Atherosclerosis – the silent killer

Atherosclerosis, a chronic disease of the arteries that is accompanied by cholesterol deposition, is the gray cardinal of death, a silent killer that people, alas, underestimate. At the age of 30, 40% of Russians already have atherosclerotic lesions. At the age of 40, 50% already have pronounced atherosclerotic lesions. In 60 years, 70% of people have pronounced manifestations of atherosclerosis.

But in most cases, the course of atherosclerosis is asymptomatic. As long as the 70% plaque does not overlap the vessel, there will be no complaints. This is the case when “suddenly”, against the background of complete health, a person enters the hospital with an infocalct or stroke. But this is not “all of a sudden”, but because all people’s reserve capacities are very large and the vessels can carry the load for a long time.

“The main thing is the state of the vascular wall,” explains Alexey Chudinov. – From the outside, the vessel is smooth, like plastic. And if pure cholesterol is passed through this vessel, then cholesterol is not deposited there. Therefore, the discovery made was so important: even if the cholesterol is high, but the vascular wall is in a normal state – cholesterol plaques will not form there. But if microdamages appear on the vascular wall, then vascular plaques begin to form on these microcracks even with normal cholesterol.

What damages the vessels

The main aggravating factors that cause vascular damage are hypertension, diabetes, smoking, alcohol, obesity, a sedentary lifestyle, and taking various medications, often uncontrolled.

“Also, microdefects of blood vessels cause free radicals, saturated fatty acids, aggressive environmental factors, various additives and toxic components that are found in our food today,” Alexey Chudinov continues. – For example, in meat – in fat beef and pork – there are two main unhealthy fats – cholesterol and saturated fatty acids. When saturated fatty acids are subjected to heat treatment, they turn into aggressive factors that cause damage to the endothelium of the vessel. Not immediately, but the more meat there is, the higher the risk of damage to the blood vessels. With age, the vessel becomes rough and atherosclerotic plaques begin to deposit on it.

Headache – a sign of atherosclerosis?

“Atherosclerosis has been modified,” says Alexei Chudinov. – Even 25-30 years ago, we found plaques in large vessels – in the carotid artery, in the aorta, and so on. But now plaques affect even small capillaries, including the brain. Those people who suffer from headaches, dizziness, memory loss, should know that this is primarily a sign that the small vessels are no longer working, that is, they are amazed. After all, intracerebral vessels have a thinner endothelium.

All our organs and tissues, primarily the heart, liver, brain – have a phospholipid membrane, a membrane that protects our cells from damage. When a person constantly uses saturated fatty acids, this saturated fat has the same ability as a dishwashing detergent that destroys fat on a plate. It destroys the phospholipid membrane of brain cells, cardiac cells, liver cells. Two clinical studies of the Institute of Nutrition of the Russian Academy of Medical Sciences proved that excluding saturated fatty acids from food reduces the risk of death by 22%, and the incidence of heart attacks and strokes by 18%. The same studies proved that if a person had a heart attack or stroke, then most likely this condition will recur within 5 years. But if a person switches to a healthy lifestyle, the risk of their recurrence is reduced by 80%.


5 principles of a healthy lifestyle (according to the latest scientific data)

1. Proper nutrition – the elimination of cholesterol and saturated fatty acids.

That is, try to eat less or completely abandon the fried meat, especially red and fatty – lamb, marbled beef. Less baking with margarine. Do not fry anything in butter. Try to switch to lighter dairy products (for example, reject cream, hard varieties of cheese).

Try to prepare food in a good mood, do not sort things out in the kitchen, otherwise the kitchen will automatically be perceived as an unpleasant place, and the absorption of food will be worse.

2. Active lifestyle, which raises good cholesterol.

Good cholesterol rises only in one case – if the person is actively moving. Nothing else raises good cholesterol – neither drugs, nor food. After all, the body, in addition to external influence, synthesizes its own cholesterol.

Therefore, vegetarians are not always the right level of cholesterol in the blood. For example, in India, people practically do not eat meat, but still suffer from cardiovascular diseases, atherosclerosis. Our body produces its own endogenous cholesterol, and we have the so-called cholesterol metabolism receptors. As soon as cholesterol levels fall below normal, endogenous cholesterol synthesis increasya And even without eating meat, vegetarians can have quite high cholesterol due to endogenous internal cholesterol.

