Angina pectoris 2 fc what is it and how to treat an ailment

It should be noted risk factors affecting the development of pathology:

  • Gender – men get sick more often than women; there is an earlier development of the disease.
  • Age – the risk increases after 40 years, however, in recent years, clinical signs also appear in young people.
  • Hereditary predisposition – according to statistics, the presence of one close relative suffering from heart disease contributes to the onset of the disease of the younger generation in 55% of cases.
  • Arterial hypertension – with systolic and diastolic pressures above 160/95 mm RT. Art., especially in patients who have a second hypertensive stage of the disease.
  • Overweight.
  • Bad habits – smoking at least one cigarette per day.
  • Hypodynamia.
  • The presence of concomitant pathological conditions, such as diabetes mellitus, an excess of uric ac >

    There are several reasons that can cause a pathological condition:

    • Atherosclerosis of the coronary vessels, especially the main branches that directly supply the heart muscle with blood, especially against the background of GB. The appearance of pathology is preceded by a change in metabolism, due to which there is a deposition of calcareous plaques that overlap the lumen of the arteries.
    • Spasm of the vessels. A provoking factor is psycho-emotional stress, stress, physical activity, a sharp change in ambient air temperature. The mechanism of the occurrence of such disorders is a change in the hormonal background and a sharp release of hormones, catecholamines into the blood, leading to a sharp narrowing of the lumen of the arteries. This condition most often occurs in patients with hypertension (GB).

    Angina pectoris should be distinguished from other pathologies, given the different approaches to diagnosis and treatment. The following diseases have some similar symptoms:

    • Myocardial infarction is a life-threatening condition, the main difference of which is pain, not amenable to standard treatment of relief.
    • Osteochondrosis of the spine, intercostal neuralgia – can mimic the symptoms of coronary disease. You can be suspected of having unpleasant sensations when pressing in the projections of the exit points of the nerve roots or along the lower contour of the ribs.
    • Pathology of the esophagus or stomach – the connection between the appearance of discomfort and meals is determined.
    • Inflammation of the respiratory system – clinical signs develop against the background of infectious diseases and are accompanied by intoxication and catarrhal phenomena.

    The basis of preventive measures is the restructuring of lifestyle, the elimination of the provoking factors of pathology. Recommended dosed physical activity under the guidance of a doctor, spa treatment, as well as timely treatment of concomitant pathology.

    Given the widespread occurrence of this problem among the population, the necessary task is to reduce the risk factors for coronary heart disease, and in the event of a disease, a comprehensive and comprehensive examination and treatment of the patient.

    Whatever the health problems, they always affect the quality of life. The group of the most common diseases that can cause death is cardiovascular disease.

    People do not always pay attention to some symptoms, but their timely therapy can save health and life. For example, it requires a qualitative examination and adequate treatment of 2 FC.

    What it is, how this health problem is diagnosed and stopped, will be described in this article.

    Heart problems, unfortunately, are a very common cause of poor health.

    According to the World Health Organization, of all deaths, more than 30% are due to diseases of the cardiovascular system of the human body. Moreover, half of such cases occur as a result of coronary heart disease and strokes.

    Such diseases have several pronounced symptoms, allowing them to clearly diagnose and use first aid for pain relief. One of these symptom complexes is angina pectoris. ICD (International Classifier of Diseases) classifies this pathology as an ischemic block in the group of cardiovascular diseases.

    Doctors say that angina pectoris itself is not even a disease, but a serious warning of the body about the impending danger not only for well-being, but also for life.

    Painful sensations behind the sternum, which are colloquially called “angina pectoris”, are the reason for going to the doctor for examination and making an adequate diagnosis.

    Indeed, angina pectoris is one of the symptoms of coronary heart disease – the main cause of disability and death even among young people.

    The sensation giving in the arm, neck, upper abdomen should be considered as a serious symptom of impending disaster. Treatment of angina pectoris and its other types should be carried out in a timely manner, after diagnosis. It is impossible to let such pains drift, because only a competent examination and specialist advice will help determine the diagnosis and quality therapy.

