¿Qué es una cardiopatía isquémica?

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October 6, 2017
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Ischemic heart disease is the disease caused by atherosclerosis of the coronary arteries, namely, responsible for providing blood to the heart muscle,,es,These three processes cause narrowing,,es,The main factors that produce it are,,es,Advanced age,,es,Having previously presented the disease,,es,patients who have already submitted angina or heart attack are at greater risk than those who have not reported,,es,In addition to the so-called metabolic syndrome,,es,increased cholesterol and hypertension,,es,patients most at risk,,es,The likelihood of cardiovascular disease,,es,coronary,,es,or die of heart can be calculated by different scores,,es,SCORE,,en,Framingham,,en,Types of ischemic heart disease,,es,It is a serious disease that occurs as a result of the blockage of a coronary artery by a thrombus,,es (infarction). Coronary Atherosclerosis is a slow process of formation of collagen and lipid accumulation (fat) and inflammatory cells (lymphocytes). Estos tres procesos provocan el estrechamiento (stenosis) coronary artery.

This process begins in the first decades of life, but has no symptoms until coronary artery stenosis is so severe that it causes an imbalance between myocardial oxygen supply and needs. In this case myocardial ischemia occurs (stable angina pectoris) or sudden occlusion of the artery thrombosis, causing a lack of oxygenation of the myocardium that ACS (inestable angina and myocardial infarction de agudo).

Causes

Ischemic heart disease is a disease that can be prevented significantly, if known and control their cardiovascular risk factors. Los principales factores que la producen son:

  • Edad avanzada
  • Occurs more in men, although often in women equals after menopause
  • History of premature coronary heart disease in the family
  • Increase in total cholesterol, especially LDL (bad)
  • Decreased HDL cholesterol values (good)
  • Smoking
  • Hypertension
  • Diabetes mellitus
  • Obesity
  • Sedentary

El haber presentado previamente la enfermedad (los pacientes que ya han presentado angina o infarto tienen más riesgo que los que no los han presentado)
Patients with multiple risk factors have the highest risk for obstructive coronary artery disease, and therefore, more chances of angina myocardial. Además en el llamado síndrome metabólico, namely, Obesity Association, diabetes, aumento del colesterol e hipertension, los pacientes presentan más riesgo. La probabilidad de tener una enfermedad cardiovascular (coronaria) o de morirse del corazón se puede calcular por distintas puntuaciones (SCORE, Framingham, etc.).

Tipos de cardiopatía isquémica

  • Acute myocardial infarction
  • Stable angina pectoris
  • Unstable angina pectoris

Acute myocardial infarction

Es una enfermedad grave que ocurre como consecuencia de la obstrucción de una arteria coronaria por un trombo. The final result of the blockage in the artery is death (necrosis) territory of the blocked artery that supplies. Therefore, the importance of myocardial infarction depends on the amount of heart muscle that is lost,,es,although it is usually more common in those with risk factors and in patients who have already suffered another manifestation of ischemic heart disease,,es,cold sweat,,es,Stable angina pectoris is a symptom of recurrent chest pain due to myocardial ischemia,,es,Those who have suffered with defined with oppression,,es,tightness,,es,burning or swelling,,es,It is located in the area of ​​the sternum,,es,although it may radiate to the jaw,,es,throat,,es,the shoulder,,es,back and left wrist or arm,,es,Usually it lasts,,es. Myocardial usually an unexpected event that can occur in healthy people, aunque generalmente es más frecuente en quienes tienen factores de riesgo y en enfermos que ya han padecido otra manifestación de cardiopatía isquémica.

Myocardial manifested by chest pain similar to angina characteristics, but maintained for more than 20 minutes. It may be accompanied by fatigue, sudor frío, mareo o angustia. VA often associated with a sense of gravity, therefore the patient's own perception, as urgent responses that usually results in the healthcare environment that treats. But the absence of this feeling does not exclude its presence. It can occur at rest and not self-limiting.

Necrosis of the territory that remains without blood supply is progressive. The damage increases over time and, once dies portion of heart muscle, is impossible to restore its function. However, damage itself can be interrupted if the myocardium receive blood back through procedures plungers blocked artery.

Thus, is essential that the person with a stroke reach the hospital as soon as possible. Ideally receive attention during the first hour after onset of symptoms. If this is not possible, during the hours following the attack must apply treatments such as thrombolysis (intravenously administered drugs that dissolve the thrombus) o angioplastia (with mechanical recanalization of the obstructed artery catheters). Sometimes, You can even specify urgent cardiac surgery. The sooner the patient is adhered greater chance of avoiding definitive damage has.