In order to compensate for this, there is one single way – an active lifestyle, that is, at least a person must move and walk a lot. But not to do grueling physical exertion – they also lead to an increase in cholesterol levels.

3. Freedom from stress and tension.

In addition to food containing saturated fatty acids, damage to the vascular endothelium causes stress. Stress is not what happens to us, but our reaction to situations. Only by remaining calm can we solve problems and difficulties. And only in this case our vessels will remain undamaged by stress.

4. Full sleep.

During a long (at least 8 hours) sleep, cholesterol levels are reduced. Vascular endothelium is restored. Alas, 45% of people today have trouble sleeping. The reason follows from the previous one – anxiety during the day.

5. Acceptance of omega-3 fatty acids.

These substances help the cells of the blood vessels to recover, stay elastic longer. They are contained in nuts, unrefined vegetable oils, wheat sprouts, oily fish.


Eggs can be found in any kitchen of the world. The Chinese use them to prepare the well-known egg noodles, Australians – in all sorts of desserts and baking. Finns add a hard-boiled and finely chopped egg to nettle soup, and Chileans add it to their favorite empanadas meat dish.

Eggs can be found in any kitchen of the world. The Chinese use them to prepare the well-known egg noodles, Australians – in all sorts of desserts and baking. Finns add a hard-boiled and finely chopped egg to nettle soup, and Chileans add it to their favorite empanadas meat dish.

Boiled and fried eggs are one of the most popular breakfast items in our country. Eggs contain eight essential amino acids, protein and vitamins. However, despite such a rich composition, their usefulness is often questioned.

This is due to the high concentration of cholesterol contained in them. It is certainly impossible to deny, but to understand how great such harm is, it is necessary to sort out this issue in more detail. Few know what cholesterol is. However, ignorance does not prevent the majority from considering it as an extremely harmful and dangerous for health substance. In fact, cholesterol is very important for our body. It is part of the cell membranes, ensuring their density and thereby protecting intracellular structures from the effects of free radicals; participates in the process of digestion, without it the full functioning of the liver, the formation of bile is not possible; involved in the synthesis of male and female sex hormones (testosterone, estrogen, progesterone); helps the adrenal glands produce cortisol; ensures the normal functioning of the brain’s serotonin receptors. Violations of cholesterol concentration in the blood lead to a weakening of the immune system.

Mostly cholesterol is produced by the body independently (about 75-80%), the remaining 20-25% comes from food, and therefore the level of cholesterol can deviate to one side or the other, depending on the diet. Conventionally, “bad” (in conjunction with lipoproteinaminase density) and “good” (combined with high-density lipoproteins) cholesterol are isolated, but in fact it has a single composition and a single structure, and its properties are determined by the transport protein to which it will join.

With an increased concentration of low-density lipoproteins, there is a danger of cholesterol precipitating on the walls of blood vessels and the formation of so-called plaques covering the lumen of a blood vessel, increasing the risk of developing associated diseases. High-density lipoproteins clear the walls of blood vessels from “bad” cholesterol and send it for processing to the liver.

It should be noted that individual genetic characteristics, lifestyle and food ration significantly affect the “behavior” of the body and it begins to adjust the synthesis of cholesterol, depending on how much it comes from the outside.

Nutrition plays, though not a key role in the mechanism of the dynamics of cholesterol in the blood, but it still has a significant effect on it. What type of lipoprotein it goes into can be said depending on the parallel-eaten foods and metabolic peculiarities.

So, for example, a product in itself rich in cholesterol (egg, shrimp), eaten with fatty foods (mayonnaise, sausages, etc.) is more likely to cause an increase in LDL levels. The same effect will be if a person inherits a defective gene, in the presence of which the same result will occur, even if along the way nothing fat was used.

Thus, cholesterol in itself does not cause serious concern, until it accumulates in the body in high concentrations, eating foods that contain a lot of cholesterol automatically reduces the production of its own to compensate for the incoming.

