IHD and other "diseases of the century" |
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Ischemic heart disease is a condition of decreased blood flow through the heart muscle and, as a result, a deterioration in its supply of oxygen and nutrients. The heart is the central "pumping station" of blood circulation. Cessation of the activity of the heart, even for several tens of seconds, can end sadly. Day and night, week after week, month after month and year after year, this tireless laborer pumps blood continuously. With each heartbeat, 50-70 milliliters of blood (a quarter or a third of a glass) are thrown into the aorta. At 70 beats per minute, this is 4-5 liters. And if a person got up, walked, climbed the stairs, then the figure doubles or triples. While running, it increases by 4 or even 5 times! The heart of a person who is not engaged in physical labor pumps up to 10 tons of blood per day. For the year - 3650 tons. Throughout its life, this amazing creature of nature, the size of which does not exceed the size of a fist, pumps 300 thousand tons of blood without stopping for a second. The work that the heart performs throughout its life is enough to lift a railway carriage to the height of Elbrus. The only thing our muscle pump needs to do such a gigantic job is a continuous flow of energy. The source of energy is the oxidation of sugar or fats, which requires oxygen. The heart is supplied with blood through the coronary or coronary arteries. The blood flow through them has features that distinguish it from blood circulation in other organs and tissues. It is known that the blood pressure in the arterial system is not constant; it increases during the contraction of the heart and decreases during its relaxation. Consequently, contraction of the heart muscle increases blood flow through all organs and tissues, except for the heart itself. When the heart muscle (myocardium) contracts, the coronary vessels are compressed, and the amount of blood flowing through them decreases; increased blood flow through the vessels of the heart is observed during its relaxation. With a slower heart rate, the periods of relaxation of the heart are lengthened, which improves coronary blood flow, making it easier to nourish the heart muscle. Thus, with a slow rhythm, the heart works more economically and productively. Interruptions in the supply of blood to the heart muscle reduce oxygen supply and energy production, which immediately affects the heart as a pump. Violations of the blood supply to the heart muscle can occur as a result of spasm (compression) of the coronary vessels, their clogging with a blood clot and with narrowing of their lumen. In all cases, the delivery of blood to the heart muscle worsens and there is a significant weakening of the function of the heart (these are manifestations of coronary heart disease). It arises in spite of the fact that the heart has some reserve devices for emergency supply of its energy. Such reserves are oxygen reserves in the heart muscle itself, as well as its ability to generate energy for some time without oxygen consumption. However, these reserves are weak and can provide the heart with energy only for a short time.
The works of recent years have revealed that the heart has its own mechanism of nervous regulation - the intracardiac nervous system, which continues to function even after the organ's connections with the brain and spinal cord are completely turned off. Thus, numerous control mechanisms that often insure each other ensure the adaptation of the amount of coronary blood flow to the energy needs of the heart at rest, during physical exertion, emotional, mental stress and other conditions. Disturbances in the activity of these mechanisms, causing disorders of the blood supply to the heart muscle, sometimes lead to the appearance of foci of death in it - myocardial infarction. Emotional and mental stress is accompanied by an increase in the content of certain substances in the heart muscle (adrenaline, norepinephrine), which sharply intensify and speed up heartbeats, which predetermines an increased heart's need for oxygen. But if the coronary vessels are not trained enough, they cannot cope with the task set before them - they do not provide the required level of blood supply. There is a disproportion between the needs of the heart for oxygen and its real amount brought in by the blood. This is the first manifestation of ischemic heart disease - the so-called "exertional angina". A practically healthy person, at the time of a sharp physical or emotional stress, may experience pain behind the sternum, accompanied by an unpleasant sensation of pressure on the chest, unaccountable fear, melancholy. No wonder this painful condition was previously called "angina pectoris". If this condition is not removed with the help of vasodilators, then changes characteristic of coronary insufficiency and myocardial infarction may appear on the electrocardiogram. It is known that the coronary circulation is influenced by signals acting through the higher parts of the brain (cerebral cortex) by the mechanism of conditioned reflexes. Changes in the blood flow in the heart muscle usually occur not only at the very moment of exposure to an increased load, but also before that, in advance by adjusting the heart to the forthcoming work. Conditioned