Stable angina pectoris

Symptoms

La angina de pecho estable es un síntoma de dolor recurrente en el tórax debido a isquemia miocárdica. Quienes la han sufrido la definen con términos como opresión, tirantez, quemazón o hinchazón. Se localiza en la zona del esternón, aunque puede irradiarse a la mandíbula, la garganta, el hombro, la espalda y el brazo o la muñeca izquierdos. Suele durar entre 1 and 15 minutes. The pain of angina is triggered after exercise or emotions and relieved in a few minutes with rest or nitroglycerin sublinlingual,,es,Usually worse in circumstances such as anemia,,es,uncontrolled hypertension and fever,,es,cold weather,,es,moisture or a large meal can increase the intensity and frequency of anginal episodes,,es,It is performed mainly by the clinical suspicion of chest pain,,es,although no additional tests are discarded if other atypical symptoms occur,,es,Patients with suspected stable angina pectoris,,es,they are often an electrocardiogram,,es. Suele empeorar en circunstancias como anemia, hipertensión no controlada y fiebre. Also, el tiempo frío, el tabaquismo, la humedad o una comida copiosa pueden incrementar la intensidad y la frecuencia de los episodios anginosos.

Diagnóstico

Se realiza fundamentalmente por la sospecha clínica de dolor torácico, aunque no se descartan pruebas complementarias si se presentan otros síntomas atípicos. A los pacientes con sospecha de angina de pecho estable, además, se les suele hacer un electrocardiograma.

The stress test or stress test is the test most commonly used when there is doubt in the diagnosis of myocardial ischemia and also serves to obtain prognostic information in patients with angina,,es,The patient performs continuous exercise on a treadmill or bicycle ergometer to assess clinical response,,es,If there is pain during exercise,,es,and electrical response,,es,if there are changes in the electrocardiogram during exercise suggesting myocardial ischemia,,es,This test is not evaluable if resting electrocardiographic abnormalities or if the patient is taking certain drugs,,es,digoxin,,es,evidently,,it,Nor can perform a stress test if the patient has a musculoskeletal problem that prevents him from walking properly,,es. El paciente realiza ejercicio continuo en cinta rodante o bicicleta ergométrica para valorar su respuesta clínica (si hay dolor durante el ejercicio) y su respuesta eléctrica (si existen cambios en el electrocardiograma durante el esfuerzo que sugieran isquemia miocárdica). Esta prueba no es valorable si hay alteraciones basales del electrocardiograma o si el paciente está tomando determinados fármacos (for example, digoxina). Evidentemente, tampoco se puede realizar una ergometría si el paciente presenta algún problema locomotor que le impida caminar correctamente. En estos casos, Stress tests are done with drugs,,es,dobutamine,,pt,or radioisotopes,,es,Coronary arteriography,,es,coronary catheterization or,,es,It is the reference method for the diagnosis of coronary strictures and is also useful when it is necessary to treat them,,es,dilation and stenting,,es,Since this is an invasive test and moderately expensive,,es,It is reserved if the results of the above tests are conclusive of major coronary disease and poor prognosis data,,es,It is also used in patients with atypical symptoms when noninvasive tests are inconclusive,,es,The prognosis is highly variable,,es (dobutamina) o de radioisótopos.

La arteriografía coronaria (coronariografía o cateterismo) es el método de referencia para el diagnóstico de las estrecheces coronarias y además es útil en el caso de que sea necesario para el tratamiento de las mismas (dilatación e implantación de stent). Dado que se trata de una prueba invasiva y moderadamente costosa, queda reservada a si los resultados de las anteriores pruebas son concluyentes de enfermedad coronaria importante y con datos de mal pronóstico. También se utiliza en pacientes con síntomas atípicos cuando las pruebas no invasivas no resultan concluyentes.

Pronóstico

El pronóstico es muy variable, since it depends on the extent of the disease and what has been damaged heart muscle by the same,,es,There are patients who can be controlled virtually without presenting symptoms to others who have a very shortened life expectancy,,es,Factors that influence the prognosis is good or poor control of coronary risk factors,,es,Patients with angina should strictly control cardiovascular risk factors and follow regular checks to prevent the emergence of new and,,es,if they exist,,es,must be correct,,es,Leaving snuff,,es,Monitor hypertension and diabetes and its treatment,,es,weight,,es,diet,,es,drugs,,es,Follow a diet low in cholesterol and fat,,es,Achieve an ideal body weight,,es. Existen enfermos que pueden estar controlados sin presentar prácticamente síntomas a otros que tienen una esperanza de vida muy acortada. Los factores que más influyen en el pronóstico es el buen o mal control de los factores de riesgo coronario.

