30 pills
Composition
Crestor 5 mg
Active substance: rosuvastatin 5 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Crestor 10 mg
Active substance: rosuvastatin 10 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Crestor 20 mg
Active substance: rosuvastatin 20 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Ischemic heart disease
Ischemic heart disease (CHD) is an organic and functional myocardial damage caused by a deficiency or cessation of blood supply to the heart muscle (ischemia). IHD can manifest acute (myocardial infarction, cardiac arrest) and chronic (angina pectoris, postinfarction cardiosclerosis, heart failure) conditions. Clinical signs of IHD are determined by the specific form of the disease. IHD is the most common cause of sudden death in the world, including people of working age.
Coronary heart disease is a serious problem of modern cardiology and medicine in general. In Russia, about 700 thousand deaths are caused every year, caused by various forms of IHD, in the world the mortality from ischemic heart disease is about 70%. Coronary heart disease mostly affects men of active age (from 55 to 64 years), leading to disability or sudden death.
At the heart of the development of IHD is an imbalance between the need for cardiac muscle in the blood supply and the actual coronary blood flow. This imbalance can develop in connection with the sharply increased need of the myocardium in the blood supply, but its inadequate implementation, or with the usual need, but a sharp decrease in coronary circulation. Deficiency of blood supply to the myocardium is especially pronounced in cases when coronary blood flow is reduced, and the need of the cardiac muscle in the influx of blood sharply increases. Insufficient blood supply to the heart tissues, their oxygen starvation is manifested by various forms of coronary heart disease. The IHD group includes acute and chronic conditions of myocardial ischemia, followed by its subsequent changes: dystrophy, necrosis, sclerosis. These conditions in cardiology are considered, including, and as independent nosological units.
Causes and risk factors for coronary heart disease
The vast majority (97-98%) of clinical cases of ischemic heart disease is due to atherosclerosis of coronary arteries of varying severity: from a slight narrowing of the lumen atherosclerotic plaque to complete vascular occlusion. With 75% coronasystenosis, the cardiac muscle cells respond to a lack of oxygen, and angina develops angina in the tension.
Other causes of IHD include thromboembolism or spasm of the coronary arteries, which usually develop against the background of an already existing atherosclerotic lesion. Cardiac spasm worsens the obstruction of the coronary vessels and causes manifestations of ischemic heart disease.
Factors contributing to the emergence of IHD include: hyperlipidemia
Promotes the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of IHD are hyperlipidemia of types IIa, IIb, III, IV, as well as a decrease in the content of alpha-lipoproteins.
arterial hypertension
Arterial hypertension increases the likelihood of developing coronary artery disease by 2-6 times. In patients with systolic blood pressure of 180 mm Hg, Art. and higher ischemic heart disease occurs up to 8 times more often than in hypotensive patients and people with a normal blood pressure level.
smoking
According to various data, smoking cigarettes increases the incidence of IHD in 1,5-6 times. Mortality from coronary heart disease among men 35-64 years, smoked 20-30 cigarettes daily, is 2 times higher than among non-smokers of the same age category.
hypodynamia and obesity
Physically inactive people risk CHD 3 times more than those who lead an active lifestyle. When combined hypodynamia with excessive body weight, this risk increases at times.
impaired tolerance to carbohydrates
In diabetes mellitus, including latent, the risk of the incidence of coronary heart disease increases by 2-4 times.
The factors that threaten the development of IHD should also include hereditary heredity, male sex and elderly patients. With a combination of several predisposing factors, the degree of risk in the development of coronary heart disease significantly increases.
The causes and speed of development of ischemia, its duration and severity, the initial state of the cardiovascular system of the individual determine the occurrence of this or that form of ischemic heart disease.
Classification of ischemic heart disease
As a working classification, on the recommendation of cardiologists-clinicians, the following systematization of the forms of IHD is used:
Sudden coronary death (or primary heart failure) is a suddenly evolving, unforeseen condition, which is presumably based on electrical instability of the myocardium. A sudden coronary death means instantaneous or death no later than 6 hours after a heart attack in the presence of witnesses. Allocate a sudden coronary death with a successful resuscitation and with a fatal outcome.
Angina pectoris:
Stenocardia of stress (load):
stable (with the definition of the functional class I, II, III or IV);
unstable: first arising, progressive, early postoperative or postinfarction angina;
spontaneous angina (synovial, variant, vasospastic, stenocardia of Prinzmetal)
The painless form of myocardial ischemia.
Myocardial infarction:
large-focal (transmural, Q-infarction);
small-focal (not Q-infarction);
Postinfarction cardiosclerosis.
