How is stable heart disease treated

Coronary artery disease (CHD) and stable angina pectoris

Coronary heart disease (CHD, coronary heart disease): narrowing or occlusion of coronary arteries due to progressive arteriosclerosis with fatty tissue, calcification and thickening of the vessel walls. As a result, there is always a in the heart muscle due to insufficient blood supply Insufficient blood flow (Ischemia) with angina pectoris. If left untreated or undetected, CHD turns into acute coronary syndrome with myocardial infarction and sudden cardiac death. CHD is the leading cause of death in all industrialized countries. In Germany around 30% of all men and 15% of all women develop it in the course of their lives. Lifestyle changes and the consistent treatment of comorbidities are crucial to preventing heart attacks and cardiac death. Doctors also try to improve the poor blood flow in the coronary arteries with vasodilator drugs, cardiac catheters or bypass surgery.

Angina pectoris (literally "chest tightness", more correct would be "heart tightness"): attacks of tightness and pressure in the chest, which cause fear and are associated with shortness of breath and pain. These are the typical complaints of CHD that initially only arise when the heart muscle is inadequately supplied with blood. If angina pectoris attacks also occur at rest, one speaks of unstable angina pectoris, her therapy is treated with heart attack.

Schematic drawing of the coronary artery supply to the heart. An angiography of the left coronary artery with its branches is inserted at the top right.
GRAG

More frequent than the rapid progression of angina pectoris to acute coronary syndrome is the longstanding history of CHD as chronic coronary artery disease (chronic CHD). In this case, heart pain is relatively predictable only with greater physical exertion, and it disappears again at rest or after taking medication. It is not immediately life threatening.

Leading complaints

  • Seizure burning pain or pressure and tightness behind the breastbone or in the left rib cage
  • The pain often radiates towards the neck, lower jaw, left shoulder blades, arms or upper abdomen
  • Pain triggered by physical exertion, excitement, copious amounts of food or when being in extreme cold
  • In individual cases also painless, e.g. B. noticeable in long-term diabetics or due to pain elsewhere.

When to the doctor

Today if

  • Angina occurs suddenly with low exertion or at night.
  • Angina attacks are becoming more frequent and more nitrospray is needed.
  • Physical or psychological stress or when it is cold for the first time briefly creates a feeling of pressure or tightness in the area of ​​the heart.

Call the ambulance immediately, if

  • Burning pain, pressure or tightness in the chest that lasts for minutes occurs for the first time.
  • If you have a known coronary heart disease and you are already familiar with angina pectoris symptoms persist for more than 20 minutes despite physical rest (sitting down).
  • Nitrates do not lead to significant improvement within 5 minutes.

The illness

Disease emergence

Due to the lack of exercise in everyday life and aging processes, the coronary arteries usually begin to slowly change at a young age. The originally smooth, elastic coronary vessels become uneven, rigid and vulnerable due to increasing fat deposits and calcification of the vessel walls (see also arteriosclerosis). This reduces the oxygen transport capacity of the coronary arteries. At first, the reduced blood flow is not noticeable at rest. When climbing stairs, exercising or doing other stresses with increased oxygen demand, however, there is a lack of oxygen with the typical angina pectoris complaints such as pain and shortness of breath.

Radiation of angina pectoris pain
www.salevent.de, Michael Amarotico, Munich

A few patients, especially diabetics, experience no or only slight signs of angina pectoris with circulatory disorders of the heart. This is then called silent ischemia.

Risk factors

We cannot influence some risk factors for coronary heart disease. CHD occurs more often in people whose parents or siblings have already suffered a heart attack or stroke. This indicates a genetic contributory cause. The risk of CHD also increases with age. Men are more at risk than women; they develop CAD 10–15 years earlier on average. Women are less prone to atherosclerosis up to the menopause unless other risk factors are added.

Factors that can be influenced. The development of CHD depends more on lifestyle and eating habits than on genes. 80% of these factors determine whether CAD develops. So the good news is: the CHD is to a high degree avoidable. The most important accelerators of CHD are above all

  • Smoke
  • Little physical activity
  • Diets rich in fat and calories but low in fiber
  • Obesity
  • Increased alcohol consumption
  • Stress and the related illnesses that are often associated with it

It is now also known that the sugar hidden in many ready-made meals increases the risk of CHD. The body likes to convert excess sugar into fats, namely into triglycerides. People who eat a lot of industrially manufactured foods therefore have elevated blood lipid levels and, as a result, a greater risk of atherosclerosis.

