What are the common symptoms of Irritable Bowel Syndrome. How is IBS diagnosed and what factors contribute to its development. What treatment options are available for managing IBS symptoms. Can dietary changes help alleviate IBS symptoms. How does stress affect IBS and what stress management techniques can be helpful.

Understanding Irritable Bowel Syndrome: An Overview

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that affects millions of people worldwide. It is characterized by a group of symptoms that occur together, including abdominal pain, changes in bowel habits, and other digestive issues. While IBS can be uncomfortable and disruptive to daily life, it does not cause permanent damage to the digestive tract or lead to more serious health problems.

IBS is considered a functional gastrointestinal disorder, meaning that it affects how the digestive system works rather than being caused by a structural abnormality. The exact cause of IBS remains unknown, but researchers believe that a combination of factors may contribute to its development.

Recognizing the Symptoms of Irritable Bowel Syndrome

The hallmark symptoms of IBS include:

• Abdominal pain or discomfort, often related to bowel movements
• Changes in bowel habits, such as diarrhea, constipation, or alternating between the two
• Bloating or abdominal distension
• A feeling of incomplete bowel evacuation
• Passage of mucus in the stool

Women with IBS may experience more severe symptoms during their menstrual periods. It’s important to note that IBS symptoms can vary from person to person and may change over time.

How is IBS diagnosed?

Diagnosing IBS involves a thorough evaluation of a patient’s symptoms over time. Healthcare providers typically look for a specific pattern of symptoms that persist for at least three months. There is no single definitive test for IBS, so diagnosis often involves ruling out other conditions that may cause similar symptoms.

Exploring the Potential Causes of Irritable Bowel Syndrome

While the exact cause of IBS remains elusive, several factors have been identified as potential contributors to its development:

Brain-Gut Interaction

One of the leading theories behind IBS involves the complex interaction between the brain and the gut, known as the brain-gut axis. This bidirectional communication system plays a crucial role in regulating digestive function and can be disrupted in people with IBS. Abnormalities in this interaction may lead to changes in gut motility, increased sensitivity to pain, and alterations in the way the brain processes signals from the digestive tract.

Gastrointestinal Motility

Some individuals with IBS may experience abnormal muscle contractions in their intestines. This can result in food moving too quickly or too slowly through the digestive tract, leading to symptoms such as diarrhea or constipation.

Visceral Hypersensitivity

People with IBS often have increased sensitivity to pain and discomfort in their abdominal area. This heightened sensitivity, known as visceral hypersensitivity, can cause normal digestive processes to be perceived as painful or uncomfortable.

The Role of Stress and Psychological Factors in IBS

Stress and psychological factors play a significant role in IBS for many individuals. While stress does not cause IBS, it can exacerbate symptoms and trigger flare-ups. The relationship between stress and IBS is complex and bidirectional, meaning that stress can worsen IBS symptoms, and living with IBS can increase stress levels.

How does stress affect IBS?

Stress can impact IBS in several ways:

1. Increased muscle tension in the gut, leading to more frequent contractions
2. Heightened sensitivity to pain and discomfort
3. Alterations in gut microbiota composition
4. Changes in immune system function
5. Disruption of normal digestive processes

Research has shown that individuals with IBS often have higher levels of anxiety and depression compared to those without the condition. Additionally, a history of psychological trauma, particularly in childhood, has been associated with an increased risk of developing IBS later in life.

The Gut Microbiome and Its Influence on IBS

The gut microbiome, composed of trillions of microorganisms living in our digestive tract, plays a crucial role in overall health and may be particularly important in IBS. Emerging research suggests that alterations in the gut microbiome may contribute to IBS symptoms and development.

How does the gut microbiome affect IBS?

The gut microbiome can influence IBS through several mechanisms:

• Regulation of intestinal motility
• Modulation of visceral sensitivity
• Influence on the gut-brain axis
• Production of metabolites that affect gut function
• Interaction with the immune system

Studies have found differences in the composition and diversity of gut bacteria between individuals with IBS and those without the condition. These differences may contribute to the development and persistence of IBS symptoms.

Dietary Factors and Food Sensitivities in IBS

Diet plays a significant role in managing IBS symptoms for many individuals. While there is no one-size-fits-all diet for IBS, certain dietary approaches have shown promise in alleviating symptoms.