    The occurrence of pain behind the sternum, even in isolated cases, is an alarming symptom, indicating a malfunction in the body. There may be several risk factors for heart problems. Most often, their appearance is affected by:

    • coronary artery atherosclerosis;
    • high blood cholesterol;
    • arterial hypertension;
    • sedentary lifestyle;
    • smoking;
    • obesity;
    • increased blood coagulation;
    • diabetes;
    • thrombosis;
    • thrombophlebitis;
    • phlebothrombosis.

    Doctors note, and this is confirmed by numerous observations and studies, that stress has a significant effect on the development of angina pectoris.

    And it doesn’t matter at all, it’s an emotional outburst or a chronic stressful situation.

    In both cases, pain behind the sternum may appear, indicating serious problems, one of which may be angina pectoris of tension 2 FC (what this is, we will consider in this article).

    Angina pectoris, which is a characteristic sign of coronary heart disease, is manifested precisely because of an imbalance in oxygen balance in the cardiovascular system and cardiac muscle, in particular. This occurs during physical exertion, emotional overstrain, stress. In some cases, such pains appear at rest.

    Often, after examination, the patient is diagnosed with angina of exertion of 2 FC. What it is? This name has one of the pain symptoms that indicate a violation of cardiac blood supply. This symptom is quite clear, which allows you to immediately make a diagnosis.

    The pain appears behind the sternum and has a burning, pressing or uncomfortable character. These sensations can give to the left side – the shoulder blade, arm, lower jaw, as well as to the left side of the neck or throat. Also, pain can radiate to the upper abdomen in the right side of the body – also the arm, throat, scapula.

    The most important thing is that an illness does not manifest itself outside an attack. That is, the patient does not experience any other sensations, other than bouts of pain. The attack goes away and the pain disappears until the next peak.

    A typical sign of such an attack is suddenness. It occurs unexpectedly against the background of stress, emotional outburst, physical activity. Another feature that makes it possible to clearly diagnose a typical attack of angina pectoris is its ability to pass on its own or when taking Nitroglycerin, which expands the vascular lumen, thereby relieving spasm and increasing oxygen access to the heart.

    For many of those who suffer from attacks of angina pectoris, such pains seem insignificant, because they quickly pass, often even without taking special medications. But this is a big mistake that can lead to a heart attack, disability or death. Specialists of angina pectoris are divided into two types:

    • angina pectoris;
    • angina pectoris.

    The diagnosis is made taking into account the features traced in the type names themselves.

    Angina pectoris is fairly predictable, because the patient knows that in a certain situation that causes stress, both physical and emotional (and this can be brisk walking, a sharp drop in air temperature, stress), there will be an attack that must be stopped with Nitroglycerin.

    And angina pectoris can develop in any situation, even calm for a person, when it seems that there are no prerequisites for it. Specialists, this type of heart problem is divided by the nature of the course – stable and unstable. The names speak for themselves:

    • Stable – predictable, proceeding with a certain frequency.
    • Unstable can be either first-time, progressive, or post-infarction.

    Correctly understand the essence of angina pain can only be a specialist.

    Angina pectoris is divided into functional classes, which are determined using numerous studies conducted by doctors, physiologists, and scientists.

    For each patient, a competent diagnosis is necessary, taking into account the anamnesis, general condition at the time of the onset of angina pain, concomitant diseases or pathological conditions, which necessarily reflects the medical history.

    Angina pectoris of tension 2 FC is a fairly frequent diagnosis for people of different ages and sex, because FC – functional classes – take into account the degree of physical activity that causes angina pain. You can talk about the stability of the problem when the patient feels attacks for more than a month.

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    Canadian classification

    Pathology has four functional classes. They are determined in accordance with the tolerance of the loads. So, angina pectoris 1, 2 FC can be diagnosed. These forms are considered initial and in many cases can be adjusted. The first functional class is characterized by normal tolerance of a normal load.

    Attacks appear only with physical stress. For example, it can be a long activity, climbing stairs, brisk walking. Angina of exertion FC 2, 3 is characterized by the patient’s ability to withstand loads. While in the second functional class, activity is moderately limited, then in the third it is essential.

