We are used to the fact that if we do not have anything to hurt, then everything is in order. However, thinking is so dangerous, because there are states that have no effect on the general state of the patient, while launching pathological processes inside the body. Such diseases include painless myocardial ischemia.
Features of the disease
Pain-free myocardial ischemia( BBIM) is a temporary impairment of blood supply, metabolism and electrical activity of the heart, which is not accompanied by specific symptoms such as pain or dyspnea.
BIMM can occur as an independent disease or be combined with others. The statistical data show that the elderly men are more often than not the case.
Classification of painless ischemia of the myocardium
It is common to divide painless ischemia according to the Cohn classification from 1993 into several types:
- First. Appears in people with established coronary angiography of stenosis, however, provided that they did not suffer in the past with attacks of angina, myocardial infarction, disturbances of heart rhythms and congestive heart failure.
- Second. Diagnosed in people who have suffered a myocardial infarction, however, not suffering from attacks of angina pectoris.
- Third. It is manifested in patients with angina pectoris.
If to simplify, to the second and third type are patients, in the anamnesis of which is present ischemic heart disease.
Causes of
The most common cause of painless ischemia is atherosclerotic vascular lesions. Atherosclerotic plaques abnormally narrow the vessel, thereby disrupting the blood supply to the heart muscle. Also, ischemia can appear in the background of a spasm of coronary vessels, which changes the activity of the coronary arteries. Spasm most often also occurs due to atherosclerosis of the arteries.
Doctors identify several risk factors, which together can lead to atherosclerosis and spasm, and subsequently to painless ischemia. These include:
- diabetes mellitus;
- arterial hypertension;
- high cholesterol in the blood;
- frequent emotional shocks;
- obesity;
- sedentary lifestyle;
- smoking;
- alcohol abuse;
- old age;
About the symptoms that are characteristic for painless myocardial ischemia, read below.
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Symptoms of
The peculiarity of painless ischemia is that the patient feels satisfactory. Pain symptomatology is absent completely, therefore the patient up to the development of complications may not be aware of his problem.
Often the disease is accompanied by common symptoms, for example, fast fatigue, weakness and dizziness, which many patients do not pay attention to. About how the diagnosis and treatment occurs in painless myocardial ischemia, read on.
Diagnosis
Often ischemia is detected by accident, because it does not bother the patient. However, if the patient came with a suspicion of painless ischemia, then diagnostic activities begin by collecting an anamnesis of complaints, life and family. These data help to suggest ischemia and identify risk factors. Further, the physician conducts a physical examination, in which he identifies heart murmurs, rales in the lungs and other indicative signs.
Further diagnostics are laboratory and hardware studies designed to confirm the diagnosis. These can be considered as:
- General anth of blood and urine, helping to analyze the general condition of the patient.
- Biochem.an-z of blood, helping to identify risk factors for ischemia in a patient.
- ECG, showing left ventricular hypertrophy.
- Echocardiography, assessing the structural and size of the heart, the degree of lesion of atherosclerosis, which allows studying the flow of blood inside the heart,
- Holter ECG monitoring, showing the episodicity of BBM.
Other studies may be carried out, for example, CPEX, drug tests, radioisotope probes and MSCT, which are carried out only if specific equipment is available.
For more details on the diagnosis of latent myocardial ischemia, see the specialist in the video below:
Treatment of
Treatment of asymptomatic myocardial ischemia is based on a combination of therapeutic and medication techniques. It is advisable to conduct medical measures in a hospital environment, as this will help to track the patient's condition.
Therapeutic
In the first couple of therapeutic methods is to limit any stress: physical and emotional. In this case, the patient can be engaged in exercise therapy, which will only improve his condition. In any case, first you need to discuss this point with the treating staff.
During the whole treatment it is necessary to adhere to proper nutrition. So, you need to exclude salty and fat, limit consumption of liquid to 1.2 liters, lean on vegetables and fruits. During this same period it is necessary to quit smoking completely.
Medication
Drug therapy is aimed at overall improvement of the patient's well-being and restoration of normal blood flow.for this, drugs like:
- antiaggregants, which reduce blood clotting, are prescribed;
- beta-blockers extending the vessels;
- calcium antagonists, inhibiting the penetration of calcium into the muscle;
- hypocholesterolemic drugs that lower cholesterol;
- inhibitors of ACE, which reduce blood pressure;
Other drugs can also be used, for example, nitrates for relief of pain symptoms, diuretics for relieving heart strain or antiarrhythmics for normalizing heart rhythms.
Operation
Because BIMM is often detected at a later date, drug therapy is not always successful, so surgical intervention is often required.to the basic types of surgery is:
- Coronary angioplasty, implying the installation of a metal stent in a tapered vessel. The stent helps to widen the vessel and keep it in a normal state.
- Aortocoronary bypass, during which the surgeon creates a vascular bed, along which the blood is delivered to the affected area.
Other operations can also be used: from balloon angioplasty to cardiac transplantation.
Prevention of the disease
Preventative measures are aimed at eliminating the threatening factors and are:
- Complete smoking cessation.
- Regulation of consumption of alcoholic beverages. In a day you can not eat more than 30 grams of alcohol.
- Exception of psychoemotional stresses. If you can not avoid them, you need to take sedatives.
- Supports normal body weight. Find the optimal index for yourself by using a calculator from the network, or by dividing your own weight in kg by the height in meters, squared. The index should fluctuate within 20-25.
- Compliance with normal physical activity. Phys. The load should be daily and constant, take at least 20 minutes a day. Separately from them it is desirable to engage in dynamic cardio.
- Compliance with the rules of rational nutrition, where the consumption of fatty, fried and canned products will be reduced. For normal operation of the heart, you need to eat more fiber, vegetables and fruits, lean meat and fish.
- Control of cholesterol, blood sugar and insulin.
Even following all the above recommendations, it is necessary to undergo periodic checkups at the cardiologist.
About the diet during ischemic illness will tell the video below:
Complications of
The most common complication of painless ischemia is the transition to another form of the disease. In this case, the patient has painful attacks and other symptoms depending on the form. Other complications include:
- myocardial infarction in acute form;
- heart rhythm disturbances;
- chronic heart failure;
Although painless ischemia is asymptomatic, and it may seem that it does not pose a threat to the life of the patient, the pathology can lead to sudden coronary death. Without competent first aid, coronary death always ends in a fatal outcome.
Forecast
Health professionals estimate the outlook for BWA as unfavorable. Approximately 35% of patients asymptomatic ischemia develops into angina and sudden coronary death.
Statistics showing that only the presence of this form of ischemia in the history increases the risk of sudden death 5 times, arrhythmia 2 times, and heart failure 2 times.