Can dietary changes help alleviate IBS symptoms?

Yes, many people with IBS find that making dietary changes can help manage their symptoms. Some effective dietary strategies include:

1. Following a low FODMAP diet: This approach involves reducing the intake of fermentable carbohydrates that can trigger IBS symptoms in some people.
2. Identifying and avoiding trigger foods: Common triggers include caffeine, alcohol, spicy foods, and high-fat meals.
3. Increasing fiber intake: For some individuals, especially those with constipation-predominant IBS, gradually increasing fiber intake can help regulate bowel movements.
4. Staying hydrated: Adequate water intake is essential for proper digestion and can help alleviate constipation.
5. Eating regular, balanced meals: This can help regulate bowel function and reduce symptoms.

It’s important to note that dietary triggers can vary significantly from person to person. Working with a healthcare provider or registered dietitian can help identify individual triggers and develop an appropriate dietary plan.

Treatment Options for Managing IBS Symptoms

While there is no cure for IBS, various treatment options can help manage symptoms and improve quality of life. Treatment approaches often involve a combination of lifestyle changes, dietary modifications, and medications.

What are the main treatment options for IBS?

Treatment options for IBS may include:

• Dietary modifications: As discussed earlier, identifying and avoiding trigger foods, following a low FODMAP diet, or making other dietary changes can be helpful.
• Stress management techniques: Stress reduction strategies such as cognitive-behavioral therapy, mindfulness meditation, and relaxation exercises can help manage symptoms.
• Medications: Depending on the predominant symptoms, medications may be prescribed to address specific issues such as diarrhea, constipation, or abdominal pain.
• Probiotics: Some individuals may benefit from probiotic supplements to help balance gut bacteria.
• Exercise: Regular physical activity can help regulate bowel function and reduce stress.
• Alternative therapies: Some people find relief through complementary approaches such as acupuncture or hypnotherapy.

The most effective treatment plan often involves a multidisciplinary approach tailored to the individual’s specific symptoms and needs.

Living with IBS: Coping Strategies and Lifestyle Modifications

Living with IBS can be challenging, but there are many strategies that can help individuals manage their symptoms and improve their quality of life.

How can individuals with IBS improve their quality of life?

Here are some effective coping strategies and lifestyle modifications for individuals with IBS:

1. Develop a consistent routine: Establishing regular eating and sleeping patterns can help regulate bowel function.
2. Practice stress management: Incorporate stress-reduction techniques such as meditation, yoga, or deep breathing exercises into daily life.
3. Stay physically active: Regular exercise can help reduce stress, improve digestion, and boost overall well-being.
4. Keep a symptom diary: Tracking symptoms, diet, and potential triggers can help identify patterns and inform treatment decisions.
5. Seek support: Joining support groups or talking to others with IBS can provide emotional support and practical advice.
6. Work with healthcare providers: Maintain open communication with healthcare providers to adjust treatment plans as needed.
7. Plan ahead: When traveling or attending social events, plan meals and bathroom access to reduce anxiety and manage symptoms.

By implementing these strategies and working closely with healthcare providers, many individuals with IBS can successfully manage their symptoms and lead fulfilling lives.

Emerging Research and Future Directions in IBS Treatment

As our understanding of IBS continues to evolve, researchers are exploring new avenues for treatment and management of the condition. Some promising areas of research include:

What new treatments for IBS are on the horizon?

Several innovative approaches are being investigated for IBS treatment:

• Gut microbiome modulation: Researchers are exploring ways to manipulate the gut microbiome through targeted probiotics, prebiotics, or even fecal microbiota transplantation.
• Novel pharmacological agents: New medications targeting specific aspects of IBS pathophysiology, such as visceral hypersensitivity or gut motility, are in development.
• Personalized medicine approaches: Advances in genetic and microbiome analysis may lead to more tailored treatment strategies based on individual patient characteristics.
• Neuromodulation techniques: Non-invasive brain stimulation methods are being studied for their potential to influence the gut-brain axis and alleviate IBS symptoms.
• Gut-directed hypnotherapy: This psychological intervention is showing promise in clinical trials for managing IBS symptoms.

While these approaches are still in various stages of research and development, they offer hope for improved management of IBS in the future.

