Many people know that the highest mortality of patients is caused by cardiovascular diseases, including myocardial infarction. But not many healthy people know what can lead to this heart disease.
In the previous issue of Health for All, Cardiologist of the North-Estonian Regional Hospital, Doctor of Medical Sciences Davit Duishvili spoke about the illness itself, today he will talk about how to prevent myocardial infarction. Speech – about the risks of this serious ailment.
The three most important risks
– What can (or rather, should) be done to avoid a heart attack or postpone the “meeting” with him for later?
– You need to know and take into account risk factors. The first is cholesterol. It is widely believed that the main attention should be paid to the level of total cholesterol. But for cardiologists the cholesterol of low density is much more important, the so-called. “Bad” cholesterol (LDL-low-density lipoproteins). If its content is higher than normal, then there is an aggressive development of atherosclerosis. And this is a chronic vascular disease that narrows when this “bad” cholesterol and other LDL in the form of plaques and plaques are deposited on their inner wall. This reduces blood flow.
On the second place I put boldly arterial hypertension. It is known that among all risk factors for cardiovascular disease, primacy belongs to high blood pressure.
The third factor – diabetes mellitus, a high level of sugar in the blood repeatedly increases the risk of atherosclerosis of the vessels, which leads to coronary heart disease, heart attack and stroke. Diabetics have a heart attack 5 times more likely than normal patients, because they feel slight discomfort and do not feel the pain experienced in the pre-infarcted state or in case of a heart attack people who do not have diabetes. Explanation: vascular obstruction in them can be present not only in the heart, but also in other organs. That is why ischemia is also called “mute” in them, and diabetes is “a gentle killer”.
Further – smoking. My patients may not be very happy with me, because I am critical of this habit and I even try to scold the patient if he continues to “smoke” after suffering a heart attack. In this case, the heart attack is guaranteed again. Would put this risk factor even next to the influence of “bad” cholesterol. As a result of smoking, harmful attacks on the vessels, both the heart and peripheral ones, become especially aggressive, and even stents installed in the vessels (artificial cylindrical scaffolds that expand the vessels) do not save.
No less important risks
– Excess body weight is a serious medical, social and economic problem of modern society. The urgency of obesity is determined, first of all, by its prevalence. According to the latest estimates of WHO, more than a billion people on the planet are overweight. And obesity in terms of importance is not inferior to such risk factors as increased blood pressure or smoking. Obesity is closely related to other risk factors and affects the survival of patients with coronary heart disease – myocardial infarction; it contributes to early disability and a reduction in both overall life expectancy and its quality due to concomitant diseases.
– How not to determine excess weight by eye?
– Obesity is determined by a formula that takes into account the height and weight of a person. If after calculation the indicator is higher than 25, this is a warning about obesity, and if it exceeds 30, then it is obesity, which causes a metabolic disorder. In the presence of fatty tissue in the upper body and abdomen with abdominal obesity (human silhouette resembles the shape of an apple) there is a synthesis of such biologically active substances and enzymes that aggressively “shoot” on the same vessels, narrowing them and disrupting blood supply. The same substances increase the level of cholesterol, promote hypertension, disrupt the metabolism of carbohydrates.
– Did we forget alcoholic beverages?
– Well, as without them. Alcohol is also a potent risk factor. Frequently addicted to alcohol patients ask the doctor for some kind of relief in his use. In vain! There is no normal professional doctor in the world who would have given good for obvious cardiovascular disorders, especially after myocardial infarction. And yet, according to my estimates, every second patient who escaped from a heart attack and received advice from a doctor and prescriptions for medicines nevertheless applies to the bottle. Even one harmless glass of good wine is dangerous. After all, the change in the effectiveness of the constantly taken medication (blood thinning, reducing cholesterol and pressure) in combination with alcohol, even beer, is unknown. And alcohol-dependent patients often talk about a glass of beer, and drink it 2 liters per day, which is equivalent (at 5% alcohol in beer) to a bottle of vodka.
– What risks are less common, but also dangerous?
– For example, unhealthy diet – frequent and large consumption of animal fats (source of cholesterol).
Gender – up to 60 years, cardiovascular diseases occur more often in men. By the age of 60, women are catching up with us, and then they even outstrip men. Stress – a cause of a heart attack can be any unusual situation that causes a person a strong emotional arousal. It can be caused by both negative and positive deep feelings. And if the human nervous system is not ready for stress, then even some small troubles can cause a strong emotional reaction of the body.
This is not all. The age factor. Most often, the heart attack manifests itself at the age of 45 to 65 years. But a heart attack, like other diseases, is getting younger. I had a patient when I was still in Moscow, who had a vast myocardial infarction – he was only 23 years old. The ejection fraction after treatment was about 30% (with a norm of contractile function of the heart in those who are discharged – 55%). We had patients with a heart attack of 27-28 years.
In the first case (a 23-year infarction), we also established a genetic predisposition to a heart attack. In 40 years he was tested by the father of a young man, he was also with his uncle. This risk may not necessarily lead to a heart attack, but it does exist.
– Are there any unusual cases?
A special case is stable angina. This is when a small plaque holds on the wall of the vessel, slightly reducing the lumen of the vessel. That is, the blood flow is slightly limited, but it is uniform and stable. In the case of a heart attack, this plaque for some reason ceases to be stable. It can be an emotional or physical load, even a cold. As a result of this action, cracks appear on the plaque, which lead to it from the state of stability. Immediately the brain works and sends a large portion of platelets to the plaque to stop the bleeding. But along with this flow on the plaque layered thrombi, which can completely block the blood flow in the vessel.
Lexicon of infarction
Infarction – the cessation of blood flow during spasm of arteries or their blockage.
Platelets are small, non-nuclear, flat, colorless blood cells.
Ejection fractions – a healthy heart, even at rest with every blow throws more than half of the blood from the left ventricle into the vessels. So, the norm of the left ventricular ejection fraction is 55-70%. The value of 40-55% is below the norm. An indicator less than 40% is heart failure.
Abdominal obesity is an excessive accumulation of adipose tissue in the upper half of the trunk and on the stomach and the silhouette of a person begins to resemble the shape of an apple.
Stent – a special, made in the form of a cylindrical frame elastic metal or plastic construction, which is placed in the lumen of the hollow organs and provides an expansion of the site, narrowed pathological process.
Atherosclerosis is a chronic disease of the blood vessels, in which “bad” cholesterol and other LDL in the form of plaques and plaques are deposited on their inner wall, and the walls themselves become denser and lose elasticity.
Cardiomyocytes are the heart muscle cells.
Myocardium is the name of the muscle middle layer of the heart, which constitutes the bulk of its mass.
Stroke – Acute disorders of cerebral circulation, accompanied by sudden loss of consciousness and paralysis. Vascular diseases of the brain occupy the second place in the structure of mortality from diseases of the circulatory system after ischemic heart disease.