Degrees of severity

Only when fat and calcium deposits have narrowed the original diameter of a coronary artery by at least 50% does the cardiologist speak of a CAD. From one Vasoconstriction (Stenosis) of about 70%, the blood flow in the affected vessel decreases sharply. This is then called high grade or critical Coronary artery narrowing (Coronary stenosis).

The right and left coronary arteries branch multiple times after they exit the aorta. Vascular constrictions close to the outlet therefore have much more serious effects on the myocardial blood flow than constrictions of smaller end vessels, which can be more easily circumvented by neighboring vessels.

clinic

Even with severely constricted coronary arteries, there is often a reduced blood flow to the heart only under stress, because only then healthy neighboring vessels can no longer compensate for the increasing blood demand. Oxygen deficiency develops in the heart muscle with characteristic angina pectoris symptoms such as pain, chest tightness and shortness of breath. After the end of the exercise, the heart muscle's need for oxygen decreases, so that the existing blood supply is sufficient again and the angina pectoris subsides.

If chest pain only occurs during increased cardiac output requirements and continues to subside after taking nitrospray or taking physical rest, this is referred to as stable angina pectoris(Stress angina) designated. Initially, the symptoms often remain the same for years without the blood circulation deteriorating any further. The aim of all medicinal, non-medicinal, invasive or surgical measures described below is to ensure that this state of stable narrowing of the coronary vessels does not develop into an acute coronary syndrome.

The classification of the Canadian Cardiovascular Society (CCS) divides angina pectoris into four degrees of severity (CCS stages).

  • CCS I: No angina pectoris under everyday stress such as running or climbing stairs, but with very high or longer exertion such as clearing snow or endurance running
  • CCS II: Angina pectoris during strenuous exertion such as climbing stairs quickly, going uphill or during psychological stress
  • CCS III: Angina pectoris with light physical exertion such as dressing and undressing, normal walking or light housework
  • CCS IV: Angina pectoris after a few steps or even at rest.

Special forms

One of the special forms is the Vasospastic angina, Also called Prinzmetal's angina after the name of the first person who wrote it. Here the angina pectoris is based on a temporary cramping of the coronary arteries (coronary spasm). Typically, the symptoms appear here at rest and cannot be provoked by physical strain. The occurrence of coronary spasms is reduced with the administration of calcium channel blockers and nitrate preparations.

In rare cases, diseases such as anemia, hyperthyroidism or a febrile infection can increase the stress on the heart to such an extent that angina pectoris occurs.

Diagnostic assurance

At the beginning, the doctor asks the patient for detailed information on the type of complaints, previous illnesses and a possible familial tendency for CHD. This is followed by a physical exam, a resting EKG, and a blood draw. The stress ECG reveals severe coronary artery constrictions of around 70–80%.

If no reliable statements can be made with these examinations and if CHD is still suspected, stress echocardiography, myocardial scintigraphy or stress nuclear spin are possible. The choice of examination method also depends on the possibilities on site.

With the help of coronary angiography, doctors examine the coronary arteries directly. To do this, they use a cardiac catheter to direct X-ray contrast media into the coronary arteries and make these and any constrictions visible using X-rays. This enables doctors to identify the extent of the coronary artery disease and whether an interventional procedure (widening the constriction or inserting a stent) or a bypass operation is required. Doctors use a balloon to expand severe constrictions of the coronary arteries during the examination. If several coronary vessels are involved at the same time or if the constriction is unfavorable, they recommend a bypass operation (see below).

Prinzmetal's angina. The doctor uses the acetylcholine test (ACh test) to determine whether there is a tendency to coronary spasms. To do this, he injects the body's own neurotransmitter acetylcholine (ACh) into the coronary artery to be examined in various doses via an infusion catheter. Healthy heart vessels expand increasingly. In the case of diseased vessels, on the other hand, a coronary spasm (vascular spasm) occurs after the agent has been injected.