Treatment

Los pacientes con angina de pecho deben controlar estrictamente factores de riesgo cardiovascular y seguir controles periódicos para prevenir la aparición de nuevos y, si existen, hay que corregirlos:

  • Dejar el tabaco
  • Vigilar la hipertensión y la diabetes y su tratamiento (peso, dieta, fármacos)
  • Seguir una dieta baja en colesterol y grasas
  • Alcanzar un peso corporal ideal
  • Lower cholesterol to get a lower LDL,,es,mg/dl,,en,As to drug treatment,,es,except in cases of contraindications,,es,all patients with coronary disease should take acetylsalicylic acid,,es,there are many commercial preparations,,es,but the best known is the Aspirin®,,es,chronically,,es,daily and low dose,,es,–150 mg,,en,for its antiplatelet effect,,es,Also patients are treated with beta blockers as primary treatment and to improve symptoms nitrates are recommended,,es,orally,,es,sublingual or transdermal patches,,es,calcium antagonists,,es,ivabradine y ranolazine,,sl,Patients with frequent attacks of angina undergoing treatment of various drugs combined,,es 70 mg/dl

En cuanto al tratamiento farmacológico, salvo en casos de contraindicaciones, todos los pacientes con enfermedad coronaria deben tomar Acido acetil salicílico (existen muchos preparados comerciales, pero el más conocido es la Aspirina®) de forma crónica, diariamente y a dosis bajas (100–150 mg) por su efecto antiagregante plaquetario.

También los pacientes son tratados con betabloqueantes como tratamiento principal y para mejorar los síntomas se recomiendan nitratos (vía oral, sublingual o en parches transdérmicos), antagonistas del calcio, ivabradina y ranolazina. Los pacientes con crisis frecuentes de angina se someten a tratamiento de varios fármacos combinados.

Some patients with angina are candidates for coronary revascularization treatments,,es,are to correct these strictures,,es,which can be performed by cardiac bypass surgery,,es,or coronary angioplasty,,es,with catheterization,,es,The choice between them depends on the characteristics of the disease,,es,coronary angioplasty,,es,It is performed when CHD allows this technique,,es,A catheter is inserted into the coronary artery and balloon dilates,,es,After a stent is implanted,,es,metal device as a cylindrical mesh,,es,inside the artery to achieve its permeability whenever this is possible,,es,Bypass,,en,For patients with more diffuse coronary artery disease,,es (consisten en corregir esas estrecheces), que se puede realizar mediante cirugía cardiaca de derivación (bypass) o por angioplastia coronaria (con cateterismo). La elección entre una u otra depende de las características de la enfermedad:

Angioplastia coronaria. Se realiza cuando la enfermedad coronaria permite esta técnica. Se introduce un catéter hasta la arteria coronaria y se dilata con balón. Después se implanta un stent (dispositivo metálico como una malla cilíndrica) dentro de la arteria para conseguir su permeabilidad siempre que esto sea posible.

Bypass. Para pacientes con enfermedad coronaria más difusa, when angioplasty is not possible and especially if there is poor left ventricular function,,es,It is realized by opening the chest and general anesthesia,,es,Sign is usually very high risk of acute myocardial infarction or sudden death,,es,but in this case there is no complete occlusion of the coronary artery by thrombus, and has not come to produce death of heart cells,,es,It manifests itself at rest for pain or tightness that begins in the middle of the chest and may spread to arms,,es,That is to say,,es,symptoms are the same as infarct,,es,severe arrhythmia or sudden death,,es,www.fundaciondelcorazon.com,,gl. Se realiza con apertura del tórax y anestesia general.

Unstable angina pectoris

Suele ser signo de muy alto riesgo de infarto agudo de miocardio o muerte súbita. Unstable angina is triggered as myocardial, pero en este caso no existe una oclusión completa de la arteria coronaria por el trombo y no se ha llegado a producir muerte de células cardiacas. Se manifiesta en reposo por un dolor u opresión que empieza en el centro del pecho y puede extenderse a brazos, neck, jaw and back. Es decir, los síntomas son iguales a los del infarto, although generally of shorter duration and intensity. This angina should be treated as an emergency, since there is a high risk of a heart attack occur, una arritmia grave o muerte súbita.

Fuente: http://www.fundaciondelcorazon.com

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