http___mednotess.com_hr_pages_1423762_1.xml
1.1 2.1 2.2 2.3 3.1 4.1 5.1 6.1 6.2 7.1 7.2 8.1 9.1 10.1 10.2 11.1 11.2 11.3 11.4 11.5 12.1 13.1 14.1 15.1 15.2 15.3 16.1 16.2 17.1 17.2 18.1 18.2 18.3 19.1 19.2 20.1 20.2 21.1 21.2 21.3 21.4 22.1 22.2 23.1 23.2 24.1 24.2 25.1 25.2 25.3 26.1 27.1 27.2 27.3 27.4 27.5 28.1 28.2 28.3 28.4 28.5 29.1 29.2 30.1 30.2 30.3 31.1 31.2 31.3 31.4 31.5 32.1 33.1 33.2 33.3 33.4 33.5 33.6 34.1 34.2 34.3 34.4 34.5 35.1 35.2 35.3 35.4 36.1 36.2 36.3 36.4 36.5 37.1 37.2 37.3 37.4 37.5 37.6 38.1 38.2 38.3 39.1 39.2 40.1 40.2 40.3 41.1 41.2 41.3 41.4 41.5 42.1 42.2 43.1 43.2 43.3 43.4 44.1 44.2 44.3 44.4 44.5 45.1 45.2 46.1 46.2 46.3 46.4 46.5 47.1 47.2 47.3 48.1 48.2 48.3 48.4 48.5 48.6 49.1 50.1 51.1 52.1 52.2 53.1 53.2 53.3 53.4 54.1 54.2 54.3 54.4 55.1 55.2 55.3 55.4 55.5 55.6 56.1 56.2 56.3 57.1 57.2 57.3 58.1 58.2 59.1 59.2 59.3 59.4 60.1 61.1 62.1 62.2 62.3 62.4 63.1 63.2 64.1 64.2 64.3 65.1 65.2 65.3 66.1 66.2 66.3 67.1 67.2 68.1 68.2 68.3 69.1 69.2 69.3 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 71.1 71.2 71.3 71.4 72.1 72.2 72.3 72.4 72.5 73.1 73.2 74.1 75.1 75.2 75.3 75.4 75.5 75.6 76.1 76.2 76.3 76.4 77.1 78.1 79.1 79.2 80.1 81.1 81.2 81.3 81.4 82.1 82.2 82.3 82.4 83.1 83.2 83.3 83.4 83.5 84.1 85.1 85.2 86.1 86.2 87.1 88.1 88.2 88.3 89.1 89.2 89.3 89.4 89.5 90.1 90.2 90.3 90.4 91.1 91.2 92.1 92.2 93.1 93.2 94.1 94.2 94.3 95.1 95.2 96.1 97.1 97.2 97.3 98.1 98.2 98.3 98.4 99.1 99.2 99.3 99.4 99.5 99.6 100.1 100.2 101.1 101.2 102.1 102.2 102.3 102.4 103.1 104.1
Coronary Artery Disease Coronary artery disease (CAD), also called heart disease, is a condition in which fatty deposits, called plaque, build-up in the heart’s arteries. These deposits cause arteries to become narrow and blocked, which restricts blood and oxygen flow to the heart muscle. CAD is the leading cause of death for both men and women in the United States. Risk Factors The most important factors that increase the risk for CAD are: Symptoms Angina is the primary symptom of coronary artery disease. Angina feels like gripping pain or pressure in the chest area. Some patients with CAD have few or no symptoms. Sometimes a heart attack may be the first sign that a person has CAD. Treatment Lifestyle changes (such as a healthy diet and regular physical activity) are essential for preventing and treating CAD. Medications for preventing and treating CAD include aspirin, cholesterol-lowering drugs (statins), and high blood pressure medications. Some patients take nitrate drugs such as nitroglycerin or other medications to treat angina. Procedures may be needed to open a blocked or narrowed coronary artery and improve blood flow to the heart. This approach is known as reperfusion therapy. Percutaneous coronary intervention (PCI), also called angioplasty, uses a small balloon to open the blood vessel. Coronary artery bypass graft (CABG) is a more invasive procedure that is generally recommended for patients with severe heart disease. It uses grafts from arteries or veins to reroute blood flow. Heart Disease Guidelines The American College of Cardiology, American Heart Association, and other professional organizations’ guidelines recommend: Coronary artery disease (CAD), also called heart disease or ischemic heart disease, results from a complex process known as atherosclerosis (hardening of the arteries). In atherosclerosis, fatty deposits (plaques) of cholesterol and other cellular waste products build-up in the inner linings of the heart's arteries. This causes blockage of arteries and prevents oxygen-rich blood from reaching the heart (ischemia). There are many steps in the process leading to atherosclerosis, some not fully understood. Cholesterol and Lipoproteins. The atherosclerosis process begins with cholesterol and sphere-shaped bodies called lipoproteins that transport cholesterol. Oxidation. The damaging process called oxidation is an important trigger of atherosclerosis. Inflammatory Response. For the arteries to harden there must be a persistent reaction in the body that causes ongoing harm. This reaction is an immune process known as the inflammatory response. Blockage in the Arteries. Eventually the calcified (hardened) arteries become narrower, a condition known as stenosis. The End Result: Heart Attack. A heart attack can result in several ways from atherosclerosis: The external structures of the heart include the ventricles, atria, arteries, and veins. Arteries carry blood away from the heart while veins carry blood into the heart. In the following image, the vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide. Heart disease is the leading cause of death in the U.S. Over the past few decades, heart disease rates declined in both men and women as they quit smoking and improved dietary habits. This improvement, however, has leveled off in recent years, most likely because of the dramatic increase in obesity in the U.S. and other industrialized nations. The risk of CAD increases with age. About 85% of people who die from heart disease are over the age of 65. Men have a greater risk for CAD and are more likely to have heart attacks earlier in life than women. Women's risk for heart disease increases after menopause, and they are more likely to have angina than men. Certain genetic factors increase the likelihood of developing significant risk factors, such