Did you hear about such a diagnosis as "breast toad"? Such an unusual term really existed. So what "squeezed the chest" of a person?
With questions about the common disease of modern civilization - angina, we visited the reception from our permanent consultant, the doctor's doctor, the Cardiologist "Clinic Expert Voronezh" Kalinina Anatolyevna.
- Anatina Anatolyevna, what is angina and what is the danger of this disease?
Angina - this is a syndrome that manifests itself with a feeling of discomfort or chest pains, often compressing, burning or godic character. In most cases, they are localized behind the sternum, can "give" to the left hand, neck, lower jaw, under the blade, in the area of the epigastria. Typically, the pain is stopped alone after 3-5 minutes or after a few seconds or minutes after taking a nitroglycerin in the form of tablets or spray.
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Angina - one of the varieties of ischemic heart disease (IBS). It is dangerous in that there is a risk of myocardial infarction.
Read material on the topic: Ischemic heart disease: diagnosis and treatment
- What are the reasons for angina?
Cause of the classical angina angina in more than 90% of cases - atherosclerosis of the heart arteries. Sometimes angina is caused by vessel spasms (vasospasm) or functional disorders at the microcirculation level. Often there is a combination of the above reasons.
Risk factors for the occurrence of angina are divided into the so-called modifiable (i.e., those on which a person is able to influence) and unmodifiable (those that cannot be changed).
The modifiable includes dyslipidemia, increased blood pressure, diabetes, tobacocco, excessive use of alcohol-containing beverages, hypodynamine, obesity, nutrition, etc.
Unmodifiable is a male floor, age, hereditary predisposition.
What can provoke the appearance of chest pain? These cases when a person has exposed himself to physical exertion, quickly walked, rose to the mountain or on the stairs, transferred gravity. Also, pain may appear with an increase in blood pressure, the effects of low temperature, overeating, stress.
Read the material on the topic: Cashbalo! We are looking for the causes of high pressure
- For what signs you can recognize angina?
A detailed patient survey is very important. It is isolated typical, probable (or atypical) angina, as well as cardialgia (the pain is not associated with the deterioration of the blood supply to myocardium).
Symptoms of typical angina region include stubborn pain or specific discomfort. Due to exercise or psycho-emotional stress. Pass alone or after using nitroglycerin. With this type of angina, all three manifestations should be present.
With atypical angina, there are only two of three.
With cardialgies, one or a single symptom of the above is noted.
Taking into account this, with a patient next, either a cardiologist or a different specialist who continues to search for the causes of pain in the heart pain.
- What happens angina?
The following types are distinguished: stable, unstable and spontaneous.
Separately, the so-called cardiac X-syndrome (X-syndrome, otherwise, is a microwave angry). With it, there is a combination of classical signs of angina with unchanged heart arteries. To the end, this species has not yet been studied.
- What happens to the heart during the attack of angina?
The process is developing as follows. Initially, the blood supply to myocardium is disturbed, and later it is noted by metabolic and electrophysiological "shifts". Then the ability of the heart to relaxation is disturbed, after - to the reduction. And only then pain and corresponding changes on the electrocardiogram appear.
Read the material on the topic: Why are the ultrasound of the heart prescribe?
- How to provide urgent help in the attack of angina?
Preparations are accepted - short-acting nitrates (tablets or spray), under the tongue. Take them better in the sitting or lying position (for preventing reduction in pressure, dizziness and related possible drops). Dosage tablets - 0.5 mg. A total of up to 3 tablets are accepted - 1 tablet every 5-7 minutes. Focus need to disappear pain.
Nitroglycerin should not be used if "upper" (systolic) blood pressure is less than 90 mm. RT. Art.
This blood pressure should be monitored and during nitroglycerin intake, even if it was initially above 90-100 mm. RT. Art.
If in the process of receiving nitroglycerin, pain does not retreat for 15-20 minutes, it is necessary to call an ambulance to eliminate myocardial infarction.
- angina and ischemic heart disease - is this one and the same or there is a difference between them?
Angina is one of the varieties of coronary heart disease.
- Whose angina occurs more often: in men or women?
In general, with age, its frequency increases in persons of both sexes.
At the eve of the age of angina (and not the OBS as a whole), there are more often in women - probably due to the higher prevalence of Vazospasm and Cardial syndrome X. For senior age groups, the situation is reverse, i.e. And IHDs in principle, and angina, as its private case, more often are celebrated in men.
- Who is predisposed to the emergence of angina? What risk factors provoke angina region?
These are modifiable or unmodifiable factors that we have said earlier.
- Anatina Anatolyevna, how is the diagnosis of angina?
Firstly, a careful collection of complaints and anamnesis (with the refinement of the nature of pain, its localization, duration, conditions of occurrence, the effect on the reception of various medicines - in particular nitroglycerin, if it is accepted).
In case of inspection, signs of atherosclerosis, heart failure, increased blood pressure, obesity, as additional risk factors can be found.
A general analysis of blood and urine, a lipidogram (total cholesterol and its fractions, triglycerides), glucose, creatinine clearance is performed. With an unstable and acute state, markers of myocardial destruction (troponins T and I, creatine phosphocainase (MV fraction).
Instrumental diagnostics. Invasive and non-invasive methods are used here.
The first is the ECG. How is the angina region visible on it? These are specific changes in the ST segment.
Echocardiography and ultrasound duplex scanning of brachiocephalic arteries are performed.
Load Samples - Bicycle Eargometry and Tredmil Test.
Halter monitoring. It is performed when the load tests are contraindicated, if it is impossible to record the ECG at the time of pain, etc.
Read material on the topic: Holter (daily) ECG monitoring - full instruction for the patient
Stress echocardiography (ultrasound of the heart under load).
Perfusion scintigraphy with exercise.
Invasive methods. The "Gold Standard" of the visualizing diagnosis of atherosclerosis of the heart arteries - coronougiography (especially those having a high risk of cardiovascular complications and death), as well as multispiral computed tomography with coronary calcium assessment, or calcium-scoring.
- What is the treatment for angina treatment? Is this diagnosis - an indication for the operation?
Main goals - elimination of manifestations and improved forecast.
If the symptoms cannot eliminate the symptoms, it is recommended to send a patient to a consultation to the cardiovascular surgeon to determine the possibility of surgical treatment of angina.
- Angocardia is well amenable to treatment? Is it possible to cure it completely?
Treatment of angina at the present stage of development of medicine effectively. You can either significantly reduce its manifestations, or eliminate them at all. At the same time, even after surgical treatment with the full restoration of the adequate blood supply to myocardium, drug therapy continues indefinitely, because The risk of cardiovascular complications remains very high.
- Angocardia can be resolved? How to properly carry out the prevention of this disease and at what age it is necessary to start it?
The main activities are aimed at preventing the occurrence and progression of atherosclerosis and, accordingly, the defeat of the heart arteries. Those. This is an effect on changing risk factors. It is necessary to abandon smoking, control the weight, eat rationally. If there is diabetes mellitus, you need to achieve blood glucose targets. Provide rational regular physical exertion. Control blood pressure. We regularly take drugs assigned drugs or cardiac surgery and observed in these specialists.
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Kalinina Anatina Anatolyevna
In 2007 she graduated from the Voronezh State Medical Academy. Burdenko.
From 2007 to 2008, an interlineature on therapy was held, in 2010 - professional retraining in the specialty "General medical practice (family medicine)", and in 2017 - in the specialty "Cardiology".
Since 2015, he has been occupied by the doctor's doctor in the "Clinic Expert Voronezh". Leads reception at: ul. Pushkinskaya, d. 11.
What is the angina of the heart with simple words Basic cause of angina Causes of the attack of angina Unstable angina Symptoms: Stroke angina (1, 2, 3, 4 FC) Functional classes Stenria Prinzmetala Symptoms: Road angina Vazospadic angina Progressive angina Stable and unstable angina Signs and symptoms of angina Diagnosis, identification and research methods Symptoms and first signs of angina in women Symptoms and first signs of angina in men Pain with angina Duration of pain during angina Pressure during angina First aid and relief of the attack of angina How to remove the attack of angina at home The optimal position of the patient during the attack of angina Nitroglycerin to relieve the attack of angina Preparations to prevent angina attacks Painting angina Risk factors Cholesterol level in blood Overweight Smoking Arterial hypertension Violation of blood properties Stress Proper breathing
What is the angina of the heart with simple words
Angina is a clinical form of coronary heart disease (IBS), that is, its consequences. It meets almost half of patients with ischemia. Men suffer from almost one and a half times more often. The spacious name is "breast toad." By the way, the coronary heart disease is also she.
The emerging and silent pain in the heart of the heart in the form of an attack, which can be given to the neck area, jaw, teeth, left hand, forearm and shovel - this is the angina of the heart with simple words. The pain wears a compressive, burning character flows with a feeling of pulse frequency interruptions, increase pressure and weakness.
Whatever viruses and infections have overwhelmed us, no matter how alarming, it is still a major cause of mortality of Russians - cardiovascular diseases. Unfortunately, in our country there are about 17 million people suffer from various forms, and one of the most common hearts and vessels of problems in the list of amazing hearts.
Basic cause of angina
This is a pathological condition in which the blood supply to myocardium is impaired due to the damage to the coronary arteries. With ischemic disease, myocardium suffers, in other words, heart muscle. She lacks normal blood supply, its metabolic health is under threat. The heart muscle with ischemic heart disease seems to be starving, constantly suffering from lack of oxygen and nutrients. She starts working for wear, from time to time feeding pain signals about "hunger". She needs oxygen. A sharp shortage causes myocardial infarction, the death of a part of the heart muscle, and chronic - periodic seizures of angina. The heart muscle consists of cardiomyocytes - muscle heart cells. They, like any cell cells, constantly need oxygen. But their needs are not satisfied due to vessel spasms, blood flow is not enough, the flow of oxygen is broken. Conducting and blood flow does not allow the heart muscle to be filled with the substances necessary for full life and work, its metabolism is broken. It would have nothing to breathe. This leads to ischemia, damage to the heart muscle.
As a result, metabolic processes in myocardium are violated. For example, excessive accumulation of unsophisticated metabolites (milk, coal, phosphoric acids), ion equilibrium is disturbed.
All this leads to the appearance of pain. Myocardium changes, these unpleasant changes are called the "ischemic cascade", which begins with hardly noticeable changes in blood flow into the muscle, and is revealed in angina, pain symptoms of the heart muscle responding to the lack of oxygen. Stenicard attacks are developing with a narrowing of the surveillance of coronary arteries by 50-70%, the spasm must be confident and strong.
Causes of the attack of angina
The attack is a very unpleasant phenomenon, frightening, painful. It may occur as a result of voltage in physical or emotional loads. Sometimes enough walk with effort (uphill, with heavy bag) or negative emotions after a complex telephone conversation. Quite often, angina and makes itself felt in a state of full peace of the body, in a dream. These symptoms became the basis for the classification of angina, adopted by the World Health Organization in 1979 and the All-Union Cardiology Scientific Center for the Academy of Medical Sciences of the USSR in 1984.
- severe pains for the sternum,
- heart rate violation
- attacks last more than 20 minutes
- Reducing the effectiveness of nitroglycerin.
Unstable angina is the acute phase of coronary heart disease, with its manifestations, high risk of myocardial necrosis. It has poorly controlled clinical manifestations. Together with myocardial infarction, it enters the concept of acute coronary syndrome, threatening life.
Cardiomyocytes are dying with unstable angina, myocardium does not cope with the lack of oxygen. The heart muscle dies, and, alas, in 15 percent of cases, medical care is ineffective for the first seven days from the date of the attack of acute coronary syndrome.
Stroke angina (1, 2, 3, 4 FC)
The angina of the voltage is the attacks of the coarse pain arising due to emotional or physical exertion. They increase the metabolic needs of myocardium. Typically, such pains disappear alone or after taking drugs from the nitrate group. By how a person transfers physical exertion, stress angina can be several functional classes (FC).
- With the first class (the stenform of the Voltage of FC I) of the burden of load is moved well, the pain causes only confident overloads, which flow for a long time and intensively.
- With the second grade (angina of the Voltage of FC II), the attack may have a walk to a smooth area for the distance from a semi-kilometer, the lifting of the stairs is greater than on the second floor.
- The third class (stenform of the Voltage of FC III) strongly limits the usual physical activity, for attacking enough to rise to the first floor.
- The fourth grade (angina stress of FC IV) is the hardest, it develops with it even alone.
- Characteristic Painful Pain Character
- selection of sweat
- Full blood pressure
- loss of consciousness.
Natina printela is an infrequent variety of disease, which A different is called "variant" or "vasospadic". It develops alone, and its reasons are spasms of coronary arteries. Such angina is distinguished by severe long attacks. Usually they arise in night or early-handing hours, are intensive with a whole group of symptoms.
It arises literally "on scratch", without obvious provoking factors. The attack begins in the conditions of physical peace, is characterized by durability and strong pains, a lack of air, a violation of cardiac rhythm. In order to relieve attacks, complex drug therapy is prescribed. Usually angina rest is manifested in severe, multiple damage to the arteries. It is dangerous, and often, with its symptoms, an aorticoronary artery shunting with the creation of alternative paths for coronary blood flow is shown. In a few years later, the operation must be repeated, since the rest angina has a property to resume symptoms.
Regardless of the stress or rest, sudden chest pain is a consequence of spasm of vessels that are responsible for the blood supply of the heart muscle. Spasm does not give the heart enough oxygen. Unlike acute myocardial infarction, after which the heart muscle or her fragment cannot be restored, the disorder of the coronary blood circulation is not constantly.
Vazospadic angina develops in a state of rest, which distinguishes it from other types of angina, whose attacks occur during the period of activity. The symptoms of the vasospadic angina occasion at night, in the period from midnight to dawn. Painful syndrome is pronounced. Often, smokers, hypertensis and patients with elevated cholesterol suffer from this type of angina region.
The cause of pain syndrome is a spasm of a coronary artery and a sharp slowdown of coronary blood flow. The heart muscle is experiencing an increased load and begins to root. The cause of spasm artery can be:
- supercooling of the body
- Increased cholesterol levels
- Alcohol and drugs.
At the same time, this type of angina develops in patients from 50 to 60 years, and men suffer from 5 times more often than women.
The symptoms of this type of angina region include:
- pain in the chest at rest
- feeling of constraint in the chest
The attack lasts from 2 to 20 minutes, the attacks can occur with a frequency of several weeks to several months.
Progressive angina (or in the spacious "breast toad") is the type of unstable angina. Its reason is a violation of coronary blood circulation.
Provoke a progressive angina may:
- excessive smoking
- Alcohol abuse
- long stress
- Increased cholesterol.
Also, doctors allocate internal progressive angina factors:
- Reducing collagen synthesis,
- The predominance of the lipid nucleus,
- an increase in macrophages (cells of the immune system),
- Other cellular and metabolic changes.
Each of these factors may cause thrombus formation over an atherosclerotic plaque. They overlap the clearance of the arteries, and the heart is reduced. Such phenomena are accompanied by a clinic of progressive angina.
It is formed against the background of a stable stainless angina, when its current deteriorates. This can be stated when:
- the participation of seizures of the progred pains,
- increasing their duration
- appearance at rest
- Development of new symptoms (nausea or dizziness).
Progressive angina may develop as the severity of the state of different functional classes amplified.
Stable and unstable angina
"Unstable angina" is the period for the beginning of the formation of thrombus and the transition of the chronic period of ischemic heart disease to acute. When moving the process of thrombosis in a coronary artery in the blockage of the vessel, myocardial infarction may occur.
Stable angina (stainless angina) - bouts of pain in the heart area associated with physical or emotional load. It is called:
- a large number of cigarettes
- "hard day",
- Physical overload.
The attack lasts up to 15 minutes. Communication with a load on the body and bolt attacks is the main sign of a stable angina.
When transitioning a stable angina (in the presence of a diagnosis) into unstable, pain becomes stronger, the attacks are longer, they require high doses of stopping drugs. If the patient was not diagnosed with stable angina, but there were signs of angina, clearly limiting activity, then unstable angina diagnosis. Unstable angina diagnosed in the event of attacks alone or at night.
It is important to know that in all cases it is necessary to contact the cardiologist. In compliance with the treatment and change in the lifestyle, unstable angina may go to the stable phase, which significantly reduces the risk of heart attack.
Signs and symptoms of angina
- sore pain
- lack of air,
- leather pale
- Changing blood pressure,
The main symptom is the pain behind the sternum, less often - the left of the sternum. Paints can be compressive, godes, burning, sometimes - cutting, dragging, drilling. They can be very strong, frightening and poorly tolerated.
The pain most often gives to the left hand and shoulder, under the left blade, lower jaw, in the area of the stomach.
When attacking the lack of air, an increase in blood pressure, leather pale, pronounced arrhythmia. It is the pain that the main symptom of angina is based on the diagnosis of this disease.
In addition to obvious pain, symptoms of angina are:
- heart palpitations,
- the impossibility of agreed
- abdominal pain,
- Elevated concern
- Funny is possible.
Diagnosis, identification and research methods
The character of pain, its periodicity, localization and distribution is taken into account when determining the diagnosis. Obviously, strong heart pains require a survey. It includes a blood test to the indicators of general cholesterol, intracellular enzyme aspartataminotransferase (AST) and endogenous enzyme (ALT). Analysis of the latter will give information about the fact of the destruction of the muscle tissue of the heart. Indicators are investigated:
- high and low density lipoproteins,
- lactate dehydrogenase,
- blood electrolytes.
