- Types of prevention, differences
- Current data on the effectiveness of medical interventions
- Drug prevention - part of the rehabilitation
- physical methods How to reduce the impact of
risk factors include general preventive measures to reduce morbidity diseases of the cardiovascular system heart attack prevention is enabledin the state program as the most important. This is due to a significant level of disability of able-bodied people, a high proportion of deaths and complications.
According to the Federal State Statistics Service and the report of the Minister of Health, in the last decade the number of deaths from heart and vascular diseases has decreased in Russia by 2 times. But 2 years the lethality from myocardial infarction remains unchanged.
An independent audit of civil society organizations has shown a link with the miscalculations of the health authorities in the organization of care. However, the weak awareness of the population, the misunderstanding by adults of the dangerous consequences of indifferent behavior is still of great importance. Unfortunately, it comes with a great delay, when the disease is already reaching a pronounced stage.
Types of preventive activities, differences
It is accepted to distinguish 2 types and directions of prevention:
- primary prevention of myocardial infarction;
Primary activities are aimed at:
- complete and effective treatment of those diseases which can be complicated by myocardial( hypertension, diabetes, endocrine pathology, neurotic conditions, menopausal changes in men and women);
- correction of disturbance of thrombogenesis processes;
- decrease in the intensity of coronary artery lesions by atherosclerosis;
- detection of patients in the pre-infarction period and their timely treatment;
- effective therapy of ischemic disease with the use of modern achievements of vascular surgery;
- indispensable hospitalization of patients with symptoms of ischemia;
- prevention of complications of acute infarction( control of cardiogenic shock, thrombolysis, stabilization of blood pressure, glucose level, blood lipoproteins);
- organization of cardiac care for the population, including providing affordable drugs for conservative therapy.
Treatment begins at "Ambulance", fast delivery profile in the hospital you can go to
targeted therapy In contrast to the primary, secondary prevention of myocardial infarction regard to patients who have had an acute form of coronary artery disease. Drugs and methods of therapy should be effectively prevented:
- repeated infarctions;
- thromboembolic complications;
- arrhythmia development;
- manifestations of heart failure. Secondary prevention
It is desirable to indicate all the results in the documents at discharge from the hospital. Let us dwell in more detail on the problems of secondary prevention, since they coincide with the period of postinfarction rehabilitation.
Current data on the effectiveness of medical interventions
development of the right approaches to treatment, the development of the standard tactics allow to speak confidently about the proven effectiveness of drugs:
- The use of Intensain in a course of six months allowed a two-fold reduction in postinfarction attacks of pain in the heart.
- Introduction to the complex therapy of direct-acting anticoagulants with a gradual transition to the indirect 3 times reduces the frequency of deaths from repeated acute thrombosis of the coronary arteries. Taking Aspirin proved the possibility of reducing mortality by 15-30%.At the same time, the frequency of recurrent myocardial infarctions is 31% less than among patients who do not take drugs of this group.
- Constant admission of β-blockers reduces mortality by 22%, and repeated heart attacks - by 27%.
- Long-term therapy with captopril reduces mortality by 21%, the risk of heart failure is reduced by 37%, and the number of repeated infarctions is reduced by 25%.
Medication prophylaxis is part of the rehabilitation of
. In secondary preventive activities, it is impossible to do without medications. They must fully provide support for the affected heart, improve metabolic processes and blood circulation. The following groups of medicines are used:
- Antiaggregants and anticoagulants with indirect action - Aspirin group( Kadio Ass, Trombo Ass, Cardiomagnol, Curantil, Tiklid) is widely used, they are prescribed in small dosesOnce a day, constantly. The efficacy is proved for unstable angina, as well as a transferred infarct without a Q wave on the ECG.To the use of anticoagulants with an indirect effect( Warfarin, Fenilin), the attitude of cardiologists is cautious. It is considered difficult to select a dose and monitor the level of prothrombin index in outpatient settings. Therefore, they give bleeding in 3-8% of patients.
- Beta-adrenoblockers - are most effective in case of anterior anterior infarction with Q-wave and ventricular arrhythmia, in the initial stage of heart failure. Applied: Propranolol, Anaprilin, Metoprolol, Atenolol. The course of treatment is 1.5 years and more. If the patient has had a heart attack without complications, then the prescription of this group is not necessary.
- Calcium antagonists - are used Diltiazem, Cordarone, Amiodarone. In case of risk of ventricular arrhythmia or after defibrillation, the drugs are combined with a group of adrenoblockers. Assigned courses for the first six months.
- ACE inhibitors ( adenosine pyrophosphoric acid) - Captopril, Kapoten, Enalapril, Vasotec on admission from the third day of acute infarction slows the expansion of the left ventricular cavity, prevents the formation of heart failure and restores blood flow in the coronary arteries. Preferred preparations are derivatives of Captopril. A minimum dosage with a gradual increase is prescribed.
Application of physical methods
Prevention of repeated violations does not require constant bed rest. On the contrary, physical rehabilitation aims to return the patient to the feasible work activity.
LFK is appointed in the subacute period. Usually it coincides with the stay of the patient in the cardiological rehabilitation center or sanatorium. After 2 months, an ECG test is performed with minimal physical exertion, the most common is bicycle ergometry. Only after this is the set of exercises.
Bicycle ergometry allows changing the load and controlling the heart reaction in the dynamics of
- inflammatory reaction in the form of myocarditis;
- severe heart failure;
- heart aneurysm;
- dangerous arrhythmias and conduction disorders;
- revealing the syndrome of weakness of the sinus node.
Workouts start from walking to lunch at a speed of about 100 steps per minute. The distance gradually increases to 3 km. Controls blood pressure, pulse, the patient's state of health.
For therapeutic exercise it is advisable to use group exercises. They allow you to improve your mood, give you the opportunity to share your achievements. In the future, you can do it yourself at home.
For sexual life, patients are allowed to return 1.5-2 months after the illness. To determine the readiness of doctors recommend first to perform an affordable test: without stopping to go through 2 flights of stairs and count the pulse. A good result if the frequency is not more than 120 per minute. Some people are shown taking nitro drugs for half an hour before intimacy. A dangerous way is to try to "repair the simple" with an unfamiliar partner.
How to reduce the impact of risk factors
Smoking is accompanied by spasm of the coronary vessels and the progression of atherosclerosis, so an indispensable requirement of prevention is the abandonment of this harmful habit. In a sanatorium, you will be able to choose a technique, use exercises on auto-training.
Terrenkur, therapeutic walking or the "health path" is always available in the sanatoriums, to start the classes better with the trainer
. To reduce and maintain the total blood cholesterol level at the figures of 5.2 mmol / l, patients have to monitor the diet. In the daily diet should not be animal fats( meat, fat, sauces) and light carbohydrates( confectionery, sweets, pastries), sausages and smoked products. Recommended low-fat dairy products, cereals, chicken dishes. Great importance is attached to the availability of vegetables and fruits.
Patients with excess weight are recommended a diet with reduced caloric content, unloading days.
With a cholesterol level of 6.5 mmol and higher, statins are prescribed( drugs to reduce the concentration of cholesterol derivatives).
Hypertension may require additional prescriptions. Controlling the level of blood pressure necessarily accompanies the admission of β-blockers and drugs from the group of ACE inhibitors. For diastolic pressure, a level of at least 80 mm Hg is required.since it decreases blood flow in the coronary arteries when it decreases.
The implementation of the prevention program allows to return to full-fledged work by profession up to 80% of patients who underwent an acute infarction. Target means of secondary prevention allowed to reduce the lethality within 12 months to 5%.