as diabetes and high blood pressure. Heart disease tends to run in families. People whose parents or siblings developed heart disease at a younger age are more likely to develop it themselves. African-Americans have the highest risk of heart disease, due in part due to higher rates of severe high blood pressure, diabetes, and obesity. Smoking. Smoking is the most important risk factor for heart disease. Smoking can cause elevated blood pressure, worsen lipids, and make platelets very sticky, raising the risk of clots. Although heavy cigarette smokers are at greatest risk, people who smoke as few as three cigarettes a day are at increased risk for blood vessel abnormalities that endanger the heart. Regular exposure to secondhand smoke also increases the risk of heart disease in nonsmokers. Alcohol. Moderate alcohol consumption (one or two drinks a day; 5 ounces wine, 12 ounces beer, or 1.5 ounces hard liquor is one drink) can help boost HDL “good” cholesterol levels. Alcohol may also prevent blood clots and inflammation. By contrast, heavy drinking harms the heart. In fact, heart disease is the leading cause of death in alcoholics. Diet. Diet plays an important role in the health of the heart, especially in controlling dietary sources of cholesterol and restricting salt intake that contributes to high blood pressure. Physical Inactivity. Exercise has a number of effects that benefit the heart and circulation, including improving cholesterol and lipids, lowering blood pressure and blood sugar levels, and improving weight control. People who are sedentary are almost twice as likely to suffer heart attacks as are people who exercise regularly. Obesity and Metabolic Syndrome. Excess body fat, especially around the waist, can increase the risk for heart disease. Obesity also increases the risk for other conditions (such as high blood pressure and diabetes) that are associated with heart disease. Obesity is particularly hazardous when it is part of the metabolic syndrome, a pre-diabetic condition that is significantly associated with heart disease. This syndrome is diagnosed when three of the following are present: There are numerous ways to control your weight and diet. Unhealthy Cholesterol and Lipid Levels. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol responsible for many heart problems. Triglycerides are another type of lipid (fat molecule) that can be bad for the heart. High-density lipoprotein (HDL) cholesterol is the "good" cholesterol that helps protect against heart disease. Doctors test for a "total cholesterol" profile that includes measurements for LDL, HDL, and triglycerides. The ratio of these lipids can affect heart disease risk. High Blood Pressure. High blood pressure (hypertension) is associated with coronary artery disease. For an adult, a normal blood pressure reading is below 120/80 mm Hg. High blood pressure is generally considered to be a blood pressure reading greater than or equal to 140 mm Hg (systolic) or greater than or equal to 90 mm Hg (diastolic). Blood pressure readings in the prehypertension category (120 - 139 systolic or 80 - 89 diastolic) indicate an increased risk for developing hypertension. Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, significantly increases the risk of developing heart disease. In fact, heart disease and stroke are the leading causes of death in people with diabetes. People with diabetes, both type 1 and type 2 are also at risk for high blood pressure and unhealthy cholesterol levels, blood clotting problems, and impaired nerve function, all of which can damage the heart. Peripheral Artery Disease. Peripheral artery disease (PAD) occurs when atherosclerosis affects the extremities, particularly the feet and legs. The major risk factors for heart disease and stroke are also the most important risk factors for PAD. (The combination of such conditions with PAD also produces more severe forms of heart or circulatory disease.) Even though signs of heart disease are often not evident in the majority of patients with PAD, most of these patients also have coronary artery disease. Depression. Although people with heart disease may become depressed, this does not explain entirely the link between the two problems. Data suggest that depression itself may be a risk factor for heart disease as well as its increased severity. A number of studies indicate that depression has biologic effects on the heart, including blood clotting and heart rate. Guidelines recommend that patients who have undergone coronary artery bypass surgery or angioplasty (PCI) be screened for depression. Stress may also contribute to risk. Homocysteine and Vitamin B Deficiencies. Deficiencies in the B vitamins folate (known also as folic acid), B6, and B12 have been associated with a higher risk for heart disease in some studies. Such deficiencies produce higher blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure. However, while B vitamin supplements do help lower homocysteine levels, they appear to have no effect on heart disease outcomes, including preventing heart attack or stroke. Research indicates that homocysteine may be a marker for heart disease rather than a cause of it. C-Reactive Protein. C-reactive protein (CRP) is a product of the inflammatory process. It is not known if the protein plays any causal role or whether it is simply