Causes

The flow of blood through the coronary arteries, i.e. the vessels that supply the heart muscle with oxygen and nutrients, can be obstructed either by a narrowing of the vascular opening or by a heart muscle. In most cases, narrowing of the vascular opening has a chronic cause, namely calcification of the vascular wall and the formation of so-called plaques. In summary, this clinical picture is also called arteriosclerosis.

This is a hardening of the arterial wall due to the deposition of fats, calcium, connective tissue or blood clots. Damage to the innermost layer of the vascular wall causes an inflammatory reaction, which enables the plaques to be deposited. This disease is one of the age-related vascular damages and is found to varying degrees in almost every person over the age of twenty.

A vascular blockage is caused by an acute event and is called an embolism. This is the infiltration of material into a vascular opening, which leads to the interruption of the blood supply. This material can be an arteriosclerotic plaque that suddenly dissolves and travels through the bloodstream to the small vessels, but it can also be a blood clot, fatty tissue, tumor or foreign body.

In addition to the direct circulatory disturbance of the coronary arteries, in the case of coronary heart disease, circulatory disturbances of the heart can also occur as a result of vascular inflammation, arterial occlusive diseases or venous insufficiencies and blood clots. Roughly speaking, a circulatory disorder in the heart muscle is the precursor to a fulminant heart attack. Depending on how pronounced the circulatory disorder is, the affected person will experience different symptoms.

If the blood circulation is slightly reduced for a few seconds, slight stitches can be felt in the area around the heart.
If the reduced blood flow lasts several minutes, a so-called angina pectoris develops. Patients suffer from an enormous feeling of tightness in the chest.It is often described as if a heavy stone was lying on your chest. In the worst case, this condition can persist permanently, but usually this feeling disappears after 15 to 30 minutes at the latest.
This can already cause the first heart muscle cells to die, provided that they have to get along without oxygen long enough. The dead heart muscle cells are no longer replaced by the body. or symptoms of angina pectoris
The last and worst stage is the heart attack.
Here, certain parts of the heart muscles are completely cut off from the blood supply. Those heart muscle cells that lie in the supply area of the blocked coronary artery are lost. The underlying factor can disappear spontaneously or must be removed – usually with the help of a cardiac catheter.

or Preventing a heart attack

The coronary arteries ensure the direct blood supply to the heart itself. Although the heart is permanently flooded with blood, the heart muscle cannot draw its nutrients from this blood, but needs a separate blood supply. This results in the problem of a circulatory disorder of the coronary arteries: the heart is damaged and can no longer function normally, resulting in an undersupply of blood to the rest of the body.

In total, the heart has two outlets from the aorta, which are divided into three coronary vessels. In the case of circulatory disorders, either all the coronary arteries can be affected or only some of them. As a rule, constrictions tend to form especially in places where smaller blood vessels branch off.

Circulatory disorders of the coronary arteries can either be permanent or only passagantly noticeable. For example, heavy physical exertion can cause a temporary feeling of tightness in the chest. This is known as angina pectoris.

If one of the coronary arteries is completely blocked, this is known as a manifest heart attack. This means that a certain section of the heart muscle is no longer supplied with oxygen-rich blood, so that if this condition lasts too long, heart muscle cells die. If a circulatory disorder is suspected, a patient’s medical history is first taken, paying particular attention to risk factors and symptoms.

Afterwards, a side-by-side blood pressure measurement should be taken, which provides information about the blood flow and possible vasoconstrictions in the arms. Routine examinations also include taking blood samples and examining cholesterol levels as well as coagulation and blood sugar in order to assess the risk of arteriosclerosis. If there is a suspicion of a circulatory disorder, the doctor can search for vascular constrictions and occlusions using Doppler sonography, a special method of imaging the blood flow and the flow of blood based on the principle of ultrasound.

In this case, the device with the transducer is placed on an artery and through a loudspeaker the doctor can normally hear the whipping sound of the blood flow. If this cannot be heard, either the vessel has been missed or there is a severe circulatory disorder. Heart specific examinations include A number of imaging procedures such as: These examinations are not performed by a general practitioner, but by a cardiologist.

Especially the heart MRI has brought further progress in diagnostics in recent years.

The Electrokradiogram
Echocardiogram
Exercise ECG
Heart MRI
Scintigraphy
Computer tomography and
X-ray as well as minimally invasive procedures like the
Angiography or
The intravascular ultrasound.

If a circulatory disturbance of the heart is suspected, both a resting ECG and a stress ECG should be performed, because the circulatory disturbance can lead to angina pectoris or a heart attack. Since a heart attack can be diagnosed by means of an ECG, this examination is obligatory.

The contraction of the heart muscle is responsible for the pumping function through the heart. In order to excite this muscle, the heart usually sends an electrical impulse from the sinus node, the natural pacemaker on the heart, which spreads throughout the entire heart. This electrical excitation can be conducted through the skin on the chest wall.

For a resting ECG, twelve derivations of the heart rhythm are measured over the chest. This allows an acute heart attack to be diagnosed or ruled out. However, angina pectoris is not detectable in the ECG.Exercise ECG is the standard for the clarification of a circulatory disorder of the coronary arteries and can be performed both as an initial measure and as a follow-up after therapy.

It is performed either on a bicycle ergometer or on a treadmill. The intensity is gradually increased up to the individual load limit, while the physician pays attention to severe patient complaints and ECG changes. These can be explained by a reduced supply of oxygen to the heart due to vasoconstriction, because the heart needs more oxygen during physical exertion than when it is at rest. At the beginning of a circulatory disorder, the heart can often still balance the oxygen supply, so the exercise ECG is an important early detection measure. The examination is most effective if it is combined with an imaging procedure such as cardiac ultrasound to rule out other reasons for an abnormal exercise ECG.