signals can not only increase, but also reduce coronary blood flow, which sometimes leads to acute disturbances in the work of the heart. So, once during a concert, the conductor suddenly felt a sharp attack of pain in the chest and had to leave the stage. Vasodilators eliminated pain. However, another time, during the performance of the same piece, when approaching a musical phrase, during which the first attack occurred, the conductor again had sharp pains behind the breastbone. After he refused to perform this piece, the seizures stopped. In another case, an attack of angina pectoris occurred in an employee rushing to work. Taking the medication relieved the spasm. But the next day, when he reached the same intersection, the attack was repeated. The man had to change the route, and the conditioned reflex disappeared. Changes in the electrocardiogram, characteristic of acute coronary insufficiency, were observed in people in a state of hypnosis when they were instilled in a state of fear or anger. The foregoing makes it clear that even in healthy people a repetitive situation leading to an overstrain of the nervous system and negative emotions is capable of causing oxygen starvation of the heart muscle, i.e., coronary insufficiency. The processes of regulation of coronary blood flow deteriorate sharply in the "rust of life" - atherosclerosis, which leads to disruption of blood supply to other organs. At the same time, numerous plaques appear on the inner surface of the arteries, containing a large amount of fatty substances, especially cholesterol. As a result, the lumen of the vessel is narrowed and blood flow is obstructed.The walls of the arteries become dense, lose one of their important abilities - to change the size of the lumen, expand if the tissues need an increased blood flow. With intensive work, when there is a need for increased delivery of oxygen and nutrients, oxygen starvation of tissues appears, often accompanied by the appearance of pain. Atherosclerosis can develop asymptomatically for a long time. At the same time, a person, in some situations, may completely unexpectedly die from an excessive load. Why does atherosclerosis occur?Most researchers believe that this disease has many causes (polyetiological). The development of atherosclerosis is facilitated by errors in the regime, the observance of which most of us neglect. This is an unhealthy diet, and a sedentary lifestyle, and poorly organized work, constant nervous tension and many other factors.
Blood clotting is an adaptive, useful reaction that stops bleeding in case of injury. In small amounts, the blood clots continuously. But this does not lead to blockage of blood vessels in a healthy person, because simultaneously with the formation of small clots, their continuous resorption occurs. With an increased content of cholesterol in the blood, clot absorption slows down. There are complications associated with impaired blood supply to organs and tissues. Pain, emotional stress significantly increase blood clotting. The first to suffer from this are the "places of least resistance", the coronary arteries most often affected by the atherosclerotic process, which is facilitated by a number of features of the coronary vascular bed. It is assumed that these features include the existence of intermittent blood flow associated with the work of the heart. When the heart contracts, the coronary vessels contract, the blood in them does not move and is in long-term contact with the walls of the arteries. Thus, the vascular wall affected by atherosclerotic plaques is the site of frequent thrombus formation, which disrupts the nutrition of the heart muscle, as a result of which myocardial infarction may develop. The foregoing allows us to understand why intravascular blood coagulation is largely associated with atherosclerosis, the prevention of the development of which is the basis for preventing damage to the cardiovascular system. For a long time, it was believed that increased concentrations of cholesterol, which is the basis of atherosclerotic plaques, arise due to its increased intake into the body with food. Back in 1908, the Russian scientist A.I. Ignatovsky discovered that feeding rabbits with eggs, meat, and milk led to the development of atherosclerosis of the arteries in them, similar to this disease in humans. N.N. Anichkov and S.S.Khalatov in 1912 caused atherosclerosis in rabbits, which were fed a large amount of cholesterol. The cholesterol model of experimental atherosclerosis proposed by these scientists has become a classic and has been used for several decades. Numerous observations carried out since then have revealed that food rich in cholesterol (eggs, butter, cream, sour cream, brains, liver) actually contributes to the development of atherosclerotic vascular lesions. However, later it was established that cholesterol is mainly formed in the human body itself. The opinion about a direct relationship between the amount of cholesterol in food and its level in the blood has not been confirmed. A number of complex systems that regulate blood cholesterol levels function in the body of a healthy person. Excessive intake of cholesterol from food inhibits the formation of this substance. So, A. L.Myasnikov found that students who ate 8 eggs daily for 10 days did not increase their