Differential diagnoses. The most important differential diagnosis is myocardial infarction. But other diseases also lead to chest pain, e.g. B. pulmonary embolism, aortic aneurysm, pneumonia, pleurisy and ulcer disease. Chest pain that only lasts for seconds, can be influenced by breathing maneuvers or a change in posture or is triggered by palpation of the chest speaks against an underlying circulatory disorder of the heart.

treatment

The aim of treatment is to relieve the symptoms and prevent a heart attack. The most important requirement for this is a healthy lifestyle, especially not smoking and reducing other preventable risk factors (see below, Your pharmacist recommends). If the patient has diabetes, high blood pressure or a lipid metabolism disorder, the doctor must closely monitor and treat this disease. In addition, the doctors also treat the stable CHD Medication alone or in combination with interventional procedures (Balloon dilatation, stent insertion) or one Bypass surgery.

Pharmacotherapy

Lifelong drug therapy always takes place - be it as follow-up care after bypass, balloon dilatation or stent placement or because the patient rejects a cardiac catheter examination or his general condition speaks against it. In any case, the treatment aims to slow down the progression of the coronary disease and prevent complications such as myocardial infarction.

  • Platelet inhibitors (platelet inhibitors). In pathologically altered coronary arteries, the willingness of the blood to clot is increased. To prevent blood clots from forming in the coronary arteries and thus a heart attack, all CHD patients receive lifelong platelet inhibitors as part of their drug therapy. Acetylsalicylic acid (ASA) in a low dose of 100 mg / day is suitable as a basic medication for all CHD patients (from a dose of 150 mg / day there is an increased risk of internal bleeding). The active ingredient clopidogrel reduces subsequent complications in patients with atherothrombotic vascular disease (which also includes stable CHD) than ASA. Other new platelet inhibitors are prasugrel and ticagrelor.
  • Beta blockers such as B. Metoprolol, Atenolol, Bisoprolol or Carvedilol reduce the effects of stress hormones and thus lower blood pressure, heart rate and the oxygen demand of the heart. Beta blockers are standard medication for CHD. The fact that beta blockers have a positive effect on the prognosis is particularly evident in follow-up care after a heart attack.
  • Statins (CSE inhibitors) such as B. atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin influence the fat metabolism by lowering the cholesterol level. The target value for LDL cholesterol in all CAD patients is 100 mg / dl. If the cardiovascular risk is very high, it may be advisable to lower the LDL cholesterol even more to a value of 70 mg / dl. If statins do not reduce blood lipids sufficiently, doctors also prescribe cholestyramine or ezetimibe. Fibrates such as B. Bezafibrate are an option if the patient cannot tolerate statins.
  • ACE inhibitors inhibit the renin-angiotensin system, which inter alia. regulates blood pressure. They are particularly suitable for CHD sufferers who suffer from concomitant diseases such as hypertension, heart failure, left ventricular dysfunction or diabetes mellitus. Doctors prescribe patients with CHD and impaired systolic left ventricular function who cannot tolerate an ACE inhibitor AT1 receptor antagonists.
  • Nitrates such as B. glycerol trinitrate, isosorbide dinitrate, isosorbide mononitrate reduce the heart's need for oxygen by expanding the blood vessels, thus reducing the stress on the heart and at the same time improving the blood flow to the heart by expanding the coronary arteries. Nitrates are not only available as tablets and capsules, but also as plasters and ointments. If nitrate is taken regularly, the medication must be dosed in such a way that the nitrate level in the blood fluctuates (e.g. a nitrate break in the evening), otherwise a habituation effect occurs and the effectiveness decreases. If nitrates are taken in the form of quick-acting sprays or chewable capsules, they will relieve symptoms within 1–5 minutes, even if long-term nitrate therapy is already in place. They are therefore ideally suited for the treatment of an angina pectoris attack. No habituation effect is to be feared here. Short-acting nitrates can also be taken as a preventive measure in stable angina pectoris in order to prevent expected discomfort under certain stresses.
  • Calcium channel blockers (such as calcium channel blockers) B. nifedipine, diltiazem or verapamil lower blood pressure and cause the coronary arteries to widen. They are said to be particularly effective in the treatment of vasospastic angina. Some active substances also reduce the heart rate.
  • Ivabradine and ranolazine are used as reserve drugs to dilate the coronary vessels if therapy with beta blockers or calcium channel blockers is insufficient or the drugs are not tolerated.
  • Aldosterone antagonists such as the active ingredient eplerenone are recommended for patients who suffer from left ventricular dysfunction and heart failure after a heart attack.