In conclusion, Irritable Bowel Syndrome is a complex and multifaceted disorder that affects millions of people worldwide. While the exact cause remains unknown, a combination of factors including brain-gut interactions, stress, diet, and gut microbiome alterations likely contribute to its development and persistence. By understanding the symptoms, potential causes, and available treatment options, individuals with IBS can work with healthcare providers to develop effective management strategies. As research in this field continues to advance, new and more targeted treatments may become available, offering hope for improved outcomes for those living with IBS.

Symptoms & Causes of Irritable Bowel Syndrome

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What are the symptoms of IBS?

The most common symptoms of irritable bowel syndrome (IBS) are pain in your abdomen, often related to your bowel movements, and changes in your bowel movements. These changes may be diarrhea, constipation, or both, depending on what type of IBS you have.

Other symptoms of IBS may include

• bloating
• the feeling that you haven’t finished a bowel movement
• whitish mucus in your stool

Women with IBS often have more symptoms during their periods.

IBS can be painful but doesn’t lead to other health problems or damage your digestive tract.

To diagnose IBS, you doctor will look for a certain pattern in your symptoms over time. IBS is a chronic disorder, meaning it lasts a long time, often years. However, the symptoms may come and go.

What causes IBS?

Doctors aren’t sure what causes IBS. Experts think that a combination of problems may lead to IBS. Different factors may cause IBS in different people.

Functional gastrointestinal (GI) disorders such as IBS are problems with brain-gut interaction—how your brain and gut work together. Experts think that problems with brain-gut interaction may affect how your body works and cause IBS symptoms. For example, in some people with IBS, food may move too slowly or too quickly through the digestive tract, causing changes in bowel movements. Some people with IBS may feel pain when a normal amount of gas or stool is in the gut.

Certain problems are more common in people with IBS. Experts think these problems may play a role in causing IBS. These problems include

• stressful or difficult early life events, such as physical or sexual abuse
• certain mental disorders, such as depression, anxiety, and somatic symptom disorder
• bacterial infections in your digestive tract
• small intestinal bacterial overgrowth, an increase in the number or a change in the type of bacteria in your small intestine
• food intolerances or sensitivities, in which certain foods cause digestive symptoms

Research suggests that genes may make some people more likely to develop IBS.

Last Reviewed November 2017

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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Lin Chang, M.D., David Geffen School of Medicine, University of California Los Angeles

What’s causing your IBS – Harvard Health

While the exact cause of irritable bowel syndrome, or IBS, is unknown, studies have suggested that IBS might be related to a few specific changes in the body. Some symptoms may be caused by spasms, uncontrolled contractions in the muscles of the colon. The nerve endings in the intestines also may become unusually sensitive, magnifying pain. The reasons for these changes are not always known, but factors that have been linked with IBS include bacterial overgrowth, use of antibiotics, and stress, among others.

Psychological factors. The brain and gut are intimately connected. Your thoughts and emotions can trigger symptoms in the gut, and the health of your gut can shape your mental well-being. Stress can cause more contractions in the intestines and increase sensitivity. It’s not clear whether stress or other psychological factors may be a cause of IBS or vice versa. However, we do know that people with IBS often have higher levels of stress and anxiety and that this distress also can make IBS symptoms worse. A 2017 study in the Journal of Neurogastroenterology and Motility found that people with IBS have higher levels of depression and anxiety compared with those who don’t have the disorder. IBS also is more common among people who experienced psychological trauma as children.

Antibiotics. The human digestive tract contains trillions of bacteria, viruses, and fungi known collectively as the gut microbiota or gut flora. These microorganisms play several critical roles in our health, including digestion and immune system function. When we take antibiotics to combat bacterial infections, the drugs also kill helpful bacteria in the gut. Repeated treatments or long-term use of antibiotics may alter the gut flora in a way that disrupts the colon’s normal function. Some animal and human research suggests that this disruption may lead to IBS in some cases. However, studies have not had consistent results, so more research is needed.

Bacterial overgrowth. Some people with IBS also have a surplus of bacteria in the small intestines, a condition called small intestinal bacterial overgrowth (SIBO). It’s unclear whether SIBO can be a cause of IBS, but people with IBS are more likely than others to test positive for SIBO. In addition, some research has found that IBS symptoms often decrease after antibiotic treatment that focuses on bacteria in the small intestine.

