Angina: symptoms, treatment
Angina – a disease manifested by chest pain, which may radiate to the left shoulder, neck, jaw. The attacks is usually short and cropped taking nitroglycerin. If they arise from physical exertion, this disease is called angina.
Angina occurs when there is a significant difference between the delivery of oxygen to the cells of the heart and its consumption.
Most often deficiencies nutrient delivery occurs due to atherosclerotic changes in the coronary arteries. Atherosclerotic plaques attached to the walls of blood vessels and slowly increase in size, which leads to gradual narrowing of the lumen. As a result, some of the parts of the heart «hungry.» This condition is called ischemia and clinically evident stroke. If for a long period of time, the myocardium receives less nutrients and oxygen, this leads to the formation of a heart attack.
Seizures are caused by physical exertion or emotional excitement. Well as angina sometimes occurs on the background of inflammatory diseases of blood vessels, calcification of the vascular wall, increased platelet aggregation. These reasons relate to coronarienne.
The need of the myocardium for oxygen and nutrients increases the release of adrenaline and noradrenaline. The level of these hormones increases with emotional stress, stress (anger, grief, joy).
In addition, the angina may be due to the rise in blood pressure, hypothermia, a walk in the cool weather, plentiful meal.
At risk in this disease are:
- patients with diabetes and hypertension;
- patients with a BMI above 25, or leading a sedentary lifestyle;
- women who take combined oral contraceptives;
- patients with high levels of cholesterol, triglycerides, HDL.
Acute myocardial ischemia, which occurs when inadequate blood supply to the heart muscle that provokes an attack of angina. Angina can occur under the influence of coronarogenic or noncoronary factors, or combinations thereof.
In the myocardium due to lack of oxygen violated the oxidative processes. The result is the accumulation of oxidized products of metabolism (lactic, pyruvic acid). They and other metabolites due to insufficient flow of blood is not removed from the tissues in the proper amount and irritate sensitive receptors.
Violation of the functions of the cell membrane leads to the fact that the number of calcium ions is reduced and sodium is increased. Because of this reduced myocardial contractility and heart cease to work.
In addition to hypoxia, the myocardium does not receive the required amount of glucose. Without it, the work of the heart is impossible, as it is the main source of energy.
Angina has several classifications depending on the symptoms. According to the who classification, adopted in 1979 by cardiologists, there are three types of the disease:
- for the first time arisen stenocardia;
- progressive angina, which is characterized by a sudden increase in the number of attacks;
- stable angina.
You can talk about stable angina, if the attacks occur systematically for at least two months.
Angina most frequently occurs when excessive or habitual physical activity. With the progression of the disease by the patient tolerates heavier than usual load. In line with this, there are 4 functional classes:
Angina is paroxysmal for. Most patients seek medical care after an attack on the physical exertion or emotional stress. Stable angina is characterized by pain attacks that occur when the load is of equal strength or duration.
Patients describe the pain as burning, crushing, cutting, mainly retrosternal localization. It may radiate to the left side of the body (arm, neck, shoulder, jaw, left upper quadrant). In typical cases, pain arises in the upper third of the sternum, and from there spread to the sides.
The intensity of the feeling, all patients are different and depend on the severity of the condition. It increases gradually, reaching a peak, starts to decrease. The attack lasts no more than 15 minutes and can be easily removed by taking the tablet of nitroglycerin under the tongue. This distinguishes a stroke from a heart attack.
Also the patient may have a fear of death. He becomes restless, stands a cold sweat, quickens the heartbeat. Emotional stress promotes the release of catecholamines, that just makes for a heavier attack.
If the attack is atypical coronary artery disease develops, the patient may experience nausea up to vomiting, having dyspepsia (belching, abdominal pain, heartburn).
Diagnosis of angina includes patient examination and medical history, and various clinical and biochemical and instrumental investigations.
On examination, the patient is necessary to evaluate its General condition, to calculate the body mass index to determine the percent of excess weight. The physician must record the heart rate and blood pressure on both arms.