    In the latter case, signs of coronary heart disease become quite pronounced. Angina of exertion FC 2 may be accompanied by seizures if a person overcomes a distance of more than 500 meters without stopping. As in the third functional class, an aggravation of the state is likely during ascents by one flight. Of particular clinical importance are emotional stress, windy or cold weather.

    When performing normal physical activity for a person, he feels good. Pain appears only during intense and prolonged work, for example, when doing weightlifting or long-distance races.

    The pain occurs during normal walking, when a person walks more than 200 meters. Also, angina pectoris develops if the patient rises up the stairs above 2 floors, goes outside in very cold weather, and overeats.

    The attack begins when passing from 100 to 200 meters, or when climbing to the 2nd floor.

    Doing any physical work causes pain. An attack can develop even in an absolutely calm state.

    According to the working classification, angina pectoris is divided into two types.

    • first arising;
    • stable angina pectoris (indicating functional >

    And vasospastic (variant) angina pectoris.

    The following functional classes of stable exertional angina are distinguished, which can be defined as the stages of the disease:

    • 1 functional class (1 fc) – an attack develops only with excessive physical exertion.
    • 2 functional class (2 fc) is the state in which such signs are noted against the background of average physical activity. How do the criteria use climbing stairs one span or walking at an average pace of more than 500 meters. But it is also possible the appearance of symptoms immediately after sleep.
    • 3 functional class (3 fc) – clinical manifestations occur in response to slight physical activity, in the form of a quiet walk, or psycho-emotional stress. Infrequently observed
    • 4 functional class (4 fc) – attacks often disturb the patient at rest, even with minimal movement.

    Overview of angina pectoris tension 2 FC: symptoms, treatment, prognosis for the disease

    2 fc angina pectoris – what is it and what symptoms are accompanied by? This is a form of coronary heart disease, in which, due to narrowing of the lumen of the coronary vessels, insufficient blood flow to the heart muscle occurs.

    As a result of this, a deficiency in the supply of oxygen to cells, a change in cell metabolism, and the death of heart tissues are formed. The disease is one of the leading causes of death worldwide. Moreover, the statistics indicate a greater risk of developing a pathological condition in men.

    From this article you will learn: a description of angina pectoris of the second functional class, what kind of disease. Causes of its development, symptoms and treatment methods.

    The author of the article: Yachnaya Alina, oncologist surgeon, higher medical education with a degree in General Medicine.

    Angina pectoris of tension 2 FC is one of the forms of coronary heart disease (CHD), which is characterized by attacks of chest pain and shortness of breath (rapid breathing and a feeling of lack of air) after exercise. The people often call angina pectoris “angina pectoris.” Such a definition very accurately describes the nature of the pain during an attack: a person has a feeling that he is “crushing something” right inside the chest.

    Doctors give out angina pectoris of rest and tension.

    The first is characterized by the spontaneous occurrence of seizures in the absence of physical activity. Pain can appear even in a sedentary or a lying person. This type of disease is the final stage in the development of angina pectoris. It significantly limits the ability to work and reduces the quality of life of a sick person.

    A feature of angina pectoris is the appearance of chest pain only after performing physical work. Depending on the severity of the load, which can provoke an attack, four functional classes (FC) of the disease are distinguished. This distribution helps doctors very accurately describe the severity of the disease in their documentation. Angina of exertion of 2 FC is characterized by the appearance of an attack after walking to a distance of 500 meters or rising by 1 flight of stairs.

    Therapist or cardiologist is involved in the treatment of this pathology. The disease cannot be cured completely, but following all the recommendations of the attending physician, you can slow the progression of angina pectoris, improve the quality of life and avoid the development of complications.

    Coronary heart disease (CHD) is a group of severe cardiovascular diseases that occur against the background of atherosclerotic lesions of blood vessels supplying the myocardium. IHD includes:

    1. angina of rest and tension,
    2. myocardial infarction
    3. acute coronary death.

    The reason for the development of IHD is the deposition of excess cholesterol in the vessels of the heart, followed by the formation of atherosclerotic plaques. This leads to a progressive narrowing of the lumen of the small vessels supplying and nourishing the heart muscle (myocardium). This phenomenon leads to ischemia – oxygen starvation of myocardial tissue.

