Why almost a million Russians die from heart attacks and strokes every year
Tatiana Bateneva, "News of Science"
Every year we see off about two million fellow citizens on their last journey. More than half die from cardiovascular diseases: coronary heart disease and hypertension with their fatal complications - heart attacks and strokes. Of these, 100 thousand people are of working age. In many developed countries, the statistics of these sudden deaths are 3-4 times less. What is so fatal about Russian heart attacks and strokes?
The bill for minutes
Doctors call heart attack and stroke vascular catastrophes – they develop so suddenly and quickly and the consequences are so tragic for the heart or brain.
It all starts imperceptibly. The well-known "bad" cholesterol, or in other words, insoluble fat, is deposited on the walls of blood vessels. The lumen of the vessel decreases, less blood flows through it. If this story occurs in the vessels of the heart, there is an ischemic heart disease, that is, he simply does not have enough breath. If the vessels of the brain are narrowed, the brain suffocates.
And if a blood clot (thrombus) gets stuck in this already narrow place, a catastrophe occurs: a heart attack in the heart or an ischemic stroke in the brain. In our country, about half of the "heart attack patients" and a significant part of the "stroke patients" die before the ambulance arrives.
However, if proper medical care is provided in the first hour, a significant majority can not only be saved, but also successfully cured.
– We are able to dramatically reduce mortality from such disasters in the coming years, – says the head of the Moscow Scientific and Practical Center for Interventional Cardioangiology, Chief cardiologist of Moscow, Professor David Ioseliani. – To do this, it is necessary to introduce a single and correct algorithm for helping such patients throughout the country.
In developed countries, in such cases, doctors act according to the standard, without thinking about what to do. First, it is urgent to dissolve the blood clot with medications, and then examine the blood vessels of the heart if there is a heart attack, or of the brain if there is a stroke. A treacherous narrowing was found – the operation is performed immediately. If possible, minimally invasive, that is, sparing – with the help of a catheter, a stent is inserted into the lumen of the vessel. This is a metal mesh that "reinforces" it from the inside. If this is not possible, perform more complex operations – but with the same effect. Long-known and proven effective measures reduce mortality from vascular catastrophes from 13-15% (as with us) to 3-4% (as with "them").
Thrombolysis was invented in our country
The dissolution of a blood clot directly into the heart during myocardial infarction was the first in the world performed by our cardiologist academician Evgeny Chazov back in 1974. Before that, by the way, he had experienced the tolerance of the "solvent" – the drug fibrinolysin on himself.
But even now, thrombolysis in heart attacks and ischemic strokes is not performed in all of our hospitals. Drugs are expensive for him, and the Ambulance staff often lacks knowledge and skills.
It's the same with coronarography. If abroad this procedure is considered outpatient and any cardiologist can do it, then we perform it only in a hospital, and even then not everyone.
In fact, such assistance is available only in Moscow, St. Petersburg, Yekaterinburg, Novosibirsk, Tomsk and several other large cities where there are cardiology institutes. But even here, the opportunities far from covering the needs. In the capital, for example, only 65% of those who need it are treated this way.
The program has been accepted, it's up to the organization
This problem is not new, it is well known at all levels. What prevents you from actually reducing mortality?
Of course, for the development of this direction, it is necessary to purchase complex and expensive equipment, to train doctors in subtle manipulations.
– In many regions, the necessary equipment has even been purchased, – complains Professor David Ioseliani. – But it is more difficult to retrain cardiac surgeons with experience of open operations on minimally invasive cardiology techniques than to teach young doctors "from scratch". Unfortunately, the skepticism of cardiologists and therapists towards the new direction has not yet been overcome.
The story is well-known. Sometimes therapists and even cardiologists have been treating such patients with "pills" for decades and even persuading them not to agree to coronary angiography or surgery. They miss time, their condition becomes heavier, and this is always a serious risk factor – complications during coronary angiography or stenting occur only in neglected patients with many concomitant diseases. And the earlier such operations are performed, the better the prognosis and the longer the period of normal full-fledged life.
One of the programs that have been implemented since this year in the development of the National Priority project "Health" should turn the situation around. This is a program to reduce morbidity and mortality from vascular diseases, primarily heart attack and stroke. The Government allocated 8 billion rubles for the implementation of the program in 2008-2010, including 3.6 billion rubles this year.
Help yourself
– If you feel discomfort in the heart area, palpitations, chest pain, shortness of breath during exercise, if you have high blood pressure, you should definitely consult a cardiologist, - advises the readers of Izvestia Professor David Ioseliani. – He will select medications, recommend lifestyle changes. But if after two or three months you do not feel relief and, moreover, if the condition worsens, you must persistently ask for a referral to a specialized clinic for examination.
Two out of three people who have had a myocardial infarction feel its early symptoms in a few days. This is a paroxysmal chest pain that does not subside, even when you lie down, shortness of breath, incomprehensible fatigue. There are also precursors of stroke: severe headache, high blood pressure, drowsiness, confusion, speech disorders and / or limb movements on the one hand. In such cases, there is no need to wait for a catastrophe, it is necessary to urgently consult a doctor or call an ambulance.
Portal "Eternal youth" www.vechnayamolodost.ru27.06.2008