Angina pectoris

April 19, 2012

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Angina pectoris   - A condition in which a person has manifested paroxysmal pain in the chest. This is due to the acute shortage of blood supply of the myocardium. Thus, the patient's clinical manifestations occur coronary heart disease .

Causes of angina

Angina - is both a disease and a clinical syndrome. If we are talking about a single disease, it is most often occurs as a consequence of angina atherosclerosis coronary artery . This phenomenon provokes a marked narrowing of the arteries, which in turn interferes with normal myocardial perfusion. Very often manifested angina in humans due to the strong tension of physical and emotional. If an artery narrowed by atherosclerosis due to a sharp 75% or more, angina occur in a patient and as a result of moderate mental and physical stress.

Angina usually occurs after blood flow to the mouths of the coronary arteries is reduced. This occurs in patients hypotension   (particularly dangerous in case diastolic hypotension ), With venous hypotension . fall in cardiac output . tachyarrhythmia . Also can provoke an attack of angina reflex influence of the esophagus, bile ducts, spine, if there are concomitant diseases of these organs. The sharp narrowing of the lumen of the coronary artery occurs as a consequence of neobturiruyuschego clot, swelling of the atherosclerotic plaque.

Angina subsides, if the level of the work of the heart muscle is normalized under the influence nitroglycerin   or reduce the load. At the same time the blood flow to the coronary arteries normalized.

Types of angina

In medicine taken to determine several varieties of angina, depending on the frequency and nature. Thus, when new-onset angina   symptoms of angina occur around for months, then regressing disease, or the transition of the disease in the form of stable angina.

At intense (stable) angina   attacks occur regularly develop the disease. They arise at this stage as a consequence of various kinds of stress. About this form of angina is referred to as the "purest" form of the disease. This stage of the disease often indicates high risk for the patient myocardial infarction .

At progressive (unstable) angina   patient attacks occur suddenly and unexpectedly. Often they develop and a person who is in a state of rest. In the development of such an attack the person feels a very strong pain in the chest. This type of angina is most dangerous precisely because of the increased risk of myocardial infarction. Very often in unstable angina patients hospitalized.

At variant angina   development of an attack often occurs at night and is a direct consequence of vasospasm. Track this form of angina can be the results of the ECG. In general, it is a rare disease.

The symptoms of angina

Symptoms of angina always clearly defined. So, pain in angina pectoris are paroxysmal in nature, having a clearly defined start and end time attack. Pain is always shown in similar circumstances and conditions. After taking nitroglycerin pain gradually subsides or stops completely.

The basic condition for the existence of an attack of angina in humans is a state of tension. Most often it develops during walking - for example, during acceleration of the lifting up during the shifting of heavy load or when moving immediately after a heavy meal. However, the symptoms of angina can trigger other types of stress and emotional overload. If the physical efforts continue or increase their intensity, the pain in your chest increases. But if the efforts of a person ceases, the angina pain symptoms gradually disappear after a few minutes.

Sometimes the pain of angina is localized behind the breastbone, which is the most common symptom. In more rare cases, the pain radiating to the neck, jaw, teeth, left arm and shoulder blades. Generally pain is crushing, squeezing character, more rarely seen burning, like a heartburn   pain. Sometimes a person feels chest heaviness, discomfort from the sensation of having a foreign body in the chest.

When angina patient is a sharp increase Blood Pressure Manifested sweating, pale man.

All above characteristics are accounted pain in diagnosing disease. They make it possible to distinguish manifestation of angina pain in the heart, which is indicative of other diseases.

Experts note that a similar mechanism of pain in angina pectoris is of great importance, as a result of severe pain man stops and stops exercise, which is not the strength of his heart.

Diagnosis of angina

Diagnosis "angina" often occurs at the first contact person to complain to a specialist. At the same time to reject such a diagnosis should be a long time to observe the condition of the patient, conduct a series of surveys and a thorough survey of the patient.

In the process of diagnosis of angina applied research with the help of an electrocardiogram and stress test, myocardial scintigraphy, two-dimensional echocardiography, radionuclide ventriculography, coronary angiography and other methods. The study of a patient with ECG technician can observe the presence of specific symptoms that indicate that a patient has a place myocardial ischemia . However, during diagnostics should fate of the fact that at rest such symptoms are not observed, however during the standard ECG is not always possible to establish the correct diagnosis.

To detect such features in patients with suspected angina held Holter monitoring . This technique consists in the fact that for a certain time, typically days to produce a continuous ECG recording. The man continues to live his normal life. With this technique it is possible to fix the symptoms of ischemia, to determine how they are dependent on all sorts of stress, find out how effective the treatment is and whether strongly expressed pathological changes.

With the load test, in which simulated a situation where increased myocardial oxygen demand, we can determine a number of points important in the diagnosis process. Such tests are carried out exclusively under the strict supervision of a specialist in the process of registering signs of ischemia. It is important to note that in case of unstable angina and myocardial infarction such tests are not carried out. It is also a contraindication to the use of this method is severe arrhythmia , Choose cardiac and respiratory failure . arterial hypertension   with high blood pressure, severe tachycardia .