cholesterol levels. He also cites a case when a 55-year-old resident of the coast of the Sea of Okhotsk ate fish and caviar, eating a colossal amount of them every day. Every day for many years, the fisherman received 15 times more cholesterol than any Muscovite, but careful research did not reveal any signs of atherosclerosis. Consequently, cholesterol-rich foods are dangerous only if there are a number of aggravating factors that contribute to the development of atherosclerosis, namely: constant nervous tension, negative emotions, a sedentary lifestyle, an inadequate protein diet, etc. Researchers have found that animal fats also lead to excess accumulation of cholesterol in the blood. A direct relationship was found between the amount of animal fats consumed, the level of cholesterol in the blood and the degree of development of atherosclerosis. The least amount of animal fats is consumed by blacks of the Bantu tribe, as well as by the population of Japan and China, the diet of the British and Finns contains 3 times more of such fats, and 4 times more of those in the United States. And it is the Americans, the British and the Finns who have the highest blood cholesterol levels. It has been noticed that the Japanese living in their homeland have half the cholesterol in their blood than the Japanese living in the United States. During the Second World War, the inhabitants of the Scandinavian countries consumed significantly less animal fat than before and after the war. At the same time, they also experienced a significant decrease in mortality from coronary heart disease. In Leningrad besieged by the Nazi invaders, despite the fact that the nervous tension of the inhabitants of the blockaded city, it seemed, should have led to an increase in blood cholesterol, this was not observed. Plant food helps prevent atherosclerosis. The protective role is played by vegetable fats, which contain unsaturated fatty acids: sunflower, olive, corn oil. Coconuts, on the other hand, contain fats with a high content of saturated fatty acids; the use of this product in the inhabitants of India is accompanied by atherosclerosis. Why do animal fats have a detrimental effect on the cardiovascular system? Fats and cholesterol, unlike other blood-borne substances, are insoluble in water, which is the basis of blood. When absorbed in the intestine, fats enter the bloodstream as separate droplets. Remember how, when whipping cream, droplets of fat stick together to form a lump of butter. Something similar could happen with droplets of fat suspended in moving blood. So that the formed lumps do not clog the vessel, nature provides for the protection of fat droplets from sticking to each other by covering them with a protein film. (Fat droplets covered with a protective film are often called balls.) The larger the balls, the more fat each of them contains, the thinner (in relation to the total mass of the ball) the protein shell covering them. As a result, large fat globules are unstable, their shell can be destroyed, and the contents, settling on the walls of blood vessels, contribute to the development of atherosclerotic plaques. Atherosclerotic deposits in the vascular wall are the result not only of adhesion of the contents of the balls to the inner walls of blood vessels, but also a consequence of an increase in blood coagulability. And although the mechanism of atherosclerosis development is not limited to these processes, they are important links in the development of this disease. It should be noted that the body has devices that prevent a large amount of fat from entering the blood at the same time. The digestion and absorption of fats is very slow. Only when a large amount of animal fat is consumed, the rate of absorption increases, and unstable fat droplets of large sizes enter the bloodstream.The deposition of fat in special fat cells, the consumption of fat by the muscles, the burning of fat in the lungs and other processes help to free the blood from excess fat droplets. Muscular work enhances these processes, and this is one of the reasons for the protective effect of physical labor in relation to the development of atherosclerosis. The development of atherosclerosis is facilitated not only by food rich in animal fats, but also by excess nutrition in general, especially the increased content of sugar and other refined foods. Human consumption of various refined products, and first of all sugar, in highly developed countries is constantly growing. If in England 200 years ago one person consumed an average of 2 kilograms of sugar per year, then today it is 50 kilograms, that is, 25 times more. The English cardiologist Yudkin found that in persons who had suffered myocardial infarction, the daily intake of sugar before the disease was equal to an average of 148 grams per day, while in another group of subjects, which included people without pathology of the cardiovascular system, sugar consumption was 78 grams. It is now known that both cholesterol and fat can be formed from sugar in the liver. The increased consumption of refined sugar in experiments on animals led to an increase in blood cholesterol and other metabolic changes characteristic of atherosclerosis. These changes were caused by refined, easily digestible sugar, while poorly digestible carbohydrates found in fruits and vegetables