Atherosclerotic cardiosclerosis – diffusion development of connecting cicatricial fabric in a myocardium owing to atherosclerotic damage of coronary arteries. The atherosclerotic cardiosclerosis is shown by the progressing IBS: stenocardia attacks, violations of a rhythm and conductivity, heart failure. Diagnostics of an atherosclerotic cardiosclerosis includes a complex of tool and laboratory researches – the ECG, EhoKG, a veloergometriya, pharmacological tests, a research of cholesterol and lipoproteid. Treatment of an atherosclerotic cardiosclerosis conservative; it is directed to improvement of coronary blood circulation, normalization of a rhythm and conductivity, decrease in level of cholesterol, knocking over of a pain syndrome.
Cardiosclerosis () – process of focal or diffusion replacement of muscle fibers of a myocardium with connecting fabric. Taking into account an etiology it is accepted to distinguish miokarditicheskiya (owing to myocarditis, rheumatism), atherosclerotic, postinfarction and primary (at congenital collagenases, fibroelastoza) a cardiosclerosis. The atherosclerotic cardiosclerosis in cardiology is considered as the display of coronary heart disease caused by progressing of atherosclerosis of coronal vessels. The atherosclerotic cardiosclerosis comes to light mainly at males of middle and advanced age.
Reasons of an atherosclerotic cardiosclerosis
Atherosclerotic defeat of coronary vessels is the cornerstone of the considered pathology. As the leading factor of development of atherosclerosis serves the violation of cholesteric exchange which is followed by excess adjournment of lipoid in an internal cover of vessels. The speed of formation of atherosclerosis of coronary vessels is influenced significantly by the accompanying arterial hypertension, tendency to a vazokonstriktion, excess consumption of food rich with cholesterol.
Atherosclerosis of coronary vessels leads to narrowing of a gleam of coronal arteries, violation of blood supply of a myocardium with the subsequent replacement of muscle fibers with cicatricial connecting fabric (an atherosclerotic cardiosclerosis).
Pathogenesis of an atherosclerotic cardiosclerosis
Stenoziruyushchy atherosclerosis of coronary arteries is followed by ischemia and metabolic violations in a myocardium, and, as a result, - the gradual and slowly developing dystrophy, an atrophy and death of muscle fibers on which place sites of a necrosis and microscopic scars are formed. Death of receptors promotes decrease in sensitivity of tissues of myocardium to oxygen that leads to further progressing of IBS.
The atherosclerotic cardiosclerosis carries diffusion distribution and a long current. When progressing an atherosclerotic cardiosclerosis the compensatory hypertrophy, and then and dilatation of the left ventricle develops, symptoms of heart failure accrue.
Taking into account pathogenetic mechanisms allocate the ischemic, postinfarction and mixed options of an atherosclerotic cardiosclerosis. The ischemic cardiosclerosis develops owing to long insufficiency of blood circulation, progresses slowly, diffuzno affecting a cardiac muscle. The postinfarction (post-necrotic) cardiosclerosis is formed on the place of the former site of a necrosis. The mixed (transitional) atherosclerotic cardiosclerosis combines both above-named mechanisms and is characterized slow by diffusion development of fibrous fabric against the background of which the necrotic centers after repeated myocardial infarctions are periodically formed.
Symptoms of an atherosclerotic cardiosclerosis
The atherosclerotic cardiosclerosis is shown by three groups of the symptoms demonstrating violation of sokratitelny function of heart, coronary insufficiency and violations of a rhythm and conductivity. The clinical symptomatology of an atherosclerotic cardiosclerosis long time can be expressed slightly. Further there are zagrudinny pains with irradiation in the left hand, in a left shoulder-blade, to the epigastralny area. Repeated myocardial infarctions can develop.
In process of progressing of cicatricial and sclerous processes increased fatigue, short wind (in the beginning – appears at heavy physical activities, then - at usual walking), it is frequent – attacks of cardiac asthma, hypostasis of lungs. At development of heart failure developments of stagnation in lungs, peripheral hypostases, a gepatomegaliya join, at severe forms of an atherosclerotic cardiosclerosis – pleurisy and ascites.
Violations of a warm rhythm and conductivity at an atherosclerotic cardiosclerosis are characterized by tendency to developing of premature ventricular contraction, vibrating arrhythmia, intra ventricular and predserdno-ventricular blockade. In the beginning these violations have paroksizmalny character, then become more frequent, and further – constants.
The atherosclerotic cardiosclerosis is quite often combined with atherosclerosis of an aorta, cerebral arteries, large peripheral arteries that is shown by the corresponding symptomatology (decrease in memory, dizzinesses, the alternating lameness, etc.).
The atherosclerotic cardiosclerosis carries slowly progressing current. Despite the possible periods of relative improvement which can proceed several years repeated sharp violations of coronary blood circulation lead to deterioration in a state.
Diagnostics of an atherosclerotic cardiosclerosis
Diagnosis of an atherosclerotic cardiosclerosis is based on data of the anamnesis (existence of IBS, atherosclerosis, arrhythmias, the postponed myocardial infarctions etc.) and subjective symptomatology. Biochemical blood test comes to light a hypercholesterolemia, increase beta . Signs of coronary insufficiency, postinfarction hems, violations of a rhythm and intracardial conductivity, a moderate hypertrophy of the left ventricle are defined on the ECG. This echocardiography at an atherosclerotic cardiosclerosis is characterized by violation of a sokratimost of a myocardium (a gipokineziya, dyskinesia, an akineziya of the corresponding segment). Veloergometriya allows to specify degree of dysfunction of a myocardium and functional reserves of heart.
The solution of diagnostic tasks at an atherosclerotic cardiosclerosis can be promoted by performance of pharmacological tests, daily ECG monitoring, a polycardiography, ritmokardiografiya, ventrikulografiya, coronary angiography, heart MRT, etc. researches. For the purpose of specification of existence of an exudate ultrasonography of pleural cavities, a X-ray analysis of a thorax, ultrasonography of an abdominal cavity is carried out.
Treatment of an atherosclerotic cardiosclerosis
Treatment of an atherosclerotic cardiosclerosis comes down to pathogenetic therapy of separate syndromes - heart failure, a hypercholesterolemia, arrhythmias, atrioventricular blockade etc. Diuretics, nitrates, peripheral vazodilatator, statins, antiarrhytmic means are for this purpose appointed. Constant reception of dezagregant (acetilsalicylic acid) is obligatory.
As important factors of complex therapy of an atherosclerotic cardiosclerosis serve the dietotherapy, observance of the mode, restriction of physical activities. The balneoterapiya – carbonic, hydrosulphuric, radonic, coniferous bathtubs is shown to such patients.
When forming anevrizmatichesky defect of heart the surgical resection of aneurism is made. At permanent violations of a rhythm and conductivity implantation EX-or a kardioverter-defibrillator can be required; at some forms restoration of a normal rhythm is promoted by a radio-frequency ablation (RChA).
Forecast and prevention of an atherosclerotic cardiosclerosis
The forecast of an atherosclerotic cardiosclerosis depends on extensiveness of defeat, existence and a type of violations of a rhythm and conductivity, a stage of insufficiency of blood circulation.
Primary prevention of an atherosclerotic cardiosclerosis consists in the prevention of atherosclerotic changes of vessels (healthy nutrition, sufficient physical activity and so forth). Measures of secondary prevention include rational therapy of atherosclerosis, a pain syndrome, arrhythmias and heart failure. Patients with an atherosclerotic cardiosclerosis need systematic observation at the cardiologist, inspection of cardiovascular system.