

• heart failure — a gradual decrease in the pumping function of the heart due to chronic ischemia or a previous myocardial infarction;

• heart rhythm disorders — development of tachycardia, atrial fibrillation, ventricular arrhythmias, which may be life-threatening;

• cardiosclerosis — replacement of damaged areas of the myocardium with scar tissue, which reduces the contractile ability of the heart;

• recurrent myocardial infarction — with progression of atherosclerosis or repeated thrombosis of the coronary arteries;

• sudden cardiac death — a possible consequence of severe rhythm disturbances or massive myocardial damage.

After a myocardial infarction, part of the heart muscle loses the ability to contract fully. This may lead to cardiac remodeling — changes in its shape and size, which over time worsen the overall prognosis. In patients with significant coronary artery damage, tolerance to physical exertion decreases, chronic shortness of breath, edema, and other signs of heart failure appear.

Prolonged ischemia also increases the risk of thrombosis, which may cause not only a heart attack but also other vascular complications.

Therefore, early diagnosis, control of risk factors, and timely treatment are key to preventing the progression of CHD and the development of its severe consequences. Regular follow-up with a cardiologist makes it possible to assess the condition of the cardiovascular system, adjust therapy, and reduce the risk of complications in the long term.