Angina pectoris

Stenocardia (SC) - has been known to mankind for many centuries and was first described by English physician William Geberden. The disease is characterized by the appearance of remitting pain, which typically ends 10-15 minutes after occurrence. An important feature of angina pectoris is the compression of the attack by taking nitroglycerin. Sometimes painful sensations are not removed by nitrates.

The probability of developing angina pectoris largely depends on age. In Wikipedia, it is noted that "in 45-54 years the incidence of angina is about 2-5%, whereas in the age range 65-74 years it is 10-20%."

An increase in predisposing factors leads to the annual occurrence in Europe of an average of 30,000 new angina patients. Different research methods are used to determine the disease, but most often it is electrocardiography and Holter monitoring.

What is angina?

Classification

There are various angina classification that have been developed over 30 years ago. Some are designed to more accurately distribute the disease by flow, others are designed taking into account clinical characteristics.

Classification from 1979, presented by WHO:

• Angina of rest, also known as spontaneous and variate. In it there is a rare species of angina pectoris.
• Angina of tension. May be primary, progressive and stable. The latter varies according to the functional classes.

Stenocardia is a separate point in the clinical classification of 1984, which deals with all forms of coronary heart disease.Correspondingly to this classification, angina may be:

• Stable, which, depending on the flow, can have I-IV FC.
• An unstable, additionally divided for the first time arising, progressive, preinfarction, Printsmetalla.

Some authors have carefully considered manifestations of unstable angina, depending on predisposing factors. As a result, this variant of the IC is considered separately:

• on acute development (class I, II, III);
• under the conditions of occurrence (class A, B, C).
• by the presence of medical interventions provided at the time of its occurrence (1, 2, 3).

Reasons

The appearance of angina associated with a violation of the circulatory process in the coronary arteries of the heart, which leads to a shortage of oxygen and nutrients required for the myocardium. There is acute coronary insufficiency for various reasons, but most often due to atherosclerosis of the coronary arteries. The more the atherosclerotic plaque closes the lumen of the vessel, the more disturbed the blood flow and the more pronounced ischemia of the myocardium.

In the development of pathology, the size of a vessel infected with atherosclerosis is of considerable importance. If a large artery of the heart is involved in the pathological process, then a larger portion of the myocardium is exposed to a lack of oxygen. Involvement in the pathological process of a small part of the capillary mesh leads to a less pronounced illness.

During ischemia in the myocardium, oxidative-reduction mechanisms of action are violated, due to which a lot of different metabolites accumulate in the muscle (in particular, acetic acid, as well as pyruvic, lactic, phosphoric).

Video Ischemic heart disease and angina pectoris: mechanism, localization of pain and cause of myocardial infarction

Risk factors

Many bad habits, like the wrong way of life, can contribute to the development of angina. Also, in determining patients with SC of certain risk factors, the progression of the disease is noticeably increased. Therefore, cardiologists are engaged in the identification of predisposing factors, after which the patient is explained the principles of their elimination.

At present, there are several groups of risk factors that are involved in the development of angina:

1. Unmodified factors (insurmountable) - this includes sex, age and heredity. Looking at these factors, it turns out that men aged 50-55 years are more likely to suffer from angina, whereas after menopause in women, the risk of developing SC increases.
2. Modified factors (overcome) are a large group in which some factors influence the formation of others. For example, when using fatty foods, body weight increases, which increases the risk of angina pectoris. This group of risk factors includes:

• hyperlipidaemia;
• obesity;
• hypodynamia;
• smoking;
• arterial hypertension;
• psycho emotional experiences;
• increased blood viscosity.

The correction of the harmful factors of influence and the establishment of a way of life that is as close as possible to the healthy gives the opportunity to strengthen the cardiovascular system and in some cases to avoid the development of angina.

Kinds / photos

In clinical practice, special attention is given to such clinical forms of the disease as stable angina and unstable. There are differences in the development of these two pathologies. Also, a stable SC is divided into functional classes.

Stable angina pectoris

The disease is mainly manifested in physical activity. By the degree of severity of painful sensations, four functional classes of angina are distinguished:

1 FC - pain or shortness of breath arises in the face of considerable physical activity in the form of prolonged running or lifting of gravity.
2 FC - daily physical activity is somewhat lowered, due to which pain in the chest appears when running for short distances or climbing up the stairs to several spans.
3 FC - Tolerance to physical activity is reduced. Movement for both a single span and a small distance begins to cause difficulty breathing and discomfort behind the sternum.