The value of cardiac troponins I and T - markers, testifying to damage to myocardiums. Their detection speaks of a microfarct or myocardial infarction.
Daily ECG monitoring allows you to fix the ischemic changes with each selection or arrhythmia and determine the type of angina. EchoCG will show local ischemic changes and disorders of myocardial.
Research of cyergometry (VEM) - a sample that establishes a maximum load for a person carrying without attacks. The load is set using an exercise bike until the maximum heart rate is achieved with simultaneous ECG record. This will help determine the class of angina.
See the lesions of the heart muscle, its maximum voltage can be using myocardial scintigraphy. Diagnostic coronary art shows the localization, degree and prevalence of the damage to the arteries of the heart, will show whether the operation is needed or angina can be stopped without surgery.
Symptoms and first signs of angina in women
- sore pain
- severe dizziness,
- Menstrual disorders.
Despite the fact that the walls among women under the age of 55 are spreading less than among men, and the reasons for this recognized the work of hormone estrogen, and the symptoms are not insured completely women of all age.
Moreover, this violation in women is often manifested intensively, brighter expressed concomitant symptoms of angina. It is nausea, loss of orientation in space, psycho-emotional disorders, severe dizziness.
For women during angina, the pallor of the skin, their marble shade with a branched tree of small vessels. In the chronic flow of coronary insufficiency, the development of specific insomnia is possible. It affects the impaired blood circulation of the brain and spasm of the vessels.
The common option for insomnia during angina is sharp awakening 10-20 minutes after immersion in deep sleep. Moreover, the woman feels like sleeping, then fatigue returns. Another common form of insomnia is constant awakening overnight. The body is exhausted, symptoms of asthenia appear. There are blood pressure impairment that provoke the appearance of attacks. If you have a breakdown of sleep, you need a specialist help, otherwise the tired body will generate new attacks of angina and aggressive.
With a long-term course of the disease, women have a change in the menstrual cycle and a violation of fertility. Cardiovascular diseases quite often lead women to a gynecologist, which does not detect problems with the reproductive system, except for symptoms of delays, cycles, strong menstrual pain. It would seem what is the relationship between diseases of the heart and female health?
Ischemic heart disease does not give the opportunity to normal ripening egg, degenerating the fetal tool functions. For these reasons, a gynecologist is needed to normalize the state of a woman with ischemia in order to observe the process of restoring reproductive functions.
Symptoms and first signs of angina in men
- sore pain
- Changing blood pressure,
- Reduced sexual function.
Stenzardia is a disease, unfortunately, widespread in men over 50 years old. The reason for his appearance becomes
Xia aging vessel walls, cholesterol sediments and stress. Today, anginary "the youth" and is registered in men under 35 years old. Careless attitude towards himself, a high level of work, dependence and overload becomes the cause of the angina increasingly.
At the same time, men do not give the values to pools, ignoring them. Appeal to the doctor is happening when angina Enters the pre-infarction state.
Incompute visits to the cardiologist leads to a fatal outcome. In the early stages of the angina, the men speak of a rigorous pain behind the sternum, in the jaw, hand or neck. Sometimes men do not talk about pain at all, their attacks are an increase in blood pressure, pallor, a desire to be alone, especially after intensive physical exertion. Often, the first seizures are underway with the termination of situational overvoltage. Nausea, vomiting, abdominal pain in men is extremely rare.
Angocardia affects both male sexual function, it decreases even in young people.
Pain with angina
A frequent problem at the first attacks is to identify the nature of pain. It is often confused with other types of pain. Let's try to figure out what the character of pain during angina is distinguished. In the case of a heart attack behind the sternum, there is a feeling of strong compression. If you can find a painful point, with a pain of a stitching character, the probability of intercostal neuralgia is high.
Pain in the attack of angina no more than 20 minutes , it often occurs with the load and passes alone, does not depend on the position of the body . Neuralgic pains are intensified when moving, breathing, changing body position and can last several days.
Pains for the sternum can be of different etiologies are associated with diseases of the gastrointestinal tract, inflammations of the nerves, intercostal neuralgia, may be psychosomatic symptoms against the background of stress. Moreover, it is important to remember that neuralgic pains on the power of pain is not inferior, and often superior to heartfelt. Therefore, with similar symptoms, you need to visit the cardiologist to exclude angina.
Duration of pain during angina
As a rule, the duration of the pain attack at angina range is from 2 to 5 minutes. Less often, the attack can last up to 15 minutes. Under the walls of the printela, the attack can reach up to 20 minutes.
Pressure during angina
Most often, the pressure during the attack of angina is growing, and after the end comes to the state of the upper boundary of the norm. It happens that after the attack, the pressure decreases so sharply that a person is experiencing strong weakness. Cases of pressure drop during attack are rare. Depending on the accompanying patient, hypertension or hypotension in the attacks of angina the doctor prescribes a different treatment. It is important to remember that the reception of nitrites at low pressure (hypotension) during angina attacks enhances the symptoms and can be very dangerous. An independent decision on the admission of drugs in the attack of angina cannot be taken under any circumstances.
First aid and relief of the attack of angina
How to remove the attack of angina at home
With the attack of angina need immediately call an ambulance . It is important to unbutton the gate of clothes and ease your breath. In the room you need to open windows, ensuring oxygen access, reassure a person and convince him of the need for calm deep breathing. During the attack you can not eat and drink.
The optimal position of the patient during the attack of angina
- Sitting or half a walk,
- exemption from close elements of clothing,
- Fresh air,
- Calm breath.
In anticipation of ambulance, it is necessary to take the position of sitting or half a walk. Feet should be lower than the head. The situation is capable of significantly worsening the state of a person. , Therefore, it is necessary to avoid it. If the attack passed and severe weakness appeared, then you need to change the position of the body. To ensure the venous return of blood, you need to raise your legs to the "above head" position and have a half-table of water. These are all actions that can be allowed at the first prefigure. It is important not to give in the attack of angina, no drugs without appointing a doctor, in the event of a person's death, this may lead the punishment.
Nitroglycerin to relieve the attack of angina
Many in the old manner in anginary use nitroglycerin without consultation with the doctor, since they are convinced that he helps. But only a doctor can take decisions on drug treatment of angina, and this is the only faithful treatment rule. Therapy of heart disease is individual, and during independent decisions, excluding numerous factors of the body's reaction to the attack of angina, nitroglycerin can greatly harm the person.
Preparations to prevent angina attacks
- Anti-Hishemic drugs
- acetylsalicylic acid.
Often, the drug therapy of angina region includes the reception of anti-host drugs that reduce the need for the heart muscle in oxygen. They allow myocardium not to "dare" in search of oxygen and get used to its restrained income. In the treatment of angina, the doctor may prescribe statins and antioxidants, acetylsalicylic acid, which helps reduce blood coagulation level. Each treatment protocol may have individual recommendations, so attempts to get rid of angina through the reception of medicines without appointing a doctor are not allowed.
Who risks sampling angina? As with any disease, risk factors may depend on a person and be manageable, and may be objective data. These include:
It has already been noted that men suffer from this disease more often. The point here is in hormones. Estrogens protect the heart and blood vessels, and women with a good hormonal background are in a more secure position before the climacteric period. After 55 years, estrogens cease to perform their protective function, and the women's angina becomes the same common as men's. Stenzardia tends to heredity, and direct descendants of patients with coronary heart disease or infarction in the risk area.
It is difficult to influence these factors, and you need to constantly take care of your health and condition of the heart muscle. Moreover, there are also modified risk factors of angina, with which a person is able to cope, eliminate from his life or at least significantly to reduce. These include:
- Cholesterol level in blood,
- "thick blood",
- Stress and psycho-emotional loads.
Often these risk factors are reduced one by one, simply due to all the well-known rules of a healthy lifestyle. We reduce cholesterol, weight, more moving, less nervous, throw smoking. In a word, if there is something that can be corrected - correct.
Cholesterol level in blood
Hyperlipidemia or increasing cholesterol level is present in almost every steep angina. Due to the fact that we want to give food myocardium, we do not need cholesterol deposits in arteries and thrombosis in vessels. To do this, it is necessary to captivate adequate physical exertion (at least walk for 30 minutes a day), maintain a waist in the form (at least 95 cm - for men and 80 cm - for women), there are bean, bone, sea fish, vegetables and fruits. Love kefir and cottage cheese, break out sweets and buns. Translated into numbers, patients with angina Do not use more than 300 mg of cholesterol per day and 5 g salt per day .
Another risk factor of angina - obesity. Physical activity will have to increase. Insufficient physical activity - good "gates" in obesity and violation of lipid metabolism. Reduce food with "fast" carbohydrate products makes sense even in order to avoid the development of diabetes. With it, the risk of angina rises by half.
About smoking know, probably, everything. The connection between the risk of angina and smoking is the most direct. Smoking increases blood carboxygemoglobin in the blood. This is a combination of carbon monoxide and hemoglobin. It causes oxygen fasting cells. Moreover, they suffer primarily those the most cardiomyocytes, the cells of the heart muscle. Due to smoking, a spasm of arteries occurs, the heart muscle begins to in dire need of oxygen. The soil for angina is the most obvious.
In addition, when smoking, anemia and intoxication of the body often develop, and they also reduce the delivery of oxygen to the heart muscle even in the absence of pronounced atherosclerosis.
Very common angina risk factor - arterial hypertension. With moderately elevated pressure, myocardial voltage is enhanced, it needs more and more oxygen. Its lack in this case is more obvious than in normal arterial pressure.
Violation of blood properties
Another risk factor of angina is a violation of the rheological properties of blood, mainly due to an increase in the concentration of red blood cells, leukocytes and platelets. It is often combined with an increase in blood sugar. Such a "kit" causes cell membranes to be active, erythrocytes and platelets literally "bonded". So the thrombus appear. It is believed that "thick blood" is capable of becoming normal, due to oxygen and proper nutrition. Many fans of traditional medicine drink aspirin "from thrombov", but drugs with a recipe "self-treatment" - not the most unambiguous way to maintain health. Therefore, depending on the state of the digestive system, food can be introduced into the diet, contributing to the normalization of blood viscosity. These are acidic products (lemon, pomegranate, black currant), beets, nuts, garlic, fatty fish. Our grandmothers said that Kalina - a berry in which there are rare vitamins P and K and a lot of valuable minerals remaining a priceless medicine from "thick blood". By the way, she helps calm down well, and will be a good help when delivering from the next risk factor - stress.
Many love confidently to pronounce that "all diseases from nerves". Maybe not all, but the heart problems are really closely related to the factors of stress and the ability to worry. The mechanism of exposure to stress on the heart muscle is as simple as the same and dangerous. Fear and stress does not allow to remove tension from the muscles. We know about it, each more than once heard the expression "squeezed from fear" or felt muscular spasms during the stressful situation. So, not only the muscles are compressed from stress, the vessels in the same way occur inside our body. And it is difficult to do something here, because only the disposal of pathological emotions allows the central nervous system to launch the mechanism, eliminating fixation, allowing to remove spasm. The heart under stress also works in conditions of high load, angiospazm is developing - the narrowing of the vessels, small arteries and capillaries. So blood circulation is disturbed and the supply of myocardium oxygen is reduced.
The correct way to ensure the heart muscle with a sufficient amount of oxygen is to reduce risk factors and breathe correctly. Oxygen we get through the respiratory organs, and they must be trained and tuned to support a full respiratory cycle.
The breathing simulator "Samozdrav" can be confident and powerful support in the prevention of angina and ischemic heart disease. One of the basic positive effects of respiratory training on the body is sufficient admission to the organism of oxygen and the support of the normal level of CO2. Thanks to training with "self-coastal", you can constantly maintain the level of oxygen at the level that excludes its deficiency. This means a high probability of myocardial safety and significantly reduces the risk of diseases of ischemia and angina.
In addition to the "direct supply" of oxygen into the body, breathing workouts strengthen the work of the nervous system and adjust the reactions to stress, provide peace and even emotional background even at high loads.
Training with "self-sharp" corrected metabolism and effective in the treatment of obesity. They activate metabolism due to the normalization of oxygen levels in cells and tissues, normalize the removal of the exchange products, allow nutrients better to be absorbed.
Indispensable "self-sharp" for patients with hypertension. It was the treatment of this disease that became the primary task of the creators of the respiratory traineler, and today its effectiveness in the treatment of hypertension without medicines is completely proven by research and many years of practices with millions of people.
Breathing workouts are able to cope with any modified risk factor of angina and ischemic heart disease. Regular classes will give myocardium to a sufficient level of oxygen and retain the heart is healthy. Remember, the reasons for angina are in the lack of oxygen, and the main task of each of us is to provide them with the body. This is the basis of the foundations of a healthy lifestyle, his alpha and Omega.
In the late 19th and the beginning of the 20th century, angina region was a rare disease, and in the 21st century it already has the nature of the noncommunicable pandemic. In the Russian Federation, more than 10 million people suffer from coronary heart disease, of which more than 3 million people have a stable angina. Half patients with angina 60 years old.
What is angina region
Angina is a complex of symptoms that develops when the heart needs in oxygen and blood flow capabilities are inconsistent. The lack of oxygen for myocardials is manifested by the following symptoms:
- a sense of discomfort or pain in the thoracic squeezing, gravity;
- most often felt "for the sternum";
- May be irradiated into left hand, neck, lower jaw, epigastric area.
For the first time, this state was described in detail in 1772 and called the "chest toad" syndrome. A long deficiency of oxygen can lead to myocardial infarction.
Often, people suffering from angina, with the next attack, put the nitroglycerin tablet under the tongue, stop, sit down and wait when "release". It seems that everything ended well and can be continued to continue to continue their affairs. It turned out that even the end of the attack does not mean that the heart works as before.
During several hours after the attack, the reduction of this portion of myocardium can be broken, the heart cells are alive, but due to the oxygen deficiency, they switched to energy-saving mode.
The main complaint is the pain in the chest. But first it is necessary to understand it is connected with the blood supply of the heart or not. Make it is not always simple, especially in the elderly. This interferes with hearing problems, memory and vague description of sensations.
The main symptom is the pain in the chest. But there may be other manifestations.
The pain should be associated with exercise, emotions, cold, occur after abundant food or in the morning when waking. Pass in a few minutes of rest or receiving nitrates. This can be attributed to classic symptoms. Pain can give to the elbow, shoulder, lower jaw, epigastria area. But even one person, the place of irradiation of pain may change during the day.
It happens that angina attacks alternate with asymptomatic myocardial ischemia. This is especially pronounced in people with diabetes mellitus, since it is affected by nerve endings and the sensitivity is disturbed.
To correctly assess the symptoms, it is necessary to exclude diseases of the spine, the gastrointestinal tract, depression.
Previously, it was generally an observed opinion that angina is the consequences of the development of atherosclerosis. "Bad" cholesterol (low density lipoproteins) is deposited on the walls of the arteries. It occurs its accumulation, a lipid stain appears. The function of the vessels is disturbed, the process of inflammation is launched, an atherosclerotic plaque is growing. The main thing is that the fibrous tire of the plaque becomes stable and did not formed a thrombus. When the narrowing of the lumen of the vessel becomes significant for powering the heart, symptoms of the lack of oxygen may appear during physical exertion in the form of pain.
The cause of dyslipidemia and the development of atherosclerosis can be genetic features. Either a violation of lipid metabolism The investigation of other reasons:
- diabetes mellitus, hypothyroidism, Izsenko Cushing syndrome, lipodystrophy;
- Problem with bile outflow, liver cirrhosis;
- chronic renal failure;
- Features of lifestyle and nutrition;
- Reception of medicines possessing atherogenic effect (in-adrenoblays, estrogens and progestins, anabolic steroids, corticosteroid drugs, immunosuppressants, thiazide diuretics, retinoids, protease inhibitors).
It turned out that atherosclerosis is not the only cause of the attacks of angina. Moreover, a discrepancy was identified: plaques in coronary arteries could be present and did not cause symptoms, while other people narrowing the lumen of large arteries feeding the heart, but there were no symptoms of angina.
The blood supply problem has emerged at the level of the smallest vessels. They did not let the desired amount of blood due to the violation of vasodilation and excessive blood flow resistance. This may be due to dislipidemia, smoking, as well as insulin resistance, estrogen deficiency in women in the perimenopausal period, oxidative stress and inflammation. Microsievous angina region is more often observed in women than men.
Another reason is the spasm of coronary arteries. As well as various combinations of all the above factors.
Another factor affecting the delivery of oxygen may be the blood itself. With anemia, the transport function of blood suffers and it cannot carry a sufficient amount of oxygen to the heart, although the vessels can work correctly.
Simplified angina can be divided into several types.
Stable angina - manifests itself under load, the smaller the endurance of myocardium and earlier pains are the higher class of the functional class from I to IV.
Unstable angina - can be first arising, after a suffered infarction.
Spontaneous angina - during spasme of coronary arteries, does not depend on the load.
Microsievous angina - with a violation of the operation of the microcirculatory bed.
It seems that it is enough to make an ECG and everything will become understandable. Unfortunately, it is unlikely to remove the ECG testimony with an attack of angina at rest. Therefore, for obtaining accurate data, a plurality of diagnostic methods are used on samples with physical activity, daily ECG monitoring to a study of blood current with the introduction of a contrast agent.
Remove the ECG testimony with the angina attack at rest is unlikely. This is compensated by other diagnostic methods.