    With angina pectoris of any functional class, ischemia occurs only against the background of physical activity, when myocardial oxygen demand sharply increases. Semi-blocked vessels cannot deliver the necessary amount of blood to the heart, which is why a person has pain in the heart.

    It is possible to distinguish angina pectoris of tension 2 FC from other forms of coronary heart disease by the duration of pain. With this disease, it will last up to 20 minutes, while myocardial infarction is characterized by pain for half an hour or more. Also, with myocardial infarction, the symptoms are more pronounced, and nitroglycerin does not help stop the attack.

    Angina pectoris of the second functional class (like other forms of coronary heart disease) is a multifactorial disease with a genetic predisposition. That is, it most often occurs in people whose relatives also suffered from coronary heart disease. There is no specific reason for the occurrence of the disease, but there are many factors that contribute to its development. It:

    • lack of physical activity
    • smoking and alcohol abuse
    • persistent increase in blood pressure,
    • obesity or being overweight,
    • private stress and psycho-emotional stress,
    • unhealthy diet and unhealthy lifestyle.

    Angina pectoris of tension 2 FC very often develops in people with high blood pressure. However, regular use of antihypertensive drugs significantly reduces the risk of coronary heart disease. That is why doctors recommend hypertensive patients to control their pressure, avoid stress and eat right – a healthy lifestyle helps to maintain health and significantly extend a person’s life.

    This pathology has a number of characteristic symptoms:

    • sharp chest pain lasting 3-5 minutes;
    • irradiation (“backache”) of pain in the left shoulder or arm;
    • intense shortness of breath, feeling of lack of air;
    • sharp weakness and need for rest;
    • the appearance of cold sweat and intense fear.

    Pain with angina pectoris can have a compressive, stitching, burning or cutting character. It can spread to other parts of the body, confusing people and doctors. Possible places of irradiation of angina pain: left shoulder blade, lower jaw, abdomen, spine, neck and even ear.

    Sometimes the pain is how strong that provoke the appearance of nausea and even vomiting. If an attack of angina pectoris occurs for the first time, a person may be in terrible horror and begin to fear for his life. However, this form of coronary heart disease is not life threatening. With adequate treatment, it will not progress and is unlikely to lead to a heart attack.

    Treatment of coronary heart disease should begin with the correction of lifestyle and nutrition. By eliminating the influence of provoking factors, you can significantly slow down the progression of the disease. Physical activity and proper diet are the key to successful treatment of most diseases of the cardiovascular system.

    People with angina pectoris of the second functional class should avoid heavy physical exertion. If running or power loads will benefit a healthy person, then they can seriously harm a patient with this form of coronary heart disease. A heavy load can not only provoke a severe attack, but also lead to a heart attack or other serious complication.

    With this disease, a person is shown:

    • light housework
    • breathing exercises,
    • unhurried walks
    • special exercises.

    The elimination of stress factors that could provoke an attack or aggravate the course of the disease is very important. Therefore, a person should protect himself from people and things that annoy him. You may have to stop communicating with some people or quit hard onerous work.

    Diet with angina pectoris 2 FC should exclude fatty, cholesterol-rich foods and salty foods. Salt retains fluid in the body, thus increasing pressure. This, like the formation of cholesterol plaques in the vessels, contributes to the development of IHD.

    Products recommended for the disease:

    • marine fish rich in omega-3 fatty acid;
    • chicken, turkey meat, veal, game;
    • sunflower, olive, corn and other vegetable oils;
    • any fresh or frozen vegetables and fruits;
    • cereals, brown bread, wholemeal pasta.

    In the presence of excess weight (which is very characteristic of angina pectoris), a person should lose weight. To do this, you should exclude from the diet fast carbohydrates (sweets, flour products from white flour) and limit the consumption of animal fats as much as possible. You need to eat 4-5 times a day, in small portions. It is better to forget about smoking, alcohol, carbonated drinks and coffee.


    Drug groupsDescription

    Examples: Acetylsalicylic acid, Aspirin Cardio, Clopidogrel, Dipyridamole, Ticlopidine.