4 FC - even a slight physical stress causes an SC attack, so pain and shortness of breath may appear after several steps.

The presented functional classes serve as a peculiar indicator of the degree of narrowing of the coronary arteries. The worse the blood flow in the vessels, the heavier the patient's condition and the higher the FC. Bicycle ergometry is used to determine the functional class in hospitals.

Unstable angina

The development of the SC attack is not related to the physical activity of the patient. Pain and shortness of breath can occur at any time, which is why the disease is defined as unstable. The manifestation of the disease is characterized by pronounced painful sensations, which are often complemented by dizziness. Because of the high risk of unstable angina transition to myocardial infarction, patients should be surveyed even with a single stroke.

Diagnostics

The possibilities of modern medicine allow in most cases to determine the type of disease and to establish the clinical form. To do this, various research methods are used, from laboratory analyzes to instrumental methods. But first of all, the patient is interviewed, his examination and auscultatory listening of the heart, which allows us to present a more or less complete clinical picture.

Clinic

A characteristic symptom of angina pectoris is a back pain. It is through her frequent detection of patients with angina the disease was previously defined as "chest frog".

Pain for the sternum is often felt as a pressing, burning, compressing. Her localization is in the area of the heart, and the area of distribution is about the fist or palm of the patient. Pain can be transmitted to other parts of the body, namely the shoulder blade, left arm, and lower jaw.

Pain can irradiate into the epigastric region, contributing to the appearance of heartburn, nausea or discomfort in the form of a colic. Not so often, the pain is localized in the head, which does not immediately allow the exact diagnosis to be made.

Angina is manifested by attacks, which are relatively short, lasting about 10-15 minutes. There are predisposing factors contributing to the development of angina even with apparent well-being. The following applies in the first place to:

• physical load;
• taking a large amount of food;
• emotional overvoltage;
• stay in a cold room;
• increase in blood pressure.

With such factors, the effects of myocardium require more oxygen, which causes the heart muscle to begin to experience oxygen starvation. If the spasm or blockage of the vessel is small, then after the cessation of the effect of the predisposing factor, the blood circulation is restored, and the pain passes. That is why the appearance of angina often associated with physical activity or other external circumstances.

Instrumental survey methods

Laboratory and instrumental research methods are used to clarify the diagnosis. It also establishes the reason for the development of the disease, which will result in the appointment of effective treatment.

Laboratory analyzes consist in conducting of clinical analysis of blood and determination of biochemical indices of damage of heart muscle. If necessary, a glucose tolerance test is performed or a concentration of thyroid hormones is determined.

Patients with cardiovascular pathology necessarily make electrocardiography . With its help, associated pathologies can be identified in the form of arrhythmia, postinfarction state. Also, a number of pathologies of the type of hypertrophy of the left ventricle are clearly visible on the ECG. Depending on the indications and condition of the patient, the ECG is performed in a calm state and after physical activity. In the latter case, bicycle ergometry or treadmill test is used. For this purpose special equipment is offered, offered in hospitals and medical centers.

Holter ECG monitoring is less informative in comparison with loading tests, but at the same time it provides an opportunity to diagnose myocardial infarction in almost 15% of patients with angina pectoris, which is not practically determined on a regular ECG. A similar diagnostic method is often used to determine vasospastic angina, the seizures of which are difficult to catch.

Echocardiography in a calm condition is done for the purpose of differential diagnosis, that is, to confirm or, conversely, to exclude the presence of various diseases of the heart. If necessary, the contractile function of the ventricles is assessed, the size of the cavities of the heart is determined. In some cases, standard echocardiography supplements stress-echocardiography. To do this, use a pharmacological or physical load.

In exceptional cases, that is, only by indications, is done coronary angiography . This is an invasive technique, often prescribed for patients who had a history of heart failure or other methods of study did not allow to determine the cause of the disease.

