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The Coronary Heart Disease (CHD) is defined as the acute or chronic damage of heart caused by reduction or the termination of delivery of blood to a myocardium as a result of pathological changes in system of coronary arteries. Discrepancy between opportunities of supply of a myocardium with oxygen and needs for it is the cornerstone of a pathogeny of this disease.
Morphological basis of coronary heart disease usually is the atherosclerosis causing stenozirovany one or several coronary vessels that leads to hypoperfusion and developing of ischemia in the corresponding sites of a myocardium. An essential role in a pathogeny of ischemia is played by a vasospasm and bent to formation of blood clots.
Clinical displays of coronary heart disease include stenocardia, a myocardial infarction, disturbances of a rhythm and conductivity of heart, heart failure. This disease is also the reason of considerable number of cases of sudden death.
Ischemia of a myocardium can be caused also by the following rather rare reasons. It is observed at abnormal development of coronary arteries, at patients with inflammatory defeats of vessels (Takayasu's illness, an illness of Kawasaki, system vasculites, in particular, a nodular periarteritis); at infectious processes (a syphilitic mesaortitis with koroparity); at embolisms of coronary arteries (at patients with an infectious endocarditis, a prolapse of the mitral valve), etc. The risk of coronary thrombosis is increased at patients with an erythremia and at a thrombocytosis. At all listed diseases there can be an obstructive defeat of coronary vessels with clinical manifestations in the form of stenocardia and even a myocardial infarction. However coronary heart disease usually does not appear in the diagnosis at such patients, and the disease which led to myocardium ischemia (for example is specified: "Nodular periarteritis. Myocardial infarction"), since. in practice concept coronary heart disease means existence of coronary atherosclerosis as a morphological basis of a disease.
It is established that the atherosclerotic plaques representing pathomorphologic substrate coronary heart disease can be found already in children and teenagers, but clinical displays of this disease most often arise 30 years — at persons of mature, middle and advanced age, and at men on average 10 flyings earlier, than at women are aged more senior.
Despite serious progress, dostignugy for the last three decades in prevention, diagnosis and treatment of coronary heart disease, this disease is the main reason of premature mortality and an invalidism of the population in the majority of industrialized countries also now.
Clinical classification of coronary heart disease
1. Sudden coronary death (primary cardiac standstill)
2.1. Angina of exertion
2.1.1. For the first time the arisen angina of exertion
2.1.2. Stable angina of exertion
(with the indication of a functional class from I to IV)
2.1.3. The progressing angina of exertion
2.2. Spontaneous (special) stenocardia
3. Myocardial infarction
3.1. Macrofocal (transmural) *
4. Postinfarction cardiosclerosis
5. Disturbances of a cordial rhythm (with the indication of a form)
6. Heart failure
7. Bezbolevy ("mute") ischemia of a myocardium
8. Syndrome of X
* In cases when the main manifestations are heart failure and/or disturbances of a rhythm, on there is no macrofocal (postinfarction) cardiosclerosis, in Russia the term "melkoochagovy (atherosclerotic) cardiosclerosis" is used; in foreign literature this form is designated as "an ischemic cardiomyopathy" (N. Braunwald. 1988).
Treatment of coronary heart disease
It is necessary to take care of lifestyle change (obligatory refusal of smoking, correction of level of cholesterol, decrease in body weight) and of influence on risk factors of coronary heart disease. Drug treatment of coronary heart disease is directed mostly to elimination of symptoms of stenocardia. The purposes of treatment of coronary heart disease are defined as improvement of quality of life of the patient, that is reduction of expressiveness of signs, prevention of development of such forms of coronary heart disease, as a myocardial infarction, unstable stenocardia, a sudden cardiac death, and also increase in life expectancy of the patient.
At more hard cases of coronary heart disease surgical methods of treatment are used.