НАСКОЛЬКО ОПАСНА БОЛЬ В ОБЛАСТИ СЕРДЦА? Как избежать осложнений?

OLEG ANATOLIEVICH Good afternoon, friends! This is Life Without Pain channel and I am a neurosurgeon Andrey Gorodnov and a cardiologist OLEG ANATOLIEVICH Oleg Anatolievich Today we will talk about the pain in the heart and the most common reasons why it all occurs. Because the most important thing in this matter, I believe, is not to miss the chance to stay alive. Do you agree with this? Everything is correct. We have had very often and continue to have these situations in our clinical practice, when it seems that the spine or the rib hurts, for example, but in fact the heart hurts and we saved people in cardioreanimation. There have been such cases more than once. More than once. Let's try to figure it out. What is the pain in the heart that you have in your practice? Of course, when a patient comes for a consultation with a cardiologist with chest pain, with heart pain, it is necessary to exclude, first of all, the ischemic nature of the pain, that is, those pains that are associated with insufficient nutrition of the heart muscle with oxygen. Most often, the pain of the ischemic nature manifests itself in the form of stenocardia, that is, in the situation when the heart requires increased consumption of oxygen and other nutrients. The main cause of the ischemic heart disease is atherosclerosis of the coronary arteries, that is, those arteries that feed the heart. Cholesterol and other fatty acids are deposited in the walls of these vessels, and, accordingly, then there is a formation of atherosclerotic sclerosis, which gradually leads to the clogging of this coronary artery and worsening of the blood supply of the heart. Therefore, the main clinic for patients with ischemic heart disease is the development of a characteristic chest pain attack, which, most often, is pressing, burning, localized behind the chest. The patient cannot mark any point in the chest, and, accordingly, this pain is most often developed under physical stress or against the background of increased blood pressure, when, as I have already said, myocardium requires increased nutrition, increased oxygen supply. And, accordingly, these pains are associated with physical exertion, this is a characteristic sign of myocardial tension, and occurs in a state of rest, when a person stops physical exertion, stops, or takes a pill to reduce blood pressure. A characteristic sign of myocardial tension is the accumulation of pain syndrome after taking a pill of nitroglycerin or nitrospray. Everything is very simple, right? Unfortunately, there are situations when the pains are delayed and become longer, and are preserved for more than 15-20 minutes. This is a different situation, and the risk of developing acute coronary syndrome and myocardial infarction is increased, that is, it is a myocardial necrosis. Very often, this situation occurs when the patient has an unstable atherosclerotic bulge, when it is unstable, it is loose, it is subject to thrombocytosis, that is, thrombocytes settle on this bulge, stick together, stick together, and coronary artery clotting occurs. And, accordingly, if this coronary artery clotting continues for a long enough time, unfortunately, the myocardial cells die, and a person develops a heart attack. Heart attack, yes. That is, the heart muscle remains without food for some time. That's right. And how long is enough for your blood to flow? 15-20 minutes, unfortunately, is enough for the myocardial cell to die. Therefore, the most important thing is to provide the person with help in time in order to save as much heart muscle as possible. Heart muscle, yes. This condition is quite serious, but it is not hopeless. There are many drugs that are aimed at preventing the development of atherosclerosis in the vessels, in order to prevent thrombocytosis in the vessels. Disaggregants are particularly related to them. Well, as you know, a common drug is acetylsalicylic acid. Yes, but this is a prevention. Accordingly, it is both a primary prevention in the presence of atherosclerotic failure of the brachiocephalic arteries, hemodynamically significant stenosis in the brachiocephalic arteries, and is also used most often for secondary prevention in patients with heart disease in order to prevent the progression of this process of atherosclerosis and, accordingly, the formation of the most unstable blisters, which can lead to such fatal complications as a myocardial infarction. Let's talk in more detail about prevention. We are now talking about prevention of acetylsalicylic acid, so that our subscribers do not have the illusion that if you take aspirin, everything will be fine in life. Not at all. That's right. Very often patients come to see a cardiologist having already started taking acetylsalicylic acid for some kind of virtual bleeding in order to prevent complications. In fact, this is not so. Very often patients read some literature themselves, look on the Internet, not always where they can find true information, and begin to be treated incorrectly. This leads not to a positive effect, but to the development of complications. That is, acetylsalicylic acid in the form of hemorrhagic complications. Therefore, medicines, including aspirin, should be prescribed to cardiologists or therapists, and only according to the readings. Okay, let's get back to the pain that occurs with myocardial infarction or ischemic disease. Yes, it's good here, everyone knows what heart pain is, but it can also give to the spine, right? And to the hand. Where else can it give? It can give to the lower jaw, the intervertebral region, the epigastric region. And look, what is the trick here? In the fact that the pain in the spine, with loads, also hurts with loads. And here it also hurts with loads. But the pain in the spine, it seems to me, does not hurt with excitement, and here with excitement it can also hurt. Well, excitement is stress. Stress leads to increased blood pressure, increased heart rate, and, consequently, to increased load on the myocardium. Yes. And when coronary arteries are damaged by atherosclerosis, there is no way to deliver this increased amount of blood to the myocardium, and therefore these stenocardial pains occur, characteristic of ischemic heart disease. Yes. All the same, okay, if you told us very well how this trauma begins to form, all the same, most often it begins with atherosclerotic pain, right? Yes, of course. And to prevent thrombosis, we need to prevent atherosclerosis. That's right. Right, yes? What methods can be used to do this, right? Cholesterol, what about prevention? Well, first of all, of course, the simplest thing is to prevent the disease, rather than