a marker for other factors in the disease process. pneumoniae and Other Infectious Organisms. Some microorganisms and viruses may possibly contribute to the inflammation and damage in arteries. The most interesting evidence to date suggests a potential role for Chlamydia (C.) pneumoniae (an atypical bacterial organism that causes mild pneumonia in young adults). C. pneumoniae is sometimes detected in plaques in the arteries of patients with heart disease. However, treatment with appropriate antibiotics has not been found to reduce the risk of future heart problems for patients infected with this organism. Other studies suggest that cytomegalovirus (CMV), a common virus, may have similar effects. Many people, however, have been infected with these organisms, and no clear association has been found with any of these infections. Sleep Apnea. Obstructive sleep apnea is a condition in which tissues in the upper throat sag at intervals during sleep, thereby blocking the passage of air. Patients with severe, untreated apnea are at increased risk for CAD, high blood pressure, stroke, and heart attack. However, there is no evidence to date that obstructive sleep apnea is an independent cause of cardiac events or stroke. Periodontal Disease. Periodontal disease and heart disease are both inflammatory conditions that share common risk factors such as smoking and diabetes. According to the American Heart Association, more evidence is needed to establish a cause-and-effect relationship between gum disease and heart disease. Still, periodontists and cardiologists recommend that patients who have periodontal disease and at least one risk factor for heart disease should have a medical evaluation for heart problems. Patients who have CAD should have regular exams to check for signs of periodontal disease. Common symptoms of coronary artery disease (CAD) include angina, shortness of breath (particularly during physical exertion), and rapid heartbeat. Sometimes patients with CAD have few or no symptoms until they have heart attack or heart failure. Angina is a symptom, not a disease. It is the primary symptom of coronary artery disease and, in severe cases, of a heart attack. It is typically felt as chest pain and occurs as a consequence of a condition called myocardial ischemia. Ischemia results when the heart muscle does not get as much blood (and, as a result, as much oxygen) as it needs for a given level of work. Angina is usually referred to as one of two states: Angina may be experienced in different ways and can be mild, moderate, or severe. The intensity of the pain does not always relate to the severity of the medical problem. Some people may feel a crushing pain from mild ischemia, while others might feel only mild discomfort from severe ischemia. Stable Angina. Stable angina is predictable chest pain. Although less serious than unstable angina, it can be extremely painful or uncomfortable. It is usually relieved by rest and responds well to medical treatment (typically nitroglycerin). Any event that increases oxygen demand can cause an angina attack. Some typical triggers include: Angina attacks can happen at any time during the day, but most occur between 6 a.m. and noon. Specific symptoms that are more likely to indicate angina include: Other symptoms that may indicate angina or accompany the pain or pressure in the chest include: Unstable angina is a much more serious situation and is often an intermediate stage between stable angina and a heart attack, in which an artery leading to the heart (a coronary artery) becomes completely blocked. A patient is usually diagnosed with unstable angina under one or more of the following conditions: Unstable angina is usually discussed as part of a condition called acute coronary syndrome (ACS). ACS also includes people with a condition called NSTEMI (non ST-segment elevation myocardial infarction) -- also referred to as non-Q wave heart attack. With NSTEMI, blood tests indicate a developing heart attack. These conditions are less severe than full-blown heart attacks but may develop into major attacks without aggressive treatment. Prinzmetal's Angina. A third type of angina, called variant or Prinzmetal's angina, is caused by a spasm of a coronary artery. It almost always occurs when at rest. Irregular heartbeats are common, but the pain is generally relieved promptly with standard treatment. Silent Ischemia. Some people with severe coronary artery disease do not have angina pain. This condition is known as silent ischemia, which may occur when the brain abnormally processes heart pain. Silent ischemia is a dangerous condition because patients have no warning signs of heart disease. Some studies suggest that people with silent ischemia have higher complication and mortality rates than those with angina pain. (Angina pain may actually protect the heart by conditioning it before a heart attack.) Chest pain is a very common symptom in the emergency room, but heart problems account for less than half of all chest pain episodes. There are many other causes of chest pain or discomfort including injured muscles, arthritis, heartburn, and asthma. Still, if you are experiencing chest pain, it is best to seek immediate medical attention. Many tests are used to diagnose heart disease. The choice of which (and how many) tests to perform depends on the