Interventional procedures via the cardiac catheter

The cardiac catheter is not only used diagnostically but also therapeutically: in the Vasodilation (Coronary dilatation, balloon dilatation, balloon angioplasty) the doctor inserts a special cardiac catheter, at the tip of which is a folded balloon (balloon catheter), into the narrowed artery. When he squirts liquid into the balloon, it unfolds and takes on the size of the original vessel diameter. Any material that protrudes into the coronary artery and constricts it is thereby pressed into the vessel wall and is distributed there. The constriction is thus eliminated. This procedure is called the heart PCI (Percutaneous Coronary Intervention) or also PTCA (Percutaneous Transluminal Coronary Angioplasty). The risk of fatal complications during treatment is less than 1% and depends primarily on the general condition, concomitant diseases and existing heart damage. PCI is the first treatment option for acute myocardial infarction and for less complex constrictions of one or two coronary arteries without an acute myocardial infarction.

Here the vessel expansion in a schematic drawing: The working steps shown consist of finding the constriction (a) and subsequent expansion (b). The right picture describes the expansion by placing and unfolding a stent at the constriction.On the one hand, this pushes the atherosclerotic plaque into the vessel wall and, on the other hand, the expanded stent makes the vessel wider and thus more pervious.
Georg Thieme Verlag, Stuttgart

Stents. Sometimes the superficial layers of the vessels tear as they expand and then close the vessel. The doctor counters this danger by inserting vascular supports, Stents. A stent is a fine tubular metal mesh that surrounds the collapsed balloon at the tip of the catheter. As the balloon unfolds, the stent also enlarges and is pressed into the vessel wall. While the balloon is refolded and removed, the stent will permanently maintain its size and remain in the coronary artery. In this way it keeps the vessel open and in most cases prevents a tear in the coronary artery from developing into a vascular occlusion. If further complications arise, however, an immediate bypass operation is necessary.

Relapse prevention. Unfortunately, expansion with the balloon catheter does not permanently remove the constriction. In about a third, narrowing (recurrent stenosis) occurs again in the treated areas, usually within the first six months. The use of stents also only slightly reduced the number of recurrent stenoses. For this reason, special stents (cypher stents, drug eluting stents) have been developed that are coated with a growth-inhibiting drug, a cytostatic agent. These drugs are designed to prevent new cells from forming in the area of ​​the constriction, which would lead to renewed stenosis.

Bypass surgery

The coronary Bypass surgery is the recommended form of treatment for

  • Condition after myocardial infarction and persistent angina pectoris
  • Reduced cardiac output
  • Multiple and complexly narrowed coronary vessels.

The cardiac surgeon directs the blood through an artificially created vascular connection, the bypass, past the constriction. These bypass vessels are removed from other parts of the body beforehand. Healthy superficial leg veins, which are available without great effort and are inserted between the main artery and the coronary artery, are suitable as bypass vessels (Aortocoronary venous bypass or ACVB). But arteries of the forearm can also be used as bypass vessels if it has been ensured through previous examinations that the blood flow to the hand is guaranteed (Radial artery bypass).

The two main bypass surgical procedures. Left: Bypassing the bottleneck (blue) through one or more veins (taken from the leg). (Aortocoronary venous bypass, ACVB, gray). Right: bypassing the bottleneck through an artery (MCB, here a LIMA bypass, red).
Georg Thieme Verlag, Stuttgart

Another bypass variant is a connection of the stenosed coronary artery with arteries of the chest wall: Internal mammary bypass (Abbreviated: MCB, right and left arteria-mammaria-interna-bypass, abbreviated to RIMA and LIMA bypass). These chest wall arteries remain connected to their actual bloodstream and release blood into the coronary arteries.

The cardiac surgeon decides which options are available for the individual patient, depending on the individual case. Not all conceivable bypass vessels are equally well developed and usable in every person; several different bypasses are often required.

The engagement. The chest must be opened during bypass surgery. To do this, the surgeon saws the length of the breastbone through the middle. Less extensive, minimally invasive operations are rarely possible. In most cases, a heart-lung machine takes over the work of the heart during the operation so that the surgeon can perform the necessary operation on the heart at rest. After completing the operation, the sawn-up sternum is fixed with wire loops so that it grows back together again within 6–8 weeks. After the heart-lung machine has been switched off, the heart beats itself again with an electric shock.