    All patients with angina pectoris 2 FC are prescribed antiplatelet agents. Drugs in this group reduce the risk of thromboembolic complications and thin the blood, making it easier for it to flow through the vessels. They must be taken under the control of blood coagulation.Statins

    Examples: Roxer, Krestor, Torvakar, Atoris, Leskol Forte.

    They are prescribed to reduce the level of cholesterol in the blood of a sick person. These drugs inhibit the synthesis of cholesterol in the liver. They should be taken strictly in the evenings. Fibrates have a similar effect.Fibrates

    Examples: Fenofibrate, Exlip, Linapril, Tsiprofibrat, Trilipiks, Lipanor, Tricor.

    They are used to reduce the level of “harmful” lipids in the blood: cholesterol, triglycerides, very low and low density lipoproteins. At the same time, fibrates increase the concentration of high-density lipoproteins that strengthen blood vessels and relieve inflammation of their inner shell.Nitrates

    Examples: Nitroglycerin, Nitrolong, Pentacard, Isoket, Cardiket.

    To stop attacks, short-acting nitrates are used. They expand the vessels of the heart and resume the flow of blood in the myocardium. Long-acting nitrates are used to prevent seizures.Beta blockers
    (selective or non-selective)

    Examples: Concor, Celiprolol, Bisoprolol, Nebicor, Talinolol.

    Beta-blockers reduce heart rate and oxygen demand in the heart muscle. This has a positive effect on the heart and helps to avoid attacks.Calcium channel blockers

    Examples: Verapamil, Amlodipine, Diltiazem, Nifedipine, Felodipine.

    Drugs in this group block the flow of calcium into the smooth muscle fibers of blood vessels. This causes them to expand and relax. Thus, the blood supply to the myocardium is improved.ACE Inhibitors

    Examples: Enalapril, Captopril, Prestarium, Fosinopril, Perindopril, Ramipril.

    In many respects similar to the drugs of the previous group, however, they have an obvious advantage: they do not cause the appearance of cough. ACE inhibitors have a vasodilating and pressure-reducing effect.

    Antiplatelet agents for the treatment of angina pectoris 2 FC

    Stable (non-progressive) angina pectoris of the second functional class has a relatively favorable prognosis. According to statistics, only 4,3% of people die from this disease within 5 years.

    This form of coronary heart disease cannot be completely cured, since organic changes in the vessels are irreversible. But to eliminate the negative symptoms, stop the progression of the disease and live a normal full life – it is quite real. The normal blood supply to the heart can be fully restored only with the help of stenting, bypass surgery, angioplasty or other surgical interventions.

    Principles of treatment

    Treatment is aimed at reducing the number of seizures and improving the quality of life, as well as identifying and treating diseases that worsen the symptoms of angina and its course.

    With angina pectoris of the second functional class, it is recommended to change the lifestyle, avoid physical exertion, leading to seizures, take medications prescribed by a doctor. In parallel, you can resort to traditional medicine.

    Of the drugs for angina pectoris:

    • aspirin to prevent thrombosis;
    • beta-blockers and calcium antagonists to reduce the oxygen demand of the heart;
    • statins to lower cholesterol;
    • nitrates to eliminate coronary spasms.

    Folk methods

    Folk remedies are used for angina pectoris as an addition to the main drug treatment. For this, medicinal plants have long been used.

    From its fruits prepare tincture. Berries of hawthorn (7 tablespoons with a slide) are laid out in a jar and pour seven glasses of boiling water into the jar. The jar is closed with a lid, wrapped in something warm and put in heat for a day. When the deadline is reached, the tincture is filtered and put in the refrigerator. Drink three times a day with meals in a glass.

    Angina FC 2: diagnosis, treatment

    February 14, 2015

    Angina pectoris is an episode of transient myocardial ischemia. There is a pathology due to emotional or physical overload, which provokes an increase in the oxygen demand of the heart muscle. Next, we take a closer look at how the exertional angina of 2 FC manifests itself, how it differs from other functional classes.

    Angina of exertion is quite simple to confuse with other pathologies. In this regard, experts recommend that if there is pain or discomfort in the region of the heart, do not delay the visit to the hospital and undergo an examination. Often, when contacting a doctor, an angina of exertion of 2 FC is already detected. Disability is one of the most serious complications of pathology.