patient's risk factors, history of heart problems, and current symptoms. Usually the tests begin with the simplest and may progress to more complicated ones. Doctors routinely check for high blood pressure and unhealthy cholesterol levels in all older adults. Specific tests are also important in people who may have risk factors or symptoms of diabetes. An electrocardiogram (ECG) measures and records the electrical activity of the heart. Up to half of people who suffer from angina or silent ischemia, however, have normal ECG readings. The waves measured by the ECG correspond to when different parts of the heart contract and relax. Specific waves seen on an ECG are named with letters: The most important wave patterns in diagnosing and determining treatment for heart disease and heart attack are called ST elevations and Q waves. Exercise stress test for evaluation of coronary artery disease may be performed in the following situations: Basic Procedure. A stress test (exercise tolerance test) monitors heart rhythms, blood pressure, and clinical status. It can tell how well the heart handles work and if parts of the heart have decreased blood supply. A typical stress test involves: An ECG is used to monitor heart rhythms during a stress test. (An echocardiogram or more advanced imaging technique may also be used to visualize the actions of the heart and blood flow.) Interpreting Results. To accurately assess heart problems, varieties of factors are measured or monitored using the ECG and other tools during exercise. They include: Using these and other measures, doctors can determine risk fairly accurately, particularly for men with chronic stable angina. The test has limitations, however, and some are significant. In patients with suspected unstable angina, normal or low risk results may not be as accurate in predicting future risk of cardiac events. About 10% of patients, particularly younger people, will have false positive test results. In such cases, test results indicate abnormalities when there are no heart problems. In addition, for many reasons, the test is less accurate in women and an echocardiogram may be a more accurate procedure for them. An echocardiogram is a noninvasive test that uses ultrasound images of the heart. This test is more expensive than an ECG, but it can be very valuable, particularly in identifying whether there is damage to the heart muscle and the extent of heart muscle damage. A stress echocardiogram may be performed to further evaluate abnormal findings from an exercise treadmill test or a routine echocardiogram. Examples include identifying exactly which part of the heart may be involved and quantifying how much muscle has been infected. It may be the first test done when the exercise treadmill test cannot be performed due to certain abnormal rhythms. Radionuclide procedures use imaging techniques and computer analyses to plot and detect the passage of radioactive tracers through the region of the heart. Such tracing elements are typically given intravenously. Radionuclide imaging is useful for diagnosing and determining: Myocardial Perfusion (Blood Flow) Imaging Test (also called the Thallium Stress Test). This radionuclide test is typically used with an exercise stress test to determine blood flow to the heart muscles. It is a reliable measure of severe heart events. It may be useful in determining the need for angiography if CT scans have detected calcification in the arteries. About a minute before the patient is ready to stop exercising, the doctor administers a radioactive tracer into the intravenous line. (Tracers include thallium, technetium, or sestamibi.) Immediately afterwards, the patient lies down for a heart scan. If the scan detects damage, more images are taken 3 or 4 hours later. Damage due to a prior heart attack will persist when the heart scan is repeated. Injury caused by angina, however, will have resolved by that time. Radionuclide Angiography. This is a technique for visualizing the chambers and major blood vessels of the heart. It uses an injected radioactive tracer and can be performed during exercise, at rest, or with use of stress-inducing drugs. It can help determine the severity of coronary artery disease and is an alternative to echocardiograms in certain situations. Angiography is an invasive test. It is used for patients who show strong evidence for severe obstruction on stress and other tests, and for patients with acute coronary syndrome. It is required when there is a need to know the exact anatomy and disease present within the coronary arteries. A limitation of angiography is that it is not always the most occluded (narrowed) artery that causes the next heart attack. In an angiography procedure: Magnetic Resonance Angiography (MRA). MRA is a newer noninvasive imaging technique that can provide three-dimensional images of the major arteries to the heart. Computed tomography (CT) scans may be used to evaluate coronary artery disease. Calcium Scoring CT Scans of the Heart. These scans are used to detect calcium deposits on the arterial walls. The presence of calcium correlates well with the presence of atherosclerosis of the heart. If the calcium score is very low, a patient is unlikely to have coronary artery disease. A higher calcium score may indicate an increased risk of current and future coronary artery