The procedure and methods of diagnosis should determine the doctor. Usually go from simple to complex:
- Laboratory studies: Clinical blood test, blood glucose on an empty stomach, lipid profile on an empty stomach, creatinine.
- Electrocardiography at rest and during a painful attack and with exercise.
- Daily monitoring of ECG, if arrhythmias, vasospadic angina or high probability of nonsense ischemia are suspected.
- X-ray study of the chest if heart failure or severe pulmonary pathology is suspected if cardiac noises are listened.
- Echocardiography, if cardiac insufficiency is suspected, there are changes at heart tones, with blockades of a beam legs of a beam, with pronounced changes to an ECG, accompanying hypertension or diabetes mellitus.
- Visualizing techniques at rest or with a load.
The purpose of treatment is the prevention of myocardial infarction or sudden death, an increase in life expectancy. For this you need:
- Stop the progression of atheroma.
- Stabilize the plaque, reduce its inflammation and improve the function of the endothelium.
- To warn the thrombosis if the endothelium dysfunction or the plaque break occurs.
- Restore the damaged artery if it supplies a large portion of myocardium.
Reducing the frequency and intensity of attacks improves the quality of life.
Smoking strongly affects the development of atherosclerosis and, as a result, angina.
Reception of medicines needed, but "homework" is important:
- avoid loads causing pain;
- quit smoking and other bad habits;
- adhere to the diet to normalize the lipid profile (Mediterranean diet);
- Avoid self-medication by pharmacological preparations, as they will be a lot of fundamental treatment;
- to learn psychological methods for removing stress;
- Perform the recommendations of the doctor on dosage physical exertion regularly.
As we see the drugs set. Only the doctor may choose the necessary dosages and combinations of drugs to get the desired effect. Usually it takes time, since each has individual features, other diseases, contraindications to those or other drugs.
Also possible surgical treatment to eliminate atherosclerotic plaques and restore adequate blood supply.
- Frolova E.V. Stable angina: principles of diagnosis and treatment // Russian family doctor 2008
- Sudzhaev O.A. The possibilities of metabolic therapy in microwave angry, taking into account the new IBS development paradigm // Medical news 2016
Publication date April 18, 2019. Updated July 22, 2019.
Definition of the disease. Causes of the disease
Angina - It is a clinical syndrome, accompanied by a sense of discomfort or compressive, gulling pain in the chest, which can irradiate (give) to the left hand, neck, lower jaw and the epigastric area. [one]
This syndrome refers to the ischemic heart disease and arises due to the violation of the balance of the needs of oxygen and its receipts into the heart muscle - myocardium.
There are three main reasons for angina:
- Atherosclerosis of the coronary arteries;
- vessel spasm;
- Thrombosis, i.e., the blockage of the vessel by Trombus (Embol), received from other areas of the body or an atherosclerotic plaque resulting from the gap.
In 95% of cases, angina occurs due to an atherosclerotic plaque, which is formed in the wall of the vessel and narrows its lumen. This process is usually generalized, that is, in all vessels of our body. Therefore, the detection of plaques in one area does not exclude the formation of the same plaques in the vessels that feed the heart (coronary arteries). Ultimately, the formed plaque can break, and the thrombus arises at this place.
In less than 5% of stenocardia cases, due to other violations:
- vessel spasm;
- congenital anomaly of the dishellion of coronary arteries;
- Martan's disease;
- Elessa - Dunlosy syndrome ("hyperalasticity of the skin") with the bundle of the aorta root;
- Kawasaki disease;
- Bacterial endocarditis;
- overdose of vasoconducting agents and some drugs;
- Coronary vasculitis.  
In order to understand why some sneakes are sick, and others do not need to know which factors increase the risk of atherosclerosis.
To controlled risk factors that can be avoided include:
To uncontrolled risk factors, for which it is impossible to influence, doctors include:
- male gender;
- age (older than 50 years);
- Family history, burdened by the presence of cardiovascular diseases in relatives.  
When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of angina
Each person in his life experienced an unpleasant sensation in the heart. Someone was bored with someone pressing. These complaints may disturb patients of different ages. Young people often turn to a doctor with suspicious unpleasant feelings in the heart area, but in most cases from the side of the cardiovascular system of pathology is not detected. Some patients suffer and believe that at their age, unpleasant sensations in the field of sternum, nothing is dangerous, but later they come with irreversible changes in the heart.
In what cases do you need to contact the doctor?
If you collect all patients with pain in the heart, then they can be divided into three groups. The first will include patients who have Typical (undoubted) angina Three distinctive features:
- Zaborny pain or discomfort with a characteristic duration;
- Pains arising in the case of a physical or emotional load;
- Pains disappearing alone or after the reception of nitroglycerin. [four]
The second group will include patients with Atypical (probable) angina who will have only two features from the above.
The third group will include patients with pain that are not associated with myocardial ischemia . These people have all the above symptoms are absent, or only one characteristic of the above is marked.
What can be attributed to characteristic pains during angina?
Most often, the symptoms resemble graceful pains for breasts of a burning character, sometimes giving left hand, lower jaw, to the left blade. In some cases, pain is accompanied by shortness of breath. Some patients describe such sensations as if they laid a hot iron on their chest. The term "breast toad" is found in the literature.
This pain appears usually during a physical or emotional load and also quickly disappears after the termination of the load that caused the attack.
For example, if there is a burning pain of the sternum, which does not give to one floor, therefore, when the rise has to relax and wait until the pain passes, then these are a typical (undoubted) angina signals. On this occasion you need to urgently consult a doctor.
If when walking there is an unpleasant feeling near the left blade or on the left jaw, therefore it is not possible to go quickly and have to stop for the disappearance of this sensation, this case is a manifestation of an atypical (probable) angina.
Unfortunately, some patients cannot assess the nature of pain and often confuse angina with other diseases than they can mislead themselves and the attending physician. For example, some patients take it for an ordinary heartburn. There were cases when a person complained only to pain in the left half of the jaw, his way with its toothed pain. Therefore, it is important to remember that their relationship with physical or emotional load is characteristic of the angular pain. In some cases, an increase in blood pressure can be equal to physical exertion.
For angina, not peculiar :
- pain with local, point character;
- Pains that are present longer than half an hour, i.e. for several hours or day, as well as constant, "shooting" and "suddenly piercing" painful sensations;
- pains that occur during tilt or turning the body, in the position of the lying or with a long position in an inconvenient position, as well as in the case of deep breathing at the height of inhalation;
- Pains that are increasing when tugging the chest in the course of intercostal intervals;
- Pains moving from one chest area to another, i.e. alternately arising from the right, then on the left. [five]
Pathogenesis of angina
To disassemble in the pathogenesis of angina, it is necessary to pay attention to the pathogenesis of its main reason - atherosclerosis.
There are two main theories of growth of atherosclerotic plaques in the wall of the vessel, which complement each other. Even those people who do not have medical education are one of them - this is an excessive cholesterol formation in the blood.
Nowadays, everyone knows about the properties of cholesterol, so many pay attention to food, where there is an inscription "without cholesterol". Some even use low cholesterol products tables to properly approach their diet. It is really important. Another Patomorphologist N.N. Anichkov in 1913 in the experiments on rabbits showed that the addition of cholesterol to the usual feed causes changes in the aorta, similar to violations that are observed in a person during atherosclerosis.
But, despite this, cholesterol is a significant chemical element involved in metabolism. Without it, a person cannot exist. And even if people constantly ate products with a high cholesterol content, an atherosclerotic process with age would still flow, not as fast as in humans with the presence of risk factors for the development of atherosclerosis.
The second theory of the development of atherosclerosis appeared later. It consists in response arising from the damage to the endothelium of the vessel - thin an inner shell of arteries, in one cell thick. It can damage the same risk factors:
- The increased blood pressure, which presses the vessels, as a result of which they cannot withstand constant lifts and pressure drops, which arise due to emotional stress, low physical activity or overweight;
- high level of glucose, which is toxic for endothelium cells;
- The action of carbon monoxide - carbon monoxide generated during active or passive smoking.
As a result, an increase in the concentration of cholesterol in the blood and damage to the endothelium is beginning to form atherosclerotic plaques, causing various diseases, including angina. 
Classification and stage of development of angina
Stenzardia is divided into three main groups:
- Vazospadic (spontaneous).
Most often there are first two types.
Stable angina It is characterized by a regular occurrence of angina symptoms, and their severity over time does not change. This is due to the structure of the plaque, which retains its shape or slowly increases.
Unstable angina Related to the gap of atherosclerotic plaques and the occurrence of thrombus. Based on this, there are three subgroups of such angina:
- The emerging for the first time - when a person does not know about the character of the plaques;
- progressive - when symptoms of the burst break arise;
- Early post-infarction or postoperative - when the symptoms of angina appeared after resolving myocardial infarction again.
Unstable angina requires urgent measures.
Vazospadic angina It is very rare. It is characterized by the lack of plaques and the emergence of spasm of coronary arteries caused by stress, load or drugs.
In addition, there is a classification of a stable angina, which is developed by Canadian cardiovascular society. It includes four functional class (FC) as the syndrome sergency and the preserved lumen of the coronary vessel:
- FC I is the absence of angina attacks with normal physical expenditures. They appear only with unusual heavy loads. For example, if a person is used to climbing two floors without rest, then with a three-floor approach, symptoms characteristic of angina are characteristic.
- FC II - the minimum limitations occur during normal physical activity. For example, angina occurs already in the rise of more than one staircase or with a calm walk of more than 500 meters.
- FC III - physical activity is significantly limited. Stenzardia does not yet arise alone, but it appears when calm walking less than 500 meters or with a rise in less than one staircase. Also, angina attacks occur when equipped the jacket or when switching from one room to another.
- FC IV - Angina appears even alone. For example, attacks occur in the position of the lying, and with light physical exertion they increase. [five]  
Complications of angina
In the absence of treatment and late appeal to the doctor may arise serious complications.
Most often there is a transition from stable angina to unstable, and further to the heart attack, when the heart cells die off due to the cessation of oxygen intake and nutrients. In most cases, this process develops as a result of an atherosclerotic plaque gap with such damaging factors as high blood pressure, the effect of carbon monoxide resulting as a result of smoking, the toxic effect of the high concentration of glucose in the blood, etc. Subsequently, a scar is formed at the scene of a heart attack - post-infarction cardiosclerosis. In the worst cases, everything ends with a fatal outcome.
Another complications of angina can be attributed to various types of arrhythmias and chronic heart failure.
In order to estimate the likelihood of the risk of death from cardiovascular disease, a Score scale was developed, which is based on the results of cohort studies conducted in 12 European countries, including Russia, with the participation of 205 178 patients. It estimates the risk of any fatal complications of atherosclerosis, be it death from coronary heart disease, myocardial infarction or aortic aneurysm rupture, and not just the risk of death from coronary heart disease, like many other risk calculators. [eight]
It should be noted that this scale does not apply to patients who suffer atherosclerosis, diabetes (any type), chronic kidney disease (SCF <60 ml / min / 1.73m 2), and to persons with a very high level of risk factors. These people have a total risk automatically considered high and very high - more than 15%.
Score scale very well shows not only the likelihood of death in the next 10 years, but also those risk factors to notice attention so that the sad outcome does not occur.
The assessment of the total risk is made on the basis of factors such as age, gender, smoking, blood pressure and level of total cholesterol, but does not take into account chronic stress, excess body weight, HDL and new risk factors (C-jet protein and homocysteine). Therefore, this scale will still not replace the knowledge and clinical experience of the doctor.
Diagnosis of angina
After collecting complaints, the history of life and disease and inspection are appointed additional laboratory and instrumental surveys.
Laboratory studies are mainly aimed at the diagnosis of dlypidemia, which contributes to the formation of atherosclerotic plaques. For this purpose, an analysis of the lipid spectrum of blood is appointed, which includes general cholesterol and its fraction.
The instrumental methods are primarily attributable Electrocardiogram (ECG) . Many patients go to the cardiologist with a question "Is everything normal with my heart" only with one film ECG. But, unfortunately, these indicators have informative significance only during an attack. In most cases, on one ECG film, removed alone, it is impossible to identify angina, since it can show only rhythm disorders, hypertrophy (increase) of various parts of the heart, violation or presence of myocardial infarction.
Also exist Ultrasound examination of the heart which shows its structure and can identify possible deviations. Echocardiography Designed to determine the size of the heart and its cameras, the presence of vices (stenosis and deficiency) of valves, neoplasms and transferred infarction. But this study, as well as an ECG, is not informatively informative if it was carried out outside the attack of angina, at rest.
Halter monitoring ECG (outpatient monitoring) is much more informative than the above studies. It is advisable to spend it in order to identify signs of myocardial ischemia during everyday activity. For this purpose, the patient goes about a day, eats and sleeps with the apparatus attached to it, that is, performs the usual daily physical exertion. If an attack occurs, the examined records the case in the diary and then informs the doctor about when and what conditions the symptoms occurred. The sensitivity of this method in the diagnosis of ischemic heart disease is 44-81%.
Since in alone seizures of angina, there are practically no, there are methods of examination using physical exertion. By analogy with the electrocardiogram spend Veloergometry and Tredmil Test : ECG removal is carried out at a time when the patient performs exercise on a bike or treadmill. The sensitivity of this method is approximately 68%.
More sensitive method is Stress-Ehocheg - This is the same ultrasound examination of the heart, only made after exercise. With increasing pulse during running myocardium consumes more oxygen and nutrients. With the narrowing of the vessel in the muscle, a sufficient amount does not receive, as a result of which the attack of the stunned pain occurs, and disorders appear in the reduction. As a result, hypocinezia develops, which can be considered at ultrasound examination. Such a study has a greater sensitivity (80-85%) and specificity (84-86%)
If it is impossible to perform ECG and ECCG during exercise, you can use Expiratory Eclectrocardiomulation (ChPES) or Pharmacological tests . These methods are based on improving the need of myocardium in oxygen by increasing the pulse without a significant change in blood pressure.
There are also two less common research methods: Myocardial Perfusion Scyntigraphy with Load и Multispiral computed tomography heart .
The basic method of assessing the state of the arteries, in which visually can be recognized by the narrowing of the vessel, is Coronary angiography (kA) - X-ray-contrast method of examination, reliably determining the place and degree of narrowing of the arteries, as well as the type of blood supply, signs of thrombosis, ulceration, calcinosis and spasm of the coronary artery.
In terms of execution, this examination is divided into emergency (within 6 hours), urgent (within 6-12 hours) and planned.
Emergency KAG It is performed at an unstable angina or the myocardial infarction when every minute is important.
To the testimony of K. planned kag Believe:
- objective signs of myocardial ischemia;
- transient ischemic changes detected during the ECG at rest or during daily monitoring of the ECG;
- Positive test with physical activity with cycle ergometry, Tredmil test, ChPES, stress-echocardi or myocardial scintigraphy;
- The occurrence of seizures of the angina stained voltage II-IV FC or roast angina;
- the state of early post-infarction angina;
- dangerous ventricular rhythm violations in the history of life with a high risk of clinical death;
- Planning operation on the valve apparatus of the heart in people over 40 years;
- conducting differential diagnosis with non-coronal diseases of myocardium (including atypical pain syndrome);
- Social testimony in the presence of minimal and fuzzy signs of myocardial ischemia, provided that the patient's profession is associated with risk for the lives of other people (pilots, drivers), combat duty, etc.;
- The transferred heart transplantation (the study is carried out every year, sometimes in combination with intravascular ultrasound research).
Absolute contraindications for destination kAg currently do not exist.
Intermediate place occupies urgent kag . It is carried out in case of deterioration of the patient's condition, which is in the hospital treatment on the progression of angina, when the attacks of the stenokard of rest, the absence of the effect of maximum therapy, as well as with a deterioration of the state after the endovascular operation or the aorticoronary shunting. [one] 
Treatment of angina
As a disease that arises mainly due to lifestyle, angina treatment should be started with its change. Without this, it is impossible to achieve 100% of the result in the treatment of angina.
First of all, you need to pay attention to food. Products included in the diet should contain more plant fiber and less cholesterol: fatty meat types should be eliminated, such as pork and beef, and increase the number of consumed vegetables and fruits.
Additionally, the attitude to physical exertion should be changed. It is recommended to spend 40 minutes on physical activity every day, which should not be in lifting severity or work in the garden / garden, but in walking, walking, skiing, skating and dancing. These types of physical activity should not be exhausted, but to bring only pleasure.
After changing food habits and physical activity, factors such as stress and overweight will disappear. Among other things, smoking and alcohol abuse should be abused.
As for drug therapy, it provides for the solution of three main tasks:
- reduce cholesterol;
- control the frequency of heart abbreviations;
- Stabilize blood pressure.
First of all assign Statins - Preparations that reduce cholesterol. These drugs affect the main cause of the narrowing of the vessels - atherosclerosis.
The reception of statins should be carried out constantly and select a dose until the low-density lipoproteid target levels are achieved (part of the total cholesterol affecting the atherosclerosis of the vessels). Target level with very high total risk - less than 1.8 mmol / l or more than 50% reduction on the initial level. At high risk, less than 2.5 mmol / l, with moderate - less than 3 mmol / l. [nine] [eleven]
Statins are the main class of drugs in the treatment of angina. And although they do not bring noticeable improvements as drugs that reduce blood pressure, but significantly improve the disease forecast.