Risks. Around 50,000 bypass operations are performed in Germany every year. The surgical risk depends largely on age, the current pumping capacity of the heart and the accompanying circumstances (emergency surgery, repeated surgery, additional illnesses). Serious complications such as a stroke or heart attack must be expected in up to 3% of operations, and around 1–2% of patients do not survive the operation.

Studies have shown that married people have a greater chance of survival after bypass surgery than singles because the partner takes on the role of carer. In the case of smokers in particular, it has been shown that the partner strictly adheres to the medically prescribed smoking ban. Patients who are in a happy relationship are more motivated to get well again quickly and therefore pay particular attention to sufficient exercise and a healthy diet.

Aftercare. If a bypass operation goes without complications, the operated person can be shown around the corridor after 3 days with physiotherapeutic assistance and then increase his walking distance daily. In the second week after the operation, the patient is usually discharged again. This is often followed by a stay of several weeks in a rehab clinic. Here, physical performance is increased through increasing stress on the bicycle ergometer and through walks. Depending on the healing process of the sawn sternum, swimming training and more extensive gymnastic exercises can be started after 5–6 weeks. 3 months after the bypass operation, the consequences of the operation are usually overcome and the patient can return to work or plan vacation trips.

After a bypass operation, a stress ECG should be performed once a year in order to detect any recurrent circulatory disorders in the heart in good time. The long-term results with arterial bypasses are generally better than with veins. After 10 years, around half of the vein bypasses are no longer functional, while the majority of the arterial bypasses are still open. Not every bypass occlusion that occurs in the course of the following years is necessarily associated with serious health problems. Vascular dilatation is often sufficient; a new operation rarely needs to be done.

The durability of a bypass also depends crucially on how each individual recognizes and reduces their influenceable risk factors. Because the cause of the bypass operation, the CHD, has not been eliminated by the operation.

forecast

Coronary artery disease manifests itself in a third of CHD patients with a heart attack, which in 30% of cases is not survived. 25% of patients with stable angina will have a heart attack within 5 years.

After a bypass operation, the prognosis also depends on what material the bypass is made of: after 10 years, every 2nd venous, but only every 10th arterial bypass is narrowed again.

Your pharmacy recommends

What you can do yourself

If you have already been diagnosed with CHD, you can use these individual measures to reverse the path towards a heart attack, scientifically proven:

Smoke.

Quitting smoking is the single most important and most effective measure. Because: Smokers not only have increased fat deposits in the arteries, their blood also tends to form clots, the so-called thromboses. For more information, see the tips on nicotine replacement therapy.

Nutrition.

In countries in which fats and oils, predominantly unsaturated fatty acids, and high-fiber foods with lots of vegetables and fruit are consumed, the CHD risk is 50% lower than in our country. Therefore, prefer a low-calorie, low-fat, high-fiber diet that is rich in fruits, vegetables and carbohydrates and contains more unsaturated than saturated fat. Ideal is z. B. the Mediterranean diet.

Weight normalization

. Especially if you tend to have an android fat distribution, "apple type", your heart is at risk. The waist circumference can be used to estimate whether there is a dangerous distribution of fat in the body. For women, an increased risk begins from a waist circumference of 80 cm, for men from 94 cm. The goal should be a BMI (Body Mass Index) of less than 25. Try to slowly reach this level in 6–12 months and then try to maintain it.

Food supplements.

The increased intake of omega-3 fatty acids is said to have a beneficial effect on the further course of the disease. Omega-3 fatty acids, especially eicosapentaenoic acid, are abundant in (cold water) marine fish (e.g. sardines, herring, anchovies, salmon and mackerel). We recommend around two fish meals a week. Whether omega-3 fatty acids in capsule form have a beneficial effect is always controversial. In prevention with fish oil capsules, it is important to take them with the main meal, otherwise the fatty acids will not be absorbed. Alpha-linolenic acid (another omega-3 fatty acid) is mainly found in plant-based foods such as walnuts, almonds, green leafy vegetables (e.g. spinach, rocket, purslane), beans, lentils, parsley, flaxseed and vegetable oils, e.g. . B. in linseed oil, rapeseed oil, walnut oil, soybean oil, wheat germ oil or mustard oil.

The gift of Hormones, e.g. B. in the context of hormone replacement therapy for women, has no proven positive effect on the prevention of coronary artery disease.

Alcohol.