    It is to her that a late visit to the doctor leads and, as a consequence, untimely appointment of adequate therapy. Many pathologies are accompanied by the same symptoms as angina pectoris of FC 2 stress. The medical history, test results, information obtained during ultrasound, Holter monitoring, ECG during an attack, coronary angiography are mandatory examined by a doctor. The specialist’s task is to exclude other cardiac and non-cardiac pathologies, including:

    • Osteochondrosis and other diseases of the spine.
    • A heart attack.
    • Diseases of the digestive system (ulcers, disorders of the esophagus and others).
    • Pulmonary pathology (pneumonia, pleurisy, etc.).

    The main difference between pain in angina pectoris is that it is quickly eliminated after a patient has taken Nitroglycerin. Relief also occurs at rest.

    Health February 14, 2015

    Angina pectoris is an episode of transient myocardial ischemia. There is a pathology due to emotional or physical overload, which provokes an increase in the oxygen demand of the heart muscle. Next, we take a closer look at how the exertional angina of 2 FC manifests itself, how it differs from other functional classes.


    Angina pectoris is a clinical form of coronary artery disease. The pathology is characterized by periodic attacks that appear against the background of an increase in the metabolic needs of the heart muscle. Symptoms of angina pectoris increase with exertion and decrease after the use of Nitroglycerin.


    IHD, angina pectoris of FC 2 are often detected in the older age group. So, according to statistics, in patients aged 45-54, pathology is detected in 2-5% of men and 0.

    5-1% of women, in patients over 65 years old – in 11-20% of men. and 10-14% of women. Before the onset of a heart attack, angina pectoris is diagnosed in 20% of cases, after it – in 50%.

    The most common disease is among men over 55.

    Causes of pathology

    Most often, the provoking factor is atherosclerosis, which affects the coronary arteries. It was found that the mismatch between the oxygen demand of the myocardium and its transportation appears with atherosclerotic narrowing in the lumen of the coronary vessels by 50-75%. Clinical signs of this disorder are angina attacks.

    Other potentially probable provoking factors include hypertrophic cardiomyopathy, severe arterial and primary pulmonary hypertension, stenosis at the mouth of the aorta, coronaritis, abnormalities in the coronary arteries of a congenital nature, aortic insufficiency.

    Among the immediate causes of the attack, physical stress, emotional stress, temperature changes, overeating, a sharp change in climate and others are noted.


    Pathology has four functional classes. They are determined in accordance with the tolerance of the loads. So, angina pectoris 1, 2 FC can be diagnosed. These forms are considered initial and in many cases can be adjusted. The first functional class is characterized by normal tolerance of a normal load.

    Attacks appear only with physical stress. For example, it can be a long activity, climbing stairs, brisk walking. Angina of exertion FC 2, 3 is characterized by the patient’s ability to withstand loads.

    While in the second functional class, activity is moderately limited, then in the third it is essential. In the latter case, signs of coronary heart disease become quite pronounced. Angina of exertion FC 2 may be accompanied by seizures if a person overcomes a distance of more than 500 meters without stopping.

    As in the third functional class, an aggravation of the state is likely during ascents by one flight. Of particular clinical importance are emotional stress, windy or cold weather. Angina of exertion FC 2 differs from the latter form in the frequency of occurrence of seizures.

    So, the fourth functional class is characterized by aggravation even with minor loads, and in some cases at rest. In this case, the physical activity of the patient is significantly limited.

    When diagnosing angina pectoris of 2-3 fc, the following activities are carried out:

    • Conducting electrocardiographic studies. It allows to exclude acute diseases and identify the presence of indirect signs of changes in the heart muscle, rhythm disturbance.
    • Echocardiographic examination with dopplerography – this method makes it possible to determine the morphological features of blood vessels and the heart, the presence of lesions of the valves.
    • Functional tests with load – help establish the functional class of the disease.
    • Holter monitoring – a study during the day is performed to determine the number and type of rhythm disturbances, as well as correction of therapy.
    • Scintigraphy – an auxiliary method determines the exact location of heart lesions.
    • Coronarography is a study of the blood vessels of the heart with the introduction of a contrast medium. The method has no analogues, it is performed to diagnose the size and localization of narrowing of the arteries. An examination is necessary to determine the type and extent of surgery.
    • A blood test to detect signs of inflammatory changes, cholesterol and protein fractions.