Despite the presence in the yolk of significant amounts of cholesterol, eggs contain a lot of protein (about 5.5 g in one egg), the high nutritional value of eggs is due to the presence of amino acids necessary for various biological processes, which play an important role in maintaining the normal functioning of the body, and provitamin A, vitamins B2, B5; B12, E, D, folic acid, phosphorus, lecithin, choline, lutein, iodine, biotin, iron, selenium makes them truly useful.

So, taking into account all the pros and cons of this product, it is not recommended to include more than 1 egg per day in the diet. If the level of cholesterol in the body is elevated, it is better to limit yourself to 2-3 eggs per week or to avoid consuming yolks.

Do not forget about the dangerous conditions that can occur when excessive or improper use of chicken eggs:

Salmonella infection (when eating raw eggs and when the technology of cooking dishes from them is not followed);

excessive cholesterol in the blood (excessive consumption of eggs, especially without taking into account the initial level of cholesterol in the blood); the development of an allergic reaction, especially in children (the use of eggs without taking into account the individual sensitivity of the body).

And remember, a balanced diet combined with adequate physical activity is a guarantee of health and longevity.


Ultrasound is reflected from boundaries tissue deforms piezoelectric crystal and generates electric sky pulse which transformed at the point on the screen .

Brightness and position points depends on from of character and depths investigated structures .

For create two-dimensional Images ultrasonic Ray skipped through region interest . Ultrasound is transmitted along several (90-120) lines scanner of by wide ( about 90 ° ) arc up to20-30 times at second.

Summation reflected ultrasound waves form beats picture on the screen . Fast generation after respectable of images creates ” Living “ picture movable structures . Any frameliving Images can be “Frozen”, analyzed on the screen or printed out on thermal paper .

Two-dimensional Echocardiography allows to study anatomy hearts and relationship different structures .

With two-dimensional cardiography possibly revealing intracardiac formations and pathologies pericardium , visualized motion walls ventricles and leaflets valves .

Also spend measurement thickness walls wish daughters and sizes cameras, computed shock volume fraction emission and cordial overshoot .

Two-dimensional picture use at quality orientation shooting gallery at research at M – mode , and also at doppler – echocardiography for installations control volume .

The clinical significance of diastolic dysfunction of the left ventricle 

Clinical manifestations chronic heart not sufficiency can to arise on normal background or almost normal systolic LV function by according to Echocardiography . A common cause of chronic heart failure is LV diastolic dysfunction .

Diastolic dysfunction is detected at a whole range of cardio – vascular diseases . She is more sensitive at comparing with systolic cal function to natural aging processes . Violations of diastolic function can be iso Rowan , combined with systolic dysfunction or precede a clear violation of systole . Violations of diastole is dominated by about at thirdspatients with chronic heart failure . Required evaluate as systolic , so and diastolic function of the left ventricle , so as the causes of their violations and , that more importantly , their correction methods are different . Simplified times division on systolic and diastolic dysfunction is often unjustified . Systole and diastole – Inter – liyayuschie phase of the cardiac cycle . With minor systolic dysfunction some segments with on ruined local contractility can keep shrinking at diastole , resulting in to decrease in time for ventricular fillingand diastolic dysfunction . On the contrary , a stubborn LV , unable to adequately fill at diastole , provides low stroke volume at systole and leads to systolic dysfunction . High peak BUT It corresponds to the fourth auskultativ Nome tone of the heart , then as high peak E – the third auscultatory tone

Possible errors in identifying dysfunction of the right ventricle.

Echocardiographic assessment of the pancreas is difficult at svya communication with significant trabecular , complex geometry cal form and interaction with other chambers of the heart . More than that the prostate is located directly behind the breastbone which hinders its visualization . Evaluation The pancreas is especially difficult with increased airiness of the lung tissue ( emphysema ), pneumosclerosis and torus kotomii at history . For unfortunately , namely with of these states estimation function of the pancreas is the largest zna chenie . RV function depends not only from myocardial contractility , but and on the conditions of load , contractility of the left ventricle , excursions IVS and pressure atpericardium . With analysis of pancreas function should be considered everything these factors . Even an experienced researcher is able to conduct a full study of the pancreas less than in 50% of patients .