In Germany, people often drink too much alcohol. Moderate alcohol consumption (less than 20 g per day for men, less than 12 g per day for women) does not harm the heart or liver. 20 g of alcohol correspond to about 0.5 l of beer or 0.25 l of wine. Some studies even attribute small amounts of alcohol to a reduction in the risk of CHD. With higher amounts of alcohol, the risk of CHD increases again. In addition, alcohol promotes the development of the "Bavarian beer heart", which was first described in the beer-drinking Bavarians (= dilated cardiomyopathy). If the pump function is severely restricted, alcohol should be avoided entirely.

Move.

If you do not move enough in everyday life, take the time to be physically active for at least 30 minutes each day. But even 30 minutes three times a week is much better than nothing.

  • Regular endurance exercise such as brisk walking, jogging, hiking, cycling, cross-country skiing, ice skating, inline skating, swimming, dancing, soccer, tennis, golf and the like - all of a medium intensity, recognizable by the fact that you can still entertain yourself, are ideal .
  • At home, an exercise bike or a treadmill can be used. B. train while watching TV.
  • In everyday life you can get exercise by foregoing the use of escalators and elevators, parking the car 10 minutes before your destination or getting off public transport earlier, or even running errands or going to work on foot or by bike.

Comorbidities.

As a diabetic or high blood pressure patient, you attach great importance to a normal blood sugar and blood pressure setting.

Travel and leisure.

How much stress you are allowed to exert yourself as a CHD patient depends on the individual heart condition. Therefore, discuss beforehand with your general practitioner or specialist whether you can expect a stay in the high mountains, swimming in cold water, winter vacation with minus temperatures, skiing or snow clearing. The basic rule is: If you can use more than 100 watts on the bicycle ergometer for a long period of time without any symptoms, there are hardly any restrictions for you.

You can usually visit the sauna if you can pedal at least 75 watts on the ergometer without any symptoms and do not suffer from cardiac arrhythmias. But stay in a temperature range around 80 ° C and then cool down slowly, as the sudden immersion in cold water puts unnecessary stress on the heart.

Appropriate medication

Lowering cholesterol.

In exceptional cases, to prevent CHD, it is also advisable to take preventive medication to lower cholesterol.

  • If there are no risk factors for CHD, men from the age of 35 and women after the menopause are recommended drug therapy with statins if the LDL cholesterol value is above 190 mg / dl despite non-drug measures.
  • If at least 2 of the risk factors are present (high blood pressure, diabetes, smoking, HDL cholesterol below 35 mg / dl, increased age: men older than 45 years, women older than 55 years or a family predisposition to CHD), an LDL- Cholesterol levels of 160 mg / dl can be treated with statins if dietary measures are unsuccessful.

Nitro spray.

Always carry a fast acting nitrate (e.g. as Nitro spray,Nitrolingual®) and spray two strokes under the tongue as soon as angina pectoris occurs. If you know your load limits well, you can also use nitrospray as a preventive measure before stressful activities. Nitrates also lower blood pressure. If your blood pressure is low, you must therefore expect dizziness or poor circulation.

If you get a headache while taking nitrate therapy, this side effect will often decrease over time as you continue to use it. Alternatively, a substitute drug (molsidomine) can be used.

Prevention.

The "pill" as an estrogen-based contraceptive is unsuitable for CHD because it increases the risk of heart attack considerably. This is all the more true for smokers. Both the hormones and many substances in cigarette smoke cause the blood to thicken. See alternative methods of contraception.

Complementary medicine

The course of a stable CHD can often be influenced favorably with complementary medical therapies. They work best if you also lead a healthier lifestyle. However, they are not suitable for the treatment of acute angina pectoris.

Mind-Body Therapies.

Mind-body therapies aim to learn, through a neurophysiological "reprogramming" of the brain, to reduce stress levels and thus to minimize their harmful effects on the cardiovascular system. The spectrum ranges from individual procedures such as biofeedback or the mediation of psychotherapeutically oriented stress management measures to complex programs for modifying lifestyle, e.g. B. Ornish program or SAFE-LIFE program. In a broader sense, relaxation therapies, e.g. B. meditation, progressive muscle relaxation according to Jacobson, autogenic training and breath-oriented relaxation exercises, z. B. Yoga, Tuna breathing exercises, Qigong in addition. Based on numerous study results, all procedures are given an important therapeutic value for treatment and especially for prevention - provided they are carried out regularly for at least 30 minutes a day.