Impaired cardiac conduction and rhythm (form).
Heart failure (form and stage).
In cardiology, there is the concept of "acute coronary syndrome," which combines various forms of coronary heart disease: unstable angina, myocardial infarction (with Q-tooth and without Q-tooth). Sometimes a sudden coronary death caused by coronary artery disease is included in the same group.
Symptoms of coronary heart disease
Clinical manifestations of IHD are determined by the specific form of the disease (see myocardial infarction, angina pectoris). In general, coronary heart disease has a wavy course: periods of stably normal health alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially with painless myocardial ischemia, do not feel the presence of IHD at all. Progression of ischemic heart disease can develop slowly, for decades; at the same time the forms of the disease can change, and, consequently, the symptoms.
Common manifestations of IHD include chest pain associated with physical exertion or stress, pain in the back, arm, and lower jaw; shortness of breath, increased heartbeat or a sense of interruption; weakness, nausea, dizziness, blurred vision and fainting, excessive sweating. Often, CHD is detected already at the stage of development of chronic heart failure with the appearance of edema on the lower extremities, pronounced dyspnea, which causes the patient to take a forced sitting position.
The listed symptoms of coronary heart disease usually do not occur at the same time, with a certain form of the disease, there is a prevalence of certain manifestations of ischemia.
Precursors of primary cardiac arrest in ischemic heart disease are paroxysmal feelings of discomfort behind the sternum, fear of death, and psycho-emotional lability. In case of sudden coronary death, the patient loses consciousness, there is a stop of breathing, there is no pulse on the main arteries (femoral, carotid), heart sounds are not listened, pupils dilate, skin becomes pale-gray in color. The cases of primary cardiac arrest account for up to 60% of the lethal outcomes of IHD, mainly at the prehospital stage.
Complications of coronary heart disease
Hemodynamic disorders in the cardiac muscle and its ischemic damage cause numerous morpho-functional changes that determine the shape and prognosis of coronary heart disease. The result of myocardial ischemia are the following mechanisms of decompensation:
insufficiency of energy metabolism of myocardial cells - cardiomyocytes;
"Stunned" and "sleeping" (or hibernating) myocardium - forms of violation of contractility of the left ventricle in patients with IHD, which are transient;
development of diffuse atherosclerotic and focal postinfarction cardiosclerosis - a decrease in the number of functioning cardiomyocytes and the development of connective tissue in their place;
violation of systolic and diastolic functions of the myocardium;
Disorder of excitability, conduction, automatism and myocardial contractility.
The listed morpho-functional changes in the myocardium in IHD lead to the development of a persistent decrease in coronary circulation, i.e., heart failure.
Diagnosis of coronary heart disease
Diagnosis of IHD is performed by cardiologists in the conditions of a cardiological hospital or dispensary using specific instrumental techniques. When a patient is interviewed, complaints and the presence of symptoms characteristic of coronary heart disease are clarified. When examined, the presence of edema, cyanosis of the skin, noise in the heart, rhythm disturbances are determined.
Laboratory-diagnostic tests suggest the study of specific enzymes that increase with unstable angina and infarction (creatine phosphokinase (during the first 4-8 hours), troponin-I (on the 7-10th day), troponin-T (on day 10-14), aminotransferase , lactate dehydrogenase, myoglobin (in the first day)). These intracellular protein enzymes in the destruction of cardiomyocytes are released into the blood (resorption-necrotic syndrome). The level of total cholesterol, low (atherogenic) and high (antiatherogenic) density, triglycerides, blood sugar, ALT and AST (non-specific markers of cytolysis) are also studied.
The most important method of diagnosing cardiac diseases, including ischemic heart disease, is ECG - recording of electrical activity of the heart, which allows to detect violations of the normal mode of the myocardium. Echocardiography - the method of ultrasound of the heart allows you to visualize the size of the heart, the state of cavities and valves, assess myocardial contractility, acoustic noise. In some cases with IHD, stress echocardiography is carried out - ultrasonic diagnostics with the use of dosed physical activity, which registers myocardial ischemia.
In the diagnosis of ischemic heart disease, functional tests with load are widely used. They are used to identify early stages of IHD, when the disturbances can not yet be determined at rest. As load tests, walking, climbing stairs, loads on the simulators (exercise bike, treadmill), accompanied by ECG-fixation of heart function. Limited use of functional samples in a number of cases is caused by the inability to fulfill the required volume of load by patients.
