Physical examination and auscultation

Ischemic heart disease

Ischemic heart disease is caused by atherosclerosis of the coronary arteries, that is, responsible for providing blood to the heart muscle (myocardium).

Coronary Atherosclerosis is a slow process of collagen formation and accumulation of lipids (fats) and inflammatory cells (lymphocytes). These three causes lead to the narrowing of the coronary arteries.

This process begins in the first decades of life, but no symptoms until coronary artery stenosis is so severe that it causes an imbalance between myocardial oxygen supply and needs.

Causes

Ischemic heart disease is a disease that can be prevented significantly, if known and control your cardiovascular risk factors. The main ones are:

More prevalent in older people.

It is more common in men, but the frequency in women is equalized after menopause.

History of premature coronary heart disease in the family.

Increased total cholesterol, especially LDL (bad).

Decreased values ​​of HDL (good).

Smoking.

Arterial hypertension.

Mellitus diabetes.

Obesity.

Sedentary.

Coronary heart disease is primarily manifested as angina or myocardial infarction. It can also cause heart rhythm disturbances (arrhythmias).The two cases are caused by lack of oxygen to part of the heart muscle. Angina occurs when the lack of irrigation is temporary and leaves no damage. When the lack of oxygen is so long that muscle cell death occurs myocardial infarction occurs.

Angina pectoris

It's a feeling of tightness, pain or discomfort that usually starts in the center of the chest that may spread mainly to the arms, neck, back and jaw, it is a progressive intensity and limited duration. Often this pain coincides with exercise, work, sexual activity and emotions, all situations that increase the heart's oxygen needs. Angina disappears when the circumstance ceases triggered.

At other times, pain or angina crisis, appears at rest. In this case what happens is that a clot on a plaque that not all occluded artery or spasm of the artery wall that hinders the passage of blood is formed.

Myocardial infarction

An infarct is an area of ​​tissue that has died from lack of oxygen. It is characterized by:

Intense and prolonged chest pain that is perceived as intense pressure, and can spread (radiate) in arms and shoulders especially left, back, and even the teeth and jaw.

The pain is described as a huge fist heart wrenching. It is similar to angina, but longer, and unresponsive to nitroglycerin under the tongue.

The pain sometimes is perceived differently, or not follow any set pattern, especially in the elderly and diabetics, which can be perceived as a prolonged pain in the upper abdomen that one attributed to indigestion.

Difficulty breathing.

Dizziness: This is the only symptom in 10%.

Other: nausea, vomiting, fainting and sweating may occur.

History of unstable angina: frequent attacks of angina not linked to physical activity.

The myocardium, or heart muscle, can suffer a heart attack when advanced coronary disease exists.

The crown of blood vessels that carry oxygen and nutrients to the heart muscle itself ("coronary" vessels) may develop atherosclerotic plaques (see arteriosclerosis), which engages in more or less the flow of oxygen and nutrients to the heart itself, with effects ranging from angina (when the interruption of blood flow to the heart is temporary) to myocardial infarction (when it is permanent and irreversible).

The presence of atherosclerosis in a glass making since there are constrictions in said vessel and therein more easily develop a thrombus: a clot of platelets, coagulation proteins and cell debris just plugging the vessel. An embolism is a clot that has traveled through the blood to reach a small vessel where they are situated, ocluyéndolo.

A heart attack is a medical emergency by definition. If you think you can be by suffering or are with someone who can have it, seek immediate medical attention. The delays are a serious error that claims thousands of lives each year.

Treatment

In most cases, patients with angina or myocardial infarction can be controlled with medical treatment and lead a normal life.

The goals of treatment are, as appropriate, to disappear or at least decrease the episodes of pain or other symptoms of the disease, prevent further heart attacks and lengthen life.

The treatment usually used in patients with coronary heart disease (angina and myocardial infarction) can be of three types:

Treatment with drugs: antiplatelet drugs, beta blockers, calcium antagonists, statins.

Coronary angioplasty: when the blocked or narrowed coronary arteries cause angina or myocardial infarction in a rather young patient without other complications may be indicated percutaneous transluminal coronary angioplasty (PTCA), simply called coronary angioplasty.

The procedure is easier than the name. Basically it comes to remodeling (angioplasty) capping vessel (coronary) from within the own glass (transluminal) that is accessed through the skin (percutaneous). All this is done under local anesthesia, with the affected awake.After an injection of local anesthetic in the groin or in the shoulder area, it is inserted into an artery in the leg or arm a hollow, flexible tube called a catheter guide. Guided by a TV monitor showing a radiographic image of the catheter moving through the vessel, the doctor takes the catheter to the narrowed coronary artery.

Once there catheter another second, smaller, is inserted within the guide catheter.

This second catheter has an inflatable balloon at the tip is inflated to about half a minute to widen the occluded portion of the artery; when inflated, it can be noticed anginal pain which disappears slowly deflate.

The balloon catheter is removed, and again take radiographs (injecting a radiopaque contrast through the catheter guide) to see how improved the flow. The entire process is completed in 30 to 90 minutes.

The results are good. The procedure fails only in a small percentage of patients, which required major cardiac surgery (bypass or aorto-coronary bypass) is made. The advantages of angioplasty are countless with respect to major surgery. The risks and costs of personnel and equipment are much lower, and the subsequent stay in the hospital may be a few days, rather than weeks.

However, angioplasty does not cure the underlying disease (atherosclerosis, usually), and sometimes must be repeated to reopen the same vessel has become occluded.

Surgical treatment: The most commonly used technique is known as the "bypass" (in Castilian is known as "graft" or coronary "bridge"). Is to re-restore blood flow to the ischemic area using for that a fragment of a secondary vein or artery (obtained from the leg or chest) that "jumps" over the blocked area.

Drug treatment

Analgesics (pain medication). If chest pain persists and is unbearable, morphine or similar drugs to relieve it is administered.

Thrombolytics: These medications to dissolve the clot prevents blood flow. Substances such as streptokinase or "tissue plasminogen activator" or in the vein or put directly into the clot through a catheter (a long, flexible tube).

Nitrates: nitroglycerin derivatives produce vasodilation of the coronary arteries. In the angina is taken into tablets are placed under the tongue or in spray. They can also be taken long-acting capsules or call-release patches on the skin. In the acute phase of a heart attack, often they used intravenously.

Beta-blockers act by blocking many effects of adrenaline in the body, particularly the stimulating effect on the heart. The result is that the heart beats more slowly and with less force, and therefore needs less oxygen. Also lower blood pressure and loso relaxing muscles in the arterial wall.

Digital: The digital-derived medicines, such as digoxin, act by stimulating the heart to pump more blood. This is interesting especially if the heart attack heart failure occurs.

The calcium antagonists or blockers of calcium channels prevent calcium entry into myocardial cells by limiting their ability to contract and consequently its oxygen requirements. This reduces the tendency of the coronary arteries to narrow and also reduces the heart's workload and therefore needs oxygen. Also lower blood pressure. Not commonly used in the acute phase of a heart attack, although immediately afterwards.