Vasospastic angina: symptoms and treatment

Coronary heart disease (CHD) is a pathology associated with impaired heart circulation, manifested in different ways. One of the manifestations of CHD – angina, which can be classical (the vast majority), as well as spontaneous or vasospastic (are relatively rare).

The concept of strokes

Angina – a pathological condition or disease characterized by attacks of sharp pain in the heart area. The cause is insufficient blood supply to the heart muscle through the coronary arteries. Thus there is a lack of oxygen to the myocardium, causing paroxysmal pain. Last angina was called «angina pectoris», which describes the sensation of pressure in the chest accompanied by pain.

Types of angina

Clinical classification of coronary artery disease angina can be:

  • stable with regular attacks occurring over a period of more than one month;
  • unstable – new-onset, spontaneous, with progressive symptoms, and preinfarction angina.

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  • Angina, or classic, which occurs during or after physical or mental stress.
  • Angina at rest that occurs without previous loads. A special form is allocated an infrequent vasospastic angina, also called variant, spontaneous and angina Prinzmetala (by author, for the first time describe it).
  • Symptoms of vasospastic angina

    This form of the disease is characterized mainly for people age 30 – 50 years and is one of the forms of unstable angina. The cause of pain in this pathology is the sudden spastic contraction of the coronary arteries. Repeated spasms of the blood vessels that supply blood to the heart, leading to progressive narrowing of the lumen. Characteristic features:

    • pain in retrosternal region that occur for no apparent reason, often at night or in the morning;
    • the pain is intense, accompanied with a feeling of «compression» inside the chest;
    • the duration of pain from 2 to 20 minutes, removed the medication;
    • the rise time and decrease in pain intensity is about the same (with classic angina pain decrease, while the required action is fast);
    • recurrence of seizures: the pain occurs once per month, week, day; each pain attack has its cycle: the pain increases, reaches a peak and decreases with the probability of repetition in the same order;
    • the attack may be accompanied by abnormal heart rhythm, headache, nausea and vomiting, release cold clammy sweat, pallor of skin, shortness of breath and loss of consciousness.
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    Diagnosis

    Important medical history and patient’s complaints: whether there is a hereditary factor when the seizures started, whether they are connected to loads, what are the frequency and nature of pain. To identify comorbidities are made clinical tests of blood and urine. Be sure to biochemical blood tests for cholesterol, glucose and lipids to assess metabolic processes in the body.

    Of the functional methods of diagnostics of an electrocardiogram is significant only during the attack. There is a characteristic change, reminiscent of the picture of myocardial infarction, which lasts from 2 to 5 minutes, after which the ECG pattern is restored to normal. The preferred method is Holter monitoring (daily ECG). This will recorded start and end time of angina attack, during the attack, the presence of arrhythmias. In exceptional cases, is carried out coronary angiography – invasive method to detect changes in the coronary arteries.

    Treatment

    During the attack, urgent action is needed: give the sublingual short-acting nitrates (Nitroglycerin, Niospray, Nifedipine). Mandatory control of blood pressure and call a cardiac ambulance. Treatment vasospastic angina is a life character and includes several methods: medication, non-pharmacological and, in some cases – surgery. Non-drug measures to treat and prevent the occurrence of seizures:

    • selected with the help of a doctor regular physical activity;
    • diet: exclusion from the diet of fatty foods and fried foods, balanced menu;
    • regulation of psychoemotional sphere;
    • refusing from alcohol and Smoking;
    • good organization of daily routine.

    Applied medications:

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    • antiplatelet agents (drugs that prevent platelets from sticking together and the formation of blood clots) – Aspirin, Thrombotic-ass;
    • the beta-adrenoceptor – protect the myocardium from excessive exposure to hormones, normalize the heart rhythm (Metaprolol, Propanolol);
    • calcium channel blockers – reduce the heart muscle demand for oxygen (Diltiazem, Verapamil);
    • nitrates: short acting – sublingual during the attack, the prolonged – treatment (Kardiket, Monocinque).
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    In severe cases, in the absence of effect of conservative treatment and with concomitant coronary atherosclerosis resort to surgical intervention. To restore the coronary circulation is coronary angioplasty or coronary artery bypass grafting.