treat the disease itself and its consequences. To do this, it is necessary to influence the existing risk factors in the patient. There are modified risk factors and non-modified. That is, the non-modified risk factors include heredity, age, gender. Unfortunately, we cannot influence them. The fact that we cannot influence. Yes, but most importantly, we can influence hypodynamics. That is, we move more. We move more, yes. Every day you need to devote 30-40 minutes for physical exercises. So that the blood moves faster, faster, faster, and this also prevents the formation of blisters. Obviously, hypodynamics is associated with obesity, increased body weight. Therefore, our patients should follow their weight and strive for its normal indicators. In order to lose weight, of course, it is necessary to eat rationally. So. In nutrition, we must exclude food rich in fats, simple carbohydrates. For example? Fatty meat. Yes, everyone loves it, but unfortunately it is harmful. If you choose a healthier meat, turkey, white meat, chicken, they actually do not contain cholesterol. Therefore, for us, they are just the most useful. In the diet, at least twice a week, we should use fish, preferably sea. It is also useful for people in preventing the development of atherosclerotic vessels. Okay. Let's say a person has atherosclerosis. Somewhere in other vessels. And he already knows about it. A person is 50-60 years old. How to find out if a person has a blister somewhere in the coronary vessel? What methods of research can be used to do this? If a patient older than 50-60 years has, for example, hypertension, with risk factors, as I said, hypodynamics, obesity, increased cholesterol levels. Of course, it will be difficult for us to look at the ultrasound sensor in the coronary artery, but we can clarify in what condition the vessels located directly near the surface of the body are. Therefore, we can conduct an ultrasound study of the parathyrocephalic vessels and, accordingly, clarify whether there is a thickening of the intima-media complex, or already the presence of atherosclerotic defects of the vessels, and thus the presence of atherosclerotic blisters. That is, we are looking for blisters in other places. Because with the help of an ultrasound, we cannot look into the vessels of the heart and understand whether they are there or not. Okay. Found. Found, for example, blisters in the vessels of the neck. What's next? Well, it is necessary here, of course, to clarify in general the volume of the defeat. In this case, if these blisters are hemodynamically insignificant, then it is enough for the patient to be recommended to observe a healthy lifestyle, to prescribe drugs aimed at lowering the level of cholesterol. This is hypolepidemic therapy. The drug of choice in this case is statins. Well, if these blisters have already grown enough inside these vessels, the pain takes up more than 60% of the defeat. Here, of course, it is necessary to include disaggregative therapy, again, aspirin or clopidogrel. Okay. To whom do you do angiography with coronary vessels? Yes. Coronary angiography is an invasive method of examination of our patients. And most often we use this method of diagnostics and possible further treatment in patients with ischemic heart disease, which we have already assigned treatment. But, unfortunately, despite the competently selected therapy, this is also an achievement of pressure figures and the appointment of all kinds of hypolepidemic drugs, but, unfortunately, the patient's clinical stenocardia is preserved. That is, the pain in the heart is preserved. That is, despite the competently selected conservative therapy, the patient's clinical stenocardia is still preserved. Here, of course, it is necessary to temporarily direct the patient to coronary angiography in order to identify the nature of coronary artery damage and solve the issue of the need for surgical treatment in the form of hypolepidemic coronary angiography or large surgical intervention in the form of coronary artery damage. I will try to sum up this thought. It is actually very good. When a person has a pain in the heart area, proving that it is the heart that hurts, not the spine, it is necessary to conduct conservative treatment. If the pain goes away, then, in principle, we do not move on. We do preventive medicine, as Oleg Anatolyevich said. We do treatment, take drugs, a healthy lifestyle, and so on. If it does not work, we go to coronary angiography. And during coronary angiography, can a stent be installed? Of course. This is a one-off procedure. First, a diagnosis is made, and then a joint surgeon and cardiologist, who is present at this surgical intervention, about the need for the implantation of a stent. And what does the stent do? The stent opens from the inside, squeezes the bladder, the blood flow is restored, and the probability that a thrombus is formed there is minimal. But at the same time, unfortunately, patients still have to take drugs and do not forget that stentation is not a reason not to follow the recommendations for medical and non-medical treatment. And I want to conclude that this state, when there is a thrombus in the coronary vessels, it is dangerous for life, and this needs to be dealt with seriously and immediately. Unlike our diseases that we are talking about here on our channel. More than 50% of success depends on the patient himself. Therefore, the doctor is an assistant in this case. An advisor, an assistant. We love you all, we adore you, but you should also take your illness seriously. Thank you, friends, for watching this video to the end. If you liked it, do it like this. And be healthy, take care of yourself, bye. Thank you, all the best. For more than 10 years, we have been dealing with spinal and joint diseases and achieved very good results. More than 90% of our patients with pain are treated in our hands. Laser varicose removal. Why is there pain in the clinic? We work in the operating room, and this is sterile. Next to me is an anesthesiologist for patient safety. We have modern lasers, and I am always confident in the result. More than 2,000 Kaluzhans have treated their vessels here and are happy with the treatment. When I dreamed of becoming a doctor, I thought I could save many people. But years have passed, and I realized that nothing can be achieved alone. There are many of us now. 100 professionals, 100 people who love their job, and almost 100,000 patients. Now, in the Pain Clinic, we treat almost any disease. And we do it beautifully. They know us in many countries of the world and come to Kaluga for treatment. Would you like to get rid of your pain? Come to us at 23 Bolotnikovo or call 21 00 00.