SIBO occurs when extra bacteria in the colon back up into the small intestine. In this situation, people often have symptoms typical of IBS such as bloating, constipation, abdominal pain, and diarrhea. Estimates vary about how many people diagnosed with IBS also have SIBO, but research in the March 2017 issue of Gut and Liver suggested it may be between 19% and 37%. Most studies diagnose SIBO with a breath test that measures gases released by the body’s breakdown of sugars such as glucose and lactulose. There is a debate, however, about the reliability of the test results.

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causes, symptoms and treatment at the FSCC FMBA

General description

Ischemic heart disease (CHD) is the leading cause of death worldwide. According to experts, in 2030 more than 23 million people will die from CVD.

Coronary artery disease (CHD) is a disease caused by insufficient supply of oxygen and nutrients to the heart (myocardium), which occurs due to impaired blood supply to the myocardium due to damage to the coronary arteries. Clinical manifestations of coronary artery disease are diverse: from acute manifestations in the form of myocardial infarction or sudden cardiac death to long-term chronic diseases – angina pectoris (periodic retrosternal pain), postinfarction cardiosclerosis, chronic heart failure.

Causes

IHD occurs as a result of atherosclerosis of large (epicardial) coronary (cardiac) arteries of varying degrees: from a slight narrowing of the lumen in the vessel to its complete blockage by atheromic (cholesterol, fatty) masses or a thrombus that has developed at the site of a “vulnerable” (damaged) atherosclerotic plaque (ASP) . Other causes of coronary artery disease are spasm of the coronary arteries and damage to the microvasculature in the myocardium. In most cases, they also develop against the background of existing atherosclerosis.

It is possible to identify the most susceptible to the development of coronary heart disease (CHD) groups of the population: people suffering from high blood pressure; addicted to smoking; suffering from high cholesterol; diabetes mellitus; with chronic kidney disease. Male sex and advanced age are also powerful risk factors for developing coronary artery disease.

Symptoms of coronary heart disease

The main, but far from the only symptom of coronary artery disease is pressing or squeezing pain behind the sternum or in the region of the heart. In chronic coronary artery disease, pain occurs initially during exercise and causes a gradual decrease in its tolerance. In the acute form of coronary heart disease, myocardial infarction or a pre-infarction state (unstable angina pectoris) develops.

During an attack of coronary artery disease, the patient may also feel:

• pain or burning in the chest, under the shoulder blade, in the back, in the upper abdomen;
• feeling of heaviness in the chest;
• sensation of uneven heartbeat, irregular heartbeat, palpitations;
• feeling of sinking heart;
• shortness of breath;
• weakness;
• nausea;
• dizziness and fainting;
• sweating.

The discomfort may disappear or disappear completely after the completion of physical activity. With myocardial infarction or with unstable angina, the connection between complaints and physical activity is lost, and complaints can develop at rest and last for a long time (tens of minutes, hours). Usually, all of the above symptoms do not appear at the same time. In various forms of coronary heart disease, a certain feeling of discomfort dominates.

If you notice such sensations in yourself, contact your cardiologist as soon as possible. If chest pain or other symptoms described above do not disappear within 10 minutes at rest, call the ambulance team. IHD progression can develop slowly over years. At the same time, in some patients, coronary disease is asymptomatic or with erased or atypical symptoms.

To prevent disturbances in the work of the heart or the development of severe forms of coronary artery disease, undergo a comprehensive examination of the heart at our center of the Federal Research and Clinical Center of the Federal Medical and Biological Agency. Running coronary disease is very dangerous! At a later stage, it can lead to a fatal heart attack or severe heart failure with severe disability.

IHD diagnostics

Diagnosis of coronary artery disease is carried out by cardiologists in several stages. When questioning the patient, complaints are clarified, symptoms that may be characteristic of coronary heart disease are clarified. Examination of the patient helps to note visual changes – swelling and discoloration of the skin (cyanosis), listening to the heart reveals murmurs, rhythm disturbance.

Next, the patient passes laboratory tests for certain indicators in the blood, which may indicate a pathology. Also important is the standard biochemical analysis, as well as the determination of glucose and cholesterol levels.

But the most accurate method for diagnosing coronary disease is instrumental:

• ECG;
• ultrasound of the heart;
• stress tests with exercise or drug stimulation of the heart;
• Holter ECG monitoring;
• angiography of the coronary arteries (coronary angiography).