The following class of drugs is medicines that reduce the frequency of heart abbreviations. Most often used beta blockers . They are easy to remember, as they all have the ending "-Lolol" - Bisoprolol, metoprolol, nebivall, etc. They should also be taken to reduce angina attacks and improving the forecast.
Favorable cardioprotective action ACF and Sartan Inhibitors . Although they are used as a decrease in blood pressure, in this case they play the role of cardioprotectors (heart defenders). [four]
Each patient with angina should understand that he has a high risk of myocardial infarction, therefore rapid action nitrates (nitroglycerin, nitrosprey) and acetylsalicylic acid tablet (aspirin) should always be in its home first-aid kit. Nitroglycerin can be accepted in the form of prolonged tablets or in the case of angina attacks.
In addition to the conservative (therapeutic) treatment, surgical methods exist. They can be performed both as planned and emergency. These include:
- Stenting is the expansion of the vessel section using the stent;
- Aorto-coronary shunting - laying a new way to bypass the affected area of blood supply with the help of Shunts.
Unfortunately, in the practice of doctors there are patients who are not perceived seriously by the myocardial infarction. They do not remember the name of drugs that are taken, provide control of these drugs to their spouse or spouse and turn help not in a planned manner, but only when pain in the heart. Such an attitude to its health is extremely dangerous.
However, most often there are people with angina, which control their pulse and the LDL level, know all the drugs by heart, understand the therapist and cardiologist every year. In such patients, the disease forecast is definitely favorable.
These two groups of patients well demonstrate that the forecast depends on the risk factors, commitment to treatment and timely therapy.
What to do in case of an attack of angina or myocardial infarction
- Stop any load (both physical and emotional).
- Try to sit down if there is such an opportunity.
- Frequently from the making things: weaken the belt or tie, unbutton the chain on the neck and other toilet items, tightening the chest.
- Open windows and doors in order to let fresh air.
- Put one nitroglycerin tablet under the language of IL to use nitrosprey. If the feeling of pain did not disappear after three minutes, re-accept another nitroglycerin or nitrosprony tablet.
- If the pain did not disappear after 10-15 minutes, call a doctor ambulance and spike one tablet aspirin. 
What you need to do so that angina does not appear
- Refuse bad habits: smoking, alcohol abuse.
- Regularly performing cardion loads, in which the lift of gravity is not included: running, walking, swimming, skiing and skating, Scandinavian walking, dancing, etc.
- Balanced to eat: use more vegetables and less animal fats, fried and salty.
- Avoid stress.
- Spend enough time for sleep.
- Control body weight.
The most important thing is to keep an active lifestyle. If you like to ski, walk on dancing or walking in the evenings with friends, then you should not refuse it, because then the mood will be good, the body is slim, and the vessels are healthy.Threw stress
manifesting sharply arisingPain in the chest
, Usually behind the sternum. The pain wears a pressure, compressive character, may be irradiated (spread
) In the nearby areas, arises after physical or emotional overvoltage, and passes after stopping the load or after the adoption of nitroglycerin tablets under the tongue. The cause of pain syndrome is a short-term ischemia of myocardium - a condition characterized by absolute or relative insufficiency of blood supply to the heart muscle or increasing its oxygen needs.
Stroke angina is the most frequent manifestationIschemic heart disease
at which adequate oxygen delivery to the heart muscle is disturbed. This condition is characteristic of the elderly people and arises due to development in the wall of the atherosclerotic plaque vessel, which leads to a gradual narrowing of his lumen. If the occurrence of the attack is due to another reason (spasm of vessels or blocking their thrombus
) - Then we are talking about spontaneous (Option
To date, the ischemic heart disease is one of the first causes of death mortality in economically developed countries. Extremely rarely rarely angina stress is registered in children and adolescents - the probability of developing this disease under 30 is less than 0.7%. With age, the risk of angina development is significantly increasing, which is associated with the pathogenesis of the disease - an atherosclerotic plaque can develop in the walls of vessels for years, sometimes dozens of years, while not showing itself. Thus, between the ages of 45 and 55, the probability of the appearance of angina symptoms is no more than 2 - 5% in people of both sexes, while after 65 years this figure increases to 15 - 20%.Interesting Facts
- In Europe, more than 40 thousand new angina cases are revealed annually, with more than half of them - stroke angina.
- The cause of the stress angina is an atherosclerosis is a chronic disease resulting from a metabolic disorder, in particular fats.
- The main cause of the death of patients with angina is a sharp myocardial infarction.
- The first description of the classical occasion of angina dates from 1772, when the term "Angina pectoris" was used for the designation for the first time, which means "breast toad".
- Approximately 40% of men and 56% of women of the stress angina are the first manifestation of coronary heart disease.
- To relocate the attack of angror diagram Nitroglycerin was first applied in 1879 and since then is the main drug used in the treatment of this disease.
Anatomy of the heart
In order to understand the essence of a person taking place in the human body in the development of angina, certain knowledge is needed from the field of anatomy and heart physiology.
Structure and heart function
The heart is a muscular organ that provides blood circulation in the body. It is located in the center of the chest and has the form of a cone, the vertex of which is directed down and left.Three layers are distinguished in the heart structure:
- Myocardium - directly muscular layer, consisting of cardiomyocytes ( Special muscle cells found only in the heart muscle ). These cells have the ability to shrink and relax ( that is, shorten and lengthen ) Under the influence of the nervous impulse, which leads to a change in the volume of cavities of the heart.
- Endocard - The inner layer, lining the cavity of the heart and preventing the adhesion of blood cells to them.
- Pericard - The outer shell consisting of two sheets - internal, directly covering the heart muscle ( epicarda ), and outdoor ( actually pericardia ) separating the heart from neighboring organs and prevents it from displacement in the chest. There is a thin sliding space filled with a special liquid between pericardium and epicardium, which provides a sliding of these shells relative to each other during heart abbreviations.
The heart consists of four cameras, which are separated from each other with muscle-fibrous partitions and holes (Valves
). All heart chambers are regularly reduced and relax in a certain sequence, providing constant blood circulation in the body.Heart cameras are:
- Left atrium. Four pulmonary veins fall into it, according to which blood saturated with oxygen is coming. Reducing, left atrium pushes blood through the left atreservant ventricular valve into the left ventricle. This valve, like everyone else, passes blood only in one direction, which ensures its circulation in the body.
- Left ventricle. With the reduction of the left atrium, the left ventricle is in a relaxed state, as a result of which it is filled with blood. From it, blood through aortic valve enters the aorta - the largest artery of the body. Many smaller arteries are departed from the aorta, which deliver blood to all tissues and organs.
- Right atrium. On the periphery oxygen proceeds to cells of various organs, providing their livelihoods. Blood leakage from tissues ( venous ) Collected in Vienna. They, combine among themselves, form the upper hollow and lower hollow veins, which fall into the right atrium. Reducing, the right atria pushes the blood through the right atrial and ventricular valve into the right ventricle.
- Right ventricle. When reducing the right ventricle, blood is expelled from it into the pulmonary artery ( through the same valve ) And it is delivered to the lungs, where it is enriched with oxygen and goes back to the left atrium.
The heart rate process occurs synchronously, which is carried out due to the presence of a conductive heart system - a whole network of special nerve fibers that provide fast, unidirectional carrying out the nerve pulse throughout myocardium. This impulse arises in the field of right atrium (In the so-called synoatrile node
), causing the simultaneous reduction in both atrium and blood release in ventricles (which at this time are in a relaxed state
). Immediately after that, the phase of ventricular reduction occurs (systole
), during which the height of blood from the heart occurs (in the aorta and pulmonary artery
), after which the atrium and ventricles relax again (The phase of diastole occurs
), and the cycle is repeated.
Blood supply of the heart
The heart gets blood from two main arteries, called coronary or corona. They depart from the aorta immediately behind the aortic valve and branching penetrate into the thickness of the heart muscle. Under normal conditions, about 20% of the blood emitted from the ventricle during systole enters the coronary artery - it is thus the permanent delivery of oxygen to cardiomyocytes and removing the exchange products.
As follows from the above, the blood comes to all organs mainly during the reduction of ventricles, that is, during systole. Coronary artery, on the contrary, get blood during diastole. This is due to the fact that with the reduction of the heart muscle, all the vessels penetrating it are compressed, as a result of which blood flow in them is impossible. In addition, the mouths of the coronary arteries are arranged in such a way that during systole they overlap with the flaps of the aortic valve.
During the diastole, when the aortic valve is closed, and the cardiomyocytes are in a relaxed state, the blood from the aorta enters the coronary arteries and spreads throughout myocardium, after which (During the next systole
) It is assembled into coronary veins and flows into the right ventricle.
It is worth noting that the systole time is almost unchanged, therefore an increase in heart rate (Heart rate
) It takes mainly due to shortening diastole, which leads to a decrease in the amount of blood coming into myocardium. Under normal conditions, this is compensated by the expansion of the coronary arteries, however, with certain diseases, this compensatory reaction is not able to ensure adequate blood supply to the heart muscle, as a result of which ischemia can develop.
Causes of angina stress
The cause of the development of the stress angina is atherosclerosis - a chronic disease characterized by the appearance of fat deposits in the walls of the coronary (and others
) Arteries. As a result of the gradual progression of the disease, the so-called atherosclerotic plaques are formed, which narrow the clearance of the arteries and violate its physiological functions, first of all, the ability to narrow or expand depending on the needs of the heart muscle.
The defeat of the coronary arteries atherosclerosis
The cause of atherosclerosis is a violation of fat metabolism in the body. An important role in the formation of atherosclerotic plaques occupiescholesterol
- Zip-like substance (Lipid
), which is part of the cell membranes required for the normal operation of the nervous and other organism systems. In the blood of a man cholesterol is in the associatedProteins
condition, in the form of so-called lipoproteins.In the blood of a person circulates several types of lipoproteins, namely:
- Lipoproteins are very low density. They contain little cholesterol and do not affect the formation of atherosclerotic plaques. The main function is the delivery of energy to the muscles.
- Lipoproteins of low density ( LDL, "bad" cholesterol ). These lipoproteins contain more than 70% of total blood plasma cholesterol and transport it throughout the body. Penetrating endothelium ( The inner layer of the blood vessel wall ), They are subjected to oxidation, which is considered the main starting mechanism in the development of atherosclerotic plaques.
- High density lipoproteins ( HDP, "Good" cholesterol ). They are poor cholesterol, resulting in a washing out of this substance from the walls of the arteries and the allocation of it from the body, which prevents the progression of atherosclerosis.
As mentioned earlier, the deposition of lipids in the vascular wall begins in adolescence and at the beginning does not exhibit in any way. Over time, the disease progresses, as a result of which an atherosclerotic plaque is formed. This contributes to the development of inflammatory processes in the wall of the arteries and leads to the formation of fibrous (Rubatova
) Fabric, which aggravates the violation of the physiological functions of the vessel.
In the initial period of the disease whenstenosis
) The coronary artery is expressed slightly, various compensatory mechanisms are able to maintain adequate blood flow in the heart vessels. This is carried out due to the expansion of distal arteriols (Smaller arteries, located after the place of the stenosis
), which increases the number of blood delivered to the heart. As the disease progressing, there is a further narrowing of the lumen of the affected artery, and, therefore, an even greater expansion of vessels located behind the stenosis.
Under normal conditions, with increasing the need of a heart in oxygen (With an increase in the frequency of heart rate, increase blood pressure
) The coronary arteries are expanded, which increases the blood circulation and the delivery of oxygen to the heart muscle. However, with the narrowing of the lumen of the vessel atherosclerotic plaque, this compensatory reaction is very limited, since the arterioles are already in a more or less relaxed state. As a result, during exercise, the discrepancy between the needs of myocardium in oxygen and its delivery, which leads to ischemia and the appearance of angina symptoms.
The narrowing of the enlightenment of the coronary artery by 75 - 80% is a critical point at which distally located vessels are in the most relaxed state, and their further expansion is impossible. In this case, the symptoms of angina can appear not only during physical exertion, but also at rest.
Causes of atherosclerotic plaque
The rate of formation of atherosclerotic plaques in various people is not the same and determined mainly by the level of cholesterol in the blood, as well as some other factors.The formation of atherosclerotic plaques contributes:
- Hereditary predisposition. There are family forms of metabolic disorders characterized by an increase in the concentration of LDL or a decrease in HDL.
- Male gender. The process of forming an atherosclerotic plaque more quickly proceeds in men than in women, which is associated with the participation of estrogen ( Female genital hormones ) in metabolism ( Processing ) And the elimination of cholesterol from the body. During the period of menopause, the risk of atherosclerosis in women is also increasing, which is associated with a decrease in the concentration of estrogen in the blood.
- Arterial hypertension. This disease is characterized by persistent, long-term increase in blood pressure. It has a damaging effect on the endothelium of blood vessels, which contributes to impregnation with lipids and more rapid formation of atherosclerotic plaques.
- Eternal nutrition. It has been scientifically proven that the increased content of animal fats in the food diet leads to a violation of the exchange of carbohydrates and lipids. In addition, the rate of separation of "bad" cholesterol is reduced from the body, which also contributes to the development of atherosclerosis.
- Obesity. An increase in the number of adipose tissue is combined with an increase in blood cholesterol concentration ( mainly due to low density lipoproteins ).
- Sedentary lifestyle. The absence of physical activity leads to insufficient formation of high density lipoproteins, and also contributes to obesity.
- Smoking. It has been scientifically proven that smoking contributes to the development of atherosclerosis. This is due, first of all, the influence of nicotine on the exchange of fats in the body - it leads to an increase in the concentration of "bad" cholesterol, at the same time reducing the number of "good". In addition, nicotine directly damages the endothelium of blood vessels, and also causes spasm of coronary arteries, which aggravates myocardial ischemia. Spit 1 - 2 cigarettes after receiving write ( Especially fat ) Promotes a longer increase in the concentration of low-density lipoproteins in the blood.
- Diabetes. This disease is characterized by a disorder of metabolism and damage to the walls of all vessels of the body, which contributes to the formation of atherosclerotic plaques and scar tissue.
- Hypothyroidism. The disease of the thyroid gland, characterized by a decrease in the concentration of its hormones in the blood. This leads to an increase in cholesterol.
- Nephild syndrome. This term is indicated by the defeat of the kidneys, occurring in many systemic diseases, characterized by loss of proteins with urine, edema and an increase in blood lipids.
- Chronic renal failure. A long disturbance of kidney functions leads to an increase in cholesterol levels and a decrease in the concentration of HDL in the blood.
- Reception of drugs. Receiving oral contraceptives ( contraceptive tablets ), as well as anabolic steroids ( containing men's sex hormones ) used by many athletes for the rapid growth of muscle mass, can lead to a violation of metabolism in the body and an increase in the concentration of LDL.
Causes provoking the attack of angina
As mentioned earlier, the angina attack is provoked by the inconsistency between the need of the heart muscle in oxygen and the level of its delivery. Consequently, various situations or diseases that manifest themselves with an increased heart load can lead to the development of myocardial ischemia and the occurrence of the attack of angina.An increase in the load on the heart may be due to:
- Increasing cardiac frequency ( Heart rate ) - If cardiac rhythm accelerates 2 times, then the need for myocardium in oxygen is also doubled.
- An increase in blood pressure - The higher the more energy it is necessary to drive the blood in the aorta during systole.
- Increasing circulating blood - This leads to a heart overflow with blood during a diastole, and it needs more energy to expel blood during systole.
- Exercise. Any physical activity requires an increase in the delivery of oxygen to the muscles, as well as the accelerated removal of by-products of metabolism from them, which is carried out due to the increase in heart rate. In addition, physical activity is almost always accompanied by an increase in blood pressure, which further increases the load on the heart.
- Psycho-emotional stress. With any strong emotion ( fear, maliciousness, joy and so on ) Special hormonal substances are highlighted in the blood - Catecholamines ( Adrenaline and Noraderenalin ). Their basic function is the adaptation of the body in the stressful situation. This is manifested by the narrowing of peripheral vessels ( in the skin, in the muscles ) and an increase in blood pressure. In addition, catecholamines have direct activating influence on myocardium, increasing the strength and frequency of heart abbreviations, and, consequently, the need for heart in oxygen.
- Low temperatures. In the cold, there is a spasm ( narrowing ) peripheral vessels ( predominantly skin ), as a result of which the organism heat transfer decreases. The side effect of this compensatory reaction is an increase in blood pressure.
- Tobacco Nicotine, which is part of tobacco, has a direct activating effect on the heart muscle, increasing the heart rate. In addition, its action is mediated by the activation of the nervous system and the release of norepinephrine in the blood, which leads to an increase in the frequency and force of heart rate, as well as to increase blood pressure.
- Taking a large number of food. When overflowing the stomach and intestines can squeeze the lungs, which makes it difficult to breathe and disrupt the delivery of oxygen to the heart. In addition, after meals, the blood is redistributed to the organs, the activity of which is currently the maximum, that is, to the stomach, intestines, liver and pancreatic gland, as a result of which the so-called "the phenomenon of the miscarriage" can develop, characterized by the insufficient blood supply of the heart muscle. This condition is characteristic of the elderly, as well as for patients with severe dehydration ( Liquid deficiency in the body ).
- By changing body position. With a rapid transition from the vertical position to the horizontal, the flow to the heart of the blood from the veins of the lower limbs is facilitated, which leads to the overflow of the right, and then the left heart chambers and an increase in its oxygen needs. In addition, in a horizontal position, the internal organs are shifted up ( under the action of gravity ) and can also squeeze the lungs and heart.