The clinical significance of right ventricular dysfunction

Identification of dysfunction of the pancreas is a principled nym with a number of congenital and acquired diseases of the heart for the choice of tactics of treatment , planning the timing of surgical intervention , determine the prognosis .

With congenital defects , such as defect MZhP , defect MPP or tetralogy of Fallot , evaluation function of the pancreas to and after surgery treatment allows define prognosis of the disease .

In a similar manner as possible surgical vmesha ments with defects of the heart , such as mitral ste ERA , stenosis of the mouth of the pulmonary artery or tricuspid regurgitation ( TR ) depends on the availability or lack of dysfunction of the pancreas . Patient long-term prognosis with chronic diseases of the lung ( chronic obstructive disease of the lungs , interstitial for bolevaniya light ) depends on the function of the pancreas . Dilatation of the pancreas , pulmonary hypertension and pulmonary heart are predictors of negative prognosis .

With myocardial infarction pancreas dysfunction observed at following situations :

.       lower myocardial infarction with involvement of the pancreas ;

.       anterior myocardial infarction with acute defect MZhP .

Tactics treatment pancreatic infarction is different from leche of LV infarction . Dysfunction of the pancreas due postin farktnogo defect IVS is an important cause of death ( see . Chapter ” Coronary disease of the heart ” ). Diastolic kollabirovanie pancreas is an important echocardiographic sign of tamponade of the heart ( see . Chapter ” Diseases of the pericardium ” ).

Possible errors in the detection of diastolic dysfunction of the left ventricle.

Indicators transmitral blood flow depends on many factors , and not only on tensile properties and LV relaxation . Therefore , when assessing diastolic function of the left ventricle to rely only on E / A ratio is incorrect .

On The transmitral bloodstream is affected by the following factors :

.       load capacity ( preload and afterload );

.       frequency of heart contractions ;

.       systolic function of the LP ;

.       respiratory phase .

Overload volume due to mitral or Aortic insufficiency reduces peak A , so as atrial contraction not at able to effectively push blood at already maximally stretched the desire of daughters . With tachycardia peak amplitude BUT increases at connections with shortening of diastole ( greater contribution of atrial systole ). On the contrary , if bradycardia peakBUT Decrease the creases due to the elongation phase of diastolic filling ( smaller contribution contraction of the atria ). So manner , high peak BUT It has a greater value onbackground bradycardia .

Ratio E / A incorrectly when atrial Arita mission , complete transverse blockade and lengthening the PR interval . Have elderly patients dominated by peak A. Ratios e E / A > 1 or E = A at combined with the shortening of time for slowing reflects the increase in course – diastolic pressure at LV . This type of diastolic dysfunction was the name pseudonormal .

Parasternal position along the long axis

2D echocardiography not It allows you to directly Rate Vat diastolic function of the left ventricle , however, may reveal associated with It LVH , violations of local by kratimosti , infiltrative diseases myocardium or thickening of the leaves of the pericardium . Alongside with diastolic dysfunction can be detected violation sistoliche tion function of the left ventricle . Special features Diastolic the blood flow ka of LP at LV can be studied with using pulse doppler – echocardiography . For of this control volume is set on level of the cusps of the mitral valve at apical four- position . This study allows to obtain a spectrum of good quality transmitral blood flow .

AT Normally transmitral bloodstream has the following characteristics ( Fig . 6.6, A).

.       Peak passive early diastolic Napoli nenie LV .

.       Peak BUT – active later diastolic Napoli nenie LV .

.       Ratio E / A— > 1.

With LV relaxation disorder at connections gipertro fiey or myocardial ischemia an increase in peak BUT and reduction peak E . With In this respect, the E / A ratio becomes less than 1 ( Fig . 6.6, B). Time deceleration of peak E is lengthened (> 220 ms ).

Have patients older than 50 years for confirmation dia stolicheskoy dysfunction required reduction ratio E / A of less than 0.5 in connections with normal increase am plitudy peakBUT with of this age . This type diastema netocrystalline dysfunction received the title of ” slow relaxation ” and reflects reduced LV compliance . With This is marked by an increase in the pre- rhythm systole contribution . at filling the ventricle .

