What does ischemic heart disease involve?
Ischemic heart disease - acute or chronic myocardial damage, resulting from the reduction or termination of the supply of the heart muscle with arterial blood, which is based on pathological processes in the coronary artery system.
What is the factor of development of coronary heart disease?
Atherosclerosis of the coronary arteries. Atherosclerosis develops consistently, undulating and unswervingly. As a result of the accumulation of cholesterol in the artery wall, an atherosclerotic plaque forms. Excess cholesterol leads to an increase in plaque in size, there are obstacles to the flow of blood. Later, under the influence of systemic adverse factors, the plaque transforms from stable to unstable (cracks and ruptures occur). The mechanism of platelet activation and the formation of thrombi on the surface of an unstable plaque is triggered.
Symptoms are aggravated with the growth of atherosclerotic plaque, gradually narrowing the lumen of the artery. Reduction of the artery lumen area by more than 90-95% is critical, causes a decrease in coronary blood flow and worsening of well-being even at rest.
What is the statistics for mortality in the disease?
Our patients, unfortunately cardiac and cardiosurgical, they are not treated according to the norms, which are treated all over the world. That is, if we are talking about patients with ischemic heart disease.
The most common cause of death in Ukraine and in neighboring countries is cardiovascular disease. About 68% of people die from these diseases. If we take the cardiovascular disease, then coronary heart disease in cardiology is in second place after hypertension (high blood pressure). If a diagnosis is made - ischemic heart disease, then there must be at once a risk stratification, i.e. we must determine how much it threatens. This should be done by the doctor to whom they addressed, this is not even a cardiologist, this is a family doctor, a therapist.
The doctor should first of all ask himself how much this threatens the patient?
To say exactly about the threat at once is almost impossible without additional surveys. In this case, there are recommendations of the European community of cardiologists and cardiosurgeons for the treatment of coronary heart disease and recommendations for revascularization. It says that the overwhelming majority of these patients show studies or confirming or rejecting coronary heart disease - these are stress, cardiography, tomography, non-coronary coronary vascular study, karanarography. At us in Ukraine as a matter of fact two basic methods of research:
1) This screening method if a person has a heart ache, he was sent to a computer tomograph to inject a contrast into the vein and said whether there really are significant changes in the vessels or not? If they are, then we need to talk about another method of research.
2) This is coronography - it punctures the artery, leads a catheter there and injects the substance into the coronary vessels themselves and records the digital image on the video image and then analyzes how much the vessel is narrowed. When we analyze which vessel is narrowed, we can stratify the risk. If this is the main vessel - this is threatened for life and health, then you need to do something quickly. If this is a small vessel, even if it closes and there is a heart attack (does not threaten life), drink medicines and live peacefully. If these are larger vessels, doctors suggest expanding, opening a coronary vessel, and you will live relatively normally without significant threats. If, for example, it is three or more vessels, then doctors offer coronary bypass (suturing an additional vessel). And what of these treatments are offered to the patient, one can decide after coronography.
What does coronography imply?
Coronography is an X-ray surgical intervention on the arterial bed, and is performed only in a hospital setting, MSCT of the coronary arteries is usually performed on an outpatient basis by intravenous administration of a contrast agent. When people do not go for carnography, this is a big problem. Because we can not say how much heartache threatens his condition. If this does not carry a threat, it's a small vascular that can be treated medically.
To date, in most cases, doctors give drugs that lower cholesterol, reduce blood clots, but do not tell patients how much it is threatening. Most often in particularly difficult cases, shunting is used. If we compare neighboring countries, Poland, Germany and Ukraine, then the incidence of coronary heart disease in populations is the same. But at the same time in these countries, they are 10 to 13 times more likely to do carnography than we do. And it does not really depend on the equipment, it has long been represented in Ukraine, but we do not have enough doctors who can do the carnography. Doctors with great confidence can not tell patients what awaits them in the near future. What the patient should do, either be treated medically, or surgical intervention.
What is the main problem today in the cardiology of Ukraine?
The main problem for today in cardiology is not cardiac surgery, but the trouble of all Ukraine. There is a solution to the question, as well as in Europe, we have angiographs. Studies on every angiogram every day should be conducted approximately 30 times, and at this time 2-3 coronagraphs per day, which is ten times less than in civilized countries. If we talk about myocardial infarction, then these patients for the first time twelve hours, and it is better in the first hour to be quickly sent to the opening of blood vessels. To make it clearer, if we are treating, by the heparin method without resorting to something, then with myocardial infarction, more than 20% of the deaths of patients. If treated with thrombalysis, then this is 10-11% mortality in infarcts, and if treated with stenting, then from 3-6% mortality. Therefore, angiographs should be provided with all the raw materials, karanograms, contrast material, stents, primarily trained personnel who will do everything and work 24 hours a day, seven days a week and there must transport people. Cardiologists, therapists or family doctors, when a patient with coronary disease comes to them, they simply have to stratify the risk and choose a more convenient method of treatment in this or that case of the disease.
Sergey Viktorovich MAXIMENKO
Head of Department of Cardiac Surgery
Dnipropetrovsk Regional Clinical Center to arthology and cardiac surgery,
Member of the Association of Cardiac Surgeons of Ukraine Member of the European Association of Cardiothoracic Surgeons.
+38 (056) 778-21-13
+38 (0562) 34-04-69
Street Prince Vladimir the Great, 28,
Dnieper, region. Dnipropetrovsk, 49000
Sergey Viktorovich MAXIMENKOHead of Department of Cardiac Surgery