Signs and symptoms of stress angina
Under normal conditions, no manifestations of the disease are observed. If the impact of the factors described above leads to myocardial ischemia, a stress angina attack can develop, which, in most cases, has characteristic manifestations that allow you to quickly determine the diagnosis.Typical stress angina attack manifests itself:
- impairment of cardiac abbreviations;
- changing the pulse;
- the pallor of the skin;
- reinforced sweating;
- The characteristic behavior of the patient.
The pain syndrome is the constant and most characteristic manifestation of the angina angina. Other symptoms can complement the clinical picture of the disease, but their absence during pain attack does not exclude angina diagnosis.
The mechanism of the occurrence of pain is associated with ischemia of a certain section of the heart muscle. In the Heat of Ischemia, there are activation of various cellular elements of blood (platelets, basophils, tissue macrophages and other
). Of these, a large number of biologically active substances are distinguished, also called the polyathist of pain - histamine, serotonin and bradykinin. The durable and pronounced ischemia myocardium, the more pain mediators stand out into the surrounding blood flow. When a certain concentration is reached, these substances activate the so-called pain receptors - the nerve endings located in the heart muscle. Nervous impulse is formed in them, which, according to sensitive nerve fibers, is carried out in the brain, where painful sensation is formed.
The pain syndrome occurs in the patient during the attack of angina, is typical in most cases, and its correct interpretation is the main condition for the diagnosis.During the attack of pain in the chest, it is necessary to estimate:
- Conditions of occurrence. Pain occurs on a background of relatively prosperous state and always carries an approached character, that is, a sick person can clearly determine the time of its appearance and disappearance. In more than 70% of cases, the occurrence of pain is associated with exercise, less often there are other reasons ( Describes above ). The pain is quickly enhanced, which causes the patient to almost immediately stop the work performed. A characteristic feature of a pain attack with a stainless angina is that it appears at the same volume of physical activity characteristic of each individual patient.
- Type and localization of pain. In typical cases of angina stress, patients describe their feelings as a gone, compressive, burning pain behind the sternum or in the field of the front departments of the chest, mainly on the left. Often, painful pain is preceded by a "feeling of discomfort in the chest", which can last a few seconds or minutes. Describing its condition, patients usually press the palm to the chest and squeeze the hand in the fist, thus trying to convey the character of painful sensations.
- Irradiation ( Spread ) Pain. Almost always notes the spread of pain in the left area of the body - in hand, shoulder, shovel, clavicle, lower jaw, less often - in the upper departments of the abdomen and extremely rare - to the region of the right half of the chest, right hand. Sometimes pain in one of these areas may be the only manifestation of angina, which makes it difficult to diagnose. The emergence of this symptom is explained by the fact that the nerve fibers conducting pain impulse from damaged myocardium to the brain are located in the spinal cord quite close to other nerves conducted by sensitive pulses from nearby parts of the body. As a result of this, a feeling of pain is formed at the brain level, although in fact no pathological processes are developing in them.
- The duration of a painful attack. In a typical case, the duration of pain ranges from 1 to 5 - 7 minutes, extremely rare - 15 - 20 minutes ( For example, if the patient does not stop physical activity after pain, either with an extensive zone of myocardial ischemia ).
- Termination conditions for pain. The cessation of physical activity or eliminating another causal factor that caused the attack of the anginoard, as well as the resorption of nitroglycerin tablets leads to a rapid ( within a few minutes ) Reducing and disappearance of pain without any residual phenomena.
Dyspnea is a subjective feeling of air shortness, accompanied by an increase in the frequency and depth of respiratory movements. Dyspnea can appear during the attack of angina, if ischemia is exposed to a large portion of the heart muscle, usually in the region of the left ventricle. Due to the lack of oxygen, the contractile ability of myocardium decreases, and the blood coming from the lungs cannot be "pumped" in the aorta. This leads to a stagnation of blood and increase the pressure in the pulmonary vessels, as a result of which the liquid part of blood goes into the lumen of the respiratory tract, significantly hampers the gas exchange process. The consequence of the described phenomena is hypoxemia (Reducing oxygen concentration in arterial blood
) that reflectically causes an increase in the frequency and depth of breathing.
After eliminating the cause that caused the angina attack, the feeling of lack of air disappears almost simultaneously with pain syndrome. It is worth noting that shortness of breath can appear before the occurrence of pain, being a consequence of physical activity provoked by the attack.
Heart rate violation
The violation of the blood supply to myocardium may lead to a violation of the rhythm of the heart, which is manifested by an increase (Tachycardia
), decrease (Bradycardia
) cardiac frequencies or alternating data formsarrhythmia
.Arrhythmias can manifest themselves:
- sense of lack of air;
- common and muscle weakness;
- darkening in the eyes;
- loss of consciousness.
The development of these manifestations is due to a decrease in blood circulation in the brain, muscles and other organs resulting from a violation of the pump function. With pronounced tachycardia (When the heart rate may exceed 200 shots per minute
) Diastole is shortened to so much that the heart does not have time to fill in blood, so the amount of blood expeded in the artery during systole is significantly reduced. In bradycardia, the heart can decline with a frequency of less than 60 shots per minute, which is not enough to maintain blood flow in vital organs at a constant level.
Pulse is the oscillation of the elastic walls of the arteries caused by the release of blood in them. As a result of a decrease in the contractile activity of myocardium, with each systole in the artery, fewer blood is pushed out, which leads to a change in the characteristics of the pulse. It is possible to determine the pulse by pressing the fingers to the large artery, which is relatively shallow.The most affordable arteries allowing to determine the pulse are:
- Carotid artery - Determined on the side surface of the neck, 2 - 3 cm on the side of Kadyk ( Adamova Apple ).
- Shoulder artery - Determined in the region of the middle third of the inner surface of the shoulder.
- Radiation artery - Protects in the field of the front surface of the wrist or the lower third of the forearm.
- Increasing or, on the contrary, a decrease in frequency - Normally, the frequency of heart abbreviations and the pulse ranges from 60 to 90 shots per minute.
- Violation of rhythm - unequal intervals between several subsequent pulse waves.
- Low filling ( empty or filamental pulse ) - The pulse wave felt weaker than usual.
- Soft - The slightest effort to overlook the artery and prevent further pulse wave.
Pallor of skin
During the attack of angina, the skin can lose its familiar pink shade, "lighten" or become slightly yellowish. This symptom occurs due to the release of catecholamines to the blood (which narrow skin vessels
), as well as in severe cases of angina, when the heart is not able to pump the necessary volumes of blood, resulting in a narrowing of peripheral vessels of the skin, aimed at maintaining blood circulation in vital organs (brain, liver, kidneys
On the other hand, the narrowing of the skin vessels may be the root cause of the attack of angina region (For example, in the cold
), which also needs to be taken into account when diagnosing.
This reaction develops reflexively and is associated with the flow of hormoneStress
, in particular, adrenaline and norepinephrine, which leads to a rapid allocation of a large amount of cold, sticky sweat. This is due to the pain in the chest, the lack of air and the reinforced heartbeat during the attack of angina, which in itself is a strong stress factor for a person. Enhanced sweating can occur throughout the body surface, but the most expressed in the area of the face, the axillary depression, palms and soles.
Behavior of patients during an attack
The attack of the stress angina is characterized by a very typical behavior of the patient, which allows the surrounding timely to recognize this disease. During the attack, the patient "freezes", that is, it ceases to any physical activity. If the pain arose during walking - it stops, applies his hand to the chest and lightly bent forward. If the attack has evolved at night (with severe forms of the disease
) - Patients try to take a sedentary position in bed (This reduces blood flow to the heart and its need for oxygen.
Frequent and strong heartbeat, lack of air and pain significantly affect the psycho-emotional state of the patient, which is described by many patients as "fear of death." The patient's face during the attack is pale, frightened, "suffering", the droplets of sweat appear on the forehead.
Types of angina stress
There are several angina classifications developed on the basis of pathological processes occurring in a heart muscle, taking into account clinical manifestations, the risk of developing complications and forecast. In this section, a clinical classification will be given, as it is better than others make it possible to understand the essence of the changes occurring in the body of the patient with a given disease.From a clinical point of view distinguish:
- for the first time arising angina stress;
- stable stress angina;
- Progressing stress angina.
It is worth noting that for the first time arising and progressive angina is included in the group of unstable angina. This is due to a higher risk of developing complications (including acute myocardial infarction
) With these forms of the disease. Stable angina opposite is characterized by a relatively favorable flow and forecast.
For the first time arising angina stress
This group includes angina attacks that have arisen for the first time or after a long time (in several years
) The period of life without attacks. Attacks may arise as a result of the effects of any of the factors described above. Usually, this diagnosis is made within a month after the appearance of the first attack, after which, depending on the progression of the disease and the severity of manifestations, it is diagnosed with a stable or progressive stress angina or another kind of ischemic heart disease.
It is important to understand that for the first time the angokery attack may be due not only to the narrowing of the loss of the vessel, but also the gap of atherosclerotic plaques,Thrombosis
or spasm of coronary vessels. These states relate to the so-called spontaneous angina and require the immediate hospitalization of the patient.
Stable angina stress
This diagnosis is set in case the pain attack occurs during the physical activity of a certain intensity. At the same time, the load needed for its occurrence does not change for a long time, and clinical manifestations are always the same type and similar to each other.
Stable angina stress is divided into 4 functional classes, which are determined depending on the load necessary for the occurrence of pain.In the stable angina stress distinguish:
- I functional class. Stenicard attacks rarely occur with extremely severe physical exertion or stress. The duration of the attack usually does not exceed 2 - 3 minutes. Daily patient activity is not limited.
- II functional class. Stenicard attacks occur with long, continuous walking ( More than 500 meters ), During run, when lifting steps on several floors. The likelihood of an attack increases during stress, in the frost, after eating or smoking, which slightly limits the daily activities of the patient.
- III functional class. The attack occurs at a slow walking at a distance of more than 100 - 200 meters, with a lift to the 1st floor, with any excitement or stress, which significantly limits the daily activities of the patient, but it is able to serve himself.
- IV functional class. The attack occurs at any, even the most insignificant load ( Lifting with bed, dressing coat ) or even alone ( more often at night in the lying position ). Any movement is accompanied by pain, so such patients need constant care and observation.
Progressive stress angina
If the clinical picture of the disease occurs over time (Compared with previously observed symptoms
), We are talking about the progressive angina stress.The characteristic features of the progressive angina stress are:
- Reducing the minimum load causing the occurrence of pain attack, including the appearance of symptoms alone.
- Increase the duration of the attack.
- Increase the frequency and severity of the progred pain.
- Joining new symptoms ( In addition to pain, shortness of breath can appear, dysfunction of heart rhythm, fainting ).
- Reducing the effectiveness of nitroglycerin ( the earlier dose becomes not enough to eliminate pain syndrome ).
Diagnostics of stainless angina
The diagnosis and treatment of angina is a cardiologist. To confirm the diagnosis, the correct survey of the patient plays an important role (Collect Anamneza
), during which the doctor reveals the presence of risk factors, and also asks the patient to describe in detail the attacks of angina, to tell that they provoke and that the patient undertakes to facilitate his condition.
The correct survey makes it possible to suspect the stress angina, however, for the final confirmation of the diagnosis, the definition of the form of the disease and the appointment of the right treatment should be carried out a number of additional research.To confirm the diagnosis of the voltage angina, applies:
- inspection and clinical examination;
- Electrocardiography ( ECG );
- Functional load tests;
- Daily monitoring of the ECG by the method of the Holet;
- Echocardiography ( Ehoche );
- heart scintigraphy;
- positron emission tomography ( PAT );
- laboratory research.
Inspection and clinical examination
With suspected angina tension, the doctor necessarily conducts a complete clinical examination of the patient, paying particular attention to identifying risk factors that could lead to the development of atherosclerosis.During clinical examination, the doctor assesses:
- Skin condition;
- body weight;
- cardiovascular system;
- respiratory system.
During the general inspection, we can identify a number of nonspecific signs that indicate a violation of fats and for a common atherosclerotic process. Thus, in the region of the upper century, xantellasma can be determined - the yellowish color of the formation, protruding over the surface of the skin, which are a cluster of lipids. The same formation (xanthomy
) Can be determined on other areas of the skin throughout the body.
Another sign of atherosclerosis is the old root arc - a light gray strip, located along the edge of the cornea of the eye. Of course, the lack of these features does not exclude the possibility of presence of atherosclerosis, but their presence is a rather specific symptom of this disease.Estimation of body weight
More than half of the patients with angina, there is an excessive body weight, up to obesity of varying degrees. Estimate the weight of the patient is possible using the body mass index (BMI
) - standardized indicator calculated by the formula - BMI = (Weight per kilograms
) / (Growth in meters
. Normal is the indicator ranging from 18.5 to 24.9.Research cardiovascular system
At percussion (Treaty
) And the palpation of the chest can be determined by the shift of the boundaries of the heart to the left. This is due to hypertrophy (Increase
) Myocardial - a compensatory reaction arising from a long high load on the heart.
When listening to the heart during the attack of angina, the mute is determined by the muffling of the heart tones (Due to the reduction of myocardial contractility
), the emergence of pathological noise, arrhythmias, rapid or rare heartbeat. Outside the attack in light cases of the disease, no changes are noted. With severe forms (III - IV functional class
) The muffition of cardiac tones and arrhythmias can be determined alone.
Characteristics of the pulse during the attack of angina were described earlier. It is very important to carry out simultaneous listening of the heart and determining the pulse on the radial artery, since in some arrhythmias of the heart rate can be greater than the pulse rate.
In more than half of the cases, an increase in blood pressure is revealed above 140/90 millimeters of mercury pillar (at a rate of 120/80 mm. RT. Art.
).Research of the respiratory system
The character and frequency of respiration, the participation of the chest and auxiliary muscles is evaluated (Neck and shoulder belts
) In the act of breathing, the presence or absence of shortness of breath. If, when listening to lungs, wet wipes are determined - this may be a sign of heart failure and the release of liquid blood in the respiratory tract (Development of edema of the lungs
), which is typical for late stages of the disease.
ECG allows you to determine the functional activity of the heart and identify signs of a number of diseases. The principle of the method is based on measuring the difference in electrical potentials between excited and non-excited portions of myocardium arising from the sequential propagation of the nerve impulse.
Electrocardiography takes no more than 2 to 5 minutes. The patient's body attach electrodes connected to a special apparatus - an electrocardiograph that records the data of the electrical activity of the heart on paper.
Half of patients with angina region (especially in young patients
) Outside the approach of ECG will not reveal any changes. With III - IV functional classes in elderly or long-friendly patients, changes are made characteristic of various complications of the disease. During the attack of angina, signs of myocardial ischemia are always noted.Outside the attack of angina ECG can reveal:
- rhythm and conductivity disorders;
- Signs of myocardial hypertrophy;
- signs of myocardial infarction;
- Increase the time of the heart cycle.
- Change of amplitude and polarity of the T. T. This tooth displays the repolarization process ( Relaxation ) Heart ventricles during diastole. Normally, he is positive ( That is, directed to the same side as the QRS complex that reflects the systole ), Its height is not more than 3 - 6 mm. In case of ischemia, myocardia gets insufficient oxygen, and therefore the processes of muscle relaxation are disturbed, which can manifest themselves high ( More than 8 mm ) and / or negative teeth T per ECG.
- Depression ( Reduced ) ST segment. The ST segment displays a period of time from the end of the reduction of ventricles before the beginning of their relaxation, that is, the moment when myocardium is most tense. Normally, this segment is at the level of isolation. With ischemia, an easy or moderate severity, the maximum strength reduction of the heart muscle decreases, which will reflect in the decrease in ST segment below the isolated.
- Lifting segment ST. He indicates severe ischemia that propagates on the whole thickness of the myocardial wall.
ECG is registered in 12 standard leads, which allows not only to identify the presence of ischemia, but also determine the area of the heart in which it develops. The changes described are registered exactly as much as the painful attack lasts, and disappear after it is disappeared.
Functional load tests
Due to the fact that outside the attack of changes on the electrocardiogram is often absent, with the diagnostic purpose, various methods that provoke the development of myocardial ischemia are used, that is, the occurrence of the attack of angina. During the execution of tests, an ECG continuous registration is performed, blood pressure (Every 2 - 3 minutes
), as well as listening to the tones of the heart.
It is important to understand that these studies are associated with certain risks, so they must be performed only in the hospital in the presence of a qualified physician in the presence of instruments and medicines necessary to provide first aid.Contraindications to the execution of load tests are: For the purpose of provoking the attack of angina, it is used:
- Tredmil ( Treadmill );
- Dobutamin test;
- Dipyridamil test;
- Cleaning electrical stimulation of the heart.
With this study, the patient sits on a special apparatus, resembling an exercise bike, and the doctor using a computer program sets the load of a certain intensity, gradually increasing it. When signs of myocardial ischemia on the ECG either, with a worsening of the health of the patient, the study is immediately terminated, and the patient is given a nitroglycerin tablet under the tongue.Tredmil
In this case, instead of a bicycle ergometer, a moving track is used, the angle of inclination and the speed of which is regulated by the doctor. The patient goes or runs through it, and at this time the ECG registration and other heart work indicators are registered.Dobutamin test
Dobutamine is a drug, the intravenous administration of which leads to an increase in the heart rate and the rise of blood pressure, which enhances the load on the heart and increases its need for oxygen. If at the same time the patient has an atherosclerosis of coronary vessels, a typical clinical and electrocardiographic picture of the attack of angina will occur.