To date, three types of applied stress tests: Load the physical character on a bicycle ergometer and treadmill, pharmacological tests, pacing.

Using any of the methods for the registration of ischemia using one of these methods: ECG, scintigraphy, echocardiography .  The most commonly used exercise test on a bicycle ergometer (special exercise bike) or treadmill (treadmill) with ECG monitor .  With the help of special tables that take into account gender and age, calculated load capacity .  Termination of the test takes place after reaching this value .  If symptoms of ischemia does not, then the result of the sample is negative and the person is not sick angina .  If signs of ischemia occurs, it means that the person is sick angina .  If a particular event seems very difficult to specialists, it is possible the use of coronary angiography .  This method is a highly .  In the course of such an investigation is carried out selective opacification and visualization of the coronary arteries using rentgenapparatury .  Coronary angiography to determine the presence of stenotic arteries areas and the degree of their restrictions .

Complications Angina

Angina is fraught with the development of very serious complications. Among them, the most frequently seen in patients progression cardiosclerosis And subsequent development myocardial infarction . In this case, the first symptom of a heart attack sometimes is a long stroke, which lasts about half an hour in a patient. In addition, symptoms of angina provoke in the individual Arrhythmia .

Treatment of angina pectoris

As the main mechanisms remission angina attack: determined by a rapid drop in the level of work of the heart muscle and the normalization of the adequacy of the inflow. Therefore, the treatment of angina primarily involves mild asthma disease. Patients should be aware that this disease is a dangerous disease, so the treatment should take place only under the supervision of a specialist, and preferably in a hospital.

With adequate treatment of angina pectoris is important to achieve the following results: reduce the risk of symptoms in a patient in the future myocardial infarction, to improve the overall quality of life.

To treatment of the disease has been most effective, it is important to necessarily follow the doctor's recommendations. So, you need to completely stop smoking, balanced daily diet, optimize exercise, constantly monitor the blood pressure.

Dietary   for patients with angina pectoris involves the use of a minimum number fat . It is important to prevent the emergence of overweight And to limit the use of alcohol to 30 g per day.

In order to eliminate the causes that directly influence the display of the person angina attacks, it is important to prevent the situations that increase myocardial oxygen demand. So, it should not be allowed as the physical and emotional stress, which provoke the appearance of pain. If it is difficult to implement, for the prevention should always take antianginal drugs . It is equally important to give up physical activities that are taking place in parallel with other factors causing angina. It's cold, the wind, the condition of the body after a meal and then sleep. Do not take medicines that increase myocardial oxygen demand, for the treatment of other diseases.

As medical treatment of angina appointed by the three main groups of drugs that affect the coronary arteries, expanding them. This products- nitrates in-blockers, calcium channel blockers. To stop an attack of angina pectoris, choose fast preparations: it is, first of all, nitroglycerine   in tablets, sprays, baths, ampoules and pills nifedipine . Most often, these tools take patients sublingual, but to date gain wide popularity and sprays. After nitroglycerin effect is noticeable already after 1-3 minutes later. If the effect after taking the pill is not observed, it can be five minutes later to take another pill of nitroglycerin. In the most severe cases, preparations of nitroglycerin can be administered intravenously.

Long-acting nitrates are medications nitrosorbid . Fort sustak ; Among the drugs-in-blokatoryov most commonly used metoprolol . atenolol . Drugs - a calcium channel blocker diltiazem . verapamil . nifedipine . Typically, at the beginning of treatment used most simple and cheap drugs - nitrates. If the effect of their reception there, or the patient does not tolerate this medicine and other connected groups of drugs.

Prevention of angina

Prevention of angina pectoris is primarily undertaken to prevent atherosclerosis . Therefore, preventive measures should be taken in the middle age - 35-40 years. It is important to note that prevention of angina is especially necessary to those people whose relatives have been cases of angina.

It is important to balance the daily diet so as to limit the amount of easily digestible carbohydrates   and fat That are of animal origin. Parents should ensure that children do not overeat, thus preventing the appearance of their excess weight. In addition, the recommended diet should not contain the fatty meat broth and fish, fried and smoked food, herring, canned foods, fatty meats, condiments and sauces, alcohol, starchy foods, strong tea and coffee. It is impossible to overeat at night, it is important to divide the food into equal doses. Experts recommend regular fasting days: they can be carried out once every two weeks.

From an early age need to provide adequate and constant physical activity. The most suitable load in this case is swimming, leisurely jogging outdoors. Each day to walk at least half an hour. In addition, an important point in the realization of the prevention of angina pectoris is not smoking.

If a person is prone to heart disease, it is important to take all measures aimed at reducing the pressure. People who periodically appears angina should always carry a pill prescribed by your doctor, and take them, and during the attack, and to prevent angina. Thus, the patient can take nitroglycerin to severe physical exertion.