disease. However, the presence of calcium does not necessarily signify narrowing of the arteries that would need further immediate evaluation or treatment. CT Angiography. CT scans may also be used to visualize the coronary arteries. When compared to invasive angiography, CT angiography is not as accurate in identifying who truly has coronary artery disease and who does not. Other types of newer CT techniques include electron beam computed tomography and multidetector computed tomography. Heart disease prevention is important before and after someone is diagnosed with the condition: Key prevention measures include: Your doctor should ask about your smoking habits at every visit. Smoking is a chronic condition and often requires repeat therapy using more than one technique. All patients should start following a heart-healthy diet and exercise regularly, after talking to their doctors. Patients with CAD should aim for LDL cholesterol levels of less than 100 mg/dL. (Doctors may recommend levels below 70 mg/dL for certain patients.) If patients cannot reach the LDL target through lifestyle measures, current guidelines recommend a statin drug. Statin drugs are the primary medications used for lowering LDL (“bad”) cholesterol levels. Keep Blood Pressure Low. People in normal health should have a blood pressure reading of 120/80 mm Hg or less. Blood pressure readings of 120/80 are considered normal, readings of 140/90 or higher indicate high blood pressure (hypertension), and readings in between the two are called pre-hypertension. Patients whose blood pressures stay above 140/90 despite lifestyle therapy (diet, exercise, and weight control) should be treated with blood pressure medications. All patients with diabetes should have their blood sugar (glucose) levels well managed. For most patients, a goal would be to bring HbA1c levels down to around 7%. In general, people with diabetes (both type 1 and type 2) should aim for blood pressure levels of less than 140/80 mm Hg (systolic/diastolic). For some people, especially younger patients, a systolic blood pressure goal of less than 130 mm Hg may be appropriate. People with diabetes and stable heart disease should not take the diabetes drug rosiglitazone(Avandia) because it may increase the risk for heart attack and heart failure. Current American Heart Association (AHA) for guidelines for a heart-healthy diet recommend: People should aim for a BMI index of 18.5 - 24.9. Weight reduction is recommended for overweight patients who have high blood pressure, high cholesterol levels, metabolic syndrome, or diabetes. Some obese patients with coronary artery disease may consider having bariatric surgery (stomach bypass) to lose excess weight. The weight lost after surgery can help improve blood pressure, cholesterol, blood sugar and other factors associated with CAD. Everyone in normal health should do at least moderate physical activity for a minimum of 30 - 60 minutes on most, if not all, days of the week Even small amounts of moderate exercise (such as walking 12 miles a week) can help produce beneficial changes in cholesterol and lipid levels. However, more prolonged exercise is required to significantly change cholesterol levels, notably by increasing HDL ("good cholesterol"). Resistance (weight) training has also been associated with heart protection. Your doctor needs to know if your activity causes any angina symptoms. Sudden strenuous exercise (especially snow shoveling) puts many people at risk for angina and heart attack. Patients with angina should never exercise shortly after eating. People with risk factors for heart disease should seek medical clearance and a detailed exercise prescription. And all people, including healthy individuals, should listen carefully to their bodies for signs of distress as they exercise. Sexual Activity. Most patients with stable CAD can safely engage in sexual activity. Patients with severe heart disease should abstain from sex until their condition has stabilized. Exercise and cardiac rehabilitation can help lower the risks associated with sexual exertion. PDE5 inhibitor drugs [sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), avanafil (Stendra)] are safe and helpful for most patients with stable CAD who have issues with erectile dysfunction. However, patients who take nitrate drugs in any form must never take PDE5 inhibitors. Patients with CAD are considered at high risk for complications from influenza. People with CAD should get an annual flu shot. Lifestyle changes (such as weight control, exercise, and quitting smoking) are the first approach for all degrees of coronary artery disease. Depending on severity and individual conditions, patients may also need one or more medications, surgery, or both. Medications. Many types of medications are used to treat angina and CAD. They include: Interventional Procedures and Surgery. Intervention is usually recommended for people who have: The two main surgical procedures for patients with coronary artery disease are: The decision to choose angioplasty or coronary artery bypass depends on a patient’s individual profile, including the number and types of coronary arteries involved, previous procedures, other health conditions, patient preference, and more. PCI is less invasive than CABG and is more commonly performed. However, CABG may provide better