Herbal medicine.

CHD patients benefit above all from standardized plant extracts that aim to reduce the causes of their illness, such as phytopharmaceuticals that promote blood circulation (e.g. ginkgo) or vascular protective drugs (e.g. garlic). If necessary, hawthorn (Crataegus laevigata, e.g. Crataegus® Stada dragees, Crataegutt® film-coated tablets), which is mainly used in cases of moderate heart failure, but recent studies also suggest a relieving effect of hawthorn in mild angina pectoris Close complaints.

Acupuncture.

Depending on the symptoms, individual points are needled. Whether acupuncture contributes to a long-term improvement in the course of the disease is still being investigated.

Homeopathy.

Homeopathy recommends, among other things. Aconitum, arnica and cactus in low potencies for constitution therapy as well as some complex homeopathics (e.g. Cralonin®, Diacard®).

Alternating baths (Kneipp treatments).

Alternating baths Alternating warm partial baths, steam baths, hip baths and other water applications should best be carried out as part of a cure (heart bath or Kneipp cure) under medical supervision. Some studies certify that the procedures relieve symptoms of both stable CHD and mild forms of heart failure.

Manual therapies.

Manual therapies tend to be of a complementary nature. Massages that aim to improve peripheral blood circulation are helpful, and CHD patients also benefit from their relaxing effect.

Prevention

Live healthy. Whether you will suffer from life-threatening CHD is largely up to you: Healthy eating habits and a healthy lifestyle can prevent the development and progression of CHD by over 80%. For example, those who do not smoke halve their CHD risk. Get regular exercise, reduce your alcohol consumption, and watch your weight.

Reluctance to use fat and sugar. Avoid fatty meat and sausage products, non-fat dairy products, fast food and ready meals, but also fried or fatty baked goods and sweets. Also, watch out for your sugar intake, not just when eating sweets.Avoid finished products and industrial foods, which often contain large amounts of hidden sugar.

Constant dripping wears away the stone: Not the feast on special days, but the daily excessive consumption of animal fats leads to long-term vascular damage.

Psychological factors. Also living conditions that lead to inner serenity, e.g. B. Security in the family or in faith, good social contacts and daily routines without a lot of hectic, stress and deadline pressure, reduce the risk of CHD. Check how you deal with stressful situations and seek relaxation regularly. There are many good relaxation methods available. B. offered at adult education centers or by health insurance companies.

Special programs. If you want to join a lifestyle change and stress reduction program specially developed for cardiovascular patients, you should think carefully beforehand whether you are prepared to radically change your life in case of doubt and whether your daily requirements leave you enough time to do so Consistent implementation of the overall concept in everyday life. So z. For example, the Ornish program, in addition to a strict, low-fat vegetarian diet and group-supported restructuring of the previous way of life, also offers relaxation exercises, walks and other physical exercises for which at least two hours per day must be planned.

Orthomolecular medicine.

Studies prove the positive effect of magnesium in the prevention and treatment of angina pectoris.

Antioxidants

render the free oxygen radicals harmless, accelerate arteriosclerosis, and prevent the formation of the particularly harmful LDL cholesterol. The main antioxidants are vitamin E and vitamin C as well as secondary plant substances such as carotenoids, coenzyme Q10 (ubiquinone) and the trace element selenium. You are z. B. contained in fresh fruits and vegetables. Their value as part of a healthy diet is undisputed, their isolated intake as part of a dietary supplement, on the other hand, does not seem to be very successful, and possibly even harmful.

While the regular intake of coenzyme Q10 (therapeutic dose range up to 300 mg per day), vitamin C (therapeutic dose range from 1000 mg per day) and selenium (therapeutic dose range up to 300 mg per day) cannot yet be conclusively assessed, a therapeutic one could be determined The effect of vitamin E has not yet been proven. It is not advisable to take beta-carotene - it has been shown that regular intake can be associated with an increased risk of cancer.

Infections.

Take advantage of the flu vaccination offered and, if you are suffering from heart disease, especially the vaccination against pneumonia (Pneumovax®). Both vaccinations are offered free of charge in every family doctor's practice for heart patients and reimbursed by all health insurances. Always cure infections of any kind thoroughly before stressing yourself again.

Further information