Unstable angina: symptoms and treatment
Angina pectoris («pectoris») is a dangerous disease. The word «angina» means «stomach-churning». This name comes from the characteristic pain in the region of the heart, wearing a compressive nature. This disease leads to oxygen starvation (ischemia) of the main muscles of the human body – of the myocardium, and may lead to heart attack and even death. Particularly dangerous forms of disease, in which unknown factors that trigger the process of ischemia.
Unstable angina is a process threatening oxygen starvation of the myocardium, which can be transformed into a heart attack. While there are no clear conditions for its occurrence, and the patient often cannot understand how he is to behave and what to do.
What is stable angina?
Stable angina is a condition in which oxygen deprivation of the myocardium is evolving with increased physical activity. The patient is warned that while walking uphill, carrying heavy loads or trying to catch a bus first develops shortness of breath, then chest pain. These symptoms warn about the risk of development of heart attack, so you need to avoid physical exertion, and excitement – all of situations associated with high blood pressure.
In the same case when I had to «catch a tram», you need to calm down, to breath and to take under the tongue Validol or special preparations expanding coronary vessels and not giving them to develop spasm and ischemia. As you can see, the situation is very clear and easy to understand, patient and ischemia at a stable voltage has a preventive character: «don’t do this, and you will not develop it.»
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The main difference between unstable myocardial ischemia
This unpleasant variation of coronary heart disease can be not connected with physical activity – pain appear, regardless of tension and excitement. In addition, there are the insidious variations of the disease – painless forms of unstable angina. This means that to prevent a heart attack is almost impossible, and the events develop in the worst way.
Thus, among the relative health develops a sudden pallor, shortness of breath, sweating, weakness, cyanosis and pain in the heart, there is fear of death. When recording an ECG revealed fresh myocardial infarction, the patient needs urgent hospitalization in the cardiac intensive care unit was. The unpredictability is the main difference of unstable myocardial ischemia.
What is unstable angina?
About painless forms mentioned above. There are many different ways groups of myocardial ischemia on various grounds, but the greatest practical importance of the acquired classification of unstable angina according to Braunwald. According to this classification, there are several groups of diseases:
- Group a: there is an external cause (e.g., alcohol consumption). This secondary angina.
- Group b: external causes no. It is the primary unstable angina.
- Group C. it belongs To patients who have suffered a fresh heart attack, if you experience post-infarction angina within 2 months after acute coronary thrombosis.
Except for letter designations, adopted as the designation of «Roman numerals», that indicate the timing of the appearance:
- I – new attack or no pain at rest;
- II – subacute angina at rest (the last attack from two days to one month ago);
- III – attack alone, less than 48 hours ago.
In group III have a higher risk of heart attack and sudden death as it relates to frequent bouts of severe pain at rest with unknown reasons.
What is unstable angina?
Signs of unstable ischemia pain when classic forms are well described:
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- acute, compressive, paroxysmal pain radiating to left arm, jaw, shoulder and under the shoulder blade;
- the attack lasts from 1 to 15 minutes, the beginning and the end you can «pinpoint the hour»;
- pain cannot stop or taking nitrates (Nitroglycerine) or an urgent cessation of physical activity (need to go);
- in the case of provocation of pain load, if not end, excessive physical stress, the pain will increase and will force the person to quit work, and then begin to recede; this is a point which distinguishes ischemia from other functional pain in the heart, and attacks of intercostal neuralgia.
How to treat unstable angina?
Competent treatment of this disease is a difficult task. First of all, when you first developed chest pain in the heart, without the possibility to record the ECG, a patient needs hospitalization in the cardiology Department for round the clock surveillance, constant monitoring of ECG and pulse oximetry, to «identify all of the circumstances.» The main principles of therapy aimed at the eradication of an existing attack and prevent them in the future are:
- improvement of blood rheology (fluidity), the prevention of thrombosis (aspirin, low molecular weight heparins);
- the intake of nitrates for the relief of acute ischemia;
- the use of beta-blockers that reduce cardiac output and reduces the need of myocardium in oxygen;
- the use of calcium antagonists with particular types of unstable angina;
- means to restore heart rhythm when it is violated.
Of great importance are the operational methods of treatment: coronary artery bypass grafting, endovascular prosthesis and stenting. Their task is a good blood supply to the myocardium and preventing the development of ischemia even with exercise. What this condition says about the effective treatment of unstable angina that must be confirmed by the results veloergometry.