Treatment

First aid for angina pectoris

When first encountered SC necessarily need to immediately call an ambulance. If the patient had earlier attacks, then resorting to the medical brigade should follow:

• prolonged stroke that failed to be stopped with nitroglycerin or previously prescribed by the doctor drugs;
• the clinic worsens due to the appearance of severe weakness, severe breathing, vomiting and so on;
• Chest pain appeared again after her temporary damping.

When waiting for an ambulance, you have to take a number of actions:

• The patient needs to be comforted and comfortable to sit down, while the legs should be omitted.
• Under the tongue is put a half or whole tablet of aspirin.
• In the absence of nitroglycerin it is possible to take nitrolining or to use an iskoet spray.
• You can take nitroglycerin again at intervals of three minutes, and aerosol drugs - in one minute.
• You can take medications no more than three times.

After cessation of an attack of a stenocardia the doctor prescribes the basic treatment, at realization of which pursue the following goals:

1. Remove unwanted manifestations or at least reduce their severity.
2. Prevent development of such a formidable complication as myocardial infarction.
3. Improve the patient's quality of life.

Different treatment tactics are used to achieve the objectives presented: medical, surgical, auxiliary.

Medicinal therapy

It is based on the use of drugs from various pharmacological groups. With their help, the state of the circulatory system of the heart improves, the biochemical parameters of blood are corrected, the severity of clinical signs decreases.

The main groups of drugs from which drugs are selected for patients with angina:

• Antiagregantum - are prescribed practically for a lifetime as they prevent thrombosis due to dilution of blood. In the absence of diseases of the digestive tract, patients are advised to take acetylsalicylic acid, and if there are contraindications to it, clopidogrel, which is equally effective, but more expensive and with less contraindications.
• Beta-adrenergic blockers help to cope with anginal attacks, since their mechanism of action is aimed at reducing the consumption of oxygen in the heart muscle. Bisoprolol and metoprolol are most commonly used. But at the same time cause a number of side effects in the form of bradycardia, cold hands and feet, general weakness, etc.
• The blockers of calcium channels are quite effective in eliminating antianginal attacks caused by angina. They can be combined with beta-blockers. Of this group, verapamil and nifedipine are more commonly used.
• Nitrates - In the treatment of angina pectoris uses drugs from this group that have a short or prolonged effect. It is very important not to overdose medications so as not to cause orthostatic hypotension, therefore they are used only for medical purposes.

Video Angina Symptoms And Species. Treatment and nutrition for angina pectoris

Surgical treatment

There are three types of surgical intervention that are most commonly used today to eliminate malignant angina.

1. Aortic coronary artery bypass graft is used to restore normal blood flow in the cardiac arteries.
2. Balloon angioplasty - a technique that allows the stenosis of vessels to be expanded by using a special balloon introduced with a catheter.
3. Stenting of the coronary arteries - in the process of execution in the narrowed arteries, stents are installed that do not allow them to fall again. Conducted, most often, immediately after balloon angioplasty.

Before each type of treatment, coronary angiography is mandatory, which allows precise determination of the sites of narrowing in the system of coronary arteries. The surgical method of exposure is selected on an individual basis, taking into account the available evidence.

Complications

The long course of angina is dangerous because cardiomyocytes gradually begin to die in the affected area of ischemic heart muscle. The result is necrosis, which is a myocardial infarction. Therefore, it is extremely important to begin treatment of SC in a timely manner in order to restore the circulatory system of the heart as soon as possible.

With the frequent occurrence of seizures of angina in the patient significantly deteriorates the quality of life. It is difficult to perform the usual physical work. There may be difficulties with long-term location in transport. In severe cases, the attacks of the SC provoke the development of arrhythmia.

Forecast and prevention

The prognostic conclusion for angina pectoris largely depends on the severity and duration of seizures. With their rare occurrence and relatively normal quality of life, the patient's prognosis is favorable. If back pain often appears or they occur in the type of unstable angina, then talk about the malignant course of the disease.

In order to improve the prognosis, as well as to prevent angina pectoris, it should aim not only at receiving medication, but also to fulfill other medical recommendations. In particular, it is required:

• modify lifestyle;
• refuse to smoke;
• to observe dietary nutrition;
• control body mass;
• carry out permissible physical activity.
• to treat concomitant diseases;

Video How to protect the heart and blood vessels? Prevention of cardiovascular diseases