    In order to make a differential diagnosis, i.e. To distinguish ischemic pain from non-ischemic pain based on symptoms, I use specially developed criteria, including 3 main signs:

    • classic fits of angina pectoris
    • their appearance during physical work,
    • weakening and disappearance after taking the tablet / spray Nitroglycerin or termination of the load.

    The presence of all three criteria is typical for a typical angina pectoris, two for atypical. If the patient has only one criterion, then the diagnosis is doubtful.

    I also conduct a general examination of the patient, in which you can identify symptoms of heart failure:

    • swelling of the legs
    • thickening of the tips of the fingers,
    • bluish lip color
    • swollen veins around the neck
    • enlarged and painful liver.

    Especially often I manage to note such symptoms in the elderly. In patients with heart defects during auscultation, various noises can be heard. It is mandatory to measure blood pressure, since the vast majority of people with angina pectoris have hypertension.

    To confirm or refute the diagnosis, I appoint an additional examination, which includes:

    1. Blood analysis. Almost all people with coronary heart disease have high cholesterol. Therefore, I always prescribe a lipid profile (cholesterol fraction). Also, following the protocol, you need to check the glucose concentration and do a general blood and urine test.
    2. Electrocardiography (ECG) is the main diagnostic method for suspected angina pectoris. The main symptom of the disease is a decrease (depression) in the ST segment. Sometimes a negative T wave is recorded. However, often these changes cannot be detected at rest, i.e. when there is no pain. Therefore, I prescribe additional ECG tests to my patients.
    3. Electrocardiography with exercise. Of all these tests, I prefer bicycle ergometry (riding a stationary bike) and a treadmill test (walking or running on a treadmill). If after a certain time symptoms of angina pectoris appear and typical signs are noted on the ECG (ST segment depression is greater than 1 mm and a negative T wave), the test is considered positive. It is worth noting that such studies are not suitable for everyone. For example, I don’t take them to patients older than 85 years and people with severe heart failure (functional class III-IV).
    4. Daily ECG monitoring. In cases where the performance of physical tests is impossible or the results obtained are doubtful, it is advisable to conduct a Holter study. It is also a very good way to detect painless myocardial ischemia. Most often, I prescribe Holter-ECG to patients with diabetes.
    5. Echocardiography (Echo-KG, ultrasound of the heart). The method allows you to check the ability of the body to pump blood, to assess the condition of the valves, the degree of thickening of the walls, the presence of intracardiac blood clots.
    6. Transesophageal electrical stimulation of the heart (NPES) – the procedure is as follows. A flexible probe with an electrode is inserted through the nose through the nose and is installed in the esophagus in the projection closest to the heart. Then weak signals are given, causing an attack of angina pectoris. In parallel, an ECG film is removed to record specific changes. I also carry out this method to patients for whom physical tests are contraindicated.
    7. Myocardial scintigraphy – with this method I study the intensity of myocardial blood supply. For this, a radioactive preparation is used (I mainly use thallium-201 and technetium-99-m), which is administered to the patient intravenously. Then he proceeds to perform moderate physical activity, after which an image is displayed on a special device. The degree of intensity of the glow is used to judge the blood circulation of various parts of the heart. I resort to myocardial scintigraphy if the patient has serious arrhythmias (blockade of the bundle of His, repeated ventricular extrasystoles), in which it is impossible to see specific changes on the cardiogram. This method is uninformative in women, since breast tissue accumulate a significant part of the pharmaceutical product.
    8. Coronary angiography is the gold standard for the diagnosis of coronary heart disease, which can reliably make a diagnosis. With its help, you can also find out whether surgery is necessary.