This study is shown in the event that it is impossible to perform a cyergometry or a treadmill test (For example, when fractures or other diseases of the musculoskeletal system, with respiratory failure
) - a medication that causes the rapid and pronounced expansion of small coronary arteries. In case of intravenous administration of this drug, the blood flow is redistributed in the heart muscle - healthy arteries are expanding, and more blood flows in them. At the same time, the arteries affected by atherosclerosis cannot expand, so the amount of blood incoming in them decreases (There is a phenomenon of the troughing
), which leads to the development of ischemia of the affected area of myocardium.
This study is shown when it is impossible to perform tests with exercise, as well as young, physically strong people (To cause an attack of angina at the athlete, you need extremely severe or long-term loads
).Cleaning electric heap stimulation
This method is shown in cases where it is impossible to perform tests with exercise. In this case, in the esophagus (through mouth or nose
) A special electrode is introduced, which is installed at the atrium level and begins to send electrical pulses to the heart, thus increasing the heart rate and provoking angina attack. Registration of heart performance is carried out in the same way as with other load tests.
Daily monitoring ECG on Holter
The essence of this study is to use a small portable electrocardiograph, which is attached to the patient's body and registers the ECG within 24 or more hours. The data obtained are stored in the embedded computer and can be studied after the termination of the study.
The main advantage of this method is the ability to study the work of the heart during the daily activity of the patient. This allows you to identify the conditions for the occurrence of angina attacks and possible risk factors.
The principle of the method consists in ultrasound examination of the heart and large vessels, carried out in order to identify functional or organic lesions.EchoCG allows you to determine:
- heart dimensions and its cameras;
- Heart filling degrees;
- Blood stagnation in pulmonary veins;
- myocardial hypertrophy;
- Violation of blood flow in coronary arteries ( Doppler Ehokg );
- Moved myocardial infarction.
Echocardiography can also be used during the execution of load tests described earlier (Stress-Ehocheg
). During angina, a decrease in the mobility of the myocardial wall in the zone of ischemia will be determined.
The principle of this method is to be introduced into the coronary arteries of the radioactive substance (Tyvali is usually used
). The waist is absorbed by cardiomyocytes and is decayed in them, as a result of which radioactive radiation is allocated, registered by special cameras in three projections. The portion of myocardium, the blood supply to which is broken, absorbs less waist and will be determined on the scintigram as a "cold" focus.
The efficiency of the method increases significantly if it is used during tests with exercise or during dipyridamol test.
Positron emission tomography
This method is based on the introduction of special radioactive substances into the body, which are included in the metabolic processes occurring in the heart muscle. Thus it is possible to determine not only the zones of ischemia, characterized by a decrease in metabolic (exchange
) processes, but also areas of non-visual myocardium (After heart attack
This X-ray study, which is the "gold standard" in the diagnosis of heart vessels atherosclerosis. The essence of the method is carried out in the coronary arteries of the X-ray infertility, which allows you to identify the affected vessels, determine the localization, dimensions of the atherosclerotic plaque and the degree of narrowing of the glorification of the artery. This method is always used when planning the surgical elimination of sclerotic plaques.Performing coronaryogeniography contraindicated:
- with systemic infections;
- with severe heart failure;
- at arrhythmias;
- With violation of cerebral circulation.
With uncomplicated angina stress, the laboratory test of blood does not reveal any deviations from the norm. However, certain analyzes may be useful to identify the cause of angina or if the development of myocardial infarction is suspected.Under the voltage angina, the doctor may assign:
- General blood analysis. Reducing the concentration of erythrocytes and hemoglobin in the blood indicates the presence of anemia, aggravating myocardial ischemia.
- Blood chemistry. The level of glucose is determined ( To eliminate diabetes ), as well as the levels of all blood lipoproteins are determined. An increase in the level of general cholesterol may indicate on the violation of fats in the body ( more than 5.2 mmol / l ) and LDL ( Over 3 mmol / l ), as well as a decrease in the concentration of HDL ( less than 1 mmol / l ).
- Determining the level of hormones of the thyroid gland ( T3 and T4. ). Reducing their concentration in the blood can be observed in hypothyroidism.
- Determination of biochemical myocardial damage markers. These markers are intracellular enzymes that fall into the blood after the destruction of cardiomyocytes ( With myocardial infarction ). The most informative is to determine the level of troponins, myoglobin, creatine phosphocainase ( MV Fractions ) and lactate dehydrogenase ( LDH. ).
Treatment of angina stress
Therapeutic measures for angina should be aimed at reducing the frequency and intensity of pain attacks, preventing the development of complications and eliminating the cause of the disease (if possible
). Typically, patients with stable angina stress do not need hospitalization, but when developing complications, they may need urgent medical care.The main directions in the treatment of stained angina are:
- elimination of pain attack;
- medication treatment;
- diet and therapy;
- lifestyle change;
- Folk treatments;
Elimination of pain
As mentioned earlier, the pain attack occurs suddenly and lasts about 5 minutes. However, it should be understood that each attack of angina is accompanied by a violation of the work of the heart muscle, and this in the absence of proper and timely treatment can cause myocardial infarction and death.In the occurrence of the attack of angina, it is necessary:
- Immediately stop any physical activity. It is necessary to calm down and take a comfortable position. It is not recommended to go to bed, because at the same time the pain can increase. It is best to sit down or if the attack happened on the street, find, to rely on. If the attack has evolved at night, a half-sidier position should be taken. No need to get up sharply from bed, as this can lead to dizziness and loss of consciousness.
- Take a nitroglycerin tablet under the tongue. Nitroglycerin ( drug from the group of nitrates ) relaxes the muscles of the vessels ( Mostly veins ), reducing the amount of blood coming to the heart. This reduces the burden on the heart muscle and its need for oxygen. When taking a nitroglycerin tablet ( 0.5 mg ) Fast is noted ( After 30 - 60 seconds ) The effect of the effect, which is due to the receipt of the drug directly into the bloodstream. If after 5 minutes the pain did not decrease, you can take another 1 tablet. If after the resorption of 3 tablets, the pain attack did not pass, it should be immediately called an ambulance, since in this case the likelihood of myocardial infarction is high.
- Contact a specialist. If the pain arose with less than usual, exercise, if symptoms appeared during the attack, which were not before ( shortness of breath, dizziness, loss of consciousness ), Or if the attack arose for the first time, it is necessary to consult with the doctor, since the manifestations described may indicate the progression of the disease or unstable angina.
Patients with a light form of stable stress angina (I - II Functional Classes
) Medical treatment is shown during attacks (For their relief
), as well as for the correction of the disturbed exaglamation of fats in the body. With other wall shapes, drugs are additionally prescribed, affecting the cardiovascular system, which implancing the properties of blood and reduce the risk of complications.The main directions of drug treatment of the stress angina are:
- Antitrombocytic therapy - Reduces the risk of blood clots on the wall of atherosclerotic plaques ( What is the main cause of heart attack and death ).
- Anti-Hishemic therapy - Preparations that reduce the load on the heart are used, thereby preventing or eliminating the attack of angina and other symptoms of the disease.
- Improvement of metabolism in the zone of ischemia - Preparations that increase the stability of myocardium under conditions of lack of oxygen are used.
- Fat Exchange Correction - Prevents further progression of atherosclerosis.
Medical treatment of stress angina
|Group of medicines||Main representatives||Mechanism of therapeutic action||Method of application and dose|
|Non-steroidal anti-inflammatory means||Aspirin (Acetylsalicylic acid )||Inhibits the cyclooxygenase enzyme, which prevents the activation of platelets, gluing them with each other and with a vascular wall ( that is, the formation of thromba ).||Take inside, after eating, drinking a glass of water. Recommended dose - 100 - 325 mg 1 time per day. The duration of treatment is several months.|
|Antiagreganta||Tiklopidine (Tiklid. )||Blocked platelet receptors, acneeted thrombosis process. Reduce the concentration of the IV coagulation factor in the blood.||Inside, during or after meals, at a dose of 250 mg 2 times a day. The duration of application is not more than 2 - 3 months. During treatment, it is necessary 2 times a month to hand over a general blood test ( The drug can coagulate blood formation ).|
|Clopidogrel (Plavix )||Inside, regardless of meals, at a dose of 75 mg 1 time per day. During treatment, it is necessary to take a general blood test twice a month.|
|Nitrate||Nitroglycerine||Expand the veins of the body, reducing the load on the heart ( A more detailed mechanism of action is described above. ). The difference lies in the speed of the offensive and the duration of the effect.||The rules of application and dosage are described above.|
|Isosorbide Dinitrat (Flashing, aerosonit )||Inside, 1 tablet of long-term action ( 60 or 120 mg ) 1 - 2 times in the knocks. The effect develops after 30 - 50 minutes and lasts 12 - 15 hours.|
|Isosorbide Mononitrat (Izomonat, Monizid, Mono Mac )||Inside, 1 tablet of long-term action ( 50 - 100 mg ) 1 time per day. The effect develops after 30 - 50 minutes and lasts up to 24 hours.|
|Other vasodilators||Molomin||Expands veins of the body ( Like nitrate ), as well as depress the activation of platelets and thrombosis.||Inside, regardless of meals, 2-4 mg ( 1 - 2 tablets ) 2 - 3 times a day. Durable preparations - 1 tablet ( 8 mg ) 1 - 2 times a day.|
|In-adrenoblocators||Propranolol|| Block specific in-receptors in the heart, causing: ||Inside, regardless of meals, at 20 - 40 mg 3 - 4 times a day. Treatment is long. Cancellation of the drug ( like all B-blockers ) should be carried out slowly with a gradual decline in dose for several weeks ( Otherwise, tachycardia, headache, arrhythmia can develop ).|
|Atenolol||Inside, 50 - 100 mg 1 - 2 times a day.|
|Bisoprolol||Inside, 5-20 mg 1 time per day.|
|Blockers of slow calcium channels (BMKK. )||Verapamil||Blocks the flow of calcium into the cells of the synoatrial node and cardiomyocytes, reducing the heart rate and the contractile activity of the heart.||Inside, regardless of meals, 80 - 120 mg 2 - 3 times in the knocks.|
|Nifedipine||Expanding peripheral arteries, reducing blood pressure and heart load.||Inside, 20 mg 1 - 2 times a day.|
|Diltiazem||Combines the effects of the two medications described above.||Inside, in a dose of 90 - 180 mg 1 time per day.|
|Improved metabolism zone of ischemia|
|Cytoprotectors||Riboxin||ATP predecessor ( Adenosine Triphosphate - Energy Source in the Body ). Improves coronary blood circulation and metabolic processes in the zone of ischemia, prevents the development of arrhythmias.||Take inside. The initial dose is 200 mg 3 - 4 times a day. If necessary, the daily dose can be increased to 2.5 g. The duration of treatment is up to 3 months.|
|Trimetazidine||Optimizes the use of oxygen with cardiomyocytes in the zone of ischemia.||Inside, during meals, 20 mg 2 - 3 times a day.|
|Correction of the exchange of fats|
Simvastatin (Zocor, Symmer )
|Preparations of this group are inhibited by cholesterol formation in the liver, which leads to a decrease in the concentration of LDL and simultaneously increase the concentration of HDL in the blood.||Inside, 1 time per day ( in the evening, during dinner, as cholesterol synthesis takes place mostly at night ), at a dose of 5 - 80 mg. Squeeze with glass boiled water.|
RTustatin (Lipostat )
|Inside, 1 time per day during dinner, at a dose of 10-20 mg.|
Lovastatin (Mevor, Rovakor )
|Inside, 1 time per day during dinner, at a dose of 10 - 40 mg.|
|Nicotinic acid preparations||Acipimox||Reduces the concentration of free fatty acids and LDL in the blood.||Inside, 250 mg 2 times a day, after eating.|
|Enduracin||Reduces the concentration of cholesterol and LDL in the blood. Increases the concentration of HDL.||The initial dose is 500 mg 1 - 3 times a day. In the absence of effect, the daily dose can be increased to 2 grams.|
|Sequestrants of bile acids||Cholestyramine||Bind bark acids in the intestines and contribute to their removal from the body, resulting in the liver the formation of bile from cholesterol is activated. Reduce the level of total cholesterol and LDL blood.||From 2 to 5 grams of the drug to dissolve in a glass of water. Take inside, before meal, 2 - 4 times a day.|
|Colestip (Heller )||Inside, before meal, dissolving in the glass of water. Initial dose - 1 - 1.5 g 2 - 4 times a day. If necessary, the daily dose can be increased to 30 g.|
It is a key point in the treatment of stress angina, especially in obesity and pronounced increasing level of cholesterol and LDL in the blood. Such a patient is shownDiet number 10.
"C", the purpose of which is the normalization of cholesterol concentration in the blood, elimination of excess body weight and normalization of metabolism in the body.
According to WHO (World Health Organization
) A healthy person should not consume more than 300 mg of cholesterol per day. In patients with atherosclerosis or angina phase, this indicator should not exceed 200 mg per day.
Cholesterol content in major food
|Product name||Approximate amount of cholesterol ( in milligrams )|
|Kidney ( 100g )||1120.|
|Liver ( 100g )||430.|
|Red or black caviar ( 100g )||300.|
|Shrimps ( 100g )||150.|
|Cream 20% ( 1 cup )||120 mg|
|Middle Fat Fish ( Marine Okun, Carp )||90.|
|Cooked meat ( Beef, lamb )||90 - 95.|
|Sausage boiled ( 100g )||60.|
|1 cup of milk ( 6% )||45.|
|1 cup of kefir ( 3% )||thirty|
|Dairy ice cream||fifteen|
|1 teaspoon mayonnaise||5|
During stress angina, fractional power is recommended (4 - 6 times a day in small portions
). The last meal must be at least 2 - 3 hours before bedtime. Power must be regular, as long-term fasting activates fat spanning processes in the body.
Diet and therapy in patients with stress angina
|Recommended to use||Not recommended to use|
| || |
Changing lifestyle is one of the important stages of treatment. First of all, it is necessary to eliminate all risk factors that can cause angina progression and provoke pain attack. In addition, it is scientifically proven that moderate physical activity leads to a decrease in the concentration of "bad" cholesterol and to increase the level of HDL, so patients need to be regularly played.
Recommendations for lifestyle change during stress angina
|What is recommended to do?||What is not recommended to do?|
| || |
Some medicinal plants apply to traditional medicine to combat heart disease. A certain effect of them can be expected at angina stress. Basically, relaxing and soothing herbs are used, substances that improve the work of the heart and the normalizing metabolism in the body.For the treatment of stress angina is used:
- Infusion of hawthorn. For the preparation of the infusion you need to take 3 tablespoons of the berries of the hawthorn and pour 2 liters of steep boiling water. Insist the day in a dark place, then strain, squeeze the swollen berries and take 1 cup per day during meals. It has an antiarrhythmic effect, reduces blood pressure, improves the blood supply to the heart, and also reduces the amount of cholesterol in the blood. The duration of treatment is not more than 3 weeks in a row.
- Infusion of Valerian root. You need to take 1 tablespoon of chopped valerian core and pour 1 glass of boiling water. Insist in a dark place during the day, then strain and take 1 tablespoon 3 times a day in 30 minutes before meals. Valerian has a soothing action, expands the coronary vessels, and also reduces blood cholesterol levels ( Strengthening bile from the body ).
- Motherwort tincture. 100 grams of dry dye leaves pour 500 ml of 70% alcohol and insist in a dark place for 3 to 4 weeks. Strain and take 5 - 7 drops of tincture 3 - 4 times a day 30 minutes before meals. The dyingman has a soothing effect, improves the heart of the heart, and also contributes to the removal of fluid from the body, which reduces the load on the heart muscle.
It is important to remember that stress angina can lead to very serious complications, so treatment is extremely undesirable for the treatment exclusively by folk remedies.
Surgical treatment is to revascularization (Restoration of passability
) Coronary arteries during surgery. This technique reduces the risk of complications and increases the average duration of the patient's life.In order to revascularizing the coronary arteries, used:
- Cressing transluminal coronary angioplasty. The stenosis site is carried out a special canister, which is swept under pressure in a few atmospheres, destroying an atherosclerotic plaque and increasing the clearance of the arteries by 50-80%. The risk of re-samples with this method is more than 30%. In this connection, the stinting method has recently been used - after expanding the stenzated artery, a special wire frame is established in it ( stent ), which prevents re-stenosis.
- Aorticoronary artery shunting. The essence of this operation is to impose anastomosis, that is, a bypass path of blood from the aorta to the coronary artery on the place of narrowing. For this purpose, a part of the patient's subcutaneous vein is usually used. The effectiveness of this operation is almost 90%, which ensures the normal blood supply to myocardium for 10 years or more.
- defeat two or three coronary arteries;
- lesion of the left coronary artery ( larger, nourishing left ventricle );
- pronounced decrease in the pump function of the heart ( regardless of the number of affected arteries ).
- With diffuse stenosis of all coronary arteries.
- With a decrease in the pump function of the heart, due to the presence of a set of scars ( After transferred infarcs ).
- In the presence of severe concomitant diseases ( renal failure or liver failure, cancer in the last stage and so on ).