outcomes for certain patients, including those with diabetes. Patients considering surgery should discuss all options and risks with their doctors. Guidelines recommend that patients with CAD discuss their treatment options with a medical team that includes both a cardiac surgeon (who performs CABG) and an interventional cardiologist (who performs PCI). No surgical procedure cures coronary artery disease, and patients must continue to rigorously maintain a healthy lifestyle and any necessary medications. For some patients, lifestyle changes and medications may be able to control the disease without surgery or angioplasty. Anti-clotting drugs that inhibit or break up blood clots are used at every stage of heart disease. They are generally classified as either anti-platelets or anticoagulants. Both anti-platelets and anticoagulants prevent blood clots from forming, but they work in different ways. Anti-platelets prevent blood platelets from sticking together. Anticoagulants are “blood thinners” that stop blood from clotting. Both of these therapies carry the risk of bleeding, which can lead to dangerous situations, including stroke. For most patients with CAD, anti-platelet drugs are preferred over anticoagulants. Anticoagulants may be prescribed for patients with atrial fibrillation or prosthetic heart valves. Current guidelines recommend that patients with CAD receive anti-platelet therapy with either aspirin or clopidogrel. Two newer anti-platelet drugs, Prasugrel (Effient) and ticagrelor (Brilinta), may be recommended for patients with unstable angina, acute coronary syndrome (unstable angina or early signs of heart attack), or those who have received a stent during PCI. Aspirin. Aspirin is known as a nonsteroidal anti-inflammatory drug (NSAID). It stops blood platelets, which are major clotting factors, from sticking together to form a blood clot. Aspirin therapy is extremely beneficial for patients with coronary artery disease or history of stroke. If yo © 2017 KentuckyOne Health • 200 Abraham Flexner Way, Louisville, KY 40202
1.1 2.1 3.1 4.1 5.1 6.1 7.1 8.1 9.1 9.2 10.1 10.2 11.1 11.2 12.1 13.1 14.1 15.1 16.1 17.1 18.1 19.1 19.2 20.1 20.2 21.1 21.2 22.1 22.2 23.1 23.2 24.1 25.1 26.1 27.1 27.2 28.1 28.2 29.1 29.2 30.1 31.1 32.1 33.1 34.1 35.1 36.1 37.1 38.1 39.1 40.1 41.1 42.1 43.1 44.1 45.1 46.1 47.1 48.1 49.1 50.1 51.1 52.1 53.1 53.2 54.1 55.1 56.1 56.2 57.1 58.1 59.1 60.1 61.1 62.1 63.1 64.1 65.1 66.1 67.1 68.1 69.1 70.1 71.1 72.1 73.1 74.1 75.1 76.1 77.1 78.1 79.1 80.1 81.1 82.1 83.1 84.1 85.1 86.1 87.1 88.1 89.1 90.1 91.1 92.1 93.1 94.1
Infarkt miokarda : uzroci , simptomi , dijagnoza i liječenje Kardiovaskularne Bolesti / / August 12, 2017 srca - najteži radni organ ljudskog tijela.Kroz čovjeka kontinuirano pumpa krv kroz arterije mreže života, obogaćuje kisikom i vitalne hranjive tvari do svih tkiva u tijelu.Za izvođenje ovog zadatka napeta, sam srčani mišić treba obilje krvi bogate kisikom kroz koronarne mreže.Te arterije nose krv bogatu kisikom na zid srčanog mišića - miokard. Infarkt miokarda ili srčani udar nastaje kada je blokiran protok krvi u srčani mišić, dolazi nekroze (smrti) od tkiva od gubitka kisika i ozbiljno oštećeni dio srca. Koronarna bolest srca (KBS) uzrokuje gotovo sve srčani udar.KBS je krajnji rezultat složenog procesa koji se zove "ateroskleroza".To dovodi do začepljenja arterija (ishemije) i daje bogatu kisikom krv da stigne do srca. uzroci i faktori rizika za infarkt miokarda faktori rizika za infarkt miokarda - isti su kao faktora rizika od koronarne bolesti srca.To su: - doba. povećanje rizik od koronarnih arterija povećava s godinama.Oko 85% ljudi umre od bolesti srca u dobi od 65 godina.Za - Paul. Muškarci imaju veći rizik od bolesti koronarnih arterija, a više vjerojatno da će imati srčani udar u ranijoj dobi nego žene.Rizik od razvoja bolesti srca kod žena povećava nakon menopauze, a to je vjerojatno, angine pektoris; - genetski faktori i obiteljske povijesti. Neki genetski faktori povećavaju vjerojatnost razvoja značajnih čimbenika rizika - kao što su dijabetes, visoki kolesterol i visoki krvni tlak; - rasa i nacionalnosti. Afroamerikanci imaju najveći rizik od kardiovaskularnih bolesti, a osobito s obzirom na visoke stope visokog krvnog tlaka, kao i dijabetesa i pretilosti; - Pretilost i metabolički sindrom. višak masnog tkiva, osobito oko struka, može povećati rizik od razvoja bolesti srca.Pretilost povećava rizik od drugih stanja (npr visokog krvnog tlaka i dijabetesa), koji su povezani s bolesti srca.Pretilost je posebno opasno kad je dio metaboličkog sindroma - pre-dijabetičko stanje koje je jako povezano s bolestima srca.Ovaj sindrom dijagnosticira kada postoje: - abdominalnu pretilost; - nizak kolesterol (HDL); - visoke razine triglicerida; - visoki krvni tlak; - otpornosti na inzulin (dijabetes ili pre-dijabetes). životne navike - nedostatak fizičke aktivnosti. Vježbe pružaju brojne učinke koje koristi na srce i cirkulaciju.To je, uključujući i - poboljšanje zdravog kolesterola i krvnog tlaka i održavati normalnu težinu.Ljudi koji su se uglavnom sjedeći, gotovo dvostruko češće pate srčani udar od onih koji su redovito sudjelovali u tjelesnoj kulturi i sportu. - Pušenje. Pušenje je najvažniji faktor rizika za bolesti srca.Pušenje može uzrokovati visoki krvni tlak, lipide, te ga degradirati vrlo ljepljive čini trombocita, što