    Therapeutic activities

    The therapeutic program includes the following areas:

    • The use of antianginal drugs. They help to eliminate seizures and restore blood circulation and are the basis of therapy.
    • Treatment with antiplatelet agents. They lead to a decrease in platelet function, the accumulation of which at the site of calcareous plaques is an additional factor causing vasospasm.
    • Correction of the lipid composition of blood plasma. Restoring the optimal ratio of biochemical parameters contributes to normal blood flow and reduce the risk of atherosclerosis.
    • Psychopharmacological effects positively affect the nervous system, reducing the frequency of seizure intensity.
    • Extracorporeal method. The use of plasmapheresis, hemosorption helps cleanse the blood of immune complexes that are involved in the formation of plaques.
    • Metabolic therapy improves metabolic processes in the myocardium.
    • Physiotherapy is possible with symptoms of coronary heart disease with angina pectoris up to 2 fc. Electrosleep, magnetotherapy, laser treatment, various baths are used.

    Surgical intervention

    Operational methods are shown in case of ineffectiveness of therapy with the medicines listed above. Surgical intervention is also prescribed if, as a result of angiography, the probability of death is present. In case of pathology, endovascular angioplasty and stenting, coronary and mammarocoronary bypass grafts may be performed. The effectiveness of the intervention is about 90-95%. After surgery, complications can occur – heart attack, re-development of angina pectoris, restenoses.

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    The surgical treatment method is used in cases of insufficiently effective conservative treatment of coronary heart disease with angina of FC 2 or FC 3, as well as in the presence of a significant degree of atherosclerotic lesions. The main directions are two methods of surgical treatment:

    • stenting – installation of special springs in the lumen of the vessel at the site of atherosclerotic plaque formation;
    • bypass surgery – creating bypass blood flow using limb veins.

    The choice of surgical intervention method is determined by the surgeon depending on the extent of the lesion, the anatomical features, the age of the patient, and the stage of the disease.

    In recent years, stenting of coronary arteries has been preferred, given the good treatment results, especially with angina pectoris 2 fc. Patients recover faster in the postoperative period, and the quality of life with properly selected conservative therapy improves significantly.

    The second FC disease and its features

    In order for an attack to occur, additional factors are necessary that provoke an increase in the oxygen demand of the heart muscle. However, physical activity is considered the main cause of the attack. Only from stress or cold does it occur rarely. In some patients who are diagnosed with angina pectoris of stress 2 FC, in the morning hours tolerance to physical activity is reduced.

    However, during the day, tolerance returns to normal, as a person begins to gradually walk around. It should be noted that the severity of the clinical picture, which is accompanied by stable angina pectoris stress 2 FC, depends on the level of physical activity. In those people who exceed the constantly permissible limit, seizures can occur several times during the day. Those patients who are trying to adjust their regime so as to minimize stress, practically do not experience exacerbation.

    The following factors are among the main parameters for reducing motor activity for angina of exertion FC 2:

    • difficulty in climbing to the second floor and above;
    • maximum distance for walking not exceeding five hundred meters;
    • stress, which is accompanied by overexcitation of an emotional-psychological nature.

    When the patient begins to experience a load not exceeding the above, then he has the onset of symptoms.

    Most often with this disease, the following symptoms appear:

    • dyspnea;
    • tachycardia;
    • increased sweating;
    • sharp jumps in blood pressure (blood pressure);
    • interruptions in the heart;
    • pain in the area of ​​the heart projection or chest;
    • fear of death.

    The main symptom of IHD 2 FC is an attack in pain. The pain most often has an acute, burning, compressive or stitching character and lasts up to ten minutes.

    The main place of localization of pain is the region of the heart or sternum. Often, pain can go to the neck, left shoulder blade, lower jaw, or left arm.

    The main characteristic feature of this stage of the disease is the fact that it can be quite easily stopped by taking nitroglycerin and eliminating the factor that triggered the attack, for example, stress or physical overwork.

    Drug therapy

    Before starting treatment, it is necessary to eliminate all provoking factors, if possible. The most effective way to stop the attack is the drug Nitroglycerin. It is taken sublingually (under the tongue). To prevent episodes of ischemia, nitrates of a long (prolonged) action are prescribed.

    These include drugs such as isosorbide mononitrate and dinitrate, nitroglycerin ointment or patch. The doctor may also recommend taking beta-blockers – Atenolol, Metaprolol, Betaxolol, calcium channel blockers – Diltiazem, Verapamil, antiplatelet drugs – Aspirin.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.