Forecast for the abdation and quality of life for patients with stress angina
The forecast is determined primarily by the type of disease. With I - II functional classes of stable angina voltage, the quality of the life of patients is generally not reduced. They can live to a deep old age provided that they will take adequate treatment, comply with the diet and lead a healthy lifestyle. The only limitation of patients from this group is the work associated with severe physical activity (Professional sport, work in the agricultural industry, on the forestworker and so on
). The risk of developing complications under these walls of angina is relatively low.
With an unstable stress angina (first or progressive
) Either at the III - IV functional classes of stable angina, the outlook is less optimistic. Such patients are often disabled, and their daily activity is significantly limited, which sometimes requires constant surveillance. Without timely treatment, the life expectancy of such patients is reduced. This is due to the high risk of developing complications, many of which they may end with fatal.The stroke angina may complicate:
- Myocardial infarction. The heart attack is the most formidable complication of angina, resulting from the rupture of the wall of atherosclerotic plaques and the formation of a thrombus, a fully blocked lumen of the affected artery. The consequence of this is the death of a portion of myocardium, blood delivery to which is broken. If immediately after that did not come the death of the patient ( Due to a sharp and pronounced reduction in the contractile activity of the heart ), dead cardiomyocytes are replaced by fibrous cloth, that is, a scar is formed.
- Arrhythmias. Violation of blood supply to myocardium, as well as the presence of scars, contributes to the occurrence of arrhythmias, which may cause dizziness and fainting. The most dangerous type of arrhythmia is the fibrillation of ventricles, in which cardiomyocytes are reduced and relaxed separately with high frequency. The pumping function of the heart is almost absent, which without emergency assistance ( Defibrillation ) He leads to the patient's death within 2 - 5 minutes.
- Heart failure. With pronounced atherosclerosis, either as a result of a set of transferred heart attacks the heart is not able to perform its function, which leads to the appearance of edema on the legs, shortness of breath, elderly and other manifestations of heart failure.
- Thromboembolism of the pulmonary artery. In some cases, when the atherosclerotic plaque is broken, the thrombus can get into the right ventricle. With blood current, it is transferred to pulmonary artery and clog them, which can lead to acute respiratory failure and death of the patient.
- elderly age;
- The appearance of the first attacks up to 30 years;
- common atherosclerotic process ( With the defeat of more than 3 coronary arteries, the forecast is less favorable );
- pronounced stenosis of the left coronary artery ( narrowing more than 70% of her lumen );
- pronounced reduction in the contractile ability of the heart;
- high blood pressure ( more than 180/90 mm. RT. Art. );
- Concomitant respiratory failure.
Angina - The form of IBS, characterized by the bogged pain in the heart region, due to the acute insufficiency of the blood supply to myocardium. There is a stress angina, arising from physical or emotional loads, and a chape angularity arising outside the physical effort, more often at night. In addition, the sore pain is manifested by a sensation of suffocation, the poverty of the skin, the oscillations of the pulse frequency, the sensations of interruptions in the heart of the heart. May cause the development of heart failure and myocardial infarction.
Angina - The form of IBS, characterized by the bogged pain in the heart region, due to the acute insufficiency of the blood supply to myocardium. There is a stress angina, arising from physical or emotional loads, and a chape angularity arising outside the physical effort, more often at night. In addition, the sore pain is manifested by a sensation of suffocation, the poverty of the skin, the oscillations of the pulse frequency, the sensations of interruptions in the heart of the heart. May cause the development of heart failure and myocardial infarction.
As a manifestation of ischemic angina disease, almost 50% of patients occurs, being the most frequent form of IHD. The prevalence of angina is higher among men - 5-20% (against 1-15% among women), with age, its frequency increases sharply. Stenzardia, due to specific symptoms, is also known as "breast toad" or coronary heart disease.
The development of angina is provoked by the acute insufficiency of coronary blood flow, as a result of which the imbalance is developing between the need of cardiomyocytes in the flow of oxygen and its satisfaction. Violation of perfusion of the heart muscle leads to its ischemia. As a result of ischemia, oxidative processes in myocardium are disturbed: an excessive accumulation of unsophisticated metabolites (dairy, coal, peyrograde, phosphoric and other acids) occurs, ionic equilibrium is disturbed, the synthesis of ATP is reduced. These processes are first caused by diastolic, and then systolic dysfunction of myocardium, electrophysiological disorders (changes in the ST segment and teeth T per ECG) and, ultimately, the development of pain reaction. The sequence of changes occurring in the myocardium is called the "ischemic cascade", which is based on a violation of perfusion and changing metabolism in the heart muscle, and the final stage is the development of angina.
Oxygen insufficiency is particularly acutely felt by myocardium during emotional or physical stress: for this reason, the angina attacks are more likely to occur with enhanced heart performance (during physical activity, stress). Unlike acute myocardial infarction, in which irreversible changes are developing in the heart muscle, the disorder of the coronary circulation is transient. However, if the hypoxia of myocardium exceeds the threshold of its survival, then angina may grow into myocardial infarction.
Causes of angina
The leading cause of angina, as well as ischemic heart disease, the narrowing of coronary vessels caused by atherosclerosis. Stenicard attacks are developing with a narrowing of the surveillance of coronary arteries by 50-70%. The more pronounced atherosclerotic stenosis, the hardest angina flows. The severity of the angina also depends on the length and localization of the stenosis, on the number of affected arteries. Pathogenesis of angina is often mixed, and along with atherosclerotic obstruction, the processes of thrombosis and spasm of coronary arteries may occur.
Sometimes angina develops only as a result of angiospams without atherosclerosing the arteries. Under a number of pathologies of the gastrointestinal tract (diaphragmal hernia, gallstone disease, etc.), as well as infectious and allergic diseases, syphilitic and rheumatoid lesions of vessels (aortitis, periaterite, vasculitis, endarterite), reflex cardiosphazm, caused by a violation of the highest nervous regulation of crown The arteries of the heart is the so-called reflex angina.
The development, progression and manifestation of angina influence the modifiable (disposable) and unmodifiable (uncommunicable) risk factors.
Unmodifable risk factors of angina region include gender, age and heredity. It has already been noted that men are most susceptible to the risk of angina. This trend prevails up to 50-55 years, i.e., before the onset of menopausal changes in the female body, when the production of estrogen is reduced - the female sex hormones, "protecting" the heart and coronary vessels. After 55 years, angina region occurs in the face of both sexes with approximately equal frequency. Often angina region is observed in direct relatives of patients suffering from IBS or mocked myocardial infarction.
For modifiable risk factors, a man has the opportunity to influence or eliminate them from his life. Often these factors are closely interrelated, and a decrease in the negative influence of one eliminates the other. Thus, the decrease in fats in food consumed leads to a decrease in cholesterol, body weight and blood pressure. The disposable risk factors angina include:
- Hyperlipidemia. In 96% of patients with angina, cholesterol and other lipid fractions, which have an atherogenic effect (triglycerides, low density lipoproteins), which leads to deposition of cholesterol in the arteries that feed myocardium. The increase in the lipid spectrum, in turn, enhances the processes of thrombosis in vessels.
- Obesity. Usually arises from persons who use high-calorie food with an excessive content of animal fats, cholesterol and carbohydrates. Patients with angina, it is necessary to limit cholesterol in nutrition to 300 mg, salt - up to 5 g, an increase in the use of food fiber - more than 30 g.
- Hydodine. Insufficient physical activity predisposes to the development of obesity and violation of lipid metabolism. Impact of several factors at the same time (hypercholesterolemia, obesity, hypodynamine) plays a decisive role in the occurrence of angina and its progression.
- Smoking. Smoking cigarettes increases the concentration of carboxygemoglobin in the blood - compounds of carbon monoxide and hemoglobin, causing oxygen starvation, primarily cardiomyocytes, arterial spasm, increased blood pressure. In the presence of atherosclerosis, smoking contributes to the early manifestation of angina and increases the risk of developing acute myocardial infarction.
- Arterial hypertension. Often accompanies the CHD flow and promotes the progression of angina. In arterial hypertension due to an increase in systolic blood pressure, the myocardial voltage increases and its need for oxygen is increased.
- Anemia and intoxication. These states are accompanied by a decrease in oxygen delivery to the heart muscle and provoke the attacks of angina, both on the background of coronary atherosclerosis and in its absence.
- Diabetes. In the presence of diabetes mellitus, the risk of CHD and angina rises by 2 times. Diabetics with 10 years of experience suffer from pronounced atherosclerosis and have the worst forecast in the event of the development of angina and myocardial infarction.
- An increase in the relative viscosity of blood. Promotes thrombosis processes at the site of an atherosclerotic plaque, increases the risk of coronary arteries and the development of hazardous complications of IBS and angina.
- Psycho-emotional stress. The heart under stress works under conditions of increased load: angiospace develops, the blood pressure increases, the supply of myocardium with oxygen and nutrients is worse. Therefore, stress is a powerful factor provoking angina, myocardial infarction, sudden coronary death.
The risk factors of angina region also include immune responses, endothelium dysfunction, an increased heart rate, premature menopause and receiving hormonal contraceptives in women, etc.
The combination of 2 or more factors, even pronounced moderately, increases the overall risk of angina. The presence of risk factors should be taken into account when determining therapeutic tactics and secondary prophylaxis of angina.
According to the international classification adopted by WHO (1979) and the All-Union Cardiological Scientific Center (VKNC) of the AMN of the USSR (1984), the following types of angina region are distinguished:
High stress angina - proceeds in the form of transient seizures of the prudged pain caused by emotional or physical exertion that increase the metabolic needs of myocardium (tachycardia, increased blood pressure). Typically, pains disappear alone or bought nitroglycerin intake. The stress angina includes:
For the first time arisen angina - duration up to 1 month. from the first manifestation. May have a different course and forecast: regress, go to stable or progressive angina.
Stable angina - longer than 1 month duration. By patient's ability to transfer physical exertion is divided into functional classes:
- I class - good tolerance of ordinary physical exertion; the development of angina seizures is caused by excessive loads performed for a long and intensive;
- Class II - the usual physical activity is somewhat limited; The emergence of angina attacks is provoked by a walking around at a flat area by more than 500 m, the climb on the stairs is more than 1st floor. Cold weather, wind, emotional arousal, first hours after sleeping are affected on the development of the attack of angina.
- III class - ordinary physical activity is dramatically limited; Stenicard attacks are caused by walking in the usual pace in the smooth terrain by 100-200 m, the lifting of the stairs to the 1st floor.
- IV class - angina develops with minimal exercise, walking less than 100 m, among sleep, alone.
Progressive (unstable) angina - an increase in gravity, duration and frequency of attacks in response to the patient's usual load.
Spontaneous (special, vasospast) angina - caused by the sudden spasm of coronary arteries. Stenicard attacks develop only alone, at night or early in the morning. Spontaneous angina, accompanied by the lifting of the ST segment, is called the variant, or the walls of the printela.
Progressive, as well as some options spontaneous and first angular angina, are combined into the concept of "unstable angina".
Symptoms of angina
A typical sign of angina is pain behind the sternum, less often the left of the sternum (in the projection of the heart). Paints can be compressive, godes, burning, sometimes - cutting, dragging, drilling. Pain intensity can be from tolerant to a very pronounced, forcing patients to moan and scream, feel the fear of close death.
Pain irradiates mainly in the left hand and shoulder, lower jaw, under the left blade, in the epigastric area; In atypical cases - in the right half of the body, legs. The irradiation of the pain during angina is due to its propagation from the heart to the VII cervical and I-V breast segments of the spinal cord and then in centrifugal nerves to the innervored zones.
Pain with angina times occurs when walking, lifting the stairs, effort, stress, can occur at night. Pain attack continues from 1 to 15-20 minutes. The factors facilitating the attack of the angina are nitroglycerin, standing or sitting.
During an attack, the patient experiences a shortage of air, trying to stop and stop, presses his hand to the chest, pale; The face takes an afflicted expression, the upper limbs are cold and ease. Initially, the pulse is studied, then the development of arrhythmia, more often than extrasystolia, increase blood pressure is possible. The progress of the angina can turn into myocardial infarction. Remote complications of angina are cardiosclerosis and chronic heart failure.
When angina recognition, patient complaints, character, localization, irradiation, pain, the conditions of their occurrence and the factors of the binding of the attack are taken into account. Laboratory diagnostics includes a study in the blood of general cholesterol, AST and Alt, high and low density lipoproteins, triglycerides, lactate dehydrogenases, creatinecinase, glucose, coagulogram and blood electrolytes. Special diagnostic significance is determined by the definition of cardiac troponins I and T - markers, indicating damage to myocardium. The identification of these myocardial proteins is talking about the microindarkte or myocardial infarction and allows you to prevent the development of post-infarction angina.
ECG, removed at the height of the attack of angina, reveals a decrease in the ST-interval, the presence of a negative teeth t in breast leads, conduction disorders and rhythm. Daily ECG monitoring allows you to fix the ischemic changes or their absence with each seating of angina, heart rate, arrhythmia. The increasing frequency of heart abbreviations in front of the attack allows you to think about the angina stress, the normal heart rate is about spontaneous angina. EchoCG during angina reveals local ischemic changes and disorders of myocardial reductions.
Velonurgometry (VEM) is a breakdown showing what maximum load can be transferred to the patient without a threat to the development of ischemia. The load is set using a bike barker to achieve a submaximal heart rate with simultaneous ECG record. With a negative sample, the submaximal heart rate is achieved in 10-12 minutes. In the absence of clinical and ECG manifestations of ischemia. A positive is considered a sample, accompanied at the time of load by the angina attack or the displacement of the ST-segment by 1 or more millimeter. The identification of angina is also possible by induction of controlled transient myocardial ischemia using functional (emergency stimulation of atrial) or pharmacological (isoproterenol, samples with dipyridamol) load tests.
Myocardial scintigraphy is carried out in order to visualize the perfusion of the heart muscle and identifying focal changes. The radioactive drug thallium is actively absorbed by viable cardiomyocytes, and during angina, accompanied by coronarrikerosis, focal zones of the myocardial perfusion disorders are detected. Diagnostic coronorography is carried out to assess the localization, degree and prevalence of the damage to the arteries of the heart, which makes it possible to determine the choice of the method of treatment (conservative or surgical).
Treatment of angina
Aims on relief, as well as preventing attacks and complications of angina. Nitroglycerin is served by the preparation of first aid during the attack of angina (on a piece of sugar to keep in the mouth until complete resorption). Pain relief usually occurs after 1-2 minutes. If the attack did not stop, nitroglycerin can be used again with an interval of 3 minutes. And no more than 3 times (due to the danger of a sharp drop of blood pressure).
Planned drug therapy of angina region includes the reception of anti-inanal (anti-ischemic) drugs that reduce the need of the heart muscle in oxygen: prolonged action nitrates (pentaeryrythritis of the tetrantrate, isosorbide dinitrate, etc.), B-adrenobloclockers (anapriline, oxprenolol, etc.), Moludomin, calcium channel blockers (verapamil, nifedipine), trimetazidine, etc.
In the treatment of angina, it is advisable to use antisclerotic drugs (groups of statins - Lovastatin, Simvastatin), antioxidants (tocopherol), antiagregants (acetylsalicyl k-you). According to the testimony, prevention and treatment of conductivity and rhythm disorders are carried out; With a high functional-class angine chain, a surgical reflailing of myocardium is performed: balloon angioplasty, an aortocortonary shunting.
Prediction and prevention
Stegonland is a chronic disabled heart pathology. Under the progression of angina, the risk of myocardial infarction or death is high. Systematic treatment and secondary prevention contribute to the monitoring of angina, improving the forecast and conservation of disability when restricting physical and emotional loads.
For the effective prevention of angina region, it is necessary to eliminate risk factors: reduction of overweight, control over blood pressure, optimization of diet and lifestyle, etc. As secondary prophylaxis with the already established diagnosis of angina region, unrest and physical efforts must be avoided, to propagate nitroglycerin before loads, Prevention of atherosclerosis, carry out therapy of associated pathologies (diabetes, gastrointestinal diseases). The exact following recommendations for the treatment of angina, receiving prolonged nitrates and the dispensary control of the cardiologist make it possible to achieve a state of long-term remission.
Angina - This is a form of ischemic heart disease. It meets at half of the patients who are diagnosed with IHD. During an attack, a man is suffering and strong graceful pain in the left side of the chest. Such a state is a consequence of a sudden lack of blood flow into one of the most important muscles of the heart - myocardium.
Myocardium is responsible for pumping blood and heart cut cyclical. As soon as malfunctions arise in his work, the pulse can slow down or grow threateningly. Such a state can be a precursor of deadly ailments: heart failure and myocardial infarction.
Under angina, the coronary blood circulation is restored independently. And in the case of a heart attack, oxygen starvation exceeds the threshold, permissible for the heart muscle, and irreversible changes occur in it.
Angina may occur during physical exertion, strong excitement, and at some stages of the development of the disease - at rest and even during sleep.
In young and middle age, men suffer more often. However, after 50, the number of women and men suffering from heart disease is approximately the same.
Causes of angina
Main the reasons The occurrence of angina is the narrowing of the lumen of the coronary vessels. This condition causes atherosclerosis. Especially heavy attacks of angina disease occur in people who have a lot of arteries and stenosis sites are extended.
It is difficult to treat patients with mixed causes of angina. For example, when atherosclerosis is affected by the spasm of coronary arteries and blood clots.