With tackle extensibility infarction due infiltrative disorders or constrictive pericarditis peak E becomes very high , and the peak BUT low . Time deceleration peak E ukorachi INDICATES (<150 ms ). These violations diastole include to restrictive type and reflect an increase in diastolic pressure of course at LV . Filling of the ventricle occurs quickly. atearly diastole , when this contraction schenie atrial unable longer stretch of LV .


For An adequate assessment of LV diastolic function is necessary to know the physiology of the diastolic phase of the cardiac cycle .

AT diastole there are four periods :

.       phase relaxation : on closing of the aortic valve stem Pan to the opening of the mitral valve ( phase 1);

.       early rapid filling phase : from the opening of the mitral valve to the end of filling ( fa for 2);

.       phase of diastasis — equilibrium ( phase 3);

.       phase systole predserdiy- active cut of auricles ( phase 4).

The first two phases correspond to the relaxation of the ventricular myocardium ( energy-intensive process ). Tre tya and The fourth phase reflects the passive extension of the myocardium , depending on its rigidity . So way , allocate two major type dia stolicheskoy dysfunction :

slow relaxation ;

restrictive type .

Diastolic dysfunction occurs at connections with by Vyshen stiff LV , which leads to disruption of diastolic blood flow of LP at LV .

Scanning in the M-mode at the level of the mitral valve

AT normal movement PSMK at diastole has character hydrochloric M – shaped form ( with waves E and A ) With diastema netocrystalline dysfunction LV tour PSMK reduced , wave BUT becomes higher , than the wave E , that leads to reducing the E / A ratio . These changes OCU by previously increased rigidity LV and subsequent increase in pressureat LP . Indicated signs not are highly sensitive or specific for identify diastolic dysfunction .

Causes of left ventricular systolic dysfunction

Practically everything diseases hearts early or late lead to systolic dysfunction of the left ventricle . The main reasons are given below at order decreasing frequency .

Ischemic disease of the heart : recurrent myocardial infarction , commonly infarction , multivessel lesion .

Hypertensive heart : LVH decompensation .

Valve pathology : mitral or aortic insufficiency ( volume overload ).

Primary myocardial damage : dilated ILC or acute myocarditis .

Congenital malformations of the heart : reset the left to right ( defect IVS ).

The clinical significance of left ventricular systolic dysfunction

Systolic dysfunction of the left ventricle at any zabole Vania heart is an independent negative prognostic factor .

Have Patients with ischemic disease of the heart with systolic cal dysfunction of the left ventricle is less than the survival rate after operations revascularization ( coronary artery shunt vanie ). The development of systolic dysfunction in a patient with LVH on background of arterial hypertension characterized by transition to phase decompensation hypertensive heart . Volumetric overload of the LV due to valve insufficiency or intracardiac discharge from left to right will inevitably lead to systolic dysfunction of the left ventricle . AT addition to prognostic information , devel term systolic dysfunction plays a key role at determining the tactics of managing patients with heart defects . LV systolic dysfunction is one of major diagnostic criteria for dilated CMP . Serial echocardiographic examinations allow not just trace the natural flow disease , but and define efficiency Spend my therapy . Minor violations of systolic function , imperceptible at alone , it can be identified at

research at load . On the background of adequate medical management of heart failure is also can observed only minor violations of systolic function .

One of The causes of LV systolic dysfunction are myocarditis — inflammation of the myocardium viral ( Coxsackie type B virus ), bacterial ( mycoplasma ) or parasitic ( Lyme disease ) nature .

Echocardiographic signs of myocarditis are similar. with picture dilated ILC , consisting By combining of systolic and diastolic dysfunction of the left ventricle , as well as insufficiency of the valvular apparatus . Occasionally can determined by the violation of local contractility due to focal nature of inflammation . By differential differential signs of myocarditis include the presence of febrile fever at recent past as well as sinus tachycardia at rest at combined with Inversion her teeth T on ECG . Rapid improvement in LV function and reduction of mitral insufficiency by according to serial echocardiographic studies allows you to lean at favor the diagnosis of myocarditis , and not dilated KMP .