povećava rizik od krvnih ugrušaka.Iako je teški pušači cigareta su na visokim rizikom, ljudi koji puše samo tri cigareta dnevno imaju veći rizik od krvnih žila abnormalnosti koje u velikoj mjeri ugrožava srce.I redovito izlaganje pušiti vani ( "pasivno pušenje" pušenje) također povećava rizik od kardiovaskularnih bolesti. - Alkohol. Umjereno konzumiranje alkohola u malim dozama, može povećati razinu HDL-a - "dobar" kolesterol.Alkohol u malim dozama može spriječiti stvaranje tromba i upale.Za razliku od toga, opijanje je vrlo štetna za srce.U stvari, bolesti srca je vodeći uzrok smrti u alkoholičara. - Power. Dijeta igra važnu ulogu u zaštiti srca, posebno smanjivanjem prehrambenim izvorima trans masti, zasićene masti i "loš" kolesterol i ograničavanje unosa soli, koja pridonosi visokog krvnog tlaka. - NSAID i inhibitori COX-2 (ciklooksigenaza enzima tipa 2). Svi nesteroidni protuupalni lijekovi (NSAR), osim aspirina, nose rizik za srce.NSAID i inhibitori COX-2 može povećati rizik od smrti kod pacijenata koji su imali srčani udar.Najveći rizik - pri višim dozama, ali neke studije su pokazale da čak i niske doze NSAR su poduzete za kratko vrijeme, nisu sigurni nakon srčanog udara.NSAR su neprepisan lijekove, kao što su ibuprofen i lijekova na recept poput diklofenaka.Pacijenti koji su imali srčani udar trebali razgovarati sa svojim liječnicima prije uzimanja bilo kojeg od tih lijekova. Simptomi infarkta miokarda simptoma infarkta miokarda može biti vrlo različita.Oni se mogu pojaviti iznenada i snažno, ili može napredovati polako, u rasponu od blage boli.Simptomi mogu također razlikuju kod muškaraca i žena.Žene su manje vjerojatno da imaju klasični bol u prsima, ali oni su više vjerojatno da će doživjeti nedostatak daha, mučnina ili povraćanje, bol u čeljusti ili leđima. Najčešći znakovi i simptomi srčanog udara uključuju: - bol u grudima. Bol ili nelagoda u prsima (angina pektoris) glavni je znak srčanog udara.Može se osjećaju kao pritisak, stiskanje, proširenje srca ili bol u grudima centra.Pacijenti s bolesti koronarnih arterija koje imaju stabilne angine često doživljavaju bol u prsima koja traje nekoliko minuta, a zatim se ugasi.Kad je srčani udar bol obično traje duže od nekoliko minuta, a taj osjećaj može otići, ali onda se može vratiti; - nelagoda u gornjem dijelu tijela. Ljudi koji imaju srčani udar može osjećati nelagodu u rukama, vratu, leđima, čeljusti ili trbuhu; - Pomanjkanje daha. Kratkoća daha može dogoditi s boli u prsima ili bez nje; - Mučnina i povraćanje ; - hladan znoj ; - vrtoglavica ili nesvjestica. slijedeći simptomi mogu biti manje povezani s infarktom miokarda ili srčani udar: - akutne boli uzrokovane disanje ili kašalj; - pritisak u prsima; - bol koja se javlja uglavnom ili samo u sredini ili u donjem dijelu trbuha; - bol koja se može igrati pomicanjem prstiju na tijelo, a pritiskom na prsni koš ili ruku; - bol koja je stalna i traje nekoliko sati (u ovom slučaju, nitko ne mora čekati nekoliko sati, ako je osumnjičeni imao srčani udar); - oštra bol, koja je vrlo kratak, traje samo nekoliko sekundi; - bol koji se širi u noge. Međutim, nedostatak tih simptoma uvijek ne odbacuje mogućnost ozbiljne bolesti srca. Silent ishemije Neki ljudi s teškom bolesti koronarnih arterija i angine nemaju bolove.Ovo stanje je poznato kao "tihi ishemije".To je opasno stanje, jer je bol - pokazatelj bolesti, a ti pacijenti nisu primili od svojih tjelesnih uznemirujućih znakova upozorenja od srčanih bolesti.Neke studije pokazuju da ljudi s "tihe ishemije" imaju veći pobol i smrtnost od onih sa simptomima boli. Što ako je srčani udar ljudi koji pokazuju simptome koji su bili srčani udar simptomi, učinite sljedeće: - angina bolesnici trebaju uzeti jednu dozu nitroglicerina pod jezik (tablete) ili u obliku spreja upojava simptoma.Potrebno je uzeti drugu dozu svakih 5 minuta (do tri doze) ili do bol smanjena; - odmah treba nazvati broj lokalnih hitne medicinske pomoći.To bi trebao biti prvi radnja, ako angina pacijenti i dalje doživjeti bol u prsima nakon uzimanja tri doze nitroglicerina.Međutim, samo 20% od srčanog udara se javljaju u bolesnika s anginom pektoris ranije dijagnosticirati.Dakle, svatko tko razvije simptome srčanog udara, odmah treba nazvati "brzo"; - pacijent treba sažvakati i progutati aspirin za odrasle (325 mg) nije obložen, a liječnici kažu da oni nisu mu dati dodatnu dozu nitroglicerina; - bolesnika s boli u prsima ne treba se umoriti, oni bi trebali ići u bolnicu. Dijagnostika infarkt miokarda Kada pacijent dođe u bolnicu s bolovima u prsima, kroz obično uzimaju dijagnostičke mjere za utvrđivanje bilo kakvih problema sa srcem, ako su prisutne, a njihov stupanj ozbiljnosti.Pacijent mora obavijestiti liječnika o bilo kojem simptoma koji liječnici nisu mogli isključiti mogućnost srčane probleme i predložiti moguće druge uzroke teške bolesti. ispitne slike, uključujući ehokardiografija i perfuzijske scintigrafije, pomoći eliminirati srčanog udara, ako postoje bilo kakva pitanja i sumnje. - elektrokardiogram (EKG). EKG mjere i bilježi električnu aktivnost srca.Val mjeri na elektrokardiogram mjereno odgovara kontrakcije i opuštanja različitim dijelovima srca. Liječnici koriste pojmove «PQ» i «PR-interval" - to je vrijeme koje je potrebno da se presele električni impuls iz atrija do ventrikula. najvažnije valovi u dijagnostici i određivanje liječenja srčanog