Clinical and biochemical analyses are unable to make an accurate diagnosis of angina, but help to identify the presence of risk factors of cardiovascular diseases. It is necessary to determine the level of cholesterol, epidemically profile, level of glucose in the blood, the amount of creatinine, hemoglobin.
Instrumental methods of research
More informative instrumental methods of research. If you suspect the patient has angina to verify the diagnosis it is necessary to conduct ECG, echocardiography, stress tests, CAG, CT.
In coronary artery disease electrocardiogram 12-lead ECG is the gold standard of diagnosis. When removing the film alone changes in the heart may not be so particularly successful is the ECG, which is taken during the attack. It visualizes the lesion of ischemia and you can define its location.
To remove the ECG at the moment of attack, conduct the test with the physical loading. The patient performs exercises with increasing load on a treadmill or Bicycle Ergometer. While the doctor monitors the patient’s state of health with regular blood pressure. ECG test with exercise – the most informative and accurate non-invasive method of diagnosing coronary artery disease.
If the person can’t carry the load on the cycle Ergometer or treadmill (as with concomitant osteoarthritis of the hip joints), it can be assigned to conduct transesophageal atrial electrical stimulation. The patient is injected with a fine electrode, which is attached closest to the myocardium of the place and conducted electrical stimulation of the heart muscle. While artificially quickens the heartbeat, and therefore increases the need of cardiac muscle for oxygen. On ECG are recorded the changes in CHD.
Echocardiography is performed for the differential diagnosis of angina from noncoronary pain. On the screen well visualized defects of the heart valves, thickening of the walls of the myocardium and other organic and functional changes of the heart muscle.
Coronary angiography refers to invasive methods of diagnostics and allows to investigate the degree of narrowing of the lumen of the coronary vessels. Also with this study, you can determine the type of blood supply to the myocardium (left, right), the nature of atherosclerotic lesions, spasm of the coronary arteries, the degree of development of collateral blood flow.
Treatment of angina is aimed at improving the prognosis of the disease, reducing the risk of myocardial infarction and reduction in the incidence of seizures. Stable angina is treatable better.
The patient in the early treatment should be informed of angina, causes, and prognosis of your condition. It is important to explain to the patient the necessity of modification of lifestyle.
When angina attack shows the use of nitrates. They expand the blood vessels and improve blood circulation. Because the drugs in this group act on all vessels, the most common side effect after taking is severe headache. It appears due to the expansion of blood vessels of the brain. The most famous drug of this group is nitroglycerin.
When treating IBS it is necessary to adjust the lifestyle. Patients should stop Smoking. When excess BMI (>25%) it is necessary to reduce the consumption of fatty and carbohydrate-rich food. You need to add exercise, e.g. walking, yoga, gymnastics (subject to the recommendations of the doctor). In your diet it is better to add fresh vegetables and fruits, juices, sour-milk products.
Possible, avoid stress and emotional stress. With timely treatment to the doctor and compliance with all appointments and recommendations the prognosis is favorable.
To prevent the formation of blood clots patients life should take antiplatelet agents. Are drugs that reduce the «gluing» of blood platelets and prevent blood clots. These include the following drugs: aspirin cardiomagnyl, clopidogrel. Drugs based on aspirin must be taken with caution, as they adversely affect the gastric mucosa and may provoke the occurrence of erosive gastritis.
Statins reduce the lipid content in the blood. It is important for primary and secondary prevention of atherosclerosis. These drugs also need to take a long time.
To prevent the development of complications of myocardial infarction prescribed beta-blockers. They reduce the need heart of oxygen and reduce heart rate. When heart attack, history of or are at risk of developing heart failure, you need to prescribe ACE inhibitors.
If medical therapy does not bring the expected result or stenosis of the coronary arteries more than 70% performed myocardial revascularization using coronary artery bypass surgery. This surgery significantly reduces the mortality and improves the quality of life of patients. The operation involves the creation of additional paths of blood flow in the heart muscle.
To improve patency of vessels make coronary angioplasty with stenting. It is conducted with the ineffectiveness of conservative treatment. During such interference in the cavity of the atherosclerotic vessel inserts a thin frame, smoothing and restoring vessel lumen.