lead to increased excretion of cholesterol from the body. Excess nutrition also contributes to the development of atherosclerosis. Excess calories entering the body do not disappear, but are stored as fat. A direct relationship has been established between overweight, the development of atherosclerosis and the incidence of coronary heart disease. Reducing the intake of calories slows down the progression of atherosclerosis and even reduces its development. When examining arteries taken from persons who died from exhaustion, resorption of atherosclerotic plaques was observed. In New York, 500 men aged 35-65 years were examined, most of them are representatives of "sedentary" professions. The subjects were divided into 3 groups: overweight, normal and underweight. It was found that in the first group of coronary heart disease against the background of severe atherosclerosis occur in 9.2% of cases, in the second - in 7.8%, and in the third - in 4.8%. A sharp decrease in the intake of calories leads to the fact that the body begins to utilize internal reserves, while those deposits in tissues and cells that are considered an inevitable attribute of old age and significantly impair metabolism are recycled. Noteworthy are the data on the relationship between overweight and increased mortality, given by a number of foreign insurance companies. In the group of people aged 50 to 59 years, whose weight was 15-20% higher than normal, the mortality rate for the period from 1909 to 1928 was 17% higher than the average for people of this age. If the excess weight was 25-34%, then the mortality rate was 41% higher. And at a younger age, starting from the age of 20, the death rate was the higher, the greater the body weight of the insured. Since the connection between excess calorie intake and the development of atherosclerosis has been proven, you need to learn how to suppress or, better, interrupt appetite, monitor the dynamics of body weight, the arrival and consumption of calories, avoiding even short-term weight gain. Accumulating extra pounds is much easier than getting rid of them! Recently, more and more data have appeared on the role of table salt in the development of many diseases, primarily lesions of the cardiovascular system. No wonder salt (like sugar) has come to be called "white poison". The comparison may be overblown, but essentially true.Table salt is a substance whose content in body fluids and tissues prevails over other mineral compounds. Salt retains water; with an increase in its concentration in the body, the volume of tissue fluid and blood increases, leading to an increase in blood pressure. The main regulator of the constancy of the salt content in the body is the kidneys. Excessively salty food causes an overload of the mechanisms that regulate the excretion of salt, which, in addition to the kidneys, also include some endocrine glands. This contributes to a persistent increase in blood pressure, i.e. hypertension. The International Symposium on Hypertension presented the results of a study of 5 population groups that differ in the amount of salt consumed, among them were the Eskimos of Alaska, consuming 4 grams of salt per day, and the inhabitants of Northern Japan, consuming 26 grams per day. The former had no cases of hypertension, while almost half of the inhabitants of the northern regions of Japan suffer from this disease. Salt has become a necessary attribute of life only in a civilized society. Many peoples did not know her before. Salt was not consumed by the Eskimos inhabiting Greenland, the indigenous people of Australia, the Chinese of the mountainous regions, the American Indians. At first it seemed to them just tasteless, but then they liked it. “In the process of evolution of mammals living on earth, - wrote academician V.V. Parin, - the main problem of survival has almost always been to adapt to the lack of salt in the environment, and, naturally, individuals with a particularly developed ability to preserve salt should have survived. " in the body. The same mechanisms have arisen in the process of evolution in humans. But today, people can get virtually unlimited amounts of salt as a food supplement. And the human body is faced with the problem of excess salt, having no mechanisms to counteract this. Salt has become a contributing factor to many metabolic disorders. Hence the practical recommendations: it is necessary to give up the bad habit of oversalting food. You should train yourself to do with the minimum amount of table salt, following the rule "Better undersalted than oversalted!" This is important not only for the prevention of hypertension, but also for the prevention of myocardial infarction, since, according to a number of authors, a heart attack occurs in hypertensive patients 5-8 times more often than in people with normal blood pressure! In an environment of prolonged nervous, mental or emotional stress, which appears when complex tasks arise in front of the body, excitation of the central nervous system and a prolonged increase in blood pressure are observed. However, such a condition is not yet hypertension. This is a normal physiological response to a difficult environment. Such a state turns into a disease only in the presence of factors that disrupt the functions of the nervous system, breaking its regulatory mechanisms.