udara pod nazivom «S-t» i «P-val". - Povišena segmenti S-t: srčani udar. Povišene segmenti S-T su uvjerljivi dokazi od srčanog udara u pacijenata sa simptomima infarkta miokarda.Pretpostavlja se da je arterija dovodi do srca su blokirani i da ukupna debljina srčanog mišića je oštećen.Vrsta srčanog udara povezanog s tim nalazima, pod nazivom «Q-infarkt miokarda (IM)" ili "s usponom IM S-t» (povišenje S-t-segment infarkt miokarda).Međutim, povećanje S-t segment ne znači nužno da pacijent ima srčani udar.Na primjer, upala u vreći oko srca (perikarditis) je još jedan razlog visina S-t-segment. - Stabilna angina (kad su rezultati ispitivanja krvi ili drugih testova ne ukazuju na ozbiljan problem i ne otklanja bol u prsima).Između 25-50% ljudi koji imaju angina ili tihi ishemije, normalan EKG čitanja. - Akutni koronarni sindrom (AKS) - uključuje iznenadnu i tešku bolest srca koja zahtijeva ozbiljno liječenje, ali bolest koja još nije postala full-puhano srčani udar. - echocardiogram - neinvazivni test koji koristi ultrazvučne slike srca.Liječnik je važno znati da li je dio srčanog mišića je oštećen.Ehokardiografija također može koristiti kao dio testa opterećenja otkriti lokaciju i opseg oštećenja srčanog mišića u vrijeme otpusta ili ubrzo nakon otpuštanja iz bolnice nakon srčanog udara. - radionuklida slike (talij stres test). radionuklid postupci koji koriste imaging tehnike i računalnu analizu za izgradnju i otkriti prolaz radioaktivnih izotopa kroz srce.Takovi elementi su obično daju intravenozno.Radionuklida slike koristiti za dijagnosticiranje i: - težini nestabilne angine, kada jeftiniji dijagnostički pristupi su nedostupni ili nepouzdani; - ozbiljnost kronične bolesti ishemijska srca; - uspjeh operacije u ishemijskom bolesti srca; - ako ste imali srčani udar; - položaj i opseg oštećenja srčanog mišića u vrijeme otpusta ili kratko nakon otpuštanja iz bolnice nakon srčanog udara. Postupak je neinvazivan (bez intervencije u tijelo).Ako postoji oštećenje srčanog udara, radioaktivni izotop (tehnecij ili talijev) uvedena u pacijenta venu.Radioaktivni izotop prolazi kroz krv koja cirkulira u srcu.Izotopa mogu se pratiti kroz srce pomoću posebnih kamera ili skenera.Slike mogu biti u kombinaciji s elektrokardiogram.Pacijent je testiran tijekom blagdana, a zatim ponovno ispitivanje prolazi vrijeme testa opterećenja.Šteta zbog srčanog udara prošle bit će spremljene kada se ponavlja skeniranje srce.Trauma uzrokovana anginom, međutim, pojavit će vrijeme. - angiografija. angiografija je invazivni test.To se koristi za pacijente koji pokazuju jake dokaze o teškom opstrukcijom (prepreka normalnom radu) zbog stresa i drugih ispitivanja, kao i za pacijente s akutnim koronarnim sindromom. Postupak: uska cijev se umeće u arteriju - obično u nogu ili ruku, a zatim s navojem se pokretnom tijelu da koronarnih arterija.Boja se ubrizgava u cijevi, a Rendgenski zapisi boje kroz arterije.Ovaj proces omogućuje kartu koronarnu cirkulaciju, otkrivajući blokiranog područja. - Biološki biljezi.Kad srčane stanice su oštećeni, oni oslobađaju razne enzima i drugih tvari u krvotok.Povišene razine tih markera srčanog oštećenja u krvi i urinu može pomoći u predviđanju srčanih udara kod bolesnika s teškim bolovima u prsima, te određivanje metode liječenja.Testovi za tih markera često izvode u stroj "hitne" ili u bolnici, kada se sumnja na srčani udar.Neki markeri su troponini;miokarda kreatin kinaze (CK-MB), itdOpcije infarkt miokarda Liječenje liječenja uključuju infarkt miokarda: - terapija kisikom; - Nitroglicerin ili morfij - za ublažavanje boli i nemir; - kontrolu bilo aritmije (smetnje srčanog ritma); - blokira daljnje zgrušavanje krvi (ako je moguće); - otvaranje blokirane arterije što je prije moguće - obavljanjem angioplastika ili lijekove koji tanka krvnih ugrušaka; - beta blokatori, blokatori kalcijevih kanala ili ACE inhibitori - za pomoć mišiće srca i arterija rade bolje. prvo pomoći pacijentu s infarktom infarkom U ranim postupcima za podršku su slični za pacijente koji su pretrpjeli infarkt miokarda.Potrebno, osobito kisik, aspirin, nitroglicerin, morfij, otvaranje arterija kroz hitne angioplastike ili tromboliticima. Standardna opće medicinske i kirurške skrbi za otvaranje arterija: - angioplastike (perkutane koronarne intervencije - PCI) - postupak željeni hitnu za otvaranje arterije; - trombolitici (lijekovi) - standardni lijekovi koji se koriste za otvaranje arterija.Trombolitik lijek treba dati u roku od 3 sata nakon početka simptoma; - CABG - ponekad koristi kao alternativa angioplastike. - tromboliticima. tromboliticima - lijekovi koji se preporučuju kao alternativa angioplastike.Ovi lijekovi otopiti ugrušak krvi blokira arterije i vodi srce mišićno tkivo umrijeti. tromboliza smatra dobar izbor za pacijente sa srčanim napadima, u kojima simptomi su manje od 3 sata.U idealnom slučaju, ti lijekovi moraju se dati u roku od 30 minuta nakon dolaska u bolnicu, kada je angioplastika nije izvediva opcija. druga situacija gdje možete koristiti droge: - kontinuirani transport pacijenta; - predugo čekaju kateterizacije; - ako se postupak koronarne premosnice nije bio uspješan, ili ako anatomski previše komplicirano. trombolitici treba izbjegavati ili koristiti s oprezom u sljedećim skupinama bolesnika nakon srčanog udara: - više od 75 godina; - one čiji simptomi potraju duže od 12 sati; - trudnice;Art.