Timely examination helps to avoid serious consequences and the development of an irreversible form of coronary heart disease. Give your health a few hours, because this time will help preserve the quality of life in the future.

Prevention of coronary heart disease

Prevention of CVD is much easier than cure. To maintain healthy arteries and blood vessels, it is necessary to eliminate risk factors that negatively affect your health:

• Smoking cessation;
• Blood pressure monitoring
• Normalization of the level of “bad” cholesterol (low density lipoprotein)
• Stress and Depression
• Minimizing alcohol intake;
• Refusal of smoked, fatty, fried and salty foods.

Give more time to an active lifestyle: moderate physical activity, therapeutic exercises, morning exercises, walking, swimming, dancing. Physical activity will help strengthen the walls of blood vessels and maintain normal weight, if necessary, reduce it.

The most important thing in the prevention of coronary artery disease is timely observation by a specialist. In order not to visit medical institutions several times to pass all the necessary tests and undergo research, contact our cardiology center. FSCC FMBA offers patients several programs for a comprehensive study of the heart. You can get acquainted with them here.

IHD treatment

When IHD is detected, the cardiologist determines the treatment model. Our clinic can offer you:

• drug therapy for coronary artery disease – a complex of modern medicines is prescribed, which allows you to control the symptoms and significantly improve the prognosis of the disease. The main drugs for the treatment of coronary artery disease are: antiplatelet agents (reduce the likelihood of blood clots in the coronary arteries), B-blockers, nitrates, calcium antagonists, enzyme inhibitors / angiotensin II receptor blockers (allow to prevent the development of pain, shortness of breath, edema) and statins (allow to reduce and control cholesterol). Treatment of coronary disease can take place on an outpatient basis or in the cardiology department of our center. When drug therapy for coronary artery disease does not help, they seek advice from a cardiac surgeon who will apply the following treatment methods:

  • surgical intervention aimed at myocardial revascularization (restoration of normal blood flow to the heart muscle):
  • stenting of affected arteries of the heart – intravascular surgery. Under local anesthesia, a catheter is inserted through the radial (on the forearm) or less often through the femoral (in the groin) artery, through which a special device is passed into the arteries of the heart. A special metal frame construction coated with drugs that suppress inflammation at the site of intervention is installed with the help of a balloon in the place of narrowing of the vessel. The balloon expands, as a result of which the stent presses the cholesterol plaque against the walls of the vessel and restores its patency;
  • coronary artery bypass surgery is an open heart surgery, the purpose of which is to restore a full blood supply. It is carried out by bypassing the place of narrowing of the vessel with the help of shunts (vascular prostheses), which redirect blood flow from the clogged areas of the arteries to healthy ones. The most commonly used coronary bypass grafts are the patient’s own arteries and veins. At the same time, arterial bypasses have a significant advantage in terms of long-term improvement in prognosis and pain relief as a result of surgery. In our Department of Cardiac Surgery, the operation is performed both with the help of cardiopulmonary bypass, and without (off pump).

The FSCC FMBA Cardiology Center is one of the few that performs coronary bypass surgery using mini-thoractomy. This method of surgery significantly speeds up postoperative rehabilitation and has no significant restrictions on physical activity within three months after the operation.

Our center employs highly qualified specialists who have confirmed their experience at the international level. Many years of experience and high-tech equipment allow us to achieve excellent results in surgical procedures.

In their daily practice, our doctors use the latest achievements of medical science and the most advanced medical technologies. Offering treatment to patients with coronary artery disease, our cardiologists, angiosurgeons and cardiac surgeons are always looking for the most effective, less traumatic and most appropriate way for each individual patient to carry it out.

It is important for us not only to save you from suffering, but also to ensure a long and comfortable life.

With care for you and your heart!

This article is an informational material and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

forms and risk factors for complications of IHD

Ischemic disease occupies a leading position among cardiovascular diseases that have severe consequences – disability and death. How the disease proceeds, what to do to reduce the risk of acute and chronic complications, and also for what symptoms you need to urgently call an “ambulance” – we tell in the article.