It is important to emphasize that, despite the complexity of the course of hypertension and the participation of many body systems in this process, its initial stage, according to modern views, has a neurogenic nature, is associated with constant overstrain of the nervous system, i.e.with the influence of factors that impose increased, often unbearable requirements on the body. Chronic trauma to the nervous system leads to hypertension, which is observed with the constant action of some, sometimes even not very intense factors. Their single and short-term exposure to harmful effects may not cause. Moreover, some of them train the nervous system, tempering it. But, influencing continuously, for a long time, they contribute to the development of hypertension. Here quantity turns into quality. The emergence of hypertension is facilitated by an unhealthy environment in the team, rudeness, harshness, systematic problems in family life, lack of understanding between spouses, parents and children, conflicts with others, an increased level of street or industrial noise, and many more factors. These include constant fatigue, insufficient sleep, lack of adequate rest and little physical activity. Hypertension is "the most human of all human diseases." It is the lot of people who live a tense emotional life, especially with constant restraint of the external manifestations of their mood. Essential hypertension is a frequent companion of ischemic heart disease, myocardial infarction, severe forms of atherosclerosis and other lesions of the cardiovascular system.
Similar observations carried out in different regions of the world show that nutritional factors do not play a decisive role in the development of lesions of the cardiovascular system. The human body has sufficient capacity to compensate for nutritional errors. But the reserves of compensation are not unlimited. They sharply decrease in case of metabolic diseases, nervous overstrain, restriction of physical activity. Kositsky G.I. - Let's get away from a heart attack |
Experts consider circulatory disorders of the heart itself to be one of the main health-threatening factors, which are increasingly being combined with the single term "ischemic heart disease".
Nature, not inventing a partner for the heart, as is the case for the kidney, lung, adrenal gland, etc., has created in the process of evolution a complex "multi-storey" system of coronary blood flow regulation, including various mechanisms inherent in the heart itself, and various levels of the central nervous system.
But atherosclerosis is not the only cause of chronic circulatory disorders. Intravascular coagulation is also a serious hazard.
The largest Soviet cardiologist G.F. Lang, based on the principles of nervousism of I.M.Sechenov and I.P. Pavlov, and summarizing the rich clinical experience, created a neurogenic theory of the origin of hypertension. He showed that the disease occurs in conditions that cause overstrain of the central nervous system and a sharp increase in blood pressure. The vascular wall cannot tolerate a prolonged and frequent increase in blood pressure with impunity. Circulatory disorders appear. If they occur in vital organs, such as the heart, the consequences can be dire.
It is known that the peoples engaged in hunting or cattle breeding do not have cardiovascular diseases, although they feed mainly on animal products with a large amount of fat. Representatives of the Massai people (East Africa), who consume an average of 180 grams of animal fat daily, practically do not get coronary artery disease. Camel drivers in Somalia drink up to 10 liters of camel milk every day and eat 200-250 grams of sugar each day, getting about 6200 kilocalories per day, which significantly exceeds the body's need. Camel's milk is 2 times richer in fat than cow's milk and contains about 70% saturated fatty acids. However, during a ten-year follow-up, they did not have a single case of myocardial infarction. A survey of 203 people from this tribe revealed that they have extremely low blood cholesterol levels, the absence of atherosclerosis. All these people live far from civilization and make little use of its benefits. They are not subject to the action of significant mental and nervous stress, they are constantly engaged in physical labor.
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