Koronarit — inflammatory defeat of walls of the vessels feeding a myocardium. Develops against the background of infectious and inflammatory diseases of heart, other bodies and fabrics, including system character. Can be complicated by arrhythmia, a thrombembolia, a heart attack. Patients complain of the short wind, tachycardia pressing feelings and pain behind a breast. The disease is diagnosed by means of fizikalny inspection, the ECG, Ekho-KG, laboratory analyses. Treatment includes a diet, etiotropny and symptomatic medicamentous therapy. At the expressed violations of a coronary blood-groove the question of surgery is considered.
Koronarit — a rare inflammatory disease of coronal arteries which is practically always diagnosed in the presence of provocative pathologies (infectious, autoimmune processes). In most cases remains not diagnosed that complicates definition of its prevalence. Reliable data about occurrence are absent. The probability of development of a koronarit in the form of a complication of system vaskulit, especially Takayasu's diseases, Kawasaki, a system red volchanka, reaches 80%. The risk of defeat of coronary vessels antibodies to own cages of an organism is high at patients of young age.
Reasons of a koronarit
The disease practically never develops initially, usually becomes a complication or a consequence of other pathology. Both small, and large coronal arteries can be surprised. Establishment of the reasons of a koronarit is of great importance for drawing up the program of treatment, prevention of dangerous complications. Allocate three main groups of provocative factors:
- Heart diseases. Damage of vessels arises against the background of inflammatory defeat of covers of body — myocarditis, a perikardit, an endocarditis of the infectious or noninfectious nature (a trauma, a postinfarction state). Sometimes koronarit it is provoked by cardiomyopathies (alcoholic, toxic), local beam influence, a malignant tumor.
- Extra warm infectious processes. Most often arteries of heart are surprised at scarlet fever, flu, tuberculosis, syphilis (it is characterized by especially heavy current), typhus, malaria. Pathogenic microbes with current of blood get into vessels, krovosnabzhayushchy a myocardium, the new center of an infection is formed. Also koronarit can develop at septic defeat of an atherosclerotic plaque against the background of coronary heart disease.
- System diseases. The inflammation of coronal arteries is exponentiated by autoimmune processes — vaskulita (the nodular periarteriit, gigantokletochny and nonspecific arteritis obliterating trombangiity), rheumatism. More often young patients suffer, the defeat of small branches which is followed by a poor clinical picture that complicates diagnostics prevails.
The koronarita is the cornerstone an inflammation which can be localized in one of three layers of a vascular wall in the form of a mezanteriit, an endarteriit, a periarteriit or to strike all layers along with development of pan-arteritis. Influence of a pathogenic factor leads to activation of adaptive and protective mechanisms with formation of hypostasis and infiltration. The long course of a disease causes change of structure and a sklerozirovaniye of a vessel that is followed by reduction of its gleam and deterioration in blood supply of a myocardium.
Transition of a myocardium to anaerobic glycolysis in the conditions of deficiency of oxygen leads to accumulation of a large number of the sour products of exchange stimulating pain receptors. Deformation of coronal arteries, growths of connecting fabric or the centers of septic defeat often become an etiologichesky factor of formation of intra vascular blood clots. The separation of trombotichesky masses provokes further deterioration in a blood-groove with angiospazmy or necrotic damage of heart.
The uniform nomenclature of a koronarit is absent. The general systematization is based on features of a clinical picture, degree of expressiveness of the main symptoms. Eventually the disease forms reflected in classification can pass one into another that demands change of approach to holding medical actions. Allocate two main types of pathology:
- Sharp. The inflammation usually is a consequence of infectious process inside - or extra warm localization. Damage of coronary vessels has massive character that leads to essential violation of local blood circulation. It is shown by a sharp burning kardialgiya, the speeded-up breath, fear of death. Often is complicated by arrhythmias, a heart attack, a thrombembolia.
- Chronic. Koronarit has slow character with rare short-term attacks of stenocardia, insignificant violations of a rhythm. In most cases becomes result of system pathology — a vaskulita, rheumatism therefore to the forefront there are symptoms of autoimmune diseases. At the long course, lack of therapy the inflammation aggravation is possible.
Symptoms of a koronarit
The clinical picture is defined by an etiology and a form of a disease. At damage of small coronal arteries the symptomatology can be absent or come to light only against the background of heavy physical activities. The latent form of a koronarit is usually found incidentally during the passing of planned diagnostics or inspection concerning other pathology. Short wind and tachycardia become the first symptoms of a disease usually. The hypoxia of a myocardium can lead to melkoochagovy dystrophies, necroses of a kardialny muscle that becomes a basis for development of violations of a rhythm, blockade of heart.
The most widespread display of pathology is the pain in heart arising owing to deterioration in blood supply as a result of inflammatory changes. Muscular tissue has deficiency of oxygen, nutrients. At damage of the main coronal arteries emergence of the heavy attacks of stenocardia which are not stopped nitroglycerine is possible. The expressed pain syndrome meets mainly at a sharp course of disease. At a chronic koronarit of a kardialgiya arise extremely seldom, have smaller intensity.