Pulmonary valve

The valve of pulmonary artery is of three shutters : back ( left ), front and right . With scan at M – mode of parasternal position by the long axis , as a rule , only the rear ( left ) leaf is visualized . Front and right flap rarely Visualize are , so as located at the corner to Ultrasonic th beam . AT moving the rear flap valve pulmonary artery is isolated next phase .Evaluation function of the ventricles , in features Pancreas , is one of most important tasks of echocardiography . Dysfunction of the left ventricle is a significant prognostic factor with any disease of the heart . Identification of LV dysfunction often leads to change medication therapy and at whole patient management tactics .

Possible errors in the identification of systolic dysfunction of the left ventricle

Linear dimensions LV measured from the endocardium of the IUS to endocardium of the posterior wall of the left ventricle . Mistakes are possible ki at measurement of hypertrophic papillary muscle or with calcification of the mitral ring , which is erroneously possible to accept beyond the posterior wall of the left ventricle .

For more accurate measurement should be taken into account , that of of these structures at systole thickens only the back wall of the left ventricle . With violation of the MZhP kinetics ( for example , blockade of the left leg of the bundle of His ) measurement of the shortening fraction becomes difficult . Required Remember , that the range of normal values of course diastolic and of course – systolic size depends on many factors , including age , gender , height and physique . Systolic dysfunction of the left ventricle , as a rule , combined with an increase in the linear dimensions of the LV . but at a number of cases , for example when a large area of akinesia after suffering a myocardial infarction , a violation of systolic function may be observed , despite on normal dimensions LV . An experienced researcher can often visually assess LV systolic function. of parasternal positionby long axis even before carrying out measurements . However, such a rough estimate not allows you to serially estimate volumes and the function of the left ventricle .

With assessment results serial measurements whether linear and volume indicators of the left ventricle , as well as fractions shortening and fraction of ejection is necessary to take into account mezhissledovatelskuyu and internal research variability of measurements . The main causes of variability is the choice frames for of measure and difficulties atdefining the border of the endocardium . With the calculation of the volume indicators of the left ventricle using certain geometric models forms LV . With diseases of the heart , in particular with violations of local contractility , use of data models reducible dit to significant errors . After LV acute myocardial infarction loses its normal ellipsoidal shape andbecomes spherical . The process received the name of post-infarction remodeling .

With assessment of systolic function of the left ventricle should take into account the possible effects of drug treatment and conditions of pre – and afterload . Volume overload as well as antiarrhythmic drugs with negative inotropic properties can reduce systolic LV function .

With presence of mitral insufficiency fraction ejection may be normal , although on decrease in contractile LV function . This is due with lower LP resistance at comparing with aorta . In contrast , with aortic stenosis , a low ejection fraction value can be obtained. despite on normal LV contractility . This is due with increased resistance , is overcome by direct LV at systole . So manner , after surgical correction of MR fraction ejection decreases , and after -compensation tion aortic stenosis fraction emission increases .

Cardiac output calculation by peak aortic blood flow rate incorrect at AR conditions or stenosis at connections with increase the speed of the aortic blood flow . Possible errors when measurements Diamé tra aortic rings significantly distort values cardiac ejection , so as diameter when calculating is being built at square .

Tricuspid valve

The tricuspid valve is formed by three leaves : a large front , a small septal and tiny back sash . The movement of the front tricuspid valve is visualized when scanning at M – modeat parasternal position by long axis at RV , in front of the IVS . The movement of the front leaf of the tricuspid valve is very similar. with as described by the PSMK motion.

The septal valve of the tricuspid valve is visualized only during dilatation of the pancreas. or turning the hearts due to emphysema, lung and development pulmonary heart . Septal leaf of tricuspid valve makes movement of smaller amplitude at direction.

Aortic valve

Aortic valve consists of three valves : in front of her right coronary , posterior non-coronary and middle left coronary cusps . Right and non-coronary vie zualiziruyutsya when scanning at M – mode of pair – sternal position by long axis .

AT front systole and back sash diverge by direction to front and the posterior walls of the aorta, respectively . This kind of movement forms a characteristic “ box ” when the valve opens systolic at form of parallelogram . AT diastole sashes touch , forming a centrally located at the lumen of the aorta line of closure . Clamp line on is going on almost equal distance from the front and back of the aorta .