The main reasons for the occurrence of angina region:
- The narrowing of the vessels and small arteries as a result of angiospace. At the same time, the pathology does not accompany the atherosclerosis of the arteries;
- Some diseases of the gastrointestinal tract: a diaphragmal hernia, ulcerative disease of the esophagus, duodenum, stomach and biliary disease;
- a number of infectious and allergic pathologies;
- Blood vessel damage syphilis or rheumatoid diseases. It can be awritten, periaterite, vasculitis, endarteritic.
No matter how much angina wanted to avoid angina, it is important to understand - not all risk factors can be adjusted. Unfortunately, the chances of getting transmitted by inheritance. Stenicard attacks are almost inevitably manifested in the elderly.
However, there are quite a few risk factors with which you can and must be struggling. From the life of a person prone to heart disease, it is enough to exclude only a few dangerous habits - and a number of provocateurs factors will stop their destructive action. For example, if a person changes its food addictions, preference to light, nutritious, proper food, its weight will come to normal. Reduced cholesterol and blood pressure. So, there will be less risk factors, because of which the heart is harder to cope with its tasks.
Among the risk factors that can be eliminated:
- Increased cholesterol content and other lipid fractions in the blood. It provokes cholesterol deposition in arteries and an even greater escape of the coronary lumen, the formation of blood clots;
- excess body weight;
- sedentary lifestyle;
- smoking. Nicotine causes oxygen starvation and artificial narrowing of the arteries. The smokers increases blood pressure and angina, comes earlier than those who do not have bad habits.
- High psycho-emotional loads and stress. In this case, angiospazas and a sharp increase in pressure occur. The consequence may be not only angokard attack, but also a heart attack.
- Receiving women hormonal contraceptives.
It is much more difficult to cope with the disease, if you have the following pathologies:
- high blood pressure. It causes the stress of myocardial muscles;
- General weakness, intoxication. The weakened organism does not cope with the supply of oxygen into the heart muscle, so anemia often entails the seizures of the rapid heartbeat;
- Elevated blood viscosity. This leads to the occurrence of blood clots, even greater narrowing of the lumen of the vessels and weakness of myocardium;
- endothelium dysfunction;
- Early menopause.
The metabolic syndrome is especially dangerous when the patient has several risk factors at once: overweight, high blood pressure, elevated cholesterol content in the blood.
Classification of the disease
Based on the characteristics of the clinical picture, the causes of the occurrence of the attack and the degree of danger to the patient are distinguished by three main types of angina:
- Stable angina. This is a stress angina, it appears during exercise, sports, excessively abundant food, stress, with exacerbation of chronic diseases.
All listed states cause the narrowing of coronary vessels and provoke the appearance of pain syndrome. The attack passes at rest, after the patient accepted nitroglycerin.
As a rule, the disease proceeds without visible deterioration over several years. Stable angina, depending on the level of portability of the physical and emotional load, is divided into latent, light, middle and heavy. In its worst version, the attack can develop with a leisurely walk for a distance of more than 100 m.
- Unstable angina . Over time, the attacks are becoming harder and longer, additional symptoms are joined.
With an unstable angina, the pain behind the sternum occurs even without exercise and during the rest. If the attacks occur no more than 1 time per month, angina is a low degree of danger, if every 2 days - the average degree of danger. When the pain attacks more often is the sharp angina of rest. Unstable angina is a harbinger of a heart attack or a possible infarction.
With an unstable angina, the patient must undergo a survey and treatment in a hospital.
- Vasospadic angina. It happens in the case of a local spasm of the coronary artery, while this state is not associated with atherosclerosis. The pain during the attack is strong and long, the attack occurs regardless of the physical activity, often in bed. Vazospadic angina may not be accompanied by pain, but only a feeling of squeezing in the chest.
Symptoms of angina
The patient is experiencing pain behind the sternum or a little left in the heart. Feelings can "give" to the left side of the body - shoulder, hand, jaw, under the blade. With an atpon current, a person may feel pain on the right, in any part of the body or in the leg.
Patients describe pain in different ways, as a drilling, compressive, rejection of different intensity. Sometimes suffering angina people are experiencing a pronounced fear of death.
Moreover angina It has such Symptoms :
- lack of air;
- Pallitude of the skin;
- forced body position;
- Human hands are cold and ease;
- The pulse is readily, then becomes rare;
- The blood pressure increases.
The diagnosis establishes a doctor on the basis of a patient's survey, taking into account the nature of the pain, its location, the duration of the attacks. It will be necessary to take into account whether the attack is removed by nitroglycerin.
When clinical examination, the doctor estimates the skin condition - is there signs of metabolic disorders and atherosclerosis. To estimate the state of cardiovascular and respiratory systems, the doctor will measure blood pressure, will hold the trimming of the chest, listening to the tones of the heart and measure the pulse.
Auscultation of the tones of the heart is listening to its work with a stetofendoscope. In this case, the doctor will determine the existence of noise, the nature of the heartbeat, heart rhythm.
The patient needs to pass tests for the content:
- AST and Alt;
- Lipoproteins are low and high density;
- Cardial troponins and markers, which indicate damage to myocardium.
To diagnose the risk of the occurrence of thrombotic complications, a coagulogram is necessarily carried out.
- ECG, especially Halter monitoring.
- Functional load samples (exercise).
- Scintigraphy - will help identify the areas affected by ischemia after the special introduction of Tallliament isotopes.
- Echocardiography makes it possible to understand what condition is the heart muscle, the vessels, whether the heart is enough filled with blood, there is a thickening of myocardium.
- Coronaryography - the doctor will appreciate whether the heart vessels affected by atherosclerosis and how narrowed by the clearance of the arteries. To do this, the patient is administered an x-ray-contrast drug and evaluate the state with X-ray shots.
Treatment of angina
What to do During the attack of angina? First aid In the attack of angina, the reception of the tablet or the spray of nitroglycerin. If after 2 minutes the pain does not pass, the drug can be reused.
In the treatment of angina, the doctor will appoint anti-hicemic drugs - they regulate the need for the heart muscle in oxygen. As well as beta blockers and calcium antagonists. To maintain the circulatory system, the doctor will recommend the reception of antisclerotic and antioxidants.
In difficult cases, shunting and angioplasty are prescribed.
Prediction and prevention
It is impossible to fully recover from anginara. However, compliance with the recommendations of the doctor, a healthy lifestyle, proper drug therapy will detain the progression of the disease. The doctor can keep the development of angina under control, but for this the patient must become his ally.
The best prevention of the development of the disease is to eliminate or minimize risk factors. First of all, this is monitoring psycho-emotional state, reasonable physical exertion and overweight. A physician should be observed and with the slightest deterioration of health to undergo diagnosis.
The concept of "angina region" combines various types of pain symptoms in the heart area arising mainly during intensive exercise. In the language of medicine, this is a sign of myocardial ischemia, which makes itself felt the attacks by 15-20 minutes and comes when taking nitroglycerin. Symptoms can give themselves to know simultaneously or single manifestations, it makes it difficult for primary diagnostics. When the first alarming features appear, it is important to immediately seek medical care, because Stenzardia is a faithful forerunner of myocardial infarction and indicates serious violations in the work of the heart muscle.
Classification and symptoms of angina
Depending on the symptomatic picture, it is distinguished:
- stable type of disease occurring unchanged and requiring serious treatment;
- Unstable angina - the most dangerous, carrying primary character or every time makes himself a felt new symptoms;
- The angina of the voltage acts as an unchanged sign of increasing physical activity;
- Road angina does not have clear reasons and can be manifested even in a dream, accompanied by a feeling of panic, choking, set of vegetative disorders.
Distinguishing the angina of the voltage from other diseases of the heart muscle allow characteristic signs:
- gouring burning pain;
- return to the left blade, in the neck or hand;
- Noticeable oscillations of pulse and pressure.
Any signs of angina should become a reason to appeal to a profile doctor to clarify the diagnosis and appointment of appropriate treatment.
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Perennial study of the angina region allows you to accurately name the physiological mechanism for the development of the disease. Due to the disorders of nutrition and metabolism, the surveillance of the arteries is gradually narrows due to atherosclerotic plaques. The deterioration of blood flow causes oxygen fasting of the cells of the heart muscle, which becomes the cause of obvious and sufficiently strong pain. At the same time, spasm of vessels caused by nervous overvoltage or supercooling of the body can occur.
- The appearance and accumulation on the walls of the vessels of atherosclerotic plaques is often provoked:
- symptoms of arterial hypertension;
- symptoms of diabetes;
- hypodynamines, a low-tech lifestyle;
unsatisfactory food quality.
The process of reducing the enlightenment of the artery occurs gradually. When it is a narrowing of 50% and more bloodstream, it worsens noticeably, which leads to violations in the work of the heart muscle. Physical activity and psycho-emotional stress contribute to the exacerbation of the situation, forcing the heart to work in intensive mode against the background of oxygen starvation. The disadvantage of oxygen becomes the cause of the nutrition of the muscle tissue, which causes a characteristic pain syndrome with signs of chopping and pressure in the heart.
Risk factors that launch the process of narrowing vessels due to the formation of sclerotic plaques
- When performing primary diagnosis, a specialist necessarily takes into account the possible action of one or more of the following factors:
- hyperlipidemia - cholesterol metabolism with a simultaneous decrease in high density lipoproteins;
- Obesity caused by the predominance of animal fat and calorie dishes in the diet against the background of lack of cereal, vegetables, fruits and legumes;
- hypodynamia is a lack of movement, which launching obesity development against the background of cholesterol accumulation;
- Arterial hypertension is a satellite of ischemic heart disease due to oxygen deficiency;
- anemia is a decrease in hemoglobin levels against the background of the general weakness of the body;
- Sugar diabetes of second type, which is considered one of the most dangerous risk factors;
Tobacco addiction - helps to reduce the volume of oxygen in the blood, increases pressure and contributes to the spizming of arteries, narrowed due to accumulation of atherosclerotic plaques.
Enough actions at least two factors so that angina gains serious and demanded an immediate intervention of a specialist.
Methods of diagnostics of angina
- Put the patient's accurate diagnosis help laboratory and instrumental examination methods. Blood test allows you to determine:
- the level of total cholesterol and the so-called lipid fractions;
- blood coagulation indicators;
- glucose level;
- System inflammation markers;
The presence in the composition of the blood of other substances affecting the exchange of cholesterol and the level of blood saturation of oxygen.
- Among instrumental diagnostic methods are of particular importance:
- ECG at the peak of the attack of angina;
- Daily ECG monitoring, allowing to identify deviations in the work of the heart in various external conditions;
- Ehoche - identifies ischemic changes and disorders in the process of reducing the heart muscle;
- Bicycle ergometry - reveals the limit level of load for the patient without the risk of angina symptoms;
- Stress echogocardiography using ultrasonic waves;
- Computed tomography of the structure of the heart;
Coronaryography - radiography with the introduction of a contrast agent.
Treatment of angina
Based on the results obtained, the therapeutic course is being developed and a decision on operational intervention is made.
Since stenopography develops against the background of coronary heart disease, it is important to eliminate the root cause of the disease in order to then cope with the concomitant features. At the same time, measures are taken to remove pain syndrome and preventing new attacks.
The first help with angina is the reception of nitroglycerin, which reduces pain. The permanent therapeutic course focuses on the reception of anti-host drugs, thanks to which the heart continues to work stably in the conditions of lack of oxygen. Expand the clearance of blood vessels allows stenting and aortocamonary shunting, which returns to the arteries conductive ability. Other clinical guidelines for angina are selected taking into account the state of the patient, its age and the degree of severity of cardiac pathology.
The absence of timely assistance in the emergence of stable signs of angina may cause an extensive myocardial infarction with a high risk of fatal outcome. On the contrary, timely treatment allows you to control the occurrence of new attacks, reduce their frequency and ensure a patient a full-fledged healthy life.
Reduce the risk of developing the disease allows control of weight and blood pressure, a healthy lifestyle, a refusal of smoking, a full physical activity, the preservation of a stable psycho-emotional state, treatment of diabetes mellitus.
Treatment of angina in JSC "Medicine" (Clinic Academician Rotiberg)
The best cardiologists of JSC "Medicine" (Clinic Academician Roytberg) in the Central Bank of Moscow are ready to conduct an inspection and appoint a full range of surveys to form an accurate diagnosis. It is possible to quickly pass all the research in the diagnostic department of the clinic, which will save time and will allow reliable results. You can clarify the time of receiving specialists and sign up for surveys by calling +7 (495) 775-73-60.
What is dangerous angina?
In the event of a patient's dismissive attitude towards his health and abandonment, the frequency of attacks can increase, and the pain intensify. Further decrease in the lumen may cause acute oxygen starvation and the development of myocardial infarction with an unfavorable forecast.
How to remove the attack of angina at home?
With the appearance of the first pain, it is necessary to stop working or movement, take a sedentary or a supest position, put a nitroglycerin tablet under the tongue, which should always be at hand. When darkening in the eyes and worsening perception, it is worth asking others about help. It is important to try to fix the state preceding the attack, and the last duration of the latter to report it at the attending physician.
How to define angina?
Among the characteristic signs of angina, a strong gulp pain in the heart area with a return to the peripheral parts of the body, tangible oscillations of the pulse and pressure. The attack occurs with a sharp physical or psycho-emotional load and comes on no for 15-20 minutes. Conduct differentiated diagnosis and just to name the cause of the disease can only attending a doctor.
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What is angina?
Stenzardia is not an independent disease, but by syndrome, which is a manifestation of coronary heart disease (IBS). Ischemic heart disease occurs due to the insufficient supply of the heart muscle with blood. Angina - a peculiar heart of the heart on oxygen deficiency of the heart. How does the heart submit such a signal? The signal is felt in the form of attacks of short-term sudden sharp compressive, gulp, burning pain in the heart area. In some patients, pain is accompanied by a state of general discomfort, a sense of air shortness, interruptions in the work of the heart.
What provokes the attack of angina?
Stable and unstable angina
The attacks first can be non-intensive, short-term, 1-2 minutes, with very heavy or intense physical exertion, running, lift along the stairs, outlet of the cold, walking against the wind. The attack can provoke emotional disorders, smoking, staying in stuffy space, overeating, receiving energy removal or excessive doses of alcohol.
With a stable angina in patients with IBS, pain occurs with a certain physical activity and is well eliminated with medicines.
Unstable angina is called the first-emerged attack or condition, when against the background of a stable flow of the IBS, angina attacks are rapid and lengthened.
What is dangerous unstable angina?
If angina occurs with an unpredictable level of physical activity, it is necessary to limit the load for several days to the minimum and consult with the attending physician: more active treatment will be required and, possibly, hospitalization. The state of the episode of the unstable angina can end the myocardial infarction. When pain in the chest is preserved and it is difficult to diagnose, the term "acute coronary syndrome" is used.
How to distinguish a stenocardium from myocardial infarction?
Pain in the center of the chest, in the middle third of the sternum, can spread to the left hand, the blade, the lower jaw, the upper part of the abdomen.
Pains like during angina, but more often felt as more intense, unbearable, tearing and capture the entire left half of the chest.
Discomfort is weak or moderately pronounced.
Pronounced discomfort, reinforced sweating, dizziness, nausea, increasing sense of air shortness, fear of death.
The attack of the angina is more often associated with preceding physical activity or emotional excitation.
Myocardial infarction may occur at any time, including at rest.
The time of the pain attack takes about 3 to 15 minutes.
The pain attack with discomfort and chopping continues at least 15 - 30 minutes or more, there is a tendency to grow symptoms.
In peace of pain, as a rule pass.
In a state of physical peace, the pain does not pass completely, strengthen when talking and deep breathing.
The use of nitroglycerin under the tongue or in the form of an aerosol from 1 to 3 doses interrupts the attack of angina.
Symptoms do not pass completely after use 3 nitroglycerin doses.
First aid in the attack of angina
- In the occurrence of the attack of angina, it is necessary to follow the instructions received from the attending physician or (if there was no such instruction) to act according to the algorithm:
- Mark the start time of the attack.
- Measure arterial pressure, heart rate and pulse.
- Sit (better in a chair with armrests) or go to bed with a raised headboard.
- Ensure fresh air (freeze neck, open the window).
To adopt acetylsalicylic acid (aspirin 0.25), a tablet to warm up and swallow.
It is impossible to take acetylsalicylic acid (aspirin) in the intolerance of it (allergic reactions) and the admission of it on this day, as well as at a clear exacerbation of the ulcer of the stomach and duodenum.
6. Take 0.5 mg nitroglycerin. If in the form of a tablet - put under the tongue and dissipate, if in the form of a capsule - to cut, not swallow, if in the form of a spray - to inhalation (injection) one dose under the tongue without inhaling.
If, after taking nitroglycerin, there is a sharp weakness, sweating, shortness of breath, or a strong headache, then it is necessary to lie down, lift the legs (on the roller, pillow, etc.), drink one glass of water and then nitroglycerin does not take.
It is impossible to take nitroglycerin at low blood pressure, harsh weakness, sweating, severe headache, dizziness, acute violation, speech or coordination of movements.
7. If the pains completely disappeared and the state has improved after taking aspirin and 1 dose of nitroglycerin in 5 minutes, limit the physical exertion, further treatment agree with the attending physician.
8. When saving pain Over 10-15 minutes, it is necessary to accept nitroglycerin for the second time and urgently cause ambulance! ATTENTION
! If aspirin or nitroglycerin is not available, and the pains are saved for more than 5 minutes - immediately call ambulance!
9. If the pains are preserved and after taking the second dose of nitroglycerin after 10 minutes, nitroglycerin must be taken for the third time. Wait for ambulance.
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