Inflammatory process in the vessels feeding a cardiac muscle leads to violations of haemo dynamics and ischemic (often – irreversible) to damages of kardiomiotsit. Formation of the centers of a necrosis in a look small - and krupnoochagovy heart attacks in which outcome the postinfarction cardiosclerosis can be observed is possible. Hems in a cardiac muscle break the movement of impulses on the carrying-out system of heart that negatively influences excitability, conductivity, automatism of body. At some patients the giberniruyushchy myocardium comes to light. The inflammation can be followed by the hyper plastic phenomena which often become the reason of thrombosis, tromboemboliya.
Koronarit comes to light cardiologists. The disease badly gives in to diagnostics, especially at a combination to IBS of which formation of the fatty plaques reducing a gleam of arteries that gives very similar clinical picture is characteristic. The inflammation of coronary vessels can be assumed in the presence of the contributing factors after an exception of an ischemic disease by all available diagnostic methods. Enter the list of diagnostic actions:
- Objective inspection of the patient. The major stage is collecting the anamnesis for identification provocative koronarit diseases and differential diagnostics with IBS. Existence of the system pathologies, the chronic centers of an infection, pain in a breast which are not stopped nitrates, episodes of violation of a rhythm testifies to a possible inflammation of vessels of heart. At survey and fizikalny inspection search of symptoms of heart failure is carried out: hypostases of the lower extremities, cyanosis of skin, noise in heart, violations of a rhythm.
- Electrocardiography. Allows to find violations of work of a myocardium. On koronarit specify signs of insufficiency of blood circulation on coronal arteries in dynamics, especially young patients with inflammatory diseases have hearts or symptoms of system pathologies. Diagnostic criterion is the ECG picture of multiple melkoochagovy heart attacks. Daily monitoring of the ECG (Holter) when which carrying out periodically arising violations of a rhythm and ischemia of a myocardium come to light is often applied, conditions of their emergence are defined.
- Coronary angiography. The contrast X-ray analysis of coronal vessels gives the chance to visualize arteries, to establish extent of their narrowing, to assume an etiology of violations of a blood-groove. Besides, the X-ray contrast research helps to diagnose thrombosis as a possible complication of a koronarit. The technique is used at the solution of a question of expeditious treatment.
- Laboratory analyses. The biochemical blood test revealing increase in level of enzymes which are markers of a necrosis of muscular tissue of heart is key: kreatinfosfokinaza, aminotransferases, laktatdegidrogenaza, troponin, myoglobin. Points the high level of cholesterol, an imbalance of a lipidic range to IBS – decrease in maintenance of lipoproteins of high density at increase in other fractions, and also triglycerides.
Treatment of a koronarit
Therapy of a disease includes several directions: treatment of the main pathology which led to an inflammation of coronary vessels, correction of metabolic changes in heart, the prevention of development of dangerous complications — a myocardial infarction or a thrombembolia. The significant effect is possible in the absence of irreversible changes in a cardiac muscle and the arteries feeding it. Treatment is usually conservative, at heavy violations application of surgical methods is expedient. Allocate the following components of therapy of a koronarit:
- General actions. The patient appoints a diet with the low content of cholesterol, salt. The use of seafood, enough vegetables, fruit, dairy products is recommended. Fat dishes, spicy, salty snack, sugar, confectionery, coffee are excluded. The patient has to refuse addictions, have daily physical activity in the form of slow foot walks, try to avoid stressful situations, overfatigue.
- Etiotropny medicamentous therapy. The choice of medicines directly depends on an initial disease against the background of which developed koronarit. At bacterial damage (tuberculosis, syphilis, a streptococcal infection) appoint antibiotics. The inflammation of allergic genesis demands use of antihistaminic medicines, in the presence of system pathologies use glucocorticoid means.
- Symptomatic medicamentous therapy. Improvement of quality of life and the forecast of the patient is an important component of complex treatment of a disease. The adrenoblokator reducing the heart rate and, as a result, oxygen consumption by a myocardium, nitrates, diuretics, antiarrhytmic medicines are shown (in the presence of violations of the carrying-out system). At threat of a tromboobrazovaniye antiagregant and anticoagulants are obligatory.
- Surgical treatment. At considerable narrowing of a gleam of coronary vessels (to 90% of normal diameter) the decision on operation is made. The main method is coronary shunting at which the alternative way of the movement of blood below the place of a stenosis is created. Usually connect close located aorta (aortocoronary shunting) to coronal arteries. Also balloon dilatation with the subsequent implantation of the stent supporting a vessel gleam open is applied.
Forecast and prevention
At timely diagnostics of a koronarit, its adequate therapy and lack of serious changes of a myocardium forecast favorable. In the presence of irreversible structural pathologies of vessels and a cardiac muscle treatment can slow down a course of disease only. Prevention consists in full diagnosis of diseases which can lead to development of a koronarit. It is important to follow rules of a healthy lifestyle — to exclude addictions and psychoemotional overloads, to keep the sufficient level of physical activity and the correct food allowance.