Holter daily monitoring of ECG presupposes the registration of an ECG performed during the day and revealing periodic irregularities in the work of the heart. For the study, a portable device (Holter monitor) is used that is fixed on the shoulder or waist of the patient and reads the indications, as well as a diary of self-observation, in which the patient observes his actions and the changes in his state of health by the hour. The data obtained during the monitoring is processed on the computer. ECG monitoring allows not only to reveal the manifestations of coronary heart disease, but also the causes and conditions of their occurrence, which is especially important in the diagnosis of angina pectoris.
Transesophageal electrocardiography (PPEH) allows a detailed assessment of the electrical excitability and conductivity of the myocardium. The essence of the method consists in the introduction of a sensor into the esophagus and the recording of cardiac performance, bypassing the interference created by skin, subcutaneous fat, and thorax.
Carrying out of coronary angiography in the diagnosis of coronary heart disease allows to contrast the vessels of the myocardium and determine violations of their patency, the degree of stenosis or occlusion. Coronarography is used to solve the problem of cardiac surgery. With the introduction of a contrast agent, allergic events are possible, including anaphylaxis.
Treatment of coronary heart disease
The tactics of treating various clinical forms of IHD have their own peculiarities. Nevertheless, it is possible to identify the main directions used to treat coronary heart disease:
- non-pharmacological therapy;
- drug therapy;
- surgical revascularization of the myocardium (aorto-coronary bypass);
- the use of endovascular methods (coronary angioplasty).
- Non-drug therapy includes measures to correct lifestyle and nutrition. At various displays of an ischemic heart disease the restriction of a mode of activity is shown, t. To. At an exercise stress there is an increase in requirement of a myocardium in blood supply and oxygen. The dissatisfaction with this requirement of the cardiac muscle actually causes manifestations of IHD. Therefore, in any form of ischemic heart disease, the patient's activity regimen is limited, followed by a gradual expansion during rehabilitation.
The diet in IHD involves limiting the intake of water and salt with food to reduce the load on the heart muscle. In order to slow the progression of atherosclerosis and combat obesity, a low-fat diet is also prescribed. The following groups of products are limited, and if possible, the following groups of products: animal fats (butter, fat, fatty meat), smoked and fried foods, quickly absorbed carbohydrates (baked pastry, chocolate, cakes, sweets). To maintain a normal weight, it is necessary to balance the energy consumed and consumed. If it is necessary to reduce weight, the deficit between consumed and consumed energy reserves should be at least 300 kC daily, taking into account the fact that a person spends about 2000-2500 cCl per day during normal physical activity.
Drug therapy for IHD is prescribed by the formula "A-B-C": antiplatelet agents, β-blockers and hypocholesterolemic drugs. In the absence of contraindications, nitrates, diuretics, antiarrhythmics, etc. can be prescribed. The lack of effect from the ongoing drug therapy of coronary heart disease and the threat of myocardial infarction development are an indication to the consultation of a cardiosurgeon to resolve the issue of surgical treatment.
Surgical revascularization of the myocardium (aortocoronary shunting - CABG) is used to restore the blood supply to the ischemia (revascularization) site with resistance to ongoing pharmacological therapy (for example, with stable angina pectoris III and IV FC). The essence of the CABG method is the application of an autovenous anastomosis between the aorta and the affected heart artery below the site of its constriction or occlusion. This creates a bypass vascular bed that delivers blood to the site of myocardial ischemia. CABG operations can be performed using artificial circulation or on a working heart. Minimally invasive surgical techniques for coronary artery disease include percutaneous transluminal coronary angioplasty (PTCA) - balloon "expansion" of a stenotic vessel followed by implantation of a carcass-stent, which maintains a sufficient clearance for the blood flow of the vessel.
Prognosis and prevention of coronary heart disease
The definition of the prognosis for IHD depends on the interrelation of various factors. So the combination of coronary heart disease and arterial hypertension, severe lipid metabolism disorders and diabetes mellitus adversely affects the prognosis. Treatment can only slow the steady progression of IHD, but not stop its development.
The most effective prevention of IHD is to reduce the adverse effects of threats: exclusion of alcohol and tobacco, psycho-emotional overload, maintaining optimal body weight, physical education, blood pressure control, healthy eating.
Attention!
Description of the preparation "Krestor" on this page is a simplified and supplemented version of the official instructions for use. Before purchasing or using the drug, you should consult with your doctor and read the annotation approved by the manufacturer.
Information about the drug is provided solely for informational purposes and should not be used as a guide to self-treatment. Only the doctor can decide on the appointment of the drug, as well as determine the dose and methods of its use.