The course of the disease, its forms and complications

Classification IHD differs from the classifications of other diseases: since coronary disease itself is a state of imbalance between the supply of oxygenated blood to the myocardium and the need of the heart for it, it is difficult to draw an unambiguous line between its forms and complications. So, both myocardial infarction and heart failure are both clinical forms of the course of the disease (acute and chronic ), and complications caused by lack of myocardial oxygenation.

In this regard, the medical community speaks of the clinical classification of forms IHD in the following order:

• Sudden coronary death (cardiac arrest).

• Angina pectoris : exertional angina (new onset, stable, unstable or progressive) and rest angina (spontaneous/vasospastic/variant/Prinzmetal) are distinguished.

• Myocardial infarction.

• Postinfarction cardiosclerosis.

• Heart failure (acute and chronic).

• Violations of cardiac rhythm .

• Painless myocardial ischemia.

• hibernating myocardium.

• Stunned myocardium.

• X syndrome.

The development of the disease is not linear, and clinical forms can replace each other. If you do not follow the recommendations of the attending physician, chronic forms of IHD may be complicated by an acute form (heart attack or sudden coronary death). At the same time, after an acute form of coronary artery disease (the same heart attack), chronic consequences of ischemia develop in the form of postinfarction cardiosclerosis

Both acute and chronic forms of coronary artery disease can lead to severe consequences for the body.

Risk factors for the development of IHD complications

In a general sense, the risk factors for the development of IHD are not much different from the risk factors for heart failure and any other pathology of the heart and blood vessels of a non-infectious nature.

How to reduce the risk of complications

The simplest prevention of coronary disease is to maintain a healthy lifestyle: proper nutrition, adherence to the daily routine and the rejection of bad habits.

In a narrower sense, secondary prevention is very important, that is, compliance with the doctor’s instructions for an already diagnosed pathology. In addition to correcting behavioral risk factors, secondary prevention of coronary artery disease should include the following:

• Control of lipid metabolism. The basis of atherosclerotic changes in blood vessels is the deposition of lipid complexes in their walls, which leads to a progressive narrowing of the lumen of the arteries . The fight against the risk of complications includes lowering the level of total cholesterol, including medication. A level of up to 4.2-4.8 mmol / l is considered safe. With an increase in this indicator by 10 mg / dl, the risk of progression of stenosis arteries is growing by 1%.

• Blood pressure control. Hypertensive patients are at risk of developing coronary artery disease three to four times more than people with normal pressure. The risk of stroke in such patients increases seven times compared with normotonic people – people with normal blood pressure.

• Complete cessation of smoking. This bad habit increases the risk of developing angina pectoris and is an important long-term risk factor for sudden cardiac death.

• Body weight control. Overweight and obesity predetermine the development of up to 17-23% of cases of CHD. At the same time, about 30% of obese people have disorders or other eating disorders, which requires a revision of the diet and correction of eating habits. However, there are also cases requiring medical intervention (endocrine and cerebral forms of obesity).

• Psycho-emotional stability of the patient. Exposure to strong emotions, including stress, leads to a sharp spasm of the coronary vessels, increasing the risk of myocardial infarction or sudden cardiac death.

The most effective prevention of the development of coronary artery disease and its complications is a healthy lifestyle.

IHD red flags: when to call a doctor

In the clinical sense, both acute and chronic forms coronary disease pose a danger to life. However, in the first case, hours and minutes count, so it is important to know for which symptoms you should immediately seek medical help.

Signs of acute myocardial ischemia:

• discomfort, pain or burning in the heart or behind the sternum;

• pain radiates to the left arm, left half of the lower jaw, neck, back or abdomen;

• attacks of pain last for 3-5 minutes and recur periodically.

These symptoms most often occur with angina pectoris , can be provoked by any physical activity, stress, cold, smoking, and stop when the cause is eliminated or nitroglycerin is taken.

Important! Similar symptoms occur in the first minutes of myocardial infarction. A doctor should be called immediately if the pain does not stop within 15 minutes or after taking nitroglycerin or the dose of antianginal drugs recommended by the attending physician.

Call an ambulance immediately if:

• the pain repeats in waves even at rest, and its intensity increases;

• weakness appears, accompanied by fear;

• pulse and blood pressure fluctuate;

• there is sweating and a feeling of lack of air.

Delays in providing first aid for myocardial infarction can cost a person life

First aid for acute myocardial ischemia

In the first minutes of myocardial ischemia it is impossible to differentiate its nature.